Thinking Outside the Box

In a few weeks I will be giving a presentation and leading discussions on “thinking outside the box”.  I thought I would try out some of my ideas here on my blog.  The presentation will be for a local hospital system as part of their “Focus on Excellence”.  They are seeking new ideas for reaching ambitious performance outcomes.  I was invited to bring ideas about complexity leadership and nonlinear relationships.

Today I sat in on a presentation by a nurse leader who has a Doctor of Nursing Practice degree and observed the group work and discussions she led.  I was very impressed with the level of knowledge in the group regarding Six Sigma, Deming’s PDSA cycle, and Principles of Change.

I think I will employ the “box” metaphor by introducing four sides of the box that confine our thinking in health care and oversimplify the exquisitely complex environment within hospitals.  Those environments can become even more challenging for hospitals which operate as for-profit organizations, constrained by policies developed at a distance by persons who have little if any first-hand knowledge of the effects of those policies on actual staff and patients.

As I said, my box will have four sides.  Each side represents a limiting factor that can keep us from seeing realistic, effective, measures for improving care.  The sides include 1) the language we use to name and discuss problems and solutions; 2) our basic ideas about how the world does or should work; 3) prevailing scientific tools for solving problems; and 4) fear and mistrust of those operating within the environment.

Over the next few weeks I will cover one of those sides and would really appreciate your observations, critique, and discussion of the material.  Stay tuned.

DNA or ZNA, which affects health more?

I just read an interesting report on the importance of  geographic location on life expectancy.  As a past Public Health Nurse I can’t say I was totally surprised.  What did surprise me was the notion that our social environment can outweigh our genetic makeup when it comes to health.

The Robert Wood Johnson Foundation has a website you might find interesting. The website explains the effect of our physical surroundings on health and life expectancy.  I found a link to this map of one Texas city, El Paso. LE-Map-ElPaso-Purple

Visit this site and check to see how your county’s health ranks among Texas counties.

Can you guess which county in Texas has the longest life expectancy?  What about best health outcomes?

These ideas are influencing our research on Maternal Mortality at Texas Woman’s University.  We are mapping rates of maternal risk and maternal death as well as the locations of maternal health resources.  We are in the process of obtaining birth records at the zip code level.  However, death records are only available at the city level.  As you can see from the example of El Paso, even within a single city there can be wide variation in health and longevity related to location.


the desire to learn or know about anything; inquisitiveness.

Look up at the stars and not down at your feet. Try to make sense of what you see, and wonder about what makes the universe exist. Be curious.

Stephen Hawking

As a nurse I often see persons struggling with serious health problems and faced with barriers to the care they need.  Stephen Hawking’s life was an example of what can be accomplished by someone who has adequate healthcare resources and support for maintaining quality of life and astounding curiosity.

Through this blog I plan to share news and views about a wide range of topics.  I hope you will join in and post comments on your own perspectives and puzzles you are curious about.