I have introduced in prior writings a five step process that I have used in assessing and developing systems and procedures and the associated training protocols. I would like to expand on that here and also offer a few different perspectives from which to understand it. My primary objective is to communicate the reality of the challenge that faces those of us who have Type 1 Diabetes and to put forward a perspective and a process to achieve positive results.
The 5 steps are:
Step 1: Objective
Identify and state primary objective. What is it you want to accomplish or manifest? What does the outcome look like? It should be, in the end, a written statement that is specific, time bounded and measurable.
Step 2: Functions/Ingredients
The second step is to identify and prioritize the ingredients or functions involved in accomplishing the objective. This step is a brainstorming exercise followed by a ranking from most important to least important. What are the components involved? Which ones are more important?
Step 3: Systems and Procedures
In this step it is time to create a system that most effectively accomplishes the functions we identified in step 2. This is the creative step. How do I want to go about this? How do I integrate the tasks so that I am doing it in an effective way? What procedures do I want to put in place?
Step 4: Implementation
Step 4 is the implementation step. We work the system that we created. Training is involved here as well as action steps. What do I need to do? How do I do it? What should be my practice?
Step 5: Managing Outcomes
As a result of employing steps 1 through 4 we will have achieved outcomes. Step 5 is about managing these outcomes. How do we measure them? Am I getting the results I want? How do I enjoy the results I get? What are these results telling me?
The 5 steps are a step-by-step process but it is by no means linear. Instead it is more cyclical. Once we have reached step 5 and assessed our outcomes then it is time to go back and re-commit to the primary goals, explore for unseen or now more important functions or ingredients that we may have missed, alter systems and procedures, and evaluate our implementation strategies.
This 5 step process was born from what I have learned over the years as a systems developer and trainer. One of the most profound things I came in contact with is something called the Growth Cycle. The 5 step process mirrors the growth cycle. What is interesting, at least to me, is that many of my studies in metaphysics, religion and spirituality have similar tenets running through all of them. They all in one way or another refer to the cycle of growth from the seed level to the manifestation level. Christianity and Judaism reference the Tree of Life and the Tree of Knowledge. The Buddha sat under a tree and contemplated the roots of suffering.
The Growth Cycle has 5 steps as well:
Weaving the two processes together we have……
Step 1: Confusion
What is it we desire? What do we want to accomplish? This is the seed level. We want to reduce confusion. I have observed throughout my career a wide range of business operations. Those operations that had a clear and agreed upon understanding of what was the product or what it was they wanted to accomplish always did much better than those that were less clear on the objective. That is why it is critical to have this written and that it is specific, measurable and time bounded. I heard a quote a long time ago; “Production is the basis of morale.” Every one produces something. When there is clarity on what the end product is there is a higher chance that the product will be achieved and that individuals will know it. In fact, when it can be measured and there is a target date for achievement it makes it even more clear. Without this in place there is, at best, confusion and, at worst, chaos. Success has been defined as the realization of predetermined worthwhile goals. Perhaps the most important word in that statement is predetermined. We have to know what it is we want. We will always get some results. Without knowing what we want there is a disconnect between the desire and the fulfillment. Step 1 is all about eliminating that disconnect.
Step 2: Exploration
Once we know what we want to accomplish then it is time to start brainstorming the ingredients required to make the pie. What functions are involved. Sports and games are and always have been a big part of human endeavors. The metaphor of a game is applicable here. Every game has an objective; score more points than the other opponent, put the ball in the hole in the least amount of strokes possible, put the opponents King in checkmate, etc. Every game has component parts to it; the game board, a ball, a puck, a bat, a net, game pieces, the rules, etc. Step 2 is an exploration of the component parts. What is involved? What equipment do I need in order to play? What do I need to know how to do? In Step 1 we identified and stated our objective. In Step 2 we are exploring all of the things involved in accomplishing our objective. It is helpful, once we have done this, to list them and priority rank them. Which ones are more important? What things are necessary to plant it and ensure it has a chance at making it? We now know we need a place to plant it, good soil, a shovel, water, sunlight, etc.
Step 3: Incubation
Once we have completed step 2 it is time to put together a strategy in which the ingredients and the functions can be put together and systematized. Step 3 is the process of incubation. It is the creative stage. We want to make sure that we put the ingredients together effectively and that what needs to get done gets done in an effective, systematic manner. We have put the pie together. Now we are putting it in a dish and sticking it in the oven. This is where magic seems to happen. In my experience I have seen business operations become significantly more productive simply from an objective assessment followed by a “tweak” in the in their current systems and procedures. Kinda like needing a teaspoon or two of salt or baking soda in a food creation. It can make all the difference. Too much water on the seed will kill it. Not enough will kill it. Step 3 is where everything is put together so that it can work. In our game analogy…….where in step 1 we became clear of what the game is and what the objective is and in step 2 we explored and gained an understanding of the component parts, now in step 3 we are putting that all together as a strategy for getting out there and playing.
Step 4: Illumination
Now we are ready to play. I have played many sports in my life and also love watching them. I played golf, hockey and soccer through college on a relatively high level. There is nothing like getting out there and competing. Step 4 includes all of the actions and all of the effects caused from these actions. It is the manifestation stage. The seed has been planted, we smoked out all of the required ingredients and functions involved in ensuring the success of the seed, we created the environment necessary by integrating the ingredients and functions into a system. Now it is time for something to break out and be realized. From our game perspective it is really about donning our equipment, practicing and playing. Step 4 involves training because training is an action not just a system. In fact, most successful athletes who play sports at the highest levels will tell you that they practice at least 10 times more than they actually play. I would submit that the highest level of illumination and implementation occurs when practice is seen as playing. Nevertheless, this is where we put our systems and procedures into action. For every action there is an equal and opposite reaction. This is an agreed upon law of of our universe. Another way of saying it is that for every cause there is an effect. So this is the cause and effect step. This is the ……”curtain is up” time. Back to our seed analogy…….The desire of the seed has broken out and manifests into it’s intention. The result, in the case of an apple seed, is roots, a trunk, branches, leaves, buds, and ultimately apples.
Step 5: Celebration
I, at first, was confused about the word celebration here. As I contemplated it I began to see how profound a perspective it seeks to create. A lot of people set goals. A matter of fact, a lot of people set goals and write them down, and brainstorm the ingredients and functions and create amazing systems and procedures and train and implement well. And then what happens after that is that things are manifested and created and production is sometimes good or bad. In other words, there are results. What happens with most operations I have observed is that results are used for one of two reasons. 1. To point out the shortfall from what the goal was. 2. To use them as an excuse to raise the bar; to set a new goal. This is how outcomes are used to cycle back to one of the previous steps. I heard a quote once from one of my mentors in training. He said, “Goals are for planning. Results are for pleasure.” This is the perspective that the growth cycle suggests in using the word celebration. Results are to be received and processed with validation and celebration not with criticism or a sense of loss. Once this has happened then it is time to cycle back to step 1 to perhaps reassess, explore, create, train and implement. Step 5 is not the end. Yes, the apple seed has turned into and apple tree and yielded fruit. And yes the fruit has become ripe and is ready to be picked or fall from the tree. But within the apple is nutrition, good taste and pleasure. And within the ripened apple are more seeds that can be planted. To touch on the game analogy…..Step 5 is about the score or the outcome of the game. Sometimes you win and sometimes you lose. Sometimes you achieve your primary objective and sometimes you don’t. This step is not about lamenting the loss or focusing on the shortfall. It is about celebrating the results.
Now, I want to take the two step by step cycles I have intertwined and add one more perspective. This third perspective will be instilled with the topic of Type 1 Diabetes as it’s heading. Three is an important number. The addition of the third dimension achieves a balance that two dimensions cannot achieve. Two dimensional perspective is quite common and accepted in our world. Polarity and duality seemingly exists throughout nature; positive – negative, male – female, light – dark, good – bad, ying – yang, etc. The third dimension is the one that connects the poles. In a light bulb there is the positive end of the circuit and the negative end. Connecting the two together creates a great spark of light but is followed by a short circuit. The third component in the equation is the resistor or the filament. This is the one that allows a circuit to be performed. This is the one that results in lasting and sustained light. So this third perspective is something I have recently been working on so it is not perhaps complete but here it goes. It mirrors the previous two cycles set forth.
Step 1: Confront
The objective in the game of dealing with Type 1 diabetes is to balance blood sugars between a predetermined acceptable range resulting in A1C’s below a predetermined number. Having stated that as the objective the confusion surrounding the diagnosis of the disease is significant and must be worked through before one can most effectively move on to the next steps. Being diagnosed with diabetes kind of feels like being on a plane and having the oxygen masks drop down amidst tremendous turbulence. Everything feels out of control. So, in addition to establishing our objective we must deal with this being out of control and all of the confusion that comes with it. We must confront the reality of the situation. And we must first put on the mask which implies we must breathe. There is a lot to learn and everyone of us has different tools to deal with the situation. Confronting is sometimes the hardest part. Many of us are resistant to it. But this is a game that demands a serious and courageous attitude of confrontation. A system within the body has failed and has been destroyed. We need to know that. The system that failed is critical to the survival of the rest of our existence. We need to create a manual system outside of the body that simulates the internal system of a normal person; us just before the diagnosis. If we are unable to create this manual system we will cease to exist in a matter of weeks.
Step 2: Understand
Now we are ready to explore the ingredients and the functions involved in achieving the objective of balancing blood sugars. I am not going to go through all of them here but we know the main ones – food, insulin, physical activity. We need to understand how these parts work in a normal person and that we are going to put them together to create a new system.
Step 3. Integrate
This is the step where we put things together. A lot of this is understanding the strategies of insulin delivery, i.e. basal rate, ISF, insulin-carb ratio, carbohydrate counting and exercise.
Step 4: Master
The problem I see in the education of people with Type 1 diabetes is that they have been unable to either confront, understand or integrate what they understand. This means that they will never reach step 4 with all they need to achieve mastery. And mastery is what you need if you hope to get the results you stated in step 1 in this game. Sure, people survive and live. But they are compromised with high and low blood sugar swings, complications and doctor visits. This game ranks really high in difficulty. It is like one of those gymnastic routines that many try but few pull off. The secret, in my opinion, is in the first three steps. And the seed level is in step 1. Not just in the objective statement but in the quality and sustainability of the confrontation. Mastery in this game requires constant practice and implementation. You really are up on a high wire and taking the eye of the ball means falling off. Everyone falls off..even the masters. But the masters hustle to get right back up on the wire. They run they don’t walk. You see mastery involves attitude more than knowing what to do and how to do it. And attitude is developed and enhanced by working these steps.
Step 5: Triumph
I am not sure I like this word for the final step. At first, I used God willing, Conquer . Then I changed it to Liberate. Now I am using Triumph. Every 3 – 4 months we get an A1C number. This tells us how successful we have been in staying in range. Every day we should be testing our blood sugars at least 8-10 times per day and more if needed. Blood sugar results are the feedback we need to know how we are doing and to intelligently make adjustments and corrections. I am very excited about the continuous blood sugar monitors. They don’t work for me if I need a second port in me. I have enough trouble with site maintenance without adding another one. No matter how much I have prayed and no matter how much Voodoo magic I engage in I have not, to date, been able to cure myself . But one thing I have not done is given up. Not yet at least. And as I enter my 32nd year with the disease I find myself healthy and desiring to help others. I have not nor will ever give up the dream of a cure. So, in step 5 it is important to celebrate what we are grateful for and for what we have achieved. Everyone with Type 1 diabetes whether struggling or balancing with ease is triumphing, to some degree, by continuing to battle and not give up.