How Customer Satisfaction Hurts or Helps Long-Term Care

Every company provides a customer experience – good, bad or indifferent – and it is up to the facility leadership to determine that experience.  Enhancing a customer’s experience requires collaboration across departments in facilities that traditionally are accustomed to working in silos.  A positive customer experience requires an organizational strategy with a focus on operations and processes around the needs of the individual consumer.  In addition, high customer satisfaction drives census, increases financials and is a national initiative for AHCA, ACO’s/MCO’s and CMS.

I am looking forward to presenting on customer satisfaction at this week’s AHCA Independent Owner Leadership Conference.  Owners will have the opportunity to discuss all the challenges independent owners face and take home innovative strategies and valuable leadership tools.  This year’s Independent Owner Leadership Conference will take place March 16 – 18 in San Diego.

Click HERE to register or to learn more on scheduling of events for the conference.

Teaching Practice Change Leaders about Leadership and Culture Change to Impact Long-Term Care

Practice Change Leaders and experts in the care of older adults are working together to enhance the care of older adults in all environments.  The class of 2016, during their initial meeting February 24 & 25 in Phoenix, introduced projects incorporating long-term care as a part of new initiatives to enhance care and outcomes

Robert Schreiber, MD of Harvard, Hebrew Senior Life, and I teach a workshop in which participants use the evidence-based 8 Step Framework developed by John Kotter of Harvard to develop a deeper understanding of how to lead and overcome their individual and organizational challenges and barriers to create organizational change.  Through this process they identify mechanisms to facilitate change, garner support, include all stakeholders, and ensure more successful outcomes.

It was exciting to note that a majority of projects in the 2016 class of Practice Change Leaders included long-term care as one of the sites that will play a role in their new initiatives.  Individual projects and initiatives focused on transitional care, ACO’s, palliative care and hospitalization.  Increasing attention is being placed on the role of long-term care as a major player in the health care continuum.

Practice Change Leaders for Aging and Health is a national program designed to develop and support organizational leaders committed to enhancing the care of older adults.  Selected applicants hold a leadership role with decision-making capacity and the direct responsibility for care that impacts older adults.

This conference is one of four national meetings over fifteen months for those participating in the Practice Change Leaders program.  Attended by the Senior Leaders and select national experts in health and health care delivery to older adults, the meetings are founded on the premise that every attendee is both a teacher and a learner. Practice Change Leaders will have the opportunity to receive input on their projects and progress in pursuing their career goals through case-based discussions complemented by group problem-solving activities.

The Practice Change Leaders program is supported by The Atlantic Philanthropies and John A. Hartford Foundation.  It is administered through a National Program Office based in the Division of Health Care Policy and Research at the University of Colorado Anschutz Medical Campus under the direction of Eric Coleman and Shelly Nebel.

More can be found about Practice Change Leaders for Aging and Health HERE.

Caring for Individuals with Memory Loss – Not a “Mind-Numbing Duty”

There comes a time when caring for someone with dementia can no longer be managed at home, and the family must turn the over the care of someone they love to others.  I have worked with these health care professionals – and I do mean professionals.

I know I have addressed this topic before in reference to the contents of an article, but I am troubled about what I perceive to be a slight on those who are professional caregivers to those with memory loss, Alzheimer’s disease and dementias.  And unfortunately, I believe this is a common perspective regarding those who choose long-term care as a vocation.

In the column I am referring to, the author, James Berklan, states the following about a new book:  “The primary target is the “family,” or at least non-professional, caregiver. But I also see great value in this for the caregiver on the payroll. On one hand, it can help set one’s mind straight about the figurative mind-numbing duty of looking after people whose minds have gone numb.”

I would guess that it was not the author’s intent that perhaps an unfortunate use of words might offend professional caregivers.  I can assure you that professional caregivers do not view caring for those with dementia as a “mind-numbing duty” or see residents for whom they care as those “whose minds have gone numb.”

The ability to care for individuals with memory loss requires special skills: an exceptionally caring attitude; patience, understanding, and empathy; a desire to serve; effective non-verbal communication; and initiative as one must be willing to try new things, think outside of the box and be a detective.

For over 25 years I spent nearly every day with individuals who have been diagnosed with Alzheimer’s disease or a related dementia, the families and friends who love them, and the employees/professional caregivers who care for them.  I created the first residential facility dedicated to Alzheimer’s disease and dementia facility in the United States, and together, we made it a “home” to hundreds of individuals over the years.

I never intended to spend much of my career in long-term care and for me the surprising, yet most touching, was discovering a community of people who are truly the “angels on this earth” – the individuals who have chosen to work and care for persons with dementia.  This includes all individuals within the walls or a facility – the personal care and certified assistants, nurses, social workers, therapists, and housekeepers, laundry aides, cooks, dish washers, maintenance folks, activities and other direct care providers who touch lives daily.

While much of what we hear in the news or media about those who work in long-term care is not positive, what I have experienced is that when employees are respected, valued, educated, supported, nurtured and have a “voice” in the organization, they make miracles happen.  Most of the people I have met have selected this work as a vocation.  They choose to care for those who no one else will or can.  And they do so with no expectation for gratitude, acknowledgement or accolades.

For individuals with dementia this is particularly significant, as at this point they have no voice and little ability to advocate for themselves.  They must be surrounded by employees who truly care – who choose to serve residents above all else.

Having worked with over 1,000 individuals with dementia and their families, we have learned a great deal.  First and foremost is that each and every individual with Alzheimer’s disease is the “love of someone’s life.”  We all have someone in our life we think we cannot live without or would choose not to – so do they.  Someone, somewhere, loves each and every person with dementia as much as we love that special someone in our life.  And they should be cared for and nurtured in the same fashion we would wish for the person we love the most.

I believe that if you have not witnessed the genuine acts of kindness so often performed by this group of professional caregivers, if you have not spent time with a genuine desire to know them, you have missed some of the world’s most incredible people.

Medications, Alzheimer’s Disease and Dementia: Consider Comfort and Quality of Life

Families and healthcare professionals question medication use for people diagnosed with Alzheimer’s disease or a dementia, especially due to the media coverage about the overutilization and potential dangers of antipsychotics and other medications.

It is important to investigate potential causes of symptoms or behaviors and identify what can be done before resorting to medication.  Sometimes the person’s behavior, agitation, anxiety is due to unexpressed physical needs, perhaps they are in pain, have an infection, are tired, hot or cold, or distressed by an over stimulating environment or demanding caregiver.

I have worked with Robert Cluxton, Pharm.D., Professor at the University of Cincinnati College of Pharmacy for twenty-five years.   Without going into great detail, we share decades of experience and some views on medication for distressed individuals with cognitive impairment.

  • Not all medication is bad:  Often anxiety and aggression are expressions of depression because their world seems out of control.  If a person is depressed, an antidepressant can be helpful and improve quality of life for the individual (and caregiver).
  • Anxiety: It is agonizing when an individual with dementia is upset most of the time and for the caregiver as well.  A low dose of medication may ease their anxiety and make life better for all.
  • All behavior is about something:  identifying a cause, understanding what that “something” is remains the problem, and if you can’t identify a reason for uncontrollable agitation or rage – should they continue to suffer?
  • Sedation: Medications to reduce restlessness and anxiety often causes sedation initially.  Giving the medication consistently results in stabilization in time, when the periods of sedation and anxiety dissipate – usually about 3 to 4 weeks.  Too often medication is started then stopped due to sedation. Taking a person on and off a medication is problematic for the individual, and the targeted symptoms are not addressed.
  • Consistency versus “as needed:” Certain medications must be given routinely for optimum results.  If an antianxiety medicine is prescribed for someone who is frequently anxious, especially in the evening, it may be best to prescribe a routine dose throughout the day and evening.  Medications prescribed “as needed” are often given too late to be effective.
  • Stay the course:  Some medications take time to build up to certain levels in the body before they are effective.  For instance, you may not see results from many antidepressants or similar medications for 4-6 weeks.  While it is not easy, the benefits are often worth the wait.
  • Medications need not be given forever:  Starting a medication does not mean it needs to be taken indefinitely.  As an individual moves through the dementia disease process, the need for medications will change.  Ongoing routine evaluation is needed to determine if any medications need to be reduced or discontinued. This will help ensure all medications continue to be needed and are at the lowest effective dose.
  • Pain: People with dementia do have pain.  It is reasonable to expect pain if they have a history of arthritis or have surgery or dental work done.  We should anticipate they are in pain even if they are unable to verbalize.  Assume and treat pain as you would for any person.

Caregiving is difficult for both families and healthcare professionals.  Medication can be beneficial and should be considered when appropriate.  Yes, we must weigh the benefits versus risks, but important too is that we consider the quality of life and comfort for each individual with dementia and what is in their best interest.




Customer Service? Not Exactly…

While I’ve written about customer service before, a friend’s recent experience prompts me to write again.  My friend, Amy, was asked to help find a facility for a relative with memory loss.  This relative had been diagnosed with dementia some years ago and needed more care than could be provided at home.

Amy spent countless hours over the course of three weeks attempting to find a facility for him.  She called fifteen facilities, eventually toured six and in time, found one for her relative.

What is important here is what happened to Amy along the way.

The initial phone call:

  • Amy called facilities to gather information, and set up a tour.
  • Rarely was there someone available to speak with her at the time of the call.
  • Most of the time, the person answering the phone took a message, said someone would call.
  • Others answering the phone told Amy to call back later.
  • Even when someone took a message – her call was not returned.
  • Five facilities did not return the initial phone call.
  • Two facilities didn’t respond to multiple calls.

Response to phone connection:

  • Amy felt that her calls seemed like an “inconvenience” or an “annoyance” to the person answering the phone or the admissions personnel.
  • One admissions coordinator was very abrupt and argumentative, demanding she send/fax records prior to any discussion about admission.
  • In one facility the person answering the phone asked:  “And you are with?”   Amy could only reply she wasn’t with anyone, she was calling for admission information.

Concerning conversations regarding admission:

  • One admissions director asked Amy if her relative with dementia might be “too far gone.”
  • Another stated that if “he hits people in the hallway, we can’t fix that.”
  • Yet another stated, “If we can’t handle it from the get-go it’s pointless to be on a waiting list.  They usually don’t get better if they have a behavior.”


  • Multiple facilities provided a list of requirements without inviting Amy to tour.
  • Two facilities said no tour until they had reviewed “paperwork and a med list.”
  • When admissions were done with Amy – they were done.  They did not help her, and few offered any assistance or referrals.
  • Most were reluctant to provide suggestions or direction.
  • One facility said Amy’s family member wasn’t “appropriate” for them.
  • Another indicated that they had no availability for an individual with “dementia.”
  • Few seemed genuinely willing to “accept” residents with memory loss and “behaviors.”

Signs of Hope:

  • Four of the fifteen facilities were kind, attentive, accommodating and helpful.
  • Two were sensitive and provided additional resources.

My experience has been that when a family finally comes to the point of deciding to turn the care of someone they love over to another, it is usually because of a crisis or it is the “last straw.”  Families do not take this lightly and many family members say that this is one of the most difficult decisions they have had to make in their life.

So when they are ready and pick up the phone to call, it may be the only chance you have to help them – one chance.  And when a family member finally gets up the nerve to call, they need help and information now – right now.

I know that each person in need of care in any healthcare setting – acute and long-term care is important in the life of someone.  Each and every resident or patient is the “love of someone’s life.”  All staff need to understand this, especially receptionists and admissions personnel.  All conversations should be respectful and sensitive to the needs of all people.

I believe that there are a great number of facilities who do a wonderful job with individuals and families in need, and that those who don’t simply have not taken the time to reflect on the impact of their words and behaviors.  We find that assisting an organization to view their work in another light, raising their awareness of their actions and words creates a more sensitive culture and better customer satisfaction.

As a simple review, here are some ideas of what facilities can do:

  •  Sensitize all staff to the impact of this decision for families.  Make it personal, help them to understand it – through discussions about their own family, people they love, what they would want and how it would feel.  Share stories about people like Amy.  Have a discussion about her feelings, how they might feel if in the same situation.
  •  Provide staff education on the “expectations for performance,” to be welcoming, accommodating, helpful and kind to anyone who calls, tours or visits the facility.
  •  Have processes and systems in place that accommodates all calls immediately, 24/7/365.
  • Have multiple people on site or available who can talk to a family or tour an interested party.
  • Ensure that receptionists and any staff who answer the phone are trained and understand that a call for information or a tour is a priority, and see that it is addressed quickly by a designated person on staff.
  • Develop systems and processes to be prepared for a tour, including a communication system for all staff to know when a tour is scheduled or occurring.

Educate staff on the emotional and physical impact of memory loss on a person or family, and act accordingly.  Remember that each person is special and loved by someone in this life.  And that their job is to help them, care and nurture them – serve them.




Alzheimer’s and Joy – No Surprise to Me

The title of a recent column caught my eye and perhaps yours as well.  The column was entitled, “Alzheimer’s and joy, an unlikely couple.”  I was a bit surprised by the author’s perspective, but perhaps I shouldn’t have been.  Many people believe only what is written about people with dementia, which is often the negative and unpleasant side of the disease and unfortunate lack of treatment available.

Sadly, if that is the case, they miss the beauty that can be found; the beauty that exists in each individual who, through no fault of their own, has a disease we cannot cure.

As it turns out, the author of this column was discussing a new book “Finding Joy in Alzheimer’s: New Hope for Caregivers” written by Marie Marley and Daniel Potts.  Marie is a friend and colleague of mine and I was fortunate to know her during that time, experiencing her joy as well as her despair, as that is how it goes when you love someone with this disease.  Though there was tremendous heartache, she has written about the humor, love and joy that can be found, in this book as well as her prior book, a touching, loving memoir, “Come Back Early Today.

Years ago Lela Shanks wrote the book, “Your Name Is Hughes Hannibal Shanks: A Caregiver’s Guide to Alzheimer’s.”  As a long-time caregiver to her beloved husband, Hughes, she described the strategies for caregiving that she learned along the way.  But more importantly, Lela also shared how much she grew, learned, as a more independent woman during that journey, her love for her husband, and the humor and joy they experienced together, despite the disease.

Much is determined by your experience and how you choose to look at it.  If you have not had a personal experience, you often perceive it as a “disease” and lose the “person” perspective.  People who have had to experience this disease in someone they care about or love will look at the “individual” with a disease, and not just a disease.  When it is your mother or wife, father or brother, your perspective will change.

I have worked with individuals with memory loss and their families for over 25 years and it has been a gift to me. I do not see them, as this column’s author suggests, as “people whose minds have gone numb.”  For those of us who have experienced the “people” are dedicated to improving care and committed to making life as pleasurable and full as we can for those who are affected and their families; we see joy every day.  Each person is unique.  We take the time to know them – one person, like no other – and do whatever is necessary to make them happy.  Yes, sometimes we are more successful than others, but when you search for ways to create happiness and joy in their lives, and are open to finding ways, joy can be found in experiences with every person – if you choose to look.

Leading Systems Change in Health Care – Why Efforts Fail

Leading change is not easy and 50-70% of change efforts fail.  Leaders, directors, project managers, program, coordinators and others are looking for strategies to move programs and projects forward, to manage change, in challenging times and circumstances.     They seek to develop a deeper understanding of how to overcome their individual and organizational challenges and barriers.  Yet many leaders, CEO’s, directors do not consider all of the aspects/components/phases of change, they simply initiate it – a new program, process, system without examining how to make it work, the impact it will have on the people involved.  Or, all too often if the return on investment is not immediate, they abandon it altogether – change takes time.

Every organization has its own culture, an agreed upon mindset from which they work. People fear and resist change, because they are comfortable as it is or do not know how a change – your change – will impact their work and lives.  It is essential to “walk in their shoes” to understand from the stakeholder perspective the impact of your project or program for each person whether they are actually involved in the project or impacted by it.  In leading change you will likely be impacting and changing the culture of the organization and as such, a more holistic approach is needed.

The John A. Hartford Foundation Change AGEnt’s meeting in Philadelphia in December of 2015 afforded participants a learning opportunity, a way to advance their individual initiatives.  Rob Schreiber MD, Medical Director Hebrew Senior Life and Clinical Instructor Harvard Medical School and I were honored to co-facilitate a workshop on Kotter’s 8 step change framework.    This framework developed by John Kotter of Harvard University afforded participants an opportunity to examine their individual projects/programs in light of this evidence based change process.   Kotter’s change process was developed over four decades of observation and testing and is addressed in many of his books and publications including one used in this workshop, “Our Iceberg is Melting.”  It is a wonderful framework and guide from which to plan and work on creating change in an existing system or organization.

Kotter’s eight steps include:

1.            Establish a Sense of Urgency

2.            Pull Together a Guiding Team

3.            Create a Change Vision and Strategy

4.            Communicate for Understanding and Buy In

5.            Empower Others to Act

6.            Produce Short Term Wins

7.            Never Let Up

8.            Make it Stick


After an overview of Kotter’s change process participants discussed their programs and receive feedback from colleagues.  Change agents found this to be very valuable engaging a colleague, one or more, in examining “change” projects is an effective way to solicit diverse viewpoints and feedback.

Some of the lessons learned during the Change AGEnts process included:

  • Change involves loss which has to be acknowledged and time is needed for people to mourn and heal in order to move forward.
  • It is important to take a look below the surface, for the beliefs, values and thoughts of those we involve and engage.
  • While the eight steps are a roadmap for change it is not linear process– reviewing and repeating steps may be necessary and often several steps need to be engaged at the same time.
  • Sometimes we may need to change our own beliefs and perspectives first.
  • Stories are a very powerful method of engaging others support and their “hearts”.  Thinking differently can help change behavior and lead to better results.  However, stories and experiences that change how people “feel” about a situation can lead to a significant change in behavior.
  • Conflict is inevitable, plan for it.  Examine ways in which conflict will surface and strategies to address it.
  • Sustainability is critical – keep talking about the change and create a plan for it to be continued even after you have moved on as a leader.
  • Change is relationship driven and requires a village approach
  • Change takes patience and time and is most often worth it.


These were just some of the many lessons that were learned and it is clear that leading change is an evolving skill set and demands ongoing, continuous learning and a willingness to be open to the thoughts, beliefs and perspectives of others.


*The Hartford Change AGEnts Initiative accelerates sustained practice change that improves the health of older Americans, their families, and communities. It does this by harnessing the collective strengths, resources, and expertise of the John A. Hartford Foundation’s interprofessional community of more than 3,000 scholars, clinicians, and health system leaders.

For more information, see:

The John A. Hartford Foundation

Hartford Change AGEnts Initiative

The Gerontological Society of America

Stress, Negativity and Alzheimer’s – Happy New Year!

The start of a new year often brings promises that “this year” you are going to take better care of yourself, relax, eat healthy foods, and eliminate stress.  All of this is good given everything we know about health habits and stress.  And the results of a recent study gives us even more incentive to reduce stress, as it may have a role in developing Alzheimer’s disease.

The study published in the Journal of Alzheimer’s Disease and Associated Disorders suggests that increased stress could be a risk factor for Alzheimer’s.  The article mentions that stress can raise levels of certain neurotransmitters and lowers others, affecting the efficiency of the brain.

The negative effects of stress are well known, including cardiovascular problems, the impact on our immune system, depression and anxiety, etc., and now we have cause for concern related to cognitive impairment.  Of course more research is needed, yet how much more information do we need to understand the impact of stress on our bodies and mind?

The article also points out that unfortunately, all too often stress is self-imposed.  It is noted that perceived stress is a “modifiable risk factor” for cognitive impairment, and hence a target for treatment.  How are we advised to deal with it?  As with other diseases, we should do all of the things we don’t necessarily want to do!  Regular physical exercise, eating healthy, practicing stress management techniques, meditation, and yoga are just a few methods for prevention.

When considering strategies for better mental and physical health, think about your attitude as well.  Another study indicates that how we think and “choose” to think impacts our attitude and the risk for Alzheimer’s.  The study suggests that people who hold negative beliefs about aging (and who doesn’t sometimes!) are more likely to have brain changes associated with Alzheimer’s.  The good news is that it is not inevitable – if you change your beliefs.  Prior studies on harboring thoughts on aging indicate that a positive attitude about aging may add as many as seven or more years of life versus those who are negative.

All the research provides more reasons to get a handle on your thoughts, beliefs and consequently your behavior.  Make a promise to yourself in the coming year to control the stress and negativity instead of letting it control you.  There are a plethora of books, articles and strategies to access in order to improve your physical and mental health.

Besides, life is short!  Choose to be happy, relax more, worry less and enjoy – leave the harmful, damaging, stressful negativity behind. Wishing you a healthy, joyful and relaxing in 2016!

Easing the Hustle and Bustle of the Holidays for Our Aging Population

The holidays are a time of year when we strive to create happy memories. We take joy in organizing events for family and friends, socializing, exchanging gifts, and enjoying the company of those we love.  Yet as our relatives age we may need to adjust our plans and expectations by taking into consideration the changes that come with aging.

Changes related to aging may affect one’s ability – or willingness – to participate fully in past traditions.  Changes in eyesight and hearing, mobility, and memory loss are just a few conditions that might influence a senior’s ability or desire to participate fully in all family events.

Large group gatherings may be too stimulating, particularly for a relative with dementia.  Many older folks find loud and crowded events overwhelming and stressful.  Perhaps they can’t physically navigate well through crowded rooms, or they may be uncomfortable struggling to recall a relative’s name.  These gatherings can put a great deal of unintended pressure on your senior.

It may be necessary to arrange a few smaller and more intimate celebrations as alternatives to large gatherings.  This is especially effective for elders who are experiencing memory loss or anxiety. Many seniors appreciate separate visits, shorter in duration, from family and friends throughout the holiday season. Or, propose briefer outings as alternatives, such as a holiday lunch or ride to see Christmas lights.

Keep in mind that it is not uncommon for seniors to be apprehensive of traveling near or far.  They may decline your invitations because they fear driving themselves and do not want to be a burden to others.  Some will not want to disappoint you but are truly afraid of the traffic and weather.  Pay attention to what they say and how they say it for clues as to their true feelings.

Ask your older relative if they would like to be included in shopping, baking, church outings or larger gatherings and plan these events around their usual routine.  Be cognizant of the amount of time you ask of them and keep it simple.  We tire more easily as we age, and rest becomes important for maintaining mental and physical abilities.

Above all, communicate with your senior prior to making plans.  Ask how they would like to spend the holidays, and offer suggestions and options.  Understand that sometimes we force our older relatives into parties and events because we want them to be there.  It is important to consider what is best for them, especially for individuals with dementia.  They may be more likely to enjoy a quiet visit, holiday music and a favorite desert versus a large gathering.

Let us also not forget those older adults who are alone without family or friends for whatever reason, and take some time to reach out to them.  Everyone enjoys a visit, a short conversation and a cookie or two.

Embrace the true meaning of this time of year by taking the time to reflect on your blessings and share the holiday spirit with people you know, and those you don’t.



Helping Staff Cope During The Holidays

In a perfect world, we would all approach December with great anticipation, thinking of that Norman Rockwell Christmas gathering, the opening of beautiful gifts surrounded by a loving family, all followed by a picture-perfect holiday dinner. No doubt, we all strive to provide a meaningful and memorable holiday season for ourselves and our families.

Our staff members are no different. They, too, are feeling the stress and pressure to provide these memories for themselves and their own families. After giving to others all year and during the holidays as well, staff want to be at home when not scheduled (often not on the holiday itself) to enjoy their families, gifts, and dinners as well. We will all be fighting the crowds while shopping, determining what to give each family member, and worrying about how to stay within budget. Many of us might not necessarily be looking forward to gatherings with immediate and extended families, causing us to lose focus on the true meaning of the season. Whether it is Hanukah, Kwanzaa, Ramadan, or Christmas, staff may be approaching a holiday that may or may not be as meaningful or joyous as they desire.

As leaders we must acknowledge that the holiday season isn’t always what it’s cracked up to be. It is important to be in touch with employees and acknowledge that the additional stress of the holiday season affects everyone’s personal life. And while most of the year our employees can leave their personal troubles behind, it seems the hope for the holiday season is simply too overwhelming to leave at home.

To ease this stress on staff, be gentle with one another and extend a hand to your colleagues. Remember, when someone seems overly tense or irritable, it may simply be the holiday hassle. Forgive them without saying so. Offer a friendly ear or if necessary, a shoulder to cry on. An excellent way to lighten the mood is to share a laugh—or a hug.

Embrace the “reason for the season,” and facilitate ways in which you can all help others together. Nothing takes your mind off of your own troubles quite like doing something to help another. Have your facility participate in a coat drive for kids, or hold a collection for a local food bank. Adopt a family in need of holiday gifts or meals, and watch in wonder as your staff members excitedly participate. You will be amazed at their enthusiasm and generosity. The holiday spirit will be alive and well.

Think of all of the blessings in your life. Write them down, share them with others, and encourage colleagues to do the same. Do something kind for another person, without expecting anything in return and keep it to yourself—this holds the greatest power of all.

The holiday season may be a time of stress and worry, but it should also be a time of appreciation, joy, and fun. And you can help to make it that way—at least at work!