In: Planning

The CEO (Tony Hsieh) of (one of) the coolest companies (Zappos) on Earth on planning:

At Zappos, we either think one year ahead or ten years ahead.  We don’t really do anything in between. For ten years ahead we think about what our long-term vision is,  which is definitely very important both for employees and the company.  It’s important to take a step toward that vision every day.  And then in terms of one year ahead it’s more about executing on the short term.  I think a lot of companies like to put together three or five years plans and I have yet to meet anyone who has done that where things turned out as they expected.  I think it’s more important to be able to react to the environment and marketplace.  There’s a quote by Darwin where he talked about the species that’s most likely to last longest is not the one that’s the strongest or the fastest, but the one that’s the most adaptable to change.  If you just have that mentality on an ongoing basis, the same thing applies to business. (the 26th story)

BONUS! The World Health Care Blog mentions Zappos and relates the company to health care here.

Control does not scale.

The definition of a traditional hierarchical organization includes the hospital as an example.  That’s a problem because our society has entered a new age.  The world is messy and getting messier.  Extolling the good is becoming more difficult.  Jeff Jarvis:

So now, we’re digitizing and connecting in an age of abundance. There’s an abundance of good and of crap but, he says, we’re much better at dealing with the abundance of crap. Yes, we filter it, kill it. David [Weinberger] says that when there’s an abundance of good, our institutions are not built for it. “Control does not scale,” he says, “except at tremendous human costs.” Damn, he’s good at setting down the clear law. Control does not scale. Next: “The mess is essential.” The mess is the better reflection of who we are.

Hospitals, in the effort to rid the environment of messiness, control.  They control messages, processes, people, patients, service, etc.  But as Mr. Weinberger so efficiently proclaims, “Control does not scale.”  Hospitals today are not built for the wild environment in which they have begun to operate.  That means a tough road ahead.  Because control as a business model is eroding quickly.  The response, of course, will be more intense efforts to control.  The transition to a completely open model is something that most hospitals are not equipped to handle: in systems, management, and practices.

Who is good at the open model?  Google.  Granted the company was founded on open principles but there are lessons to be gleaned from their operation.  Jeff Jarvis and his new book “What Would Google Do” to the rescue (it was released this week and could become the bible from which to learn from).  An excerpt from the book’s first chapter:

That world is upside-down, inside-out, counterintuitive, and confusing. Who could have imagined that a free classified service could have had a profound and permanent effect on the entire newspaper industry, that kids with cameras and internet connections could gather larger audiences than cable networks could, that loners with keyboards could bring down politicians and companies, and that dropouts could build companies worth billions? They didn’t do it by breaking rules. They operate by new rules of a new age, among them:

  • Customers are now in charge. They can be heard around the globe and have an impact on huge institutions in an instant.
  • People can find each other anywhere and coalesce around you—or against you.
  • The mass market is dead, replaced by the mass of niches.
  • “Markets are conversations,” decreed The Cluetrain Manifesto, the seminal work of the internet age, in 2000. That means the key skill in any organization today is no longer marketing but conversing.
  • We have shifted from an economy based on scarcity to one based on abundance. The control of products or distribution will no longer guarantee a premium and a profit.
  • Enabling customers to collaborate with you—in creating, distributing, marketing, and supporting products—is what creates a premium in today’s market.
  • The most successful enterprises today are networks—which extract as little value as possible so they can grow as big as possible—and the platforms on which those networks are built.
  • Owning pipelines, people, products, or even intellectual property is no longer the key to success. Openness is.

The mess is essential.  Openness, too.

IDEO Inspiration

Ideo is a (beyond) cool company that helps organizations think strategically about design.  IDEO’s Method Cards provide insight (and help) into what they do and may allow you to add design components to your next project:

Hat tip: Dan Pink

Push pause, it’s time for your appointment

Health care delivery is going to look tremendously different in the near future.  More evidence, this time from Nintendo Japan:


It was inevitable we guess what with everyone plus your grandma using the Wii. Now Nintendo Japan has announced a new Wii “Check-Up” channel that acts as a health guidance system between you and health professionals.


Developed along with Hitachi, NEC, Panasonic and an unnamed health insurance company, the service will offer a communications space where users can get advice from health professionals using the Wii Fit and NEC’s mobile phone platform. Fit users have had success in the past using the system as a method for getting in shape, and now the check-up channel looks like a valuable enhancement.

No Medicare for you!

Anyone under 30 should fully expect to never see a Medicare dollar to help pay for health care when they reach the appropriate age.  As continued evidence of those slimming chances “60 Minutes” reported last night on an effort to increase both quantity and quality of life through Resveratrol—the substance found commonly in red wine:×3.swf
Watch CBS Videos Online

The implications of an extended life are large for Medicare—even if the promises include a reduced prevalence of disease.  So any health care reform must be adaptable…isn’t that a big part of the problem now?  A reimbursement system founded on the health care delivery realities of 50+ years ago?  Science has advanced, the way we pay for that science needs to as well.

Hospitals looking like hotels


Amenities such as good food, attentive staff, and pleasant surroundings may play an important role in hospital demand. We use a marketing survey to measure amenities at hospitals in greater Los Angeles and analyze the choice behavior of Medicare pneumonia patients in this market. We find that the mean valuation of amenities is positive and substantial. From the patient perspective, hospital quality therefore embodies amenities as well as clinical quality. We also find that a one-standard-deviation increase in amenities raises a hospital’s demand by 38.4 percent on average, whereas demand is substantially less responsive to clinical quality as measured by pneumonia mortality. These findings imply that hospitals may have an incentive to compete in amenities, with potentially important implications for welfare.

Hospitals as Hotels” a working paper by RAND‘s Dana Goldman and John A. Romley

Art: “Hmms,” “Hmphs,” and “Ahas”

Andy Warhol was quoted as saying, “Making money is art and working is art and good business is the best art.”  And since Twyla Tharp said, “Metaphor is the lifeblood of all art,” I’m taking an art history class this quarter to add some perspective to my health care business thinking (if you’re skeptical, you aren’t the first; using A Whole New Mind by Dan Pink as evidence I was able to get this reluctantly approved by the powers that be).  Classes like art history should become part of an MHA curriculum to inspire new approaches to health care’s tired problems.

Here’s the thing: art is difficult to interpret (this is my first foray into the effort), especially modern art (especially conceptual art).  There is a fine line between over-analysis and under-analysis.  Finding meaning isn’t always the easiest task, either.  But. That. Is. Exactly. The. Point.  This is challenging my thinking in a way it’s never been challenged.  It is definitely exciting (at least for the time being, a research paper is required for the final and my experience with art history research papers is slim, at best.)

But there is a relation between art and health care and business here.  Sitting in lecture and reading the necessities has provided more than a few “Hmms,” “Hmphs,” and “Ahas.”  Sol LeWitt‘s “Sentences on Conceptual Art” is the first extensively business-related reading we’ve had in the class.  The most thought-provoking metaphorical “sentences” appear below (many have been axed for various reasons) and a personal analysis of their meaning is encouraged (share in the comments if you would like):

2. Rational judgements repeat rational judgements.
3. Irrational judgements lead to new experience.
5. Irrational thoughts should be followed absolutely and logically.
6. If the artist changes his mind midway through the execution of the piece he compromises the result and repeats past results.
9. The concept and idea are different. The former implies a general direction while the latter is the component. Ideas implement the concept.
12. For each work of art that becomes physical there are many variations that do not.
13. The words of one artist to another may induce an idea chain, if they share the same concept.
19. The conventions of art are altered by works of art.
20. Successful art changes our understanding of the conventions by altering our perceptions.
21. Perception of ideas leads to new ideas.
24. Perception is subjective.
30. There are many elements involved in a work of art. The most important are the most obvious.
32. Banal ideas cannot be rescued by beautiful execution.

For some Friday entertainment (I can’t help but smile at this) here is a clip of John Baldessari singing LeWitt’s “Sentences:”


“…these sentences have been hidden too long in the pages of exhibition catalogs…”

Hopefully, they do some good here, too.