Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for February, 2012

Less Said, Sooner Mended

A week ago I ended my weekly “musings” with a thought about CrossFit and character. “CrossFit doesn’t so much create character as expose it.” I think the implication of this during a WOD (workout of the day) is quite obvious; we see glimpses of an individual’s true character during and after a WOD. Did they will themselves to that dark place where we find the magic of the program? Were they honest, counting every rep and striving for the virtuosity inherent in a perfect movement? Was their post-WOD analysis of the performance free of excuses and directed toward yet more improvement?

CrossFit tends to identify those character traits that lead to more of better, but to seek more of better requires that at least some of that character be in there to start. Hence my contention that CrossFit is more of an identifier, and perhaps magnifier, of character that is already on board.

I’ve found time and again that CrossFit and CrossFitters tend to benefit from something called “transference”, the extension of a training benefit in one domain into another wholly different, unrelated domain. For example, I handle the stress inherent in my day job a full order of magnitude better now, despite the fact that my advancing age should produce just the opposite. I believe that this is because I have trained my ENTIRE stress response in the WOD, not just my physical. By purposefully placing myself under the very significant stress of high intensity exercise I have trained my neuro-endocrine system to respond in a less dramatic fashion to ever greater levels of stress.

As an extension of this the CrossFit community has almost always been a “live and let live” place, something that stems from a broad-based sharing of this particular kind of physical experience. There’s an assumption of goodwill among and between CrossFitters, those who’ve met and those yet to meet. As we’ve grown as a community so, too, has grown the extent to which we encompass the vastness of the differences that can exist between human beings. When CF was young you would find more of these vast differences co-existing under one roof; there were simply fewer roofs back then, eh? CrossFitting in common was enough to overcome almost all differences. We were all a little different, only together. If you wanted to CrossFit or be part of the CrossFit community there just wasn’t much of a choice.

Now? The neighborhood has grown. You likely have many options. Multiple Affiliates in most cities to choose from. You can do CrossFit among folks who share much more in common than just the WOD, a little island of CrossFitting homogeneity. Is this such a bad thing? Of course not, at least not on the surface. People like to hang out with kindred spirits. Where this becomes not such a good thing is when the OTHER, non-CrossFit similarities in one group become the focus, when it is NOT the CrossFit that defines what is or isn’t held in common. This saddens me.

Think about this, won’t you? As CrossFit grows there is simply no reason why this wonderful part of the whole experience, ignoring or forgiving our differences while focusing on the wonderful thing we share, must be lost to the growth. At least for all of us out here in the great “outdoors”. So excited about something great about your CrossFit? Awesome! Sing it loud, but there’s no reason to do so while knocking someone or something else. Someone else doing something really great? Cool! Tell everyone you know, don’t try to bury it.

There will be times when something very real happens. Sad, but true. In these instances CrossFit, too, can reveal character. When that happens, whether you might have tossed the first grenade or simply returned fire, DO be the one to stop. “Less said, sooner mended” as my lovely Beth likes to say. It’s way harder and really uncomfortable to do that, be one who says ‘enough’, but you can do it. You do really hard stuff that makes you uncomfortable all the time, on purpose. So do the other folks.

You do CrossFit.


The Role of The Boss in a Flat Organization

Skyvision centers is a hybrid organization that brings together multiple, disparate skill sets in a medical environment. If you ask any of the staff or doctors who we are and what we do you will hear something along the lines of “we’re a customer service business; our product just happens to be eye care.” The founding principle for Skyvision was the creation of a truly patient-centered experience achieved by borrowing liberally from such customer service stalwarts as Nordstroms and the Canyon Ranch Spa organization. These practices were then layered on top of a flow process that was adopted from the Toyota manufacturing system in order to allow the doctors and staff to provide medical care that exceeded all industry standards for outcomes, safety and efficiency.

It became clear very early in the development of Skyvision that a traditional management structure would be counter-productive. Most small businesses, and essentially all medical businesses, are run using a steep pyramid set-up: doctor at the top, office manager next, and all kinds of middle management on top of the folks doing the real work of caring for patients. Command and control was exactly the wrong strategy for us. We adopted the ultimate flat organizational structure, the POND.

The Pond Theory of Management is best viewed from overhead. Unlike the pyramid of the traditional management flow chart, the Pond Structure is nearly invisible when you look from the side. Staff members “float” on the pond like overlapping lily pads. Tasks are determined initially by job description. Responsibility for seeing that larger projects are accomplished is determined by “mutual affirmation” in the overlapping individuals, and those who affirm a leader take on the responsibility of helping that task leader succeed.

With the appropriate systems in place and so much of what we think of as traditional staff management happening on something that looks like “cruise control”, what is the role of the “Boss” in a flat organization? Rising just above the lily pad-covered surface of the pond are the very few “flowers”, the leaders of the organization. If the “Tribe of Adults” is managing its own intra-staff personal relationships and taking responsibility for outcomes, what does the Boss do?

The common misperception of management in a flat organization (and in groups practicing TQM/CGI) is that there is no longer a leader or “Boss” role at all. This, of course, could not be further from the truth. The primary role of leadership in a flat organization is to make broad policy decisions and set major goals for the organization as a whole. The first of these is to choose to have a flat organizational structure! It is the few leaders who are charged with setting the general course of the business, from choosing the products or services to be offered, to determining the variables that will be measured to keep the organization on track.

Once the organization is up and going it’s important to identify the metrics necessary to maintain a tight focus on the goals that have been chosen. Monitoring these metrics and reacting to them is the responsibility of the “Boss”. From just above the Pond an effective leader is able to offer broad guidance without being involved in the minutiae of the day-to-day machinations of the business by reacting to these metrics. This also frees up the Boss’ time for critical planning, meeting with significant customers, and other larger picture tasks that will help the business grow and prosper.

It seems as if the flat organizational structure is designed to inoculate the Boss from any real staff management, doesn’t it? In reality, the only thing that the Boss might miss out on is any of the fun aspects of day-to-day interaction with employees. For better or for worse while the Boss may not do the hiring it is the Boss, and only the Boss, who must do the firing. At the end of the day, a business that chooses a flat organizational structure is not immune to any of the factors that make an individual employee an unsuitable member of the team. Remember, there are no managers, only a Boss, and no one else available to perform this (hopefully rare) task.

The role of the Boss in a Flat Organization is at once bigger and smaller than in a traditional hierarchical structure. Smaller in that the number of management tasks he is asked to perform is radically reduced. Bigger since the remaining tasks are more global and reach into every aspect of the business. Certain types of individuals are more geared to fulfilling this role (it helps to be a little more laid back and patient), and certain abilities are more helpful (delegation, data analysis, “blue-sky” planning). Indeed, the more of these characteristics one has in a leader, the fewer leaders you need!

The better the Boss, the flatter the organization.




Bingo Does the Open II

How am I going to approach the 2012 CrossFit Open? I’m a realist. I will not qualify for the CrossFit Games. I’m in the Masters age 50-54 division and even here I am simply too small and weak as a kitten (at least in comparison with my competitors). We will be required to use the same loads and do the same exact WOD’s as the 20-something firebreathers. Last year the weights were simply too much form me; I don’t see ’em getting any lighter this year.

So what will I do? Well, I’m certainly going to make the effort to get a legit score on each workout. Like the 2011 Open it’s exciting to be a part of the conversation. I have every expectation that the loads will be on the very edge of my abilities, but so what? It’ll be a worthy test.

However, I did learn a very important lesson last year. The Open totally messed up my training. Wrecked it in fact. Five weeks of inconsistency. I altered my WOD’s early in each week, and I rushed to CrossFit Cleveland every Thursday to get the Open WOD done at a registered Affiliate. Remember the mantra “form then consistency then intensity”? Consistency got the shaft.

This year my approach will be a bit different. My CrossFit program is designed to fit around my life, specifically my OR schedule. Some of those Open workouts were so beyond my reasonable ability that they were essentially worthless as training, and that made me lose one workout each week. One of four. My Open experience this year will fit my schedule and my training program. I train for tomorrow…for life. I’m pumped for the Open, excited to be part of the conversation, but my competition still needs to be “you vs. you.” After I give my all to the Open WOD as Rx’d my plan is to do a scaled version adjusted so that I get the same TRAINING  stimulus from the WOD as the better CrossFitters are getting.

Will it work? Heck, I dunno. Might be the best of both worlds, but then again I might crash and burn, too. I like the idea that I’ll be testing myself not only against the rest of the CrossFit community but also against myself. Last year I allowed the Games to occupy me.

This year I occupy the CrossFit Games!

Approaching The CrossFit Open

The first workout for the Open, the gateway to the CrossFit Games, will be announced Wednesday, February 22. You’re in, right? Registered and ready for the first WOD? Maybe you didn’t register but you’re gonna do the workouts anyway. Great! What are your goals? What’s your strategy? You thought about this, right? Re-visited your CrossFit goals, your life goals, and how the Open fits in? Right?

Like I told you last week, you are I aren’t going to the Games. Not gonna happen. Sorry to be the one to break it to you. Only ~1000 of us will go to Regionals as individuals, and maybe another ~2000 or so as team members. Probably not you and me, though. We’re doing the Open for all the reasons I mentioned last week. We’re part of a community and this is how we take part. We’re fortunate enough to be able to do pretty much exactly what the best CrossFitters will do, just like we’re playing Pebble Beach after Phil and Tiger. We’re gonna do this because we own it. We’re CrossFitters; registered or not we do the Open.

But how? Think about this a bit. This is important. No going on cruise control here. What are we going to do?

The Open WOD’s will arrive during our training. We can simply apply them as such, another training tool, and just do them in the course of the week as another WOD in our program whether we send in our score or not. If memory serves, the Open WOD shows up as one of the Main Page CrossFit.com WOD’s as part of the flagship’s programming. Perfectly legit way for us to be a part of this gig. We can also work them into our training as a test, use them as a little measuring stick of our own personal fitness. You know, my whole “you vs. you” thing. Another perfectly reasonable application.

Or we can ramp it up a bit and compete. After all, The Open is a part of the CrossFit Games season, and this is the Sport of Fitness. There will doubtless be scads of local competitions using these WOD’s, some within individual Affiliates, some just among friends. Any place there’s a clock or a scoreboard (or both) and more than one athlete you’ve got a contest. We don’t need $250,000 on the line. Bragging rights, a new tee-shirt, last one to buy a round at the next Affiliate gathering? The prize isn’t the prize. Why the heck not?

Maybe you’ve been aiming for this for months, ramping up your training, tightening your nutrition, clearing your schedule. For you this is serious. Each week is about planning your attempt, the timing, pre-WOD rest, maybe a dry run on Thursday and a redline effort on Saturday. Maybe you’ve got a real chance and maybe not. Who cares? The point is that YOU care! In your mind you are not like me and most of us, and you’ve been just itching for these five weeks since, well, LAST year’s Open.

The point is simple: this is your CrossFit Open. Think it out before you start the journey. Drive the Open, don’t let it drive you. Pop the clutch. Grab the wheel. Decide what it means to you,where and how you’re traveling. Three more days to set your course.

Occupy the CrossFit Games!


Going To Work

One of the strongest statements yet made in support of the private practice of medicine was made this morning at 8:00 AM, EST. I went to work.

What’s the big deal? Of course you went to work. You’ve got a job and today is a work day. Ah, Grasshopper, there’s the rub. I am a doctor in private practice. I don’t have a job, I own a job. I don’t report to any centralized HR department; there’s no single supervisor looking over my shoulder. Nope, I’m a practicing physician in a private practice specializing in eye care, and this morning there are some 60 patients who’ve scheduled appointments and a staff of 14 on their way in to the office, all of whom are depending on me going in. So even though I feel like a damp campfire long past its useful life, I came to work.

If all I had was a job I’d a stayed in bed.

The dirty little secret of private practice medicine is that market-based economics works on a micro basis. There’s payroll to meet and rent to pay. The mere perception that your patients will leave your practice if you don’t go to work drives the private practitioner to work even when she feels lousy. Even more than that, the absence of a corporate barrier between doctor and patient makes the private practice doc think twice before he takes that sick day, because each one of those patients belongs to him, and vice versa. The unfiltered connection is so personal that the private practice doc thinks about what Mrs. Pistolaclionne (bonus points if you name the movie) will say if he calls off sick.

The dirty little secret in large, corporate medical practices is that market-based economics work there, too. All that talk about how your “World Class Clinic” doctor isn’t paid by how much work he does? Nonsense. In fact, the amount of money generated by any individual doctor is even MORE closely monitored and includes stuff like how many tests and procedures get done on her patients even if she isn’t doing the work herself. That doc’s compensation is absolutely driven by how much revenue she is responsible for bringing into the institution.

It’s just that the corporate Doc doesn’t own a job, he simply has a job. He has no direct responsibility for the staff surrounding him or the bricks and mortar over his head. His compensation is driven by his corporate performance, and that compensation includes time off for vacation and for sickness. Leaving time on the table is the same as leaving money there. There’s no bonus for loyalty to the institution. Points aren’t accrued for attendance. Frankly there are no real points to be won for extraordinary customer satisfaction, only demerits for egregious behavior. Unused time off, like extending your hours or taking patient calls when it’s not your turn, is simply donating your services and talents to your primary constituent, your boss the institution.

We should all be very cautious about the trend toward fewer private practice doctors and more docs employed by ever-larger institutions. Continuity of care is more than simply an always available electronic chart, it’s also a relationship forged over time between two real, live people with skin in the game. The next time you see your private practice doc and she’s a little sniffly and hoarse, remember to give her a little pat on the back and a ‘thank you’. After all, she owns this job and could have stayed home today, but she knew you had an appointment.

She knows who she works for!

An EPIC Adventure III: First Solo Attempt

Fly an airplane. Take Dad’s car on a date. Finish your residency and perform your core surgery without a professor over your shoulder. The first solo is a milestone event, and many such events become life’s touchstones to which we return time and again. My first solo attempt to log on and clear out my “Basket” on EPIC, the EMR that I am mandated to use in order to continue to operate at a surgery center where I’ve been the primary ophthalmologist for >15 years? Meh, not so much.

At 0 Dark 30 I was doing glaucoma lasers, and I finished well before I was due in the office. Perfect time to log onto a dedicated terminal, take a look at the items demanding my attention, and get on with the real work of eyecare. Full disclosure: I called the IT guy with whom I’d bonded a  couple of weeks ago to see what I should do with the pharmacy boondoggle and received permission to blow off all of those entries. Whew! Home free. I sat down and went through the log-in process, just like my new best friend had shown me. No love. 0 for 15. Unable to log in.

BZZZZTTT. Sorry. Johnny, tell Dr. White about our lovely parting gifts for losing contestants.

Might turn out to be more like expected after all.



Occupy The CrossFit Games

The CrossFit Games season is upon us. The Open begins in 10 days. Do you care? Should you care? Why?

You, me, we are the 99% of CrossFit. Seriously, the chances that you or I will make it to the Regionals is pretty similar to the proverbial snowball thrown across the River Styx. It ain’t gonna happen. Is that the kicker?

The Open is going to be too heavy and too long for you and me. It sure as heck was last year. I don’t expect that we will see too much more in the way of load this year (I think Tony Budding and Dave Castro did a remarkable job making it inclusive last year), but I also don’t see it being any lighter, either. Will that be your tipping point?

It’s impossible to plan for the Open WOD’s. They come right in the middle of the week, and if you push your Open attempt back to the weekend you have to decide how you will prepare once you know what’s coming. It wreaks havoc with your training and your schedule. What’s gonna give?

Do you care? Yes, you do. Why? Because where else can you play Pebble Beach, the same track as the big boys and girls, for $20? The Open is your chance to take a few laps at Indianapolis Speedway or that fancy-dancy roadway in Germany whose name no one can pronounce. Old or young, big or small, you get to dig in at home plate and take your hacks at Fenway Park, field a punt at Candlestick, line up your PK at Wembley.

You are part of a much larger whole, whether you are a member of an Affiliate gym or a solo CrossFitter in a Globo. This is the time of year when everyone still comes to a central cyber-gym, congregates around the CrossFit table, and dines on our particular fitness cuisine. Together.

You…me…we are the 99% of CrossFit, and the Open is ours. You do care. You’re damn right you’re in. Register. Post.

Occupy the CrossFit Games.


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