Healthcare Quality & Analytics, Personal, Writing, Editing & Journalism

An October Update

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After a brief stretch of unseasonably warm weather in late September, West Michigan has unambiguously slipped into autumn. I look out my home-office window—the air is nice, with that charming mix of cool and moist that suggests “tailgate season”—and I see more and more orange and red amidst the green. Squirrels scamper with earnestness. Bugs are vanishing. Things slow down.

“Winter is coming,” I’m told. And I hope it does. I’m excited for this year’s holiday season. In my head, it kicks off with my mid-September birthday, which marks for me the end of summer (Labor Day doesn’t do it for me) and the beginning of “winter Lent.” Then October sees the tree transitions and sweater weather and writing prep that culminates in Halloween—holiday season kickoff!—and the beginning of National Novel Writing Month. Thanksgiving re-grounds me with family and marks a pivot point for NaNo. And as soon as the mad-dash of writing is over, I pivot to Christmas and then take two or three weeks off from the day job to recharge, etc. It’s a great time of the year, even in years when I’m not “feelin’ it.”

So today seems like as good of a time as any to offer some updates, offered as usual in no particular order, but as always under the watchful gaze of my feline overlords.

VLO’s Summer Vacation. Tony and I took a half-vacation (i.e., work slowdown) in late July and throughout August; as of September, we were back to a normal weekly podcasting schedule. The upside to VLO now rolling in its sixth year is that we’re stable and mature. And, of course, that we have thousands of downloaders and hundreds of engaged listeners on Twitter, Facebook, the blog, etc. Given that we don’t monetize this program—it’s a hobby and labor of love—the response by people all across the world has been fantastic. And for almost all of the shows for September and October, our alcohol segments came to us free of charge courtesy of gifts from our listeners. It’s a ton of work, but it’s a joyful thing.

NAHQ @ Cincinnati. On my birthday, I flew to Cincinnati for the back-to-back board meeting and educational conference for the National Association for Healthcare Quality. It was a professionally rewarding experience. Being a board member means that the conference is tightly scheduled for us. Six days, five nights. But what made it personally rewarding was the deep camaraderie among the current members of the board and the great cadre of seasoned, senior volunteers who work with us. NAHQ is about to go into a very tight period where the organization pivots from an association-management model (i.e., a separate company “manages” the association, hires the staff, provides the office, etc.) to a fully stand-alone model where the association itself handles all its own operations, leases its own offices, hires its own team, stands up its own I.T., etc. This is a huge deal. We’re bigger than most groups that make the independent pivot and we have only about a quarter of the time the average group enjoys to make the move … but our staff are awesome (almost all are leaving the management company to be hired by NAHQ outright) and our finances are rock-solid. It’ll be a heavy lift, but it’ll be done with finesse and—we expect—utterly transparently to our thousands of dues-paying members.

Jot That Down. I’m pleased to share that Jot That Down: Encouraging Essays for New Writers has been successfully released. I worked with A. L. Rogers, the book’s editor, to get it produced in print. It’s a great resource for new/aspiring writers, covering a variety of topics and genres in an easy-to-digest manner. Currently available for purchase for $14.95 from Caffeinated Press or by special order from your local independent bookseller.

Other CafPress books. And speaking of Jot That Down, I’ve wrapped up Isle Royale from the AIR, an anthology edited by Phillip Sterling that collects stories, poems and art from former artists-in-residence at Isle Royale National Park. I’m also in the production phase of Brewed Awakenings 3, our annual anthology, and Off the Wall: How Art Speaks, a collection of poetry and art co-developed by Elizabeth Kerlikowske and Mary Hatch. And final edits are due from the advance review copy for Ladri, a novel by Andrea Albright. Barring disaster, each of these books should be in-scope for a boost event we’ll host at the end of the month. Two more novels await this year—Kim Bento’s Surviving the Lynch Mob and Barbara David’s A Tale of Therese—plus Jennifer Morrison’s local-history book The Open Mausoleum Door, then I’m caught up with production across all of our lines of business.

NaNoWriMo. NaNo’s coming, so that means that I’ve had to (a) re-curate my author page and (b) think about what I’m going to work on. I think my technical focus will be on sharpening conflict and using that conflict to be the primary driver of the plot (instead of my usual, which is to let the plot drive the conflict). The story itself will be another bite at a Jordan Sanders murder mystery because I’m well-acquainted with the characters in this universe. But I still have three weeks to nail down my idea.

Grand River Writing Tribe. The Tribe has been together for 10 months now, and it’s been going gangbusters. People are participating. Getting published. Supporting each other. Without a regular, focused critique group, a writer stands at a significant disadvantage. GRWT meets twice monthly for three hours, combining critiques, focused education and dedicated writing time. And we still welcome potential new applicants!

Juicing. So this happened. On October 1, a scant week ago, I began a significant diet program. I had purchased a juicer and accessories. For several days, I had nothing but fruit and vegetable juice. Then, on the advice of clinicians at work, I’ve migrated to a part-juice, part-good-food regimen. So it’s been juices with a little bit of, e.g., shredded chicken or sushi or carrot/celery sticks. The thing is, I’m avoiding all processed sugars, alcohol, refined carbs, etc. Not even doing my traditional Lean Cuisines. It’s either juice I prepared myself, or plain shredded chicken or sashimi without the rice. (Tonight, I’m making a salmon fillet with asparagus.) Already down five pounds in a week. And although the diet part isn’t hard—I really like what I’m consuming—what’s been more interesting is the level of planning I’ve had to do. Actually preparing a shopping list (“I need this many swiss chard leaves, this many pears, this many ounces of blueberries …”) and planning my evening schedule around my dinner schedule has been both illustrative and challenging. And now that I bought an elliptical, which just got set up in my living room—whoa! Credit to my friend Tony who did a 30-day juice diet in May (and lost a ton of weight!) and who remains incredibly supportive even when I mock him unfairly for becoming a vegan.

The Great Outdoors. Tomorrow, a half-day kayaking trip beckons, with Jen, Brittany and Steve. Next Saturday, I’m doing a day hike on a section of the North Country Trail in the Manistee National Forest.

Home Shopping Spree. With the annual management bonus we received at the day job, I was able to pay off some bills, pay other bills early and invest a bit in both Caffeinated Press and my own home front. Of note, with the mid-summer swap of my bedroom and my office, I had to buy all new bedroom furniture. That’s done: Dresser, headboard, vanity with bench. Then some odds-and-ends, including the aforementioned elliptical, some knickknacks like candles and new lamps, a full-length mirror and a stool for the bathroom, and a replacement computer. My “normal” all-in-one home computer is very old and has been intermittently hostile, so it’s been retired to be a dedicated writing machine at my dedicated writing desk. The new machine—the first upgradeable tower PC I’ve owned since, I think, 2005—is an iBuyPower box with a quad-core i7-7700 processor, 16 GB of RAM and a 3GB GPU (GeForce GTX 1060). In all, a decent if not bleeding-edge machine. The only real hesitation I had with it is that it appears to have been designed by a 13-year-old boy, with proliferating LED lights (that I covered with electrical tape!) and a keyboard that looked like a l337 toddler toy. Picked up a 27-inch monitor for it; almost got two but I’m glad I didn’t because with it and the 17-inch aux monitor I already had, I’m literally out of room on my desk. I literally cannot fit two 27-inch monitors. Anyway, Duane, if you see this: “SIXTEEN GIGS OF RAM.”

Great Lakes Commonwealth of Letters. It’s an exciting time at GLCL. The board has been discussing a very, very robust programming schedule for 2018 as well as rebranding and an expansion of the board. A ton of work, to be sure, but I think it’ll help focus the organization and promote local literary citizenship. More to come.

All for now. May your autumn Winter Lent warm your soul even if it chills your toes!

Personal, Writing, Editing & Journalism

A Month in the Life

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The onset on seasonal fur-shedding by my feline overlords reminds me that summer’s coming, a welcome reminder in the mid-winter gloom. The characteristically goofy weather in the Upper Midwest has contributed to a sense of change: Last night, we were in the low 20s F, but a few days before we enjoyed the upper 60s.
Some updates, in no particular order:
Ziggy and Tiger. So speaking of cats, my two neighborhood friends, Ziggy and Tiger, continue to be a near-daily presence around the property. Of the two, Tiger — a neutered male, and sweet as molasses — is probably an indoor/outdoor cat for someone. He’s obviously well cared-for, with no signs of injury or illness, and he’s extremely friendly to strange humans. Ziggy, a black tuxedo female, is a bit worse for wear. She’s also adorable, with a chirpy meow, but she’s underweight and is now showing occasional signs of injury (perhaps from fights) as well as patches of fur loss and ear damage. She has a collar, and I texted with the phone number on the tag a few months ago, but the response was cagey. I suspect she was abandoned last fall. If she starts to appear to be in real distress, I’ll probably scoop her up and take her to the vet, and then look into having her put in a shelter. She deserves a loving forever home.
Chicago. Just got back from an unusually warm and sunny Windy City for the semiannual commission meetings for NAHQ. Great experience. The four commission chairs met Wednesday for a day of planning with the executive director and the president and president-elect. My commission met Thursday and Friday. Went well. Flights were also pretty good, although I was thiiiiiis close to starting an angry tweetstorm with American Airlines. Apparently, AA swapped the plane type. The plane arrived into O’Hare on time, but it was a different model with different weight-and-balance requirements. I was one of nine passengers pulled aside on the “you’re probably gunna be bumped” list. Ultimately, we all were able to board, but — THE PLANE WAS ONLY TWO-THIRDS FULL. Why we’d be over-weight on such a de-populated flight defies reason.
Caffeinated Press. We’re entering a make-or-break year. We’ve mastered the art of making books, but the bigger challenge is selling those books. Although we’re in various catalogs, and we do a fair amount of hand-selling on our own, the real trick is networking with independent bookstores. So it appears that we’ll be doing our own state-wide distribution operation. With Partners having closed, and other distributors being big and expensive, I think that divvying up our target market and personally serving participating bookstores is probably the key to success and the next evolution of our business. Meanwhile, we’ve got exciting changes coming for our literary journal, The 3288 Review, and nine new titles in various stages of completion. And also: Most of the heavy lifting of our tech migration has now concluded. New project-management tools, new email server, new learning-mangaement system … yay!
Grand River Writing Tribe. The Tribe continues to meet. It’s going well, so far. Great participation and engagement, and a wonderful group of people around the table. We’ll be re-opening the door to membership at the end of March, so if you’re local to the Grand Rapids area and wish to join, consider our Grand River Writing Tribe online application.
Poetry. Poems are funny things: When you want to write them, you can’t; when you don’t have the time to write, inspiration strikes. I’ve been working on a collection — a chapbook provisionally titled Whiskey, Cats & Poems — for a while. Got a half-dozen poems or so complete. Then … nada. But, this morning, eight new ideas struck me, like the cars in an out-of-control freight train. At least I had the foresight to take notes. I’m not a skilled poet, by any measure, but I’m working on it. Very relaxing, especially writing by candlelight with (you guessed it!) a cat and some whiskey. But working more with poets and reading much more poetry, thanks to my time with the Great Lakes Commonwealth of Letters, has proven instructive.
Get Published! and UntitledTown. We at Caffeinated Press have been invited to participate again in the Get Published! writers conference, which this year will be in Holland in mid April. Then, in late April, I’ll be off to UntitledTown in Green Bay, WI, to present a session about publishing. Exciting!
State Convention. I went to my political party’s state convention earlier this month. Got to meet some great new people from mid-Michigan. Stayed the night with Tony and his wife at their palatial estate in Dimondale. Great weekend all around! I went to my political party’s state convention earlier this month. Got to meet some great new people from mid-Michigan. Stayed the night with Tony and his wife at their palatial estate in Dimondale. Great weekend all-around!
Personal Goals. During my Christmas vacation, I did a great job of more carefully planning my 2017 goals down to the month level. That approach seems to have paid off — progress and visibility are now more “in my face” than they were before, leading to more deliberate decisions about how I spend my time and what I choose to prioritize.
Ash Wednesday. Lent’s coming this week. I’ve had a personal goal of returning more actively to regular liturgical life. Perhaps this year will be the year.
All for now. Enjoy the rest of the winter!

Personal

There and Back Again: A Reflection

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Flight DL300 touched down in Grand Rapids last night around 8:40 p.m. I got off the plane — it took off from Atlanta; I started in Orlando — then trekked home to greet the feline overlords and head to bed. The great thing about that ATL-GRR segment was the tranquility: I enjoyed an exit-row seat with no one next to me on the two-person side of the MD-88 aircraft. Plenty of space! But also room to unfold my Surface to take some notes. Some of which, are presented below in the form of a reflection.

Updates

NAHQ Board Meeting. This year, our board of directors convened for a destination meeting. We settled on Orlando, FL so we could partake in a “behind the magic” tour offered by the Disney Institute. Interesting experience: It’s a mix of a bus tour and a walking tour of parts of the Magic Kingdom and Epcot. It started at Textile Services, which is basically the commercial laundry for Disney Resorts. Huge. Efficient. And lots of the folks on the floor who saw us on the catwalk waved and smiled, which I guess is the Disney way. Then we went to Epcot and got to go “behind the scenes” at the places where cast members get their costumes and have their break rooms and such. Then off to the Magic Kingdom, which included a brief tour of Main Street inside the park as well as a chance to walk through parts of the Utilador — the “secret tunnel” under the Magic Kingdom that’s actually neither secret nor a tunnel. (You can’t dig into Florida swampland, so the 1.5-mile “tunnel” was actually built on a normal foundation and then it was buried, with the park built atop it.) All the while, our host kept inserting comments about Disney culture and process improvement, to help tour guests better understand the specific mechanisms of Disney’s commitment to operational excellence and guest satisfaction.

We stayed two nights at Boardwalk Inn, which — I must admit — was a great location.

Apart from the Disney Institute tour, we enjoyed 1.5 days of board meetings. These conversations have really solidified; Day One was mostly strategy, with the final half day focused on operations (budget, consent agenda). I’m cautiously optimistic that we’ve settled on a really solid framework for setting program/service strategy for the next few years.

NaNoWriMo. As I mentioned in my last post, I ended the year with a moral victory but not a word-count victory. I am, however, eager to translate my experiences from this November into a more nuanced master plot-and-conflict timeline that I can weave into a better version of the original story.

Grand River Writing Tribe. As part of my general commitment to “rite moar gooder” I’m launching a writing group for authors serious about publication. Read more, and apply, on the Tribe’s temporary landing page.

Kent County Republicans.  By virtue of having stood for county-level office, I was automatically extended the privilege of serving as a member of the Executive Committee for the next two years. So that’s fun. I also got to see my friend Edgard, which was awesome. He suggests he might be moving back to the area next year — a suggestion I hope translates into reality!

Social Schedule. November was busy:

  • 11/3 — Nat Sherman 85th event at Grand River Cigar with Scott
  • 11/4 — Writers’ group Thanksgiving fest (turkey and all!)
  • 11/5 — “Dead Presidents” Halloween party @ PPQ’s in Royal Oak, MI
  • 11/10 — Dinner with Roni
  • 11/11 — Sister-in-law’s 40th birthday party
  • 11/13 — Day of Knockout Noveling at CultureWorks in Holland, MI
  • 11/18 — Murder-Mystery dinner at Ruth’s Chris in Troy, MI
  • 11/24 — Thanksgiving Day at mom’s house
  • 11/27 — The End Is Nigh celebration at KDL/Kentwood
  • 11/28 — County convention, Kent County GOP
  • 11/30 — NAHQ board meeting commences

… and all of this, plus the day job, plus me attending Jessica’s write-ins every Tuesday, plus me hosting write-ins every Saturday morning.

About.com. I’m back into the editorial-consulting space, working as a contractor for About.com and its migration of content to premium verticals. Similar concept to the Demand Media “renovation,” but executed with a much higher degree of sanity.

Reflection

This morning, Saturday, Dec. 3, the National Weather Service’s landing page for Grand Rapids says: “November was among the Top 2 to 4 warmest on record around the area. Meteorological Fall (Sep 1 through Nov 30) eclipsed Fall 2015 as the second warmest on record.”

So, yeah. It’s been unusually warm. My landlord mowed the lawn last week, if that’s any indication. The forecast is for roughly an inch of snow locally over the weekend, although temps will still hover around 40 F; however, the freeze starts to set in around Tuesday night, with predicted high temps between 28 F and 33 F and lake-effect snow likely for the end of the coming work week.

I like cold, snowy Decembers. Warm/dry Christmas seasons totally suck the life out of the holiday. That point was impressed upon me in Orlando, where the Magic Kingdom now stands bedecked in holiday regalia. Looking at Christmas trees while walking around in 85-degree weather just feels weird.

I spent some time on the last leg of my trip home working through some planning notes for my upcoming two-week Christmas vacation, as well as penciling in some goals for 2017. It occurs to me that some of these goals require downtime. When the seasons are out of whack, it’s as if my body’s calendar gets out of whack, too. Downtime is a function of environment as much as a schedule.

Catholic liturgy values seasonality. We have a clock to rule the day, a calendar to rule the month, but the seasons rule the year. Throw some sand into the gears of any of those three temporal markers, and things grind to a halt. I noticed, perusing some old blog posts, that as recent Decembers have been unseasonably warm or cold, dry or snowy, my reaction tends to follow suit. 2012 = warm/dry; 2013 = snowy; 2014 = frigid; 2015 = warm/dry. I got into my vacation and come back again either refreshed or dejected, in part based on my attitude about it all, which is influenced by the climate.

I have high hopes for this December. Let’s see if the weather cooperates.

Healthcare Quality & Analytics

Learnings from the @myNAHQ #NAHQsummit for Population Health

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This week I attended the National Quality Summit in Dallas, Texas. The event, sponsored by the National Association for Healthcare Quality, was chaired by Dr. Drew Harris, a nationally known expert on population health, and co-chaired by NAHQ’s own Len Parisi and Nancy Terwood.

Disclosure: I’m a member of the NAHQ board of directors, and part of our attendance in Dallas included our quarterly board meetings. However, my summary of the summit does not constitute a NAHQ-endorsed communication. My observations, below, are solely my own.

The summit included roughly 250 in-person and more than 400 virtual attendees. The event highlighted current trends in population-health management presented, partially, as case studies in how health quality professionals can help move the needle on the health of patients at a population level.

The “population” distinction is significant. Much of healthcare today focuses on the treatment of individual patients. Although some initiatives, like Pay for Value, roll up results at an aggregate level, the truth is, we don’t manage the health of cohorts very well. Even the vaunted Patient Centered Medical Home model is, at heart, a treatment paradigm for individual human beings. But treatment at a population level requires different incentives, different skills and (potentially) a different political climate.

Some core learnings from the summit:

  • “No margin, no mission” migrates to “no outcomes, no money.”
  • Hospitals might decline as incentives against inpatient care mount, but health systems will endure. Those systems must be adaptive, not reactive, if they are to thrive.
  • Population health features a dual focus: from the “patient out” (looking at individual humans within a system) to the “population in” (looking at the community as a whole to remediate socioeconomic problems contributing to poor health outcomes.
  • The community aspect requires a reliably delivered, broad set of preventative interventions for prevalent but inadequately addressed health risks. Advanced preventative care mixes care coordination across the continuum with effective chronic disease management and personalized prevention services. However, “personalized prevention” is wildly under-employed.
  • Programs must be relevant to the targeted population. It’s foolish to develop a program and then find a population to channel toward it.
  • Good pop-health programs use a portfolio of 30-35 robust, evidence-based interventions. No one-size, one-program approaches work. Analytics should rely on statistical process capability techniques to assess ongoing effectiveness (before a formal evaluation study) and make better use of geomapping capabilities.
  • Population targeting presents an interest set of challenges —
    • What’s the aim of the targeting initiative?
    • Why obsess over 1-5% of costs if other populations with lower costs can yield better clinical results? [A CMS study suggested better cost savings with low-to-medium risk targeting (aversion) instead of high-risk (management) activities.]
    • Can we target rising-risk patients?
    • Can we move beyond claims data to identify a population?
  • An optimal mix for program targeting might include moderate-to-high risk patients based on diagnosis, physician opinion and health-risk assessments. A typical candidate pool might be roughly one-fifth of the 65+ population and with good outreach, perhaps 40-50% can be enrolled.
  • The system perversely incentivizes wasteful care precisely because some stakeholders profit from it. But when average costs for a median family of four consume 40 percent of disposable income — there’s a problem. The fee-for-service model creates a structural barrier to the care of populations. And despite their unpopularity, narrow networks consolidate care teams and health information much more effectively than wide networks.
  • Over-reliance on primary care physicians, instead of comprehensive care teams spanning stakeholders, isn’t helping advance the cause. PCPs can be an entry point, but they can’t do it alone. Clinical integration (including coordinated care, evidence-based practices, waste reduction and network management) is essential, as are the infrastructure pieces like health IT, info exchanges, predictive modeling, population segmentation and a stronger emphasis on behavioral-health and wellness services.
  • Could an Uber-like model disrupt healthcare at a consumer level?
  • We have a lot of data, but not much capability to transform data into actionable information. If you can’t measure it, you can’t improve it.
  • We tend to focus on high-cost/high-risk patients, but perhaps we should invert the pyramid. It’s easier and better in the long run to focus on wellness and routine gaps in care than to let people progress through rising risk until they hit a “you’re at the edge of the cliff” threshold after which — when it’s too late — the care team rallies.
  • Partnership with health plans is essential (integrated wellness, behavioral health services, patient engagement) but the messaging has to be deliberate. In one case study, telephonic care management engagement jumped from 15 to 80 percent when the caller-ID string changed from the insurer to the provider.
  • The move from “volume” to “value” will be hugely disruptive.
  • Clinical interventions take time — from 3 months to 5 years — to generate value. Need to level-set expectations accordingly and avoid premature evaluation and trending.
  • Pharmacists are one of the least appreciated professionals in the industry. PharmD’s make a real difference when integrated into the care team. Coordinating pharmacists, dietitians and SNFs as part of overall home-health outreach may be worth exploring.
  • Decision science — using aggregate data to inform strategy — is under-valued in health analytics. Metric-based decision making can be a barrier to effective population health. Solo dashboards — data viz w/o substantive analysis — are rarely helpful and sometimes harmful. You can’t do “analytics” without storytelling.
  • Problems in most health-analytics projects: Not asking the right questions from the outset, disregarding qualitative information, not reviewing published research, not acting on the results of the analysis.
  • Let some analysis follow from “microtrends” (the small forces behind big changes). Census-block analysis is more helpful than it appears.
  • Near-real-time surveillance is key, and can be built by individual institutions with adequate resources. BRFSS is broad, NHANES is detailed — but both lag. By the time you know your population, you’ve lost your actionability window, unless you do your own surveillance using claims and lab data with incremental census data. Knowing something useful about your community helps shape the tree of questions during individual patient encounters — i.e., you’re treating your patient as being a member of the population they represent instead of an automaton disconnected from their community.

Because of the board meeting, we were not able to attend the second-day sessions. But the first day certainly left me with many valuable take-aways.

Personal, Writing, Editing & Journalism

Some Spring Housekeeping

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The last few months have been more hectic than most. Of note:

  • Our HEDIS medical-record review with our new processes and new vendor is winding to a halt. It’s been a lot of work, capturing roughly 17k medical records in six weeks. But preliminary rates look OK. So that’s a relief. We’ve been on a multi-million dollar journey to swap vendors for nearly 10 months now. With the end of our first-year effort now approaching, it’s time to reflect on lessons learned and to soak in the fact that I was a core leader in such a huge and politically high-profile project.
  • Two weeks ago, I spent two nights in Chicago doing NAHQ commission coordination. Interesting stuff. The association is really firing on all cylinders for it’s five-year strategic plan; now the goal is to keep everyone pointing in the same direction without stepping on toes. Details are TBD, but I may well be presenting in conferences in June in Toronto and near Baltimore.
  • And speaking of NAHQ, I’ll be in Dallas in the coming week for the Summit and for board meetings. Back to back to back to back to back …
  • I submitted a novella to Amazon. It’s an experiment; the novella is in a fringe sub-genre of erotica and it’s written under a pseudonym, using a name with no social platform and no author history. In the last eight hours, I’ve already sold three copies of the ebook and have earned $2.03 in royalties. Interesting. The whole exercise follows from a thought experiment in Jane Friedman’s excellent Publishing 101. (And no, I’m not going to tell you the pseudonym or the novella title. Like I said: fringe.)
  • My friend Brittany and her husband Steve welcomed a baby girl into their family on Thursday. She’s adorable. I went to the hospital to see mom, dad and baby.
  • Life at Caffeinated Press has had its ups and downs of late. Powering through the “painful growth phase,” I guess.

 

Personal

Two Brief Reflections: Winning NaNoWriMo, and Governance

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I did it — I crossed, barely, the 50,000-word mark on The Children of St. William’s to earn my third consecutive “win” for National Novel Writing Month. The story isn’t finished, of course; my detailed scene graph pushes the final word count much closer to 85k. But working through the story when you’re at 50k aiming for 85k is much easier than starting from zero. Which, I believe, is the whole point of NaNoWriMo. And as I finished, I figured I’d change the book name, too, to the less cumbersome Six Lost Souls.

Some take-away observations about writing this past November:

  • I wrote my last 10,000 words in a single marathon day. That’s a lot. I couldn’t have started the month with that kind of productivity, mostly because — for me, anyway — I have to get north of 30k to 35k words before scenes start to roll off fluidly. Prior to that, and I’m still spending too much time thinking about structure and characters, so the writing process is slower: I’m making follow-up notes, thinking through the finer points of character voice, making decisions about scene details, etc. I tend to plan in detail, but you can’t plan for everything.
  • Much of my writing in the moment focuses on dialogue. I usually have to swing back after I’ve finished a scene to insert environmental details.
  • I don’t write much action — most of my scenes tend to be people arriving at a place and talking. I varied it this time around, however, and had a fight scene and two scenes of extended narration while a character does something alone. On rewrite, I’ll chop things up a bit. But, as they say, just knowing you’ve got an authorial quirk is half the battle.
  • For the first time, I was deliberate from the get-go about my point-of-view characters, and which scenes led with a specific POV. By default, I tend to write Third Person Limited, with a small number of POV characters.
  • I couldn’t write nearly as efficiently without Scrivener for Windows. With this app, I can condense notes and research and plot my story on a chapter-and-scene basis, with target word counts and synopsis cards. I can also configure various status flags for each scene (I customize my own) and set color codes to indicate which character’s POV governs a chapter or scene. I don’t think I could be nearly as successful if I had to rely on a generic word processor.

State Leaders’ Summit

I spent some time last week in Chicago, for the State Leaders’ Summit sponsored by the National Association for Healthcare Quality. The event went off without a hitch. I drove, which was fine, although I managed to hit eastbound I-90 around O’Hare just in time for Friday-evening rush-hour traffic. Took a full two hours to get from the airport area (Cumberland Avenue) to the Skyway Bridge. That said, there was much fascinating discussion to be had, including a valuable two-hour presentation by an association-management attorney about the basic principles of governance and legal/tax compliance for small non-profits.

Board members have three duties: A duty of care, a duty of loyalty and a duty of obedience. I think this tripartite distinction offers a good framework not just for business endeavors, but also for how we nurture personal relationships. More to ponder about that, I think.

Strategic Planning Retreat

Tonight the Caffeinated Press board of directors conducts a four-hour annual strategic governance retreat. Lots on the agenda. We’ve had a busy year, with a great mix of successes and … ahem, opportunities. We’ll cover Governance 101, plus look at our board composition, 2016 editorial strategy, the annual budget, and ways to grow the market.

The retreat starts after the regional TGIO party — celebrating the end of NaNoWriMo — so it’ll be a long day. But worth it.

Personal

November: The Busiest Month — A Recap & Reflection

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Hard to believe that tomorrow is the last day of the month. Over the last few years, the Eleventh Month has become the Busiest Month, much of it related to writing-related activities. This year was both more packed, but more manageable, than most. Herewith a recap, in no particular order.

  1. Library election. With all due gratitude and appreciation to the 17 people who wrote me in for the Nov. 3 election for the Grand Rapids Public Library’s Board of Library Commissioners, another candidate managed to get more than 450 votes. Wow. I am considering running on the formal ballot in 2017, because I still believe GRPL is far too parochial and antiquated in its thinking, particularly about local writing talent. The Kent District Library far outpaces GRPL on that front. Doesn’t need to be that way.
  2. Caffeinated Press update. Speaking of GRPL, we presented at the KDL fall writer’s conference in October, to a group of probably 200. We (John, Brittany, AmyJo and I) had 40 minutes to talk about the gotchas of moving a manuscript from your desktop to a publisher’s desktop. Likewise, I’ve been working like a mad demon on book projects. In the last six weeks, I’ve wrapped up production on A Crowd of Sorrows, A Broken Race and The One Friend Philosophy of Life. I also completed our corporate catalog and helped John with final proofing on The 3288 Review (vol. 1, issue 2). We even managed to hold a well-attended kickoff for National Novel Writing Month, here in the office, and to nominate six worthy pieces for the prestigious Pushcart Prize. Next on the list: Edits on Letters lost then found, final production on Grayson Rising and proofing and production on Brewed Awakenings 2.
  3. The Children of St. William’s. My own NaNoWriMo novel, The Children of St. William’s, recounts the tale of Sarah Price, a young progressive woman who, although she had known she was adopted, discovers that she has several siblings. The novel addresses her shifting motivations for tracking each of them down — and how connecting all these people together both hurts and helps them all, while her parish priest struggles to understand how and why the adoptions happened in the first place. Currently at just a hair above 40k. On track for a NaNo “win.” I like the story and will continue to work on it; the current storyboard targets around 85k words. More to come.
  4. Treks to the Windy City. This coming week, I drive to Chicago for NAHQ’s State Leaders’ Summit. Then in January I have back-to-back NAHQ-related Chicago trips, both by air — the first for the quarterly board of directors meeting, and the second for the inaugural meeting of the Recognition of the Profession Commission (which I chair). Interesting professional-growth opportunity. Looking forward to the National Quality Summit in Dallas in the second week of May.
  5. MAHQ Conference 2015. Our October conference went off well — more than 60 attendees and fairly good results. I spoke about the health policy climate in the state government, as well as serving as overall conference chairman. Our venue, the Amway Grand Plaza Hotel in Grand Rapids, served lovely food, but wow … horrific service standards. I expected better from the Amway. Did receive, however, solid support from ExperienceGR.
  6. Requiem by Brahms. AmyJo and I went to see German Requiem by Brahms earlier this month. The performance, guest conducted by Rune Bergmann, was a delight; the symphony was wonderful, as usual, and the chorus was well-balanced relative to the symphony. Before the performance, we stopped at Reserve for wine and cheese. In all, a great way to de-stress after a rough month (for each of us, individually). I have so few folks who enjoy fine-arts performances, so slipping out with AJ was awesome. (And I’ll have to book another opera trip with April soon.)
  7. Fully staffed! I now have a completely staffed department at Priority Health. A few weeks ago, two of my new hires — Jen and Maria — joined the team. A few weeks before that, it was Gabriel. And now we have Patrick. Focus will be on predictive modeling, quality improvement analytics intended to transform the care model, and ongoing support for our employer-group reporting team. Exciting time to be a leader in health data analytics.
  8. RIP Abbey. My classmate at West Catholic, Abbey Czarniecki, passed away recently. She was a lovely lady; may her soul find eternal rest.
  9. Hell = Frozen Over. I ended up buying an iPad Mini 4. The device makes work at Priority Health so much easier, since Spectrum Health’s IT department apparently only understands iOS. That said, although the device is conveniently portable, I still prefer my Surface 3. The way I see it, the iPad is great for quick, single-focus tasks, like answering an email or browsing something on the Web. But iOS falls far short compared to Windows 10 regarding multitasking and true productivity work. On my Surface 3 (not even the Pro model), I can do pretty much the same stuff I can do on my CafPress laptop. For context, the CafPress box is an HP laptop with a medium-high-end AMD processor and 8 GB of RAM. On the Surface 3, I can use Scrivener and the full MS Office suite. On the iPad … I can use simple versions that look and feel like Web apps. I’d give iOS the edge in core OS stability, app availability and ease of executing single tasks; Windows 10 wins in terms of sheer power and versatility and harmony of design. (Yes. Design harmony. You have no idea how hard it is to find basic settings in different iOS apps; some are in the app, some are in the Settings app. Geez. And writing with a stylus? Astonishingly infantile on iOS, smooth as butter on Win10.)
  10. VLO 250. Hard to believe that a weekly 30-minute podcast dedicated to casino gaming, premium cigars and fine adult beverages would last five years and 250 episodes, yet yesterday Tony came into town and we recorded through episodes 247 through 249 for The Vice Lounge Online. Wow. In December we’ll hit the quarter-millennium mark. We’re planning a “VLO Anniversary Party” for April 1-3 in Louisville, KY. Basically, distillery tours, the Urban Bourbon Trail and fine dining. And a cigar-related event. Probably no gambling, though, unless we do something minor at the Horseshoe Southern Indiana. More details to come. And I believe VLO is doing something fun as a scheduled activity in this summer’s 360 Vegas Vacation III in Las Vegas.

All for now. Have a lovely December, y’all.

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November: The Busiest Month — A Recap & Reflection

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Hard to believe that tomorrow is the last day of the month. Over the last few years, the Eleventh Month has become the Busiest Month, much of it related to writing-related activities. This year was both more packed, but more manageable, than most. Herewith a recap, in no particular order.

  1. Library election. With all due gratitude and appreciation to the 17 people who wrote me in for the Nov. 3 election for the Grand Rapids Public Library’s Board of Library Commissioners, another candidate managed to get more than 450 votes. Wow. I am considering running on the formal ballot in 2017, because I still believe GRPL is far too parochial and antiquated in its thinking, particularly about local writing talent. The Kent District Library far outpaces GRPL on that front. Doesn’t need to be that way.
  2. Caffeinated Press update. Speaking of GRPL, we presented at the KDL fall writer’s conference in October, to a group of probably 200. We (John, Brittany, AmyJo and I) had 40 minutes to talk about the gotchas of moving a manuscript from your desktop to a publisher’s desktop. Likewise, I’ve been working like a mad demon on book projects. In the last six weeks, I’ve wrapped up production on A Crowd of Sorrows, A Broken Race and The One Friend Philosophy of Life. I also completed our corporate catalog and helped John with final proofing on The 3288 Review (vol. 1, issue 2). We even managed to hold a well-attended kickoff for National Novel Writing Month, here in the office, and to nominate six worthy pieces for the prestigious Pushcart Prize. Next on the list: Edits on Letters lost then found, final production on Grayson Rising and proofing and production on Brewed Awakenings 2.
  3. The Children of St. William’s. My own NaNoWriMo novel, The Children of St. William’s, recounts the tale of Sarah Price, a young progressive woman who, although she had known she was adopted, discovers that she has several siblings. The novel addresses her shifting motivations for tracking each of them down — and how connecting all these people together both hurts and helps them all, while her parish priest struggles to understand how and why the adoptions happened in the first place. Currently at just a hair above 40k. On track for a NaNo “win.” I like the story and will continue to work on it; the current storyboard targets around 85k words. More to come.
  4. Treks to the Windy City. This coming week, I drive to Chicago for NAHQ’s State Leaders’ Summit. Then in January I have back-to-back NAHQ-related Chicago trips, both by air — the first for the quarterly board of directors meeting, and the second for the inaugural meeting of the Recognition of the Profession Commission (which I chair). Interesting professional-growth opportunity. Looking forward to the National Quality Summit in Dallas in the second week of May.
  5. MAHQ Conference 2015. Our October conference went off well — more than 60 attendees and fairly good results. I spoke about the health policy climate in the state government, as well as serving as overall conference chairman. Our venue, the Amway Grand Plaza Hotel in Grand Rapids, served lovely food, but wow … horrific service standards. I expected better from the Amway. Did receive, however, solid support from ExperienceGR.
  6. Requiem by Brahms. AmyJo and I went to see German Requiem by Brahms earlier this month. The performance, guest conducted by Rune Bergmann, was a delight; the symphony was wonderful, as usual, and the chorus was well-balanced relative to the symphony. Before the performance, we stopped at Reserve for wine and cheese. In all, a great way to de-stress after a rough month (for each of us, individually). I have so few folks who enjoy fine-arts performances, so slipping out with AJ was awesome. (And I’ll have to book another opera trip with April soon.)
  7. Fully staffed! I now have a completely staffed department at Priority Health. A few weeks ago, two of my new hires — Jen and Maria — joined the team. A few weeks before that, it was Gabriel. And now we have Patrick. Focus will be on predictive modeling, quality improvement analytics intended to transform the care model, and ongoing support for our employer-group reporting team. Exciting time to be a leader in health data analytics.
  8. RIP Abbey. My classmate at West Catholic, Abbey Czarniecki, passed away recently. She was a lovely lady; may her soul find eternal rest.
  9. Hell = Frozen Over. I ended up buying an iPad Mini 4. The device makes work at Priority Health so much easier, since Spectrum Health’s IT department apparently only understands iOS. That said, although the device is conveniently portable, I still prefer my Surface 3. The way I see it, the iPad is great for quick, single-focus tasks, like answering an email or browsing something on the Web. But iOS falls far short compared to Windows 10 regarding multitasking and true productivity work. On my Surface 3 (not even the Pro model), I can do pretty much the same stuff I can do on my CafPress laptop. For context, the CafPress box is an HP laptop with a medium-high-end AMD processor and 8 GB of RAM. On the Surface 3, I can use Scrivener and the full MS Office suite. On the iPad … I can use simple versions that look and feel like Web apps. I’d give iOS the edge in core OS stability, app availability and ease of executing single tasks; Windows 10 wins in terms of sheer power and versatility and harmony of design. (Yes. Design harmony. You have no idea how hard it is to find basic settings in different iOS apps; some are in the app, some are in the Settings app. Geez. And writing with a stylus? Astonishingly infantile on iOS, smooth as butter on Win10.)
  10. VLO 250. Hard to believe that a weekly 30-minute podcast dedicated to casino gaming, premium cigars and fine adult beverages would last five years and 250 episodes, yet yesterday Tony came into town and we recorded through episodes 247 through 249 for The Vice Lounge Online. Wow. In December we’ll hit the quarter-millennium mark. We’re planning a “VLO Anniversary Party” for April 1-3 in Louisville, KY. Basically, distillery tours, the Urban Bourbon Trail and fine dining. And a cigar-related event. Probably no gambling, though, unless we do something minor at the Horseshoe Southern Indiana. More details to come. And I believe VLO is doing something fun as a scheduled activity in this summer’s 360 Vegas Vacation III in Las Vegas.

All for now. Have a lovely December, y’all.

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Philadelphia Freedom

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With a dram of Glenmorangie at hand and a cat on my lap, gather ’round, kiddies, cuz grandpa’s gonna tell you about his last few weeks.
National Quality Summit
Wednesday through Friday, I attended the National Quality Summit sponsored by the National Association for Healthcare Quality. The event, held at Penn’s Landing in downtown Philadelphia, focused on transitions in care. Credit to the NAHQ planning team: The event packed a lot of good information shared by top industry experts like Dr. Eric Coleman and Cheri Lattimer. The more intimate venue — the Summit replaced the longstanding general conference this year — gave in-person and virtual attendees more time to network and more time to think through the QI implications of managing a whole person across every setting where clinical services get rendered.
Health care, as an industry in the U.S., really sucks at transitions; the subject is probably the next big area of improvement on a national scale. Glad to see NAHQ taking a leadership role in setting the agenda.
While I was there, I enjoyed the chance to re-connect with colleagues I’ve gotten to know over the years, because of the small-group lunches, the general reception and the invite-only president’s reception. I met new colleagues, too, thanks in part to a focus group with Abbott Nutrition (and what a learning experience that was — we too rarely include dieticians in our care-planning teams despite the effect of nutrition on readmissions and complications).
The only downside? I wish I would have planned to do some sightseeing. Looks like a lot of fun things to check out in Philly, but I didn’t allot myself enough time to take it all in.
Planning for The 3288 Review
Last week Friday, John, Elyse and I met at John’s charming front porch to start our detailed planning for The 3288 Review, the forthcoming literary journal sponsored by Caffeinated Press. John’s obvious enthusiasm for the project is infectious, and Elyse’s practical wisdom keeps our ambitions on the straight-and-narrow. We’re targeting a mid-August release. Next planning meeting is this coming Monday; I expect (ahem!) Alaric to grace us with his presence.
The Merry Widow
Last Sunday, I trekked to the East Side of the Mitten for a full day of merriment with April. We did brunch at the oh-so-tasty Pantry then drove to downtown Detroit to catch The Merry Widow, an opera featuring famed soprano Deborah Voigt and tenor Roger Honeywell, conducted by Gerald Steichen. We had excellent seats (close enough to peer into the orchestra pit!). The excursion marked my first, but surely not my last, visit to the storied Michigan Opera House.
Funny aside: After the mid-afternoon event, I took April home, but we stopped at American Grand Coney for a quick, informal dinner before I dropped her off. I wore grey dress slacks, a burgundy shawl-collar sweater and white shirt with a burgundy paisley tie (same shade as the sweater, mind you). She wore a stunning black-and-white dress. We sat down in the restaurant and the waitress said something to the effect that she’s never seen such well-dressed customers before, a compliment that made my hot dogs extra tasty.
Célébration au manoir Dimondale
But before the opera, I spent the evening with Tony, Jen, Joe, PPQ and The Good Doctor at Dimondale Manor. We first dined at a local roadhouse, then retired to the palatial estate in the sticks for an evening of snacks, Tony-style mixology and darts. The revelry continued until after 3 a.m., but the chance to spend time with such amazing people was well worth suffering through my 7 a.m. alarm. And although I was displaced from The Blue Room, the air mattress in Jen’s office was astonishingly comfortable.
The Community Welcome
On April 6, the board of directors and a few of our anthology authors enjoyed a “community welcome” sponsored by Schuler Books and Music. We had more than 40 attendees and Schuler sold more than half the stock they purchased. The enthusiasm of the SBM team and the way our guests were so engaged with our presentation and the Q&A session really inspired me. We done did good — and my mom and my nephew even made an appearance!
Sic Transit
Seasons change, and people too. I learned of one workplace transition on my way to Philly. Just before that, I learned that my primary section editor at Demand Media Studios was departing. I wish both of them the very best as their careers take exciting new turns — even as I weep to myself over all the forthcoming changes.
Cards Against Humanity … With Thy Family
On the 3rd, I dined with Jen, Dave and Tawnya as we settled up on our arrangements for our forthcoming diving trip to Bonaire later this spring. It’s going to happen! So that was fun. But on my way from Lowell, my brother texted me. That day was his birthday, and he and my sister-in-law and my mother were at mom’s house, enjoying snacks and beer and playing Cards Against Humanity.
I showed up, and had fun — but wow. You learn a lot about people by playing that game. 🙂
… And With Thy Friends
But at the infamous “sushi night” at Steve and Brittany’s — wherein the Lady of the House learned that guzzling an entire bottle of wine on an empty stomach makes for a poor life choice — we also played the game. With a table full of gamers, only one of whom was a paragon of virtue.
Anyway. A quiet(er) week awaits.

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Blowin' in the Wind …

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Behold the whirlwind.
Where to begin? I’ve posted photos of the drama related to my dining-room window. The broken pane is from a century-old window, so the glass repair is taking some time. The storm window is in place — the A/C unit is now in front of my bedroom fireplace — so it’s not terrible, but I do occasionally feel a draft. Ugh.
Two weeks ago, I went on a casino trip to Detroit (MGM Grand, Motor City and Greektown) as well as Caesar’s Windsor and Hollywood Casino Toledo. Tony and Roux attended. It was a great time — we covered it in a podcast last week — but regrettably expensive.
Last Friday, a six-hour board meeting of the Michigan Association for Healthcare Quality. In Mount Pleasant. The board accepted my proposal, endorsed by the MAHQ education committee, to hold our annual conference in early October in Traverse City. Can you say “wine tour?” Lots of good planning, though — I think we have a real opportunity to coordinate more with leaders in Lansing about state health policy, and the board endorsed my fuzzy proposal to deliberately cultivate contacts in state government.
This coming weekend, I’ll be in Chicago for a state-leaders conference sponsored by the National Association for Healthcare Quality. Should be a good networking opportunity. The folks at NAHQ asked me to help moderate a speed-networking event on Saturday morning.
Life has been busy, but good. My normal routine still hasn’t recovered from NaNoWriMo, though. I’ve done a bit of writing, mostly Saturday mornings with Brittany. Caught the Lego Movie with Duane on Sunday.
I’m really excited about some upcoming scuba trips. I had dinner two weeks ago with Jen, Dave and Tawnya. T is my new dive buddy; she just got certified and just bought her gear. Woohoo. We’re planning a weekend trip to Gilboa, Ohio, for late June. Of course, we’ll have to do some local lake diving in late May and early June to get Tawnya some logged dives. I’ve already paid for a advanced cert course through the dive shop. I think I’m going to target “Level 4” status in SSI by the end of the season. That’s basically 50 dives and four additional courses, plus Stress and Rescue training. If I can get that nailed, then next year I can work toward Divemaster in 2015. I’m thinking maybe I’ll do deep diving, Nitrox, navigation and wreck diving. We’ll see.
The feline overlords are doing well. One of them has decided that I make a great elevator, so when I’m crouched over or kneeling down, he sometimes hops on my back/shoulders and expects a pony ride to whatever shelf or cabinet he cannot otherwise access. It’s cute.
I have officially loved this winter. We have the second-snowiest winter in Grand Rapids history this year, and we’re like #2 nationally for snow cover. Yay. I have 4WD and my landlord shovels/snowblows, so for me, it’s just been fun. I grow weary of everyone bitching about how much they hate the winter.
Although, come to think of it, drivers do piss me off. I’m glad you treehuggers out there buy your Priuses and Civics, but in Michigan, those vehicles aren’t exactly prudent between Nov. 1 and April 1. Sheesh. And since so few people are shoveling their on-street parking curbs, I’m having fun counting how many cars have a smashed driver-side mirror. In some stretches of road, every fourth or fifth car has a missing or damaged mirror.
Writing has been slow. I’m still pleased with my novel, but I’m hung up on Chapter 4. To me, it’s obviously an addition that stuffs in material that counterbalances content in the second half of the novel. I think I need to remove it and find other ways of addressing plot continuity deficiencies.
I’m woefully behind on a bunch of chores, though. All the travel and events I’ve been doing in January and February have conspired to deprive me of time to get stuff done at home. I’m behind on routine paperwork, and the re-launch of some of my business properties is delayed thanks to some tax/legal considerations. Oh, and I need to pay Abbi for her excellent design work so far.
I might have some time in late March. I’ve got a long-planned return trek to Las Vegas scheduled. I’ll do three nights in Sin City. Knowing my travel companions as I do, I figure my mornings will be free to work on stuff. Since I’m the only person who seems to arise before the sun begins to set.
Lent begins tomorrow. Interesting perspective on the Lent/Easter cycle given my time this year as an RCIA sponsor. I think I will, for the first time ever, attend a Chrism Mass at the Cathedral. Maybe I’ll get to meet the new bishop.
All for now.