Prospicience

Tic Tac Toe – Three in a Row

Or

Prophecy and Providence

Or

Prospicience

Or

The Skill and Action of Looking Forward

?

November 20, 2021

by Marshall W. Ritchey, M.S., M.B.A., R.C.I.S., C.P.F.T., C.E.T.

?

?

This is a different time.??This is a strange time.??This is a time we knew never thought would happen again.??This is a Pandemic Time. COVID 19 (2019-SARS nCoV-2), a novel SARS Virus had changed our world.???So how do we deal with the unknown???This complicated, uncharted, and novel situation is a challenging situation.??If only we could predict the future! Well to a certain degree we can.??

?

The best predictor of future behavior is past behavior (author unknown)! This prediction is only a high percentage, not totally accurate by any means. High frequency behaviors are more practicable than infrequent behaviors.??You already know what is going to happen, but how you react to the behavior is most important.??So be prepared!??The Boy Scout motto works.??And don’t believe everything you read!?

?

Now on with prophecy!

?

I have played Tic Tac Toe for years.??I know the game well.??So well in fact,??that I can predict a win or a draw after the second choice or move is made with high reliability.??I will usually start with my “X” in the top right corner.??The opponent will place his “O” and I will immediately know if the game is??going to Win or end up a Draw. I can predict the future early in the game.

?

If the “O” is in the center, then there is a high probability of a Draw.??Should they choose any other of the seven available squares, then I predict that I will win.??No probability about it, I know the options and can foresee the future of this game.??The best predictor of future tic-tac-toe moves is past choices or moves of tic-tac-toe.?Better put, there is no substitute for experience, if you learn to adapt from the experience.

?

Now for a little more complex strategy.???I also like to play Checkers.??I have had lots of training by my Grandfather von Wehrden.?His skills and knowledge were taught me by practicing after ever lunch and dinner on the back porch of his home in St. Louis when we visited in the summer.??As a young lad my mother encouraged me to play checkers with Grandfather.??At first I wasn’t??very successful.??I soon learned his strategy and I was able to capitalize and win a higher percentage of the contest.??I became a worthy adversary.??We bonded a friendship and understanding.??Each of us were pleased with the contests.??I played him from the age of??10 until I was a college student and when he passed away, I inherited the wooden checkers.??I have them today.??

?

Now the strategy Grandfather taught was simple.??I mean - keep it simple smarty??(KISS).?To begin with there are only four (4) moves you may make at the start of the game.??Your opponent can only make four (4) moves on his turn.??Then things can get a lot more complicated quickly and not as easily predictable or foreseeable.??Unless, you jump your opponent’s checkers and remove them and future possibilities from the board.??You will also lose some of your checkers in this strategy.??The fewer checkers on the board, the fewer options, the fewer moves, the easier to predict your opponent’s possible moves.??This reduction in number of moves makes the checker game easier predict opponent’s move and thus to win.??Reduce the number of options available to make decision making or moves easier analyze.?Thus using KISS is how I win the checker game. I make it simpler for me to predict your options and future moves with less checkers on the board.?

?

Make the game less complicated.??Eliminate the distractions.??Focus on a few and see what the future possibilities are.??This understanding of what the options are and what they will be is how I have won computer run programs for checkers as well.??I can usually beat the computer on the intermediate checker level.??The high level is most difficult and I usually don’t win with the computer using all its foresight, for it knows all the possible moves and outcomes and can out strategy me.??

?

Chess is another of my favorite strategy games.??Well things get even more complicated with Chess.??Your opening move is expanded to twelve (12) possible movements of your pieces.??Your opponent’s opening move is twelve (12) as well.??The openings are so well known that there are over one thousand three hundred and twenty-seven named openings and variants according to the Oxford Champion Chess.??

?

When I play Chess I do try to Open by moving pieces where they will have impact, Control the center, and protect the king.??My main strategy is to eliminate my opponent’s pieces so I can more easily predict the future and control key squares.??I trade a pawn for a pawn,??a Knight for a Knight, and even a Queen for a Queen in an effort to eliminate the complexity of the game.??I try to make it and keep it simple.??

?

Unfortunately, after my opponent has played a few games, they understand and they also take advantage of a less complex problem.??The best predictor of future behavior is past behavior on both sides of the game. So an Intermediate Chess player may be a bit of a boastful claim, but at least I am not a beginner.??Prediction and planning are essential to be successful in Chess.

?

So now think about sports, the great players or all star athletes are the ones that use their experience and predict or anticipate where the ball will be! That ability to predict makes them the most successful.??Those players overwhelmed by the all the factors, all the players, and all the movement get lost, confused, and sometimes just fooled by the opponent.

?

In baseball, the batter who correctly prophesized where and what the pitcher is going to throw his way is the professional player making millions of dollars.?The football player that can read and anticipate where offense will move the ball, will make the tackle and force the punt.??In basketball, knowing where the players will be and where they will pass the ball provides many a turnover.??Hockey, Soccer, Rugby and others sports you see the prophets at work and playing professionally.??

?

In business the stock market, real estate, and even the corner store who predict what stock will gain value, what property will increase in price, and what items will increase in demand, price and profit are the winners in business.

?

Throughout history there have been prophets to guide and warn people.??Now in the Bible the prophets that were good have books in the Bible named after them.??The prophets that were not so good were eliminated. “Thus says the Lord GOD, Woe to the foolish prophets who follow their own spirit, and have seen nothing.?Your prophets have been like jackal among ruins, O Israel.??Ezekiel 13:3-4.??You may want to read Matthew 7:15 too!

??

This is also true when working in health care, false prophets don’t last long.??The best action and plan is to become a good prophet and know what the next ten moves are going to be.??The not so good prophets in health care will be eliminated or will see the Peter principle is in effect. So you need to focus and think about the future daily.??You need to practice and become good at predicting the future.??Don’t gamble at predicting the future.??Learn from your mentors, study history, and don’t make the same mistakes as others have.??Avoid being surprised by something new or a pandemic.

?

Now on to Providence.

?

What you need is providence.??The?timely preparation for future eventualities.??Devine Providence is what you may be familiar with. Stated clearly, you already know that somethings are going to happen, you prepare to meet those needs or challenges before they happen.??You know the sun will rise again tomorrow, so get a good night’s sleep to be ready for the tasks of the day.??Be prepared!

?

Therefore, in healthcare when dealing with the management of everyday and long term planning . . . keep it simple (KISS) so you can be a good prophet of the future.??Don’t bite off more than you can chew. Don’t over schedule your day.??Have a routine that allows for changes but keeps you focused on addressing the challenges at hand.

?

In the morning I start with rounding my departments.??I huddle with my teams and listen to what has happened in the last 24 hours and what is planned for the next 24 hours.??I then go to bed report, followed by A-Team huddle.??Based on this information, I know what needs my immediate attention and leadership.??I provide the direction and get the support, materials, and equipment to keep my departments running at top quality and quantity.??

?

I listen to supply problems, physician problems, staff problems, and all the other challenges of the day.??I do not try to solve all problems by myself.??I assign my managers and supervisors to research and resolve what challenges they can handle.??I provide added support to negotiate the lack of staffing, equipment, and supplies.??

?

Some may be easily predicted by vacation, pregnancy, or retirement.??Accidents, illness, and new opportunities at other facilities maybe a surprise but you know from past experience that this will happen and we never know when.??So have plan B ready for these sudden changes in personnel.??Waiting for a traveler to be hired will leave you waiting.??Have part-time staff, have prn staff, have seasonal staff, have semi-retired staff and have staff in training.??You know that staff shortages will happen, have Providence – be prepared with appropriate staff.

?

Your greatest expense is your X-ray equipment. How long will X-ray equipment last??You are probably pretty good at predicting its life expectancy.??Most durable equipment is about ten (10) years.??You know your equipment will eventually need replacement.??Plan ahead and make your team aware of what will be involved with the shutdown of a lab for a minimum of thirty (30) days and more likely ninety (90) days to restore activity.??This is going to happen eventually.??Will you need a portable lab???What time of year is going to be the best for patients, physicians, and staff.?Technology continues to advance, are you planning for multiple use for you labs and recovery areas.??How will you use video visits and medicine in the future???Will your pre-testing have viral scans???Will you need social distancing for family members in waiting rooms???Will you need terminal cleaning for waiting rooms???Will you allocated more room???

?

You have some experience with equipment and equipment replacement.??Apply this knowledge to predict what will need replaced and when.??Listen and watch technology changes and physician’s interest in what is trending technology.??Have at a minimum quarterly meeting with physicians to discuss and learn what is on their agenda.??You need the right tools to do a quality job.??How many of you can do a cut down and x-ray on a cradle table???Who would want to do that now???Keep the quality high.??

?

I remember getting equipment and supplies for removing EP pacing wires.??The physician wanted this program to start and grow. Now!??After the second resulted in emergency surgery, we never had another removal and the supplies eventually expired with the loss of thousands of dollars.??Make sure the physicians and administration are committed to the new equipment, the new technology and the new program.?Don’t get caught holding the bag of expired supplies and trying to explain why the program stopped (failed)?

?

My favorite fable in this regard is the?“Pig and the Chicken.”??The Pig and the Chicken are walking down the road.??The Chicken says “Hey Pig, let’s start a restaurant.??We can call it Ham and Eggs!”??The Pig looks at the Chicken and shakes his head “No!”??saying “I don’t think so.??You only contribute, while I’m committed.”??Now there is the difference between contributing and committed.?Make sure everyone is committed to the program.???

?

Material or supplies mostly have expiration dates on them.??Nothing lasts forever.??You can’t keep an abundance of material.??Inventory is expensive to keep a lot on hand and so your par level is expected to be low.??When possible have the manufacturer own their inventory (consignment) in your supply room.?The more inventory they own, the less you have to work on avoiding expiration dates.??The company’s representative will work hard to avoid supplies expiring on your shelves.??Consignment means less hospital money in your supply room and less work for your staff and you to keep level of product available and usable.??

?

Whenever possible have material’s management provide the staff to maintain your stock room inventory.??This improves communication and coordination.??You know on the weekends or during the night there may be a shortage of supplies.??Nothing is nicer than having the material management being able to go Central Supply and know where to retrieve the products you need in an efficient manner and record appropriately for Central Supply and the Cath Lab what was removed from their inventory added to your inventory.??I have been in Central Supply looking for Med-Rad syringes for hours over the weekend.??Not a pleasant memory.???????

?

Learn from other people’s mistakes, you won’t live long enough to make or remake all those mistakes. I personally, have made so many mistakes and tried to learn from them, that I am almost a genius!??

?

Multitasking is praised but if you have too much to handle, you are going to drop a few things.??We all are limited in our ability to juggle.??(The?most?balls?juggled?is 11 and was achieved by Alex Barron (UK), who managed 23 consecutive catches in what is known as a "qualifying”?juggling?run. This feat was achieved at Roehampton Squash Club, London, UK, on 3 April 2012.) Only eleven balls by the very best can be juggled.??You don’t want to let things fall by the wayside. Especially when healthcare is involved.??Therefore, don’t bite off more than you can chew! Focus on a few things.??Keep it simple smarty!

?

Organize your priorities. Your most important responsibility is your staff. Don’t micromanage them.??Your staff and co-workers should be well trained to do their work well. If they can’t do their job, then train them.???They don’t need you looking over their shoulders.??You don’t have the time to keep an eye on all of them.??Nor do they wish to be second guessed or nitpicked.????

?

Your staff, your team, your co-workers are very important too!??You can only keep track of five folks at best. This in itself uses a lot of time. So build you organizational chart so you and the rest of the crew are only leading or guiding five others.??Assign team leaders in each Cardiac Cath Lab.??Have them report to supervisors.??That report to managers, and so on to run a taut ship that has good communications and coordination.??Don’t try to control thirty-four people.??That will not happen.??Look at the military chain of command.??Responsibility and accountability is spread through the different layers of leadership.

?

Effective leadership (guide), management looks at what is coming down the road and is ready to smooth the ride and build the bridges to cross the troubled waters.?Patient demographics change over time.?What is the trend and what are health services that they will need???So you know that reimbursement will change over time.??What will services will be most profitable???Will you have the staff, skills, and supplies to provide those services? You know that your physician’s and staff will age, plan for transitions to meet their needs and have plan for providers in the future.??

?

Cath lab imagery equipment, physiological recorders, and all capital equipment age and will need replacement.???New Technologies develop and become the main stay, IVUS, EP, and Structural Heart.??Be careful there were new technologies such as Laser coronary angioplasty, Brachytherapy, and bare metal stents that did not meet expectations.??Being on the cutting edge of technology is predictably risky with outcomes less than expected.??Someone has to experiment but will this benefit your department in the long run???You are best at predicting this.

?

·??????Some American scientists have extrapolated that one second of exposure to the delta variant is equivalent to 15 minutes of exposure to the original SARS-CoV-2. But that doesn’t mean you’ll get infected, and not everyone agrees with that calculation.?

How long does it take you to setup for a Cardiac Catherization with the patient in the room.?Do you even know if a STEMI patient has COVID-19 before bringing them in the Cath Lab???

?

Video medicine (tele medicine) has gotten a big push with the pandemic.??Robotics medicine is also benefitting from the need to avoid contact with virus or other contamination.??Which way will the future lead to avoid contact and contamination??These technologies currently have high interest and priority.?

?

When looking for trends and trying to forecast the future.??You may become buried with data.??There are only 24 hours in a day.??Statistics will lie and liars will use statistics.??So take them with a grain of salt.??Listen to your contemporaries.??Listen to your mentors.??Listen for the signs of change.??Don’t be bowled over with what is trending.??Relying on popular and popularity is another risky move in health care.??

?

2021 has been a challenging year. Prepare for 2022 with a list five achievements for the coming year.??Make the achievements measurable by fact and deed.??Be it patient satisfaction improvement by 5% or reduced overtime by 10%, make it a realistic achievement.??Review the progress quarterly, and just like an airplane going from Pittsburgh to Miami, make adjustments periodically to make sure you reach the goal.??

?

The Past

?

As we speak about the future, we should remember the past.??One day you will be gone – due to promotion, retirement, demoted or death.??Someone else will fill your position.??What will you have left behind? How will you be remembered???Will you be remembered? Who do you remember that has retired or died??What qualities???Usually we only remember the real good and the real bad.??The mediocre are forgotten like all the others that were ordinary or teams in the middle.??Not the champion and not in the basement, they may have had the potential but it was kinetic energy that brought them to life.??The extra effort that was focused on the problems at hand an in the future.?

?

There have been many, many, managers, directors, and hospital administration that have come and gone.??Some don’t last long and others have been there almost forever.??They all come and go, just some last longer than others.?The leaders who guided are valuable.?The misguided bosses do not last long, hopefully.??

???

I can see the future and I predict that you are not in a leadership position for long.?Your term as a health care leader is limited.??Others will replace you in the future.??Few will remember you.??Who will remember, What will they remember about you and why will they remember you, that is the big question???Did you use people???Or did you help your colleagues and staff???Did you build a winning team or only work for yourself???When you leave your current position, will they shed a tear or give a sigh of relief????You are the one that made the decisions, provided the leadership, and affected their lives for better or worse.??

?

What legacy will you have, if any? Who was the first Cardiologist to do a Cardiac Cath at your facility???Is that even known now???Who was the first Chief Technologist for the Cath Lab? Who was the Head Nurse at the beginning of the Cath Lab???Does anyone remember that physician, nurse or tech who left two years ago? One year ago??Six months ago????Such may be your fate.??Will you be fondly remembered or forgot????

?

Unless you put in the extra effort, you will be ordinary and nothing more.??When you help, encourage, coach and provide extra leadership, then you are extra ordinary.??What extraordinary person do you recall????I have met a few extraordinary people in my career.??Dr. James Shaver, Dr. P.S. Reddy, Dr. Barry Uretsky, Rand Ackermann, RCIS, Betty Bell RCIS, Mary Ann Scully, RN, and Sally Thomas, RN to name a few.??They put in the extra effort.??They helped me with encouragement and good advice.??They gave me positive memories and they helped me accomplish learning new technologies, building new Cath Labs, training new team members, providing positive patient outcomes and profitable gains for the hospital.

?

Conclusion

?

Everything is Beautiful – Ray Stevens 1970’s song

?

Keep it simple smarty!??Focus on the priorities.??Multitasking is a great distraction.??Don’t gamble by over investing time and resources to new technologies without assured ROI.???The best predictor of future behavior is past behavior.??Do unto others as you would have done to you.??Change from your past behavior to make life less complicated and more focused. I predict you will be stronger and smarter.??Study the future!??Build morale, build trust, and build hope for others and yourself. May you have the Providence to meet the challenges of the future and build good memories for the past.??Take the time to smell the roses but share the opportunity with others. Predict the future and make it happen by simplifying goals, work, and life.??Make your work, your life, and the world a better more beautiful place.??Sealed it with a KISS (SWAK)!

?

?

“It’s a beautiful day in the neighborhood, won’t you be my neighbor.”

Mr. Rogers.

?

?

Respectfully yours,

?

Marshall W. Ritchey,??M.S., M.B.A., R.C.I.S., C.P.F.T., C.E.T.