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The Business of Diabetes

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I am not going to discuss economics or money. I'm going to talk about management.


Effective managers have authority to make decisions, they are responsible for achieving objectives, and they are held accountable for their decisions. Too often in business these three get out of alignment. We might tell our managers to run their unit, but we might also tell them that any expenditure over $1,000 has to be approved by a director. We might not give our employees bonuses because they didn't achieve their goals, but when we dig into it, we discover that those goals were forced on them and we gave them no authority to make necessary and timely decisions. There are countless examples of this sort of mis-alignment in the business world, and it will keep management consultants employed in perpetuity.


One of the turning points in my own self management was to determine who had authority, responsibility, and accountability. Obviously I was being held accountable. It was my fault my A1C was in the 7's or higher. It was my fault my eyes were deteriorating. Nobody was suffering but me. Well my family was too. Dealing with my hypos was not fun.


Not only was I not taking responsibility for my disease, but my doctors weren't delegating it. Doctors don't do that. Well they do some, but they don't act like a senior business mentor that discusses your actions with you and encourages you to take the reigns. No, our doctors generally want to make decisions for us. They only delegate what they feel i necessary.


Authority is not an easy concept to get your head around. It's very similar to responsibility, but they are different. I can be responsible for dosing my insulins, but I will never have the authority to prescribe it to myself. My doctors and my insurance company, Medavie Blue Cross, held most of the authority. But I can certainly make the decison on which meter to use, where to buy my supplies, and how many strips to buy.


The disconnect was in responsibility, and it likely is in your world too.


Understand that you are being held accountable for your actions. Your doctor might say to you "take 5 to 10 Novarapid" before lunch, but it's you that suffers when that doesn't work. Is your doctor going to work hard at finding a unique dosing system that works for you? Not bloody likely. They'll maybe modify it slightly at each three month visit, charge you a few bucks for their services, and wait for you to fail again. And you will fail again. This disease needs rapid decision making. We can't send every decision to head office. We need to act now. If we ever want good decisons made, we need to take responsibility for making those decisons.


My health team members are now consultants. I ask them questions, and I listen to their advice, but I make my own decisions. I do not bring my test results to my doctors. There is no place in this relationship for them to hold me accountable for my actions or make decisions on my behalf. They provide me with advice, and I choose to give them information as needed.


For good or bad, I am in charge. I am the boss. Are you?

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