The time to brilliance

Consider what this means for your health care career (whether it be a reformer, innovator, provider, manager, entrepreneur, etc.) or for any other endeavor in your life:

In the early 90s, the psychologist K Anders Ericsson and two colleagues set up shop at Berlin’s elite Academy of Music. With the help of the academy’s professors, they divided the school’s violinists into three groups. The first group were the stars, the students with the potential to become world-class soloists. The second were those judged to be merely “good”. The third were students who were unlikely ever to play professionally, and intended to be music teachers in the school system. All the violinists were then asked the same question. Over the course of your career, ever since you first picked up the violin, how many hours have you practised?

Everyone, from all three groups, started playing at roughly the same time – around the age of five. In those first few years, everyone practised roughly the same amount – about two or three hours a week. But around the age of eight real differences started to emerge. The students who would end up as the best in their class began to practise more than everyone else: six hours a week by age nine, eight by age 12, 16 a week by age 14, and up and up, until by the age of 20 they were practising well over 30 hours a week. By the age of 20, the elite performers had all totalled 10,000 hours of practice over the course of their lives. The merely good students had totalled, by contrast, 8,000 hours, and the future music teachers just over 4,000 hours.

The curious thing about Ericsson’s study is that he and his colleagues couldn’t find any “naturals” – musicians who could float effortlessly to the top while practising a fraction of the time that their peers did. Nor could they find “grinds”, people who worked harder than everyone else and yet just didn’t have what it takes to break into the top ranks. Their research suggested that once you have enough ability to get into a top music school, the thing that distinguishes one performer from another is how hard he or she works. That’s it. What’s more, the people at the very top don’t just work much harder than everyone else. They work much, much harder.

This idea – that excellence at a complex task requires a critical, minimum level of practice – surfaces again and again in studies of expertise. In fact, researchers have settled on what they believe is a magic number for true expertise: 10,000 hours.

The above from the Guardian, go read the rest…very interesting.  The ideas come from Malcolm Gladwell and his soon-to-be-released book “Outliers: The Story of Success.”

The (dis)incentives of transparency

Paul Levy (CEO of Beth Israel Deaconess Medical Center in Boston and health care transparency champion and CEO blogger): “Shouldn’t there be some correlation between what you get paid for doing something and the quality of what you do?”

That quote from an intriguing exposé of sorts in The Boston Globe (a fair presentation of the situation in my opinion).  The bottom line: Partners Healthcare in Boston (generally) makes quite a bit more (around 30 percent) than other hospitals in the state (Massachusetts has lots of good hospitals, especially in Boston).  So the question is: why?  Here’s the secret: it’s less about quality and more about market control.  What’s more is that it is happening in nearly every corner of this country.

Okay, so the free market is the United States of America.  Economists have a list of conditions in order for markets to be “perfectly competitive;” they include: large numbers of anonymous buyers and sellers, easy mobility of resources, homogeneous goods, and perfect access to information.  Health care, more or less, fails on every condition.

It is very difficult to efficiently, effectively, and equitably distribute resources when a market fails.  What that translates to is that health care costs more than it needs to (for a multitude of reasons).  But the argument here is that more information would prevent such wide disparities in payment (especially when a requisite increase in quality is not the reason for a higher price).  If insurers knew what hospitals collected from other insurers; if hospitals knew what insurers paid other hospitals; if patients and payers could effectively compare quality; if hospitals could benchmark quality against other hospitals; a more efficient, effective, and equitable distribution of health care dollars would occur.

All of that above summed up in one word: transparency.  We need: complete financial and quality of care transparency.  Watch health care costs fall and quality improve as hospitals start competing on outcomes and cost effectiveness instead of on market share and perceived notoriety.

Ross Dawson at Trends in the Living Networks writes:

Secrecy has its place in business, but it is highly over-rated. In most cases there is no valid reason not to share information, just a disinclination to give away things. We are going to see transparent models increasingly favored moving forward.

A disinclication indeed.  Transparency is the future.  It’s how we’re going to improve our health care system.

38. Change!

It doesn’t take an extremely enlightened person to realize the challenges that hospitals are facing today.  They’re cutting staff.  They’re experiencing drops in demand.  They’re taking care of more non-paying patients.

Payer, patient, and government pressures are only increasing.  The solutions are diffuse and unpredictable.  Preparing for the future becomes much more difficult when preparing for tomorrow reigns in importance.  But we need to prepare for the many possibilities that tomorrow, next week, next year, and beyond hold.  Because one thing is for certain: we are unable to continue on our current path.  While health care likes to think that it deals with change on a continuing basis, it doesn’t do it particularly well.  And that needs to change.

Health care is responsible, in part (a significant part), for the gloomy forecasts of our economic future.  To think that this industry won’t be targeted to cut domestic spending is naive.  To think that hospitals won’t be significantly affected by economic ship-righting would be simpleminded.

In developing our strategy for adapting to change we not yet know, there are several principles we’re borrowing from a recent notable presidential campaign and the requisite transition planning.

1. Be realistic.  This isn’t going to be easy.  We know the mountain is tall and there’s nothing we can do as an individual health system that will put health care on the right track.  But we can set attainable, yet strenuous, goals.  Transparency to the Nth degree to improve patient safety.  Reducing organizational waste to enable flexibility with our dollars.  Empowering front line employees and providers to solve problems.  It’s a laundry list but it’s time to get the house in order.

2. Bring people together.  Enable all organization stakeholders to meet and work together.  No more separate units within the organization.  We are one.  The interactions will lead to innovation and problem solving like nothing we’ve ever seen.  It will also improve our culture.

3. Be consistent.  Our approach, our message, our solution will be consistent with making the organization ready for whatever will come.

4. Be inspirationally optimistic.  There’s no doubt we’re in for some hurt.  A health policy solution that works (read: lower costs) means our bottom line will be (optimistically) flat or (a little more optimistically) rising only slightly.  But if we prepare now–and do it correctly–our exposure will be minimized.  The real optimism comes with preaching a message of preparation.  We can and will succeed in our efforts of creating the ultimate in flexible hospitals.

5. Execute.  Easier said than done.  Also required.  Get the right people on board (everyone).  Get the right people in positions where they can be effective (everyone).  Give them the empowerment they need to get things done (everyone).

Principle #38: Change is most definitely coming.  We can either be the recipient of change or we can lead it.  It is time to prepare.

England Gets Offensive on Obesity

Yikes! From the Mirror:

It is the biggest health challenge facing the nation – nine out of 10 adults and two-thirds of children will be obese or overweight by 2050.

Holy _ _ _ _!

Nine areas in England are developing programs to combat rising obesity through local and national government matching funds.  They’re calling the areas “healthy towns” with the hope that eventually it will become a country-wide effort.

Each town is trying something different; the plans range from grow-your-own vegetable gardens to bike maintenance help to encourage more cycling.  Tower Hamlets is rewarding restaurants that offer healthier choices (ed.: a Quarter Pounder is a Quarter Pounder is a Quarter Pounder).

At least they’re doing something.

Manchester may have the most promising approach.  From the Associated Press/Yahoo News:

Manchester is hoping to fight fat with a reward system that works like a retail loyalty card. But instead of earning credit for opening their wallets, residents will be rewarded for keeping their feet on the treadmill and their fridge stocked with healthy food.

Starting next fall, Manchester residents will be able to swipe their rewards cards and earn points every time they buy fruits and vegetables, use a community swimming pool, attend a medical screening or work out with a personal trainer. Points can be redeemed for athletic equipment, donations to school athletic departments and personal training sessions with local athletes.

The programs are part of a 400 million pound (the currency, not the unit of measure) effort to help Brits get fit.  We will watch with interest…

Extricate, Communicate, Innovate

Think of the possibilities if we could do this within a hospital:

Imagine a global corporation – maybe a software company or an accounting-consulting firm – in which people at all levels and positions could interconnect and network together, and then solve problems together. A company with an internal intranet containing an internal Facebook, blogs, work logs, etc. fully searchable by anyone else in the company. Perhaps employees anywhere in the world could connect in any way they needed to: video conference instantly from their laptops, or leave video messages for each other.

If all the talent in the company could connect easily, that could bring enormous innovation acceleration. Problem solving could be far more efficient. Maybe David in the office in Singapore has already solved a problem now facing new person Carly in the office in Boston? What if Carly could type in a few key words and learn that David dealt with the same issues last month?

While I’ve heard of companies trying to better connect their workforces through intranet applications, I haven’t heard of too many turning all or most of the process over to all employees, especially the younger generation (but please comment and tell me who is doing this if you know).

The first company that achieves this extreme interconnectivity would instantly have tremendous leverage against competitors from an enormous boost in productivity and innovation.

Connect:  Extricate!  Communicate!  Innovate!

Encourage employees to solve problems by connecting and empowering them.  Remove traditional barriers (I work on the 7th floor, I work in Radiology, I’m a nurse) and allow innovation from below: give employees the tools to communicate with each other and access to actionable data.  This challenging time is not one in which to exert more control; for it will be the free organization that will prosper.

Carol shifts strategy

You may recall a Minnesota company that debuted an online marketplace for health care services a few months back.

Well, it’s not working out.  Carol has announced a shift in strategy.  From the Minneapolis Star Tribune:, a Twin Cities start-up that drew national attention for its efforts to create an online medical marketplace, has cut 25 jobs, or a quarter of its workforce, a sign that consumers may not be ready for the trend known as consumer-driven health care.

Bloomington-based Carol has struggled to attract users to its year-old website, which it bills as a Travelocity for health care.

Medical providers never got comfortable with the idea of posting their services online for comparison shopping and consumers “didn’t know what to do with us,” said Carol’s chief marketing officer, Marcia Miller. The economic downturn and the pressure to produce results finally forced a shift in direction.

What are they going to do now?  Focus on providers.  Again, from the Star Tribune:

Carol’s two consumer websites — in the Twin Cities and Seattle — will remain up. But the company will now focus on consulting and software services aimed at hospitals, clinics and physicians.

It will help providers repackage services in ways patients can understand, rather than in the current system organized around insurance payments. It may also rent the Carol software platform for hospital and clinic groups to include on their own websites — backing off from the original goal of allowing users to compare directly among providers.

Interesting.  Wonder if they always had a back-up plan?

Improving Health

A boon to Health 2.0 and health in general:

But before they can benefit from online government, many Americans must get online. The US ranks 15th out of 30 industrialized nations in the percentage of citizens with access to the Internet. Obama promises to make Internet access as commonplace as telephone service.

With high-speed internet access all patients will have access to online interactions (and not just email!) with providers.  Patients could be monitored from home if they need it.  Patients would have access to healthy living information.  Patients could manage their PHRs, find doctors, and compare quality of hospitals.  The benefits of universal access for health care are nearly endless.

Open Innovation

Formalizing getting out of health care: Open Innovation.


The term can be broadly defined as the process by which an organization seeks ideas and expertise outside company walls. Under this concept, it is argued that a company cannot and should not rely solely on its own research, but will benefit by engaging individuals outside the company to further innovation and business goals. Additionally, under this concept, businesses also look for opportunities outside of the company for internal inventions not used within the firm’s business. Open innovation is the opposite of “closed innovation,” the term broadly used to define companies that make limited use of external knowledge and limit the use of internal knowledge outside the company.

The goodness:

Additionally, research has found that companies that do best in a tough economy are those that innovate and are open to outside ideas. The only way to do this affordably is through open innovation. Now more than ever, companies need to innovate and do it more efficiently by focusing on the most efficient use of corporate resources. It enables companies to have their employees focus on the most important tasks while outsourcing for additional ideas and input. Open Innovation also enables a company to do more with its current budget or cut budgets without compromising innovation. It can also lead to more innovative products that can be brought to market more quickly than in using traditional methods.

Again, leave (but come back soon) health care!

Re: Poor Patient Satisfaction

HealthDay/Washington Post:

In the first national survey of patients’ experiences, many hospitals were found wanting in key areas such as pain management and discharge instructions. In fact, almost one-third of patients gave low ratings to pain management, and one-fifth gave low ratings to communication at discharge.

Solution?  Work on the organization’s culture.  See post below.