Lean Health Care Discussion

Recently I received an email communication from Helen Zak, Chief Operating Officer of Lean Institute http://www.lean.org/ in Cambridge Mass reminding me of the ongoing debate in Washington D.C. regarding Healthcare and how Six Sigma and other lean process analysis tools might be utilized to save money, increase efficiency with medical claims processing and ultimately make the quality of health care better. We have not heard much discussion about the wonderful lean work being done in the public sector, both in the healthcare setting and in government. In response to this apparent lack of awareness the Lean Enterprise Institute has collaborated with the ThedaCare Center for Healthcare Value to form a nonprofit partnership to make sure lean thinking is part of the current discussion and the future state of healthcare in United States. You can learn more by reviewing their statement of values at http://www.healthcarevalueleaders.org/partnership_announcement.pdf

This seemed very important news to share with the Continuous Improvement blog community, especially in these economic times. Certainly lean thinking and tool use is not a panacea for all the ills of government, healthcare and manufacturing, but in most cases incorporating this analysis in the planning process of each of these industries will increase product and service outcomes and assure the highest customer satisfaction. To completely ignore these effective process analysis tools in the health care discussion would be, dare I say, ridiculous.


Patience comes with age and wisdom. When you are young you want everything now. Right now, not in a few minutes or a few days or, in the case of completing college or starting a business some amount of years. But as time goes on we learn that all good things eventually come. I wrote a poem many years ago and it recently became more meaningful. Here it is.


Patience is a funny thing,
that not inside of me.
I wonder how, and why, and when,
patience will come to me.
I hope it’s soon for it’s getting late,
I really am afraid.
For if I don’t get it soon,
I just will have to wait.

Available in 4 wallet size booklets Transformation Press

Spiritual Resources

Spirituality is a personal issue. We must each find our own path and then stay true to it.

I was raised in the protestant tradition. I attended the First Presbytarian Church of Pitman as a child and teenager. In College I met and married a wonderful Lebanese Maronite women. I discovered Eastern Christianity which combined my Christian upbringing with eastern spirituality in a Monastic tradition. St Sharbel a Maronite Monk sets the tone and reverence of the Divine Liturgy.

In 1978, after a year of study with the local Maronite Priest, I converted and became a Maronite Catholic.

May God be with you (and me) in your (our) search for the source of life and truth. Ultimately I believe you will find God within you and within others who believe.

Once, having been asked by the Pharisees when the kingdom of God would come, Jesus replied, “The kingdom of God does not come with your careful observation, nor will people say, `Here it is,’ or `There it is,’ because the kingdom of God is within you.” (Luke 17:20-21) This last line has also been interpreted as the “kingdom of God is within your midst”.

You must discern for yourself which meaning rings true. For me the silence of prayer and regular attendance at the Maronite Divine Liturgy is the best way to discern this. Silent prayer is best practiced as Centering Prayer, as taught by Fr Thomas Keating and discussed in the Cloud of Unknowing.

Thank you Fr Keating and others in the Centering Prayer and contemplative network, my connection to you sustains my hope in the Lord, which is supported by unending Love provided to me from the Maronite faith and particularly the people of St Joseph Maronite Church in Waterville, Maine.

Peace Be with you.


Below are some other links that may help you in your spiritual search:
The World Community for Christian Meditation
A Christian Way to Transformation by M. Basil Pennington, O.C.S.O.
Society of Friends
Centering Prayer Articles by Fr Thomas Keating
Sacred Space: a Jesuit website for daily prayer

Contemplative Outreach
Living Water Spiritual Center
Bible Search

Here are some other links related to the Maronite Church

The Maronite Diocese
Bkerke: Home of Maronite Patriarche
Our Lady of Lebanon – Washington,

Copyright (C) 1997 – 2008 Stephen C. Crate Permission is granted for academic use of this material if cited appropriately.

Recovery and Rehabilitation Perspective

Successful mental health recovery and rehabilitation is a process that has evolved to an individual recovery process or model. Individual responsibility is the key. Unless you make a conscious choice to move forward and recover, it will not happen. While there may still be a need for medication and medical treatment when biomedical imbalance exists or regular psychotherapy or counseling is necessary, this approach transcends the medical model with a significant paradigm shift. It adds a spirit dimension to the healing process. The spirit dimension adds the awareness that your spirit or consciousness exists beyond your ego and body. You accept where you are, be present in the moment and do what needs to be done. This is spiritual in that it relies on faith in something yet unseen. Some people choose to relate this to a higher power. Others consider it a function of the mind. In any event the belief must come from you. Recovery will not happen until this awakened spiritual consciousness is present.

I believe in YOU

Many mistake more traditional rehabilitation as occurring when the professional practitioner does something to the patient with the professional taking significant responsibility for success or failure. Was the therapy correct? Was the medication correct? Were the counseling sessions long enough? In the self directed recovery and rehabilitation process you take responsibility for your healing process with guidance of your rehabilitation counselor and support from other medical professionals you work with. Each contact between you and the counselor is a separate moment in time. The same process is utilized each time but the result is up to you. You decide the next constructive creative step from a list options in accordance with your vision for the future, your plan. The counselor empowers you to work your plan. The counselor encourages you to make conscious choice to move to a balance of function.

This model is based on a number of psychological theories. These include Carl Roger’s Client Centered Theory, Albert Ellis Rational Emotive Theory, William Glaser’s Reality Therapy and a touch of Victor Frankel from a Search for Meaning among many. It is an ecletic blend of these theorists and the individual counselors own centeredness. William Anthony is the prolific writer on this model. He is connected, among other institutions, with the Boston University, Center for Psychiatric Rehabilitation Another great source for this movement is the
National Consensus Statement on Mental Health

Mental Health rehabilitation process is recovery. Recovery is an ongoing process that must start now, where you are at, where you believe the focus is. Then each choice moves you towards healthy behavior and activity. The recovery model empowers you to take an active role in the decisions or choices regarding your future. There are some limits to this where medication is necessary to control biochemical imbalance. However, to the extent it is possible each decision must be made by you with guidance and a clear understanding of probable consequences of those choices or decisions. This process evolves your awareness with individual dilemma, then choice, suffering and choice, and then some success comes. It does not take place in a single point of time but rather is an ongoing recovery process. The choices you make are personal. Professionals cannot make the choices for you but rather facilitate the exploration of all options. Sometimes this requires going outside the box, at least during the exploration stage. By outside the box I mean using a brainstorming and/or visualization to imagine the ideal. Let the body, mind and emotions feel that ideal in a thought and that vision can then become a goal. When goals are visualized and believed they can be achieved. The goal must come from your center in recovery. Professionals may suggest, encourage or even demand certain goals but the final choices must be left up to the individual. The only exception of this is when the choice will be harmful to the individual or any other human. Then the professional must intervene.

Finally, psychosocial rehabilitation is still evolving in its own definition. Each time you fail to reach a goal, but get up and going again there is progress. Each success brings new possibilities for healing. The final measure is the peace and balance you experience, the ease with which you live and make decisions and the love you have for your self and others.

Email Steve

One Eye is Enough

It was Monday June 22, 1970, five days after I had graduated from a small high school in Pitman, New Jersey. I was working as a carpenters helper at a boys camp in Etna, Maine called Camp Katahdin. My grandfather had founded the camp in the thirties to bring boys from the Philadelphia area to Maine for an eight week summer camp experience. Most of the boys came from Friends Central School but other boys were recruited from surrounding schools. Friends Central was a Quaker school. I had come to Camp Katahdin every summer since my birth year, 1952. The camp was called Katahdin because the major summer activity for boys attending was to climb Mt. Katahdin.

Monday morning we started work. Before the day was over my life had changed forever.The project that particular day was to build a petition in the farmhouse on the main road. My task that day was to cut spacer two-by-fours to wedge in the petition and give it some stability. I was working out side the building and had finished cutting about ten spacers. I picked up the load and walked into the house, the carpenter was on a ladder toeing a nail into a top stud. Just as I entered the room where the petition was being constructed, I heard a ping. I looked up. Something struck my eye. I blinked. An eight penny nail fell to the floor. My eye watered. A sharp pain darted from my eye to the back of my head. I squinted my eye shut. I sat down and waited a few minutes. Then I tried repeatedly to open that eye but couldn’t. A co-worker rushed me to a local family doctor in Newport.

The waiting room was like someones living room. It seemed like hours before I finally was called in. I sat in the doctors chair. The smell of rubbing alcohol filled the air. My hand held a white gauze over my right eye. A sharp penetrating pain shot from my eye to the back of my head. The old Maine doctor approched.

“Let me see young man”, he calmly said.

The doctor removed the gauze from my eye and used his thumb and forefinger to pry my eyelids so he could get a better look. The light from his penlight burst through my eye with a kalidescope of bright color.

“What happened Steve?” he inquired, as he looked intently into my right eye.

“I was working in the farmhouse at camp. We were building a partition in the bathroom to make extra space for a closet. The carpenter was nailing a stud into the top plate. He had to toe it in because of the angle. I was carrying in a load of wall spacers. My hands were full. Just as I entered the room he hit the nail. I heard a ping. It wasn’t a square hit. I looked up. The nail struck my eye. I blinked. The nail fell to the floor. The pain started then and has gotten worse since.”

“How long ago did this happen?”

“About an hour and a half.”

“Is your father here”?.

“No a friend brought me, Dad is still at Camp” He looked into my eye again.

“You need to see an eye Specialist immediately.” The physician briefly left the room and returned with a nurse.

“Please put a loose gauze on this boys right eye I must call Dr. Osler.”
He went quickly to his desk. He pulled a small book from the right hand drawer. His eyes darted from the book to me and back to the book.

“There it is “, he muttered.

He dialed the phone. There was a pause. I froze.
“Hello Margaret this is Dr. Burke, is Dr. Osler in? He listened. His expression showed exterme annoyance.

” Yes it is an emergency”, he scorned.

My mind went crazy. Emergency? What had happened to my eye. Things had gotten into my eye before. A little water usually flushed the spec and everything was allright. Fear overwhelmed me for a momment, I was stunned I refocused on the what the doctor was doing.

The doctor got off the phone. ” Steve, you need to go directly to Bangor from here. I will call your Father. Dr. Osler’s office is off State Street a block or two from the hospital, he is expecting you.”

Emergency surgery was performed and the lense was removed. Luckily the nail did not pierce my retina. I was left with limited light vision and no focus, which is kind of like looking through four sheets of wax paper, essentially blind in my right eye. I stayed in the hospital for about three weeks and then was released home for the summer.

The fall of 1970 I enrolled in a local community college, and went out for soccer, but was unable to play. I would get tremendous migraine headaches every time I ran full speed or my head was jolted. This was one of my first major disappointments because I was jock in high school and relatively successful, although now looking back I could have been much better. With out sports I drifted from an academic purpose to a feel good purpose. College study time was in competition with other more ic pleasures such as drinking beer, listening to The Beatles, and trying to impress young beautiful college women, among other things. The only course I passed that first semester was Psychology 101. I remember a paper I wrote on autonomic function. That spark of knowledge led me to the interest I now have in quantum healing and rehabilitation.

I left school after one semester and headed for Boston with failure number one under my belt. That winter, the winter of 71 was my winter of discontent. I lived in a hippie Commune in Cambridge sold Boston Phoenix Newspapers on a street corner, ate a lot bagels and wondered about the future. By spring I was ready to get a real job so I moved home to Maine.

I worked as a junkyard auto disassembler at Rolnick’s in Brewer Maine for the summer and was fired. The owner told me I was too smart to do hard labor and that I should go back to school. I wasn’t ready for college, so I signed up to go to cooking school through CETA. The school was in Lewiston Maine. I lived at the Auburn YMCA, a real palace. While learning culinary arts, I started volunteering as a crisis counselor at a crisis and rescue center called Rap Place.

Rap Place was accross the street from the park and next to the police station. Recreational substance abuse was at an all time high. Some veterans were returning from Vietnam addicted to all kind of substances, and others with Post traumatic stress disorder, although I don’t believe it had been labled that yet. Street people were strung out on anything they could get their hands on. Street people were different in the early seventies. They were homeless because they wanted to be, runaways, both teenagers and young adults. Running from strict parents, pregnant wives and other situation beyond their coping skills. This was my first line training as a rehabilitation counselor. We maintained a 24 hour hot line. People would call in saying they had just eaten a bottle of blue pills or taken 10 hits of something else. Our job was to stabilize the individual emotionally on the phone long enough to find out what they had taken and to get an ambulance to the site quickly. We saved many lives back then. However, not all were grateful of our efforts. We once had a visit from a returning Vietnam Vet who came in wielding a 38 revolver. He wanted to shoot all of us. He said we were all communists because we didn’t go into the service. Luckily one of our staff members was a vet who was able to convince him we were all ok. That experience shook me. I decided to take a leave of absence.

I had saved some money so I went Europe to find myself. I lost my homemade leather satchel with my passport and all my American Express travelers’ checks two days after I arrived in Amsterdam. Two weeks later, after hanging around the American Embassy for hours every day, my passport and checks were returned to an Amsterdam police department. They had been found by some honest European. I was able to continue my trip. On to France, Germany, Italy and finally Spain, where I stayed throughout the Fall of 1971 and winter of 1972. Knowing some Spanish, I was able to get a job as a short order cook. I spent Christmas in the Canary Islands. They fill shoes left on the door step with candy and St. Nick rode a camel.

I returned to the states and continued working at the rescue center as a crisis intervention counselor but was tired of that kind of work. I was writing poetry and had kept a journal of my travels while in Europe the first time. I met a woman who told me she owned a villa in Spain. On the Island of Majorca. She said I could use it to write my great American novel. So I returned to Europe. What a mistake! There was no villa. She had lied to me. I had a difficult time with that situation. I couldn’t believe I was so naïve. Boy was I gullible. I began to question God and many other things. Why me? I never hurt anyone.

I traveled to the major city of Palma de Majorica and mingled some with local vendors. I had the great luck of meeting some Americans who ran a school in San Augusti Palma de Majorica. They hired me to coach the Basketball team, and cook. I remember cooking their thanksgiving feast that year.

Finally, I needed to come home immediately. But I was broke. I met some people who let me stay with them while I figured out what I was going to do. I finally had to get the money for a return ticket from my Dad, who couldn’t afford it because he was a public school teacher. This added to my anxiety. When I arrived in this country I was exhausted, stressed out and in need of some serious rest and relaxation.

I spent Christmas with my family and recuperated enough to enroll in College for a second try. I didn’t even complete the semester. I couldn’t stay focused. I had some residual anxiety leftover from my European trip. I did have one great experience during this period. I learned to use meditation as a calming focusing exercise. This was the beginning of my personal rehabilitation and recovery.

Over the next 18 months I worked as a short order cook and assistant manager. I was a good cook but I disliked the hours. I finally decided to see a Vocational Rehabilitation Counselor. I went through a series of assessment, physical and mental restoration and was funded for one year of college. I was to complete the rest of school on my own. I entered the University of Maine at Augusta in September 1974.

I met Allison that fall at UMA about two months after she had been in a severe automobile crash. She wore a scarf covering where they had shaved her head to do exploratory surgery. She walked with a cane and her pain medication gave her speech patterns a slight slur. I admired Allison then more than anyone I had ever met. This traumatic event had nearly killed her but she was able go on. She is the strongest person I have ever known. Over the years I have watched her heal to a point today where she works out every day and looks great. I tease her sometimes saying she was my first rehabilitation client even before I knew Rehab would be my life work. She has been my rock, my inspiration, and most of all my best friend. We were married in Augusta 1975.

I also had an inspirational experience in September of that same year. I was meditating and decided to pray that Jesus would enter my life. Even though I had thought I was a Christian long before this, raised a Presbyterian, I was awestruck at the experience. I believe the Holy Spirit touched my soul and I never have never been the same. I developed a relationship with God through that experience that has been nurtured by the Maronite Church where Allison and I were married. I also developed an interest in an Eastern Christian based monastic practice and called centering prayer or Contemplative Prayer . This has been a transformational experience for my spiritual development.

I have a great deal of respect for other cultures, religions and faiths. The Maronite approach to spiritual development and worship works for me. I have found my creative source in Jesus Christ. I have found a great sense of peace through this faith and I do believe that all people should seek their creative source and find peace in that center. Once we must be careful not to judge other peoples beliefs or lack of belief. Faith is a personal experience and there is nothing like sharing the joy of faith in a community of like minded people. I have found a home in the Maronite Catholic Church.

Next, as a response to my own injury and tragedy,  I decided I wanted to become a rehabilitation counselor. I began to focus my reading on rehabilitation and recovery related material. This included veterans with PTSD, Alcohol Dependency and theories of therapeutic intervention.   I graduated in 1980 from the University of Maine at Farmington with a B.A. in Rehabilitation Psychology.  Over the course of my career I have worked as therapeutic recreation staff, an Employment and Training Specialist, a Vocational Evaluator and started my private consulting practice working with other injured workers in January of 1985. October of 1987 I prepared and sat for the most miserable test of my life, the grueling CRC exam. I passed after having to appeal my application process three times. I founded a rehabilitation consulting company in 1985 which I closed in 1998 due to market conditions but continued working privately as work was available.  I had been serving on the YMCA board of Directors and became a participant in the merge with the Waterville Area Boys and Girls Club into the Alfond Youth center.  I worked there for a year with youth development and then got a job with the State of Maine.

I really enjoyed public service and feel challenged everyday to do a better job and empower as many individuals as I am able to get on with their lives. I sometimes feel like that rabbit on the battery commercial: He keeps on going and going and going.

I now see the emotional pain and turmoil of my eye injury as a blessing. It created a challenge and sensitivity in my soul that inspired my life and work. Only the inspiration did not occur immediately. It took a significant amount of self searching and struggle before I began to see that anything positive could come from such a traumatic occurrence. When I changed my attitude I was able to grow from the many painful, unique, and sometime extraordinary experiences.

I have had a great deal of help along the way and am extremely grateful for every bit of it. I have had a few unpleasant experiences related to the private Rehab business, but I am told that business is business. I went to Thomas College for a few years in the late 80’s to further my understanding of business administration. I learned alot. But, I also learned that private business was not going to be my life’s work. I think that is when a second life transition began. I decided I wanted to learn more about public service. I had run for City Counselor in 1987 but lost. I ran again in 1993. I was elected to the Waterville City Council. I also served on the Waterville School Board for a few years. I learned alot about our form of government. I began to think about public Service in a rehabilitation context. This was where I felt best. I returned to public sector with the Maine Department of Labor.

I decided I wanted to pursue leadership role in government. The fall of 2002 I was accepted into the Masters of Public Administration program at the University of Maine at Orono . I completed my Masters Degree in December of 2004 with a 3.7 GPA.  I then transferred to a position in the Bureau of Unemployment working in administrative law for three year hoping it would lead to a leadership/management role in state government.   I also trained as a continuous improvement practitioner learning the concepts of Lean Government, We Don’t Make Widgets, and other process analysis and organizational development strategies. What I have learned is that when the process is well defined it not only increases the capacity of employees to do their work better, it facilitates an objective way to accommodate for individuals with disabilities.

In July 2007 I transferred back to be vocational rehabilitation as a counselor but really was disappointed that the public sector did not provide any additional career promotional opportunities.  After I recieved my MPA I applied for more that 7 jobs with administrative duties related to my training and never got an offer.

I was ordained a Lector, Cantor and Subdeacon in the Maronite Catholic Church on October 24, 2010 and continue to serve on the altar each week.  I am taking some Spiritual Theology graduate online courses with an idea of eventually becoming a Deacon in the Maronite church.  I have surrendered to the will of God now and it will happen if it should.

I also left state government service to try the private sector.  I have worked in the disability benefit industry, mental health services and in a vocational assessment project.  I also consulted on a few legal cases that showed I still could do the forensic work if necessary.  I think I miss public service.

I leave you with an anonymous poem I have saved for years. I believe it reflects a helpful mindset of many faithful people who are civil servants, clergy, social workers, psychologists, educators, doctors, healers, rehabilitation counselors, business leaders, and community minded thinkers.

WE are the People Makers
WE frown they hide their heads,
We smile they come alive
WE hurl belief at them and,…
they succeed
“Take care of yourself by caring for humanity”
Copyright (c) 1997 – 2015 Stephen C. Crate
Permission is granted for academic use of this material if cited appropriately.

Divine Connection