The hospital as a complex adaptive system

The context for this is the social web. But, man, this sounds like a healthcare delivery org. Bud Caddell:

Briefly, a complex adaptive system can be identified by the following attributes: 1) a multi-level system of agents constantly acting and interacting, 2) highly dispersed control, behavior is dictated by the cooperation and competition between agents, 3) an ability to adapt as experience is gained, 4) an anticipation of the future derived by agents predicting potential outcomes, and 5) many many niches that ultimately spawn further niches.

It’s the Virginia Mason Medical Center story of adopting lean. I’m not a lean enthusiast, but I realize the power it holds to make healthcare better. So listen up.

Also, the 99% Invisible podcast is awesome. Subscribe via iTunes.

The Health Information Davos

So. Cool. Everyone needs a place to create world domination plans. Athena Health CEO Jonathan Bush:

My call is that if we are to be a national health information backbone, we are going to also be a national convener of key thinkers in health information. The market for management of health information barely exists at all, but it is the single most important missing piece to more transparent and affordable health care in the US. It needs a fertile place for idea exchange (think Davos).

Perfunctory percentile phooey

Indulge my (intended) naivete for a moment. I’ve never been a believer in viewing organizational performance through a percentile-rank lens. The 90th percentile of perfection leaves 10 percentiles of failure.

I am much more focused on perfection. That, especially in terms of patient safety, is a goal worth striving for. The folly, I think, is that comparing organizational performance against other organizations somehow matters. (Small digression: Improvement is good, too. Applaud the improvement from the 50th percentile to the 75th percentile, but boo the static 75th percentile result month after month.)

Is perfection possible? It’s not worth the argument. Perfection is the goal.

Often it is worth comparing one industry norm with a different industry’s treatment of the same norm to judge appropriateness. Thinking About Thinking recently recently wrote that in the venture fund business, top quartile performance is deemed successful. TAT then looked at what top quartile achieves in other arenas:

From professional sports

  • Major League Baseball Batting Average:  There are 750 MLB baseball players making the top quartile threshold 188.  That batter is Alfonso Soriano with the Chicago Cubs with an inconspicuous batting average of .270.
  • NBA Scoring:  There are 452 NBA players making the top quartile threshold 113.  That player is Jordan Crawford of the Washington Wizards who averaged a respectable 11.7 points per game.

From everyday life

  • Height of Male Adults:  This CDC study says that the top quartile threshold for height in adult US males over 20 years old is 71.5″.  That translates to a healthy 5′ 11.5“.
  • U.S. Household Income:  According to these statistics, the top quartile threshold for US HH income is:~$80,000.

From geography

  • U.S. State Populations:  There are 50 U.S. states, with the top quartile spot being the state of Washington with6.7 million people (with the top spot being California at 37 million).
  • Country Nominal GDP:  There are 181 countries listed in Wikipedia with the top quartile threshold occupied by Czech Republic with $192 billion (with the top spot being the US at $14 trillion).

Social skills!

New for Aspiring Doctors, the People Skills Test, New York Times:

At Virginia Tech Carilion, the nation’s newest medical school, administrators decided against relying solely on grades, test scores and hourlong interviews to determine who got in. Instead, the school invited candidates to the admissions equivalent of speed-dating: nine brief interviews that forced candidates to show they had the social skills to navigate a health care system in which good communication has become critical.