On Death, Decision Making and Community Acupuncture
and why you can't afford bad meetings, part two
Quick 5NP 4 OR update: thank you to everyone who submitted testimony! You can watch our Senate hearing here (starts at 18:46). It was very low-key compared to the one in the House. The next step is for the Senate Committee on Health Care to schedule a work session for our bill, which we expect to happen within a couple of weeks. We’ll keep you posted.
I got quite a lot of feedback in response to the post about bad meetings, including some “amen to that!” mail and follow-up questions. Some representative examples from my inbox:
As an alum, one of my favorite things that I got out of POCA Tech was: it is possible to look forward to meetings. Last summer, (my employer) asked me to facilitate one and I went full-on POCA Tech style/Sociocracy and of course everyone loved it and was amazed at how not-terrible it was. We got things done and truly didn't need another one for months. And it lasted only one hour... ahhhhh...so many heart emojis....
and
I'm curious how you think about organic small scale social decision making in an organization. I wonder if people get confused because a conversation between two people with no agenda can be productive but a meeting with ten people with no agenda is doomed. Or perhaps it’s a confusion about the goal of brainstorming proposals versus actually agreeing on them as a organization?
and
My question for you is, have you found that this format works in larger groups (over 20+ participants) who are assembled for a common purpose with people who may or may not be consistently invested in the group?
At the same time I was getting lots of mail, I was also reading the book Four Thousand Weeks: Time Management for Mortals by Oliver Burkeman. (Highly recommended!) Four thousand weeks is the average human lifespan; Burkeman is a philosophically minded, self-described former productivity geek. As he explains in an NPR interview:
“Any degree to which you can see the truth that our time is limited, that we can't do everything, that you can imagine far more goals than you could ever achieve but be OK with it, that is another degree you know you have taken ownership of your life and started to build a meaningful one,” says Burkeman. Because the more actively we can accept and embrace our limited time on Earth, the easier it becomes to spend our time on what matters most to us.
Somehow the emails about meetings, plus the book, plus some things about community acupuncture all came together in my head so let’s see if I can translate it into a post. (Beyond just, “we’re all going to die — YET ANOTHER reason not to have bad meetings!”)
The basic theme of Four Thousand Weeks is that everyone’s time is precious and finite. You can’t time-manage yourself out of your basic human limitations; trying to do so is likely to strip your life of precisely what makes it worth living. You can’t have every experience you want, and you can’t do everything well, regardless of other people’s expectations. You have to choose what you want to prioritize and what you want to be good at, which means letting go of a lot.
If WCA were a person1, it would embrace this philosophy wholeheartedly. As an organization, accepting its limits is why it’s survived for 23 years and why it’s been able to do what it does so consistently, undaunted by pandemics and two-alarm fires and the like. Everything that WCA does, including meetings, happens within a context of limits.2
In the post Last Stop on the Try-Anything Train, I wrote about part of WCA’s origin story: I treated a patient with a terminal diagnosis who got kicked off of hospice and unexpectedly lived an additional five years. Everybody involved (including his doctor) was pretty sure the deciding factor was frequent, regular acupuncture. The trouble was, he couldn’t really pay me for the treatments he needed, and I couldn’t work for free. WCA itself was how we resolved our conundrum. It was like the world said to me, “Hey, now that you know from your own experience that acupuncture might save someone’s life (at least temporarily), what are you going to do with that knowledge?” If acupuncture isn’t particularly useful, who cares if it’s only available to people with lots of money? But if it has potentially life-altering power, don’t we have some responsibility to share it as widely as possible?
Which is to say, WCA’s story has always played out against a life-and-death backdrop.
As a result of that experience, I had to let go of a lot, including most of my prior ideas about how acupuncture works.3 What I was left with evolved into community acupuncture, which, as it turned out, I liked a lot better. And doing community acupuncture successfully — against that life-and-death backdrop — is all about accepting that you can’t do everything you might want to do, or everything that every patient might ask you to do. You can’t give everybody what they want if you’re going to give more people what they need. You have to let go of some things in order to make space for the really important ones — which for WCA is frequent, regular, low-barrier access to treatment.
Okay, I promise I’m getting to the part about meetings.
But first I have to take a quick detour into a few things I’ve learned (the hard way) about small business related to autonomy, independence, interdependence, and decision making.
Humans love autonomy; it’s hardwired into our nervous systems. The promise of autonomy is a major motivation for every small business owner I know. There are trade-offs, though, and the biggest one is responsibility. The more autonomy you have in your business, the more responsibility you have to accept. We try to make it clear to POCA Tech students that if you want a business where you have total autonomy, where you don’t have to factor in anybody else’s input or requirements, you’re going to be working by yourself. Which is fine! Becoming a solopreneur is exactly what some people need to do for themselves.
But like everything else, solopreneurship has its downsides. If you get too lonely and overwhelmed and/or you want to accomplish more than you can as an individual — then you have to figure out how to work with other people. And that means learning to navigate the limits of both your autonomy and your responsibility. You’re exiting the realm of independence and entering the realm of interdependence. You need to notice that particular border, because it matters. The rules are different once you cross over.
Of course humans — especially acupuncturists — try to wiggle out of these constraints all the time. They want to live in both realms at once, they want to have their cake and eat it too. I think this conflict shows up in misunderstandings about decision-making, especially decision-making in organizations.
Sometimes people want to participate in decision-making because they think it’s a form of both power and autonomy. But in an organization, especially an organization with limited resources like WCA, decision-making has more to do with responsibility and interdependence. (See also: leadership isn’t a reward, it’s work.) In my experience, the more an organization voluntarily accepts its limits and is careful with its priorities, the more decisions tend to make themselves. Because there just aren’t that many options to choose from. By design. This can be disappointing if you were hoping for power, autonomy, and unlimited options.
Sometimes people want to participate in decision-making because consciously or unconsciously they think that making good decisions protects you from uncertainty and makes you safer. Once again, in our world it mostly doesn’t work that way. The more limited your resources are, the more uncertainty you have to deal with and there’s only so much you can do about it. Uncertainty is inseparable from small business. This is also disappointing for some people.
Here’s a quote about decision-making from Aaron Dinin, who teaches entrepreneurship at Duke University and writes a Substack about it:
(H)ere’s the thing no one tells you early enough...the decision you make isn’t nearly as important as what you do with it once you’ve made it. You don’t need a perfect plan. You need a direction and the willingness to keep going even if you’re not quite sure you’re going in the right direction. In fact, it’s especially important when you’re unsure.
Entrepreneurship, like life, isn’t linear. You’ll change your mind. You’ll pivot. You’ll build things that don’t work. You’ll get it “wrong” more than you get it right. But none of that means you’ve failed. It just means you’re in motion. And motion beats perfection every time.
In my experience, if you want good meetings and good decision-making in your organization, you have to watch out for people’s natural, hardwired, but indiscriminate (and often counterproductive!) drive to exercise their individual autonomy. Similarly, you have to keep an eye on their perfectionism and their fear. Otherwise these things will ruin your meetings — and the more people you have in a meeting, the more those negative elements can compound. What I like best about the sociocratic structure for meetings is that it offers some specific rituals for decision-making (like proposals, reaction rounds and consent) that anticipate these human weaknesses and help manage them. Sociocratic meetings help people remember that they’re working in a context of interdependence and the goal is to keep the organization moving forward.
At WCA and POCA Tech we almost never use regular meetings for brainstorming, which some people find really disappointing. Brainstorming can be a fun group activity! But it can also give the false impression that anything is possible, and everybody in the organization can weigh on in anything they might be interested in, without taking any responsibility for execution. I’ve been in some truly awful acupuncture-organization meetings where all anyone wanted to do was brainstorm, constantly, as a way of avoiding reality.4 If brainstorming is something you want to do in your organization, my suggestion is be really clear about the parameters and maybe do it outside of regular meetings?
Similarly for the question of, does this format work for larger groups and un-invested people, my suggestion is to get really clear about the purpose of your meeting. I’d be careful about letting un-invested people participate in decision-making. The acupuncture profession has a huge problem with this; acupuncturists love to share their opinions but rarely, oh so rarely, are they willing to put skin in the game. You can draw a straight line between un-invested people making decisions for an organization and regrettable outcomes.
I do think the sociocratic meeting format could work with larger groups, as long as you’re transparent with everyone about what you’re doing and why you’re doing it — which gets back to being clear on your purpose. What exactly are you aiming to accomplish with these people? Meetings aren’t necessarily the right place to share information, build group cohesion, or get to know each other. There are lots of meetings that could’ve been emails, but there are also meetings that should’ve been potlucks. Or parties.
Which is all to say, I think it’s all about accepting limits and making choices. You can’t do everything with meetings, so decide what exactly you’re aiming for and then be open about that with people. Just like you can’t do everything in clinic with your patients.
In a recent POCA Tech class, we were talking with third-year interns about their process of getting up to speed, especially the way they’ve had to get used to working with limited information. Nobody can talk a lot in a busy community clinic, because there just isn’t time for it (and some patients don’t want to talk at all). One of the interns said: Community acupuncture is a beautiful way to love people unconditionally, because you know nothing about them except what hurts them. And you can do something about it for them in that moment… and that’s profound.
It’s not a secret that I think WCA is a person, a more-than-human person.
Recently I read a good Substack (also by Aaron Dinin) about how a big part of an entrepreneur’s job is to supply context. I wish somebody had told me that 20 years ago; I had to learn it the hard way.
My relationship with Traditional Chinese Medicine diagnosis was never great but this experience was the nail in the coffin, so to speak. My patient hated getting needled so treating him was a matter of negotiating which few points he would let me put in (very shallowly). He wouldn’t change his diet and he couldn’t take herbs because he was on other medications. There was no point in using tongue or pulse diagnosis with him; it wouldn’t change what I could do as his acupuncturist — which was very little. Sometimes people wonder why WCA and POCA Tech aren’t into TCM or lifestyle advice. I blame it on a miracle.
I will bet you $20 that if you try to have a meeting with acupuncturists about the acupocalypse, you will end up in a brainstorming session where people bring up increasingly unlikely and unworkable “solutions”. Don’t take that bet, though, because not only will you owe me $20, you will lose an hour (or more!) of your limited and precious life.
Exactly right. All of it.