Holidays are nice. Labor Day marks the end of summer and its (hopefully) enjoyable 24 hours are perfect for reflecting upon the “coolness” of life. Here’s some help for getting your reflections started via the good folks at Snarkmarket:

Superpowers, Revealed because “sometimes the best abilities are the ones the world can’t see.”  The Morning News

And then this: Moments from Radio Lab, via Jonah Lehrer. Just something special about it.

Right to lie…


Two of the three largest U.S. tobacco companies filed suit against federal authorities Monday, claiming a law that gives the U.S. Food and Drug Administration new authority over tobacco violates their right to free speech.

The “right” to free speech (and sympathy) may have been taken away moments following this charade:

The speed of information, or lack thereof


Michael Stillwell pulled an interesting chart out of a book called A Farewell to Alms. It’s a table of the speed of important news reaching London. For instance, in 1805 the news of the Battle of Trafalgar took 17 days to travel the 1100 miles to London; that’s a speed of 2.7 mph. By 1891 when the Nobi earthquake occurred in Japan, it only took the news one day to travel 5916 miles, a speed of 246 mph.

Nowadays an email or a Twitter update can travel halfway around the world nearly instantaneously. The 2008 Sichaun earthquake occurred 5100 miles from London with the first Twitter update in English occurring about 7 minutes after the quake started. Assuming the message was read a minute later by someone in London, that’s 38,250 mph. Had the Twitter updater been right at the epicenter and able to send a Twitter message 30 seconds after the quake started and was read a minute later in London, that’s 204,000 mph. Five orders of magnitude improvement in 200 years…not too shabby.

And health care still can’t get hospitals across town from one another to transmit important medical information.

Insurance company, clinic play nice

Look! Over yonder!

“Minnesota nice” has brought an insurance company and a provider together to work on reducing, yes reducing, costs:

So Eustis and Tilford struck a deal. The insurance company agreed to provide an undisclosed amount of money to help Fairview — Minnesota’s second-largest health care provider — move from fee-for-service billing to a system based on fixed payments. Tilford says it was by no means a gift to Fairview.

“I was very clear that we would make investments, and that those investments should produce changes in the way care was delivered,” Tilford says.

Eustis, for his part, says Medica took a carrot-and-stick approach with Fairview: “If we don’t perform, we’re going to get less. If you perform at a higher level, you’ll be able to get additional payment.”

The idea, says Eustis, was to keep patients well — by spending more on them when they’re healthy, with the aim of reducing costly illness.

In: Staying busy (and making sense)

It’s truly astonishing how so many individuals in health care juggle a gaggle of demanding roles, especially those that do things well.  A description of how Dr. Atul Gawande keeps it all straight in “Harvard Magazine:”

This kind of effortless toggling between tasks helps explain how Gawande can keep so many balls in the air. Certain other habits also contribute. He arrives precisely on time—not late, but not early either. He leaves swiftly when meetings end, as others linger to chat. There is nary an idle moment in his day. He saves his writing for the hours between 7 and 11 a.m. and 4 and 7 p.m. to capitalize on the body’s circadian rhythms. And it helps that he isn’t bothered by a lack of downtime.

The entire article is worth the read.

Extra: Dr. Gawande cemented his position on my list of favorite people with this (via Jay Parkinson) NPR interview and this great quote that has me “harrumphing:”

That’s the disaster of our system, when you have medicine become a business rather than something about what the patient’s needs are.

Oh, and this from an interview with Ezra Klein.  Current reform efforts are focusing on insurance reform which, to borrow from the quality improvement vocabulary, is not the root cause of rising costs.  Here’s what Dr. Gawande says about that:

I had a hard time connecting the dots. My vantage point on the world is the operating room where I see my patients. And trying to think about whether a public option would change anything didn’t connect. I order more than $50,000 worth of health care in a day. Would a public or private option change that?

People say that the most expensive piece of medical equipment is the doctor’s pen. It’s not that we make all the money. It’s that we order all the money. We’re hoping that Medicare versus Aetna will be more effective at making me do my operations differently? I don’t get that. Neither one has been very effective thus far.


Does health care need to follow this path?

What kind of company declares itself uninterested in maximizing profit? “Companies looking to maximize revenue need to throw as many revenue-generating opportunities at users as they will tolerate,” Buckmaster says. “We have absolutely no interest in doing that, which I think has been instrumental to the success of craigslist.” (Wired)

Just asking.  It could actually turn into a really interesting discussion.

Health Care Should Be designed with you

A new project for your participation!

Health Care Should Be:

This is a collaborative effort in discovering ideas to improve the parts that make up health care delivery (the whole).

American medicine is good, very good. But it’s only a part of the health care experience.

Talk to almost anyone who has encountered the health care system and you’re likely to find a past disappointing experience. It might have been a lack of parking. Or getting lost navigating the hallway. Or a poor interaction with a nurse or doctor. Or an incredibly long wait. Or trouble getting your PHR to interact with the hospital’s EMR… (okay, so predicting future problems is a part of this project too).

Every day a lot of people go to work to improve health care. But there’s something lacking in the approach: the opinion of the patient.

This project in reimagination is a collaborative one. An effort, if you will, to describe a health care utopia. Share your personal opinions. Or a link to an article describing an improved registration process. Or a superior customer service story from a retailer. Or an image of a product that should be used. Or embed video of technology that could be implemented. Or a quote to provide perspective.

The information here provides only a frame for your suggestions. Don’t hold back. Share anything you feel is important, relevant, or worth pursuing. Share as much as you want, can, and/or need.
The end goal of this project, at some point in the possible future, is to implement these ideas.

Go! Now! Share!

Let the designers handle health reform

Consider the success of all reform efforts up to this point before you write this off as “creative mumbo-jumbo” or something of the sort:

The current emotional uproar has revealed that the debate over health care is about much more than mere economics alone. To be certain, much of the positioning relates to financial exposure. But when you listen to the town hall meetings, you hear the debate is supercharged with emotion. Understanding those emotional needs of the various stakeholder constituencies is what will make it possible for designers to design positive experiences from process, financial, and emotional perspectives.

By employing a full designer’s toolkit of methodologies, designers would understand and analyze our health care system and arrive at insightful solutions that go beyond logistics and economics. (Fast Company)

The reform conversation is going to continue to spiral until believable emotional refutations are constructed to combat emotional beliefs.  Only then will we be able to move onto rational discussions with those who are actually interested in discussing.  The majority of Americans will happily exclude those who are for nothing but a single-payer system or a completely free-market approach.  There is success to be found in the middle…with designers.  Sign me up.

How much your family’s health care costs in 2020: $23,842

Sooner or later health care reform will have to something to address out-of-control costs? Right? Right?

The rapid rise in health insurance premiums has severely strained U.S. families and employers in recent years. This analysis of federal data finds that if premiums for employer-sponsored insurance grow in each state at the projected national rate of increase, then the average premium for family coverage would rise from $12,298 (the 2008 average) to $23,842 by 2020—a 94 percent increase. (The Commonwealth Fund)

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: