25 May 2018

Dear Interested Readers,


From a “Bitter Pill” To a “Tailspin”

As you probably have noticed this first section of my weekly letter to you has morphed from an introduction to the main thought for the week toward the place where I expose my concerns for the moment about a wider selection of current events, politics, and issues that impact the future of healthcare. I would give two reasons in the defense of this shift. First, healthcare has isolated itself far too long from a role in the larger discussion of politics, world affairs, and the economy. Don Berwick has inferred that healthcare has taken what it wants and then left the rest of the world to accommodate. I think that is changing. In the future healthcare will need to do more than sit comfortably on the sidelines during the discussions of environmental policy, infrastructure revitalization, efforts to reduce inequality, the slide toward illiberalism, the decline of political norms, the destruction of public education, and all of the policy moves that collectively further disadvantage middle class and lower class Americans, and especially the underserved poorer citizens of our world. Yes, I said the whole world. Disease and disadvantage in other places threatens us on a small planet. Second, it is cathartic to express myself to people I respect. I hope that you will push back if you disagree and inform me where I need to be informed. Saying “amen brother” is also a welcome comment.

Will Rogers famously and facetiously said, “All I know is what I read in the papers, and that’s an alibi for my ignorance.” More than 75 years later for most of us the statement holds if you change “papers” to “my favorite media.” Lately I have been trying to expand my media sources and it is hard because I want to leave any room where “Fox and Friends” is on the television as it was in the restaurant at the hotel where I am staying in Anchorage, or as it was in a restaurant on my last visit to North Carolina. I have also discovered that there is more and more reason to turn to books. I enjoyed contrasting the recent books of James Comey and Hillary Clinton. Neither is totally right or totally wrong. Someplace between them there is something of value.

In my new attempt to encounter thoughts that do not always align with my own ideas, I have been anticipating the publication of Stephen Brill’s new book, Tailspin. It’s coming out on May 29. It is next up on my reading list. I had a hard time with parts of his book about the ACA, The Bitter Pill. Even though at the time I disagreed with many of his assertions and criticisms of the ACA and the process that produced it, I find that looking back from where we are now, his book is looking better. Brill is a lawyer who got his law degree from Yale, but he has been an author, journalist, publisher, and commentator for most of his career. He is the guy who created Court TV. He is also a guy from a lower middle class family in Queens who benefited as an early recipient of the generosity of institutions like Deerfield Academy and Yale that wanted to diversify the structures of their student bodies.

Brill has frequently written for Time magazine so I was not surprised this week that when my copy of Time arrived with a cover that proclaimed “How My Generation Broke America” by Stephen Brill. I am sure that there will be more in the book but the Time article is worth our attention now. In essence he describes himself as a beneficiary of affirmative action and the move in the sixties away from a system based on heredity and toward a system that is more merit based. Along the way there seems to have been some unintended consequences and outcomes that are either a driver of, or the result of, our world becoming more complex. All of these “currents of change” apply to healthcare and some directly undermine the road to the Triple Aim.

Brill succinctly lays out the problem from 40,000 feet in the first paragraph:

Lately, most Americans, regardless of their political leanings, have been asking themselves some version of the same question: How did we get here? How did the world’s greatest democracy and economy become a land of crumbling roads, galloping income inequality, bitter polarization and dysfunctional government?

Brill wastes no time in answering his own question and a question that I frequently ask or suggest, “What part of the problem am I/we?” As the title of the article suggests, the answer is mostly that we are the cause of our own concerns. The twist that he adds though makes his article, and I assume the book from which it is taken, much more interesting. As many have implied, the situation is complicated and it is unlikely that either political party has the ability to do much more than suggest that the solution is to elect them. Brill suggests that it will not be as easy as voting in the Democrats to replace the Republicans. America has in many ways been a victim of its core values, its success, and its efforts to fix itself, even as he and many others have been beneficiaries of these expanded values. It seems something did not go as planned. Could it be a focus on self over community? As I read his analysis I wonder whether or not his points, if correct, apply to healthcare as well as to everything else. I have added the bolding to his words.

As I tried to find the answer [to how we got here] over the past two years, I discovered a recurring irony. About five decades ago, the core values that make America great began to bring America down. The First Amendment became a tool for the wealthy to put a thumb on the scales of democracy. America’s rightly celebrated dedication to due process was used as an instrument to block government from enforcing job-safety rules, holding corporate criminals accountable and otherwise protecting the unprotected. Election reforms meant to enhance democracy wound up undercutting democracy. Ingenious financial and legal engineering turned our economy from an engine of long-term growth and shared prosperity into a casino with only a few big winners.

Brill quickly concludes that the unintended consequence of our collective actions is to bring us to the bimodal world that we see emerging. In many ways what he says is not that different from some of the core pronouncements made by the French economist, Thomas Piketty, in his powerful book of 2014, Capital in the Twenty First Century. As Paul Krugman explains, Piketty suggested that the way we use capital has evolved to create more wealth for fewer and fewer people. Piketty explains how inequality has been created. Krugman is actually a good lead in to the bulk of Brill’s Time article and, I assume, the thesis of his book that I eagerly await. Krugman writes:

Brill seems to accept that idea and adds more as he writes:

These distinctly American ideas [the ones that presumably made America great] became the often unintended instruments for splitting the country into two classes: the protected and the unprotected. The protected overmatched, overran and paralyzed the government. The unprotected were left even further behind. And in many cases, the work was done by a generation of smart, hungry strivers who benefited from one of the most American values of all: meritocracy.

Brill’s analysis does make sense. It is a myth buster that suggests that many of us, like myself, who benefited from programs of the great society did not choose to “pay it forward. Our attention to our own needs and further enrichment adds to inequity and is a root cause of the bimodal economic world that has emerged from the ideal that America is a land of opportunity. The outcome of many choices at many levels is a collective loss. In short he seems to suggest that extending opportunity to more and more people based on their demonstrated merit, which seems very fair and potentially beneficial to all of us, has resulted in the mess that now lies before us.

He does credit economic growth with creating more opportunity for many, but he would add that they are a minority and the experience of the majority, especially those in areas between the coasts, over the last few decades has been increasingly depressing. He would also add that it took a few decades, to set up the situations that created the pain we now have and implies that we should be wary of those who sell simple solutions to complex problems that they alone have the sense to recognize and the ability to affect.

This is not to say that all is rotten in the United States. There are more opportunities available today for women, nonwhites and other minorities than ever...

For too many, the present is hard enough. Income inequality has soared: inflation-adjusted middle-class wages have been nearly frozen for the last four decades, while earnings of the top 1% have nearly tripled. The recovery from the crash of 2008 – which saw banks and bankers bailed out while millions lost their homes, savings and jobs – was reserved almost exclusively for the wealthiest. Their incomes in the three years following the crash went up by nearly a third, while the bottom 99% saw an uptick of less than half of 1%. Only a democracy and an economy that has discarded its basic mission of holding the community together, or failed at it, would produce those results.

The truth in those words stings, and it does not take very long to go from that reality to the election of Donald Trump who acknowledged the pain. He then claimed that, he and he alone, could fix things. After he accused bankers, Mexican rapist, collusion between elites, bad trade deals, a self serving press, Islamic terrorists and other minorities as being the cause of the pain, he was elected. Brill is brilliantly descriptive of this moment in our history, and paints a picture that in many ways is worse than the one the president described in his own speech at the Republican Nominating Convention in July 2016, or in his very dark speech on Inauguration Day in January 2017.

Most Americans with average incomes have been left to fend for themselves, often at jobs where automation, outsourcing, the decline of union protection and the boss’s obsession with squeezing out every penny of short-term profit have eroded any sense of security. In 2017, household debt had grown higher than the peak reached in 2008 before the crash, with student and automobile loans staking growing claims on family paychecks.

American politicians talk about “American exceptionalism” so habitually that it should have its own key on their speechwriters’ laptops. Is this the exceptionalism they have in mind?

Those are the high points of the first section of Brill’s article in Time. He presents five sections that continue the analysis. It is a very long description, or you might say accusation of our collective current state which is clearly worse now than it was on Election Day in 2016.

The next three sections provide more detail and analysis of how we got to this moment in time. In his third section he outlines how the heady thinking of the sixties offered opportunities for people like him, and also me, as well as perhaps you. We are now part of the “winners” and no longer need the help of government. Less government would be fine thank you. It is his version of “What part of the problem am I?” Then there is the majority that did not win. Is it 99%? Probably not but it is much more than half and the number seems to be growing. They need help even though many do not vote as if they do.

On the other side are the unprotected many. They may be independent and hardworking, but they look to their government to preserve their way of life and maybe even improve it. The unprotected need the government to provide good public schools so that their children have a chance to advance. They need a level competitive playing field for their small businesses, a fair shake in consumer disputes and a realistic shot at justice in the courts. They need the government to provide a safety net to ensure that their families have access to good health care, that no one goes hungry when shifts in the economy or temporary setbacks take away their jobs and that they get help to rebuild after a hurricane or other disaster. They need the government to ensure a safe workplace and a living minimum wage. They need mass-transit systems that work and call centers at Social Security offices that don’t produce busy signals. They need the government to keep the political system fair and protect it from domination by those who can give politicians the most money. They need the government to provide fair labor laws and to promote an economy and a tax code that tempers the extremes of income inequality and makes economic opportunity more than an empty cliché.

That, rather than a split between Democrats and Republicans, is the real polarization that has broken America since the 1960s. It’s the protected vs. the unprotected, the common good vs. maximizing and protecting the elite winners’ winnings.
In the fourth section Brill describes how the “winners” of the 60s and 70s consolidated their gains and made it worse for the “others.” He was an insider and a big beneficiary of those “good times.” It is almost confessional.

The Meritocracy’s ascent was about more than personal profit. As my generation of achievers graduated from elite universities and moved into the professional world, their personal successes often had serious societal consequences. They upended corporate America and Wall Street with inventions in law and finance that created an economy built on deals that moved assets around instead of building new ones. They created exotic, and risky, financial instruments, including derivatives and credit default swaps, that produced sugar highs of immediate profits but separated those taking the risk from those who would bear the consequences. They organized hedge funds that turned owning stock into a minute-by-minute bet rather than a long-term investment. They invented proxy fights, leveraged buyouts and stock buybacks that gave lawyers and bankers a bonanza of new fees and maximized short-term profits for increasingly unsentimental shareholders, but deadened incentives for the long-term growth of the rest of the economy.

The analysis paints a darker and darker picture and then uses a quote from a speech given at the 2015 graduation at Yale Law School by Daniel Markovitz to bring us to this moment. 

There is some “resolution” and hint of hope in the last section.

He describes a generation of “new achievers” who are trying to lead us in a turn around. I am placing my faith in them too. In the section that follows I describe the importance of passing along the learning of my generation to them through more effective training and preparation for leadership. I think that the best that we can do is to aid them with the wisdom of a generation that did not live up to its potential, but is at least capable of self observation and examination of its failures. Lean teaches that we do not usually get things right the first time. Improvement is a continuous process built on learning from failure.

The new achievers are doing what they do not because they are gluttons for frustration, but because they believe that America can be put back on the right course. They are laying the groundwork for the feeling of disgust to be channeled into a restoration.

Brill’s Time article has certainly set me up for the book. I can hardly wait for May 29. Brill is no dummy. If you read his article online there is a link at the end to click and order the book. I think that is fine. He has much to say, and we should pay attention and consider much of it as we try to advance the Triple Aim and stop the “tailspin” that is the real threat we all share no matter which side of the bimodal divide we find ourselves.


The Triple Aim Depends on Leadership With Commitment to Mission, “Soft Skills,” and Integrity

Last Friday afternoon at the time this letter came out I was driving up Interstate 88. I was somewhere between Binghamton, New York and Albany. I do not like driving on most Interstate highways because they are usually monotonous and I miss the more interesting things that you can see if you take the back roads and byways. Interstate 88 is the exception. The drive is beautiful and the added plus is that there usually is not much traffic. For most of the way the road is carved out of the side of mountains and hills. For much of the more than a hundred miles it looks down on a valley that is dotted with villages, but is mostly filled with lush farmland and forests. The views are spectacular. The sky seems to be higher than it is in much of New England. You can see for miles. In many places the road is cut through layers of deep brown rock that look like they were formed by sediment at the bottom of some ancient sea before they were thrown to the top of the mountains. The rocks look nothing like the ubiquitous granite of New Hampshire. If time allows, you can take a twenty mile side trip off of I 88 and visit Cooperstown with its very quaint Baseball Hall of Fame.

I was on my way home from Corning, New York where I had attended meetings of the board of Guthrie Health on Thursday evening and Friday Morning. The Corning Hospital is out on Interstate 86 toward Elmira. The hospital is a gleaming state of the art facility that opened about two years ago. It replaced a tired old stack of Hill-Burton bricks, and was designed using Lean principles. [If you do not know the impact of the Hill-Burton Act on American healthcare you should definitely click on the link. Hill-Burton provided funds for 6500 hospitals back in the mid twentieth century and had a now famous, but at the time much neglected, “free care” requirement.]

Guthrie is a very progressive health system that has four hospitals (soon to be five) and a very large ambulatory practice that stretches from Binghamton in the east to past Corning in the west. It goes North to Ithaca and penetrates deep into the Northern Tier of Pennsylvania communities reaching down toward Geisinger Health in Danville. It’s a small town and rural system that gives me a window onto the world on healthcare that is experienced by the millions of Americans who do not live in the shadows of the academic medical centers of large cities.

Guthrie has longed used Epic as its EMR and has enthusiastically and effectively adopted Lean as its operating system. I have been on the Guthrie Board for several years and have enjoyed seeing the transformation toward quality and value based reimbursement that has occurred. I was one of three board members that were recruited several years ago to give the board a “national perspective.”

For several years I would fly to and from the meetings but the trip required flying through Philadelphia, and as the Patriots know, bad things happen in Philly. My batting average for making a successful connection to Elmira though Philly was below “the Mendoza Line.” The alternatives of flying through Rochester or Detroit were worse. As a retiree, I have the time to enjoy the view and can drive the slightly more than three hundred miles with more reliability and in less time than flying.

I follow rules, mostly. All along I 88 there are signs that say that it is against the law to “text and drive” and advise you of the distance to the next rest stop where you can check your mail and read your text. Just before 3:30, 3:24 to be precise, I heard the electronic “ping” from my phone that notifies me of a text or email. I glanced at the phone on the seat and saw that my old friend, and interested reader, Michael Soman, had sent me an email. He is quick. The letter had gone out at 3:01. I was anxious to read his response. As luck would have it the next rest stop was just a mile down the road. His note read:


Nice issue, my dear friend.

Wanted to share with you (I may have done so previously) something triggered for me by your discussion of "truth".

We have learned that historically, perceptions of dishonesty are one of the most difficult (or even impossible) character traits a leader can overcome. I always shared with leaders with whom I was blessed to work that fact, along with a practical definition of honesty for them to consider:

Honesty on behalf of the leader can be looked at by followers through 4 questions:

Do you do what you say you are going to do? (i.e., are you reliable?)

Do you tell the truth? (what many people call "honesty")

Are you capable of doing what you say you will do? (i.e., I can't dunk on Labron even if I want to!)

Are you beneficent? (i.e., holding other's interest at a very high level)

This seemed to be a helpful way of looking at honesty, so I pass it on to you!

Be well, my friend, and don't even TRY to apply this definition to the current President of the United States!

michael


As usual, Michael was crisp and to the point with humor. Michael knows leadership. For many years he was the president of the medical group of Group Health in Seattle which is now part of the Kaiser system. While I was leading Atrius and Harvard Vanguard, Michael had very similar responsibilities with Group Health. Our organizations had very similar missions. It sometimes felt that we were East Coast and West Coast sites of the same enterprise since we shared so many ideas about what constituted the best care. It is not a surprise that many professionals had worked in both of our organizations and at Kaiser since all three organizations were committed to the concept of value based reimbursement back when we called it “prepaid” care, or capitation.

I visited Group Health several times for ideas and inspiration and Michael brought his leadership team to Boston to visit us. A visit to Group Health to see how they were using Lean was an important factor in the decision of our leadership team to begin a Lean journey. Michael was most interested in the history of how our group had separated from its insurance function as a stand alone 501c3 non profit medical practice accepting patients covered by all insurers. We connected at GPIN and other meetings to discuss leadership and its stresses, and shared best books with one another. Finally, we both retired at almost the same time!

Michael’s note is a good introduction to the important issue of healthcare leadership at this moment in our history. The importance of reevaluating how we develop leadership was underlined in a recent “perspectives” article in the New England Journal of Medicine by Lerman and Jameson from the Perelman School of Medicine at the University of Pennsylvania. The article simply entitled “Leadership Development in Medicine” is an excellent description of the first three steps of a Lean approach to problem solving.

The paper begins with a “reason for action” that is succinct:

Health care in the United States suffers from a persistent and worsening disconnect between the capacity of the physician-leadership workforce and the needs of our expanding and increasingly complex health systems. Closing this gap will require leadership skills that are not acquired during traditional medical training.

The practice of medicine is evolving rapidly. New health care technologies and precision therapies are shaping medical decision making and patient care. A diverse group of commercial and government payers are continuously changing approaches to the approval of clinical services, quality oversight, and payment. Health systems are implementing electronic health records, quality-improvement programs, multispecialty clinical service lines, and programs to improve population health. In light of the rising costs of care and shrinking margins, payer and provider systems are consolidating to improve efficiency.

The authors add that their concerns include how the environment has added complexity to the role of academic medical centers. They note that not only is our world much more complex than it was when many of our current leaders were trained, but the complexity has increased quickly. It is my opinion, which I think they would share, that the pace of change and the competencies required to meet those changes has occurred faster than we have been able to process and change our approach to developing leaders. That we do not produce enough leaders who are prepared for the challenges that are rapidly evolving is the primary “reason for action.”

Michael and I came along at a different time and at a different pace. There was much to learn about business and leadership, but there was plenty of time for learning through doing and we were fortunate to work in organizations where there were plenty of “big brothers and big sisters” who had the time and the desire to help us develop. Our worlds were more internally focused and there was much less external pressure from changing regulatory agencies or the demands of payers.

This transformation has occurred within a short period, and the pace of change is unlikely to slow. Our profession has been somewhat complacent in the face of these disruptive forces and hasn’t prioritized cultivation of leadership skills such as communication, team building, collaboration, and deliberative decision making that will position the next generation of physician leaders to succeed in this rapidly changing environment.

The “current state” is in part subsumed in the way I have extracted their thought for the “reason for action” but they add:

Health care represents 18% of the U.S. economy, and there are nearly 6000 hospitals and more than 1 million physicians in the United States. Depending on their roles, physician leaders of departments, quality-improvement programs, clinical service lines, practice groups, information technology teams, and other units may manage budgets similar to those of medium-sized businesses and work in organizations that are often among the largest employers in their community. Although training in finance, business planning, and personnel management is central to the professional development of health system executives, these topics are not generally emphasized in the training of physician leaders.

Physician leaders were traditionally selected on the basis of their national prominence and excellence as master clinicians, star researchers, and revered educators. These credentials remain important, but they aren’t sufficient in the current health care climate.

There is some mixture in the article between the discussion “ideal state,” and the gap between current state and an ideal state, and the search for solution, but that does not detract from the importance of the problem they have called out or our need to face it. A decade ago we recognized these issues at Atrius Health and invested heavily in creating an internal “Leadership Academy.” The work was conceptualized and led by Zeev Neuwirth who is now at Carolinas HealthCare System which has recently renamed itself as Atrium Health. [That is close! Atrium v. Atrius]

Every six months we selected 30 of our best young leaders chosen from our physician leaders, medical managers, and nursing and advanced practice health professionals and started them on an eighteen month journey of intense training in all of the business skills they would need as well as the “soft skills” that are so critical in the leading and development of the professionals who are the “knowledge workers” of healthcare. The program required a huge commitment from the individuals since the training was not all done during normal working hours. Many evenings and weekends were added to the work of fully employed professionals.

There was a huge benefit to the weaving of the didactic program with the normal work of the “students.” The skills being taught and the connections being developed across a large multi sited organization yielded immediate benefits. What was being learned and the collaboration on the academic exercises were immediately applied in a way that could never have occurred if “learners” had been sent out of the organization for learning and then returned to try to influence a rigid status quo. Over my tenure as CEO several hundred internal leaders developed skills that were available immediately to help us create programs that enhanced quality and patient satisfaction, create affiliations, increase productivity, improve work life balance, and reduce costs. The Leadership Academy created relationships and imparted skills that moved us toward the Triple Aim. As our Lean transformation progressed we had leaders who knew the importance of leadership that focused on coaching, mentoring, and supporting others through meaningful relationships grounded in a mission.

Michael’s four points about honesty and leadership are foundational to the effectiveness of “relational contracts.” Professor Rebecca Henderson at Harvard Business School and others have discussed and stressed the importance of trust in relational contracts and the importance of relational contracts to successful organizational transformation using the tools of continuous improvement. Healthcare at every level is about trust between multiple parties whether they be patients and providers, providers working together or organizations working together to create business advantages that will translate into community benefit.

If there is anything that our current political environment should teach us, it is that leadership without trust rarely accomplishes anything unless it is coupled with force and intimidation. There are “top down” healthcare organizations where success seems to be possible through pressure and abuse. I could have never worked in such an environment. When I discovered pockets in our organization where those situations existed, I always favored trying to use training and coaching as a solution, but there were times when the distrust was so prevalent and the problems were so great that new leadership was the only alternative.

The authors of the NEJM paper stress the importance of beginning leadership training in medical school and I agree, but they extend their suggestion of a better state to something much like the Leadership Academy at Atrius.

Leadership development should begin during medical school, and potential leaders can be nurtured at each stage of professional advancement. We suggest that health systems focus on three key strategies for promoting the effective development of physician leaders.
First, such systems could build a diverse pipeline of future physician leaders from within the organization. This approach would expand the pool of potential leaders, allow emerging leaders to take on progressively increasing responsibility, and ensure that leadership strategies are aligned with the organization’s culture and priorities. Health systems could start by identifying potential leaders and engaging them in task forces, committees, retreats, and formal training programs. Each of these activities requires dedicated time and institutional support for leadership development.

Providing frequent, structured feedback to emerging leaders offers opportunities for ongoing assessment of leadership potential, mentoring, and succession planning. Whenever possible, goals, metrics, and incentives should be transparent and quantitative. Developing talent from within — a foundational approach in other industries — can reduce the time required for recruitment, transition, and integration...Second, health systems could implement a deliberate process for rigorously mining talent pools, whether internal or external. The most promising leaders are those who not only have experience and a compelling vision but also exemplify the core values of the institution and can engage and inspire others to rally around a shared vision.

It is gratifying to to read how close their suggestions mirror our experience. They go on to stress that leadership should be a priority. I would add that a huge challenge is that organizations avoid leadership investment if they feel financially stressed. Sometimes they make leadership development the first casualty of budget driven reductions in response to external financial pressure. Jim Collins describes the painful slide to oblivion that many organizations follow in his book How the Mighty Fail. I do not think medical systems, hospitals, or medical practices are immune from the disorder that Collins describes. The author of the HBR review that you can find by clicking on the link sums up Collins’ findings on how organizations fail as:

He settles for describing the typical path to ignominy in five phases …

1. Hubris born of success
   
2. Undisciplined pursuit of more
   
3. Denial of risk and peril
   
4. Grasping for salvation
   
5. Capitulation to irrelevance or death
   

Listening to Michael we can see that the lack of honesty or trustworthiness in management is at play in each of these steps. An organization that is not focused on leadership development is at least at stage 3 and those who had leadership programs and have reduced or eliminated them are lost causes and are at step 4 or 5 in the process. They are well on the way to giving up autonomy to the mercy of another organization as their only rational option to total failure. One can hope that the newer larger combined organization will recognize truth and honesty as core principles. There is nothing that is more essential in a new affiliation than trust girded by honesty and commitment to mission.

The authors of the NEJM article ended by saying:

In any high-performing organization, leaders have a disproportionate influence on organizational culture and performance.

And to that I would add Michael's comment:

We have learned that historically, perceptions of dishonesty are one of the most difficult (or even impossible) character traits a leader can overcome.


A New Place to Walk

I am in Alaska for the next ten days. It’s our first time and we are really having a good time. Anchorage is a very walkable city. The best place to walk is the Tony Knowles Coastal Trail. The trail runs from downtown Anchorage along the coastline to a park eleven miles away. Today’s header was taken from the trail and is an example of the inspiring views along the way. I am looking forward to many more hikes and walks over the next week or so. My only disappointment so far is that I am yet to encounter a moose although everyone says there are plenty to be seen. That’s also what I am told back home in New Hampshire where the only moose I have seen is on my license tag.

Before coming I had little idea of what to expect weather wise. To my delight what we have enjoyed has been very much like what I left in New Hampshire. The most obvious difference is that the sun is setting at eleven PM and comes up again around four in the morning. I never thought I would say that when it comes to daylight it is possible to have too much of a good thing.

Wherever you are over this first long weekend of “summer” I hope that the scenery and weather will be so good that you will find it impossible to stay inside. The calendar is giving us fifteen weekends this summer, if you start counting with the Memorial Day weekend and finish up with the Labor Day weekend. Let’s make them all memorable!