Bonuses don’t work, management will go away, and free time at work for everyone

Lots to process in Dan Pink‘s talk at TEDGlobal in Oxford.

  1. financial motivators are almost always less motivating than intrinsic motivators
  2. management is a creation of man, therefore its irrelevancy over time is as possible as the videocassette recorder
  3. free time, like Google’s 20 percent time, can create some cool stuff

Potential implications.

  1. P4P won’t work, executive bonuses either
  2. the future health care organization will be much flatter (read up on hierarchies)
  3. most health care workers don’t spend any of their time on anything BUT their approved job tasks, maybe that’s a problem…

That’s it for analysis.  The good thing for all of us is that Dan has a new book due at the end of the year titled “Drive: The Surprising Truth About What Motivates Us.”  Here’s the talk:

The toilet test

L-O-V-E the toilet test:

Whenever I evaluate a school, my first stop is the boys’ bathroom because, without an unflushed urinal of doubt, it is every school’s least common denominator. Its sticky floors, calcified wads of toilet paper and juvenile-yet-timeless graffiti (“Here I sit broken hearted…”) are generally not what a principal shows off. Then again, I once visited a school run by the Knowledge is Power Program — which focuses on preparing students in underserved communities for college — and found fresh cut flowers next to an automatic recycled-paper-towel dispenser. At another school, there were toilet targets. (Apparently, research shows that they increase accuracy by as much as 70 percent.)

Folwell Dunbar explains his metric at Miller-McCune:

In today’s data-driven world of No Child Left Behind and high-stakes accountability, administrators and lawmakers tend to obsess over hard measures. Adequate Yearly Progress determinations and School Performance Scores are based on precise formulas — formulas made up of clean, cold and supposedly foolproof numbers. In this highly calculable place, soft measures are rarely factored in. Nonetheless, after my “inspection” discovers the good, the bad and the ugly of the boys’ john, I usually have a good sense (or scent) of how a school is doing. Though I wouldn’t necessarily hold the bathroom test up against SAT scores as a measure of school success, I do consider it a telltale sign of either problems or promise.

Oh, health care and education how you are so intricately entwined. The toilet test works in hospitals, too.  The article bullets a laundry list of “soft” tests (the soft stuff is the hard stuff…).  Ideating a few for hospitals on the decline, those areas that all visitors have access to:

  • wildly outdated reading material in waiting rooms
  • trash on the floors in main corridors
  • outdated furniture and interior decor, anywhere (though especially on the floors taking care of inpatients on services that traditionally are profitable)
  • boxy tube televisions in common areas, shared televisions in patient rooms
  • anything unkempt on a mother/baby service
  • posters/announcements/bulletin boards with aged information

There are…many, maybe even a limitless list (oh, those are fun…).  Care to share?  How do you judge hospitals or any other institution/place of business when you don’t have access to metrics/don’t care about measures?

(via Tom Kuntz)

Prevention better for health, not budget

From the CBO (via AP via MedGadget):

Some policies, such as the increased use of preventive services and the coordination of care, would have clearer positive effects on health than on the federal budget balance.

Prevention: do it because it’s the right thing to do for people.  The conclusion that it will save drastic dollars in health spending seems to be faulty, in the least.  Give back the AHRQ its power to conduct effectiveness research and publish guidelines (by the way, the effectiveness of back–pun fully intended–surgery is still questionable).  Read that last link, it’s delightfully insightful.

Advertising as failure

Health care marketing is hooey.  Because it relies upon (bad) advertising.  And now we know why advertising is (generally) bad, thanks to Jeff Jarvis and his advertising as failure notion:

That is, the ideal relationship a company should have with its customer is that it produces a great product the customer loves and talks about and thus sells; there is no need for advertising there. It’s only in the case of failing at that idea that one needs to advertise.


Obvious success story: Mayo (look, it’s right there on the front page, the primary value: the needs of the patient come first).  It’s possible to be Mayo-esque (in lots of respects) in your service area.

Praising diversity

In praise of diversity, the Scott E. Page type of diversity!!; from a story in the The Salt Lake Tribune on research by Katie Liljenquist:

new workers with different backgrounds and perspectives help existing teams of employees make better decisions by prompting more discussion and analysis.

(aside: hopefully that extra discussion and analysis is fruitful.)

Hire weird.  Or just someone different than you.

via: Creative Class

August 22, 2009

Gary Schwitzer at the Schwitzer health news blog calls for the end of Twittering surgeries:

What mysteries of surgery will be revealed? And the worry of surgery? Maybe patients SHOULD be worried about surgery being done while TV and Twitter are going on in the background.

And regarding the “new way to keep patients’ families informed” — no thanks. Good old fashioned face-to-face talking about risks and benefits, about evidence, and about alternatives is good enough for me. Better for me than “dialogue” 140 characters at a time.

Let’s stop the live Twitter marketing, er, surgery.

I don’t want to hear details of a prostatectomy via Twitter. I don’t want to to hear about laser toenail fungus removal via Twitter.

I do want to hear more discussion about the need for real and meaningful health care reform.

The Tweets from the operating room do have a gimicky marketing feel.  But it’s a new technology and health care organizations are just starting to explore its opportunities.  Will it serve a useful purpose in the future?

Maybe.  But it’s hard to argue when at current growth rates “everyone in the US will have a Twitter account by August 22 of this year,” writes Ross Dawson at Trends in the Living Networks.

This comScore data, tracking unique U.S. visitors to Twitter, is astounding:

Twitter Trend Report

As for the health reform discussion, there are some meaningful health care reform conversations happening on Twitter.  Smart individuals who likely would have a reduced voice on the matter without such a platform are sharing their insights daily.  Start here.

Local health concerns

I’ve written: Who better to understand the health care challenges of a community than local delivery organizations?  Recent research by Richard Florida et al. reveals that “States with large concentrations of working class jobs had lower levels of income, GDP per capita, and well-being – pretty much everything across the board.”

Most important to health care delivery is the well-being aspect; both physical health and healthy behavior were negatively correlated in states with a large share of working class jobs.  So again, if so much of health care is based locally, why are we trying to solve its problems nationally?

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.

Health care and the creative economy

Richard Florida on the role of health care and education in the creative economy:

Our research and that of Todd Gabe show that education and health add very little if anything to regional income. It’s sectors and occupations like management, science and technology, and even arts and culture that drive regional income and development. That said, at 25 percent of GDP, eds and meds are the floor of the intangible or creative economy. They provide stable, long-term jobs which pay well. Seems to me they have to be a centerpiece of a long-run economic recovery plan and along with the massive upgrading in pay and working conditions of service jobs.

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?