Getting Organized… Again.

Ok, people, here we go…..

For the next four weeks I will be sending a daily reminder regarding office cleaning a la “Fly Lady.” This is entirely for your amusement and you can do the “missions” or delete them. The concept is that you can do anything if you do it 15 minutes at a time. If you really get into it, you can visit the flylady.net website for more inspiration…. the site itself is a little scary but the ideas behind it are solid.

Getting Organized… Again.

Stories in the Service of Making a Better Doctor

Thanks to Youpa Stein for forwarding this article.

NY Times
October 24, 2008
Doctor and Patient

Stories in the Service of Making a Better Doctor
By PAULINE W. CHEN, M.D.

The white-coated crowd with stethoscopes slung casually around their necks would have looked familiar to anyone who has attended morning hospital rounds. Resident physicians and medical students milled about, chatting animatedly, and at the appointed hour, the attending physician signaled to begin.

But instead of filing toward a patient’s room, the group at Saint Barnabas Medical Center in Livingston, N.J., settled into a conference room at the end of the hall, not to recite details of patient cases but to read “Empty Pockets,” a personal essay by Dr. Kevan Pickrel from The Annals of Internal Medicine. In the piece, Dr. Pickrel describes being unable to save a 36-year-old woman, then going to the waiting room to inform the woman’s family of her death:
“The youngest daughter sat on Dad’s lap looking at pictures in an outdoors magazine. The older sat watching her hands rest in her lap. [The] husband’s eyes lifted to me and met mine. I didn’t, couldn’t, say a word…. He turned back toward his daughters, a single father, and they lifted their eyes to his. As he drew a breath to begin, his eldest daughter knew.”

After the reading, the attending physician, Dr. Sunil Sapra, looked up at the group assembled. “Do you identify with any of these situations?” he asked.
“Yes, it happens all the time,” a resident responded immediately. Others nodded in agreement, and one resident flicked a tear away.

The next morning, in a similar room at New York-Presbyterian Hospital in upper Manhattan, a group of obstetrics and gynecology residents gathered to read E.B. White’s short story “The Second Tree >From the Corner.” Told from the perspective of an anxiety-ridden patient, the story ends with the main character finding meaning in his life and suddenly feeling liberated:
“He felt content to be sick, unembarrassed at being afraid; and in the jungle of his fear he glimpsed (as he had so often glimpsed them before) the flashy tail feathers of the bird courage.”
As the reading ended, one of the young doctors commented on how personally fulfilling it was to help her patients and how those feelings invigorated her, even after many hours of work. Other doctors in the room nodded in agreement.

While it has long been understood that clinical practice influenced the youthful writing of doctor-authors like Chekhov and William Carlos Williams, there is now emerging evidence that exposure to literature and writing during residency training can influence how young doctors approach their clinical work. By bringing short stories, poems and essays into hospital wards and medical schools, educators hope to encourage fresh thinking and help break down the wall between doctors and patients.

“We’re teaching the humanities to our residents, and it’s making them better doctors,” said Dr. Richard Panush, a rheumatologist and chairman of the department of medicine at Saint Barnabas.

The idea of combining literature and medicine — or narrative medicine as it is sometimes called — has played a part in medical education for over 40 years. Studies have repeatedly shown that such literary training can strengthen and support the compassionate instincts of doctors.
Dr. Rita Charon and her colleagues at the program in narrative medicine at Columbia University’s College of Physicians and Surgeons found, for example, that narrative medicine training offered doctors opportunities to practice skills in empathy. Doctors exposed to literary works were more willing to adopt another person’s perspective, even after as few as three or four one-hour workshops.

“You want people to be able to leave their own individual place,” Dr. Charon said, “and ask what this might be like for the child dying of leukemia, the mother of that child, the family, the hospital roommate.”

Over the last 15 years, an ever-increasing number of medical schools have begun offering narrative medicine to medical students. These courses often involve writing, reading and discussing works by authors as diverse as Leo Tolstoy, Virginia Woolf, Lori Moore and various doctor-authors. Students then explore the relevance of these texts, and their own writing, to their clinical work.

But until recently, few educators have attempted to bring such literary training into residency programs.

Residency is the most intense period of a young doctor’s life. The years spent squirreled away in hospitals and clinics are rich in clinical learning, but the wealth of that experience comes at the cost of free time.

And with time at a premium, residency program directors and clinical educators have been hesitant to add narrative medicine to their curricula, particularly since it has never been clear that such an addition would have any effect other than further overworking the trainees.

That could be changing.

For over a year now, Dr. Panush, a tall, bespectacled, soft-spoken man with the lean physique of a runner, has been systematically incorporating literature into the daily rounds of every one of the internal medicine residents at Saint Barnabas Medical Center.
As part of the Accreditation Council for Graduate Medical Education’s Education Innovations Project, Dr. Panush and his faculty colleagues bring poetry, short stories and essays to rounds each day and discuss them in the context of the patients they see. These daily discussions, supplemented by offsite weekly conferences, form the core of the residents’ narrative medicine experience.

One year into the program, Dr. Panush and his colleagues looked at the effect of these daily discussions on the residents and their patients. What they found were significant improvements in patient evaluations of residents and patients’ health and quality of life, from hospital admission to discharge.

A handful of other residency programs across the country have taken steps toward establishing narrative medicine training for their residents, including Vanderbilt University’s Department of Surgery and New York/Presbyterian Hospital-Columbia’s Department of Obstetrics and Gynecology. As with the program at Saint Barnabas, it has been the doctors within these departments who have initiated the workshops, sessions and lectures.
“As we improve the technology of medicine, we also need to remember the patient’s story,” said Dr. A. Scott Pearson, an associate professor of surgery at Vanderbilt University Medical Center.
To that end, Dr. Pearson has completed a pilot study examining the feasibility of incorporating narrative medicine into Vanderbilt’s surgical residency and has plans to make such training available eventually to all surgical residents at his medical center. Dr. Pearson believes that narrative medicine will not only help residents reflect on what they are doing and how they might do better, but may also aid surgical educators in teaching professionalism and communication skills.

“Narrative medicine changed my entire approach to medicine,” said Dr. Abigail Ford, a senior resident in obstetrics and gynecology at New York-Presbyterian Hospital/Columbia who studied under Dr. Charon as a medical student. “As a doctor you are really a co-author of patients’ experiences and need to hear their story and take it on.”

With her former professor’s guidance, as well as the support of Dr. Rini Ratan, the residency program director, Dr. Ford has initiated a narrative medicine program for her fellow obstetrics and gynecology residents. While the program is still in its first year, “we’ve always run over,” said Dr. Ford. “People have to be dragged away.”

“Our hope is to look at it in terms of physician empathy,” added Dr. Ratan, “Does it add anything? Does it prevent natural jadedness over the course of the busy training process? Does it prevent burnout?”

In the near future, Dr. Ratan and Dr. Ford also hope to begin doing the kind of patient outcome evaluations that Dr. Panush and his colleagues have begun.

“To do what we’re doing is pretty simple,” said Dr. Panush. “But the measurement stuff is harder. The program needs to be supported institutionally and internally.”

Despite such challenges, the effects of these programs are striking. Dr. Benjamin Kaplan, a second-year resident at Saint Barnabas, remarked on the transformation he saw in fellow resident physicians during the first year of the humanities program.

“Their management of patients changed,” Dr. Kaplan said. “They remembered to do things that I don’t think they would have otherwise done, like always talking to the family, gently touching patients, and continually explaining the course of treatment and what the doctors are thinking so patients know.”

And the time commitment? “It does get pretty busy,” Dr. Kaplan conceded. “But if you want to make time for it, you can. Spending a half hour a day to remember that we are all human, not just doctors or pharmacists or nurses or patients, is important enough that I think you should do it.”

Although it is still too early to determine the long-term effects of narrative medicine on doctors in training, residents were quick to note that certain essays, short stories and poems they have read on rounds continue to influence their work.

Dr. Ramesh Guthikonda, a second-year resident at Saint Barnabas, spoke about a poem called “When You Come Into My Room,” by Stephen A. Schmidt. In the poem, published in The Journal of the American Medical Association, a man struggling with chronic illness lists all that he believes a doctor meeting him should know:

“When you come into my hospital room, you need to know the facts of my life
that there is information not contained in my hospital chart
that I am 40 years married, with four children and four grandchildren….
that I love earthy sensuous life, beauty, travel, eating, drinking J&B scotch, the theater, opera, the Chicago Symphony, movies, all kinds, water skiing, tennis, running, walking, camping…
that I am chronically ill, and am seeking healing, not cure.”

The poem so affected Dr. Guthikonda that he began regularly asking his patients about their hobbies and families, and he enrolled in a Spanish class so he could learn to better pronounce their names. “My rapport with patients, especially with my Hispanic patients, was not up to the mark,” he said. “I never asked about the patients’ lives, about who they are. I am much more sensitive to those issues now.”

Reflecting on the changes in Dr. Guthikonda, Dr. Panush said, “We changed the way he thinks and does medicine. You can’t put a p-value on that.”

Have literary works made you a better caregiver or patient?

Click here and join the discussion on the Well blog, “Combining Literature and Medicine.”

Stories in the Service of Making a Better Doctor

Aging on the Today Show

Statistics say Montana will have one of the oldest populations in the United States in a few years. (Yup, blame it on the baby boomers.)

Some of you may have heard me talk about accessibility issues. Most grantees know they should be doing more about accessibility and really want to be successful with it but they are over-worked, under-staffed, and overwhelmed.

It’s ok. I understand. Me too.

But.

I really want everyone to think about accessibility every time they do anything within their organization. (I know…. small goal, right?)

You know what I’m discovering? As the staff of organizations age it gets easier and easier for me to “sell” my message….. my own staff included.

So I thought a demonstration was in order. I was sent a link to “The Today Show” demonstrating what it might be like to age. I love these kinds of hands-on things.

So check it out and let me know what you think.

Next time I’ll tell you a story (only slightly embellished) about my grandma to demonstrate the importance of anticipating the needs of your aging constituency.

Aging on the Today Show

Distribution Lists this week

Here is a summary of Beck’s 3 email distribution lists. As always, we are here to share information but we have not researched any of these opportunities in detail so use your good judgement.

FOR ARTS ORGANIZATIONS:

Nonprofit Online News: http://news.gilbert.org/
Resource Kit For Creative Community Engagement
The Australian Flexible Learning Framework has published a web-based Resource Kit For Creative Community Engagement, which is effectively a compilation of materials for e-learning on a shoestring. The site is divided into Planning, Tech & Tools, Activities, Case Studies, Networks & Mentors, and Useful Links. The longer I explore this wonderful compendium, the more useful stuff it turns up, so I suggest that you just keep clicking. I recommend this to most small and medium sized organizations and certainly any community based group.
http://news.gilbert.org/clickthru/redir/6831/5286/rms

If you want to tackle information overload, become a blogger.
I’m tempted to make this the shortest article I’ve ever written and just leave it at that, in order to be provocative. But since I won’t get the benefit of your immediate reactions, I will have to forgo that little pleasure and actually explain myself.
The experience of “information overload” has many causes, among which are these three important ones: (1) We don’t know what to do with the information we are getting. (2) We don’t know how to filter and select amongst all that information. (3) We don’t know how to influence the flows of information themselves.
Blogging addresses all three of these causes of…
For the full article:
http://news.gilbert.org/clickThru/redir/6843/5286/rms

+ Nonprofits Must Gear for Tough Economy
In Nonprofits Must Gear for Tough Economy, Todd Cohen makes some well-informed, conservative predictions about the impact of the recession on nonprofit funding. His insights, which don’t touch much on social change organizations, include: (1) Art funding may be harder hit than social services, (2) Foundations are likely to try to keep giving stable, (3) Government funding could go more than one way, and (4) Demand for many services may increase. As I see it, his overarching recommendation is to focus on organizational capacity building in order to maximize flexibility in the face of the crisis and opportunity ahead.
http://news.gilbert.org/clickthru/redir/6837/5286/rms

+ Permissible Nonpartisan 501(c)(3) and Partisan Campaign Contact on Voter Engagement/Protection Efforts
Just in time for the closing weeks of the (rather horrific, in my opinion) U.S. Presidential campaign, the Alliance for Justice has released their excellent cheat sheet on Permissible Nonpartisan 501(c)(3) and Partisan Campaign Contact on Voter Engagement/Protection Efforts (3 page PDF). Most organizations don’t know just how much they can do. I hope you find a way to enroll your organization at this critical juncture in the history of American civil society.
http://news.gilbert.org/clickthru/redir/6835/5286/rms

THE ARTFUL MANAGER WEEKLY SUMMARY
GOOD CONCEPT, BAD CONTEXT…
Yet another market plunge (and a bunch of other things) lead Madison’s Overture Center to abandon its complex financing structure and liquidate the trust that held that held that structure together.
www.artsjournal.com/artfulmanager/2008/09/good-concept-bad-context.php
Posted: Monday, September 22, 2008

FORECASTING THE FUTURE BY ”LIVING” IT OUT LOUD…
Devastating outbreaks of a pandemic respiratory disease? Climate refugees who have fled homelands made unlivable by global warming?
Legions of hackers who exult in bringing down global information networks? These are just three of the five ”super-threats” facing human society in 2019, according to an on-line game of survival set to launch in October.
www.artsjournal.com/artfulmanager/2008/09/forecasting-the-future-by-livi.php
Posted: Thursday, September 25, 2008

THE CASH (AND CONSEQUENCES) OF CULTURAL TAX DISTRICTS…
Tax districts are one of many tools in the public arsenal to fund infrastructure or operating needs for the common good — like arts and culture. But are there hidden and unintended consequenses for gathering funding in this way?
http://www.artsjournal.com/artfulmanager/main/the-cash-and-other-consequence.php
Posted: Monday, September 29, 2008

THE CANDIDATES AND THE ARTS…
The presidential debates and public discussions have been almost entirely arts-free this election season, as is usually the case.
Fortunately, Americans for the Arts has collected a quick reference for those interested in Obama’s or McCain’s vision for (or tolerance
for) arts in the national dialogue.
http://www.artsjournal.com/artfulmanager/main/-the-presidential-debates-and.php
Posted: Monday, October 6, 2008

THE UNIVERSITY AS ARTS PATRON…
Harvard professor Marjorie Garber offers some bold thoughts about the role of universities in the arts, and the place for arts within universities. She suggests that higher education should not only be accommodating art and artists as one of their many fields of study, but rather should be ADVANCING art as central to their purpose.
http://www.artsjournal.com/artfulmanager/main/the-university-as-arts-patron.php
Posted: Tuesday, October 7, 2008

Closing Down the Right Way
By Jan Masaoka • October 1, 2008 • Board Cafe
When nonprofit boards have to shut down (“dissolve”) the organization, they often find themselves swimming in a sea of unpaid bills, demanding creditors, frustrated and anxious staff, and desperate clients. Going broke — like other things in life — can be done poorly or well. Managing insolvency well can mean that client or patron services are not disrupted, that staff are given assistance in their job transitions, or that creditors can receive some satisfaction. Here are some steps for boards considering dissolution: http://www.blueavocado.org/node/235 for the rest of the article – Beck

JOB OPENINGS

COLUMBIA RIVER MARITIME MUSEUM
ASTORIA, OREGON
The President is the principal steward of the Museum’s reputation and is its most important ambassador. He or she will serve as the Museum’s chief development officer and principal major and foundation gifts fundraiser. The President will be responsible for leading and managing all Museum activities, including strategic planning, implementation of annual plans, resource development, stewardship of human and financial resources, collections, facilities and campus management. (see attached)

FOR ARTISTS:

Uintah Basin Applied Technology College and Utah State Univiersity Call for artist or artist teams letter of interest and qualifications for the creation of art for the new and the first permanent home for the Uintah Basin Applied Technology College. This first of many planned buildings on the new higher education campus will be shared with Utah State University and will house several academically oriented classrooms for them with distance learning capability. Budget $81,000 – Deadline: October 30, 2008
For more information: http://www.utahpublicart.org/ click on “Go to the Public Art Commissions page”

What: A call for 2-dimensional art reflecting the theme: Well-Being and Food: Finding Hope and Inspiration.
When: Application and CD deadline November 3, 2008
Who: The conference is a collaborative effort by the St. Patrick Hospital Montana Spine Center in association with the St. Patrick Hospital (SPH) Health Sciences Foundation.
Where: The work will be exhibited at The Dana Gallery, St. Patrick Hospital and the 5th Annual Bridging the Gap Conference in April 3 and 4, 2009 at St. Patrick Hospital in Missoula, MT
For further information: www.btgmontana.com

FOR ARTS EDUCATORS:

Hello to you all from the Kennedy Center. I wanted to make you aware of a new initiative at the Kennedy Center that Alliances for Arts Education will be working on in your states. If you know of middle schools that might be strong applicants, we hope you will encourage them to apply.
Here’s more information about the initiative:
On Location: Spotlight On Your Community
Up to ten schools from around the country will be selected to participate in this program. A Thomas school bus will be outfitted as a media lab on wheels. It will visit each school for two weeks and will be “on location” sometime between January and June 2009. Over the two weeks, a drama artist and media artist will be on location to work with one class (grades 5-8) in storytelling techniques and media/video/ technology skills. The teacher(s) and students will work together to create a short (three to five-minute) video about an artist or arts group in the community. The finished video will be uploaded to a web site maintained by the Kennedy Center to share across the world. Each selected school will receive a new media package and $1,000 to support further development of media projects.

For more information and an application form, visit the On Location website at: http://www.artsedge.org/onlocation/ or contact the National Partnerships office at (202) 416-8806.
The application deadline is November 5, 2008.

THE SCHOLASTIC ART & WRITING AWARDS OF 2009
The Alliance for Young Artists & Writers invites students in grades 7 – 12 to participate in The Scholastic Art & Writing Awards of 2009, the nation’s longest-running, largest, most prestigious recognition program for creative teenagers in the visual and literary arts.
(Montana is not listed as one of the regions. It says: “If your state is not represented in one of the Regions, submit to the Region-at-Large, an equivalent regional level program.”
Early Submission Deadline: Dec. 19, 2008 $5 per individual work, $20 per portfolio
Final Deadline: January 9, 2009. $10 per individual work, $30 per portfolio
More information here: http://www.artandwriting.org/index.htm – Beck)

I received an email from Grammy in the Schools – the message was an image so I can’t capture the text. Their website is based on Flash files so I can’t copy text. But if you would like to see what they have to offer their website is http://www.grammyintheschools.com/ – Beck

Distribution Lists this week

This Month has been Insane so…..

My boss said a funny thing last week…. she said, “As soon as we get over this October Insanity…” Which made everyone in our meeting howl because, well, October Insanity is followed by November Madness… then December Craziness… and, well, you get the idea.

So how do you cope? How do you keep all the little fires under control and the plates happily spinning on their poles?

I don’t have a clue. But…. Those of you who know me well understand my love of organizing…. that isn’t to say I’m actually organized… but I love organizing… (and office products).

It must be my Virgo nature.

So here are three of my current favorites:

Unclutterer

David Allen

43 Folders

And, as a bonus, an office products site:

See Jane Work

How about you?

This Month has been Insane so…..

Cultural Trust Review Committee

We did it! Two days and 104 grants later and the Cultural Trust Review Committee has finished the review.

We had great discussion and some really excellent suggestions to improve the process and application.

Not many applicants were present but it might have been the eighteen inches of snow in various parts of the state that kept those numbers low.

For the committee: Thanks! And your work is not done… I’ll be sending the comment pages later this month for your review and approval.

For the applicants: I’ll be sending out one-page synopsis information mid-November for you to review and approve.

Next steps: I will be getting information out to the committee and the applicants regarding the information that will be included in the Long Range Planning Subcommittee booklets.

Sometime in December I will let all the applicants know the testimony schedule for the legislative session. Historically it has been early January or February but you never know…. count on it being whenever a big snow storm is hitting Helena.

I’ll post a little power-point “how to” about testimony but anyone new to this game is welcome to call me about the process. It’s can actually be fun. You have about five minutes and the LRP committee is small and friendly. (Ok, I can’t make any promises until after the elections when I actually KNOW who is ON the LRPC.)

Then the awards -which are in HB9- will make their way through the usual channels of the legislature and be signed into law. (I make it sound so easy, don’t I??)

Remember…. we will not know your actual final award until AFTER the legislative session. You will see your recommended funding level on the one-page synopis sheet.

Cultural Trust Review Committee

Cultural Trust Committee Review

Where: Red Lion Colonial Hotel, 2301 Colonial Drive, Helena, Montana 443-2100

When: Monday-Tuesday, October 13-14, 2008

Everyone is welcome (doesn’t matter if you have a grant up for review or not).

Applicants will NOT be allowed to comment on their specific grant application (applications must be reviewed as presented… it is only fair). But public comment about the process will be welcome.

The meeting starts with orientation at 8:30. Grant review will begin around 9:00 (ish).

This is some of the best FREE grant writing professional development available…. you can see how grants are perceived by the committee and hear their comments.

The tentative agenda:

Monday, October 13
8:30 Introductions and Orientation
Overview of Cultural Trust Program
Election of Chair & Vice-Chair
Conflicts of Interest
Review Process
Ranking Sheets
Handouts
Fiscal Update & Target Funding Figures
Administrative Notes
Questions and Answers
9:00 Public Comment
9:15 Presentations to Subcommittees
Subcommittee One: State Room
Subcommittee Two: Gallery Room
12:00 Working Lunch –Buffet-style, State Room
1:00 Continue Presentations
3:00 Break
4:30 Interim ranking by Subcommittees
5:00 Adjourn

Tuesday, October 14
Public Comment
Subcommittee combined rankings are reviewed and adjusted. State Room
Break
Committee work continues
Working Lunch –box lunch, State Room
Final Ranking and Funding Levels
Break, (if appropriate)
Electronic Grant Review Discussion
Other suggestions
Adjourn

Let me (Kristin, 444-6449 or khan@mt.gov) know if you need special accommodations.

SEE YOU THERE!!

Cultural Trust Committee Review