40. Continuous Feedback

With a multitude of tools available for constant and continuous interaction with each other, why should the annual review wait for its once-a-year drudgery?  Not many (no one?) likes them anyhow.

Feedback is important—vitally important for the high-performing organization.  But what good does it do an employee when she finds out six months from now that her performance on the new business plan was exemplary?  What good does the staffer gain from a constructive critique of his less-than-satisfactory interaction with patients?  In either case, little.

Feedback that is instantaneous (or at least within a workable time line) allows a co-worker to improve a lacking skill (with the organization’s help, of course), especially with the insufficient performance as an example fresh in her memory.  It notifies the up-and-comer that his new ideas are appreciated (and implementable).  Think about how much easier nurses could offer helpful critiques of physicians.  Or how much easier physicians could do the same for administrators.  Examples given not needed: imagine the possibilities throughout the organization.

Rypple (currently in private beta) has developed a platform to institute continuous review.  Its service allows users to ask for feedback from co-workers.  From Springwise:

Employees can use the system for specific concerns, for example the impact of a presentation, or for more general issues such as areas of performance to focus on in future. Questions can be tagged with keywords, helping monitor progress in specific areas over time. Rypple’s digital interface lets it foster open and honest responses that might not be given face to face: feedback can be given anonymously, only to be viewed by the person who requested it.

Of course a digital platform isn’t necessary for continuous feedback, but it certainly makes it easier (and perhaps more comfortable for all involved).  There’s room for improvement in the model, too: we can’t expect that every organization stakeholder will be so in-tune with their performance as to always be asking for feedback (overload?) or that everyone will be so engaged with the initiative as to actually ask for feedback.

We can make it clear, however, that continous feedback is important in our provision of quality health care.  Continuous feedback is a component of outstanding communication.  Communicating outstandingly with each other is a fundamental component of an open (read: transparency on steroids) health care organization.

Principle #40: We’re opening the communication lines (all of them).  We’ll talk to each other to help.  Helping each other improve will not only improve our culture, it will improve the quality of care we provide.

Design will conquer health care

When was the last time your hospital hired a designer that wasn’t dedicated to interiors?

No, seriously.  To catch you up, design is emerging as a solution to a wide variety of problems.

We all know about IDEO (at least you should) and what they’ve done for care delivery, but what about the increasing role health care will play in community health?  Insert Participle:

We believe there needs to be a new settlement between individuals, communities and government – new ways for people to get involved in determining their lives in a meaningful way, new approaches that mean some people do not get stuck at the bottom of the heap for generations and new bonds that mean people can flourish and bring their dreams alive.

We also think that what matters is not just ideas, but real change on the ground, in our communities.

On an everyday level this means public service reform – this is where the opportunities lie, to build something different.

At Participle, we do two things: Firstly, bring together the widespread community level ideas and creative activity, and mix it with world-leading experts in any given field; Secondly, drive forward thoughts and actions around developing a new social settlement which can deal with the big social issues of our time.

Fast Company explains:

[Hilary] Cottam is one of a new wave of design evangelists who are trying to change the world for the better. They believe that many of the institutions and systems set up in the 20th century are failing and that design can help us to build new ones better suited to the demands of this century. Some of these innovators are helping poor people to help themselves by fostering design in developing economies. Others see design as a tool to stave off ecological catastrophe. Then there are the box-breaking thinkers like Cottam, who disregard design’s traditional bounds and apply it to social and political problems. Her mission, she says, is “to crack the intractable social issues of our time.”

The application to the health care industry, again from Fast Company:

Earlier this decade, while working for the Design Council, Cottam turned to health care. Originally she planned to rethink hospital design but became more interested in community-based services for sufferers of chronic diseases such as obesity and diabetes. “One in four people in Britain now has a chronic disease that’s treated at home,” she says. “So why are we investing in hospitals rather than community-based solutions?”

One problem the Design Council team identified is that diabetes sufferers often forget to raise important issues with doctors and caregivers. The solution was a pack of diabetes cards, each printed with a question to be used as a prompt. Superficially it looks like a health-care project but, as Cottam points out, design techniques were critical in identifying patients’ problems and producing an efficient graphic solution. “It’s amazing how new the simple design concept of understanding users is to many in the health-care field,” says Tim Brown, CEO of the design firm Ideo, which works in U.S. health care, among other industries. “Hilary’s work has shown that you can take rigorous design methodology and apply it successfully in social systems.”

This all goes back to getting out of health care.  Hire from outside the industry, too.  Never be afraid to hire those creative types, either.  Then let them attack the most challenging problems your organization encounters (i.e., financial constraints, throughput issues, etc.).  The solutions created may astound you.

Virtual Therapy for Burn Victims

Very cool (literally and figuratively).

SnowWorld is virtual world therapy for burn victims.  From the University of Washington HITLab:

SnowWorld, developed at the University of Washington HITLab in collaboration with Harborview Burn Center, was the first immersive virtual world designed for reducing pain.  SnowWorld was specifically designed to help burn patients. Patients often report re-living their original burn experience during wound care, SnowWorld was designed to help put out the fire.

Our logic for why VR will reduce pain is as follows. Pain perception has a strong psychological component. The same incoming pain signal can be interpreted as painful or not, depending on what the patient is thinking. Pain requires conscious attention. The essence of VR is the illusion users have of going inside the computer-generated environment. Being drawn into another world drains a lot of attentional resources, leaving less attention available to process pain signals. Conscious attention is like a spotlight. Usually it is focused on the pain and woundcare. We are luring that spotlight into the virtual world. Rather than having pain as the focus of their attention, for many patients in VR, the wound care becomes more of an annoyance, distracting them from their primary goal of exploring the virtual world.


Via PSFK via Herd.

An illustrative example

Paul Levy had questions of the clinical efficacy of a new piece of equipment that other organizations have been purchasing.  His post today is a perfect illustration of health care rivalry, not competition:

Without making any representations about the relative clinical value of this robotic system versus manual laparoscopic surgery, I am writing to let you know we have decided to buy one for our hospital. Why? Well, in simple terms, because virtually all the academic medical centers and many community hospitals in the Boston area have bought one. Patients who are otherwise loyal to our hospital and our doctors are transferring their surgical treatments to other places. Prospective residents who are trying to decide where to have their surgical training look upon our lack of the robot as a deficit in our education program. Prospective physician recruits feel likewise. And, these factors are now spreading beyond urology into the field of gynecological surgery. So as a matter of good business planning, concern for the quality of our training program, and to continue to attract and retain the best possible doctors, the decision was made for us.

Innovating based upon what really matters

Stephen Shapiro on his 24/7 Innovation blog writes about Clayton Christensen idea of the innovator’s dilemma and the U.S. economy:

The dilemma arises because most companies focus their innovation energies on building faster and more sophisticated technologies: becoming bigger and better. … Unfortunately, the newer, cheaper developments – even if they are lower quality (in the beginning) and don’t perform as well – will ultimately be the winners.

The US economy – and most of the “Western world” – is based on constantly improving everything: becoming bigger and better.

Here’s the spot-on take away which is especially relevant to the health care world:

Some would claim that we need to become more creative.  Use our right brain more.  Focus on design and experiences.  Taking things to the next level.  Although this may be true, I wonder if it perpetuates the innovator’s dilemma thinking.  Bigger and better.

What if the answer is to find ways of offering more affordable, more accessible, and more simplistic offerings?

I’m a big proponent of more right-brain thinking in health care; for far too long we have completely ignored design and experience in care delivery.  But who can argue that innovation focused on more affordable, more accessible, and more simplistic health care delivery should guide our thinking?  They should; but there’s no doubt that creativity and right-brain thinking need to be a part of that process.

The trouble with naming products

Patient kiosks are hot in health care right now. The expectation, among others, is that they will improve registration process flow. Checking in at the airport using a kiosk is easy; it would be nice to have a similar experience in a health care setting. While the new technology is far from refined, expect the proliferation of such devices to continue.

That’s not really the point of this post, however. The branding of such products is.

medGadget reports on the latest entry to the patient kiosk market: SUKIT.

The device hails from Japan and while I’m not real sure on Japanese/English pronunciation translation, it becomes obvious that some component of the branding was lossed in translation. If you haven’t picked up what I’m putting down yet: take SUKIT, insert a C after the U and before the K, throw a space between the K and the I, and how is that pronounced? SUCK IT.


From the press release:

This electronic healthcare information system, the first practical application of the kiosk terminal, allows doctors, hospitals and other caregivers to provide their patients with easy access to all types of useful information regarding health and medicine, while at the same time creating an interactive communication channel. For example, patients can use the kiosk terminal to research the contra-indications and side effects of specific medicines, to find out new medical products and services available on the market, or to set up a medical appointment.

The company’s explanation of the product doesn’t provide anything Earth shattering either. The last thing I want to do is explore drug interactions and check out new products and services available on the market from the discomfort of a kiosk. Isn’t that what a personal computer and a home internet connection are for?

39. Common Sense

…has been lacking in all too many arenas lately.

Examples given:

  1. Less than a week after the federal government committed $85 billion to bail out AIG, executives of the giant AIG insurance company headed for a week-long retreat at a luxury resort and spa, the St. Regis Resort in Monarch Beach, California, Congressional investigators revealed today.AIG documents obtained by Waxman’s investigators show the company paid more than $440,000 for the retreat, including nearly $200,000 for rooms, $150,000 for meals and $23,000 in spa charges. (ABC News)
  2. The global economy may be undergoing a significant downturn, but the White House’s dinner budget still appears flush with cash. After all, world leaders who are in town to discuss the economic crisis are set to dine in style Friday night while sipping wine listed at nearly $500 a bottle.According to the White House, tonight’s dinner to kick off the G-20 summit includes such dishes as “Fruitwood-smoked Quail,” “Thyme-roasted Rack of Lamb,” and “Tomato, Fennel and Eggplant Fondue Chanterelle Jus.”To wash it all down, world leaders will be served Shafer Cabernet “Hillside Select” 2003, a wine that sells at $499 on Wine.com. (CNN)
  3. The CEOs of the Big Three automakers reportedly flew private luxury jets to Washington to plead for a $25 billion taxpayer bailout to save their debt-ridden industry — ringing up tens of thousands in charges even as they cried poverty.Recipients of eight-figure bonuses in 2007, the corporate cowboys used their executive perks — which for GM’s Rick Wagoner include the run of a $36 million Gulfstream IV jet — to arrive in style as they went begging before Congress.Wagoner, whose flight reportedly cost $20,000 round-trip — about 70 times more than a commercial airline ticket — told Congress he expected about $10-$12 billion from the requested bailout. (Fox News)

Now is certainly the time to cut back on excesses with the worldwide economy in a free fall.  It’s not just these one time occurrences that leave questions, either.  Are these decisions representative of the way these groups have conducted their previous business dealings?  Aside from the AIG debacle, the other two examples represent pennies in comparison to the larger dollar figures being debated.  That’s not the point.  It’s the principle of making such decisions in light of what is being discussed.  After all, perception is reality.

Translating this to health care is easy.  Remember the checklist debacle?  How often is common sense part of the discussion in decision making?  Hopefully it is often.  It should be always.

A friend recently flew to interview for a health care position.  Round trip airfare on short notice approached $1000.  It just so happened that the friend had another interview with a second organzation only a short distance from the first the next day.  Both destinations were within driving distance.  So the friend asked the first organization if they would be willing to take on an extra night in a hotel and half of the cost for a rental car (the other half being picked up by the second organization), total cost no more than $600.  The response?  Sorry, organization policy only allows us to pay for one night’s stay in the hotel.  But, the first organization responded, we would be more than willing to pay for a one-way ticket and one night in the hotel if the friend was willing to pay for the rental car and the second night’s stay.

Come on!  Common sense!  Dollars would be saved!

As finances get tighter and our operating environment gets tougher it is time to insert common sense decision-making at every opportunity.

Principle #39: One would like to think that common sense is common sense, but that’s not always the case.  Decision-making at every level of our own system will be driven by common sense.  What’s best for the patient?  What’s best for providers?  What’s best for the organzation?  To determine the answers we’ll use common sense.

In: Required Reading

Both from the Wall Street Journal‘s Health Blog:

Tom Daschle will become the next Secretary of Health and Human Services when the Obama administration takes over on January 20.  He’s got big ideas for health care reform.

CEOs: Obesity is the biggest problem facing health care.  Not only is obesity extremely unhealthy, it is also going to cost the health care system big dollars in the near future (treatment, equipment, retrofitting buildings, etc.).

Employers: Stick with status quo on paying for health insurance

Jane Sarasohn-Khan at Health Populi writes, “a new survey from the International Foundation of Employee Benefit Plans finds that most employers do not want to move away from an employer-based system of health insurance.”


More than a few business people have had a tough-go of things lately; it seems obvious, then, that businesses would want to unload an ever-increasing expense line item from their budgets.


Not so fast.

Sarasohn-Khan continues:

As one of those who’ve watched the slow-cooking past efforts toward changing the structure of health care financing and delivery in the U.S. — and given the current sorry state of the macroeconomy — employers who “can” will continue to sponsor health plans for the next couple of years.

“Employers who can” depends on company profitability per employee, and clearly many companies whose good fortunes are based on consumer purchases could become compromised in their ability to provide health insurance. Milliman, the actuarial firm, calculates that the average cost of health care for a family of four in 2009 will be $17,310. This will over-burden companies in many consumer-facing industries — beyond automakers, consumer goods companies, retailers, home appliance manufacturers, and others from a large number of SIC codes.

It is baffling to read that “64% of employers believe that employer-based health care should continue to be the primary mechanism for benefits delivery,” even if that number has been decreasing over the past ten years.

No doubt that any health care reform in the near term will require employers to pick up some of the tab, but do employers fear that employees no longer needing the one benefit that keeps them on the job will up and leave en masse?

The era of one company, one career has long been dead.  The final frontier in overcoming job lock is the health care benefit and the now defunct John McCain health care plan at least had the redeeming quality of separating health insurance from employment.

Not only is divorcing health care insurance from employment the right thing to do, it also makes business sense from a financial perspective.  Or so I thought.


New ideas are always good.  The health care reform debate often rehashes ideas from bygone plans (maybe with a new twist on an idea for a change in semantics, not a bad thing since the ideas have been more fully vetted).  However, unique ideas are always more fun to consider.  Consider this one from Dr. Benjamin Brewer’s Wall Street Journal column last week:

Looking at the way the government is doling out money these days, I have a proposal to help improve people’s health and our system of care. What if the government gave each person $365 of their tax money back to be spent on primary health care?

That amount could be paid directly to each person’s primary care doctor for a year’s worth of services. Imagine if everyone in America could contract privately for medical care for themselves with a primary care doctor without government or insurance company red tape.

The patient would choose the doctor. The basket of services would be predefined, and the price would be locked in for a year, paid as a monthly subscription like cellphone service or movie rentals.

Money spent that way would cover a lot of preventive health, office visits, management of chronic diseases, email contact with the doctor, and after-hours advice. Make it tax deductible for individuals as well as businesses.

Some rough math:

  • 633,000 physicians in the United States x 40.4% working in primary care (according to the Bureau of Labor Statistics, 2005 data) = 255,732 primary care physicians (family medicine and general practice, internal medicine, OB/GYN, pediatrics)
  • 305,688,830 people currently live in the U.S. x $365 primary care tax rebate earmarked for primary care services = $111,576,422,950
  • $111,576,422,950 / 255,732 primary care physicians = $436,302 per physician to pay for the basket of services provided
  • Nurse practitioners and physician assistants (or anyone else) are not included, there are part time physicians to consider as well
  • Anyway, it isn’t enough to sustain a practice but it certainly seems that such a policy may have some impact

Interesting.  Also wonder if such an idea would pave the way for universal primary care?  That certainly opens a whole different can of worms.  Thoughts?