For a child, FAIL is nothing more than the “First Attempt In Learning.” As her father, it’s my responsibility to help her grow comfortable with failing so she can be the best version of herself.

Likewise, in business, one of the biggest mistakes I see talented people make in their careers is being afraid to fail. The prospect of failing is so intimidating, they pursue goals they are guaranteed to achieve rather than aim for more ambitious outcomes they could miss. They are so motivated to avoid error, they shortchange themselves and their colleagues, sacrificing creativity and ingenuity for the safety of the status quo.

To make any decision is to take a risk. Some percentage of our decisions will fail. According to JP Morgan’s Chief Marketing Officer, , “If you’re not failing, then you’re not learning.”

One of the best ways people can get comfortable making fast decisions is to focus on “two-way door” decisions making, rather than “one-way door” decision making. Jeff Wilke, Senior Vice President of Consumer Business at Amazon, does a great job the critical difference between these two: “A one-way door is a place with a decision if you walk through, and if you don’t like what you see on the other side, you can’t get back. You can’t get back to the initial state. A two-way door, you can walk through and can see what you find, and if you don’t like it, you can walk right back through the door and return to the state you had before.”

Two-way door decisions are reversible and therefore require less vetting. As Wilkes says, “Why would we need anything more than the lightest weight approval process for those two-way doors?” What applies for Amazon as an organization applies to people as well. Why worry too much if you can walk it back?

As a CEO, I encourage my employees to make two-way door decisions. This may take the form of releasing a software enhancement that can be rolled back, or piloting a program within a single department before implementing company-wide.

One-way door decisions require more thought and buy-in since they cannot be undone. Both decision types have the potential to yield great results, but one-way decisions risk greater repercussions if they are wrong and take greater care and vetting.

If fear of failure is hindering your organization’s ability to innovate or your personal ability to take risk in your life, consider using the concept of two-way door decision making. It is a safe, simple, smart way to open up your employees or yourself to the risk of failure, and, more importantly – the risk of success.

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Many providers contend the shift is the result of sicker patients coupled with the widespread implementation of electronic medical records, as treatment and documentation of more complex cases requires greater time and effort. But the persistent increase in costlier codes has made pursuing potential billing abuse a Justice Department priority.

One area of focus for federal investigators has been upcoding, the practice of deliberately billing for more extensive and costly services than were actually performed.

In February 2017, nationwide hospital staffing provider TeamHealth Holdings agreed to plus interest to settle allegations that its hospitalist group practice, IPC Healthcare, submitted upcoded bills to Medicare, Medicaid, the Defense Health Agency, and the Federal Employee Health Benefits Program.

In June 2017, Carolinas Healthcare System agreed to to resolve allegations that it billed federal health care programs for “high complexity” urine drug tests when the tests conducted were only of “moderate complexity.” According to court documents, this upcoding persisted for four years and cost the government an extra $80 per test.

In October 2017, multi-location New York Spine & Wellness Center agreed to to resolve improper billing claims after a federal inquiry determined the practice routinely billed for moderate sedation services – which require physicians spend at least 16 minutes with patients – despite its doctors not meeting the minimum time criteria.

But upcoding is not exclusive to tax-payer funded health care. In the case of New York Spine & Wellness Center, for example, a private insurer first detected the Center’s sedation upcoding in January 2015, initially rejecting two claims that fell short of the 16-minute rule. A subsequent audit by the same insurer resulted in more rejections, but the Center continued its upcoding abuse for two more years until the U.S. Attorney’s Office intervened, seeking to recover overpayments by the state’s Medicaid program. Indeed, of the $1.9 million settlement, more than $660,000 will be returned to the New York Medicaid coffers.

Outcomes such as these are terrific news for taxpayers, but such retrospective vigilance by the Feds has little to no impact on private insurers, employee organizations, and individual payers.

While the government concentrates on recouping federal dollars post-payment, medical cost containment firms must protect private payer clients from overpaying upfront. For example, 911łÔšĎ uses tools such as in-depth bill review by certified coders and nurse auditors and pre-negotiated, bundled rates to wean out upcoding and other billing abuses on a transactional level. Such proactive approaches are a key core competency of medical cost management, and continue to be as important today as they have been historically.

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To help combat this crisis, organizations such as the Official Disability Institute (ODG) and The American College of Occupational and Environmental Medicine (ACOEM) have released guidelines for prescribers in the appropriate use of opioids for treating pain specific to workplace injuries.

In a published in a recent edition of the Journal of Occupational and Environmental Medicine, researchers at the ReedGroup and Kaiser Permanente retroactively applied ACOEM’s April 2017 guidelines to 7,840 patients who underwent carpal tunnel release (CTR) surgery from 2007 to 2014. Of the 70 percent of cases prescribed an opioid, 29 percent were contrary to the guidelines, which recommend no more than a five-day supply of short-acting opioids for acute postoperative pain for new users. Patients given greater dosages averaged disability durations 1.9 days longer and medical costs $422 higher than their ACOEM-compliant counterparts.

While these cases were not exclusively workers’ compensation related, given the volume of injured workers who require CTR surgery annually, it’s easy to see how following the guidelines could substantially benefit payers and patients. The study estimates if 29 percent of the 577,000 CTR procedures performed annually were prescribed an opioid according to ACOEM’s guidelines, the potential medical cost savings is $71 million per year with a reduction in disability durations by 124,000 days. Incredible.

Clinicians at the Center for Surgery and Public Health at Brigham and Women’s Hospital took guideline research a step further by analyzing more than 200,000 postoperative opioid prescribing patterns to define the ideal prescription length by procedure type. Their , published by JAMA Surgery, determined the optimal length of opiate prescription was four to nine days for general surgery procedures, four to 13 days for women’s health procedures, and six to 15 days for musculoskeletal procedures.

While it’s too soon to know the time and monetary impact these guidelines could yield if implemented, it’s heartening to see that the risk of prescription opioid misuse is being considered when looking to alleviate temporary acute pain. We must all be mindful of what is in the patient’s long-term best interests and limiting opioid prescription duration is a critical step in that process.

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At Kaiser Permanente, virtual patient encounters now outnumber in-person visits. , his health system saw more than 110 million people last year, with some 59 million connecting through online portals, virtual visits or the health system’s apps. That figure represents more than half of the organization’s total 2016 visits.

“We are going through a major transformation in healthcare,” said Tyson.

At (NYP), their suite of telemedicine services includes adult and pediatric emergency and urgent care, virtual follow-up visits for surgical and psychiatric patients, and a second opinion program.  Such telehealth adoption has yielded dramatic results. In the ER, for example, low-acuity patients are now seen virtually by an ER physician elsewhere in the health system, reducing average wait times from 2.5 hours to 31 minutes.

Moving forward, NYP aims to make 20 percent of all patient visits virtual, a goal that seems readily attainable given its volume of virtual visits has increased 100 percent every month since it began piloting telehealth services in 2015.

Although telemedicine has yet to significantly impact workers’ compensation or auto, its day is coming. Workplace health clinics, such as the kind operated by , are now augmenting onsite occupational care with telemedicine services. Consider the case of a California factory worker with a blistery hand rash who had her condition treated via a teledermatology visit at her employer-sponsored clinic. It’s only a matter of time before onsite injury assessments, follow-up status calls, and prescription management are conducted virtually, with great cost, comfort and convenience benefits for all parties involved.

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However, sometimes organizations can get bogged down with too many key performance indicators (KPIs), copious desirable employee traits and overly complex review processes, so it’s nice to have a quick, “back-of-the-napkin” measure of employee value.

According to businessman Mark Cuban, the secret to career longevity in his billion-dollar empire is the ability to lower his stress level.

In a recent with Money magazine, Cuban shared, ‘’Anybody who reduces my stress becomes invaluable to me.  I never want to get rid of them.’”

Cuban’s approach really resonated with me. It’s a seemingly simple litmus test that easily encapsulates so many desirable workplace traits:

• Reliability
• Accountability
• Resourcefulness
• Team Player
• Skilled Communicator
• Solution-Oriented
• Conflict Resolver

As any manager can attest, leading teams and organizational functions is often stressful. With so many responsibilities to juggle, it makes perfect sense that an employee who minimizes disruption and spares you headaches is an invaluable asset.

So, the next time I’m considering an employee for a promotion, conducting a review or assessing performance coaching opportunities, I’ll be keeping Cuban’s insight in mind. Asking myself, “Does this person reduce my stress?” is a wise way to gauge an employee’s current worth and potential coaching needs.

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I think back to college. There were courses I admit I put off most of my effort until a day or two before the test. I would then “cram” all the information in as quickly as possible. It worked on test day, but if asked the same questions a few months later, I likely would not have known the answers. Had I spread out my learning over the whole semester, doing a little bit of learning and coming back to it, my ability to retain the information would have been much higher.

Imagine filling a bucket with a hose on full force. Let go, and the bucket has water, but it still has lots of room at the top. Try again. Water flies out of the bucket and still there is room at the top for more water when you are done. Now put the bucket under a faucet with a slow drip. Eventually the bucket will not only fill to the top, its water will actually bead up over the bucket’s edge, yet all the water is still retained. It appears learning works much the same way.

During my years of practicing Jiu Jitsu, we successfully used the interleaving method. Instead of teaching students a single technique until they perfected it, we would introduce a technique and not come back to it for a while. We would vary their training exercises. Mastery still required students to exert sustained effort over time but avoiding repetitive practice sessions sped their progress.

Not only do mixed practice sessions increase learning rates, they also improve retention. Upon completion of three months of math instruction, a University of South Florida showed that middle schoolers taught using the interleaving method tested 25% better than their blocking-educated peers. More impressive, they scored 76% better one month later.

One explanation for interleaving’s dramatic results is that the technique actually makes it difficult for the brain to rely on rote responses. Since practice sessions cover multiple skills, the same approach cannot be applied to every task. Think about your daily commute. Most of us take the same route every day, driving almost on auto-pilot. But what happens if there’s a detour and you find yourself on unfamiliar streets? You’re forced to pay more attention to get where you’re going. Interleaving is taking “deliberate detours” to hone one’s abilities and cultivate critical thinking.

Sleep is another theory for why interleaving works. During sleep, your body moves memories, thoughts, and learning from short term to long term memory. But not all of this information goes from short to long term in one night. Each time you come back to a subject, more of that knowledge is transferred into your long term memory while you sleep, allowing your body to add more pieces to the puzzle and making the learning more permanent.

When training new hires, many organizations teach and test on one procedure at a time over the course of long, consecutive days. This can produce a false sense of mastery, with employees using a single strategy, held temporarily in their short term memories, to fulfill onboarding requirements. For greater, long term impact, training topics need to be varied and sessions need to be conducted in smaller time increments. Topics need to be repeated over time. While it requires more initial effort, the rewards of interleaving make it well worth the extra planning.

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Complaining

Complaining in excess of 30 minutes a day damages a person’s brain, according to research by Stanford University biology/neurology professor . Whether you’re the griper or the listener, persistent exposure to negativity peels back neurons in the hippocampus – the part of the brain used for problem solving and cognitive function. Over time, complaining becomes habitual, and, if you’re surrounded by complainers, you’re more likely to become one.

To keep my brain as sharp as possible, I surround myself with positive people. Chronic complainers who consistently give voice to what’s wrong in their lives or who persist in seeing the world from a “glass half empty” perspective drain my energy and I avoid them. I also strive to practice discernment instead of judgement. Discernment is looking at a situation and saying, “I would have handled it differently.”  Judgement is saying, “I can’t believe the fool did that.” Judgement is draining, discernment is not.

Gossiping

“Gossip creates gall, envy, and torture that disrupt digestion and create mal-stress,” Dr. Kathy Dooley. “This stress exacerbates anxiety, tension headaches, and other pre-existing symptoms associated with stress.” On top of the physical maladies a gossiper themselves can experience, their words can hurt others and disrupt otherwise healthy workplace relationships and environments.

When I witness high school level social interactions in a professional world, gossip usually plays a large part. My customary counsel is never to say anything behind a person’s back that you wouldn’t say to their face. Of course, in business, there are times when we have to coach up or part ways with an associate and determining the right course of action requires discussing the person without them present. But if you have your coworkers, clients, and the business’ best interests at heart, the odds are any discussions will be devoid of gossip.

Making Excuses

All of us fall short sometimes. But explaining why we failed doesn’t negate the fact we did. Nor does prefacing a new project with a big disclaimer so we have a ready excuse when we don’t succeed.

“Wisdom stems from personal accountability. We all make mistakes; own them… learn from them. Don’t throw away the lesson by blaming others,” advises behavior scientist and author Steve Maraboli.

Setting (specific, measurable, attainable, realistic, time-bound) goals at the outset of any project increases the likelihood of repeated success. And embracing failures when they do occur demonstrates maturity and self-awareness. In my experience, people who succeed more than they fail and who own up to their failures are best suited for leadership roles.

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Most of us know people who are pretty smart in general and who can easily analyze the flaws of others, but struggle to apply that same analysis inward.

Sometimes it’s difficult to be self-aware, and it can be painful to really look at who you are through an unbiased lens. In fact, it’s almost impossible to evaluate yourself as clearly as others do. We all have “” – the tendency to interpret new evidence as confirmation of one’s preexisting beliefs or theories – which is often formed in childhood and influences everything we do, say, or believe. Personally, I try to force myself to be more self-aware, but I know I am not perfect at it and strive to improve every day.

If you have recurring patterns in life that are not what you want them to be (e.g. relationships, career, happiness, etc.) and you find yourself shifting responsibility to external factors/sources, try focusing that attention inward and becoming more self-aware.

Consider , for example, he “needed to fail before he could develop more accurate self-awareness.” Jobs’ narcissism at Apple made it near impossible for him to effectively collaborate with others, a flaw that led to him being removed as head of his own company’s Mac division in 1985. It was during his tenure as Pixar’s CEO during the mid-90s that he learned to be more collaborative and cede some control to others, according to , Pixar’s CFO. The emotional maturity and management skills he acquired in the aftermath of his Apple ousting laid the foundation for his successful return to the company he founded in 1997.

In your own quest for self-awareness, here are some questions the Inc. article suggests asking yourself:

1. Why do the same issues keep coming up over and over in my business/career, marriage, or life?
2. Why do I respond to situations with anger, fear, optimism, or withdrawal? What are my triggers and why?
3. What makes me think, act, and feel the way I do?
4. What makes me tick? What pushes my buttons?
5. What areas in my life can I improve or mask in my behaviors to make me more successful and happy?

I know it takes more than one article (or my little blog post) to change behavior. Still, if this is helpful to a handful of people, I will share that becoming more self-aware has helped me in my life and it is a worthy endeavor.

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