My Indonesian domestic maid really wants us to visit South Korea. Well, Korea is not a bad choice, but we kept thinking until recently.
The downside with Korea is that my maid's boyfriend works there as an illegal citizen. She'd love to go there and meet her sweetheart - but she can't get the visa without our company.
We finally agreed to go. That made my maid happy. This isn't to say that going to Korea doesn't take any kind of courage. I'd be lying if I swear my maid won't hide in Korea and elope.
I told my daughter we won't travel together with our maid in Seoul. She nodded. This time we bought a travel guidebook (that tells us a great deal about the parks there) and borrowed a Lonely Planet guide. We didn't speak Korean and yet we found ourselves bouncing around in the enormous Children's Grand Park. One of the best things that we found in the park is that she'd never run out of ideas (or energy) in the playground. She ran up and down and made new songs - she really loved the castle with two decks.
It was much more than that. At the zoo in the park, she learned how to distinguish boy mandarin ducks from girl ones by their plumage. She became fixated by the way how cormorants catch and swallow fish.
Two days later, my daughter thought of going to the park again. We did.
We combined the activity with a visit to the Seoul Children's Museum just next to the park, and that turned out to be right decision. As we wandered and wondered through the museum, discovering grasshoppers and tadpoles with magnifying glass, learning to create handmade motion pictures, we almost missed the chance to visit the royal palace - one of the "has to see" items listed in travel books. That's perfectly fine. Trust me, you should consider yourself really lucky to make up and tick your own to-do list within a journey.
We left Seoul (together with our maid, by the way) feeling enlivened and proud that we'd stumbled on an itinerary that celebrated the triumph of the travel with children.
Monday, October 21, 2013
Thursday, October 10, 2013
Metric
I'm not a great fan of performance indicator, particularly those key performance index in our hospital setting. It's really about a quality metric that is worse than useless.
It is often the case that hospitals struggle to get a better score to prove their quality. But the score might tell otherwise. The performance score runs lower and lower, unlike the hospital team's anxiety that swelled and swelled with each passing day. So eager we're to fulfill the quest of performance index that we strive for the top score by hook or by crook.
The obsession with scoring system is understandable. The scoreboard has been in place for all of us in school, from clan to clan, culture to culture, and it is embraced earnestly and repeatedly. The hard truth is, most parents believe in the score. Some students, and many teachers, do. An important and oft-quoted metric on the scoreboard is the "intelligence quotient." But there's an old parable in which two cavemen were frightened when the earth shook with each footfall of a grumpy sabre-toothed tiger. The first caveman named Ug, with his mathematical and logical intelligence, tapped his chin and calculated the angle from which the tiger is approaching to the nearest degree. His mate, Thug, with the bodily or kinetic intelligence, ran away. "Who's the clever one now? Ug or Thug?"
I will say that, whether you're a parent or a hospital manager, should not miss the article "Performance Anxiety - What Can Health Care Learn from K-12 Education?" published recently in the New England Journal of Medicine. So, then. You will see how similar the health care and education system have been misled by the shortsighted performance measures. Examples of the top-down performance measures at school: students' achievement in standardized mathematics or reading tests, teacher's certification status. Just as how physicians lose performance points when patients cannot meet certain performance targets because they were dealt bad genetic and environmental hands, teachers are hold accountable for students' varied developmental timeline and many other uncontrollable factors in their lives. In turn, the author proposed a new bottom-up performance measuring system that, for instance, looks at the discussion and questioning skills, ability to engage students in learning, the expectation that students will correct their mistakes. The proposed measures to be assessed in hospital are similar: measures of patient experience such as effectiveness of physician communication about diagnosis and treatment.
Still, in the presence of pay-for-performance programs, many of us will pay more attention to the top-down performance measures. One good example of such outcome measures is the complication of venous thromboembolism after surgery. That's referring to a blood clot that forms in a vein deep in the body. It's a neat trick to blame and punish the "bad apples," referring here to those hospitals with more event rates of venous thromboembolism. Is it that simple? A new study, using data for nearly 1 million surgical discharges from 2800 hospitals, makes a solid argument against this measure. To cut the story short, the venous thromboembolism rates simply reflect how aggressively doctors look for them, but probably are not directly related to quality of care.
In other words, because some doctors more aggressively look for complications, they find more and appear to have worse outcomes. Good lesson to learn.
It is often the case that hospitals struggle to get a better score to prove their quality. But the score might tell otherwise. The performance score runs lower and lower, unlike the hospital team's anxiety that swelled and swelled with each passing day. So eager we're to fulfill the quest of performance index that we strive for the top score by hook or by crook.
The obsession with scoring system is understandable. The scoreboard has been in place for all of us in school, from clan to clan, culture to culture, and it is embraced earnestly and repeatedly. The hard truth is, most parents believe in the score. Some students, and many teachers, do. An important and oft-quoted metric on the scoreboard is the "intelligence quotient." But there's an old parable in which two cavemen were frightened when the earth shook with each footfall of a grumpy sabre-toothed tiger. The first caveman named Ug, with his mathematical and logical intelligence, tapped his chin and calculated the angle from which the tiger is approaching to the nearest degree. His mate, Thug, with the bodily or kinetic intelligence, ran away. "Who's the clever one now? Ug or Thug?"
I will say that, whether you're a parent or a hospital manager, should not miss the article "Performance Anxiety - What Can Health Care Learn from K-12 Education?" published recently in the New England Journal of Medicine. So, then. You will see how similar the health care and education system have been misled by the shortsighted performance measures. Examples of the top-down performance measures at school: students' achievement in standardized mathematics or reading tests, teacher's certification status. Just as how physicians lose performance points when patients cannot meet certain performance targets because they were dealt bad genetic and environmental hands, teachers are hold accountable for students' varied developmental timeline and many other uncontrollable factors in their lives. In turn, the author proposed a new bottom-up performance measuring system that, for instance, looks at the discussion and questioning skills, ability to engage students in learning, the expectation that students will correct their mistakes. The proposed measures to be assessed in hospital are similar: measures of patient experience such as effectiveness of physician communication about diagnosis and treatment.
Still, in the presence of pay-for-performance programs, many of us will pay more attention to the top-down performance measures. One good example of such outcome measures is the complication of venous thromboembolism after surgery. That's referring to a blood clot that forms in a vein deep in the body. It's a neat trick to blame and punish the "bad apples," referring here to those hospitals with more event rates of venous thromboembolism. Is it that simple? A new study, using data for nearly 1 million surgical discharges from 2800 hospitals, makes a solid argument against this measure. To cut the story short, the venous thromboembolism rates simply reflect how aggressively doctors look for them, but probably are not directly related to quality of care.
In other words, because some doctors more aggressively look for complications, they find more and appear to have worse outcomes. Good lesson to learn.
Wednesday, October 9, 2013
Praise
I received a phone call from my daughter's kindergarten yesterday morning. That's her school picnic day. If you're worried that the call was to announce the cancellation of picnic, don't worry - the weather was perfect. The call was all about my daughter's lunch box.
"Hi Jasmine's daddy. Auntie Elsa didn't give Jasmine back the lunch box yesterday when the school bus came. The lunch box is with us, and Miss Rebecca will bring you the lunch box today. Remember to ask Rebecca in case she forgets; Jasmine will need the box to bring her lunch tomorrow."
I didn't say much, except the two big words "Thank you." It's beautiful to have such a sunny day and a fabulous school team.
We received the lunch box, and then told Jasmine the story.
"Well, not really," my daughter answered in a soft tone. "Auntie Elsa didn't forget. It's me. I forgot to take the lunch box."
I didn't know what to say, except two words "Good girl."
Confession time. I had not the foggiest idea where her laudable honesty comes from.
"Hi Jasmine's daddy. Auntie Elsa didn't give Jasmine back the lunch box yesterday when the school bus came. The lunch box is with us, and Miss Rebecca will bring you the lunch box today. Remember to ask Rebecca in case she forgets; Jasmine will need the box to bring her lunch tomorrow."
I didn't say much, except the two big words "Thank you." It's beautiful to have such a sunny day and a fabulous school team.
We received the lunch box, and then told Jasmine the story.
"Well, not really," my daughter answered in a soft tone. "Auntie Elsa didn't forget. It's me. I forgot to take the lunch box."
I didn't know what to say, except two words "Good girl."
Confession time. I had not the foggiest idea where her laudable honesty comes from.
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