For tax purposes, I recently added up all the various sources of income I’d received in 2017. It was a real hodge-podge of a year since I left my appointment at the U.S. Department of Health and Human Services (HHS) and started working on my own projects again. This exercise brought home the lesson that dollars and cents do not add up to someone’s value in the world. My income definitely did not reflect my impact on my family, community, or industry.
So, after closing out my financial review, I created an impact review, looking back at how I spent my time over the last 12+ months, * asking:
- Was the work useful, soul enriching, or on my mission path?
- Did it have a positive impact on the world, an organization, another individual, myself?
- Would I seek to do something similar in the next five years?
* I decided to be generous to myself and include the work I did in the last 3 months of 2016 since it came to fruition in 2017.
I started looking around for other examples of financial/impact statements and found Warren Buffet’s annual shareholder letters. He details wins and losses, sprinkling lessons learned throughout. They make excellent reading if you haven’t ever dipped into them. You don’t need to be an investor to learn from his experiences.
I’m not brave enough (yet) to post my full income and impact statements, and, as an independent advisor, I don’t have shareholders. But I do have a kitchen cabinet – the people I turn to for advice and who, I hope, benefit from being part of the work I do. And I have you, dear reader. I hope you’ll let me know what you think about the issues and lessons I share below.
The past year has been one of service and exploration, in nearly equal portions.
In January 2017, I closed out my national public service as the CTO at HHS in the Obama Administration. I also closed out five weeks of civic duty as a grand juror in Washington, DC. At the close of 2017, I served as a caregiver to my parents. In between, I ventured into new lines of work, launched a new video and public awareness campaign, took on advisory and consultant roles, and rekindled my public speaking and survey research practices.
Every year brings triumphs and setbacks, but this year was particularly challenging for the world and for me, personally. I learned that planting a seed of change is an act of faith.
For example, in the waning months of 2016, before we knew the outcome of the election, HHS Secretary Sylvia Burwell asked each of us in the leadership to submit a memo that would be given to the next Secretary, essentially proposing where to take our portfolios next. I wrote that memo and also asked my friend Len Polizzotto, a corporate strategist and innovator, to train my team so they would be ready to pitch themselves and their own projects to the incoming leadership. The team also created a public “yearbook” to capture the Office of the CTO’s accomplishments. Few people understand the depth and breadth of the programs and this document could serve as an introduction to the incoming HHS leaders, whoever they turned out to be.
I was proud to leave the HHS Office of the CTO in excellent shape, with a stellar team in place to carry forward the work of innovation and open data. The seeds I helped plant back in January came to fruition: the current Administration prioritized hiring a CTO for HHS and the portfolio is expanding in ways I hoped it would, including the creation of a Chief Data Officer role. This is an exceptional outcome and a win for the American people. The current Administration otherwise rejected much of the Obama Administration’s legacy, particularly at HHS.
On another plane entirely, serving as a grand juror was one of the most horrifying and frustrating experiences of my life so far. Jurors are treated like fodder and subjected daily to violent, upsetting images and testimony. One way I fought despair was to involve my fellow jurors in a design exercise. I conducted a survey, asking: What is the best thing about serving on grand jury? What would you change if you could? I used the responses to the first question to write a welcome letter that could be used in new juror orientation, to encourage people to look for silver linings in their service. I collaborated with another juror on a report to the supervising attorney on ways to improve the experience, based on responses to the second question. We never heard back on either front.
However, I recently found out from a friend who served as a grand juror this winter that my letter was read to them during orientation. The supervising attorney had never responded to my email, nor did she credit me when she read the letter. But the seed of change I planted in January came to fruition.
In the loss column, I spent too much time worrying about how I would make money this year. I also made some panic decisions, which led to even greater losses of time, a more precious commodity. I accepted low-impact, off-mission work at below-market rates.
I learned that I should look for ways to have impact instead of looking for ways to make near-term revenue. By contrast, the pro bono work I did this year was high-impact and highly satisfying. For example, I experimented with gathering peer health advice on behalf of a friend facing brain surgery and it was one of the most enriching experiences of 2017.
On multiple occasions I made the mistake of starting work without first agreeing on its scope or negotiating a contract. This led to frustration, lost time, and lost opportunities.
One of the worries that I have about being unaffiliated with a larger entity is that I have no infrastructure to back me up. I have no legal department or formal advisors to review deals. I will seek advice about this from peer advisors in the coming months.
The upside of independence is that I can be selective. I was careful this year to only enter long-term agreements with organizations whose missions align with mine, and whose leaders demonstrate personal integrity. Some of those organizations include: Cambia Health Solutions, Hope for Henry, and the Hopelab Foundation. Their CEOs – Mark Ganz, Laurie Strongin, and Margaret Laws – are three people I would follow into battle. I plan to add to this client list in the coming year. To do that I need to document and articulate the impact I have had on each organization.
I also engaged in short-term consulting work, such as one-day design sessions on topics like innovation in the care of older adults, pediatric care, emergency room care, and product design. These sessions are fun for someone like me – an extrovert with more ideas than I know what to do with – and clients were appreciative of my insights and energy.
Public speaking is another form of short-term consulting, bringing my experience and ideas to groups of people looking for inspiration and fuel for their own fires. This year I took the stage at symposia related to biotech, housing design for older adults, health communication, health research, nursing, hardware design, health insurance, and banking.
Writing the script for a cartoon video about peer health advice meant that I had to boil down my ideas and research to a tight 1,500 words. Sharing the video with the world forced me to face potential naysayers and critics. So far, so good on that score: One academic researcher said it was too “pop” for him to endorse, which made me smile since I have been told in the past that my writing is too serious and wonky for mainstream audiences. Three organizations have approached me for advice about how to incorporate peer health advice into their work, so that is a potential line of business in the coming year.
This brings me to another lesson: Nobody is going to come looking for your insights. And people can’t join your cause if you don’t broadcast what you are trying to achieve. By documenting your work, you better understand it and are then able to share your ideas more effectively. You have to raise your lamp high.
At HHS, we did that by blogging and memorializing the year’s accomplishments in a publication. For myself, I launched the video, relaunched my website, and started blogging again, including the publication of a monthly Now page that sends a message out to the universe about my current mission. I also continue to tweet and to add to my Storify collections (news of that platform’s imminent shutdown has prompted me to park all the links at Wakelet). In the coming year I hope to publish articles in more mainstream outlets.
The flexibility of my current work situation allowed me to devote the majority of October, November, and December to caring for my father. I leaned into that work with my whole heart and learned deep, searing lessons about clinical trials, hospitals, senior care centers, palliative care, medication management, and end of life, just to name the top six topics that come to mind. I learned the promise and the limits of peer health advice in acute situations.
Finally, I continue to rely on my peer mentors and provide advice to my mentees. I could not do this work without the support, guidance, and inspiration that this group of people provides. In asking for advice, I am forced to think deeply about the problem I am trying to solve. In giving advice, I am able to see my own work life in a new light.
Again, 2017 was a year of service and exploration. I look forward to the adventures that 2018 will bring!
(Photo credit: Christopher Smith, U.S. Department of Health and Human Services)
Lisa Fitzpatrick says
I am glad I joined your list serve. This post comes at a very good time for me as I am about to leave my job and jump off a cliff.
First, I applaud you for this introspection and self-evaluation. Necessary for many of us but so rarely undertaken. Second, you are right to bet on yourself and take risks! I wrote about my experience with this on my LinkedIn page and in many ways, find myself in the same space again. Following your arrow is scary but worth it. Finally, I share the angst about the financial losses, uncertainties and perceived value. When I went back to government in 2015, I took a $60K… at least, pay cut but I gained skills, insights and connections I would not have been afforded any other way. It was a stepping stone to get me to the next purpose. I trust the answers will come if I stay true to my purpose. You are not on your journey alone. Best of luck.
Susannah Fox says
Thanks, Lisa! I’m glad you joined the list too (note to newcomers: you can subscribe by entering your email in the box at the bottom of the homepage under “Don’t Miss a Post”).
I wrote this at first as a personal exercise, planning to share it only with my peer mentors, but they helped me see that some of the lessons are universal and it’s part of my mission to share what I’ve learned. The more we share, the less alone we feel. Rock on! Can’t wait to see what you create.
Mary Aviles says
This was a really interesting exercise to observe. I have been consulting on my own for 13 years and I can relate to much of what you have experienced. I spent two different lengthy stints affiliated with another entity and several periods completely on my own. I spent some serious time in late 2016 and early 2017 soul searching, relaunching my website, tightening up my positioning and marketing and blogging. After 12 months of working toward a better aligned professional/personal direction, I am pleased to be starting a new gig today! Best of luck and please keep sharing your valuable and insightful content. I consider you among a short-list of consistently fantastic virtual mentors.
Susannah Fox says
Thank you! Your website is gorgeous — definitely raises your lamp high and broadcasts clearly what you do. Love it! Congrats on the new gig. Here’s to new vistas in 2018.
Jen Reeves says
I think I am nervously approaching a stage where consulting/speaking could be my next career step. But that fear of not having enough income has me a bit frozen. Thank you for sharing your lessons and process in the last year. I have quietly watched and admired.
Susannah Fox says
There’s more to say here than I can capture in a comment (and I’d love for other people to chime in with their own advice) but here’s a start:
I had practice. When I left the Pew Research Center to go out on my own for the first time, I had a part-time gig lined up with the Robert Wood Johnson Foundation. As their Entrepreneur in Residence I had a guaranteed base income AND base of operations, plus a lab for experimenting with ideas about innovation, tech & health. Signing a contract with a speakers bureau was also a useful step. Note: YMMV – some people get lots of gigs on their own, don’t mind negotiating contracts and hassling with the details, and then don’t have to give a percentage to an agent.
Susannah Fox says
I forgot to mention: Check out E-patient Dave’s fantastic Speaker Academy series. For example, here’s his advice about getting a contract.
Dave deBronkart says
Boy, the LAST thing I expected to see on this jaw-dropping page was a link to that “speaker academy” series! I’ll say more on a separate comment but here I want to note some things about the speaking business, which has been almost all my income for eight years, all in healthcare.
I’ve lately been working on branching out to speak at non-healthcare events, which is a field where nobody has ever heard of me. (How would you approach finding work in a field where nobody knows you?)
An important resource for me has been the SpeakerLab podcast, which my neighbor @KevinMD steered me to. Lots of peppy episodes with the cold hard facts about marketing yourself when the phone’s not yet already ringing off the hook.
One lesson is that in today’s world of speaker agencies and time-challenged meeting planners, you gotta have a “sizzle reel” that grabs ’em in the first few seconds and gets ’em to watch the next few minutes. That’s a challenge because although I have hundreds of videos of past talks, doing significant video editing is not in my skill set. But Kevin said he used Animoto – it’s a souped-up version of a photographer’s cloud scrapbook tool. Its torture is that it has practically zero documentation, but I figured out enough to publish my first version today. Adobe Spark is another. Neither is free but they’re many many times cheaper than hiring a savvy producer. (And, importantly for me, I can experiment and change my mind without driving others nuts.)
Kevin’s is a couple pages down on his speaker website KevinPho.com.
More on other parts of this wonderful post in another comment.
Dave deBronkart says
This letter of yours resonates, because a year ago I started a series of retrospective blog posts, in which I wanted to recount the journey I’d been on. The reason was that, like you in the past year, I felt a turning point. But in my effort to explain the changes (I titled the series “Evolution”), I got too deep and stopped at April 2009, so I didn’t quite accomplish my purpose. 🙂
So it’s time to once again use your example as a model, and go write my own letter to shareholders. I’ll report back. Thanks for once again shining the light on the path.
Ruth Ann Crystal says
I really enjoyed reading your post Susannah. Let me know when you are out here again. It would be great to catch up in person.
Good luck with all of your endeavors,
Matthew Holt says
Great letter Susannah. So good to have you back and rocking your new role(s)
I saw your predecessor and successor at HHS (Bryan & Bruce) at a party the other day. I might have made some crass remark about being too early or too late and missing out on the best bit in the middle!
These words are so important:
“This exercise brought home the lesson that dollars and cents do not add up to someone’s value in the world. My income definitely did not reflect my impact on my family, community, or industry.”
So much of the work I’ve done has been unpaid and undervalued (by society). I’m sorry about your father … I also lost my mom a few months ago. Besides missing her terribly, I also realize how much free time I have now … things are so quiet now … I’m probably the type to throw myself into my work … but in a way, helping her was my work.
Susannah Fox says
Karen, I’m sorry for your loss. “Things are so quiet now” – those words resonate. It’s that quiet free time, after my dad’s death, that provided me the space to take stock and write this post.
I wonder if this resonates with you, texted to me by a dear friend: “You are forever changed now and now starts the process of incorporating him.” What inspiration can you draw from your mom’s passing? What gifts did she give you, that you can now amplify? Alternatively, what aspects of her life do you want to close the book on and leave behind?
Yes, I am forever changed, there is no doubt about it. As far as the concept of incorporating her, we were already so intertwined before she passed, we had a very close relationship. Her need for caregiver support was long-term (maybe 15 years) so we spent a lot of time together … even when I lived in a different state, sometimes she would stay with me for months at a time so that I could help her and give my dad a break.
Inspiration? Well, she was a very warm person, loving … and hospice helped her to have a few months at home with family, away from the hospitals and rehabs that she hated being in. Gifts. I see her love of music in my daughters: one plays the violin, the other is in the school choir & plays piano. My mom was talented with crafts, which perhaps is partly why I have started to crochet again … I am making both of my girls afghans (letting them choose the patterns & colors).
I won’t miss taking her to so many medical appointments – hospitals, scans, cancer, heart, kidney, etc. For so long, my life hasn’t felt quite mine … my grandma still needs some help and my kids still have some health issues, but I have the time now to take my life in a new direction, if I can only figure out what I want to do.
You might appreciate this quote from Rebecca Solnit’s book “The Faraway Nearby” (since you wrote about planting seeds):
Page 63: “The object we call a book is not the real book, but its potential, like a musical score or seed. It exists fully only in the act of being read; and its real home is inside the head of the reader, where the symphony resounds, the seed germinates.”
These quotes speak to me:
Page 64: “Writing is saying to no one and to everyone the things it is not possible to say to someone.”
Page 64: “I started out in silence, writing as quietly as I had read, and then eventually people read some of what I had written, and some of the readers entered my world or drew me into theirs. I started out in silence and traveled until I arrived at a voice that was heard far away”
fran melmed says
that text message resonates so strongly and clearly with me. i had two simultaneous and opposing reactions when my mom died: i wanted to share what i’d gained from being her daughter and i felt free of what i felt, sometimes, being her daughter. the former desire i translated into an award i founded to pass along her valuable, insightful life lessons about resilience, preparation, grit, service, etc to young women in philadelphia. the latter reaction sounds harsher than it is. with her passing i shed expectations of how i valued and spent my time that were more hers than mine. i’d obviously been a full-blown adult for some time, but with her passing i was no longer a child in that way we always are as long as our parents are alive.
i will remember this question your friend asked. thanks for sharing it.
professionally, i found the time of my mom’s illness and following her death to be a still time that allowed consideration of how i wanted my life to be formulated. while i continue my communication consulting work under the “context” brand, i have intentionally dedicated a greater portion of my work time to professional pursuits that provide income and reward.
Carla Berg says
Susannah, this is a marvelous recap! It only makes me misty when I think of what had to end after November 9 (so much great talent! so many great plans!) but my loss as a fan and ally at a distance is a mere dust mote compared to the experience of those of you who lived through it.
I loved hearing more detail of the stories where I only heard headlines at the time, such as your stint on the jury and your various speeches (mentally flagging some topics for further discussion when we catch the time). It was also gratifying to see that life did permit you to be as present as I am sure you wished to be during your father’s final months. Again, all my sympathies at so much loss in one year.
However, you are starting this year sounding energetic and optimistic, and that is super to see! I wish you all best with coming plans, including all useful experiments, and I look forward eagerly to our future intersections too (said with a grin and a wink).
Susannah Fox says
Yes! I feel invigorated by the work I’m doing now. Sad for the losses, but grateful for the lessons learned and the continuation of the mission I’ve always been on: increasing people’s access to the data, information, and tools they need.
Alexandra Albin says
Your grace and ability with words always inspire me. You seem to see the world from an oblique angle which is always fresh, positive, and solution oriented. I thank you! I love the concept of the letter! best wishes always!
Mighty Casey says
Raises some powerful ghosts for me, this post. My life shifted in 2000, when I landed in Richmond VA after close to 30 years in New York – I was still in the TV business in 2000, since the marriage that took me from NY to RVA was to a guy who had a satellite truck used by all the alphabet soup (ABC, CBS, CNN, NBC, Fox, E-I-E-I-O).
Little did I know that the move would put me in the position of having to essentially give up all efforts at maintaining my own income, beyond keeping my then-husband’s business afloat, while I spent the next 2+ years as front-line care manager for my ‘rents. They died 29 days apart, at the end of ’02. My own cancer dx, which solidified my pivot into healthcare, was five years minus two days after my mom’s death.
I learned that being a TV news field producer gave me the skills I needed to manage my parents’ care in a way that meant their needs were met (including the ability to terrify recalcitrant functionaries with a death stare, or what I call “NYC Producer Face”); that advance directives are frighteningly necessary (thanks to my savvy dad, I had them long before I needed them); that there’s never enough time with the people you love when you can see the end of the road from where you currently stand; that there is no more beautiful, heartbreaking thing than sitting with someone you love as they leave this life.
Caregiving bankrupted me financially. Parental caregiving’s economic impact on the women of my generation hasn’t been studied much at all, but I’d bet real Yanqui dollar that the impact, annually, in lost income and lost net worth is in the billions. My own personal cost is that I will likely die penniless. I’ll also be alone, since I have no kids and a really crap marital record. But I’m still glad I could be there for my folks when they needed me the most.
Susannah Fox says
Thank you, Casey, for your service to your family and now to our community of people trying to heal health care.
I have seen (I think) your NYC Producer Face and I would not want to be on the receiving end of that glare!
Mighty Casey says
Hah. Little risk you’d be on the receiving end of the gorgon’s glare, but I’m sure you saw it aimed at one shiny-object pimp or another, in some room full of either policy wonks or tech nerds (both?). That glare, along with my brainpan and comic timing, are my nuclear arsenal. I try to launch them only when attempts at persuasion fail.
I love this “letter for shareholders”… My favorite reference for “impact review” is by Bill Drayton, “father of social entrepreneurship” – who emphasizes the importance of differentiating metrics between direct service, pattern change and framework change. Confusion (and tragedy) happens when we use metrics for short term outcome in order to measure the long term, and more tacit, impact, such as framework change… so we need to be creative, and proactive, to create own metrics to tell a story, until, one day, we live in a utopia where “we do this because this is right thing to do” is enough… a tortured artist mumbles 🙂
Dave deBronkart says
> of differentiating metrics between direct service,
> pattern change and framework change.
Wow! My paradigm just popped! First time I’ve ever heard that distinction expressed!
I’ll add that to my own letter.
Jen Dyer MD MPH says
Susannah! Thank you for your inspiring letter. So sorry for your loss. I am so fortunate to have both my parents right now who are both in great health yet not quite as nimble as their old selves. Watching them begin to age has been hard as I can feel the future shift to caregiver role beginning. It makes me mourn that I am really not a ‘kid’ anymore I guess. It is comforting to know that I am not the only one who has felt the shift in the healthcare innovation scene from which I am so fortunate to have met you and so many other talented folks. Seems we are all trying to redefine ourselves and our missions in a time of uncertainty. I myself am starting to feel my ‘fire’ again as I can tell you are too in your writing. The world needs that ‘fire’ and I am looking forward to seeing all the areas that your ‘fire’ will touch in the coming year! 😉
Scott Strange says
For the last seven years I have been a live-in caregiver for my 94 year old mother. Overall, she does excellently for someone who is 94. Her neurologist says she has the best looking brain he has ever seen for a 94 year old 🙂
She is doing well, but it’s a slow decline which is hard for us sibs to watch and I gave up my advocacy efforts in 2015, including withdrawing from MedX that year to be better able to care for here. In 2016, I retired from my job for the same reason.
My family always done the best they could to help take of mom but I simply “didn’t have the spoons” to do both and I chose my mom.
Trillions of dollars of care are given by family members every year. Can something be done to help us caregivers? A few hours a week for paid caregivers to come to the home, where us family members work to make sure that our loved ones are able stay in their home? That pride in being at home, her home, which she paid for is an incredibly important thing.
What can be done at a policy level, which will hopefully be realized at a “boots on the ground” level be done?
Scott Strange “LY/MI”
Susannah Fox says
Hi Scott, thanks so much for sharing your perspective. Your question is a great one to pull out and discuss: “Can something be done to help us caregivers?”
Yes! I have a few suggestions and would welcome more, if others can offer them.
Check out Caring Across Generations, particularly their Take Action section and policy agenda.
The Elizabeth Dole Foundation runs a program for military caregivers called Hidden Heroes. I appreciate their directory of vetted resources, helping connect people to specific assistance like all-terrain wheelchairs. Their resource page is focused on veterans and their families, but there are organizations that serve all caregivers.
The Caregiver Action Network is aimed at a broader population. Check out their Family Caregiver Toolbox.
Danny van Leeuwen / Health Hats says
Thanks for this Susannah. You’ve inspired me for years. Since I stopped being an employee or a boss I’ve also written annual reports for myself. I did it every year for 25 years as an employed boss, so I thought I’d keep it up now that I’m retired from that. Helps me be sure that my work serves my mission. With so much to do in this sick, sickness industry, it’s easy to feel disappointed and burned out. Fortunately, I’ve made a career of beating low expectations – starting with something truly disappointing and finding the small thing that can have an outsized impact moving that something a lasting inch. I call them levers for best health. I’ve found that drinking water has the most outsized impact for best health. Anyway, the annual report helps keep a pulse on the balance between impactful work, stoking my fire to keep going, while managing my own health. It’s a very fun ride.
Susannah Fox says
Thanks, Danny! I love the idea of “levers for best health.” One of the books I’m reading right now is “Younger Next Year” and their suggestion is that everyone get serious exercise six days a week. Not just walking, mind you, which is easy for me, but heart-pumping, change-your-shirt-sweaty exercise. It’s a goal!