On Friday I had a chance to speak with someone who reads this blog.  He mentioned that my style of writing seemed a little edgy.  I appreciate that he chose such a polite word.

The Science Channel advertised a show regarding an update about how the universe was made.  Maybe it is the cynic in me, but all I could think of was whether someone had sent Morgan Freeman an email dated a gazillion years ago describing a littler bang that preceded the big bang.

It was too cold to go out, too cold to play ball.  So we sat in the house and did nothing at all.

So starts The Cat in the Hat.  So started my day.  For those unable to recall the book, a cat enters the kids’ home…yada, yada, yada…and pretty soon everything in their home is covered with pink stains.  The kids know that their mom will be home soon and that the house must be spotless before she arrives.

I am the Rain-Man of parenting, an idiot savant.  My cat-in-the-hat moment occurred this morning.  Permit me to set the stage.  Last night our fifteen year-old had his friends over for a party.  I was flying solo; my wife was out of town.

The first indication that something was amiss was when I tried to find the kitchen this morning.  From what I was able to recall the kitchen was somewhere beneath the compost pile and Williams-Sonoma warehouse that covered every inch of granite countertop.  The aura was a combination Snapple—Utz—Buffalo Wings.  The entire first floor looked like Animal House’s Delta Tau’s frat house run amuck.

My son was twenty-four hours away from being sent to boarding school in some country not covered on the National Geographic channel.  My message to the boys was simple, little cat Z was about to have a very long day. Mom was one her way home.  You need to be as frightened of her as I am.  I have your phone, I told my son.  You will get it back after you graduate Georgetown Law.

If I’m lucky a month from now I could be managing a Cin-A-Bun in Omaha. No, that is not a quote from the last person who tried to improve patient experience; it was Saul in Breaking Bad.

Improving patient experience.  Improving patient experience scores.  Two entirely different missions.  They involve different teams; different tasks, different scorecards and they have different outcomes.

One scorecard enables you to declare victory if you can spend a few hundred thousand dollars and bump it up by a tenth of a point.  The other measures success in two hundred thousand dollar increments.  A retained patient, a referred patient.

The focus on most hospitals is getting the next tenth of a point.  The focus of most hospitals ignores their largest stakeholder, prospective patients.

Perhaps there is merit in refocusing.

Do you recall that before the recession there were 200 firms in the Fortune 100?

How long ago was that? I think it was around the same time when people still thought you shouldn’t wear white after Labor Day. Time to drop-kick those white pumps to the back of the closet. What made me think of that bit of nonsense was a meeting I had recently with one of the sharpest people I’ve had the pleasure to meet professionally, and a classmate of mine from grad school. She happens to be the founder and president of one of the country’s go-to firms for dealing with business ethics. Having served as a board member for several publicly-traded firms, as well as chairing their audit committees, when the Andersen and Enron scandals hit she went looking for professionals who could help her help her firms. When she couldn’t find the help, she created it.

That conversation got me thinking and made me wonder why there were no longer 200 firms in the Fortune 100. Was it; is it, a matter of business ethics? How often do unethical practices come up when firms interact with their customers? A couple of takeaways from the meeting—for board members to be able to meet their obligation, they ought to do more than reply on the meeting book pulled together by the firm they serve. Simply relying on the book presumes ethical behavior, a presumption not always supported by fact—how much should one believe if the information is being provided by someone who purchased a $900 shower curtain?

What can they do? Due diligence is being reinvented, and the Social Network is leading the charge. One example is to go to the web to see what’s really being said about your organization. Other things I’ve done to obtain facts and opinions, things which particularly gauge how customers and employees feel about the firm include Google Reader, Facebook, Twitter, and YouTube, to name just a few. You don’t need patient focus groups to learn what’s being said, or to learn how good a job your hospital is doing. The patients already have a laser focus. In many instances the group lacking the focus is the healthcare provider.

Firms should focus on maintaining a strong Reputation Bank, one strong enough to be able to handle withdrawals, because you never know when there might be a run on the bank. Might be a good time to look at your firm’s bank deposit slips.  Deposits can be made easily through the social media network.  You can’t stop patients from talking about you but you can shape what they say.

When I was single my mind worked like the minds of most guys.  For example, housework.  Ironing.  I did not own an iron.  My reasoning, that was why God made dry cleaners.  If I ever lost a button on a shirt my head wanted to explode.  My only salvation, as I did not own a needle and thread, was if I had brought home the little sewing kit some upmarket hotels provided along with the coconut-guava soap, I might spend an hour or two during a ballgame trying to sew on the button.

When I married, an iron came with my wife; kind of like the prize that comes in the box of Cracker Jacks.  While I have no problem with a division of responsibilities, I think it makes sense to be efficient when the opportunity presents itself.  As an example, take dusting.  What I discovered is that if your spouse is five feet tall it would be a waste of time for me to dust anything higher than five feet tall.  As a result our coffee table is a tad over five feet tall.  It looks silly but it serves a purpose.

This morning I ironed my shirt.  Scratch one item from my bucket list.

During college, I spent several summers volunteering for a group called Young Life at camps throughout the US.  Silver Cliff was one of their camps in the mountains of Colorado.  Each week we’d take in a few hundred high school kids from throughout the US, and give them the opportunity to do things and challenge themselves in new ways; everything from riding horses to rappelling.

The prior summer I was the head wrangler at one camp—I had never ridden a horse prior to being made head wrangler.  This summer is was the person running the rappelling program.  Needless to say, I had never done rappelled before either.

We received a day’s worth of instruction before we were turned loose on the kids.  One of the first things we had to learn was that the ropes and harness, if properly secured to the carabineers and figure eight, would actually keep you from falling to your death.  My first test was jumping from a platform way up in a tree while on belay.  After a few moments of white-knuckle panic, I stepped over the edge and was belayed safely to the ground.

From there, we scouted a place for the rappel, and found two suitable cliffs, each with about a hundred foot vertical drop.  Watching my first rappel must have reminded others of what it would have been like watching a chimp learn how to use a fork.  After several tentative descents, I was able to make it safely to the bottom in a single jump.

Each day we’d run a few dozen kids through the course, ninety-nine percent of whom had never rappelled, or ever wanted to rappel.  To convince them that it was safe and that they could complete it, I would instruct them in the technique as I hung backwards over the chalk face of the limestone cliff.

Each day we’d have one or two kids who wanted nothing to do with my little course.  Occasionally, while on belay, one of them would freeze half way down the cliff, and I’d have to belay down and rescue them.

Once or twice I’d have an attractive female counselor on belay.  She knew I was the only thing keeping her from being a Rorschach stain on the rocks below.  Scared, and looking for a boost of confidence, “She’d ask, how long have you been doing this?” I’d look at my watch and ask her how many days ago was Sunday.  I viewed it as an opportunity to have a little fun with her.  I also hoped I might even have the chance to go on a heroic rescue.

How long have you been doing this?  That’s seems like a fair question to ask of anyone in a hospital setting.  It’s more easily answered when you are in someone’s office and are facing multiple framed and matted attestations of their skills.  Seen any good patient experience certificates on the walls of the people entrusted with the execution of the patient experience strategy?  Me either.  I have a cardiologist and he has all sorts of paper hanging from his wall.  Helps to convince me he knows his stuff.  Now, if I were to pretend to be a cardiologist—I’ve been thinking of going to night school—I’d expect people would expect to see my bona fides.

Shouldn’t the same logic apply to investing scarce resources to improve patient experience?  Imagine this discussion outside of the hospital cafeteria.

“What do you do?”

“I’m in charge of patient experience.”

“Why?”

“The feds say we’ve got to have it.”

“Oh.  How’s that working?”

“Nobody really knows.”

“How long have you been doing this?”

“How many days ago was Sunday?”

“What’s it cost?”

“Somewhere between this much,” he stretches out his arms, “And this much,” stretching them further.

“Do the doctors want this?”

“Some do, some don’t.”

“How will you know when you’re done if you got it right?”

“Beats me.”

There is a big difference between improving patient experience and improving patient experience scores.

My first trip to London was a while ago.  In fact, I do not think Prince Charles had even started stepping out at night with Mrs. Doubtfire.  It was at a time when television in the UK consisted of BBC1, BBC2, and Channel 3.  Jetlagged, I flipped through the three channels looking for something to watch to help me stay awake.

BBC1 was showing something about the migratory habits of the gnu, televised from some country that nobody in the US had ever heard of—sorry for ending in a preposition—and narrated by one of the dozens of British people who sound like David Attenborough.  BBC2 was playing a game show that had all of the grammarians all-a-tither.  Something to do with contrasting antediluvian prepositions employed by Emily Bronte and Lord Byron.

And Channel 3 was televising a live, week-long dart tournament.  How come ESPN doesn’t hop on that bandwagon?  I opted to watch the darts.  It had the same flare as our Superbowl.  Those attending were kitted-out with face paint, colourful (British spelling) wigs, and dressed like their favorite players, even down to the kilts some were wearing.

I watched the entirety of the first day’s matches and found myself getting somewhat caught up in the drama of the spectacle.  I made sure to leave work spot-on at half-six the next day in order to get home in time to watch Day 2.  By Day 3 I found myself in the hotel pub, drinking Guinness, and shouting at the tele with all of my new mates.

There is a lot to be said for getting what you want from television and videos.  Last night I logged into the Kahn Academy to teach my son about difference quotients for his pre-calc class.  Later that night I used a separate video to help my daughter understand the difference between elements and compounds.

That led me to ask “Where is healthcare’s Kahn Academy?”  Naturally, we will need to pick a different name, but why isn’t there something like this.  Hospitals could even collaborate, seek funding, and build it out under a public service not-for-profit entity.

I think a Healthcare Academy would be a real boost for patient experience.  What if patients could learn in detail about their illness by watching a video?  What is they could learn how to treat and what to do for flu-like symptoms.  Why not have videos that spoke to discharge orders of various procedures? What not have videos showing what to do for and MRI or what happens during an endoscopy?

A lot of the questions patients and prospective patients have could be addressed fully through such a tool, especially in an industry that accounts for twenty percent  of our country’s spend.

What do you think?

Why do you suppose there continues to be so much dissension about healthcare reform, Reform 2.0?

I think it is because Congress failed to acknowledge that ninety-eight percent of healthcare is local; Hyperlocal.  What is hyperlocal?  You know the saying, “All politics are local?”  Well, hyperlocal is local on steroids.  It is moms and dads making choices about who will care for their family.  It’s the doctor down the street, not the doctor chosen by some system.

Individuals on both sides of the aisle, those in favor and those opposed to reform, view healthcare reform and ask “What’s in it for me” and “What will reform do to me?”  The dissension comes from those who have healthcare.  Nobody who does not have healthcare is complaining about reform because no matter what happens they should be better off than they were.

For healthcare reform to work it must meet the test of meCare, it must be viewed as improving my healthcare.  Nobody who has healthcare views reform as meCare.  They view reform as themCare—what’s in it for them.  That is why so many continue to be against reform.  In a zero sum game, somebody with something has to give up something in order for those without something to get something.  The general perception of those with healthcare is that for someone else to be better off they must be made worse off.

What has people talking about trying to kill reform is that nobody who currently has healthcare believes they will see any net gain from reform—they will see a net loss.  If any benefit will accrue to those who presently have healthcare, nobody has articulated the benefit.

To gain support for Reform 2.0, or whatever it comes to be called, those doing the reforming need to dust off their English 101 textbooks and turn to the section on pronouns.  I was a math major, so you may not to take the following at face value, but here it comes.

The most important thing to understand about who supports healthcare reform and to understand why people are in one camp or the other is for the reformers to understand pronouns.

At the end of the movie The Field of Dreams Shoeless Joe Jackson asked Terence Mann to follow him through the cornfield.  Ray Kinsella is upset because Shoeless Joe did not invite him.

Ray Kinsella: I did it all. I listened to the voices, I did what they told me, and not once did I ask what’s in it for me?

Shoeless Joe Jackson: What are you saying Ray?

Ray Kinsella: I’m saying…what’s in it for me?

And therein lays the rub.  That is the question people are asking, governors are asking, and attorneys general are asking.

For reform to work it must incorporate first person interests, not just second or third.  Does that sound selfish?  I do not have a dog in this hunt, and that is probably because I have healthcare.  I do however—and this is going to kill my neo-conservative club membership—think that people who are sick, whether they have green hair and are in this country illegally, have the right, just because they are people—which should be the only criteria for admission—to be treated.

I will pause for a moment as my loyal readers take a few minutes to unsubscribe from my blog.

For reform to work, Congress must learn to conjugate the care verb: First person—iCare, meCare Second and third person—heCare, sheCare, theyCare, youCare. That about covers all the various forms of caring.

What continues to ruffle a lot of feathers is that there is no meCare in heCare, sheCare, or theyCare—hence, the dissension.

The battle over pronouns will continue to show itself as ACOs roll out and as population health gains a foothold.  When it comes to patient experience the only pronoun that matters is meCare, and anything that lessens that will not succeed.

What do you think?

Ninety percent of improving patient experience takes place from the neck up.  The other ten percent comes from CMS.  There are two camps.  The ten percent camp’s members are those that say “we can’t do that”, “that will never work here”, and “CMS already defined everything we need to know about patient experience.”

There is what I call the ninety-ten rule; it is a corollary of the eighty-twenty rule. In the ninety-ten rule ninety percent of the executives work today on what they were working on yesterday.  That leaves ten percent of the executives working on the ninety percent of the issues that can change the industry, the neck-up issues.  Innovation is not about spraying WD-40 on the wheels of the service cart to cut down on the noise.

Case in point—a case study.  Sooner or later there had to be a hospital that gets it.  A hospital that approaches the issue of improving patient experience from the neck up.  As you read through this, see if you can name the hospital.  I warn you in advance that many of you will take umbrage with some of their terminology and with how they present themselves to the market.  My suggestion is that you focus on the approach and the message, not on whether it would play in your hospital’s bureaucracy.

Eighty percent of people looking to purchase healthcare—inpatient and ambulatory—go to a hospital’s website prior to making their purchasing decision.  Fifty percent of people who are scheduled to purchase healthcare from your hospital go to your hospital’s website to decide whether or not they should go to another hospital for service.

In short, they are looking for help deciding where to buy healthcare.  The hospital in this study recognized that and decided to help prospective patients choose them.  They designed a business system—people, processes, and technology—whose goal was to make it easy for people to do business with them.

One of the unifying themes in healthcare is that hospitals do not know what services cost, but they do know what they charge for those services.  Prospective patients do not know either the cost of those services or what they will be charged.

Here is what this hospital did.  The hospital assumed that ninety-nine percent of the people who visited their website were either patients or were people who could become patients.  Based on that they concluded that the information presented on their website should reflect that audience.  They did away with information about their board of directors; they did away with links about making a contribution.  In fact their homepage did away with everything that distracted those ninety-nine percent of their visitors.

In place of those links they created a page that reflected the needs and interests of people who were in the market to purchase healthcare.  They permitted visitors to their website to complete a number of tasks.  For most outpatient procedures and all lab services visitors could:

• Check the price of the procedure or service
• Compare how the hospital’s price compared against other hospitals
• Determine the amount of the service or procedure that would be covered by the individual’s insurance
• Check available appointments
• Schedule the appointment
• Complete the automated preadmissions process
• Read information about the physicians who would be performing the procedure
• Read feedback from other patients
• Read the requirements about what to do prior to coming to the hospital and what to do upon departing the hospital
• Learn how to file a claim with their specific payer
• Interact with the hospital or physician group using online chat

What this hospital learned is that patients and prospective patients have a lot of experiences and have differing degrees of satisfaction from those experiences that have nothing to do with HCAHPs.  These experiences occur when people are shopping for healthcare and they occur after someone leaves the hospital.  These experiences answer questions like:

• Was it easy to do business with this hospital
• Would I come back to this hospital the next time I needed to purchase healthcare
• Would I recommend this hospital to my family and friends

The other benefit is that the marginal cost to the hospital of enabling patients to perform these tasks online was zero.

I try usually not to destroy my credibility until later in the blog, but by now several of you have discovered that the hospital I used in this case study exists only in my mind.

In an era of ACOs and population health in order for a hospital to compete on patient experience—and that is where it will be competing—it is pointless to compete in that arena unless you are prepared to compete on all of the experiences that patients and prospective patients have with your hospital.

Many may wish to argue that this cannot be done or that it should not be done.  For those in that camp I would ask them to present business reasons to support their claim.  For the rest of us maybe its time to approach the problem from the neck up.

Airports, heck most public places, are not good places for Myers-Briggs INTJ savants. Passengers rode the airport’s people mover—the horizontal escalator—like it was a ride at Six Flags.  It looked like my security pat-down by a burley TSA agent may wind up being one of the better parts of my day.  I felt a building pressure in my head telling me it may be time for me start thinning the herd.

The thing I like least about flying has to do with my control issues; someone else controls the plane and there is nothing I can do about it especially now that there are armed air marshals on the flights.  The pilot’s voice seemed to say “Put yourself in my hands.”  I find myself drawing caricatures of the people seated around me—I can choose do that, or I can choose to rush the cockpit and wind up being a two-minute feature on CNN with the other passengers asking how I got the gun on board.

USAIR’s SVP of customer experience wrote an article for the in-flight magazine—it was chipper, upbeat, and full of feel-good euphemisms.  Clearly she had never flown on one of the company’s flights.  During the time it took the woman in the aisle across from me to figure out how to work the seat back toggle to store her tray table I had enough time to memorize the article in three languages and translate it into Sanskrit.

The only thing I knew for certain was that my sole mission at the end of the flight was to make it into the aisle with my bag before Tray-Table lady.  This was not a lack of chivalry on my part.  It was simply a matter of trying to keep my head from exploding, for I knew whoever had the misfortune of having to queue behind her would be delayed by several hours.  I vaguely remember asking the chief steward if we could deplane in reverse IQ order.  Skippy, the name engraved on his ID, gave me look that said he and I had a different sense of humor.

Anyway, the woman seems to be resting comfortably.  She has been studiously trying to complete the same Sudoku puzzle for the last three hours.  On my cocktail napkin I quickly sketched out a binary Sudoku puzzle—four squares using only 1’s and 0’s.  I was about to pass it to her, but Skippy headed me off and took the napkin.  Maybe he did not want her to spend the next two hours struggling with it.  Maybe I should have filled in three of the four boxes.  Skippy also mentioned that several of the passengers around me were not enjoying my rendition of Tom Jones’ She’s a Lady, although an elderly woman seemed to be swooning—I must have forgotten I was wearing headphones.

I get as excited about someone sitting next to me as a dog does about a new flee crawling around on his hind quarters.  The woman next to me.  Her outfit looked like it had been knitted from some form of atomic waste.  I was tempted to ask her how she could dress like that but, I worried she would reply ‘From years of practice.’  She looked like a disaster victim might be expected to look.  The only thing missing from the scene was a reporter standing over her asking her how she felt about the plane crash.  As she gnawed angrily at her gum with her front teeth, her fingers gripped the armrests so tightly I could foresee the need to call a flight surgeon upon landing to amputate her arms at her wrists.

When I share about these things some look at me like they are staring at an unlabeled can of food and trying to guess the contents.  Perhaps objectivity is only for the truly unimaginative.

Anyway, that was my flight.  Yours?  Here’s the segue.

Some think of HCAHPs as a stupid thing.  Perhaps we should define the term ‘stupid thing’—doing long division and forgetting to carry the one is ‘a stupid thing’; mixing a red sock with a load of whites is ‘a stupid thing’.  Sometimes differences of opinion can have us all screaming infidelities.

There is nothing stupid about a hospital trying to improve its HCAHPs’ scores.  Now, if a hospital’s only focus on improving patient experience has to do with being fixated on HCAHPs perhaps that may leave the outcome a few fries short of a Happy Meal.

The thing about improving patient experience is that it is not binary Sudoku; an organization ought not to be fooled into thinking that it should only take this approach or that approach.

I just spent an hour online trying to take the perspective of a prospective patient looking at hospitals within a fifty mile radius of my home.  There are fifty hospitals; two in the top 15 in the country depending on how one scores hospitals.  For example, US NEWS & World Report ranks hospitals based on ratings of various specialties and on the cumulative ratings of the specialties.  So, as it turns out, a top fifteen hospital may not even offer the service I am seeking, or it may be the only hospital in my area that does.

Guess what else I learned?  In calculating the rankings there was no mention in the report of the dark side—CMS. No mention at all of HCAHPs.  What does that tell me as a buyer of healthcare?  Absolutely nothing since as a buyer not only do I not know how a given hospital scored, I do not know what the score means in terms of the service I need to buy, as a prospective buyer of a healthcare service I do not even know what HCAHPs means.

Let us assume for a moment that I was a highly educated consumer, someone who had heard of HCAHPs, someone who’s Happy Meal had a full complement of fries. In shopping for healthcare I went to mdeicare.gov and hcahpsonline.org.

Do you remember the children’s tune The bear went over the mountain?  If I recall correctly the reason the bear went over the mountain was to see what he could see.  And do you remember what he could see?  All that he could see was the other side of the mountain.  That was my take away from studying the importance to me as a purchaser of healthcare of the respective dot-gov and dot-org sites.

Some things are classified as nice-to-knows, and some things are classified as must-knows.  People who are involved, as it turns out, are much more impassioned about the nice-to-knows than are those in the must-knows.  There exists somewhere in our great country a sect from within a sect of people, the Ecological Extinction Society (EES) dedicated to preventing the extinction of the one-eyed, yellow-bellied, duck-billed, flying purple people eater (scratch that; one of the voices told me to throw that in), sap sucker.

Is it possible that among us exists an HCAHP EES mentality?  Sort of like the seniors in high school who sat at the cool kids’ lunch table and who were up to date on who liked who and who guarded and secreted that information as though only they had the keys to the kingdom?

Remember the rabbit in Alice in Wonderland?  What we know about the rabbit is that he—I only assume it was a ‘he’ because the rabbit appeared to be dressed like a ‘he’—was late for a very important date.  In the story nobody ever learns the occasion for which the rabbit was late.  The good news is that one could enjoy the story without knowing any more information about the rabbit.  Ultimately, where the rabbit was going had little if any bearing on the story.

If you understand HCAHPs, and know how your hospital scored your knowledge is limited to a small handful of people in your organization.  From the perspective of patients and prospective patients it means no more than where the white rabbit was headed.

On one of my first trips to England I dined—in this case ‘dined’ is a euphemism for ‘ate’—in a large, white, IBM cafeteria on the outskirts of London.  The buffet offered cauliflower, fish, rice, potatoes, pearled onions, bread, turkey—the white meat, and milk.  Various shades of white food.  It was like eating in a black and white film.

No wonder the Commonwealth did not hold together.

The following night I actually did dine.  The restaurant in the English city of Westminster, The Chesil Rectory, was built at a time when people must have been shorter as I had to duck to enter the old building.  The restaurant’s website estimates the building was constructed between 1425-1450.

This was not the IBM cafeteria.  My first clue; even the beer was dark.  The sides included carrots, tomatoes, peas, watercress, and aubergine—eggplant.

At some point instead of trying year after year to marginally improve someone’s experience (various shades of white food), an organization should simply improve it.  While that may sound like a play on words it is not.  Case in point: Microsoft keeps trying to improve customer experience—Windows 2-6, VISTA, Windows 7, and Windows 8 (shades of white food).  Microsoft followed a technology cycle where every year or two people upgraded their PCs.

Apple and Google create and sell customer experience.  Customers line up to buy the new experience.  If you had to guess which of the three firms never actually met with and watched customers use products, and designed the experience around that information, which firm would you pick?

The efforts to improve patient experience in hospitals and customer experience in payers have included dozens of tweaks, expensive tweaks, over years.  From the perspective of patients and customers it seems like a lot of hat and no cowboy.  People do not notice the affect of many slight changes over time.  To your customers, your patients, it is difficult for them to differentiate their experience in August from the one they had two years ago.  Nothing remarkable and nothing memorable.

Current efforts by many organizations remind me of placing a frog in a pot of water and gradually raising the temperature.  The frog does not recognize that the temperature is changing.  From the frog’s perspective all he knows is that he’s wet.

Several organizations have surveyed providers asking them to rank the importance of patient experience and asking them what they are doing to improve it.

Of note: those same several organizations did not survey patients or prospective patients as to what providers could do to improve the experience.  None of the initiatives mentioned by providers in the surveys mentions them asking patients or prospective patients as to what providers could do to improve the experience.

If the IRS announced that their top priority in the next three to five years was an internal effort to improve customer experience, number one, would anyone believe them, and number two, would anyone expect significant change?  If healthcare payers announced that their top priority in the next three to five years was an internal effort to improve customer experience, number one, would anyone believe them, and number two, would anyone expect significant change?

If you are not hearing a patient talk about their experience at your hospital by saying “Wow, that was different” you are just boiling frogs.  Innovate or go home.  If you don’t your patients will.

I received an email from my chiropractor letting me know she had joined a new practice and wanting me to know that “Doctor Jackie is always looking out for me.”

Doctor Jackie, if I had to guess, is about twelve.  She is perky. She always dresses in yoga pants and some kind of Under Armor sweat-wicking shirt.  In short, she looks like she has just led a spin class at the YMCA.

I have another ‘doctor,’ my cardiologist.  He has grey hair along his temples, and spends a great deal of time oversees speaking with other cardiology ‘fellows.’

I see a vast difference between the capabilities of the two, and yet she seems committed to the title.  Perhaps there a little ‘d’ docs and big ‘D’ docs. I have decided to call Jackie a little ‘d’ doc.  When I replied to her email I signed mine “Dr. Knowledge.”  She probably did not get the point but I felt a lot better.

I asked my three children how many sides constitute a box.  They had more difficulty understanding the word constitute than they did telling me that boxes have six sides.  Many of you would probably agree with their answer.

However, none of those six sides gets as much attention as the other two sides; the in-side and the out-side.  Those are the two sides that seem to get the most attention when discussing business.  Apparently, the in-side is the least favorable side because nobody wants to be labeled as being the one person doing all of their thinking on the inside.

Thinking out-side the box used to mean that you were a risk taker, someone who was pushing the boundaries of acceptable thought, someone seeking innovation.  Inside the box people were those who came to work each day and worked on the things they did not finish the day before.  Whereas outside of the box people were those who came to work and worked on things that had to do with tomorrow.

It no longer means any of those things.  Now that everyone thinks of themselves as thinking outside of the box, they are all back together looking at the world from inside of the new box.  The only thing that has changed is the location of the box.

Accordingly, the new 50, as relates to thinking and innovation are those who are willing to color outside of the lines.  This skill has never been thought of as a skill. In fact, as early as kindergarten, people have been trying to correct away that behavior.  They are probably still doing that where you work today.  That does not mean it is a bad thing.  It just means that it makes those around you uncomfortable.

Grab your crayons and follow me.