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Healing the Hospital

Applying lessons from The Healing Tree to heal our environment, to heal our caregivers, and to heal our patients.
A study guide for hospital leadership and caregiver retreats.

Contents

I. Introduction
II. How to Use this Study Guide
III. A Note to Managers
VI. A Note to Caregivers
V. Healing Lessons from The Healing Tree
VI. Healing the Environment
VII. Healing the Caregiver
VIII. Healing the Patient

Attachments:

1. Get that Pickle Out of Your Mouth: Ten Steps to a More Positive Attitude
2. Lessons in Caregiving from Florence Nightingale
3. The Self-Empowerment Pledge: Seven Simple Promises that Will Change Your Life

If you don’t have a question
You don’t have a clue
If you aren’t searching
You must really be lost

McZen in The Healing Tree

I. Introduction
The greatest miracle of all is not something that happens to you, it’s something that happens within you; this is the story of one such miracle.
The Healing Tree

The Healing Tree is a fictional story, but as every writer of fiction knows, fiction can be more real than the real world.  In The Healing Tree, for example, I have assumed away all sorts of real-world inconveniences (such as not having a utilization review coordinator questioning Carrie Anne Murphy’s length of stay) in order to create a story that can focus on deeper underlying truths about the patient experience in an idealized setting.

As told in this book, Carrie Anne Murphy’s story is a parable that in many ways parallels the journey we must all take through life.  The world knocks us down and then, though we do not recognize it at the time, the seeds of our healing are watered by our tears.  We gradually accept the loss, and begin to move (as did Carrie Anne) from “why me?” to “was me,” and undertake the challenging but ultimately rewarding work of building a new vision for the future.  It is important for all of us as caregivers to understand the trajectory of this universal story so that we can be optimally responsive and helpful to those whose care is in our charge.

Because it is a fictional story that assumes away all sorts of real-world hindrances, The Healing Tree can also serve as a yardstick against which to measure our own performance as healthcare leaders and as caregivers. What nurse doesn’t complain about not having enough time for patients?  What employee cafeteria doesn’t echo with the sort of complaining that Carrie Anne challenged Memorial Hospital to eradicate in the quest to become the world’s first misery-free hospital? And what hospital doesn’t have patients who need to be touched and nurtured, but at the same time also need to be pushed and challenged to take personal responsibility for their own health and happiness?

The questions included in this study guide will help you think more clearly about the actions that you and other members of your organization can take to heal your hospital environment, to heal your fellow caregivers, and to heal your patients.

Finally, an important distinction – that between treating and healing. Medical treatment, including the whole panoply of medical and nursing care, technology and pharmacology, is directed at achieving a physical cure, at least in part, and controlling pain and other symptoms in the process.  Healing, on the other hand, is more of a spiritual process. Some patients will be cured without having been healed in the slightest, while some of the most miraculous healing might occur in somebody who has no hope of a medical cure. More than anything, this study guide for The Healing Tree is meant to be a reminder that all of us can be part of a patient’s healing process – in fact, that we owe it to our patients to have that expectation of ourselves, of our coworkers, and of our organizations.  Just as important, it might well be that planting Healing Tree seeds is the best thing we can do to take care of each other.

II. How to Use this Study Guide
“Think about it. The word yet is only one letter removed from the word yes. Add yet to I can’t and you change your assumptions, you change your expectations, and you change your outcomes. And eventually, you might even change No to Yes.”
Amanda in The Healing Tree

Begin by reading The Healing Tree, ideally twice – the first time for the story, and the second time to highlight the lessons it contains (the discussion questions at the end of the book will help with this).

Then, read through the questions in this study guide, including the supplemental articles that are included in the appendices. Think about how these questions can apply to your hospital, and to your role as a caregiver. How can we heal our environment, and heal our caregivers, so that we can do a better job of healing our patients? What other questions would you ask, and what other actions could you take?

If you are working through this study guide as part of a group effort (such as a leadership or caregiver retreat), be an active participant in the discussions. Expect the best. Go ahead – be a Pollyanna. As Carrie Anne pointed out in her speech in the Memorial Hospital healing garden, Pollyanna brought about a miracle in her community. She reminded jaded people of what really matters in life, and she healed fractured relationships.  Could anything be more important in healthcare today? Shouldn’t we be working toward this miracle?

III. A Note to Managers
“My philosophy has always been to proceed until apprehended.  I figure if you’re going fast enough, by the time they catch up, you’ve already done what you set out to do.”
Evelyn in The Healing Tree

If you want to cultivate a more genuinely caring environment, one of your first responsibilities is to see yourself as a caregiver for your people. Of course, that means caring for them in the traditional sense of being a coach, recognizing them for their accomplishments, and being there for them in difficult times. But it also means having the courage to hold them to high expectations, in much the same way that Carrie Anne’s caregivers challenged her to stop seeing herself as a helpless victim and instead work on empowering herself to work toward dreams in which she made the most of her strengths and desires, despite her limitations.

Just as you as a manager would (hopefully!) never walk past a torn carpet or a falling ceiling tile without taking action, so too you should never look the other way at negative attitudes and behaviors that contribute to a toxic emotional environment. Effective leadership requires setting high expectations and then holding people accountable for meeting those expectations.  Including the expectation that through their attitudes and behaviors, people will do their part to create a positive, cheerful, and friendly healing environment.

In some respects, the care-giving that had the greatest impact on Carrie Anne’s healing consisted of small gifts – a touch, a poem, a few minutes of attentive presence – that would never show up in a manager’s quality or productivity indicators. How do we as managers make that difficult balance between meeting performance targets that are measured in budget and productivity numbers, while at the same time fostering a healing environment in which caregivers find a way to make the time to give these small gifts to their patients?  That question really lies at the heart of this study guide.

IV. A Note to Caregivers
“You’d be surprised just how important a simple little poem can be in someone’s healing.”
Mermaid Maggie in The Healing Tree

 “Take care of your garden, caregiver,” reads the opening line of Carrie Anne’s poem Growing Soul. The central point of that poem – and of the question “who cares for the caregiver?” – is that caregivers must take care of themselves. That means making the time to refresh and rejuvenate your spirit, for laughing and for loving, and for doing the things about which you are passionate (such as writing poems in the case of Maggie and Carrie Anne). It also means, as Carrie Anne was quick to point out, “tough-loving” yourself by avoiding toxic negative attitudes and behaviors (such as complaining and gossiping), and by confronting your own excuses and self-limiting beliefs (the way that Amanda taught Carrie Anne to confront her own “I can’t” statements).

Carrie Anne’s nurse Evelyn dealt with the many, often conflicting, demands on her time by taking a deep breath and asking herself what Florence Nightingale would have done in similar situations. The answer to that question usually put the patient first. That answer also showed her the way to do everything that needed to be done by helping her stay focused on what really matters. The article Lessons in Caregiving from Florence Nightingale that’s included as Attachment 2 of this study guide will give you more ideas of how to answer this question: what would the founder of the profession of nursing do to help us foster a truly patient-centered healing environment?

The questions on this study guide, and the three attachments that are included, will help you do a better job of first caring for yourself, and then of caring for your patients, your coworkers, and your family.

V. Healing Lessons from The Healing Tree
“The wingless angels were astonished. All the broken lady had really needed was a hug.”
Carrie Anne Murphy in The Healing Tree

In recent years, hospitals have become increasingly attentive to the softer side of patient care, acknowledging the fact that while being cured is mostly a physical process, being healed has a substantial spiritual dimension.The Healing Tree is a story of how such intangible qualities as courage and resilience, compassion and empathy, can play a vital role in the healing process. It is also a story that will help caregivers reconnect with the ideals that attracted them to the health professions, and help patients become active participants in their own healing, rather than being passive recipients of our care.

One of the factors that makes this such a unique book for the caregiver is that woven into the story are very practical techniques for helping patients to heal. From Nurse Evelyn’s “proceed until apprehended” philosophy to the advice of Amanda the physical therapist to replace “why” with “was,” this book is filled with unique and out-of-the-box ideas for helping patients do their part for their own health and healing.

VI. Healing our Environment
“I challenge us to make Memorial the world’s first misery-free hospital. That doesn’t mean we won’t have pain, it just means that we will no longer complain about our pain. We’ll no longer inflict misery upon ourselves, and upon each other. It’s a paradox that by refusing to allow the misery, we’ll do a much better job of easing the pain… I know some of you are thinking it would take a miracle, and you’re probably right, but one thing I’ve learned since becoming paralyzed is that miracles do happen. In fact, I now routinely expect them. And before you call me a Pollyanna, you should go back and read that story, or watch the movie, because that little girl Pollyanna, despite being paralyzed, did for her community precisely what I am prescribing for Memorial Hospital – she made a miracle happen. And we can too."
Carrie Anne Murphy in The Healing Tree

Reading for this section: Appendix 1 – Get that Pickle Out of Your Mouth: 10 Steps to a More Positive Attitude

What is our emotional architecture?  The environment of our hospitals is more than just the physical space in which we work.  It’s also the emotional climate that we create.  While the physical environment is important for making a good first impression, the emotional climate is more likely to influence patient perceptions of clinical quality and human compassion.

Are we who we say we are?  Just as a fish is oblivious to the water in which it swims or a bird never notices the air under its wings, we can become so used to our workplace environments that we don’t even notice how negative and toxic they would appear to an outside observer.  We might use words such as caring, nurturing, compassionate and empowering to describe what we think of the cultural climate we think we are cultivating, but based upon objective observations of our actual behaviors, the proverbial Man from Mars might instead use words like critical, self-pitying, and disempowered.

How are our attitudes affecting our patients?  Emotions, both positive and negative, are contagious.  For most patients, hospitals are already a frightening place to be.  If the organizational culture is characterized by negative attitudes (as reflected in the prevalence of criticizing, complaining, and rumor-mongering), we can actually be contributing to iatrogenic anxiety and depression on the part of our patients.

How can we be more authentic?  It is almost impossible for someone to be what Maggie called “a bitter pickle-sucker” in the cafeteria or at the nurse’s station, and somehow transform themselves into a genuinely compassionate caregiver in a patient’s room.  One of the two persona is a fraud, and patients generally see through it.  Likewise, the employee who has a negative attitude about work is likely to infect their children with the same ultimately self-limiting beliefs and behaviors.

Imagine this: When you read the article Get Pickle Out of Your Mouth in Attachment 1, ask yourself these questions:  If everyone in your hospital were to take The Pickle Pledge to heart, how profoundly would it change the healing environment?  If people were to stop criticizing, complaining, and gossiping, how much more time would there be for direct patient care and all of the other things that people complain they never have time for? And if people were to take The Pickle Pledge home with them, how much more pleasant and nurturing with their home life be?

Shouldn’t we eradicate toxic emotional negativity from our environment?  Do you remember what it was like to fly in the days before cigarette smoking was banned on commercial airliners?  We’d cough and choke and suffer in silence because we felt like there was nothing we could do about it.  But what would happen if someone were to light a cigarette on an airplane today?  There would be a mini-riot, wouldn’t there?  That’s actually a pretty good metaphor for creating what Carrie Anne called “a misery-free hospital.”  If you could wave a magic want and eliminate emotional negativity from the hospital for six months (no criticizing or complaining, no gossiping or rumor-mongering), what would happen the first time someone started in at the end of that period?  Why, the reaction would be the same as if they’d lit a cigarette – “we don’t tolerate that in our place of healing!”  What can we do in our hospital to create a shared vision of being a healing environment that is free of toxic (and contagious) emotional negativity?

The courage to confront: Do we (especially if we are managers) have the courage to confront coworkers when they are engaged in negative attitudes and behaviors such as whining and rumor-mongering? Though we might not care to admit it, when our own inner negativity is reflected in outward body language and verbalization, we can contribute to iatrogenic (hospital-induced) anxiety and depression on the part of our patients and coworkers.

Creating quiet: Part of Carrie Anne’s healing experience was auditory. What we might consider to be little things – Dr. Paulson turning off the beeping noise of the monitor before talking to his patient, or Lestelle the housekeeper softly singing in the hallways – made a big impression on Carrie Anne.  So did overhearing hospital employees complain about how they had to park farther away due to the new construction project.  What more can we do to reduce annoying ambient noise, and to offer our patients a wider variety of healing sounds?

Letting our patients rest:  When Planetree’s Laura Gilpin was a night shift nurse, she saw her primary responsibility as protecting the sleep of her patients.  The dynamic tension between caregiving and healing is perhaps nowhere more pronounced than it is on the patient care unit late at night.  On the one hand, certain activities must be carried out in order to maintain the unit and care for the patients.  On the other hand, you don’t need to read all of the research documenting the relationship between adequate sleep and physical health; your own personal experience will suffice.  Ironically, this dynamic tension is most intense in intensive care units.  What more can we do to creatively follow Laura’s lead and be more protective of the sleep of our patients?

Customizing little healing spaces:  Mermaid Maggie customized the environment in Carrie Anne’s patient room with a portable aquarium and a model of the mountains.  For Carrie Anne, these seemingly simple things were an important part of her healing process.  What more could we do that would allow our patients to tailor their space during their stay with us?

VII. Healing the Caregiver
“It’s probably not something you’d expect a CEO to say, but our patients aren’t the only ones who are in need of healing. It’s all of us. I am painfully aware of the pain our people must leave in the parking lot every day when they come to work. Family problems, financial difficulties, emotional stress – these things demand care every bit as much as a broken leg or a virus. That’s why we are redoubling our commitment to care for each other. Earlier, you heard our chief nurse executive Donna Westfall ask, ‘who cares for the caregiver?’  Well, the answer to that question has to be us. All of us."

Patrick Franklin in The Healing Tree

Reading for this section: Appendix 2 – Lessons in Caregiving from Florence Nightingale

What Would Florence Do?  Evelyn told Carrie Anne that whenever she was confronted with conflicting demands on her time, she asked herself, “What Would Florence Do?”  Florence Nightingale faced incredible obstacles as she cared for British soldiers during the Crimean War; she overcame them all, and established the nursing profession in the process.  Read the article in Attachment 2, then ask yourself what might be different at your hospital if Florence Nightingale were advising you.

Patients caring for caregivers:  Maggie told Carrie Anne that some patients can literally make their caregivers sick through the contagion of their anger, resentment, and fear.  On the other hand, patients can also care for their caregivers, as when Maggie was hospitalized and wrote a poem for one of her nurses who was going through a particularly difficult time.  What can we do to prevent our patients from making our caregivers sick?  How can we creatively ask them to be part of our campaign to foster a misery-free hospital?  In what subtle ways can we let them know that if they care for the caregiver, the caregiver will be better able to care for them in return?

Empowering caregivers to empower patients:  A fundamental quality of patient-centered care is empowering patients to be active participants in their healing, and not just passive recipients of our care.  But before caregivers can help patients feel empowered, they must feel that they themselves are empowered to do so.  If the people within our organization would hold themselves accountable for living the seven promises of The Self- Empowerment Pledge (included in Attachment 3), how much more empowered would they feel?  How much more effective would they be at empowering patients?  What actions can we take to disseminate and promote this pledge?

Do we empower or do we apprehend?  “Proceed until apprehended.”  That’s how Evelyn described her philosophy of putting patients first to Carrie Anne.  How would Evelyn fit into our culture?  Would she find the time (or rather, make the time) to read a poem for a patient who at that moment needed poems more than she needed pills?  Or would she be “apprehended” by a manager more concerned about meeting budget targets than meeting patient needs?

Moving from Good to Great by replacing OR with AND:  In their book Built to Last, Jim Collins and Jerry Porras wrote that great companies replace “the tyranny of OR” with “the genius of AND.”  What actions can we take to move from the tyranny of productivity OR patient caring to the genius of productivity AND patient caring?

How can we tap into hidden strengths of our people?  According to research conducted by the Gallup organization, a majority of workers (80% in their findings) feel that they are never called upon to utilize the greatest strengths on the job.  Mermaid Maggie’s greatest strength was writing poetry, a talent for which there is no existing hospital job description.  So she created her own.  What could we do in our organization to encourage more people to think creatively about ways in which they could share their particular strengths and talents with coworkers and with patients?

Imagine this:  An open job description entitled Fill-In-the-Blank Therapist.  Any hospital worker would be eligible to apply and be added to a roster of people who donated their talent to patients.  A housekeeper who enjoyed woodworking might offer to make over-bed reading tables that patients can take home with them.  An amateur gardener might request a small grant for growing roses to decorate patient care units.  And, of course, anyone with a knack for it could volunteer to write poems for patients.

Are we really professionals?  Dr. Paulson encouraged Robbie to think about becoming a doctor.  In the real world of today, however, it wouldn’t be long before Robbie ran into another doctor (or nurse or other healthcare professional) who discouraged that aspiration by complaining that the work was too hard, the bureaucracy too frustrating, the pay too low, etc.  Part of being a “professional” is promoting your profession, and the organizations in which it is practiced.  How “professional” are the caregivers in our organization, and what else can we do to enhance a spirit of professionalism so that it is reflected in greater enthusiasm for the mission and for the organization?

Above all, cause no harm of this sort:  Hospitals are notorious for their rumor mills, but as Lori Palatnik and Bob Burg point out in their book Gossip: Ten Pathways to Eliminate It from Your Life and Transform Your Soul, this practice harms everyone involved (especially, the authors say, passive listeners), and it contributes to a more negative and toxic cultural climate within the organization.  What actions can we take to promote a more free flow of accurate information so as to more quickly counter rumors?  What else can we do to foster a culture that is intolerant of rumor-mongering?

How can rituals help us foster a more positive environment?  Before she would write a poem for a patient, Carrie Anne went through a ritual of lighting her spice candles and saying her prayer.  At the Texas Roadhouse restaurant chain, the entire crew has a two-minute pep rally (which they call alley rallies) prior to each shift.  Rituals have always been an important way for humans to bring a sense of structure and purpose to their work, yet in today’s hospitals we’re too busy for rituals.  (We’ve replaced them with meetings.)  What can we do to restore the spirit and practice of rituals?  Not having the time is a poor excuse: the Texas Roadhouse ritual takes only two minutes.

Imagine this:  It’s been a crazy day in the intensive care unit – too many patients, not enough staff, supplies delivered behind schedule, unremitting demands from very sick people.  At the end of the shift, caregivers are flat-out worn-out.  So instead of letting people go home in that state, the supervisor calls down to Food Service and orders root beer floats – STAT.  When the next shift arrives, she organizes everyone into a line and they do a line dance all the way down to the cafeteria, whooping and singing to celebrate what they have done for their patients and for each other.  Don’t you think people would go home more positive and more energized?  Wouldn’t they be happier and more productive, be more nurturing as parents, be more likely to come to work more energized on the following day?  What can we as managers do to instill positive rituals like this, and how can we overcome the opposition and cynicism that will inevitably be provoked when we introduce the ideas?

Seeing the job description as a floor rather than as a ceiling:  When Carrie Anne’s nurse Evelyn took the time to read her a few poems, she was seeing her job description as a floor – the foundation upon which to add her own special gifts, rather than as a ceiling – the upper limit on what she was willing or capable of doing for her patient.  What more can we do to foster an organizational culture in which people see their job descriptions as simply the main course, to be enriched by adding their own special touch and talents to the basic job expectations?

VIII. Healing the Patient
“I went to nursing school because I wanted to be a caregiver.  But unless my patients take an active role, I end up just a caretaker.  You’ve reached the point where you have to decide – do you want to be an active participant in your recovery, even if it can’t be a full recovery, or do you want to be a passive recipient of my care?”
Nurse Higgins in The Healing Tree

Reading for this section: Appendix 3 – The Self-Empowerment Pledge: Seven Simple Promises that Will Change Your Life

Do we really put patients first? Sometimes it takes courage to put patients first, as when Maggie (the volunteer poetry therapist) stood up to Dr. Paulson (the chief trauma surgeon) in her insistence on giving a patient a poem about hope even when Dr. Paulson believed that there was no hope.  Does our hospital have a culture of putting patients first, even if it means putting yourself on the line?  What more can we do to assure that job titles and perceived status are not impediments to always putting our patients first (for example, in the case where a recently-graduated nurse must call a doctor late at night to question the accuracy of an order)?

Our patients need both our courage and our wisdom:  On several occasions when Carrie Anne was wrestling with what she called the tar baby of self-pity, she was given a “tough love” lesson by one of her caregivers.  Do we have the courage to treat our patients with “tough compassion” when they need it, and do we have the wisdom to perceive when they need it?  What more can we do to cultivate this courage and wisdom?

How do we help our patients dream new dreams?  Perhaps the most important choice that Carrie Anne ever made was whether the accident that killed her husband and broke her body would leave her feeling like a victim for the rest of her life, or would instead someday be seen as the doorway (or the MacGuffin, as she put it in one of her poems) to a whole new life.  One of the most under-appreciated aspects of being a caregiver is the extent to which we have the opportunity to help our patients let go of old dreams that are no longer possible, and at least begin to open themselves up to the possibility of new dreams – the way that Bill Terry replaced his old dream of playing golf with a new dream of being a wheelchair juggler.

Imagine this:  What if we gave every caregiver in our organization lessons on how to give the most important speech in the world – the speech you give when you talk to yourself.  How could helping our people erase the mental graffiti of negative self-talk help us foster a more positive and productive workplace environment.  And in turn, how could sharing those lessons help caregivers do more to help patients with the mental dimension of their own healing?

How do we collect and tell healing stories? What more can we do in our new employee orientation, in-service education, or other activities to help caregivers be more observant of the opportunities, and more confident in their abilities, to give patients hope that a new path might unfold for them?  For example, one of the most powerful ways that we can give hope to patients is sharing with them stories of others in similar circumstances who went on to rebuild their lives.  It is, of course, difficult for us to collect and share such stories given the acute short-term nature of hospitalization today.  So how can we encourage patients to share their stories with us, and then collect and catalog those stories into our hospital’s institutional memory?

True love and tough love:  When Carrie Anne’s nurse Evelyn took a little extra time to read her a poem, a tender touch was just what Carrie Anne needed at that moment.  When Amanda the physical therapist gave her a tough love speech regarding self-perceived limitations, it was just what Carrie Anne needed at that moment.  How can we help caregivers know when it is best to read a poem, and when it is best to give a tough love speech?

Power to the patients:  Empowerment is about personal power.  Did you notice how Carrie Anne’s nurse Evelyn altered the power dynamics when she stepped out of the caregiver role and into the student role:  “I’ve never really read any poetry...  But this is pretty cool.”  She gave Carrie Anne the opportunity to, for a moment, stop being a patient and step into a realm in which she felt comfortable – and empowered.  It really doesn’t take much time for a caregiver to step into the patient’s world and ask about their passions and strengths.

What more can we do to support support groups?  Following the successful model of Alcoholics Anonymous, there are now support groups for virtually every type of adversity imaginable.  For many participants, this can be a very empowering experience.  Carrie Anne benefited from her participation in the Para-Quad support group both as a contributor and as a recipient.  What more can our organization due to foster and promote a wider variety of support groups (and how could our support of these groups help us with our own public image and public relations)?

Can we become more huggable?  In the dream Carrie Anne had shortly after the accident, her caregivers were astonished when the broken lady’s body was repaired by a simple hug.  In the real world, of course, things are more complicated.  Nevertheless, healers of every tradition have recognized the power of human touch.  This can obviously have a positive impact on a patient’s healing, but it can also have a profound impact on an organization’s corporate culture.  At Southwest Airlines, for example, they give hugs instead of handshakes.  What more can we do to foster a “huggable” culture within our organization?

Who answers patient call lights?  In The Healing Tree, a number of people metaphorically answered Carrie Anne’s “call light” even though it was beyond their job description – such as when Lestelle was singing in the hallway and Peter Graves came into her room with Mistuh Rufus Maximus.  The fact is that anyone can see a patient’s call light on and walk into the room.  They might be able to take care of the problem if it’s something as simple as refilling a water pitcher, but at the very least they can reassure the patient that their nurse will be coming, and in the process help to take a bit of pressure off the nurse.  What more can we do to foster a culture in which everyone feels empowered to “answer patient call lights?”

To care is to motivate:  Several of Carrie Anne’s caregivers were also mini-motivational speakers, not only trying to inspire Carrie Anne with their words, but also giving her specific suggestions by which he could motivate herself to visualize an ideal future and then work toward the realization of that future.  How can we teach both caregivers and managers in our organization to be more effective at motivating the people for whom they are responsible?

Something to think about:  If caregivers chronically complain about their work being too hard, how can they possibly have credibility when it comes to convincing patients that they can overcome their limitations?

Faith and healing:  Modern science has reinforced what common sense and personal experience tell us: spiritual faith is good for health and healing.  This conclusion is summarized in the books of Dr. Larry Dossey and others.  On several occasions, Carrie Anne’s faith was waning, and this was a contributing factor in her being depressed.  At each point, a caregiver stepped in and helped break that cycle.  What more can we do to foster a culture that honors the faith of every one of our patients, but never crosses the line of proselytizing any particular religious beliefs?

ATTACHMENTS

Attachment 1:
Get That Pickle Out of Your Mouth!
10 Steps to a More Positive Attitude

THE NEXT TIME YOU’RE STANDING IN LINE at the airport, eating in the company cafeteria, or walking through a shopping mall, listen carefully to the conversations going on around you.  It won’t be long before you hear somebody complaining about something.  Listen long enough and it will dawn on you that you’re hearing a lot of complaining.  If you then turn your attention inward and pay attention to what you yourself are saying and thinking, you will be astonished – no, you will be appalled – at how much of your mental energy is being wasted on complaining.

We have become a nation of pickle-suckers.  Complaining and its conversational companions commiserating (Oh, you poor baby!) and one-upping (You think you’ve got it bad?  Listen to what I have to put up with!) have become conversational mainstays.  Once, while conducting a seminar, I challenged a group to monitor their own complaining for a 30-day period (the Pickle Challenge).  One participant remarked that if it weren’t for complaining, she would never talk to her mother!

Is it possible for someone to be a negative, bitter, cynical, sarcastic pickle sucker in the break room and fifteen minutes later become a genuinely courteous customer service representative or genuinely compassionate caregiver?  Not likely.  And do customers and patients see right through the act?  You bet.  Is it possible for someone to be a negative pickle-sucker at work, then go home and be a truly nurturing and empowering parent?  Or is that person more likely to be raising a Junior Dilbert, a kid who will enter the workplace preconditioned with negative attitudes that will eventually prove to be self-sabotaging?

This negativity takes a terrible toll on organizations in terms of morale and productivity, but we become so used to it that we’re not even aware of it.  An analogy I often use is smoking on airplanes.  It used to be that as soon as the seatbelt light went off, all the smokers would light up.  The rest of us just put up with it, thinking that there was nothing we could do, so we simply endured getting off the plane feeling sick and smelling like we’d slept in an ashtray.  What would happen to someone who lit a cigarette on an airplane today?

The same principle applies to emotional toxicity in the workplace environment.  If I could somehow wave a magic wand and eliminate all criticizing and complaining from your workplace for the next 30 days, the first person who started in again would be treated in about the same way as the would-be smoker on an airplane.  People would get so used to working in a positive and supportive place, they simply would not tolerate somebody contaminating it with toxic emotional negativity.

As pernicious as all this emotional negativity is to the organization, the real tragedy is the corrosive effect it has on the human soul.  Every time you complain – about anything – you are proclaiming to the world, and to yourself, that you are a victim.  Why?  Because to complain (as opposed to objectively identifying a problem and offering a solution) is to simultaneously state that: 1) something is bothering you (otherwise you wouldn’t be complaining; 2) it’s someone else’s fault (otherwise you’d be looking in the mirror instead of pointing a finger); and 3) you are powerless to do anything about it (otherwise you’d be doing something instead of just complaining).  Gradually, without even being aware it’s happening, pickle-suckers slip into the victim mindset.  And their dreams slowly die.

Here are ten practical yet powerful actions you can take to get that pickle out of your mouth and cultivate a more positive attitude.  While a positive attitude alone won’t guarantee your success, the absence of one will almost certainly contribute to your failure.

Step #1:  Don’t be a victim of your past.  In his book The Soul’s Code, psychologist James Hillman wrote that a Freudian fixation with the hurts of the past (why do you think mother loved your brother best, Tommy?) tends to turn people into self-perceived victims.  As every historian knows, the past is substantially what you choose to remember.  If you want to have a brighter future, the first step might be to remember a brighter past by being a lot more selective about the things you choose to recall.  If you don’t have a nurturing past, make one up.  Hillman wrote that many of the world’s great geniuses “remember” a past that never actually happened, but which supports their desired self-image (e.g. the musical prodigy who “remembers” getting up in the middle of the night to practice, but whose parents swear she slept the sleep of the dead).  If geniuses can boost their happiness and success this way, why not ordinary people like you and me?

In thinking about the past, it’s important to remember that the truth is more important than the facts.  I once had a teacher tell me, in front of the class, that I would never amount to a hill of beans.  The fact is, that was a humiliating statement that was not healthy to my self-esteem.  The truth is that this teacher was frustrated by my misbehavior, knew that if I didn’t change my ways I’d cause myself endless problems in the future, and was genuinely trying to motivate me in the only way that at the time seemed possible.  Which history do I remember?  The choice is mine, but remembering the truth is empowering, remembering the facts is victimizing.

Step #2:  Give your complaints The Valley Forge Test.  Whenever you find yourself complaining about something, imagine being transported back through time to Valley Forge during that horrible winter of 1776-77.  Visualize yourself describing this complaint of yours to the freezing, starving patriots who sacrificed so much to win the freedoms that you now enjoy.  If your suffering makes them cry out in sympathy, then, by Jove, you do have a legitimate gripe, so by all means keep whining about it if you must.  If, on the other hand, your mind’s ear hears them laughing at your “problem,” then either drop it or deal with it, but for heaven’s sake stop whining about it.

Step #3:  Focus your dissatisfaction.  Dissatisfaction can be a powerful source of energy and motivation, if you don’t dissipate it with promiscuous complaining.  If you are sitting on a thumbtack, you will be incredibly focused on that one problem, and powerfully motivated to move!  If you can focus your dissatisfaction on one thing that really matters, and not promiscuously spread it around on every little thing that irks you, you will have created for yourself a great source of motivation.

Say, for example, the one and only thing you allow yourself to be unhappy about is your crummy home (like Jeff Foxworthy’s redneck, your house has wheels and your car doesn’t).  If you refuse to complain about anything else, that focused dissatisfaction will grow into a raging inferno of ambition.  You’ll start waking up in the middle of the night with ideas for how to make the dream home become your real home, and getting up in the morning with the inspiration to take action on those ideas.

Step #4:  Get rid of your emotional baggage.  We all carry around emotional baggage from the past – ancient grudges we can’t seem to let go, hurt feelings that never healed, insults that have festered and metastasized.  As Charlotte Joko Beck noted in her book Everyday Zen, deny it though we may, we actually love hanging on to these little dramas.  Complaining about them comforts us in our failures (well, of course I couldn’t climb that mountain, what with all this baggage I have to haul around).  The more emotional baggage we carry around, the more we have to complain about – and the more excuses we have for living a life that is less than what we would desire for ourselves.

When I take people on wilderness retreats, I have each hiker place an ugly rock in their backpack (though I once had a geologist tell me there’s no such thing as an ugly rock).  This rock is to represent some emotional baggage they’d like to be rid of.  Trust me, by the seventh day of carrying a heavy pack, the unnecessary weight of that rock is a real burden!  On the last day, we have a ceremony: we build a cairn – a small pile of rocks that marks a trail.   Each hiker adds his or her rock and says goodbye to it.  I’ve seen miraculous things happen as people turn and walk away, leaving their rock, and the emotional baggage it represents, behind in the desert.

Step #5:  Challenge your negative self-talk.  Listen to the way you talk to yourself.  If you’re like most people, you put up with abuse from your inner critic that you would never tolerate from even your boss or your spouse.  One way to erase negative self-talk is with a technique I call Metaphorical Visualizationtm.  Visualize your inner critic as a vandal with a can of spray paint who runs around painting the graffiti of negative self-talk on the walls of your mind.  Then imagine The Janitor in Your Attictm  (my janitor is named Spike) painting over that abusive mental graffiti (How could you be so stupid!) and replacing it with positive and nurturing affirmations (I am capable of achieving my dreams and I deserve to enjoy the fruits of my success).  Be creative.  Instead of a Janitor, imagine a crew of elves up there in your attic.  All you need to make this work is frequent repetition and the belief that it will indeed work.  Make it fun and it won’t even feel like work!

Step #6:  Use Direction Deflection Questions.  Complaining is often the first step on a slippery slope of negativity that hits bottom with you saying or doing things you later regret.  Whenever you catch yourself about to complain, immediately stop and ask yourself this question:  “Will what I’m about to do or say help me be my ideal best self?”  If the answer is No, the next question is, “What would I say if I were being my ideal best self?”  If you listen to your intuition, you will hear the answer; if you act upon that answer, you’ll spend more time in “best self” mode.  Pretty soon, you’ll also find that you’ll be doing a lot less complaining because you’ll have a lot less to complain about.

Step #7:  Internalize The Serenity Prayer.  You’ve no doubt heard this prayer: grant me the courage to change what I can, the serenity to accept what I cannot, and the wisdom to know the difference.  Internalizing The Serenity Prayer can help you have the courage to confront your problems with constructive action, the serenity to accept your predicaments with equanimity, and the wisdom to not complain about either, knowing that you’re doing all you can do and the rest is in God’s hands.  It is wisdom to not complain about either problems (things you can change) or predicaments (things you cannot change).

Step #8: Be grateful for the blessings of your life instead of being resentful for what you have not (yet) been blessed with.  Any time you complain about something, you are implicitly accusing (fill in the blank – God, the universe, fate, karma, whatever) of letting you down, of not making things sufficiently perfect.  When you catch yourself griping and whining, remind yourself of just how many blessings you do have in your life (and if you live in America in the 21st century, there are many blessings indeed compared to most of the rest of the world), and replace ingratitude with thankfulness.

Step #9:  See one, do one, teach one.  This is a statement surgery residents hear all the time, because it conveys: 1) there is too much to learn to be dawdling around; and 2) to really learn something you must do it, but to be an expert you must also teach it.  The same principle can be applied to developing a more positive attitude.  In this article, I’m sharing with you ten proven strategies ( you have “seen one”).  Now your challenge will be to take one or more of these strategies and apply them in your work and your life (now your challenge is to “do one”).

Assuming that they work (and they will work), the best way for you to help yourself is to help someone else by sharing with them (the next stage is for you to “teach one”).  This can be your children or your coworkers, or both.  Anytime you “teach one,” remind yourself that you need to be sitting front and center in your “classroom” re-listening to the lesson yourself.

Step #10:  Take The Pickle Pledge:  Every time you complain about something (anything at all) you are proclaiming yourself to be a victim.  Seriously!  When you complain, you are saying three things: 1) something is bothering you – otherwise you wouldn’t be whining about it; 2) it’s somebody else’s fault – otherwise you would be looking in the mirror instead of pointing a finger (any time you complain about something, you are implicitly pointing a finger); and 3) there’s nothing you can do about it – otherwise you’d be working to fix the problem instead of just whining about it.  Can you think of a better definition of a victim than this: something is bothering me, it’s not my fault, and there’s nothing I can do about it.  The antidote to this low-grade victimhood is to memorize, internalize, and operationalize The Pickle Pledge:

Get that pickle out of your mouth and smile
Remember the woman who said that if it weren’t for complaining, she’d never speak with her mother?  Well, several months later she told our group that for the first time in her adult life, she and her mother were actually talking about things that really matter, not just exchanging gripes.

Are you unhappy with your life?  Trapped in a dead-end job, weighed down by debt, struggling with difficult relationships?  Get that pickle out of your mouth!  You can’t smile when you’re sucking on a pickle.  Smiling in the face of difficulty instead of whining about it is often the first step to turning your life around.

In their book The Mind and the Brain: Neuroplasticity and the Power of Mental Force, Jeffrey M. Schwartz, M.D. and Sharon Begley describe research evidence which shows that directed mental effort can actually bring about physical changes in the brain.  “We are seeing,” they say, “the brain’s potential to correct its own flaws and enhance its own capabilities.”

When you consciously override the negative self-talk of your inner critic and replace it with nurturing affirmations; when you replace worthless complaining with constructive problem-solving; and when you deliberately focus your attention on what really matters instead of letting it wander to whatever annoyance happens to grab your attention, you replace the toxic pickle juice of victimhood with the sweet nectar of self-empowerment.  In the process, you breathe new life into your dreams.

Attachment 2:
Eight Lessons from Florence Nightingale

The life and work of Florence Nightingale still offer valuable lessons for today’s healthcare professional. This attachment outlines eight lessons from the work of Florence Nightingale – lessons that she herself would more likely have described as calls to action.

Lesson 1:  Florence Nightingale had a mission, not a job.  She did not inquire about pay and benefits before leading her team of young nurses off to the Crimea, and endured working conditions that would be considered intolerable in today’s world.  Yet she never experienced “burnout,” and through devotion to her calling she changed the world of healthcare forever.  Many problems of today’s healthcare system stem from the fact that hospitals focus on their business plans rather than their missions, and that healthcare professionals have jobs rather than callings.  Nightingale would encourage a re-commitment to the things that really matter, those things that hopefully attracted our idealistic younger selves into healthcare in the first place.

Lesson 2:  She was courageous and she was unstoppable.  She did not allow opposition from the British aristocracy or the antiquated views of military leaders to prevent her from doing her work.  When she ran into a brick wall, she found a way around or over, even to the extent of going directly to the English public for funding support and to the Queen for political backing.  Nightingale’s commitment to putting patients first could be a powerful antidote to cultures of “learned helplessness” in which far too many patients today find that they have no real advocate during their hospital stays.

Lesson 3:  Nightingale was disciplined.  Less well-known than her contributions to hospital and nursing practice was her pioneering work in medical statistics; her painstaking efforts to chart infection and death rates among soldiers at Scutari gave weight to her demands for improved sanitary conditions first at military hospitals, and later in civilian institutions.  She demonstrated that if you want to be effective, it’s not enough to know that you’re right – you must be able to demonstrate that you’re right with the facts.

Lesson 4:  Long before Daniel Goleman coined the phrase “social radar” in his book Emotional Intelligence, Nightingale appreciated that awareness and empathy are central to quality patient care (and to effective leadership).  In Notes on Nursing she wrote: “The most important practical lessons that can be given to nurses is to teach them what to observe – how to observe…  If you cannot get the habit of observation one way or another you had better give up being a nurse, for it is not your calling, however kind and anxious you may be.”  In today’s fast-paced hospital environment, it’s important that the nurse stop for a moment outside each patient’s doorway for a quick mental reminder to really be in that room with the patient, and not mentally off on the next chore.

Lesson 5:  Nightingale had an intuitive appreciation for the impact of the hospital environment on patient outcomes that was well ahead of its time.  Today, thanks largely to the pioneering work of Planetree, we are re-discovering that quiet and pleasant surroundings are as important for healing as direct therapeutic intervention.  Planetree’s Laura Gilpin once told me that when she was a practicing nurse, she believed her top priorities were protecting the sleep of her patients at night, and making sure that their days were made more pleasant by encouraging family visitations and the smell of freshly-baked muffins wafting down from the nursing unit kitchen.  Nightingale would have approved.

Lesson 6:  Nightingale was a team-builder who cared passionately about the nurses under her wing and the soldiers under her care, to whom she was known as “the lady with the lamp.”  Many of the specific techniques in her ground-breaking work Notes on Nursing are now outdated, but her absolute respect for patient dignity still rings out with crystal clarity.  One thing is certain: she would never have tolerated, much less condoned, the gossip and the complaining that is so prevalent in hospital hallways today.

Lesson 7:  In her quiet and dignified manner, Nightingale was a cheerleader devoted to encouraging qualified young women to enter her profession – even though the work was hard and the pay was low.  One suspects that she would have had harsh words indeed for doctors and nurses of our era who are telling the next generation to stay out of healthcare because (fill in the blank – budget cuts, managed care, malpractice woes, staffing shortages, etc.) have taken all the fun out of the healing professions.

Lesson 8:  Nightingale never rested on her laurels, but rather continuously raised the bar.  After proving that a more professional approach to nursing care would improve clinical outcomes, she helped found the first visiting nurses association, chartered the first modern school of professional nursing, and through her writing helped establish professional standards for hospital management.  She remained active virtually until the end of her life at the age of 90.  Given the predicted dramatic shortages of healthcare professionals, it would be a good thing for patients of tomorrow if healthcare professionals of today would reflect upon how Nightingale maintained her enthusiasm and her stamina, and then apply those principles in their own lives and work.

A concluding thought:  Charles Dickens was a contemporary of Florence Nightingale; the opening line he penned for his classic novel A Tale of Two Cities certainly applies to healthcare today – it is the best of times, it is the worst of times.  Were she alive in our era, Nightingale no doubt would have focused on the best-of-times side of the ledger, and implored us to remember that taking care of the sick and injured is a mission, not a business; that being a nurse is a calling, not a job.

Attachment 3:
The Self-Empowerment Pledge
Seven Simple Promises that Will Change Your Life

For more on The Self-Empowerment Pledge, including all seven audio tracks from Joe’s audio CD, go to this web address: www.PledgePower.com.

Would you invest 365 minutes over the course of a year if it would dramatically improve the quality of your life?  That’s just one minute per day.  You already waste that sitting through one television commercial.  The Self-Empowerment Pledge includes seven simple promises that will change your life (not that can change your life – that will change your life).  I say that from experience – my own, and that of many people I’ve worked with.  You will empower yourself to more effectively achieve your most important goals, and to become the person you are meant to be.

Empowerment is a state of mind – not part of a job description, a set of delegated tasks, or the latest management program brought in by the boss.  Your organization can enable you with tools and training to be more effective in your job, but only you can empower yourself to take the initiative in your work and your life.  Making the seven promises (promises made by you to yourself) included in The Self- Empowerment Pledge will change your life.  As you read each of the seven, ask yourself this question:  If I started today acting as if I really believed these things about myself, how much more successful could I be in the future?

If your answer is that you would be better off, then take The Pledge.  Every day for a year, repeat each day’s promise to yourself at least four times – morning, afternoon, evening, and right before bed.  It will only take 15 seconds per repetition – that’s one minute a day.  Post a copy on the bathroom mirror, in your daily planner, on the seat of your car – wherever you’re sure to see it often.  You’ll be astonished at the changes in your thinking, attitudes, and behaviors.

At first you will probably feel awkward.  You might even feel like a bit of a fraud.  But gradually, the words will start to sink in, begin to act upon your attitudes and beliefs.  This will have a positive influence on your behaviors and actions, which will in turn begin to generate better outcomes, thus reinforcing your belief in the promise.

Monday’s promise says that you’ll take full responsibility for your life and refrain from blaming other people for your problems.  I shared The Pledge with a woman who was seriously overweight.  No diet plan ever worked, but she always had excuses – lousy parents, failed marriage, no money – you name the excuse, she made it.  I recently saw her for the first time in over a year.  I hardly recognized her.  She’d lost more than a hundred pounds and looked terrific.  I’ll never forget the proud look on her face when she simply said, “I made a promise to myself.”

On Tuesday, you promise to hold yourself accountable for meeting your obligations and for fulfilling your true potential.  I wrote the book Your Dreams Are Too Small largely out of frustration at seeing so many people cheat themselves (including myself more than I care to admit) by settling for anemic dreams and goals when they were capable and deserving of so much more.  I recently had lunch with someone who had attended one of my workshops in which I had made this point.  He told me that as he drove home, he kept thinking about Tuesday’s Promise on Accountability.  He made the decision to sell the business he’d hated almost from the day he started it and instead to create work with purpose and meaning.  He wanted to buy me lunch because he was celebrating the first big contract earned by his new business.  I’d never seen him happier.

On Wednesday you promise to bravely confront your fears.  I worked with a man who wanted to start his own business, but was paralyzed by fear.  I had him carry a stone around in his back pocket to represent that fear.  Every time he sat down, he was reminded of his promise, and of the emotional pain represented by that rock.  When he was ready, he dug a shallow grave and buried his rock.  Today, he’s in the third year of running his own very successful business.  He told me that he makes Wednesday’s Promise on Determination every single day of the week to help him overcome his fears of rejection and failure.

Thursday’s promise says you will put service before self (in the words of Rotary).  Richard Tripp was a homeless alcoholic living under a bridge in Kansas City.  One day about a dozen years ago, he decided to stop complaining about his own poverty and start helping other homeless people cope with theirs.  Every Thanksgiving and again every spring, his organization feeds more than 3,000 people.  Sir Richard (as KC newspapers call him) is no longer homeless.  He is also a living, breathing testament to the power of contribution.

On Friday you promise yourself that you won’t allow obstacles and setbacks to deter you, but rather will find in them opportunities to learn, grow, connect, and share.  My group coaching service has a number of professional speakers as members, and they can all tell the same story: the financial difficulties, the marketing challenges, even the emotional struggles of that business have made them more confident in their abilities, and more understanding of the struggles faced by people in their audiences.  Those who are successful all have their own variations on the “darkest before dawn” theme.

On Saturday you make the “silver lining” promise on perspective.  One of my favorite sayings is “Thank God Ahead of Time” (the title of a book by Father Michael Crosby).  Bad things do happen to good people: when they do, you can play the victim, or you can create positive meaning and purpose.  I’ve spent many evenings with support groups, and am always impressed with how people choose to find hidden blessings in apparent tragedy.

On Sunday you promise yourself to be faithful.  On the wall of my office is a shadow box that’s home to a delicate handmade paper angel.  A dear friend gave it to me several days before she died of cancer, at much too young an age.  During her last year, her faith in God and her gratitude for the blessings of her life radiated outward the way the sun pours through a stained glass window.  She was a constant inspiration to her family, members of support groups she stayed with to the end, and many others, including me.

Think of a rocket ship that’s been launched toward the moon.  If you alter its course by one tiny degree as it’s leaving earth, it will miss the moon altogether and end up in the stars.  In the same way, small changes made as a result of taking The Self-Empowerment Pledge, if they are sustained over time, can have a huge impact upon your future success and happiness.

Five or ten years from now, you will be in a much different place – professionally, personally, financially, and in many other ways – than you would have been otherwise.  That’s my pledge to you, a pledge that’s backed up by having seen people just like you change their lives by making these seven simple promises to themselves.

THE SELF-EMPOWERMENT PLEDGE
Seven Simple Promises That Will Change Your Life

Monday’s Promise:  Responsibility
I will take complete responsibility for my health, my happiness, my success, and my life, and will not blame others for my problems or predicaments.

Tuesday’s Promise:  Accountability
I will not allow low self-esteem, self-limiting beliefs, or the negativity of others to prevent me from achieving my authentic goals and from becoming the person I am meant to be.

Wednesday’s Promise:  Determination
I will do the things I’m afraid to do, but which I know should be done.  Sometimes this will mean asking for help to do that which I cannot do by myself.

Thursday’s Promise:  Contribution
I will earn the help I need in advance by helping other people now, and repay the help I receive by serving others later.

Friday’s Promise:  Resilience
I will face rejection and failure with courage, awareness, and perseverance, making these experiences the platform for future acceptance and success.

Saturday’s Promise:  Perspective
I will have faith that, though I might not understand why adversity happens, by my conscious choice I can find strength, compassion, and grace through my trials.

Sunday’s Promise:  Faith
My faith and my gratitude for all that I have been blessed with will shine through in my attitudes and in my actions.

 
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