It’s (almost) all about women (or completely)

This book, according to TP (it’s been placed on my Amazon Wish List), says that women make 80 percent of the health care decisions.  There really is no point in arguing the point; +/- 20 points and your service offering should still focus on helping women make decisions.  This Department of Labor site claims the same statistic; it also says that women accounted for 60 percent of all expenses incurred at doctors’ offices in the fine year of 2004.

So when evidence starts to trickle out that men and women need different treatment for identical diagnoses, it’s no wonder that the health systems that “get it” are creating dedicated women’s health centers.  It makes great sense.

The government even gets it.  The U.S. Department of Health and Human Services has deemed twenty academic medical centers National Centers of Excellence in Women’s Health to “serve as demonstration models for the Nation to provide innovative, comprehensive and integrated health care systems for women.”

Dinnertime: Henry Mintzberg

Today for dinner, the genius of Henry Mintzberg.

Mintzberg in his 1994 HBR article titled “The Fall and Rise of Strategic Planning” (there’s a book by a similar title) (the article is basically an examination on the fallacies of “strategic” planning) describes two types of planners in the planning department: the extremely analytic, order focused, right-handed planner and the more creative, quick and dirty, left-handed planner.  He then writes:

Many organizations need both types, and it is top management’s job to ensure that it has them in appropriate proportions.  Organizations need people to bring order to the messy world of mangement as well as challenge the conventions that managers and especially their organizations develop.  Some organizations (those big, machine-like bureaucracies concerned with mass production) may favor the right-handed planners, while others (the loose, flexible “adhocracies,” or project organizations) may favor the left-handed ones.  But both kinds of organization need both types of planners, if only to offset their natural tendencies.  And, of course, some organizations, like those highly professionalized hospitals and educational systems that have been forced to waste so much time doing ill-conceived strategic planning, may prefer to have very few of either!

In 2008 he sat down with The Globe and Mail‘s Report on Business to discuss the financial collapse.  The problem, as Mintzberg sees it, is too grand a focus on individualism and not enough on community building in organizations.  Hallelujah:

We should focus on building institutions and we should focus on building strong institutions and focus on building those strong institutions through what I prefer to call community-ship. In the United States particularly, they just make such a huge fuss over leadership, it has become an absolute obsession. Everything is leadership, leadership, leadership. It is not coincidental that the more fuss that Americans make about leadership, the worse their leadership is whether it is corporate or political or anything else. Their leadership is dreadful in recent years and with all of this fuss on leadership. Leadership is about individuality, leadership is about me. Even if leadership is designed to encourage and to bring along other people and engage other people, it is still the individual driving it. So, show me a leader and I will show you all kinds of followers and that is not the kind of organizations that we want. That is not the way that we build things up. I think that we need to put more emphasis on what I prefer to call, there is no word for it but I use the word ‘community-ship’, which is the idea that corporations and other organizations, when they function well, are communities. People care for each other, they worry about each other, they work for each other and they work for the institution and they feel pride in the institution.

A really good story.

### This post may look long, but I think you’ll be immersed in short order.  It might even be beneficial to your psyche. ###

As many (or none) of you may know, Beth Israel Deaconess Medical Center in Boston is in the midst of budget troubles (there are few hospitals — or organizations for that matter — who are not).  What makes the Beth Israel situation different is that the CEO, Paul Levy, blogs.  His commitment to transparency transcends the quality environment.

Here is a quick rundown if you are unfamiliar.  The problem the hospital faces:

For BIDMC, our hoped-for 2% FY09 operating margin (about $18 million) has disappeared. The state has reduced Medicaid payments by over $7 million, our major insurer is paying us less than we had hoped, and research funding has also fallen short by several million dollars. In addition, patient volumes are substantially lower than budgeted as people in the community defer or forego medical visits and treatments.

Right now, at best, we can break even for the year if patient volumes return to budgeted levels. However, if they stay at current levels, we will face an operating loss of up to $20 million. This is the contingency for which we must prepare, or else we will have insufficient funds to invest in the buildings, plant, and equipment needed.

With this knowledge in hand, Mr. Levy decided to ask the people of BIDMC for their ideas to help trim expenses during town hall gatherings.   Kevin Cullen of The Boston Globe best describes the scene at one of those meetings:

He looked out into a sea of people and recognized faces: technicians, secretaries, administrators, therapists, nurses, the people who are the heart and soul of any hospital. People who knew that Beth Israel had hired about a quarter of its 8,000 staff over the last six years and that the chances that they could all keep their jobs and benefits in an economy in freefall ranged between slim and none.

“I want to run an idea by you that I think is important, and I’d like to get your reaction to it,” Levy began. “I’d like to do what we can to protect the lower-wage earners – the transporters, the housekeepers, the food service people. A lot of these people work really hard, and I don’t want to put an additional burden on them.

“Now, if we protect these workers, it means the rest of us will have to make a bigger sacrifice,” he continued. “It means that others will have to give up more of their salary or benefits.”

He had barely gotten the words out of his mouth when Sherman Auditorium erupted in applause. Thunderous, heartfelt, sustained applause.

Paul Levy stood there and felt the sheer power of it all rush over him, like a wave. His eyes welled and his throat tightened so much that he didn’t think he could go on.

Reducing personnel costs (layoffs) became the prime target (largest expense for a hospital) and to begin senior managers took a reduction in pay.  Mr. Levy himself reduced his own pay by 10 percent while also foregoing his annual bonus (+ he and Mrs. Levy have committed to matching employee donations to the hospital at a rate of $1 for every $10 donated).  Here he is on the response he received after his call for idea assistance:

As expected, the response from the staff has been spectacular. People have a terrific sense of community and are quite willing to make sacrifices for the good of their fellow workers. … Beyond the general feeling, I was very, very pleased when I asked people if they agreed with my predisposition to protect our lower wage earners (e.g., transporters, housekeepers, food service people) from measures we take, even if it means that other people have to give up more of their salary and benefits.

Mr. Levy has finalized his decisions after exploring all considerations; the proposal includes a number of efforts to reduce expenses.  The best news is that projected layoffs were reduced from a high of 600 to the expected 150.  I cannot do the letter Mr. Levy sent to the people of BIDMC explaining his decisions justice without reproducing it whole—so I urge to you read it in its entirety.

While I am impressed by the translucence Mr. Levy allows of his organization, I’m more taken by the way he has introduced, handled, and shared the hospital’s problems with the people of the organization.  As a (hopeful) future health care leader, I’d like to thank Mr. Levy for providing an (almost) first-hand experience to an organization’s financial troubles.

At times, I’m unsure of how serious senior leaders are to exposing students and new graduates to difficult management situations (one piece of evidence: several conversations with student attendees at ACHE Congress on the general uselessness of the student program).

Granted, this educational opportunity is unlikely the motive for Mr. Levy revealing his organization’s struggles; although, as I’ve gotten to “know” Mr. Levy through his blog, he has a proven commitment to education.  I’m confident that there are more health care leaders in this country working along the same path as he; but Mr. Levy is the first to provide unprecedented (real time) insight through a blog.

Anyway, Mr. Cullen sums up how I feel nicely in the The Globe:

Paul Levy is trying something revolutionary, radical, maybe even impossible: He is trying to convince the people who work for him that the E in CEO can sometimes stand for empathy.

Though you’re likely to shrug it off, I would like to express my appreciation for your courage, Mr. Levy, along with your fresh approach to health care administration.

Keep it simple business model

Southwest Airlines provides an example of a “keep it simple” service offering (simple = concentrated, specific, focused; see post below); in other words, execution is key (and easier):

  • They don’t fly everywhere
  • Sparse customer amenities
  • No seating class distinctions
  • Fewest customer options
  • No choices on type of aircraft
  • Simplest pricing structure
  • Bare-bones frequent flier program
  • No frills
  • Few pretenses
  • Peanuts, not meals


  • Good schedules for destinations served
  • Fewest cancellations
  • Best on-time performance
  • Safest airline worldwide
  • Fastest gate turnaround
  • Employees appear to be happy
  • Simplest customer-interface
  • Highest customer ratings
  • Most consistently profitable
  • Lots of peanuts

UC Irvine Administrative and Business Services via Signal vs. Noise

In Action!

Getting out of health care in action:

Being prepared to dedicate time and money to creativity is clearly one lesson but Adrià’s ability to look beyond the world in which he works is crucial. Teamwork is a recurring theme and both Adrià and Great Ormond Street Hospital have been inspired by the seamless operation of the Formula One pitstop team.

Dr Allan Goldman is head of paediatric cardiac intensive care at the hospital, and it was while watching a race with his colleague Martin Elliot that they saw they could learn from the pitstop team’s smooth functioning. For the doctors, the critical post-op handover from the theatre to the intensive care team was an area of concern.

“We spoke to the F1 teams about the processes and safety culture, and designed a simple process we could use,” says Goldman. By compartmentalising the handover it became less haphazard and errors were reduced by around 35%.

“In medicine, who is in charge is often not defined, but it became clear the anaesthetist was the most suitable person, so they head the process now. Talking to people outside made a big difference.” The Guardian

Proving Innovation: Business Innovation Factory

The Business Innovation Factory is very cool:

An independent, non-profit organization launched in 2005, the Business Innovation Factory was founded to enable collaborative innovation. The BIF idea is simple: create a platform where public and private sector partners can collaborate across boundaries to focus on big win projects and deliver transformative innovations.

We believe that more organizations would innovate if they had access to a safer, more manageable environment to explore and test new ideas–a real world laboratory where organizations can keep current models producing while they design and test new ways of delivering value.

They call their work Innovation@Scale:

The only practical way to accelerate collaborative innovation is to test new business models in a smaller, more manageable environment. Given its location, size, and accessible public and private sector networks, Rhode Island’s unique ecosystem provides the optimal conditions to explore and test new business models. BIF offers members access to this unique innovation test bed, a capability we call Innovation@Scale.

Because of the never-offline/mistake-averse nature of health care, proving innovative ideas in manageable environments is a necessity.  It seems a practical model; one that would benefit a consortium of hospitals/health care organizations who may not independently have the resources for an innovation center.

As it happens, the BIF is working on the Nursing Home of the Future.  Read about it here.  Their pragmatic approach to solving problems is a welcome addition to the solving-health-care debate and provides a model to thinking about bettering the entire health care industry.


Collaborative networks created to improve care delivery are growing.

Here is the most recent example from Fierce Healthcare (and another example of “getting it“):

A group of nineteen New England hospitals have joined together in a network allowing them to share information about clinical practices and boost their quality improvement efforts. The hospitals are starting by focusing on preventing and reducing the incidence of pressure ulcers. The hospitals will share this information through a “Rapid Adoption Network” sponsored by VHA Inc. The hospitals will be using VHA’s clinical blueprint to mount their pressure ulcer reduction efforts.


“Geting It” continued

Maybe defining “getting it” would be easiest through the use of examples.

Here is the first.  From The Washington Post:

Is it ironic that the industry we trust to protect our health is releasing substances that may be tied to cancer, diabetes and other illnesses? Many health-care professionals think so.

In recent years, some have begun to think greener. Most efforts focus on reducing toxic waste from hospitals and medical offices as well as cutting back on water and energy use. But some doctors and health workers are also considering changes in their practices that could enhance environmental and patient health.

Read about Inova Fairfax Hospital is doing to make their operations greener.  Oh yeah, it’s saving money at a time when margins are being squeezed, too.  From the article:

“There are major parts of the building that never shut down,” said Cindy Kilgore, assistant vice president of materials management at Inova Fairfax Hospital. “We have to have a certain airflow, have to stay at a certain temperature, so there are unique things that make [cutting energy use] more complicated.”

Still, Inova has come up with some cost-saving answers. After its five hospitals completed energy audits last month, they turned off the lights in their vending machines. Kilgore said that simple change will save about $15,000 a year. More changes will come once Inova has had a chance to analyze the audit’s findings, she said.

Inova is also exploring the feasibility of a system that would shut down nonessential computers each night. And before the summer landscaping season ends, Kilgore said, Inova Fairfax hopes to use leftover oil from its cafeteria fryers to make biodiesel for its lawn mowers.

28. “Getting It”

Erik Karjaluoto at ideasonideas has a wonderfully entertaining post on a recent back-and-forth he had with a public relations firm.

The moral of the story: the world changes, and yesterday’s way of doing things don’t always continue to work.  Instead of adapting, some people keep trying the old ways over and over and over.  They just don’t get it.  You can imagine the success rate of such a ploy.

The problem happens in every industry.  Think Medicare’s fee for service in health care.  Sure, CMS tries new iterations of the payment system but the meat of the approach continues as it has for years.  What we’re left with is the problems of yesterday, only worse.

This can happen at an organizational level, too.  A favorite notion of health care folk is that change is constant.  A traditional approach to the health care change issue is to ignore it until ignoring the problem manifests into something requiring action.

Wait, wait, wait, wait, wait, wait, wait, wait, wait…hurry up and solve.  Example given: the primary care shortage, er crisis.

It doesn’t have to be like this.

Organizations that “get it” and make proactive attempts to embrace change can be successful in this hectic, ever-evolving world.

“Getting it” is difficult to define.  The problem with a definite definition of “getting it” is that it’s much easier to describe what it’s not.

Eric writes this about those who don’t, “Again, the problem is that they’re completely stuck in an old paradigm.”

There’s a way around not getting it, and that’s to get it.  Prophetic.

Realistically, the solution is diversity.  Diversity of thought, diversity of opinion, diversity of background, diversity of experiences, diversity of race, diversity of age.  Diversity etc.  Having all these people around influencing individual decision making will improve your organization’s chances of not getting stuck in an old paradigm.

Here’s the secret: utilize that diversity.  The dialog created between all this diversity will help an organization “get it.”  Listen to those with dissenting views, they may be right.

Principle #28: It all comes back to this: You either get it or you don’t.  Getting it means incorporating diversity.  It means being proactive toward change, listening to dissenters.  It means learning never stops.  Just because something worked yesterday has no bearing on its effectiveness today.  Organizations must approach each day with this notion in mind.  And we’ll do that at Our Own System.