Friday, February 28, 2014

Further Introductions & Expanded Blog Content

In reflecting over the last year of life experience, it's absolutely striking to recollect upon what has transpired. As many of you may have noticed throughout the past 12 months, I've been increasingly sharing more about my personal life via my social media outlets. Originally (way back when...), it was my intent to keep my social media presence quite professional... but, what's the fun in that?! Logically, how is that even possible to accomplish?

In any case, I had so much fun with Cinema's Interview that I felt it'd be appropriate to open my expanded blog content with Further Introductions to Yours Truly - and - perhaps share some thoughts as to why I decided to open up my blog to a broader content base. Who knows, it may inspire you to expand your reach as well!

Further Introductions to Yours Truly
I like to consider myself an aspiring connoisseur of life; I see much of the human experience as a collection of events by which we perceive, view, interpret, and consider in positive and negative valences. From those valences we develop values, creeds, beliefs, desires, our ethos, and all the other intangible which makes us human.

I love family, food, and fun. Fun, for me, includes adventuring, travels (as able), martial arts, surfing (in the past), fishing, and watching/studying human behavior from a perspective of motivators/valuations. In these fun moments, I've traveled to Africa, Asia, helping out at lone orphanages in Mexico, and hiking in overgrown forest trails. I've studied several systems of martial arts and settled down with Brazilian Jiu-Jitsu and Kali/Escrima/Arnis. I've surfed pretty big waves in the past; my favorite experience was 12 foot waves at Pacific Beach Point in San Diego - it's that feeling almost every surfer feels once a year. The feeling of "never have I been so alive, and yet, so close to not making it back on an awesome wave!"  I love surf fishing; Southern California hosts one of the most interesting game: the California Corbina, a most difficult quarry for a light line angler. Speaking of, I need to pick up fly fishing - at least to try it. Of course, studying human behavior came through with my pursuit of a psychology degree and my current studies in a marketing concentration as part of an MBA.

In my past professional life, I've been a tutor, a counselor, a life coach, a surf bum, a bartender, a physical therapy aide, a researcher, a data analyst, and bio-engineer (biomedical engineer). Tutoring was hilarious. Never have I seen so many parents be so willing to pay money so their high school children don't spend a summer in remedial classes or to be held back a year. Education system = currently broken. Counseling and life coaching because much of the same thing; many people need a "professional" word of encouragement. From there, they are good to take their own actions. Being a surf bum? Oh yeah, I was definitely one of those. Surfed twice a day and ate crazy late breakfast foods in between. Bartending was a "fun" experience; really, it was the flare that was fun. Becoming a physical therapy aide was part of my mentors digging me out of the bartender's "rut". Being a PT aide actually served to gateway me into the DPT program at Azusa Pacific University. Before then, I did research at a UCSD Bioengineering lab. I considered really getting into that arena but realized, at the time, I just hated dealing with grants and the politics of research - oh yeah, research = stab-in-back-politics. Amazing stuff. In any case, that was my choice at the time despite my penchant for devising engineering solutions. Oh yeah, one of my favorite life coach experiences transitioned to teaching students/entry-level professionals how to interview strongly. I developed a pretty good, associative track record for getting applicants into professional schools.

In my personal life, I grew up with fine arts (music, in the form of traditional percussion and concert piano). I expanded to the guitar, "tried" the cello and trumpet, and dabble in the ukulele. Additionally, I was given to experience a childhood filled with ADHD, cultural conflicts, and being the target of a noted amount of bullying. Fortunately, I was blessed with a loving and supportive family who helped me find the conviction and control - over mind, body, and spiritual matters. In regards to ADHD: this topic was where I actually got my first writing exposures. This occurred at the international platform as an anonymous author in the coaching and editorial perspectives of parenting ADHD children. Essentially, it was for those who wanted to be encouraged by someone who "made it" and to glean any wisdom from such experiences. Cultural conflicts was a learning curve. Growing up with several languages proved to be both entertaining and confusing; imagine a little kid speaking several languages all in one breath of a sentence. Kindergarten teacher - not amused. Haha! Bullying? Yeah... that sucked. That's also what got me into martial arts. But guess what? Learning to get up even when they are still kicking you while you're down is what bullying taught me; there are elements of life which is all about enduring, rising up under the pressure, and turning defeat into victory. I'm glad I got bullied. It made me stronger. Sadly, bullying has become much more these days... I feel for those kids... the people... those who need friends and family to be strong along side them. It seems bullying has turned into something far different than what I experienced. I don't believe it will ever stop, but, I do hope that people learn to intervene rather than to stand by (or worse, turn a blind eye) and watch it happen.

So then we come to all my experiences and I realized that, despite my love for stage presence, I'm actually quite the introvert! This, apparently, is quite common amongst those who thrive on stage and perfomance. With a stage to play upon, braves are no problem. And, of course, I get this response all the time - "Ben! There is NO WAY you are an introvert!" Try me! Just watch me try to mingle with groups of new people... really... it's no good. However, with a stage and with an audience; with content (prepared or impromptu), with topics for which I can perform/converse/teach/etc... I'm good. And, I love doing it! Interesting huh? Just another strange dimension of being human.

Well, I suppose the last bit of further introductions is the summary of my last year. It's been interesting. I've quit two jobs in the last year. I went from a PT Specialist II to a Rehab Director at another company. I've been blessed with a wonderful son, Nathan. I'm about to start another job. I also got into consulting. I've decided I'm going to write a book or books. I'm thinking about getting myself into meta-analyses. And, I've decided to slow things down so I can finish off the MBA & spend more time with family & friends... doing more things I like with the people I love.

So much for further introductions :)  In any case, I hope this piece of candor, if not vulnerability encourages you. It's good for us to be vulnerable with ourselves from time to time. I think it's encouraging to see it within ourselves and demonstrated among our peers and the people we watch from afar. That's a big part of why I decided to expand my blog to content regarding career paths and life experiences. I've seen that I have much to offer those who will listen. I have a good grasp of success at a fairly early stage in life. I've experienced much of what matters, what can matter, what definitely does not matter, that which is optional, that which is essential, and that which is additional. I also know I have much to yet experience - much for which I hope you share on this expanded blog in hopes that it will be of benefit to you - in whichever place, part, or time in your walk of life that you currently are upon.  Yeah... that's a touch of vulnerability, isn't it? And, so what? No one ever said vulnerability meant weakness. Perhaps vulnerability is the key to strength. Knowing your own self... is many times... the key to clarity.

I hope you enjoy the expanded blog content for Blog @DrBenFung. I truly desire and aim to be of value and benefit to your life, your career path, your health, and, should you choose - your business ventures, ideas, hopes and dreams.

My Very Best To You!

Sunday, February 9, 2014

TeleHealth PT Style!

Sorry... I had to! :)

Alright... down to business!
Soon after my Future Thoughts for Private Practice Physical Therapy (PPPT) post, I had some interest expressed to me as to what my vision of what physical therapy practice would look like in the frame of telehealth. I was thrilled to hear that this was a topic of discussion at CSM2014. I'm sure there's some overlap of material here, not to mention lots to add to it; nevertheless, I hope this post will be helpful & encouraging to you. So! Without further ado, here is my Utopian vision of TeleHealth PT style.

TeleHealth PT Style!
I made mention that I felt a large opportunity for the future of PPPT is concierge home health; in some online discussions, I also hinted that a generous segment of this practice pattern would include elements of telehealth's model. The usual questions are present: What would this cost? How would this be billed for? Is there enough business to float this model? Etc. etc. etc.

I'll start with this: Doctors exist to teach their expertise and provide solutions. That, in essence, is the Latin root - docēre [dɔˈkeːrɛ] 'to teach'. However, in the age of information, this is an inherent problem. Information is EVERYWHERE. We come across the problem of supply & demand. Since the supply of information is far in surplus, the price is basically nihl. No one cares about the information; they care what you are going to do about it. In essence, we go to doctors because we want prescriptions - a plan, an intervention, a dosage - and, we want anticipated outcome to the diagnosis and prognosis which we expect to come with every "visit."

So, when you boil it all down, all patients essentially want their Three A's:
  • Accessibility
  • Availability
  • Assurance

If we're all honest with ourselves, healthcare customers want immediate access to the expertise of their healthcare providers. Information is everywhere. BuzzFeed had one of the most entertaining and truthful posts on this very topic regarding brand slogans that are more accurate:
And thus, the consumer goes to online information platforms to get an idea... perhaps get freaked-out-by-said-idea. NOW, they want access to a provider's expertise - their abilities of diagnosis & prognosis utilizing the same information. From there, they want to know the plan - should there need to be one. Many times, there is no need for a plan (which is one of the other A's - Assurance, comes in).

While it is great that consumers can access interaction with their provider's expertise in a telehealth venue; be it a secure network, via traditional telecommunications, an app, etc. - the fact is, these consumers also want to know that their provider is physically available. The consumers demand the physical availability should interventions and/or preventive measures be warranted. They want you to be available for the solutions your accessible expertise comes up with. This is where the client contacts you via an app, gives you a video of their functional movement, describes their symptoms, and/or/hopefully follows your instructions to the letter. And, should you tell them "I'll be right over" or "You need to come in today" - BOOM - AVAILABLE! This of course, depends on if you want to operate from an outpatient clinic, a roaming home health mobile unit, or perhaps both. Of course, the availability needs to be fairly immediate. Within 24 hours is good. However, within 4-6 hours would be even better. After all, since signs, symptoms, complaints, and other concerns are being managed remotely, the physical availability will then be increased since provider are no longer tied down by in-person-clinic-visits or routine home-health-visits (if you're thinking CASE MANAGEMENT - you are spot on - post to come).

I have always championed that healthcare will always carry the aspect of service; specifically a service of and to the human experience. It's a game of managing nerves, anxieties, and unknowns. It requires a human touch in the face of uncertainty, and other times, in the face of despair. Truly, it is the assurance for which this service is of much value in the realm of this industry. In fact, it is a practice by which hope and belief in that which is possible is cherished - this is where the consumer, the "patient" is much better served as we remember they are "the person."

So then, much as many pediatric visits and primary care physician visits end with an obvious diagnosis for which the consumer expected, no required prescription, and a simple treatment plan of "Let nature takes its natural course... call me if the following warning signs show up" - strong skill sets of communicating with empathy, compassion, and confidence will be even more prized in this setting where consumer contact is primarily digital and (hopefully) rarely physical - the purpose of this model of care. This is also a key opportunity by which being a true doctor - a teaching doctor can be taken into account by which the culturing of the next generation of health aware societies can be encouraged.

So How Will It Actually Work?!
Again, all this is humbly, my Utopian vision of what can certainly be. Like any emerging practice pattern, things typically go to cash first. Private cash pay is always going to be the acid test for any market; services and products that demonstrate true value flourish. Those which do not; they go under. In any case, once it is "legitimized" and accepted through time and economics, third party payers start to consider paying such services - typically because the services have a outcome aspect which is favorable. In the case of telehealth, it is due to cost containment and higher level case management.

I anticipate that we are likely to see a subscription based model vs. fee for service - probably in a form which is much like a concierge home provider model. Why? Because it is the ACCESS consumers want - this is the first point of service, and for many, is the continuation of services from an inpatient setting. Many of these patients/residents/clients/consumers - they need full assurance that help is ever present and ready... they are coming out of a 24/7, multidisciplinary care setting to home (usually and mostly) alone.

In any case, much like subscribing to television media via the many outlets that now exist, most people like to get access to as many channels as possible - AND - will pay-per-view only for exceptional circumstances/content. For the telehealth private PT practitioner, one would be able to manage a certain amount of patients until an equilibrium of case management vs. visit-encounters is met.

I also foresee a base of operations with a small outpatient clinic ideally combined with zoned out home health networks once this trend expands. I also anticipate these home health networks to operate within the communicative structure of telehealth. They will be dispatched with mobile units with everything you'd need from a fully functioning outpatient setting (X-Ray, Doppler, labs, you name it). This way, when clientele makes an "emergency" call from a corporate office, or, at another person's home during a get together - the concierge, telehealth PT practitioner is available in just minutes! Be the "problem" a possible DVT, or, just terrible neck pain from "sleeping the wrong way"... the telehealth PT is but a click away.

Bat-Signal anyone??? (We need a PT version of this.. talk about #brandPT challenge!)

Additionally, I sense that the marketing arm of savvy firms will make for some clearly flamboyant tactics. Ridiculous uniforms, crazy visual mobile units with all sorts of paint and branding icons... after all, how could you differentiate the contracted home health provider from each brand? You'll have to do it the same way other industries do... with a news van, contractors, plumbers, IT support teams, etc. Such as.....!
And, no one will ever forget and no one will stop talking about it! Quick! Off to the PT-mobile!

Closing Thoughts
With ACO's taking over in a storm and healthcare going down the cost containment route, telehealth makes sense. For those who have their insured care managed, telehealth makes things affordable, available, and reliable - not limited, unsure, and not there for long. For those who prefer the choice of out-of-network-providers, telehealth becomes the affordable choice for care they trust & the quality they demand. With either path, this makes for a nice stream of revenue for the private practitioner with each subscription... be it conversion from inpatient, carryover from outpatient, or new subscriber from your marketing presence!

For Physical Therapy practice, I sense that those who have experienced the expertise and benefits of a physical therapist will continue to favor PT's for any musculoskeletal concern. If given the option, they would relish the chance to bypass primary care physicians who typically offer very little help of value. Subscribed patients would be able to access PT expertise; be able to make appointments for physical examination, evaluation, and interventions as deemed needed; and, will glean knowledge about their own best health through repeated exposure of easy access to their primary care PT telehealth encounters. 

The movement towards the old school "doctors make house calls" service model is something that many find attractive. It offers a sense of personalized care, pampering, and even a pinch of privilege that many can appreciate. As more and more people come across $50 co-pays with limited total visits available... a subscription based telehealth provider will look increasingly attractive and far more "worth the money." It is also far more economical than hiring on 24/7 care-giving. Also, knowing that accessing someone is literally a phone call/text/tweet/app-message/etc. away for no added cost to the original subscription... well, that sure does give people a warm sense of assurance, doesn't it? And, truth be told, this is precisely what the consumer wants, needs, and will be (if not already) looking for.

Thursday, February 6, 2014

Top 5 Interview Tips

Over the years, I've given a lot of successful advice regarding interviews for both the employment setting and for academic admission panels. Having been on all sides of the coin, I thought this would be a very useful post to those who are expecting to re-enter the job market or are considering the next level of education.

First, I owe a couple of #DPTstudent(s) my story of how I interviewed for graduate school. First off, you have to know that at the time, I owned precisely one suit - the same suit I wore for senior pictures in high school. The same suit I chose for the "fashion" of "sagging" pants of the 90's. The same suit which I chose from Burlington Coat Factory which had the cheapest price tag... a way-out-of-date european suit with a single button jacket. So really, I looked like a penguin with MC Hammer parachute pants.

I showed up BARELY on time (after a 2.5 hour drive) - and - was promptly shuffled over to the "essay writing room." What!? Yeah... they wanted two on-the-spot essays to be written up... something about why I wanted to be a physical therapist and another something about the most influential person in my life.

The first essay was really convoluted. I really panicked in the moment and have no recollection what I wrote. I just remembered that my handwriting was so bad that they actually mentioned it later in the panel interview as an academic "concern". As for the most influential person in my life: I actually had too many people in mind. I remembered from my writing classes that its best to have these types of essays circulate upon a story which demonstrated your character. At the time, I had nothing off the top of my head. I simply began writing. This lead to me mentioning how I was diagnosed with ADHD as a child and how it got in the way of my early school work.

Okay. So now I'm done with my essays. I'm dressed ridiculously - redeemed by a really nice tie my uncle gave me. Finally, I'm called in for the panel interview. They ask all the usual things: "Why do you want to be a physical therapist?" "Why this school?" - THEN - they asked the personal questions... like "Why did you have such a bad GPA in college?" "So... you have ADHD; are you sure you can handle PT school?" *Doh*... them essays... them grades... why did I mention any of it?! I must have answered in some satisfactory fashion.

When it came time for them to ask me if I had any question for them, my mouth blurted: "So.. what do you think of me??" - One professor said "I like your tie..." - Another professor said "You know, after an entire day of doing this, I appreciate your genuine responses. You didn't really rehearse anything and I like seeing personal responses rather than prepared responses." - Yeah... he had NO idea how unrehearsed my responses were.

Despite all this, the fact that I was a Bioengineer coming into the physical therapy profession must have piqued some interest. They gave me a chance - and - I am very grateful they did. I put my mind to making them proud of their choice and graduated with honors.

Fortunately, since then, my abilities of interviewing and being the interviewer have tremendously matured. Nevertheless, it goes to show that even the worst interview may be exactly what you need. Still... it's good to be prepared. Having been the interviewer in the restructuring of an entire department, I've garnished quite a bit of what is going on our there and am combining some tips just for you!

So, now that that story of embarrassing hilarity is out of the way...

Here are my Top 5 Interview Tips!

1. Look The Part! Act The Part! Like The Part!
In my experience of reconstructing a department, I conducted a lot of interviews in the hiring process. Recalling how other interview experiences went for myself as well as for people I've coached, the consensus is that the people that interview strongest, indeed, look the part. Being sharply and professionally dressed is never a bad thing. For me, I always interview in a suit. Overdressed? Possibly. I chalk it up to tradition. For what its worth, typically am complimented by whoever is interviewing me. Dressing sharp also shows that you are taking the interview seriously. This almost sounds like something silly to talk about, however, I can't tell you how many people interviewed for jobs with me who were dressed in any casual way they felt was adequate.

Acting the part is also very important. If you are interviewing to become a graduate student, you must act it; sit tall, make good eye contact, and converse in a manner which projects a spirit of learning. If you are interviewing for a company which is all about the bottom line, be sure that you project being business savvy and understand the need to be profitable. If you are trying to get in with a nonprofit hospital which is all about the "caring" of patients, be sure you mention that you always try to see situations from a patient's perspective.

Finally, liking the part is a point of failure for many who interview. If the interviewer is sensing that you don't even like what you are interviewing for... why even bother? An aura of dedication, passion, and interest must be demonstrated if you wish to get the part. And, while this first tip seems to be self-evident, I would say that most of the people who didn't make it to the 2nd round of interviews with me failed right here. Interviewing for the sake of interviewing is a fail.

2. Interviews Go Both Ways
These days, interviews go beyond trying to impress the interviewer. Selling yourself and how good you are for the job/school/profession/degree/etc. isn't enough these days. Interviewers want to know that you are also actively discerning if this job is right for you. Interviewees who give off that sense of "I'm going to get as many offers as I can possibly get then pick the best one" usually interview poorly. Why? It's business! You have to give to get. It is important that you ask questions and converse in a manner which sincerely communicates that you are just as invested in making sure the job is right for you as much as they are making sure you are the right person for the job. In essence, it tells the interviewer that you are a team player. You see the big picture, and, if the fit isn't best - everyone respectfully moves on. No hard feelings.

3. Always Ask Questions
Not that my interview for graduate studies is the best example... Still! Asking questions is an overt way of demonstrating you have true interests in what you are interviewing for. Whether its asking about the culture of the program/department/company, how campus life is like, or if you will be eligible for benefits - asking questions when asked "Do you have any questions for me?" is critical. Interviewees tend to come across as being uncertain or as being too passive if no questions are asked. Again, interviews go two ways. This is probably the one time when asking a canned question is okay - at least you fill this gap. Better yet, ask one canned question and then follow up by requesting the lines of communications remain open if you come up with questions later.

4. Never Make Day-Of-Decisions
Companies are moving quicker and quicker these days. HR recruiters are pressured to find good talent in record time. However, a huge red flag warning sign is when a company representative is pressuring you - whether overtly or covertly - to make a day-of-decision. Companies that are willing to get you in fast are just as willing to get you out in the same manner. Just be careful... it's getting weird out there.

5. Never Mind The Question. Mind How You Answer!
99% of the time, the question(s) you are asked are either part of a spiel, or, are the "tough questions" which interviewers love to ask with no good answer. Really, they don't care about what your answer is. Why? They've heard it ALL! These tough questions are not about the answer. They are about HOW you answer. Typically, they are looking for a stress response - how do you do under pressure... when no answer is a good answer.

For those of you fellow SciFi geeks of mine... this is your Kobayashi Maru. Truly, what the interviewer is looking for is your interpersonal dynamics when placed in a pressured, uncomfortable, no-win-scenario. The best way to attack this type of question (or line of questions) is to very calmly, confidently, and SLOWLY go over the situation with your interviewer. In an act of active listening, repeat the question in your own words. Analyze the situation. Demonstrate you understand that this is a no-win-scenario (if it is truly that). And finally, take the most reasonable course (not the one with least damage/easiest) with justification on why you took that direction. When you get grilled for other possibilities, affirm that other possibilities exist, however, stick to your guns in that the choice you made presented itself to be the most reasonable choice of the moment.

Remember, interviews are no longer a charade of impressing people. It is an experience of getting to know people. Be natural in your posture, confident in what you can contribute, humble of what you can continue to learn, and realistic about the expectations you carry into the experience. The people that most strongly interviewed with me treated the interview as a conversation; not a test.

Reflections: Director's Completion

For those of you who have been following me, you know my most recent service as that of Rehabilitation Director of a high-end, continuing care retirement community in San Diego. I've held this post for the last year. I was given charge of a skilled rehab department, an outpatient department, and a home-health program - a contrast to my former work in acute care physical therapy, wellness, kettlebells, national public relations/outreach, and marketing.

There are many who have asked me, "Why are you leaving?! You got to director in record time. Aren't you going to miss it?" - I can give you my very honest reasons: 

Life is made of phases; these phases are comprised of layers of experiences - I got my early start into healthcare management, at a director's level no lesse. I like it. Actually, I love it! Moreover, I've demonstrated sharp acumen for high performance from a business standpoint. However, being that this phase of life circulates around a new-born-son and beloved wife, it is time for me to refocus on things which time and money simply cannot replace. For this reason, I've decided to step down from my post to spend more time with my family.

I have nothing but the very best regards for those that have partnered with me, and, for the mentors that have taught me so very much to bring me to this point. It is now that I find the most meaningful reflections, and, a new direction that allows me to redouble my efforts in didactic enrichment, consulting work, hobbies, and of course, connecting with you.

These are my reflections upon completion of my first directorship.

Reflections: Director's Completion
A Forward: I've observed that each turn of management holds specific purposes; mine was business restructuring, organizational culture, and networking. In my time as director, there were a lot of changes; changes in staff, in operational structure, in the community itself, and in healthcare. Below, I will reflect on some of my experience. Where I would love to talk numbers, I must for now, withhold for reasons that the company for which I was formerly employed is publically traded. We'll simply use some non-specific descriptors and leave it as that, savvy? Okay! Here we go!

Business Restructuring
Restructuring is a tough business. For most who are hiring into management to perform this duty, burn out is quick and maintaining what was built is quite difficult. Typically, restructuring occurs due to a combination of people problems and professional misperceptions. My experience lead me to a place where I had to make decisions of business viability.

In the end, I was able to astronomically increase profit margins as well as increase departmental productivity by a handsome edge. The cost? Staff turnover. In the end, when a company runs practice as a profit driven business, the question is risen: Is hiring new staff and starting over, amputating old poisons before they reach the core, worth it? If so, then it must be done. And, so it was. The good that did come from this was the hand-picked-construction of a much more cohesive team than that which was inherited.

Additionally, the daily flow of work, scheduling, and service delivery required much review as the revenue generated was severely lacking as compared to the earning potential of the program. In general, service was under-delivered which also yielded outcomes much to be improved upon. On a quick side for those of you in the SNF/geriatric settings, the informal data I was able to analyze across the systems yielded that for the most part, residents that found their way to skilled rehab generally increased by 50% from their level of function upon admission until discharge.

Finally, I found myself realizing the lesson that despite my personal management style being of a collaborative, agile process operator - when a company has its own corporate structure & culture, all levels of management must jive with the same groove. This was an area which I was not able to restructure, despite my best intentions out of respect for the command structure already present.

Organizational Culture
There were many hard human resource lessons to learn in my first directorship. Much if it circulated around the fact that: If you want the "grown-up-job", you will need to live with the hard decisions - this of course, includes the hiring, firing, disciplinary actions, and keeping secrets. Also, part of serving as management is being disliked - hated even. You need to develop thick skin. The other aspect of being in management is learning to be a leader. Empowering your employees within the given structure of firm is a balancing act that requires careful planning and execution. This is perhaps, the most frustrating part of management - you cannot run as if it were your own business. The business belongs to others, many times to public trade. Therefore, you must act within the parameters given.

That said, I was once again given the opportunity to forge a culture of service, caring, and cooperation. Being that I was part of such initiatives in my former line of work, growing an expanded culture came quite naturally. Much of this is leading by example. Watching management take the time to clean tables, pick up random bits of paper, and spending extra time with customer concerns are an essential function of creating a culture by which staff are willing and empowered to do the same.

The other aspect of organization culture change is creating cohesion. Many times, departments are filled with individuals that work together. The goal is to transform the department into a team that finds it hard to work separately. Aspects of attaining this can be organic and thus unpredictable; the other aspects are a combination of strong leadership - and - unfortunately at times, letting go of people who resist the direction of the team as a whole.

Business is a human behavior of connecting with people; of communicating in hopes of reaching agreements upon perceived mutually beneficial arrangements of trade in products, services, information, and other forms of exchange. The skilled rehab setting is a delicate game of satisfying customers on all side. Typically, the facility wants to keep people as long as people. The residents want to go home as soon as possible. The rehab staff wants the residents to be a safe as possible. All these desires usually go in very different directions. For more, Management Tips (and Commentary): Skilled Nursing Rehab - may be of interest to you.

As much of the business in SNF's relies upon flow, it was incumbent to me, by my former work and connections, to develop and cultivate the relationships from the hospital & health systems for which I was familiar with to deepen the connection that was established in historical contexts. The results, an increased awareness regarding the quality of the program I was given charge of by three major health system & managed care organization by which several major hospitals found their options increasingly open for discharge disposition. Realistically, this means increased referral rates by which a SNF rehab program can add value to the facility at large.

Networking also meant that certain expectations set by the referral sources needed to be met. In preparation for accountable care organizations, I was given the opportunity to learn of the new metrics by which much of healthcare's future would be held accountable to. Discharge time frames, cost analysis, and expectant trends for the continuum of care were lessons learned from networking that I never could have learned from a course, seminar, or break-out session. As for the specifics of these lessons, I'll have to share at a later time when I am freed to convey such news - in so far, I can say that physical therapists are well poised to add value to the future of healthcare.

Some Closing Thoughts:
My first experience with directorship? I loved it! Unfortunately, the timing was poor. In the midst of finishing an Masters of Business Administration program in marketing and becoming a new dad - the combination just wasn't quite right. Nevertheless, through the experience, I found myself in high performance in regards to operations optimization, cost containment, and thus maximizing profit margins. I also learned that growing thick skin, and perhaps, time & exposure to tough HR issues is something that all managers will continually appreciate - though - not exactly wish upon. Such struggles are part of the management business.

Finally, I found that I'm quite talented in consulting business models; I am skilled at making something from good to awesome. However, I don't have the best personality for maintaining the flow. To be honest, I simply lose interest. I'm a problem solver by nature. It is best for me to enter into situations where solutions are needed; to create, implement, and successfully execute said solutions - and finally, to create an exit strategy for smooth transition and continuance of high octane performance.

I look forward to completing the MBA program and pursuing some other ventures. I also look forward to spending much more time with family, and, perhaps earning a belt promotion in Brazilian Jiu Jitsu.

As I said, I see life as that made of many phases... experiences. I've demonstrated high levels of performance in management. Now, it's time for me to refocus my experiences on some of things that simply matter more - the things that time and money can't buy.

Until Next Time, I Remain Humbly Yours,
-Ben Fung

Applications: Musashi's "Book of Five Rings"

This post continues from my Martial Arts Musings with Sun Tzu's Art of War. You can find my related posts under the Martial Arts label.

Miyamoto Musashi was a legendary samurai duelist who independently studied into an epic level of skill and understanding. Winning his first duel at 13 and retiring from dueling at age 29, this Japanese swordsman boasts over 60 victories. Now mind you, in the age and culture during Musashi's time, the Japanese did not fight to first blood - swordplay was to the death. I think from just this fact alone with surviving 60 life & death encounters, there is much to be learned from his philosophies.

This, of course, is part of the irony since Musashi wrote his book as a first draft, top-of-the-mind memoir on his career, his martial arts school, and his philosophy & approach in life.

The Book of Five Rings, perhaps better translated as the Book of Five Sphere - or perhaps even, "Five Worlds/Realms" - is Musashi's retiring thoughts as a martial arts teacher, reflecting on his career as an samurai ronin and duelist. This book is noted by many law professors, political scientists, business schools, and military academies - the content most useful concentrating on one to one combat encounters and expanding into the battlefield at large. There are many lessons in this book which can be applied in life and is readily applicable to best practices. Below is a list of my favorite quotes and excerpts for which I will also add my own thoughts.
Applications: Musashi's Book of Five Rings

"The field of martial arts is particularly rife with flamboyant showmanship, with commercial popularization and profiteering on the part of both those who teach the science and those who study it. The result of this must be, as someone said, that 'amateuristic martial arts are the source of serious wounds.'"

Musashi was obviously a man and mind far beyond his times. It was only in the last century that martial arts have truly become blended and unified into functional terms. Mixed martial arts, as we know it in recent times, has really taught us that things that look impressive tend to perform terribly. Another saying that I've heard of is: "Looks good, tastes terrible; looks bad, tastes great!"

"When your life is on the line, you want to make use of all your tools. No warrior should be willing to die with swords at his side, without having made use of his tools."

I'd like to point out that Musashi was famous for using two swords even though, traditionally at the time, only the single long sword (katana) was used in Japanese combat. This struck me as an important philosophical point; Musashi practiced that which worked - even if it wasn't popular or accepted. He studied and refined that which demonstrated repeated success.

"In distinguishing the advantages of the tools of warriors, we find that whatever the weapon, there is a time and situation in which it is appropriate. The side arm, or short sword, is mostly advantageous in confined places..."

Musashi goes on to list Japanese weapons and purposes... it goes to show that he understood beyond what he specialized in. You can always specialize in one area; however, it is important to be familiar with all aspects in any field. This culturally mirrors teachings of Sun Tzu - you must know your enemy as well as yourself.

"You should not have any special fondness for a particular weapon, or anything else, for that matter. Too much is the same as not enough... Pragmatic thinking is essential."

In combat, business, clinical thought, and life in general - flexible common sense is key. Being too terribly structured & unable to think outside the box is a mind trap for the self.

"Generally speaking, fixation and binding are to be avoided, in both the sword and the hand. Fixation is the way to death, fluidity is the way to life."

"Be water, my friend" - Bruce Lee. Enough said.

"Holding down the pillow means not letting someone raise his head."

"If you consciously try to thwart opponents, you are already late. First, doing whatever you do scientifically, thwart the opponent's very first impulse to try something, thus foiling everything. To manipulate opponents in this way is mastery of the art of war, which comes from practice. The act of holding down the pillow requires thorough examination."

I love this concept. Musashi touches on this several times in his book. When in conflict, it is of paramount importance that once engaged, you pressure your opponent so that they have to keep their head down. This keeps them on the defense, and, positionally - you on not just the offense but in a place where the opponent can't even hope to counter attack. A popular sportive aspect we see this applied in; American football.

"To 'cross the ford," puts the adversary in a weak position... then you will generally quickly prevail."

In Chinese Chess, there is a structure on the gameboard called the "river crossing" or "ford." In this, if an army cross the ford first, and can maintain position - this pressures the defending army in a manner where the consciousness can only focus on the pressure and not the tactical situation at hand. My thoughts are that similar cultural constructs exist - if not borrowed in the point in history - in Japanese cultures during the time of Musashi.

"Also, in individual martial arts, you determine opponents' traditions, observe the person character of adversaries, find out people's strengths and weaknesses, maneuver in ways contrary to opponents' expectations, determine opponents' highs and lows, ascertain the rhythms in between, and make the first move; this is essential."

More of "know your enemy and know yourself."

"Stomping is not only done with the feet. You should also learn to "stomp" with your body, "stomp" with your mind, and of course "stomp" with a sword, in such a way as to prevent opponents from making a second move."

It is important to remember that many Asian languages are highly metaphoric and figurative; I feel this conceptually has much to do with "holding down the pillow." Once you engage your opponent, it is important to stomp, step, and apply pressure to your enemy so that they are so cornered and overwhelmed, they are not mentally able to make another move.

"When you think you are going to get into a deadlock, you stop that right away and seize victory by taking advantage of a different approach."

We've seen this in large scale battles. Battle lines such as the Battle of the Bulge or any of World War I's trench warfare show how detrimental deadlocks are for both sides. If you find yourself in a mutual clinch of any sort, it is imperative to break the stalemate and immediately re-engage your opponent before they can react.

"When your opponent is not as skilled as you are, or when his rhythm is fouled up, or when he starts to back off, it is essential not to let him catch his breath. Mow him right down without even giving him time to blink his eyes."

Again, more of keeping the pressure on the enemy. Don't let up!

"When an excessive number of sword moves are taught, it must be to commercialize the art and impress beginners with knowledge of many moves with a sword. This attitude is to be avoided in military science.

This goes back to the flashy style of useless schools of thought. I think this is highly applicable to all types of business, clinical, and academic philosophical operands. I find this particularly true for intellectual reasoning. Schools of thought that seem to make more of a situation than is truly required - as if such thoughts were above its competitors... such patterns, I've observed, result in a xenophobic, elitist attitude. In the martial arts world, we see this quite frequently - some grandmaster of a sub-sect of a school never heard of. And yet, the school has many, many students. They square off with a blue belt from another school and get worked. Substance? I think not.

"The performance of an expert seems relaxed but does not leave any gaps. The actions of trained people do not seem rushed."

For those of you who grapple - especially in Brazilian Jiu Jitsu - it's as if the higher the belt level, the slower people roll. And, no matter what you do, you still feel like you are out of control, steps behind, and out of position against this slow-as-molasses moving brown belt who is trapping you at every corner. It goes to show: mastery can be performed at any speed - at any time.

"It is bias to think that the art of war is just for killing people. It is not to kill people, it is to kill evil. It is a strategy to give life to many people by killing the evil of one person."

I appreciate this quote from Musashi. I've actually left out some of Musashi's more graphic quotes from his book since I felt the content was not entirely congruent with the presence of this blog. Nevertheless, I think it worth pointing out that the Japanese consider their primary sword, the katana, as the "life giving sword" - recognizing that violence is inevitable in human history (the human condition), and thus its future. Therefore, the only way to preserve life is to defend it, and, to defeat those who wish to take life from others.

"When you strike a blow, do not let your mind dally on it, not cerning yourself with whether or not it is a telling blow; you should strike again and again, over and over, even four and five times. The thing is not to let the opponent even raise his head."

Once again, the holding down the pillow, snuffing out the opponent with pressure concept. I think this happens to many of us when we are at the moment of truth. We take our eyes off the ball to see where it went... well... it went no where because we took our eyes off the ball. Keep on it and never lose focus on until the job is done. THEN take a look at where the ball went.

Regarding the Mind
"When you wield a sword, if you are conscious of wielding a sword, your offense will be unstable. When you are writing, if you are conscious of writing, your pen will be unsteady. Even when you are playing the harp, if you are conscious of playing, the tune will be off."

An expression of true mastery can be seen in the uniting the tool, the wielder's body, and the mind - all as one. The art must become part of the consciousness of the student - only then, do they begin mastering the art.

Some Closing Thoughts:
I've learned many life lessons from martial arts over the years. Reading Musashi's Book of Five Rings has always been a life goal. While my wife was in labor with our son Nathan, I had the opportunity to go through these writings during periods of rest. It was an enjoyable read. What I learned most from the spirit of intent by which Musashi wrote. These closing thoughts stood out to me as the lessons Musashi wanted his readers to learn:
  • Learn what works, not what looks good. Practice them. Master them. And, apply their lessons.
  • When you engage an opponent, ultimate victory occurs because you have out-maneuvered your opponent so much so that they are mentally pressured out from the fight, physically out of position, and tactically incapable of striking back - rendering you safe from the beginning of the encounter.
  • Teachings that trump superiority typically lack in substance; they are only at words - not deeds. Teachings which only offer the truth that their methods work in the circumstances for which they've mastered - these systems are functional. They work for their intended purposes. These can be trusted and are worth studying.
  • Intercept your opponent as they are on their way to attack you; strike them before their strike lands; beat them back with pressure as they retreat; crush them when they stop; take advantage of their weaknesses and avoid their strengths.

I hope you've enjoyed this episode of Martial Arts Musings. Until next time!