Archive for the ‘Organizational Change’ Category

Rehab Burnout?

Sunday, May 16th, 2010









From the May 2010 issue of PT in Motion magazine [See bottom of the clipping for my response to the question on how to avoid burnout].

What went on the edit floor was the resource I linked to saying:

Just completed a two year study with exciting results when people learn very basic awareness skills.

We found that over a 2-yr period we created an environment that reduced with statistical significance all of burnout parameters we measure pre, post and 12 months post in a major rehab setting during the Great Recession of 2009 and the implementation of an awkward EMR system!

It was fascinating to watch as the rehab professionals returned to sensing and feeling their fatigue and burnout, they actually began to feel better and most importantly, act differently.

They changed their self-care routines, re-organized their time commitments, and approached management about changing processes they identified as contributing to their stress. Job satisfaction soared, considering leaving the organization or profession plummeted. Patients also stopped canceling afternoon BID sessions, so revenue increased.

All from a little posture, breath awareness, movement and attention to present sensations/thoughts and emotions.

So just like our patients, our way "home" to comfort is through feeling, NOT fleeing to one more job or numbing ourselves to get through to the weekend.

Go lay down with a pillow running length wise up your spine, spread your arms, palms up and legs comfortably apart. Watch the breathing take place (leave it alone) and pay attention to what you can feel for 15 minutes. You'll have more battery bars when you roll over and stand up…I promise….we have proof. 

How do you avoid burnout?


PT Education: A formula for craziness…

Saturday, May 15th, 2010

Einstein is famous for his formula to the right. It quite literally changed everything.

He's also widely attributed as having said,

"The definition of insanity is doing the same thing over and over again and expecting a different outcome."                

A little searching suggests he probably didn't say that….but the formula sure rings true in most instances.

How does this relate to P(hysical) T(herapy) education?

If I understand it correctly, the schools search for educators "qualified" to teach what will be on the test about topics that will be tested.

What gets tested is what has been vetted for many years through countless committees.

A surprisingly small number of the people creating the questions have recently been in the clinics delivering a product and if they were, they were doing what they'd been taught and working for pennies through the tired reimbursement system, only now doing even more paperwork to "support" their efforts. (Hence the over and over again).

Meanwhile, we fiddle with facets or expensive balance equipment, wondering why our clients won't pony up cash to consume the same old products dressed in ties called "Doctor" or new technology???

Over and over again, except now we're going to show them, at least in NY, and not provide services for one day just to shake things up!

Really???    Seriously???

That's the best response we have to a systemic craziness of doing the same thing….

Over and over again?

I'm sorry but that is nuts.

Overhaul our education system where the students not only learn science, but more importantly learn how to utilize the latest incredible findings in practical, caring ways with patients from a full biopsychosocial perspective (yes, the science says movement is affected by technique and relationships far beyond the over and over again mantra of research evidence creating a one best practice  and the need for CPR for CPR's.) .

This of course would be new, different and confusing without the purity of wholesome, white-bread sliced services. We might even find some novel ways that would get our patients excited AND results so good they'd actually pay us a full doctor's fee for the service no matter what their insurance covered….really! (They all do at my clinic)

So am I crazy to be thinking crazy like this,

or do you agree we're in some sort of vicious systems loop where

we're trapped in generating dated, boring and unvalued service?


I have more details on what this vision my look like pending publications in the APTA's PT in Motion and Private Practice section….stay tuned, we're just getting started!

The importance of being Present at Work

Sunday, November 29th, 2009

In the past rehabilitation professionals have focused on the "parts" of workplace safety and comfort. We made equipment changes, ergonomic assessments and prescribed compensatory exercises. 

Our job was to winnow down to the finest "parts" and then apply fixes to those parts. We did this even as we knew the most important predictor to recovery from work-related injury or pain was job satisfaction and a feeling as though one was making a useful contribution at work.

We now realize that was short sighted and simplistic. If we are going to be more than "band-aid" therapists, then it is incumbent that our lens broaden and we address the "whole" person…not just the body, but mind, heart and soul! 

This is where ErgoPresence enters the picture.

Quite simply how the person relates to their "work" generates postural habits and dominant breathing patterns.

If those individuals find work stressful or spiritless, the systems collapse through an absence of presence and awareness at the worksite.

No amount of stretching or strengthening or even taping will sustain such a powerful systems effect. Remember at 12 breaths/min that is 720/hr or 5760 dysfunctional movements per 8 hours.

If this person sits dis-spirited and dis-interested at her clerical position for 8-9 hrs/day, can you see the collapse toward the mouse and phone in her structure? If she never breathes from her diaphragm because she's bored/frustrated or chatting online, when will her pelvis return to a more functional balance so the tape for the knee pains can be discontinued?

We need to help our clients see how the soul connection provides heart to power the seat…it is all connected and only the competent therapist of the 21st century will broaden their skill set to generate ErgoPresence.


For more on ErgoPresence visit this page.


What do you do to generate ErgoPresence for yourself and for your clients?

Mirror, Mirror…Who is the most creative of all?

Sunday, November 22nd, 2009

Re-Habilitation: "To make fit to live in (again or for the first time)"

Each person or organization brings unique circumstances to rehabilitation. Cookie-cutter approaches and statistically average group responses to clinical trials may suggest a general direction, but are void of any creativity in a complex situation. 

So what is a creative response?

And who is the most creative of all?

These, like the Queen's own inquiry re: fairest, are actually deeply spiritual questions. They ask, Who am I? What am I? and their answers then generate drive and motivation to act/move in response.

These are questions that I as a professional must ask as part of my development of clinical mastery (pillar of EBM), as well as How creative do I think my client's are?… and therefore, What is their role?(second pillar of EBM:  Patient Values), and then finally, what's been done, accepted AND published in the literature? (3rd pillar, Levels of research)

We've got it all backwards right now in PT for sure, and in organizational management as well. Our constrained perspectives limit us to only what has been done, shutting out "What could be?" Those of us in creativity work can tell you that's a big dead end to creating a future that is "fit to live in." Whether one is living with an ACL deficient knee, an aggressive carcinoma or a dysfunctional job in a dysfunctional company in a dysfunctional economy.

So who is the most creative of all?

Here are a couple thoughts that when I came upon them resulted in the comfort box being not only stepped out of, but broken down, recycled and dispersed back into a whole new raft of perspectival (dictionary says that's a new word) containers that I use today:

  1. Creativity is the ability for an organization, system or individual to adapt to the environment…easy enough.
  2. The individual human is now sub-ordinate in evolutionary chain to the more influential and dominant top of the life chain: Multi-national corporations (See Senge et al, Presence, 2004).
  3. Single cell organisms while less complex, are faster at evolution/adaptation and have a broad and robust communication organizational net: see Swine flu etc.

So where does that leave us? 

The good news is we're right in the middle as a holon…composed of trillions of single cell organisms (both "us" and our "flora") AND we together compose the multi-nationals. 

So be sure you do your personal mindbody practice, because as Peter Senge (2004, p. 234) says,


"We may not be able to change the larger systems overnight, but we can commit to the continual development of awareness and the capacity to choose. That’s why personal cultivation is so important. It keeps you sensitive and in the matrix."


Now, go get your mirror, ask the questions, and let me know what you hear!


Do We Really Motivate and Inspire Others?

Sunday, November 15th, 2009

Attending the Private Practice Section's Annual Meeting last week raised some interesting questions I hadn't considered since my doctoral studies. Important questions that upon reflection it seems I too often glaze over:

  1. Can we really ever get/make/inspire someone or some organization to change?
  2. Or do we merely create environments of safety, challenge and opportunity to allow change/creativity to emerge rather than be held back?

To my way of thinking right now it seems all too easy to make objects out of people and have them be objects to which we do things to in order to generate preplanned outcomes…much as we do with a widget coming down the assembly line. While you can coerce certain individuals to behave in some manner, the motivational literature suggests that isn't a sustainable model.

These questions reminded me of the difference between education (educare: to draw out) vs instruction/teaching (to put in) … One has a collaborative sense to it, the other a dominating or "over thou" mentality. Instructing information and skills is fairly easy, being and educator that can provide a learning environment that permits the student to examine their assumptions and test new ones requires a whole other skill set, and I believe a deep personal practice of awareness of the educator's agenda first. If it includes being the doer/the fixer/ or the healer….ohhhhh, I don't know.

What set off this line of  thinking was when my son Adam commented on FB that he was sure "You really got them thinking." …which is true I suspect many had something to consider and contemplate. But not so much by what I said as the environment I created.  My response to my very wise son, an educator himself, was, "What I learned Adam was that it's most important that people have the chance to "feel/sense" again…once you create that space, then their thinking shifts and they access the wisdom they were looking for outside themselves….very important lesson for me."
So what do you think…where does the inspiration or motivation come from? 
Can you make someone inspired? ….I don't think so, but wonder what you think?  And if you think you can, I want to hear how you think that might occur? ….great stuff…I've been studying it since 1978….still don't have the answers but lots of good questions.

Entrepreneurship and Change

Thursday, November 12th, 2009

Had the pleasure of spending the evening with these 3 colleagues exchanging ideas about where change comes from, how to promote change and what are the barriers. Lots of good ideas and I'll be blogging more after we each do our presentations tomorrow. 

My sense is I'll come at it a little differently but I want to hear their presentation first….stay tuned!


How To Build Your Business by Getting Your Employees to Think More Like an Entrepreneur

Jennifer Wilson PT, MBA
Principal, the Leadership Institute, Initiatives Consulting

Jamey T. Schrier PT, OCS, DPT
President, Schrier Physical Therapy

Janet Bezner PT, PhD
Deputy Executive Director, American Physical Therapy Association

Session Description:
As an entrepreneur, you recognize the value of and need for innovation in your practice – it's gotten you where you are. How do you foster innovation in your practice to both enhance your practice and foster succession planning? Some of the skills you'll learn in this session include: creating a culture of innovation, recognizing and building support for potential blind spots, creating other entrepreneurs in your practice and determining the best way to implement new ideas. This session will benefit you by providing new information/tips on how to progress your practice. Participants will be invited to contribute to interactive discussions through the session.
Learner Objectives:
1. Evaluate the key aspects needed to create a culture of innovation. 
2. Review key characteristics of entrepreneurship.
3. Recognize blind spots limiting the entrepreneurial capacity of your practice.
4. Develop a plan to build innovative support systems.
5. Develop an approach to creating other entrepreneurs in your practice.
6. Determine the best way to implement new ideas.
Administrator Council Luncheon: 12:00 pm – 2:00 pm
Speaker”Creating a Vibrant, Sustainable Business Model Through Change

Matthew Taylor PT, PhD
Dynamic Systems Rehabiltation
Session Description:
This session will present the science of change technology and organizational learning as applied to a private practice physical therapy organization. Practical examples will be provided of creating positive feedback systems to fuel growth and ingenuity for more traditional practices, niche practices and those looking to diversify. The focus will move between issues as they apply to individual staff and the larger group as a whole, to include its role in the community. Evidence for practices used to address change will be presented. Examples from Fortune 50 (fifty) companies will be cited as well as case reports from small private practices. The session will conclude with how to establish ongoing practices of inquiry both personally and as an organization.

Unbelieveable Courage

Friday, November 6th, 2009



cuer heart

the quality of mind or spirit that enables a person to face difficulty, danger, pain, etc., without fear; bravery.



a suffix typically forming mass or abstract nouns from various parts of speech,

I'm just back from wrapping up Phase II of our study at the Courage Center of Minneapolis, MN . I know it will be a memory I'll hold forever. The individual and collective wisdom of this group of pioneering professionals was awe inspiring. This group truly followed the definition of the word Courage…they brought mass (embodied) the qualities of heart/cuer to their community.

As we sat in a large circle of over 25, I was impressed by the visible and palpable changes a year had brought to them. One year ago on Halloween weekend this same group sat/lounged/slumped together for the first time as they embarked on the mind~body training. Now, almost a year to the day, there sat a group with long, light spines, ease on the floor and embodied voices of confidence. Their stories inspired, challenged and moved one another from the deepest levels. From humorous anecdotes with clients to deep personal healing, each with a new sense of purpose and a new sense of hope grounded in experience.

The data isn't finished for this phase, but all indications suggest that despite going through higher levels of stress, the group experienced statistically significant increased meaning/purpose, job satisfaction and quality of life. There were opportunities to share their personal stories of the past year as well as to articulate intentions and vision for the coming year. There was no giddiness or false hoopla. Rather a quality of focused intention grounded in an embodied experience of silence. There were no ungrounded ramblings…rather each spoke with a deep confidence of conviction of the hard, but important work ahead. 

I want to thank this amazing group of individuals and the organization as an entity for their Cour-age in stepping up and making "the future of rehabilitation now" a reality. Keep leading the way my friends and rest well tonight….you are doing such important work.