Maurice A. Ramirez, DO, CNS, CMRO

The Edge of Disaster and Modern Healthcare

Stephen Flynn's recent book The Edge of Disaster, featured on national public radio this week, describes a number of large scale vulnerabilities across the United States.  His thoughts on pandemic flu, while certainly concerning, pale in comparison to the real numbers. 

Mr. Flynn describes 80 million infected with as many as 800,000 dying of the disease.  However, a review of Avian flu pandemic over the last 300 years shows that one-third of the U.S. population or 100 million people will be infected.  If this is not enough one half of these individuals or 50 million will require some level of hospitalization or institutional care from bone health all the way up to intensive care unit services.  As Mr. Flynn correctly pointed out there are fewer than 970,000 hospital beds in the United States far less than the 50 million that will be required. 

Of greater concern is the fact that half of those requiring hospitalization will develop a life threatening lung condition know as Acute Respiratory Distress Syndrome (ARDS).  Twenty-five million people requiring advanced lung care will quickly overwhelm not only the capacity of our hospitals but of our respiratory therapists and our nurses.  Of those with ARDS half will require ventilator support, unfortunately there are only 105,000 ventilators in the United States and only 16,800 are available at any given moment to treat these 12.5 million ARDS patients.  Of those that require ventilators, approximately 6.25 people.  This last number is eight times that predicted by Mr. Flynn and has been substantiated in multiple scientific reviews of the major pandemic of the past 300 years.

Mr. Flynn also spends a significant amount of time discussing surge capacity and when asked by his NPR host about the economics of increasing surge capacity beyond the pitiful 12 percent currently available nationwide Mr. Flynn simply said it was an investment in the future, an "insurance policy."  Those knowledgeable in healthcare surge capacity and healthcare vulnerability analysis differ with Mr. Flynn's otherwise star analysis of the other vulnerabilities of the United States.

Immersion Simulation based disaster training for hospitals and healthcare facilities results in a new protocol in the minds of those who are trained.  They learn to deal with triage on a moment to moment basis with every patient whether there is an ongoing disaster or not.  Those hospitals that adopt this model quickly learn that they can activate their emergency plan even when their hospital is only suffering from the daily surge of patients.  Hospitals in New York, Boston and Philadelphia have done this with increasing frequency when emergency room await times have been only two times the norm.  As a result the hospital activates its emergency operation center, calls in additional staff and increases the number of patient care areas in the hospital by re-tasking administrative and non-patient care areas to the treatment of non critical individuals.  These “green” treatment areas decrease the backlog in the emergency room lobby with surprising results.

• Fewer people leave the hospital without medical care because the wait has been reduced.
• There is an increase in hospital admissions because greater diagnoses are made by less stressed doctors, nurses.
• There is a net increase in hospital revenue despite the cost for staff and re-tasking facility.
• Patient satisfaction is improved with patient satisfaction scores on survey rising.
• The hospital saves money because a surge capacity emergency plan activation counts as one of the yearly required disaster drills.

In addition to Mr. Flynn's "insurance policy" approach to surge capacity there is a real world economic advantage for hospitals and healthcare facilities to participate in large scale disaster planning and preparation.  Every hospital in the United States has now accepted money from the federal government under HRSA grants or through various government based insurance payment programs.  As a result these facilities are now required to be compliant with the 17 elements of the National Incident Management System implementation plan for hospitals and healthcare facilities.  In addition, they are required to maintain a surge capacity equal to 20 percent of licensed hospital beds or 500 bed per million population in the geographic license area of the hospital or whichever is greater, less these facilities be guilty of fraud.

The stakes are high for healthcare not only because of the duty and responsibility they take on as part of their role in society but now as a result of the financial assistance they have accepted for the past five years as they were supposed to be preparing for all hazards and all disasters.

Mr. Flynn's book and the features on national public radio this week have brought the spotlight to bear on the vulnerabilities in America, the question is will we respond now or lament the next catastrophe?

Surge Sort and Support at St. Joseph's Womens Hospital

Dirk Palmer and the team at the family of St. Joseph's hospitals once again hosted a stellar audience for Surge Sort and Support. It is always gratifying be "back by popular demand" in any venue, but particularly when the message is so critical to community health and so well received.

St. Joseph's is the among that small 4% of hospitals in the Institute of Medicine reports who have achieved an operational level of Disaster Preparedness. The teams in attendance, in the midst of avian flu planning, enjoyed the detailed review and reconciliation of the varied statistics for the size of the coming pandemic.

The newest iteration of Continuous Integrated Triage and the implications of the latest NIMS Implementation Plan for Hospitals and Healthcare were the hot topics for discussion with the faculty during each break.

As always, the afternoon focus on the needs and stressors for responders and hospital staff was the most popular part of the day.

The progress in preparedness made by St. Joseph's in the months since our last visit was most wonderful to see and heartening to us as Preparedness Educators.

Congratulations St. Joseph's and thank you for having us back.

   

Surge Sort and Support at Cedars Miami

Today Dr. Jim Shultz and I had the great pleasure and honor of presenting the Surge, Sort and Support course at Cedars Miami. For us this was a great homecoming as Cedars is located next door our main offices.

As we expected, the Cedars team was receptive and enthusiastic! The constant applause enlivened Dr. Shultz to a point seldom seen even for him. Even a veteran professional speaker such as myself was moved to the edge of tears as I gave the emotional closing to a Cedars family who had made us their own.

As always, the morning began with a review of the Disaster Life Cycle and the Footprint of Disaster. Dr. Shultz reviewed the science and I provided the narrative stories to drive home the scope of the challenge. Surge capacity and Surge throughput are the themes of the mid-morning and the tidal wave of humanity Dr. Shultz presents focused the group on the need to plan for more than just the patients.

Sort (aka Triage) was yet another opportunity to introduce the newest iteration and integration of triage systems, “Integrated Triage.” The audience was enthralled as they listened to the first full scale application of Integrated Triage in New Orleans following hurricane Katrina. They then listened to the auctioneer like pace as the actual triage evaluation process was presented in real time.

Support finished out the morning with the introduction of Psychological First Aid, the Hospital Based Support Center and the Family Center. These new tools for the care and treatment of the survivors of disaster are now a part of Integrated Triage.

The afternoon, as always, focused on the responders. The aspects of Psychological First Aid turned inward on the responder and the healthcare professional began the afternoon. The ever present resilience toolbox finished the day by providing each participant with a sampling of the resources available to ensure their individual resilience.

Thank you Cedars for your hospitality and dedication.

Sorry for the Long Silence

Almost a proof of my admonishment to client hospitals that no plan is resistant to failure, my computer redundancy plan suffered a catastrophic failure twice in the past several weeks.

First, my primary computer suffered an operating system corruption that resulted in an almost complete loss of data. This occurred in mid January, but I had few worries as I maintain a second laptop with a full mirror image of the data on my primary computer. I never expected to lose more than one or two day's data. When my primary machine failed, I booted up the back-up and was horrified to discover that despite regular synchronization, only the last complete back-up was intact. I had lost 2 full weeks of data.

Despite this set back I resumed daily business with and reconstructed as much lost data as possible, instituting daily back-ups until the primary computer was repaired.

Steinbeck once wrote: "The Best Laid Plans of Mice and Men"

For me this would be obvious when the back-up computer began to fail in the same way that the first had done. Despite multiple negative virus scans, I began to think my computers had suffered the digital equivalent of the avian flu. Next came the feared "Blue Screen of Death."

I was computerless for a week, hence the failure to contribute regularly to this webspace. Once my primary computer returned, I restored the last data back-up only to discover that the system problem had corrupted every back-up since the 31st of December!

I am back, lacking some valuable data, but ready to write new articles and assist in your preparedness. Hopefully my next computer disaster plan works out better.

Remember, no plan is perfect.

Spiritual Resilience for Business

Of all of our sources of resilience, spiritual resilience, it is the only one that is self replenishing.  It is proven that the very act in believing adds to our resilience.  Like emotional resilience spiritual resilience grows when shared.  But unlike all other canteens of resilience it is spiritual resilience that refills itself.  Since we know that it does not matter in what we believe, but that we believe in some form of high order, high wisdom, or higher power a “God” or guiding force in life.  It makes sense that acting on our beliefs would add to our resilience.

It was spiritual resilience that sustained me during the multiple field response deployments of 2005. Hurricane Katrina was an absolute catastrophe in both humanitarian and a physical nature.  What the hurricane had not directly destroyed the levee breaches soon did.  Lawlessness and anarchy brought a few to the basis of human emotion and behavior.  But the tragedy also brought out the best in many people.  Like 9/11 before it Hurricane Katrina’s “ground zero” was dotted with signs that seem to reproduce like mushrooms each one declaring “God bless New Orleans” or we have faith, we will be saved.

These people not only publicized their beliefs (and their spiritual resilience), but they lived it.  These individuals shared not only their stories with us as we treated their physical ailments, they  told us that they would pray for us or that we were the answers to their prayers.  It is not unusual to receive perfunctory thank you’s in healthcare, but to be asked to pray with a group of survivors and then be the object of their prayerful thanks is both humbling and rejuvenating.

And for these wonderful survivors it was the act of expressing their spirituality that renewed them. Remember this is New Orleans, we are not just talking Christianity, Islam, Judaism, but Santorista and Voodoo.  Every form of religious expression both familiar and exotic and yet they all served a common end: they bound a people together and renewed them. The found the way to refill their own 40,000 gallon bathtub by pouring from their canteen of spiritual resilience.

It is this type of resilience that every business must have to handle catastrophic adversity. “Business Katrina’s” fill the news almost every week and those affected are often left bereft of emotional resilience and the financial impact literally bankrupts their physical resilience. It is at these times that an abiding faith is imperative.

But faith in what?

In the 1980’s the study of Sun Tzu and The Art of War introduced American executives to the concepts of balance and flow in battle and business. Sun Tzu wrote not only of strategy, but of the need to understand one’s place in one’s world. More importantly, Sun Tzu emphasized planning with respect and consideration of the environment and the greater forces that determine the fate of our efforts. At the deepest level, The Art of War was about victory through surrender.

In more modern times, masters of Indian philosophy have reintroduced the principles that build spiritual resilience to the American corporate community. Jeff Korhan (www.truenature.com) is the most respected of these new corporate philosophers. A protégé’ of Depak Chopra, Jeff Korhan has successfully made the jump from businessman to business guru in the truest sense of the work through the use of his spiritual resilience both for himself and his clients. How will your spiritual resilience serve you?

(Excerpted from my lecture series and book The Wounded Dog: Avoiding Business Disaster - Lessons Learned from the Disaster Field Office)

Relationship Resilience for Business

Keeping the relationship canteen full is more than just accumulating friends and acquaintances.  The relationship canteen is filled by the richness of those relationships and the connectedness created through the friendships and family.

It is said that a person with friends is never truly alone and when your resilience is tested a full relationship canteen is proof of that statement. Jim Cathcart, the guru of relationships and business (www.cathcartinstitute.com) has made a career teaching the nation’s CEO’s, Executives, Elite Sales People and Entrepreneurs to create business success and business resilience by paying attention to both sides of a relationship, you and your relationship partner. His books and seminars are sold world wide and have been the basis for some of the most successful sales campaigns in recent history. In short, the idea of relationship resilience is not new.

In my life I am fortunate to be blessed with a wonderful marriage.  My wife, Laura, is intelligent, caring, compassionate, supportive and beautiful.  She is a fantastic mother and my best friend. Laura is absolutely supportive of me in everything that I do.  No only my disaster response work but my every day life, my beliefs (even when she disagrees with them), my dreams, my goals, and even my desires. Laura and I share a relationship that is special and in modern society increasingly rare.

Because I strive for physical preparedness both in body and in resources we maintain family preparedness in the same realms.  We have a family plan in the event of an emergency and each of my children, as well as Laura, are well versed in every aspect of that plan.  I know that I can count on Laura to keep the family safe no matter where I may go, what kind of disaster I respond to, what may befall them in my absence, or even in the event that I should never be able to return home.

When I must call upon my resilience, I have a full relationship canteen.  Not only does my marital relationship contribute to this reserve, to this relationship resilience, but I have similar relationships with each of my four children and with my mother.  What is more, even though my father is now deceased, my relationship with him remains a source of relationship resilience.  I know that he is proud of me in the work that I do. This limitless source of renewing strength ensures that I am able to endure and ultimately overcome any challenge ahead of me.

But relationships are a twoedged sword when it comes to resilience.

Several years ago my younger daughter Tiffany suffered challenges of her own and I was away to assist in response and recovery for a declared national disaster. As a result of Tiffany’s hospitalization my resilience was seriously compromised. 

I was conflicted. 

I was physically strong and physically prepared.  I had all of the equipment and resources I needed to perform my disaster response duties.  But the challenges facing somebody who I cared about caused my relationship resilience to suffer significantly.  Rather than being a source of strength my need and desire to be home caring for my daughter sapped my strength.  I was no longer sipping from my canteen of resilience.  I was gulping deeply.  My 40,000 gallon bathtub had sprung a leak. 

The fact that I could do nothing even if I were at her side did not make a difference in how badly her needs affected my resilience.  The fact that I would not even be allowed to be at her side in the first week of her hospitalization did not change the impact of her needs on my resilience.

Relationship resilience is not only important those of us in the disaster field office. A major jewelry retailer saw both sides of relationship resilience. In 2003, a member of the corporate C-suite developed cancer. The diagnosis was made early and the company rallied behind their stricken leader.

Surgery, radiation and chemotherapy drove the illness in to full remission and it looked like a celebration of a cure might even be in the offing. Through out the illness, the executive drew strength from her resilience in all its forms. She was an inspiration to the company’s employees as she came back to work and assumed the reigns of leadership with full vigor.

Then she relapsed.

It had been two years since her illness and the recurrence of cancer hit hard. Not only was there the emotional blow of having cancer again, but the physical rigors of new and stronger chemotherapy. The company and its employees again rallied to her side, but this time resilience waned, the relationship resilience could not fill the void left by the loss of emotional and physical resilience.

Again the company stood by their stricken leader and again she returned to the reigns of power, but this time she had no vigor. Soon her executive assistant was her nurse and her Senior Vice President had been placed in a shadow leadership position. Confusion ruled the day as each division tried to follow two often divergent business directions. Finally, the board had had enough. They wanted to stand by a loyal career executive, but the stock price was falling and the industry wolves were preparing for the attack. The Senior VP assumed full control and the ill executive made a graceful exit.

Relationships are a two-edged sword for resilience but this does not mean that we should limit our relationships based on their potential impact.  Quite to the contrary it means that we should expand our relationships. Make them as deep and rich as possible and share in providing for the resilience of those of whom we care most deeply. Are you growing relationships that fill your Canteen of Relationship Resilience?

(Excerpted from my lecture series and book Wounded Dogs: Avoiding Business Disasters - Lessons from the Disaster Field Office)

Emotional Resilience for Business

Emotional resilience is the product of our own experiences.  The unique thing about emotional resilience is that unlike physical resilience are experiences need not be the same as the adversity that we now face.

In the training environment this type of "cross over" is exploited to help create emotional resilience in a number of professions.  Airline pilots, the military, sales people, law enforcement officers and most recently healthcare professionals employ Immersion Simulation Environments to introduce controlled, simulated stress in a way that allows these professionals to develop emotional resilience.

The Internet abounds with software programs and even video games that allow a business person to "practice" their financial forecasting skills in their business management.  Computer games and board games even provide an opportunity for emotional growth and the development of life skills.

But there is no “Flight Simulator” for life… or is there?

The “Flight Simulator" for life adversity and business adversity however is experience.  The confidence that comes from encountering and overcoming the ebb and flow of daily life gently fills our canteen of emotional resilience.  It is in the dealing with the burnt dinner, the flat tire, the person in the ten item checkout line with 12 items, and the crying babies in the theatre they give us the opportunity to build our emotional resilience.

A fine example of emotional resilience occurred during the late years of the Dot.com craze of the 1990’s. Robert had built an online business with his two brothers. The business had grown slowly to over a million dollars in sales per year with virtually no overhead because it was a virtual company. Each of the brothers were professionals with successful careers and solid business credentials so their success seemed inevitable. Unfortunately, the bubble was about to burst.

By March of 2000, Robert saw that sales were beginning to fall and inquiries to buy the brothers out, previously an almost weekly event, had completely ceased. Unlike his brothers, Robert had recently quit his job as a mortgage company president to devote himself full time to the business. The change in business climate would have caused most people in his situation to panic and in fact that was what happened as the Dot.com bubble burst. Robert however drew deeply from his emotional reserve and accomplished what most in those days could not, he calmed his fears and charted a new course.

An objective analysis of the company and the business plan disclosed a flaw that was common to most Dot.com’s of the day, there was no unique selling proposition and the product had not benefit not found for a similar price in most cities in the United State. The company was doomed!

In the book and the movie Dune fear is referred to as, “The Mind Killer.” It is through emotional resilience that we overcome the fear that chokes out thought and suffocates creativity. Robert and his brothers now took a great gulp from their canteens and took a bold move, sell a company who’s sales are falling. They accomplished this by getting creative with marketing and actually improving sales. They knew that the improvement would not be sustained and they resisted the urge to “hang on” when sales finally turned around.

When they sold the company, they made a small profit above the capital it had taken to turn the company around. The new buyer, who had seen all the financials, was thrilled when the company continued profitable for another 9 months, long enough for the new owner to add new products and develop relationships with the existing customer base. Everybody won!

Whether or not we in fact use these "life lessons" to fill or drain our canteen is entirely our choice.  We all know individuals who spend their lives complaining.  Every little set back is a major problem, every challenge an insurmountable object.  Some of these individuals when faced with a truly tragic adverse life event "rise to the occasion."  Everyone one around them is amazed that this individual is "managing so well."  Unfortunately this is the rare outcome of failing to build emotional resilience from everyday life.  In reality these individuals when studied (and they have been) are really drawing their resilience from the other three canteens and in fact most often from their spiritual canteen.  When studied objectively it is often discovered that these individuals are emotionally overwrought or emotionally numbed.  Their emotional canteen is bone dry and they are compensating from their other canteens.

On the other hand we all know people for whom life's little tragedies are nothing more than minor tribulations.  These individuals are lights in the lives of their friends and colleagues.  They are safe harbors when the emotional waters become stirred.  They are often described with phrases such as "unflappable" or "steadfast", or "strong."

With these individuals the trials of everyday life reassure them of their own strength and fill their emotional canteen.

It is not just our challenges that fill our canteen.  While our relationships fill our relationship canteen the emotions that are relationships create within us fill our emotional canteen.  That is right, we get a two for one return on our investment.  Even better, our emotional canteen is filled by the casual relationships we have at work.  While is true that some of these work relationships fill our relationship canteen by being friendships as well, the encouraging pat on the back from a boss, the applause or accolades of colleagues and even the comradery at the water cooler provides a sense of belonging and inclusion that quickly fills our emotional canteen to overflowing.

Our emotional canteen is also one of two that we can share with others.  During times of adversary we can actually help fill another person's emotional canteen by sharing the life experiences and the feelings that surround those experiences with that other person.

The beauty of this ability to share emotional resilience is that it does not take even one drop from own canteen.  In an almost miraculous fashion the sharing of the contents of emotional canteen allows us to pour almost perpetually into the canteens of others and yet retain a full canteen for ourselves.  It is not until we begin to sip or gulp from our own emotional reserve that we, ourselves, need to seek replenishment. Live richly, love honestly and fill the canteen of emotional resilience.

(Excerpted from my lecture series and book The Wounded Dog: Avoiding Business Disasters - Lessons from the Disaster Field Office)

Physical Resilience for Business

Executive Health and Corporate wellness programs have been on the rise since the early 1990’s. Main stream business magazines such as Fortune, Business Week and even the Wall Street Journal feature articles on everything from getting fit at home, staying fit at work and working out while on the road. Last year I had over 53 separate business related hotel stays and found that each facility either had health club quality equipment available or was in the process of remodeling to ensure the health and well being of their corporate guests. Most executives and entrepreneurs know that they must take care of their bodies and corporate America is making that easier every day because the benefits to the bottom line are readily evident… healthy executives are more productive.

But, imagine being 50 pounds overweight, woefully out of shape, and recently discharged from intensive care after suffering an infection that devastated your liver and kidneys.  You've regained your physical health through the skill of your doctors and nurses, but you can barely walk across the room.  You are beyond couch potato… you're Jabba the Hut! 

This was my exact situation after a simple case of salmonella food poisoning resulted in severe dehydration and hepatorenal failure.  In essence, my liver and kidneys had all but shut down and my body spent two weeks using not fat, but muscle as it's primary fuel source.  While I had lost 15 pounds, but I had not lost more than a pound or two of my excess 50 pounds of fat. 

I had been a competitive swimmer in my youth as well as a competitive martial artist while in medical school. I had intended to begin exercising after the first of the year. The holidays had not yet passed, but it was clear that I had to do something to regain even the barest minimum of physical strength and stamina. 

Imagine jumping into your 40,000 gallon bathtub in December, literally.  Even in Florida, even in a heated pool, it is a shock.  Fortunately fat floats, so my risk of drowning was low.  The first few strokes were incredibly painful.  Not only had I not exercised at all during my extended illness, but these were muscles I hadn't used to any great extent in decades.  By the time I had swum the 200 yards it took me to warm up I was physically exhausted and panting like a greyhound after a race.  By 400 yards my now warm limbs were screaming and my face was hot and flushed.  I could almost feel steam rising from my body even while I was in the water.  By 500 yards I called it quits for the day. 

Not much of a story on physical resilience except that the next day I got back in the water and again the day after that and the day after that.  By February I was swimming two miles three times a week.  I had lost 35 pounds of weight and an estimated 45 pounds of fat.  My muscle mass was up and at the end of two miles I was not breathing any harder than when I entered the water.  My kidney and liver function were back to normal and I was in the best shape that I had been in since medical school.

Physical resilience is about dedication to repeated practice, to education, to creating resources needed for any event or situation. Physical resilience is the development of perseverance through perseverance.

Physical resilience is also the easiest resilience to develop.  In the disaster field office, training it is simply the accumulation of knowledge and materials.  Five days of training, a 72-hour survival pack and four pocket handbooks shrink wrapped into a waterproof brick are sufficient to turn any healthcare provider into a proficient disaster response professional.  It is not the knowledge or the "brick of books" but the whole of physical resilience that is the key. What will you do to fill your canteen of Physical Resilience?

(Excerpted from my lecture series and book Wounded Dogs: Avoiding Business Disasters - Lessons from the Disaster Field Office)

Want Business Success? Think a Little Differently

The key to making Disaster Preparedness Education a reality is to make it applicale to everyday business life. For this reason, the "From Preparedness to Profitability" category was created. The goal is to generate dialogue on the application of Disaster Preparedness principles and techiques to the everyday operation of businesses with an eye towards a better bottom line.

While many jobs for American MBA graduates are going overseas, those who have MFA’s will be in great demand. According to Gartner Inc, by 2008, 40 percent of IT jobs for MBA’s will be outsourced to workers overseas. The reason? A person can fill in a spreadsheet from India as easily as from Silicone Valley for one-tenth the cost. However, corporations cannot outsource creative jobs as easily. The ability to go quickly from problem to problem, problem to solution, or from initial idea to unique product does not cross cultures well. The employee needs to be a part of the culture he or she is marketing to. As a result, American employees with Masters of Fine Arts degrees (MFA’s) are more in demand and earning more than those with MBA’s. Why does someone who is trained in artistic abilities do well in business? It’s not the particular artistic talent, but the thought process that creates it. Fine artists have the ability to apply non-linear thought to problems, which is a valuable business skill. Companies are looking for those employees who can apply a non-linear thought process to business problems.

What’s the Difference?
Here is a simple exercise that will demonstrate the difference between a linear and non-linear thought process. Take out a sheet of paper. In the top left corner, write a letter “A.” In the center of the page, write a “B.” Halfway down the page on the right hand side, parallel to the “B,” write a “C.” In the bottom right corner, write a “D,” and in the bottom left corner write an “E.” Now draw a line from A to B to C to D to E. That is linear thought—arriving at the final answer by following a step-by-step process. Now take your right thumb and forefinger and grab the left top corner of the page next to the A. With your other thumb and forefinger, grasp the lower left corner next to the “E.” Touch the A to the E. That’s non-linear thought—finding the solution without having to go from point to point to point.

Non-Linear Thinking is an Inherent Skill
From the moment you are born, you are an input device constantly making connections. In the first five years of life, your brain grows very rapidly and sets down patterns of recognition. For example, as a survival skill, infants smile at everyone. Next they learn to recognize mommy and daddy, then they develop a fear of strangers, and then they learn to reserve affinity for family and other trusted people. Finally, they choose their own friends. Over time, people begin to lay down patterns of normal and non-normal. That’s why you can look at a situation and know something isn’t right. If you see someone in an airport who has recently had a stroke, you may not realize the individual had one, but you do know that something isn’t right. That is called non-linear thinking—moving quickly from an observation to an end-point. Depending on your experience, that endpoint might have an accuracy as low as 50-50. However, for people trained in creativity, the accuracy is about 99.7 percent. These quick, non-linear solutions, called snap judgments or instinct, are valuable in life and in business. Too often, though, these instincts are not used in the business world, but that’s about to change. 

Creative, Non-Linear People Benefit Business
Creative people get in touch with the emotion of what they’re creating in themselves and use that as a guide to produce the same emotion in another person from the same society. Businesses see the value of that skill—an employee making decisions based on the mindset of a person of the general society, not as an employee tied to a business. Your non-linear, or heuristic, thought processes are when you observe from the inside out, seeing how your own emotions mirror the ones you observe in others. Can people only achieve this non-linear thinking ability by earning an MFA? Of course not. Not everyone is willing to go back to school for another two to three years to get their MFA. Fortunately, you can encourage the same type of non-linear thinking in yourself and your employees. Here are two of the steps to an MFA mindset:

* Eliminate your framing bias.
How you ask questions determines the answers you get. For example, if you manufacture candy bars and you’re ranked second in sales behind brand A, you may ask yourself, “How can we take market share away from brand A?” The obvious linear answer: make your product taste like Brand A. You have labs, testers, and linear thought people who can make Brand B taste like Brand A, or even better. Due to framing bias, they ask the focus group, “Which one tastes like Brand A? Which one do you like better?” Brand B wins, because now it tastes just a little better than Brand A. But the problem with this scenario is that nobody ever went back and asked the basic question: Will our existing customers accept this change? The executives assume brand loyalty will drag customers along. But if they have a core group of fans who love the original taste of the product, in changing the flavor, they alienate them.

* Quantitate non-linear thought.
Learn to apply non-linear or heuristic research methods by taking a written inventory of your own feelings, prejudices, and thoughts on the subject at hand. Now you have the ability to walk into a situation and start observing how the situation itself affects you. That’s called “going with your gut.” If you are a representative of your culture, your environment, and your area of expertise, as well as in touch with your customers and what you experience and feel, then you have unframed your bias. If you are honest, you will be feeling the same reaction as your customers, and you have just gone from point A to point E without all the letters in between. A business person needs to walk through the mental door to unframe his or her biases. For example, with the chocolate bar example, a good businessperson would go to the store, or go to the factory, or call his or her best distributors. The businessperson would evaluate whether the new product was flying off the shelf. If so, that’s good. But he or she would not let that framing bias affect the next time he or she goes through the door, as the opposite may be true then. Such an instantaneous response leads you to continue doing what you’re doing or more of it, depending on how well it’s going.

Learning Non-Linear Thinking and Dual Processing
A new intern fresh out of medical school is the ultimate linear thought machine. In medical school, students are taught that symptom equals possible disease. A equals B. They then run a test to confirm if B equals C. This process, however, is not conducive to all types of medicine. As soon as these new interns walk into an emergency room, they quickly learn non-linear thinking. After a few days of training, experience, and drilling, they become parallel processing machines. They still do their linear thought processes but they also tap back into the non-linear thinking they had before they got their higher education.

Most people who are now are drifting to an MFA degree already have their MBA. They’ve learned and honed their linear thought processes into a sharp edge; now they get their MFA to hone and reactivate their non-linear thought processes. At the end of all that education, they must learn to parallel process on their own, much like the emergency room interns. In the future, people will pursue their MFA after getting their Bachelor’s in business. This way they will achieve both linear and non-linear thought processes and they’ll learn to parallel process. Five to seven years from now, we will see people start earning dual degrees, or universities may start offering a new degree that incorporates both. In the meantime, businesses will need to find ways to encourage parallel processing in their employees. They can do this in a few days of intense training in a corporate retreat setting, or spread over several weeks in a coaching environment. Getting back in touch with non-linear thinking is not hard. Being able to parallel process takes some practice, but the payoff will be more success for businesses, a steady job outlook, and higher earnings for those who master this skill.

(Excerpted from my lecture series and book, Avoiding Business Disasters: Lessons from the Disaster Field Office)

How to Instill the MFA Mentality in Your Company

The most interesting thing I have learned in my years both as an Emergency Room Physician and as a Disaster Medicine Expert is that the lessons learned in the Emergency Room and the Disaster Arena are not only applicable tot he Board Room and the Corporate Arena. To truly reach your customers, you need to understand where they’re coming from—what they want and need in your product or service. But you don’t need to shell out a bunch of money on focus groups and marketing research. You can do the research yourself for much less. How? By learning to think like your customer and teaching your employees to do the same. Once you master this, customers will flock to you.

To think like a customer you need a heuristic thought process, that is you must “be your customer”. Much like how a fine artist “knows” if a painting or musical composition “works” by going with their “gut,” your employees should “know” what a customer wants. Artists develop this ability through an MFA (Masters of Fine Arts) program. Through traditional business education (MBA), however, most employees have refined their linear thought process—point A leads to point B leads to point C. But customers don’t analyze each part of your product or service; they just know if what you offer works well and if they like it. Employees who can think creatively, as if they had an MFA, can assume the mindset of your customers and market to your customers more effectively.

Such employees go with their instinct. They truly understand the customers’ wants and needs. The next time you want to know how your customers would feel about a particular product or service, adapt a non-linear (heuristic) research approach and become a part of your study base. Your focus group of one (you) will guide your initial thought process toward reaching your customers. As you instill this new MFA mindset, consider the following:

* Beware of Your Framing Bias
Think about what happens before a manager goes into a meeting. Rarely will people walk into the situation “cold.” They are briefed on who they’re going to meet and what they’re supposed to accomplish. They draw certain preconceptions, which is called a framing bias. Framing bias is the ability to walk into a situation with a plan—a plan to make a sale, a plan to establish a relationship, etc. As long as you know what your framing bias is upfront, then you can allow the situation to develop organically. You can then take away your feelings and your impressions and use them as an analytical tool. That’s the essence of heuristics—taking your feelings and impressions and using them analytically. Before you can fully immerse yourself in your customer’s viewpoint, you need to shed your framing bias. First, identify what your preconceptions are about your product, service, or situation. Second, once you’ve identified them, clear your mind and explore the experience for the first time. What’s your first impression? Are you reacting the way you are because of your preconceived ideas or because you are looking at the situation through fresh eyes?

* Become One With Your Customers
Become part of the story, even if you aren’t part of the product story. Generally, people like and dislike the same things. If not, you’d never have to wait in line for your favorite roller coaster at an amusement park. What do you feel? Listen to your gut—chances are your customers’ gut would tell them the same thing. You may not identify with the problem, but you’ll know what you need to do to make it feel “right.”  How can you now translate what you’ve discovered into a story for your customer? If you’re developing an ad for jogging shoes, you need to think like a runner—even if you’re not one. Why do people run? What is important to runners? How does running make people feel? After you’ve collected your personal research, you’ll be able to speak in the first person as a runner. Pretend you’re one of those successful fiction authors writing under a pseudonym. Tell your story like you live it. Now your customers will be able to personally connect with you because you’ve become one of them. 

* Passing the Torch
Not only do you, as a business leader, need to know how to think non-linearly, but you also have to encourage it in your employees for your company to truly succeed. Here are some ideas for encouraging creative, non-linear, MFA-style thinking in the workplace:

* Adopt an “Open Thought” Policy 
The old concept of the “open door policy” needs to be revamped into an “open thought policy.” Creative thinking should be encouraged at every opportunity. Let your employees freely express their “good” ideas. Sure, you’ll need to wade through the terrible ones to get to the good ones, but it’s worth it. Your employees will feel valued and be encouraged to find new, creative ways of solving problems. Over time, employees will learn to evaluate ideas on their own. At first, you will hear tons of ideas, only some which are worth exploring, but hang in there. It will take some time for an employee with limited knowledge of all the factors involved in running the business to be able to fully evaluate an idea of their own. As you take the role of mentor, rather than monitor, employees will become more creative and more skilled at self-editing. They’ll be able to take their ideas to the next logical conclusion and say, “You know, that idea is not going to work.” But they’ll also feel comfortable suggesting a well thought out “wild” idea to their supervisor that may turn out to be a great one. Over time, the manager and the employee will learn how to mentor and listen more effectively, and the company may benefit from some great new ideas. An employer can’t conceive all possibilities for his or her product or services. For progress to happen, you’ll need new ideas, so encourage your employees to speak up. If one comes up with a good hook but never has the opportunity to present it, think of how many sales you could be losing.

* Bring in a Teacher
Bring in an educator for your organization that teaches and coaches creative thinking and alternate thought processes. Rather than hiring a speaker this year who gives the same old talk about ramping up sales, consider bringing in someone who teaches employees how to think creatively. See what kind of difference it makes in your sales numbers for the following year.

* Offer Tuition Reimbursement
For very large companies, consider offering tuition-reimbursement for employees to get their MFA. The object is not to get them to master painting or an instrument; it’s to teach them a non-linear thought process—a very valuable skill in today’s business world. With funding this advanced education, you will reap the rewards of your employees’ new skills, and the expense may not be as high as you’d think—you may be eligible for tuition tax credits. If you pursue this option, be sure to set some boundaries. Require employees to maintain a certain GPA and stay with your company for a set period of time after earning their degree. You don’t want to have people earn their MFA and then get lured away by your competition!

Begin to Change Today
Creating a workplace that encourages non-linear thinking won’t happen overnight. Begin with you. Come up with a non-traditional, non-linear idea and share it with your employees, then encourage them to do the same. Encourage your employees to be aware of their framing bias and step into your clients’ shoes. Have them “become” your clients and watch how much your business grows.

(Excerpted from my lecture series and book, Avoiding Business Disasters: Lessons from the Disaster Field Office)