Design, the way of tomorrow

Scott Dadich of Wired on designing under constraint, two important thoughts in reverse order:

The idea of operating within constraints—of making more with less—is especially relevant these days. From Wall Street to Detroit to Washington, the lack of limits has proven to be a false freedom. With all the economic gloom, you might not be blamed for feeling that the boundless American frontier seems a little less expansive. But design teaches us that this is our hour of opportunity.

That’s because designers understand the power of limits. Constraint offers an unparalleled opportunity for growth and innovation.

Think of a young tree, a sapling. With water and sunshine, it can grow tall and strong. But include some careful pruning early in its development—removing low-hanging branches—and the tree will grow taller, stronger, faster. It won’t waste precious resources on growth that doesn’t serve its ultimate purpose. The same principle applies to design. Given fewer resources, you have to make better decisions.

Technology assistance

BusinessWeek‘s Gene Marks feels sorry for doctors because of the way they are being forced to purchase technology.  The issues facing independent physicians:

For example, right now there are dozens and dozens of companies offering technologies that claim to provide electronic health records. And guess what? None of their systems talk to each other. Surprise! And none of them have the same architecture. And they don’t exchange data with all the same hospitals. That’s because most hospitals’ systems are all over the place too. What, you think those big hospitals actually have their act together?

Has such a high tech industry ever had so much trouble implementing personal technology?  Feel bad for physicians, yes.  That financial benefits of an EMR accrue to payers, hospitals, and to the larger system is but one reason.  But sooner or later, a minimum level of technology in the exam room is the price of entry, right?  So the U.S. federal government is on board with the stimulus bill—should assistance to physicians in purchasing technology end there?  Does the mandate preclude participation by commercial payers and hospitals?

Preparing for international health care

Portfolio offers enlightenment on the emerging reality of international health care:

UnitedHealth, which has over 70 million Americans under its care, has already moved to make Bumrungrad International hospital in Bangkok “in network.” When Aetna, with 37 million members, bought the overseas insurer Goodhealth Worldwide last year, Aetna’s CEO explained the move by saying that globalized surgery is “an important emerging trend.” The company has already started a pilot program to send patients abroad for hip and knee replacements.

The big question: does medical tourism remain a classroom discussion or has it now entered the boardroom?

Is anyone raising concerns about the U.S. health care system’s inability to compete (even relatively closely) on price with worldwide providers at the organizational level?

The most important part of the Portfolio story is this seemingly innocuous sentence:

Surgeons in the United States hate the idea.

Physicians make the health care world go round, that’s no secret.  Surgeons will be impacted most by borderless health care.  That means the delivery system will pay serious attention when surgeons’ viability starts to be threatened (now?).  A concerted response at that point may come too late.

The time to think about this/act on this is now.  Some health care will always be delivered locally, the frailty of human life demands it.  The value proposition of primary care is such that it will remain cost-effective (and time-effective) to deliver those services stateside further into the feature than surgical care (for now).  Aside from these caveats (hardly safe scenarios, for what it’s worth), all is fair game for international disruption.

Hopefully health care deals with it more successfully than the domestic auto industry.

$21,000,000,000 + Health IT – (Human-centered design) = What?

DesignWell takes a human-centered approach in questioning the utility of the $21,000,000,000 outlay for health information technology in the stimulus (err, spending for the more conservative among us) bill:

I assume that most of the stimulus money will go to large technology companies that create complex database systems and algorithms to handle the intensity of data required to make it all work. However, I hope that the stimulus package carves out money to understand how data will actually get into these health records, and more importantly, how people will actually use them.

And comments on the state of personal technology in the health care world:

In all of this we must be cognizant of the real, and very sad, state of technology in most medical settings. Sure we have amazing scanners and procedures that are miracles of science and engineering. But the state of technology that is actually usable by regular, real people (patients, under-educated nurses, and doctors are real people too!) is shoddy at best. As I mentioned, I don’t envision my doctor entering my results into an iPhone app anytime soon.

Last, the missed opportunities for mindful, captivating self-reflection:

In a waiting room, we have a captive audience that is thinking about health issues because they’re about to see a doctor, yet there is nothing to help the patients. There is nothing to help people get ready for a visit to maximize the time with the doctor. There is nothing to help review past records or streamline the process in any way. What an amazing time and place for people to interact with their EHR! But there’s nothing even close to being on the right path for that. Technology is non-existent here, so a massive EHR system would be equally useless.

Don’t write about your physician interaction online, ok? Dumb.

Some physicians are upset because anonymous patients are leaving (reckless? sniping?) comments on review sites like Angie’s List and Zagat’s.  Welcome to the internet.

The response?  They’re asking patient’s to sign what amounts to a gag order (waiver form) according to this Associated Press article.  Welcome to medicine.

Dumb. Really dumb.  Dumb, dumb, dumb.

Why?  One of the sites that allows anonymous comments is going to create a “Wall of Shame” for physicians who use waivers.  A lawyer says the waivers likely will not produce successful results in a lawsuit anyway.  And if a patient really wants to share negative anonymous comments online, they will (despite a signed waiver).  It’s a snowball effect with bad outcomes.

What should a physician do?  Two possibilities:

  1. Change behavior so patients don’t have bad things to say.  Yes, there will be the occasional patient who is unhappy about everything.  They may even post a negative review online.  But when there are multiple patients saying the same things, it may be time to look inward.
  2. Embrace the long tail.  Ask all patients to review physician services.  Give them a business card (or an Angies’s form, pdf) or a list of reviewing sites to enable them to brag about how great the service is.  Get on the ratings sites and professionally respond to criticisms.  Build a page on Squidoo.  Write a blog.  Build a website. 

    Here’s the best advice, it’s from Seth and is especially pertinent:

    Google never forgets.

    Of course, you don’t have to be a drunk, a thief or a bitter failure for this to backfire. Everything you do now ends up in your permanent record. The best plan is to overload Google with a long tail of good stuff and to always act as if you’re on Candid Camera, because you are.

Meetings. Meetings. Meetings. Meetings.

Big health care management problem:

It is certain that every organization has too many meetings, and far too many poorly designed ones. The main reason we don’t make meetings more productive is that we don’t value our time properly. The people who call meetings and those who attend them are not thinking about time as their most valuable resource.

Reid Hastie, Professor at the University of Chicago’s Booth School of Business via Signal vs. Noise

The number of meetings is an in-house decision, but health care organizations likely have far, far too many.  The organization where managers and executives float from meeting to meeting all day is not a rare occurrence.  As far as the design problem, here is Seth Godin’s solution:

There are only three kinds of classic meetings:

  1. Information. This is a meeting where attendees are informed about what is happening (with or without their blessing). While there may be a facade of conversation, it’s primarily designed to inform.
  2. Discussion. This is a meeting where the leader actually wants feedback or direction or connections. You can use this meeting to come up with an action plan, or develop a new idea, for example.
  3. Permission. This is a meeting where the other side is supposed to say yes but has the power to say no.

PLEASE don’t confuse them. Confused meeting types are the number one source of meeting ennui. One source of confusion is that a meeting starts as one sort of meeting and then magically morphs into another kind. The reason this is frightening is that one side or the other might not realize that’s actually occurring. If it does, stop and say, “Thanks for the discussion. Let me state what we’ve just agreed on and then we can go ahead and approve it, okay?”

Twitter, bellyflopping, and the heretical hospital

So hospitals are finding Twitter (for the uninitiated).  Thanks to Ed Bennett you can find which organizations have (and YouTube, Facebook, and blogs).  Polite golf clap, please.

Okay, that’s it.  Because it has been more of a “dip the toe to test the water” effort than a fearless jump into the cold swimming pool.  That is to be expected.  It might even be a good thing.  But using Twitter as another medium to push press releases will not lead to brand engagement (brands as Twitterers is a completely different conversation).  Remember, social media is about the conversation.  It takes two+ to tango.  Until hospitals engage in conversations (individual to individual) the effort will be largely unsuccessful.

But Twitter-like white-label internal applications hold potential to help health care personnel.  It could provide quick answers to questions that may, without such an application, go unasked.  Nurses asking nurses.  Physicians asking physicians.  Managers asking managers.  Managers managing employees.  Alerts.  Updates.  Internal news.  Nurses asking physicians asking managers asking nurses.  Or encouraging.  Or correcting.  Or improving quality and processes and collaboration.  You get the idea.  That rant could go on.

Skepticism abounds.  Expected.  It’s much easier to find reasons not to use such technology than to find reasons for its use.

Be assured there is some serious opportunity here for the heretical hospital.  An organization must allow and encourage (and implement) such technology for communication to take place.  A Toronto Globe and Mail column offers advice from Don Tapscott:

Twitter has emerged as a “powerful tool that can speed up the metabolism of an organization, keep everyone better informed and enable greater agility and responsiveness to changing conditions.”

He encourages people to experiment with it. Managers should try it out – at least to understand how it works – and give employees a chance “to self-organize and collaborate using these tools.”

Steve Prentice, president of consulting firm Bristall Morgan in Toronto adds his two cents in the same column:

He suggests companies start trying it out on an internal basis – starting from the top, with CEOs, to boost communication with staff. And companies should have a policy in place so workers understand perimeters.

Here’s to bellyflopping into the pool.  Adjusting to the coldish water happens quickly.  Though the red skin may linger for a while, the pain recedes in time.