In: Gleaned Ideas

Jack Covert and Todd Sattersten of and authors of the new book The 100 Best Business Books of All Time (it’s a go to guide on key ideas from each “best” book) gleaned ten ideas from their recent work and used the forum at Fortune’s Postcards blog to share. My two favorites especially related to health care:

Any industry is ripe for reinvention. Billy Beane turned Major League Baseball upside down by using unusual metrics to evaluate talent when his team couldn’t compete with money. Michael Lewis’ Moneyball (2003) proves that all businesses are in danger of disruption. So you might as well do some of your own reinventing.

Be unreasonable. The cliché is that change is the only thing predictable in an unpredictable world. Charles Handy would disagree with this. He says that we’re living in The Age of Unreason (1990). Change is unpredictable. The best way to combat change? Become a changeling yourself.

Not only is baseball being turned upside down, but the NBA tooSo is bankingSo is health care.

Be unreasonable.  It rolls off the tongue and flies in the face of kumbaya. What great sentiment; don’t get comfortable, get moving.

Learning to manage people

I’m closing in on six (+) years (the + is for my victory lap at the undergrad level) of business-related education and I’ve yet to take a class explicitly intended to teach me how to manage people.  Now, there might be some sort of academic theory against teaching someone how to manage people but I studied organizational management for four + years and now, upon reflection, wonder why I’ve never taken such a class.

Maybe it’s not sexy enough.  But organizations expect us to know how to manage when we get there (kind of like personal money management, but we’ve seen what that assumption has done to many Americans’ finances).  Yet the common reality is that people (many? most?) quit their jobs because of their managers (not hard evidence, but it will do here).

All that to get to this: Aaron Swartz’s Raw Thought has a post on Non-Hierarchical Management—a very appropriate primer on management basics for anyone new to the responsibility (or, for that matter, anyone who isn’t any good at it).  Lots of good thoughts, especially this one (a smart person once told me that his job was to clear obstacles for physicians, he described his job as a problem solver, good stuff):

Point 5: Clear obstacles.

This is the bulk of what non-hierarchical management is about. You’ve got good people, they’ve got good responsibilities. Now it’s your job to do everything in your power to help them get them done.

A good way to start is just by asking people what they need. Is their office too noisy? Did they get confused about something you said? Are they stuck on a particular problem? Are they overwhelmed with work? It’s your job to help them out: get them a quieter office, clarify things, find them advice or answers, shift some stuff off their plate. They shouldn’t be wasting time with things that annoy them; that’s your job.

But you have to be proactive as well. People tend to suffer quietly, both because they don’t want to come whining to you and just because when you’re stuck in a rut all your attention is focused on the rut. A key part of being a manager is checking in with people, pointing out that they’re stuck in a rut, and gently helping them out.

Some think non-hierarchical management (NHM) is hooey.  I think health care is in desperate need of letting more people make more decisions especially at the patient care level (as front line as it gets) and NHM is a start.

Anyway, good luck in that new management role.

ADDITION: An acquaintance made an in-person comment today that “management is common sense.”  I’d amend: management is composed of common sense principles.  The problem is that “common sense” is defined differently by different people.  And not everyone is lucky enough to have “it.”

Health care’s problems encapsulated

The St. Louis Post-Dispatch reports on several health care meets the internet stories, the first about a cardiology group where “cardiology patients can hop online to request prescription refills, check portions of their medical records or send questions about their conditions.”

Great, but get this:

Within a few years, the interventional cardiologist expects to be trading e-mails with patients and possibly holding real-time Web chats.

Within a few years?  Four words (“within a few years”) sum up health care’s issues.  The pace of change in health care is infuriating (speaking of years)…

On the positive side, much of the article is about American Well—especially their deal in Hawaii; also included is apt skepticism provided by old grumps.

An internet infusion at Mercy Medical Group provides a bit of traditional health care delivery hope:

The patients will be able see lab results, get information about X-rays and schedule appointments through an interactive calendar.

Patients can take a picture of a suspicious rash and send the image in an e-mail. Doctors can respond to an e-mail question about high cholesterol with links to health-related websites.

Surliness ceased…for now.

The first of many…

With traditional revenue sources tightening hospitals are looking for new markets.  Example given (somewhat under the radar):

The Cleveland health-care giant today announced a new partnership with MinuteClinic, which runs walk-in medical practices inside CVS Pharmacy stores.

Under the multiyear deal, the Cleveland Clinic will provide medical supervision for MinuteClinic’s nine Northeast Ohio locations, including a site that recently opened in the FirstMerit Tower building on South Main Street in Akron. (Akron Beacon Journal)

Some hospitals have tried retail clinics of their own lending credibility to the value proposition (if hospitals are doing it, it must be worth the risk, right?).  This partnership gives MinuteClinic local brand strength, it gives the Cleveland Clinic a new market, and it gives patients access to convenient health care.

Win/win/win in my book.  Except that the model has shown not to lower costs.  Can’t win ’em all.

In: Hospital Description

A completely unfiltered, no holds barred description of hospitals from Aaron Swartz’s blog (it was published waaaaaay back in 2006):

Were the large sign reading “Hospital” to go missing, one might easily mistake the facility as one for torture: men whose clothes have been replaced by dreary gowns slowly wander the halls in dreary stupor, their battered faces making them appear as if they have been badly beaten. They are not permitted to escape.

Brutal, yes.  Worth the read, yes.

Consequence of economic downturn: the growth of local

One economic downturn reality beginning to reveal itself: an emphasis on local.

Peggy Noonan in Friday’s Wall Street Journal:

Dynamism has been leached from our system for now, but not from the human brain or heart. Just as our political regeneration will happen locally, in counties and states that learn how to control themselves and demonstrate how to govern effectively in a time of limits, so will our economic regeneration. That will begin in someone’s garage, somebody’s kitchen, as it did in the case of Messrs. Jobs and Wozniak. The comeback will be from the ground up and will start with innovation. No one trusts big anymore. In the future everything will be local. That’s where the magic will be. And no amount of pessimism will stop it once it starts.

There’s a trust composed of transparity at the local level.  A comfort level that can’t be found elsewhere.  Relationships are more familiar.  Business goings on clearer.  At at time when comfort is at a premium, local just feels better.

Implications for health care delivery are yet to be discovered (there is one nationally integrated system, but some are close, which very well could be positive).  Concerns could also arise, possibly regarding national expansion plans or organizational motivations.  We’ve yet to discover how big is too big in health care delivery (except for maybe this place).

An emphasis on local could certainly be a welcome development.  Shop local campaigns are blossomingGrowing food locally is rising in popularity, eating local too.  Health care has almost always been delivered locally; maybe it needs to stay that way.  Who better to understand the health care challenges of a community than local delivery organizations?

Generation Generosity


The most important driver behind GENERATION G is a wide variety of consumers and citizens being more generous. We’re talking the collaborative / free / creation / crowdsourced / gift / sharing movement that—especially online—has unlocked in entirely new ways the perennial need of individuals to be appreciated, to be loved, to feel part of the greater good, to contribute, to help… To basically find status and gratification in something other than consuming the most or the best.

Don’t think this a passing phenomenon: younger generations practically live online, while over the last dozen or so years, virtually every prediction of how the web would infiltrate the ‘offline’ world has proven too conservative. As our favorite online guru, Kevin Kelly, rightly stated a few years ago: ‘online culture is the culture’.

So… Everything seems to have aligned to make generosity (“liberality in giving or willingness to give”) a leading theme in the business arena this year. As always, companies can learn from consumers, though it’s not a ‘want’ but a ‘need’: companies need to mirror this societal shift if they want to regain their relevancy. We’re talking truly becoming a caring brand—one that is generous to customers, generous to employees, generous to the environment, generous to social causes, and so on. We know you know this: GENERATION G is more about context and timing than out-of-the-blue insights. (italics added)

Health care is in a unique situation to become a significant part of this movement.  Obviously, keeping the doors open is priority one.  But generosity is something needed now, much more so than in times of abundance.  Has your organization’s generosity risen, fallen, or remained the same during the economic slide?  What level of generosity existed in 2007?

Health care by the people…

Get it done yourself health care:


One morning a couple of months ago at Westchester Medical Center, Dawn Verdick gave Daniel Flood one of her kidneys.

Verdick and Flood were not friends or family. In fact, they were total strangers from the East and West coasts. But that’s not the most unusual aspect of this case.

The patient and donor were brought together after Flood’s three daughters placed an ad on Craigslist, the online classifieds site that offers everything from autos to real estate and guitar lessons to massage.

The New York Times:

They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones. When emergencies strike, they rarely can afford the bills that follow.

In dozens of interviews around the city, these so-called young invincibles described the challenge of living in a high-priced city on low-paying jobs, where staying healthy is one part scavenger hunt and one part balancing act, with high stakes and no safety net.

Appreciate the self-reliance, fear the self-infliction.  Self-health requires an ethics conversation, good or bad?

Underrated? Undervalued?

How’s this for a description of an NBA All-Star: “He can’t dribble, he’s slow and hasn’t got much body control.”

That’s Shane Battier, evidently.  But here’s the kicker: he’s a good player and he makes the teams he’s played for significantly better.  From a New York Times Magazine article by Michael Lewis (of Liar’s Poker, Blindside, and Moneyball fame):

The Grizzlies went from 23-59 in Battier’s rookie year to 50-32 in his third year, when they made the N.B.A. playoffs, as they did in each of his final three seasons with the team. Before the 2006-7 season, Battier was traded to the Houston Rockets, who had just finished 34-48. In his first season with the Rockets, they finished 52-30, and then, last year, went 55-27 — including one stretch of 22 wins in a row.

Battier makes just over $6 million per year, a paltry sum compared to the superstars.  But the Houston Rockets recognized his value—or, more importantly the fact that he is undervalued by NBA standards.  The description atop the post is from Daryl Morey, the stats minded (these kind of stats) Rockets’ general manager.  And he thinks he’s onto something.

From the article:

…there is right now in pro basketball real value to new information, and the Rockets feel they have some. What he will say, however, is that the big challenge on any basketball court is to measure the right things. The five players on any basketball team are far more than the sum of their parts; the Rockets devote a lot of energy to untangling subtle interactions among the team’s elements. To get at this they need something that basketball hasn’t historically supplied: meaningful statistics. For most of its history basketball has measured not so much what is important as what is easy to measure — points, rebounds, assists, steals, blocked shots — and these measurements have warped perceptions of the game.

Why Morey likes Battier:

Battier’s game is a weird combination of obvious weaknesses and nearly invisible strengths. When he is on the court, his teammates get better, often a lot better, and his opponents get worse — often a lot worse. He may not grab huge numbers of rebounds, but he has an uncanny ability to improve his teammates’ rebounding. He doesn’t shoot much, but when he does, he takes only the most efficient shots. He also has a knack for getting the ball to teammates who are in a position to do the same, and he commits few turnovers. On defense, although he routinely guards the N.B.A.’s most prolific scorers, he significantly ­reduces their shooting percentages. At the same time he somehow improves the defensive efficiency of his teammates — probably, Morey surmises, by helping them out in all sorts of subtle ways. “I call him Lego,” Morey says. “When he’s on the court, all the pieces start to fit together. And everything that leads to winning that you can get to through intellect instead of innate ability, Shane excels in. I’ll bet he’s in the hundredth percentile of every category.”

It’s all very interesting.  But we can’t leave it at that.  Ben Casnocha is on to my line of thinking:

…”Who’s the Shane Battier on our team?” Every organization has one.

It is true in health care, too.  Do you know who your underrated all-star is?  Is it time we start finding ways to measure value outside the traditional performance scope?  It surely would be a bad deal to learn about an individual’s value to your team because of their departure.

Undervalued health care skills?  The hard stuff.  (Tom Peters: The numbers turn out to be the “soft” stuff, abstract and subject to fudging. The “tangible,” “hard stuff” of infinite importance for performance is the depth and breadth of our relationships with others within or outside the firm.)  Especially the hard stuff (pdf).  Others?

I hate the NBA by the way, most of it having to do with a lack of players like Shane Battier.