Live Life Love | Volume Forty-One

Hi Everyone,

I hope this message finds you getting ready to have (or, better yet, already having) fun for the holidays with family and/or friends. After Christmas, I generally spend the week leading up to New Year’s setting up all the goals I hope to crush in the year ahead. However, after spending some time with one of the interviewees from this quarter, Morten Hansen, I think I am going to instead spend the next week figuring out what to leave behind in 2017.

My worldview boils down to the idea that every person should have opportunities to have fun and enjoy exceptional experiences. Going into 2018 I want to ensure I save enough focus and energy to really push that agenda forward—especially for those at-risk of these things being elusive. Good cheer, joy and the power of play should be accessible to all. These concepts generally foster gratitude, which we know is good for the mind and spirit. If you do not believe me, just ask the other interviewee from this quarter, Amanda Krantz.

Business, Innovation and Entrepreneurship: Morten Hansen is a world-renowned organizational consultant who is a thought leader in many areas of business. Morten wrote the book Great by Choice with Jim Collins. In my interview with Morten Hansen we discuss his latest book, Great at Work, looking at how top performers work less while achieving more.

Health and Wellness: Amanda Krantz is the CEO of DohJe, an amazing health technology company focused on eliminating the friction patients face when trying to convey gratitude to their health care providers. In my interview with Amanda Krantz we discuss the power of gratitude, as well as what DohJe is doing to improve the lives of nurses and other healthcare workers.

Life Experience: This quarter the family and I have done a pretty good job getting ourselves around North Carolina. We spent some time in Ashville (one of the top three U.S. cities for hippies according to Estately), as well as getting to ride an entire reenactment of the Polar Express (pictured) in Spencer, NC.

Polar Express | Spencer, NC

Contribution: This quarter I helped a friend and coworker with her efforts in the upcoming Cycle for Survival. Also, in the spirit of contributing to the fun and good cheer of others, I made a donation to the Toys for Tots Foundation.

Next month, I am going in for my second hip surgery—this time a full replacement. I am not completely freaked out. I have a good doctor. I also have a close friend whose business it is to sell these things (who I am grateful is trying to help me navigate through the process). That said, I imagine there will be significant cabin fever in January (during the recovery phase) and would love to hear from you if you feel so inclined.

Wishing you and yours a fun and prosperous 2018!

In health,
Dr. Rucker

Interview with Amanda Krantz about the Power of Gratitude

Generally, I do not break the fourth wall when creating these bios, but I am making the exception here because in the spirit of appreciation, I am grateful that my path crossed with Amanda Krantz. I had the pleasure of meeting Amanda at a 2013 Lean Startup Conference in San Francisco. At that point Amanda was just starting DohJe (for more on her story, see: Why I Left a Comfortable Corporate Gig to Bring More Gratitude to Healthcare), almost 5 years later DohJe is now an amazing health technology company doing incredible things. In addition to DohJe, her list of note-worthy accomplishments includes serving in the Air Force, receiving an M.B.A. from Harvard Business School, and co-founding Notify.Me.

1) DohJe (doe-jay), the name of your company, means ‘thank you’. What is the company’s origin story?

I came up with the idea DohJe because I really wanted to thank a nurse after the birth of my first child. It was a C-section and I did not find out all the things she had really done for me until after she had left her shift. She stayed after her night shift and waited because they had no post-partum rooms, so I was in an OR recovery area. She basically stood guard so that they would not try to take the baby off to the nursery— she just did because. When I went to try to track her down to thank her, there were all these various barriers to finding her.

Life gets in the way, and I never actually thanked her. Fast-forward three more years, I have my second child and this time I had another crazy situation where I had a nurse come in and went way above and beyond. This time, several months later, I thought, “I can’t let years go by and not thank her.” I ended up tracking her down, and at that point the conversation was, “I need to know how to thank you in the way that’s most meaningful to you. Please tell me what I can do.” I didn’t want to just leave cookies for the floor because she personally had done so much. I wanted her to know, and I wanted her supervisor to know.

That’s when I started learning about nurse burnout and how any form of appreciation is so helpful. Just a thank you was enough. Originally, it wasn’t going to be a business. It was just going to be an app that we were going to create for patients to thank nurses and other healthcare workers. In our first pilot, with UCSF, is when we learned that there’s been a change in healthcare where they were starting to really recognize the value of real-time peer to peer gratitude—creating cultures of gratitude and appreciation.

2) As you have developed DohJe over the years, what has surprised you and/or stuck out regarding the power of gratitude in the workplace?

First, just how powerful gratitude is, especially for a brand new nurse. We had a nurse that we had never met, send us an email thanking us for creating DohJe because she was getting ready to quit. Actually, I think she had not graduated yet. It was her nursing internship, or she was on the floor working and had really run into lateral violence and just was really disillusioned at how bad the working conditions were, and was looking at switching careers. Through DohJe she received one note from her patient, and that one thank you note was enough to remind her why she’s doing what she’s doing. Then she wrote us to tell us that she decided to stay a nurse after that one note. That was my aha moment, gratitude actually changed the course of her life.

Second, it surprised me how many people were like me that wanted to thank someone but never did. Whether it’s you don’t know what to say, or there is not an easy way to say it, you end up not doing it. But when it’s made easy, a ton more people will thank the person who helped them.  Spending so much time now seeing the effects of gratitude on the sender and the receiver, I will catch myself not expressing my gratitude and make more of an effort to actually thank someone and let their supervisor know, in everything from airlines to customer service calls. Research has now validated the two-way power of gratitude—but experiencing it myself, I have seen first hand how it affects my own well-being.

3) It is fairly well-established that burnout is a major problem in health care. Gratitude has been shown as a useful empathic tool to mitigate the effects of burnout among health care workers. However, you have uncovered that there are unique attributes about the nursing profession that make this difficult. Why are nurses a special case in this regard?

You have a very intimate experience with your nurse. Their name just isn’t front and center. With the doctor, it’s always like, “Dr. So-and-so will see you now…” and their name is all over your EMR and your paperwork. However, I’d argue you are much more intimate with your nurses. We will get inquiries from patients that say, “Hey, I’m trying to find this nurse. She’s from here. She’s got these many kids.” They’ve had all this time together. They know personal things about them, they’ve connected on a personal level, but because of the way things are currently set up may not know the name.

To have a public place that nurses can be found is becoming more critical because more and more patients are expecting to be able to find people on social media: LinkedIn, Facebook, Twitter. More nurses are now on these platforms than when we started. However, this is not the right platform for gratitude. Many nurses do not want patients to go find them and thank them in a public forum. That’s their personal space. Therefore, having a dedicated place that patients can go and find them directly is really helpful.

One final point, many hospitals think that the various existing feedback channels (e.g. patient satisfaction surveys, etc.) are enough. However, family members are sometimes also deeply affected during the process of medical treatment. None of those channels are effective for the family members to thank nurses. If you think about when someone who is in the ICU, a cardiac patient or oncology, the care that’s given to the family members— I mean some family members live in the hospital during these times of crisis. They are often very grateful for what the care of a family member—as well as for themselves—trying to get through a situation that they’ve never experienced before. They go through it with these people—none of their friends or family members outside of that have any idea, and they’re now more connected with these people than they are anyone else in their life. Those family members don’t have a way through any of the existing mechanisms to express their gratitude directly to any of the staff.

4) Like many digital health offerings, one of the obstacles you have had to face is the ability to integrate with other systems. What have been some of your other obstacles? And what does DohJe look like in 5 years when you successfully navigate around these?

This is a fascinating question because we’ve taken the approach to avoid having to integrate with anything. As we’ve been doing this now for four years, the landscape is changing. Before, there was an opportunity for innovation groups, and service excellence committees, and rogue health care departments to experiment. Now the CIOs and IT departments are demanding more integration regarding their technology partners. Before it was harder to get approval to integrate, so we chose not to. Now, it’s not uncommon for hospitals to have 200 digital health tools— and they want these things to be more integrated.

Fortunately, our system was built [in the beginning] as a web app with APIs that can plug into almost all systems. I would say over the next five years, DohJe in some form will be the front-end interface that connects with any health care system and all the pieces work together nicely. We are recognized as one of the most authentic and genuine ways to collect real gratitude, and then we plug this content into the system of record of the health care institution.

Lastly, we want to flip the ownership of this type of gratitude on its [current] head. The people that we work with, the nurses and health care workers that have a DohJe gratitude locker—this “locker” holds their thank you notes. In our experience, gratitude that’s delivered through survey systems generally relies on manual ad-hoc systems, sometimes the gratitude gets delivered but it is held hostage in the hospital’s HRIS system. It is not portable.  Giving ownership of the gratitude to those who earned it makes good business sense, too. Using DohJe has been shown to increase employee engagement and reduce sick time at hospitals like Delta County Memorial Hospital.

We say, “You have,” as a caregiver, “a digital thank you locker,” so that the gratitude is yours. You can plug the content into your employer’s HR system so that you can get recognized career-wise, but the control and ownership belongs to the caregiver. This way, when you leave, you get to take your thank you notes with you. They are not artifacts that belong with your previous employer.

5) Based on the wisdom you have earned up to this point in your journey with DohJe, what takeaway can you share that one can immediately put into practice using the gift of gratitude to improve the life of others?

I am going to improve your question… let’s answer: put into practice using the gift of gratitude to improve the life of others and their own life. When you feel grateful, express it! Take the step to let someone know. We often hear people ask, “Well, I don’t know what the perfect thing to say is?” The number one thing we have heard from those that get DohJe notes, any thank you helps. People can never hear thank you enough. Some people will write these really long heartfelt notes of gratitude, and others will just say, “Thank you for your compassion,” and both of those make a huge impact. After you express it, you feel better too, whether you can express it as a quick thank you or a long one. When you feel grateful, say it.

Interview with Morten Hansen about Being Great at Work

Morten Hansen is a world-renowned organizational consultant who is a thought leader in many areas of business, some of the most notable being collaboration and high performance. Morten wrote the book Great by Choice with Jim Collins. His new book, Great at Work, discusses ways top performers work less while achieving more. Morten holds a Ph.D. from Stanford and has held various teaching assignments at some of the world’s leading business schools including Harvard, INSEAD, and the Haas School of Business at University of California, Berkeley.

1) In conducting research for your new book Great at Work, you discovered that top performers spend their hours differently, and in somewhat counter-intuitive ways than one would expect. What is one of the traits/habits of these peak performers that surprised you?

One of the findings that surprised me the most is that top performers seemingly collaborate less than their counterparts. This is not to suggest that top performers are not great collaborators. What my research does suggest is that top performers are very deliberate about what collaborations they accept—meaning they often say ‘no’ to projects more than they say ‘yes’. However, when they do say ‘yes’ to collaborating they go all in. This allows top performs to fittingly maintain focus on a limited number of projects, mitigating any need to dilute their energy at the expense of not performing well on what really matters.

2) As workers, we seemingly spend too much time simply disseminating and regurgitating existing company information through meetings and in-person presentations. As a result, we leave little time for learning. What are steps organizations (and individuals) can take to change this?

First, we need to understand that meetings are most useful when reserved for discourse and debate. Organizations often underestimate the opportunity cost associated with meetings. If a meeting of ten employees in not effective, one might wrongfully attribute the time as an hour wasted—but the true cost is not simply the wasted hour. The time wasted is the cumulative time of every employee in the ineffective meeting [ten hours in the hypothetical example]. Even worse is the fact that the result of a non-effective meeting is generally the need for another meeting. Bad meetings have a propensity to perpetuate more meetings. There is a reason the coffee cup adorned with the words, “I Survived Another Meeting That Should Have Been an Email,” exists.

Why do we have a meeting when the objective [of the meeting] can be aptly achieved with an annotated PowerPoint presentation, saving everyone time? Yet, that is the state of most business meetings today. Even worse, now you see people having pre-meetings for meetings. There are edge cases where this might make sense. For instance, a presentation to a C-suite, a Board, and/or an investor group. That said, the trend of poorly run meetings is alarming. The best way to change this is to reduce the number of ineffective meetings your organization allows to take place.

3) You mention in your writing that one of the best ways to cope with complexity is, “fight it and simplify.” What are some strategies that one can utilize (regarding their work and/or daily routine) to evaluate what has enough merit to stay, and what can be successfully shaved away (with limited risk)?

To answer your question effectively, let me draw a distinction between complexity and someone with a massive task list. These are two different problems, with somewhat different strategies to resolve. There are various accessible tactics one can use to deal with a personal task list. Regarding complexity, complexity is generally a managerial problem—because managers tend to be great at adding complexity but can have a tougher time when it comes to simplifying processes. There are a number of reasons this is likely the case, but a couple are that: 1) complexity lends itself to vanity key performance indicators (KPIs) which are easier to massage/manipulate—or worse contrive—so that if a meaningful KPI is off a compelling story can still be told; 2) Similarly, complexity often looks like work.

For example, the communication platform Slack is growing in popularity. In certain business applications, Slack likely has its place. However, I have consulted with various companies using Slack. Invariably when I ask a CIO how they are measuring the effectiveness of tool like Slack, they say, “we are not”. They see their workers always using it, so they make the assumption that the addition of this new tool has benefit. People are busier, yes, but what should be measured is how the tool has increased or decreased performance and that is not taking place. When you add or make a change to a system, it is important to accurately measure the effect on the KPIs that matter. Unfortunately, all too often this does not take place.

To fight complexity, you need to look at the established system and/or processes to see what can be eliminated without an effect on achieving your primary objective(s). Evaluate what steps and resources are not essential. Ask yourself, “are the KPIs currently in place good measures for what the system is trying to achieve? Or, do the existing KPIs pull focus away from what is truly desired? What can be simplified without affecting the end result?” Answering these questions honestly, and making corrections and improvements will improve focus, as well as free up resources, to move the most important objectives forward with more force and better performance.

4) You advocate that people only try to improve one skill at a time? What is the rationale here? And, how can one determine the threshold of mastery to know that they can effectively begin to work on additional skills?

From the various academic work on deliberate practice, we know that most people get better at something when they focus their learning on a specific task. It is difficult for us to get good at something if we are diluting our attention on several things at once. While teaching at the Harvard Business School I had to acquire skills in case method [teaching methodology] to effectively lead the classroom. When I first began teaching at Harvard I found it somewhat challenging because there are at least five things you need to be really good at to master this teaching method. Trying to master all these skills at once meant I was not effectively focusing on any of them [and it wasn’t effective]. Instead, I focused on what I believed was the most important aspect until I felt ready to focus on the next.

I am not aware of an evidence-based threshold of mastery that one can use as a measuring stick to move on to another skill. Six weeks might be a good place to start, anecdotally, at the discretion of the individual. If someone can effectively learn a new skill every 6 weeks, that would equate to 8 new skills in a year, which represent significant personal growth. The takeaway is that there is evidence to suggest that working on 8 skills at 6-week intervals is likely more effective than trying to learn 8 things all at once over the course of a year.

5) There are times when advice about “working smarter” is viewed critically. For instance, when Tim Ferriss popularized the concept of batching email communication (to increase efficiency) many knowledge workers scoffed at the notion that the advice was practical in the real world. What is a piece of advice you can give about working smarter that anyone can put into practice regarding, “work less and achieve more”?

For those that work for someone else, it is learning to feel comfortable saying “no” to your boss. This, of course, is a skill that will be refined differently somewhat and is dependent on each person’s particular situation [and their relationship with their boss], but this is something many people do not do well—if at all. However, when you develop this skill it gives you back more energy and focus, which you can apply to achieving more based on all the principles we have been discussing (and I further outline in Great at Work).

Successfully applying this advice will require trust and communication with your boss, something you will need to develop if it is not inherent. While at Boston Consulting one of my colleagues successfully achieved this by simply sending out a weekly recap email to those he directly reported. Before I was aware of this practice, myself and others in the firm were always amazed at this person’s capacity to achieve while the rest of us at times felt overwhelmed. Come to find out it was his ability to communicate and negotiate his priorities that set him apart from others.