Required reading, part 2

Abraham Verghese writing in The Wall Street Journal:

“Sacred bond,” alas, is not among the descriptors I hear when patients tell me what they think of us or our health care system. The descriptors fit to publish include “inattentive,” “no-one-in-charge” and “money grubbing.” In fact, a thoughtful lay friend recently said to me in the context of her medical care, “Face it, Abraham, medicine is corrupt.” She stated this casually, as if it were an obvious and well-known fact, not waiting to see if I would agree. At the time I remember that I sputtered. I wanted to protest but the sounds would not come out. That word “corrupt” gnawed at me for days.

The truth (should) hurt.  Lots of good stuff in the article.  Here’s part one.

Plea: Pursue Perfection

A collection of collections from across the internet, health care related, during the previous week, and worth reading/viewing/listening.

Dr. Atul Gawande admits to medicine’s role in our economic troubles and praises the power of positive deviancy to rectify the situation / some high-powered, done it right CEOs offer ideas to reform health care (ideas that even have teeth; e.g., “Regionalize high-cost, resource-intensive services under Medicare.”) / hospitals (taking a cue from the airlines?) start to nickel and dime passen…err, patients

the folks at my health innovation are doing cool things: sharing low-cost low-tech ideas / on the more high-tech side, this car knows when you’re having a stroke / the ten most creative people in health care / we could all be more creative if we were just willing to fail a little more often / health care at the mall is not new, but Mayo at Mall of America is most likely not an excess space filler

lots of ideas for solving problems / here’s an action: in a brilliant move, GE is helping hospitals make health IT purchases through no interest loans / medical errors, design, calls to action: fuzzy medical error math shouldn’t make you feel better about an overnight stay in a hospital / here’s a plea: pursue perfection

AND/OR/PS: Little Red Riding Hood could have had health care troubles / was there obesity in antiquity? / in the spirit of transparency


Heterarchy: “an organizational form somewhere between hierarchy and network that provides horizontal links that permit different elements of an organization to cooperate whilst individually optimizing different success criteria.”

A potential solution to flattening hospitalsThis paper says that collaboration is the key; and what do we need more in health care given the multiple professional groups, support units, employment structures and tripartite missions (patient care, education, research)?

45. Forever Beta

So some people think the joke is on Google for its widespread use of the perpetual beta moniker.  And now, some commercial customers are said to be shying away from the Google productivity suite because of the always beta.  It’s led Google to, apparently, de-beta-fy some of its products.

Of course it’s just an illusion because the world is in perpetual beta.  Nothing is stagnant.  The shift is so that we’re fortunate just to continue standing.  Try to freeze the current environment, just try.  Leave the office for lunch and come back to find the afternoon you had planned is no more; the schedule has been burned by (metaphorical) fires across the organization.

Now extrapolate across an entire organization and it’s easy to see a different approach is necessary., “Think operating in a humble, transparent, unpolished, almost human-like FOREVER BETA mode, not just for one product, but for an entire organization.”

Forever beta is a frame of a mind.  It’s an acknowledgment that the operating environment is fluid, that service is never completely developed, and improvement is always possible.  It’s an acknowledgment that an organization is always in development, the individuals inside the organization always learning, (hopefully) improving.

Organizations in forever beta, wrote influx in 2007, show “vulnerability” and “humanity” (empathy!); they’re “open to questioning and ideas for improvement.”  Opposite (sounds a lot like health care…):

This is a radical contrast with most of the brands that came to life in the C19th and C20th, they have an industrialized view of the world, a view that assumes everything about them should be tightly controlled and perfect.

A world of them and us; the people that make and the people that buy.

Although they are created by humans and staffed by humans, they are somehow always perfect, shiny and immune to the failings of most human beings.

Sadly, for these industrial marketers, this level of control and infallibility longer endearing, the most interesting brands today and in the future are going to be the ones that are honest about their flaws and failings.

Principle #45: our own system is in forever beta. we’re always learning, we’re always working to improve; as Jay Cross writes, “after all, everything is an experiment.”  An experiment in creating excellence.

Plea: Simplicity Please

A collection of collections from across the internet, health care related, during the previous week, and worth reading/viewing/listening.

a hospital locked out nurses after their union failed to withdraw a strike notification, that’s how the process works / patient-centered care champion Don Berwick wrote an article / here’s a related interview / and a rebuttal / it may not represent both sides of the lengthy spectrum, but it’s the two most rational endpoints / is your service this good? / why are men uncomfortable going to the doctor? / the Brits are in the midst of National Men’s Health Week, the 2009 edition focuses on access to services

economic side-effect: the number of Harvard graduates entering the health care industry doubled in 2009 / hopefully they’re into solving problems / action is preferred to planning, since very few of us are any good at the latter (the “planning fallacy”) / mostly because we don’t consider this / and we’re too detail oriented; so read the second half of this and be a better planner

it would be cool if discharge instructions were similar to BOFA’s Clarity Commitment / a lack of simplicity is likely due, in part, to the monstrous size of organizations involved / yes it’s difficult, but extremely powerful / here’s another (simple) plea: simplicity please

AND/OR/PS: 20% of Americans have peed in the pool, that can’t be healthy

Incorporating Design

In a health care world of useless price and cost data (individuals pay little, what’s a charge mean anyway?), comparable quality and outcomes data (see Medicare’s futile attempt at comparison via the Hospital Compare website), similar service offerings (the general hospital is an exercise in commoditization; our system dictates that competing hospitals must offer similar services), and compromised patient satisfaction scores (hospitals game the Press Ganey system by asking for high scores), how does a hospital differentiate itself from competition?

Patient experience.  How does a hospital build patient experiences?  By making design a priority (here’s evidence on why it is important).  Robert Brunner at FastCompany:

The relatively few companies in the world that are really design-driven know the secret: That design is, in fact, everybody’s job. Rather than making design a single step in the process where requirements flow in and ideas flow out, they see design as a constant topic of discussion across all disciplines and steps in the process. It is not a vertical stripe in the horizontal process flow, but a horizontal one that extends from inception through customer service and end of life.

Granted there’s a needed educational component here.  So why not start during the summer reading season (I’m a fan of year-round reading, but if you need the extra momentum brought on by the beach, it’s upon us)?  Here are 30 important design books.  Start with “The Design of Everyday Things,” it will change your perspective.

In: Simplicity is Difficult

Larry Cheng at Thinking About Thinking:

Over the years, I have come to appreciate that building a product, service or application that is defined by its simplicity is extraordinarily hard.  It takes real talent and ingenuity to create simplicity.  And once you have achieved it – it is as real a barrier to entry as a slew of patents or technical secret sauce.  Simplicity is that valuable.

Simplicity is difficult.  But that’s the beauty.  And the opportunity.