Hospitalists were seen as people to lead the charge for safety because they were already taking care of patients, already focused on reducing LOS and improving care delivery—and never to be underestimated, they were omnipresent, Dr. Gandhi says of her experience with hospitalists around 2000 at Brigham and Women’s Hospital in Boston. “At least where I was, hospitalists truly were leaders in the quality and safety space, and it was just a really good fit for the kind of mindset and personality of a hospitalist because they’re very much … integrators of care across hospitals,” she says. “They interface with so many different areas of the hospital and then try to make all of that work better.”

Two years later, IOM followed up its safety push with “Crossing the Quality Chasm: A New Health System for the 21st Century.” The sequel study laid out focus areas and guidelines to start reducing the spate of medical mistakes that “To Err Is Human” lay bare.

“When the IOM report came out, it gave us a focus and a language that we didn’t have before,” says Dr. Wachter, who served as president of SHM’s Board of Directors and to this day lectures at SHM annual meetings. “But I think the general sensibility that hospitalists are about improving quality and safety and patients’ experience and efficiency—I think that was baked in from the start.”

The federal Agency for Health Care Policy and Research was renamed the Agency for Healthcare Research and Quality (ARHQ) to indicate the change in focus.

Dr. Wachter and other early leaders pushed the field to become involved in systems-improvement work. This turned out to be prophetic in December 1999, when patient safety zoomed to the national forefront with the publication of the Institute of Medicine (IOM) report “To Err Is Human.” Its conclusions, by now, are well-known. It showed between 44,000 and 98,000 people a year die from preventable medical errors, the equivalent of a jumbo jet a day crashing. The impact was profound, and safety initiatives became a focal point of hospitals.

“My feeling at the time was this was a good idea,” Dr. Wachter says. “The trend toward our system being pushed to deliver better, more efficient care was going to be enduring, and the old model of the primary-care doc being your hospital doc … couldn’t possibly achieve the goal of producing the highest value.”

The nutritional supplement ingestion for 3 weeks was found to increase serum GH levels with 70% relatively to placebo, whereas circulating IGF-I levels did not change.

The field’s rapid growth has both ref lected and contributed to the evolution of clinical practice over the past two decades.

The Deck

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we needed to think six to 12 months ahead and work backwards to design the processes that would get us to the scale to handle this growth.”

Nevertheless, the evidence suggests that social capital and social institutions are significant predictors of economic growth, after controlling for the effects of human capital and initial levels of income (Knack and Keefer 1997), (Knack 2002).4 So trust is a relevant dimension of social interactions that has been connected to individual dyads, network formation, labor markets, and even economic growth.

But some organizations need more attention — they need a more tailored experience

Awan: Our growth has been a  journey of constant learning, but if I were to pinpoint the principles our growth team lives by today, which I hope would help others building and growing products, they would be: Define one "North Star" metric for success that is aligned with how your users get value as well as with the success of your business, then measure everything and how it contributes to the North Star metric. Good examples of true-north metrics for growth are measures like how many users are truly engaged with your product Growth is a team sport so hire wisely and invest in your team Good product, measured by long-term retention, comes first; growth comes second Invest in multiple growth channels and identify potential channels by looking at existing user behavior, especially how they are currently discovering your product. At LinkedIn, our biggest channels are viral growth, search-engine optimization of profiles and other member-generated content and partnerships. Understand that growth requires continuous prioritization and feedback so always be testing

Awan: Our growth has been a  journey of constant learning, but if I were to pinpoint the principles our growth team lives by today, which I hope would help others building and growing products, they would be: Define one "North Star" metric for success that is aligned with how your users get value as well as with the success of your business, then measure everything and how it contributes to the North Star metric. Good examples of true-north metrics for growth are measures like how many users are truly engaged with your product Growth is a team sport so hire wisely and invest in your team Good product, measured by long-term retention, comes first; growth comes second Invest in multiple growth channels and identify potential channels by looking at existing user behavior, especially how they are currently discovering your product. At LinkedIn, our biggest channels are viral growth, search-engine optimization of profiles and other member-generated content and partnerships. Understand that growth requires continuous prioritization and feedback so always be testing

Awan: Here’s some advice to others as they focus on growing their own company: Make sure you have product-market fit before you invest in growth. What that means is you have validated that your product is in a market with large demand and your product is satisfying the need for users who try the product. You can measure this by retention rate which is essentially the percentage of your users who keep coming back. If your retention is not stable, you’d want to improve the product first rather than wasting resources on growth. Prioritize growth from the very beginning and build it right into the product. It’s much better for your users to bring other users to the product as they create and share photos or other content or, invite others in the course of normally using the app than to try growing through marketing that feels bolted onto the product. This is critically important if your product has network effects because the product value is limited for early users if the network doesn’t grow fast enough. As your company starts to scale, it’s important to create a dedicated multi-disciplinary growth team covering product, design, marketing, engineering, data science, and business operations. In a startup, a single person may be playing multiple of those roles (an engineer who’s also the data scientist) but as you scale, you can create dedicated functional roles.

To develope the reasoning faculties of our youth, enlarge their minds cultivate their morals, & instil into them the precepts of virtue & order.

increase

The major situations for growth mindset are: When we do not know an answer When we make error When we experience failure When we are anxious.

efficiently solves

There are things you must apply yourself to very specifically because there are two aspects to life: There are concrete accomplishments and there is Mystery. You must approach both. Mystery opens you to a greater assistance than you could provide for yourself and saves you from condemning circumstances. Applying yourself to tangible things enables you to reclaim your self-respect and to build a foundation that is sound and firm. That is what personal growth is for-to build a foundation for Knowledge. What other value does it have? The person you are attempting to improve will be shed like a garment when you leave. As you become stable, then you can represent something greater. Without Knowledge, you are still profoundly confused and subject to miseries. Without purpose, meaning and direction, your life is still a desperate event.

Very few people have this feeling of vitality in their engagement in life and so, to substitute for this, they seek excitement in relationship, some for excitement's sake and some in the name of personal growth. I can assure you there is not enough personal growth in the universe to justify endless involvements. What takes you beyond personal growth is that you become very tired of it, and you now seek refuge, relief and inspiration from something greater. Personal growth is very disappointing because you cannot expand the personal side of you very far. It always has great promise, and it is always very exciting when you are embarking on personal growth, but it quickly begins to get very difficult. Personal growth is natural when you are developing Knowledge, for your mind and body must now accommodate a Greater Power within you. This is the context in which personal growth has value and is governed by necessity and not by preference.

O O O O that Shakespeherian Rag

It's far better, Dweck says, to encourage a growth mindset, in which children believe that brains and talent are merely a starting point, and that abilities can be developed through hard work and continued intellectual risk-taking.

The group has reported sustained revenue and operating income growth over the review period, with revenue rising by a five-year CAGR of 14% to reach KES51.6bn in F15 and operating income rising by a CAGR of 26% to KES2.2bn. However, profits have been heavily eroded by rising interest charges, associated with the large quantum of debt that has been used to fund growth. Thus, operating profit of KES2.2bn in F14 and F15 equated to net interest cover of 1.2x in both years, compared to 1.8x in F13. Moreover, NPBT has decreased from KES823m in F13 to KES305m in F15.

You might even notice that your confidence isn’t the only thing that goes up, this was my first step in growing internally, and you’ll find that in the end Social Development isn’t just about learning to talk to other people, it’s a deep discovery about who you truly are.

I'm talking about optimizing the economy for the velocity of money rather than for the conversion of money into capital. It's going from a growth model to a flow model. Why are we, for instance, taxing capital gains at almost nothing but taxing dividends and earnings so high? That's a tax policy that is meant to favor the extraction of capital and to punish the exchange of things.

Darren Rees Meddylfryd Tŵf

Somewhere, early in our conversations, I told you that you have to be willing to stand at the point where you know nothing, because that is what allows you to become aware of Something. You are beginning to sit down and begin our conversations as though you have a pretty good idea of what’s going to come about. This is going to begin to get in the way. The meditation exercises that we have been doing have been partly for the purpose of helping you get to the point where you can see, from an experiential standpoint, that when you let go of everything, infinity has an opportunity to appear. You, yourself, have begun to find, when a subject is difficult for you to deal with, that if you will do a meditation, it removes the resistance and allows the communication to unfold smoothly. I would like you to stop forming preconceptions in the first place. Paul, we are talking about becoming the Door. The image you have in your mind of the Door is, indeed, accurate. It is a doorway, and there isn’t a single door attached to it. And yet, you have begun to come to these conversations ready to close a door—that shouldn’t even be there in the first place—if what you are hearing can’t be quickly classified, judged, and decided upon before you get the first word out of your mouth.

RAJ: Paul, you are suffering from your “should” system. You are experiencing how difficult it is to lay down conceptualized processes and theories. I will not leave my position that this conceptual thinking relates in no way to what is Actually going on—which is the infinitude of your Being unfolding Itself perfectly, properly, and nondestructively—except of course, in terms of these concepts which are binding you. They will be destroyed. They no longer serve to move you to a new base. As you are discovering, the concepts are actually impeding your growth. You must lay them down. The growth will occur. The growth is occurring. This is why you feel shoved into the corner right along with the concepts. Figuratively speaking, this is why you feel that you are going to be blown up in the blowing up of your concepts.

This truly is your task from this moment forward. As I said before, any attempt to avoid the fulfillment of your Being will result in discomfort far greater than you can imagine. It will be far greater than you care to experience, because you have graduated into the Fourth-dimensional frame of reference. Although you may attempt to ignore it at times, you cannot succeed in moving backwards. Growth only moves in one direction, and it moves inexorably and irreversibly.

Both you and Susan continue as you have been in listening for the direction in which you need to move. I do not want you to throw the responsibility for figuring everything out in my lap. You must continue to be aware that you are yourself, and I am myself. I am doing what I need to do, and you must do what you need to do. Do not give away any responsibility to another at all. As I have said before, I cannot help you with things that will deprive you of your own growth. I am here to help, nevertheless.

PAUL: Do these subtly balanced events have to do with me, within myself, or do they refer to events on a larger scale, out of the range of my immediate personal experience? RAJ: Paul, your development and growth has nothing to do with these events. Although you are on rough ground right now and are noticing the bumps, you are, nevertheless, moving across this territory quite steadily, and your fears and doubts are not hindering your progress at all.

RAJ: The delight of Life is the signal which indicates the successful completion or Awakening in individual thought. This is because it indicates the amalgamation or connection of the Alpha and Omega—the inside and the outside—the spiritual and material—the Fourth Dimension with the first three as Conscious Experience. I know that this is very difficult for you to put up with, because you feel there are more pressing needs, but if you will bear with me a little longer, it will be worth your while.

You were incorrect yesterday when it occurred to you that the only way you can tell you are growing is if you are feeling some discomfort. Discomfort can be an indication of growth, but it is not the only indication of growth. We are entering a new phase of these conversations, and in this phase we are going to be dealing with the Light energy that constitutes your Being.

Discomfort can be an indication of growth, but it is not the only indication of growth.

Growth, itself, is like this, in that there are times of changing speed, and there are times of not changing speed, and yet speed is everpresent. The change lines are as natural to life as the spaces in between. And you can see this.

civilization is a key cause of antagonism: 'society, in trying to pro- tect us from what we want (ultimately, an end to internal tension), instills in subjectivity a profound malaise, while providing "an occasion for enmity"' (Lane 2004, 28).2

RAJ: Paul, what you are trying to do here is to grow, and yet have the growth fit into the same old categorizations—the same old structure—and I am trying to wake you up to the fact that if you are, indeed, going to grow, you have to stop trying to fit everything into neat little cubbyholes before you’ll even bother to repeat my words. At least, you are going to need new cubbyholes. At the most, you will let go of cubbyholes altogether, and flow with the new unfolding of your Being. I don’t really want to tell you anything about Atlantis at all. But the time is going to come when I will be telling you things that may most definitely cross your present concepts, and I can begin to see that you are feeling more comfortable with this whole process of our conversations and are beginning to feel like you’ve got the whole thing pegged. That’s the beginning of the end.

RAJ: Paul, this sounds very elementary, but you’re going to have to understand that growth does not mean expansion within the same old frame of reference. It means expansion out of it, beyond it. I know you are having difficulty trying to classify what you are broadly perceiving of what I am saying into your present set of categories, and that is exactly the problem I am addressing here. You can understand it this way, Paul. As a tree grows, it cannot get bigger and remain the same size.

Paul, I keep saying that Being, Enlightenment, Growth, the rising of the Phoenix from its own ashes, is perfectly natural and normal, that it is always something that we are capable of doing. It will probably be some time before you realize the full impact of that fact and relax at the living of Life. But be aware of it now, to whatever degree you are able.

a more insidious and cancerous progression took hold through municipal fiscal discipline, property speculation and the sorting of land-use according to the rate of return for its ‘highest and best use’.

The most common bit of concrete advice offered by Dweck and others enamored of the growth mindset is to praise kids for their effort (“You tried really hard”) rather than for their ability (“You’re really smart”) in order to get them to persevere. (Google the words “praise” and “effort” together: more than 70 million hits.)

An underlying efficient limit on how we can pursue any mix of arrangements to implement our commitments to democracy, auton- omy, and equality, however, has been the pursuit of productivity and growth.