Solving big problems

So I suppose it’s possible I’ll get in trouble for almost completely posting Dev Patnaik’s revelation on the difficulty that big companies face when trying to solve big problems (think healthcare providers trying to solve the healthcare problem), but it’s just so damn important for everyone to read. So while it appears here, click over to Fast Co Design to read it. I don’t think “hybrid thinking” is anything entirely new, but it definitely is a wake-up call to the hyper-specialized crusade the business world is on.

It turns out that while large companies and organizations are phenomenally good at managing complexity, they’re actually quite bad at tackling ambiguity. A complicated problem is like playing a game of chess, an ambiguous problem is like having your in-laws over to dinner for the first time. In the latter situation, it’s not the number of variables that kills you. It’s what you don’t know that you don’t know.

Fortunately, there is an answer, and that answer is hybrid thinking. It turns out that the antidote to ambiguity is hybridity. Take healthcare for example. Is fixing the American healthcare system a medical problem, a political problem, an economic problem, a social problem, a religious problem, or a technological problem? The answer is “yes.” It’s all of the above.

However, the solution isn’t just gathering together different disciplines. I’ve attended several conferences on healthcare that tried to get a doctor, an economist and a priest to walk into a room. That’s the start of a great joke, but not an answer to the problem. Getting these folks together just results in having them talk past each other.

Hybrid thinking is more than just having multidisciplinary teams. It’s about having multidisciplinary people – folks who are one-part humanist, one-part technologist and one-part capitalist. When multiple disciplines inhabit the same brain, something magical starts to happen. The disciplines themselves start to mutate. They hybridize. We start practicing business like a designer – think Mark Parker at Nike. We shape technology like a culturalist – think Steve Jobs at Apple. And we start thinking about the most complex problems that plague our societies like an entrepreneur.

Some folks complain that Mark Parker and Steve Jobs are simply a rare breed – genius minds that show up only intermittently each generation. But that’s not true. What makes them rare is that they lead great companies – and that simply doesn’t happen often enough. You see, Parker and Jobs are entrepreneurs who built their companies, and as a result, their hybrid eccentricities were tolerated. It’s unlikely that their hybrid instincts would have survived in another organization. Twentieth century organizations have become extremely adept at grinding people down to become specialist cogs in their massive machines. Even at places like Nike and Apple it’s unclear whether hybridity is allowed to thrive when it’s not coming from the top.

In times of great ambiguity, we need hybrid thinking more than ever. And that means more than lip service. We may all praise Leonardo DaVinci, but we manage the world like we’re Henry Ford. And the world has changed a lot since the first Model-T rolled off the line. Isn’t it time that our thinking changed, too?

For reference, I tried to attack the ambiguity problem here a few days ago.

More than 40 years later it is unclear what the quality movement has accomplished. Very little is known about how many dollars are invested to improve quality of care nationally or who makes that investment, and there is insufficient evidence about whether or how the quality of care has actually improved. However, what is known is that there is a long way to go.

Frightening words, really. “The End of the Quality Improvement Movement” JAMA

You don’t need a patient satisfaction survey other than HCAHPS

Situation: since the advent of the compulsory use of the HCAHPS patient experience survey by CMS, your organization has been sending out two different patient satisfaction surveys: 1) HCAHPS and 2) Press-Ganey/Gallup/NRCPicker

Reality: the only survey that will determine future reimbursement is HCAHPS; the other is a nice-to-have that could be considered a broader assessment of patient satisfaction but in all likelihood is just creating competing improvement priorities; the above mentioned vendors are in full convincement mode to help you understand why two surveys are better than one

Response: up your sampling percentage for HCAHPS surveys, drop the unnecessary second vendor-survey, pocket a portion of the savings, and use the remaining dollars to create a patient insights department of one or two people to conduct ongoing patient insight panels and individual experience assessment/improvement opportunity phone calls

Result: your HCAHPS scores will improve, you’ll save a few dollars, and you will better understand your patient experience improvement opportunities

Let’s assert for the moment that you get paid to create, manipulate or spread ideas. That you don’t get paid to lift bricks or hammer steel. If you’re in the idea business, what’s going to improve your career, get you a better job, more respect or a happier day? Forgive me for suggesting (to those not curious enough to read this blog and others) that it might be reading blogs, books or even watching TED talks.

says Seth. Amen. So when you say you don’t have time to read (a book or a blog, or watch a TED talk), you’re also saying you don’t have time to be better. Off with you.

Just try some stuff

There has been a lot of talk (and blog posts) about accountable care organizations (ACO), medical homes, and value-based purchasing (I’m probably leaving a handful out)–especially since the reform package passed. It’s no secret the current model is too expensive and, frankly, doesn’t produce that great of outcomes for many patients.

But the interesting thing about all of this is that no one is quite sure how to proceed. Ambiguity isn’t something healthcare people deal with in a real productive fashion. Consultants aren’t that helpful yet as this is unfamiliar territory. Everyone is rushing around the country (have to do something!) trying to find examples of implemented ACOs (it’s a concept that is even difficult to define) and such (typical healthcare thing to do: what is everyone else doing?). All this while the words of someone I respect very much ring quite true, “if you’ve seen one model, you’ve seen one model.”

So here’s a thought courtesy of Saul Kaplan:

Instead of going to war to transform an entrenched operating model, create real world sandboxes right next door in which a new generation of transformative operating models can be explored. The imperative is to do R&D for new business models and systems the way organizations do R&D for new products and technologies today. The trick is to explore and test new models while at the same time continuing to pedal the bicycle of the current model. This requires establishing adjacent innovation platforms with the freedom to explore new ways to create and deliver value, especially approaches that are disruptive to the current model.  Adjacent innovation platforms must have the freedom to experiment with different rules and financial models.  

Experimentation isn’t something this industry has been game to promote. It’s basically a not-so-secret skunkworks but with a connection to the old world. A networked environment comprised of individuals open to failure and iteration looking for connections. Read this conversation between two very smart gentlemen, Kevin Kelly and Steven Johnson, an excerpt:

Johnson: It turns out that the lone genius entrepreneur has always been a rarity—there’s far more innovation coming out of open, nonmarket networks than we tend to assume.

Kelly: Really, we should think of ideas as connections,in our brains and among people. Ideas aren’t self-contained things; they’re more like ecologies and networks. They travel in clusters.

Healthcare types don’t deal well with ambiguity because it often involves risk. The current healthcare business model doesn’t reward risk taking; but with ambiguity comes a solution…sooner or later. James Shuttleworth, Chief Strategy Officer at Draftfcb Chicago (via PSFK) talks about ambiguity in ad agencies, same lesson applies here:

Ambiguity gives us the opportunity to be creative. Being prepared to face unguided situations enables planners to be creative. There is a need in agencies for collective genius, where people act spontaniously, while prioritizing the larger picture. 

If there is something healthcare organizations need right now, it is creativity and the ability to follow spontaneity when it arises. The hospital/typical healthcare environment isn’t one that supports this type of behavior: less creativity = more control = fewer problems. That’s understandable and expected when it comes to central lines; but when it comes to the business model, tried and true methods will not cut it. Fred Wilson writes that you need some contamination:

If you want to unleash more creativity in your company, you need to allow for a little contamination. It is the sand in the oyster that creates the pearl. 

Saul’s sandbox idea might just hold the sand for the oyster to create the pearl. It all starts with just trying some stuff.