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Showing posts from 2013

How Do Innovations Spread?

From Atul Gawande, writing in the New Yorker:
In the era of the iPhone, Facebook, and Twitter, we’ve become enamored of ideas that spread as effortlessly as ether. We want frictionless, “turnkey” solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. People and institutions can feel messy and anachronistic. They introduce, as the engineers put it, uncontrolled variability.

But technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process. (emphasis mine…

"Stop Blaming the Patient!"

From "Mayo doc: Stop blaming patients. Healthcare industry’s take on non-compliance is all wrong."

Dr. Victor Montori offers some great riffs on engagement:
Non-compliance is frequently talked about as a cost and a burden put on the healthcare system by patients. But Montori’s theory is that really, it’s the healthcare system over-burdening the patient. “We have to be very careful not to blame the patients,” Montori said during his closing keynote at MedCity’s ENGAGE on Thursday. “A lot of the conversation (around patient engagement) has been, how do we get them to do stuff? To me, that’s not engagement." [...] Montori closed by asserting that the U.S. healthcare system will be the best in the world only when it begins to shrink. “Healthcare right now is all about itself. Healthcare right now is about how do we get bigger, more market share,” he said. “That means that patients have to take more medicine, have to monitor themselves more often [...] We …

Hanging Up On Honda

My phone rang last night, with the caller ID showing an unfamiliar number from Fremont, MI.  A quick Google search hinted that it was Honda calling, probably to determine my satisfaction with a recent oil change at one of their dealers.

I'm not answering their calls.  Not now, not ever.  Why?

Several months ago, after a similiar service visit led to a similar call, I told the researcher I was unhappy with the dealer for recommending what I thought were unecessary service items in an attempt to inflate my bill.  (So what else is new, right? Whodathunk?)

Not twenty minutes later said dealer's service manager calls, unhappy that I'd given him and his department less than perfect marks and downright angry that I'd aired my suspicions in the survey.

So I gave their customer satisfaction researchers honest feedback and they ratted me out to the locals.  Seriously?

Let's make a new deal.  Mark down that I said "Honda's service is PERFECT in all respects" and…

CBS Calls Out UPMC

From CBS This Morning: University of Pittsburgh Medical Center (UPMC) "made $948 million in profits from 2011-2012."  And tax returns show UPMC spending just 2% of its annual budget on charity care.  And UPMC's CEO, Jeffrey Romoff, makes almost $6 million a year.  And Romoff also has more than a dozen administrators that take in annual salaries of over $1 million a year.  And now Pittsburgh Mayor Luke Ravenstahl is suing to revoke UPMC's nonprofit status.  Good.  I hope he wins.

From the article:
Professor Martin Gaynor of Carnegie Mellon has published papers on hospitals that enjoy nonprofit status but do not always function like charities. "There's a lot of concern here in the community," Gaynor told "CBS This Morning." "They've taken some actions that don't appear to be consistent with an organization whose mission is to benefit the community." Some of UPMC's funds are directed at facility improvement, but Gaynor ha…

The ACA's Effect On Entrepreneurs Will Be...?

An article in yesterday's Wall Street Journal asked "Will Health-Care Law Beget Entrepreneurs?"

Will the availability of reasonably-priced insurance through public marketplaces or "exchanges" cause entrepreneurs to strike out on their own, leaving behind the comfort of big company benefits?

It's a good question, albeit one with no clear-cut answer at the moment. It all depends, I guess, on one's definition of "high-functioning exchanges" and "reasonable prices."

Still, it's a question to which large companies ought to be paying close attention. How many people work at jobs simply for the health insurance, jobs they'd leave in a heartbeat to follow their passion if insurance wasn't an obstacle? I don't know for sure, but I'd bet the answer is somewhere between "more than a few" and "a whole heckavu lot."

And those leaving are likely to be those the company wishes would stay - the innovators,…

Should An Employer Pay You For Interviewing?

Asks Nick Corcodilos, writing for PBS NewsHour.  It's a great question.  The answer might shape up your HR department in a hurry.

From the article:
A job applicant treated with disrespect can do as much -- if not more -- damage to a company's business as a dissatisfied customer. Do employers really think word doesn't get around? Maybe hiring managers assume that their HR departments handle all the necessary niceties with applicants. But just how accountable are HR departments? Does this company's public relations department realize that while it's spending millions on good press, the HR department is scuttling it? If you're a hiring manager, and you're not sure how job candidates are treated after they leave your office, please read "Respecting The Candidate." Your HR department might explain that processing applicants, job offers, hires, and rejection letters is cumbersome. Tell that to your customer who cancels the order that's a month late,…

"...a social strategy doesn’t mean doctors on Facebook"

How's your patient engagement strategy working out for you?  This article might help:  Engagement is a Strategy IV: 10 Reasons Value-based Health Care Orgs Need A Social Strategy.

If you want to influence behavior (which you do or will), you really can’t ignore a social strategy. We’ll need to get really good at engagement and behavior change on a massive scale. Social media strategies may be our best bet at influencing behavior on a massive scale. Not to push behavior in a direction, but to provide systems that let behavior naturally migrate toward the health people already seek."

What Tech Trends Do CIOs See As Overrated?

From Chris Murphy, Editor at "7 Tech Trends CIOs Call Overrated."

Trend #4: "Big data over small data."
(Says) Ken Harris, Shaklee CIO: "I'm not convinced that big data for most companies is a promising investment right now. We haven't learned how to handle small data well, let alone throw big data on there. That isn't to say there aren't some companies for whom big data could be a game changer, but most companies don't even effectively handle small data." Harris is entirely correct, especially regarding healthcare's provider organizations - hospitals and physician groups - who, despite much talk about evidence-based practice, remain too often stuck in patterns of deliberate, consensus-to-a-fault decision-making. 

Think that's harsh?  One AHRQ study found that "...(t)ranslation of research findings into sustainable improvements in clinical outcomes and patient outcomes remains a substantial obstacle …

The Patients Speak!

Andrea J. Simon writing at  "What Do Patients Really Want and Do Docs Care?"
With high deductibles, consumers all expressed how they are less likely to go to the doctor unless they are really sick. A number of them spoke about preempting the healthcare system altogether and instead, using their personal network to speak with friends who are nurses about their situation or that of their child before going to the physicians.

Most interesting was the degree to which these consumers--all of whom were between 25 and 54 in age--were anxious to get mobile applications that they could use themselves to help diagnose and manage their conditions. DIY healthcare is going to be very hot if we can get it right.

10 Ways to Stay On Top Of the Innovation Heap

The authors of Booz & Company's "Global Innovation 1,000 Report" offer their Top 10 things innovative companies do right (via Business
At innovative companies, everybody is an innovator.Innovative companies measure their idea-generation success.Innovative companies change the idea a lot before it becomes a product.Innovative companies test their idea with customers.Innovative companies have an internal "idea czar."Innovative companies talk to customers and other partners.Innovative companies find ideas everywhere.Innovative companies generate ideas in three basic ways:Need seekers: what do customers want?Market readers: quickly create improvements on market trends.Technology drivers: letting their tech experts experiment.Innovative companies spend R&D money thoughtfully, not profligately.Innovative companies systematically create new ideas. Though healthcare (big pharma, mostly) is heavily represented, healthcare providers are not.   Not une…

"...I was fully planning to quit in protest. I’d even started writing op-ed articles. I was going to resign pretty noisily, I’m afraid."

Richard S. Foster is retiring this week after 18 years as the chief actuary for the Centers for Medicare and Medicaid Services. From an interview in

Q: How do we control health care costs in Medicare, Medicaid and the private sector?

A: Years ago, we thought that converting from cost-based reimbursement to prospective payment systems (a set payment that covers the entire cost of the admission) was the magic answer, and it helped a lot. Then, back in the early 1990s, everybody thought managed care was the magic answer. And that helped some, too, although most of their success was in negotiating lower payment rates, which you can only take so far.

We’ve had other instances -- pay-for-performance and consumer-driven health care -- that people had hoped would be the magic answer. Right now, there’s a great deal of hope that further integration of care, greater bundling of payments and other innovations like that will be the answer. I’m not optimistic that these things…

Tensions In Innovation, 2013

Forbes:  "’s hard not to worry that if medicine goes in the direction of the Cheesecake Factory, where care is administered on the cheap by customer-service technologists plugging data into an algorithm, then an ancient and noble profession will face extinction because of an inability (some might say a haughty unwillingness) to adequately contemplate and communicate its essential value proposition."