Meetings. Meetings. Meetings. Meetings.

Big health care management problem:

It is certain that every organization has too many meetings, and far too many poorly designed ones. The main reason we don’t make meetings more productive is that we don’t value our time properly. The people who call meetings and those who attend them are not thinking about time as their most valuable resource.

Reid Hastie, Professor at the University of Chicago’s Booth School of Business via Signal vs. Noise

The number of meetings is an in-house decision, but health care organizations likely have far, far too many.  The organization where managers and executives float from meeting to meeting all day is not a rare occurrence.  As far as the design problem, here is Seth Godin’s solution:

There are only three kinds of classic meetings:

  1. Information. This is a meeting where attendees are informed about what is happening (with or without their blessing). While there may be a facade of conversation, it’s primarily designed to inform.
  2. Discussion. This is a meeting where the leader actually wants feedback or direction or connections. You can use this meeting to come up with an action plan, or develop a new idea, for example.
  3. Permission. This is a meeting where the other side is supposed to say yes but has the power to say no.

PLEASE don’t confuse them. Confused meeting types are the number one source of meeting ennui. One source of confusion is that a meeting starts as one sort of meeting and then magically morphs into another kind. The reason this is frightening is that one side or the other might not realize that’s actually occurring. If it does, stop and say, “Thanks for the discussion. Let me state what we’ve just agreed on and then we can go ahead and approve it, okay?”

Art: “Hmms,” “Hmphs,” and “Ahas”

Andy Warhol was quoted as saying, “Making money is art and working is art and good business is the best art.”  And since Twyla Tharp said, “Metaphor is the lifeblood of all art,” I’m taking an art history class this quarter to add some perspective to my health care business thinking (if you’re skeptical, you aren’t the first; using A Whole New Mind by Dan Pink as evidence I was able to get this reluctantly approved by the powers that be).  Classes like art history should become part of an MHA curriculum to inspire new approaches to health care’s tired problems.

Here’s the thing: art is difficult to interpret (this is my first foray into the effort), especially modern art (especially conceptual art).  There is a fine line between over-analysis and under-analysis.  Finding meaning isn’t always the easiest task, either.  But. That. Is. Exactly. The. Point.  This is challenging my thinking in a way it’s never been challenged.  It is definitely exciting (at least for the time being, a research paper is required for the final and my experience with art history research papers is slim, at best.)

But there is a relation between art and health care and business here.  Sitting in lecture and reading the necessities has provided more than a few “Hmms,” “Hmphs,” and “Ahas.”  Sol LeWitt‘s “Sentences on Conceptual Art” is the first extensively business-related reading we’ve had in the class.  The most thought-provoking metaphorical “sentences” appear below (many have been axed for various reasons) and a personal analysis of their meaning is encouraged (share in the comments if you would like):

2. Rational judgements repeat rational judgements.
3. Irrational judgements lead to new experience.
5. Irrational thoughts should be followed absolutely and logically.
6. If the artist changes his mind midway through the execution of the piece he compromises the result and repeats past results.
9. The concept and idea are different. The former implies a general direction while the latter is the component. Ideas implement the concept.
12. For each work of art that becomes physical there are many variations that do not.
13. The words of one artist to another may induce an idea chain, if they share the same concept.
19. The conventions of art are altered by works of art.
20. Successful art changes our understanding of the conventions by altering our perceptions.
21. Perception of ideas leads to new ideas.
24. Perception is subjective.
30. There are many elements involved in a work of art. The most important are the most obvious.
32. Banal ideas cannot be rescued by beautiful execution.

For some Friday entertainment (I can’t help but smile at this) here is a clip of John Baldessari singing LeWitt’s “Sentences:”


“…these sentences have been hidden too long in the pages of exhibition catalogs…”

Hopefully, they do some good here, too.

A safety record to be proud of

In terms of safety, would you rather spend a night in the hospital or on the redeye flight from Los Angeles to New York?

Choose the flight.

While hospitals continue to struggle with quality and safety issues, an industry-wide example of improvement is on display:

For the first time since the dawn of the jet age, two consecutive years have passed without a single airline passenger death in a U.S. carrier crash.

No passengers died in accidents in 2007 and 2008, a period in which commercial airliners carried 1.5 billion passengers on scheduled airline flights, according to a USA TODAY analysis of federal and industry data. (USA Today)

It’s obvious that the vast majority of airlines are awful-awful-awful when it comes to customer service (everyone has a story…; I’m a staunch advocate of not using the airline industry as an example of how to treat people, ever ever!).  But they do get safety (much of the awful customer service stems from focusing on safety, btw).  Surely mistakes are still made, but they’re also corrected before harm is caused.

The Institute for Healthcare Improvement tells us that nearly 100,000 patients die annually because of preventable medical errors.  Or as some have analogized it, the equivalent of killing everyone aboard one jumbo jet every day. 

The good news from the domestic airlines comes as a result of a concentrated safety effort according to Arnold Barnett from MIT (CNN), “The manufacturers of the air frame are making better equipment. The power plant people, the engine manufacturers are doing the same. The crews are better trained. It’s just an all-around effort.”

Improvement efforts and transparency initiatives have increased hospitals’ attention to these matters.  The IHI’s latest concentration is the Improvement Map—its most encompassing safety and quality effort to date.  A grand continuation of its improvement agenda.

We’ve still a long way to go.  The checklists now being instituted in operating rooms have been borrowed from the cockpit and as the most recent statistics show, there’s room to borrow even more.

Virtual Therapy for Burn Victims

Very cool (literally and figuratively).

SnowWorld is virtual world therapy for burn victims.  From the University of Washington HITLab:

SnowWorld, developed at the University of Washington HITLab in collaboration with Harborview Burn Center, was the first immersive virtual world designed for reducing pain.  SnowWorld was specifically designed to help burn patients. Patients often report re-living their original burn experience during wound care, SnowWorld was designed to help put out the fire.

Our logic for why VR will reduce pain is as follows. Pain perception has a strong psychological component. The same incoming pain signal can be interpreted as painful or not, depending on what the patient is thinking. Pain requires conscious attention. The essence of VR is the illusion users have of going inside the computer-generated environment. Being drawn into another world drains a lot of attentional resources, leaving less attention available to process pain signals. Conscious attention is like a spotlight. Usually it is focused on the pain and woundcare. We are luring that spotlight into the virtual world. Rather than having pain as the focus of their attention, for many patients in VR, the wound care becomes more of an annoyance, distracting them from their primary goal of exploring the virtual world.


Via PSFK via Herd.

Employers: Stick with status quo on paying for health insurance

Jane Sarasohn-Khan at Health Populi writes, “a new survey from the International Foundation of Employee Benefit Plans finds that most employers do not want to move away from an employer-based system of health insurance.”


More than a few business people have had a tough-go of things lately; it seems obvious, then, that businesses would want to unload an ever-increasing expense line item from their budgets.


Not so fast.

Sarasohn-Khan continues:

As one of those who’ve watched the slow-cooking past efforts toward changing the structure of health care financing and delivery in the U.S. — and given the current sorry state of the macroeconomy — employers who “can” will continue to sponsor health plans for the next couple of years.

“Employers who can” depends on company profitability per employee, and clearly many companies whose good fortunes are based on consumer purchases could become compromised in their ability to provide health insurance. Milliman, the actuarial firm, calculates that the average cost of health care for a family of four in 2009 will be $17,310. This will over-burden companies in many consumer-facing industries — beyond automakers, consumer goods companies, retailers, home appliance manufacturers, and others from a large number of SIC codes.

It is baffling to read that “64% of employers believe that employer-based health care should continue to be the primary mechanism for benefits delivery,” even if that number has been decreasing over the past ten years.

No doubt that any health care reform in the near term will require employers to pick up some of the tab, but do employers fear that employees no longer needing the one benefit that keeps them on the job will up and leave en masse?

The era of one company, one career has long been dead.  The final frontier in overcoming job lock is the health care benefit and the now defunct John McCain health care plan at least had the redeeming quality of separating health insurance from employment.

Not only is divorcing health care insurance from employment the right thing to do, it also makes business sense from a financial perspective.  Or so I thought.

Health 2.0 Thoughts: Clay Shirky

It’s Wednesday, a whole week removed from the opening of Health 2.0.  The bad thing about posting a week later: everything has probably already changed.  And so, still relevant or not, this begins a yet-to-be-decided part series on thoughts from Health 2.0.

Clay Shirky had a great keynote.  Here are some selected comments (most likely a mix of my own words and his, with my comments in the parentheses):

  • Most valuable thing connected to the internet: people
  • Patient-Centric Medicine: internet is implementation layer
  • TRUST is the key (recurring theme throughout the conference) for information to flow
  • The changes made to the Catholic Church by the Second Vatican Council can be used as a metaphor for the changes going on in health care (very impressive metaphor, IMO); Vatican II shifted the focus of the church from the leaders to the parishioners, Health 2.0 is shifting focus of health care from health care deliverers to patients (I’d even argue it is shifting us from health care to health)
  • We’ve always had informal health care conversations, you just couldn’t see them before (innocent conversations around the table…)
  • When you give new people access to information things are are going to get weird, and they are

The “New Health Care:” Informed Patients

Tom Peters’ recent discussion with friends is nothing new.  This conversation is happening at dinner tables, around kitchen counters, and surrounding fireplaces the nation over.

But the question comes here: why do so few patients still not question the quality of health care?

We (health care) know mistakes are happening.  Our perception has been that patients know mistakes are happening as well.  But the “quality” of health care is in the eye of the beholder.  Perception is reality.  Patients have a tendency to perceive quality as everything but what health care experts have deemed clinical quality.

It becomes very obvious that we (health care) have failed patients in educating them about what clinical quality health care means.  Every reason being old health care.  The health care of blind trust and walls built so high in order to “protect” “us” from information slipping into “their” hands.

The new health care redefines “protect” “us” and “their.”  The new health care demands full participation.  It demands honesty, communication, and understanding.

We’ve got some work to do.  Transparency efforts are a start.

Mr. Peters brings to light why many health care organizations are fearful of complete transparency:

Make no mistake, this is a story of lousy management and sloppy leadership—not, primarily, the result of lousy health policy.

Make no mistake, this is a story of unconscionably lousy management and almost criminally sloppy leadership—not, primarily, the product of bad health policy.

If patients aren’t motivation enough to tirelessly improve quality, then a flat out indictment of “unconscionably lousy management and almost criminally sloppy leadership” is.  What are you doing to assure the highest (read: the H-I-G-H-E-S-T) quality of care is being provided at your organization?

Medical tourism gains Olympic notoriety, links

American speedster Tyson Gay is expected to be in the hunt for a gold medal in the 100-meter dash in Beijing on Saturday.  But he almost didn’t make the trip.

Gay took a scary spill at the Olympic trials five weeks ago that brought his appearance in the 100 meters into question.  From ESPN:

One week after setting the American record in the 100 meters and also running that distance faster than anyone else ever has, Gay’s quest to double up at the Olympics in the 200 ended prematurely and painfully during a quarterfinal heat when he collapsed due to what was described as a “severe cramp” in his left hamstring.

Gay pulled up about a dozen strides into the race, after perhaps 40 meters. He collapsed to the ground and lay there as his competitors raced ahead and a stunned Hayward Field crowd went silent. Officials quickly brought a modified stretcher onto the track and wheeled him to the medical tent for examination.

In order to be sure the injury wasn’t anything more than cramps, Gay was treated by a physician…in Germany:

“The hamstring is 100 per cent,” he said after being treated by specialist Hans-Wilhelm Mueller-Wohlfahrt, the doctor of German football giants Bayern Munich and the German national team.

Olympic Medical Tourism—it has a ring to it, no?

Niko Karvounis’ recent in-depth look at medical tourism is worth your read at Health Beat.

Also, The Economist takes a free market look at medical tourism.