Suneil Mandava's Posterous

A great article by the New York Times on what happens when doctors and clinicians begin thinking about costs of care. As was 25 years ago, today, many clinicians still dont know the costs of items and service. OK... they know whether something is "expensive" or "not expensive", but they generally dont have any further granularity then that.
I dont want my doctor, or any doctor, making decision solely on the cost of items. However, to make decisions completely without knowing the costs? In the end, it actually hurts care... money that could have been spent on another patient is wasted on a different patient because costs were not known. Cost is ONE attribute in delivering care, not the attribute.
We all want what is best for patients across the healthcare spectrum. Its time we start giving hospitals and clinicians more insight into the costs of care. Clinicians can still deliver care optimally, but by knowing the costs, they can determine if something cheaper, but just as effective, could replace it. Overall, this increased the quality of care by leaving dollars on the table to spend on another patient who may need it.

I love data... it dismisses myths, it puts you on the right path, it eliminates emotional decisions and gives you optimal decisions. There are a lot of reports in the media today saying that half of Americans dont pay taxes. As you can see on the chart, in fact, most American's indeed do (82%).
Now if the media said that half of Americans dont pay INCOME taxes they would be right. But when payroll taxes cover Social Security and Medicare, which are two or our biggest budget items, thats a big deal.
In anything, its good to know the detailed facts.. then you can have good discourse in your organization (or in Congress) and make optimal decisions.

I am keeping my eye on this one. The virtualization of spaces and products is quite interesting. This is happening to everything, reducing costs for consumers and businesses. If you think about it, it is quite "lean" - rather than having an always on, fatpipe for TV, this service only provides the proper pipe for a pooled set of users.
With Microsoft complaining about OnLive virtualization and the Entertainment industry coming after Aereo, virtualization will be an interesting space to watch.

In 1874, the inventor Lewis Miller and the Methodist bishop John Heyl Vincent founded a camp for Sunday school teachers near Chautauqua, New York. Two years later, Vincent reinstated the camp, training a collection of teachers in an outdoor summer school. Soon, what had started as an ad-hoc instructional course had become a movement: Secular versions of the outdoor schools, colloquially known as "Chautauquas," began springing up throughout the country, giving rise to an educational circuit featuring lectures and other performances by the intellectuals of the day.

William Jennings Bryan, a frequent presenter at the Chautauquas, called the circuit a "potent human factor in molding the mind of the nation." Teddy Roosevelt deemed it "the most American thing in America."

At the same time, Sinclair Lewis argued, the Chautauqua was "nothing but wind and chaff and ... the laughter of yokels" -- an event, Gregory Mason had it, that was "infinitely easier than trying to think" and that was (said William James) "depressing from its mediocrity."

The more things change, I guess. Compare those conflicted responses to the Chautauqua to the ones leveled at our current incarnation of the highbrow-yet-democratized lecture circuit: TED, the "Technology, Entertainment, and Design" conference. TED is, per contemporary commentators, both "an aspirational peak for the thinking set" and "a McDonald's dishing out servings of Chicken Soup for the Soul." It is both "the official event of digitization" and "a parody of itself." 

One matter on which there seems to be no disagreement: TED, today, can make you a star. 

TED is a private event that faces the public through its 18-minute-long TED talks -- viewed over 500 million times since they were first put online, wonderfully free of charge, in the summer of 2006. It has pioneered the return of the lecture format in an age that would seem to make that format obsolete. And in converting itself from an exclusive conference to an open platform, TED has become something else, too: one of the most institutionalized systems we have for idea-dissemination in the digital age. To express an idea in the form of a TED talk (and: to sell an idea in the form of a TED talk) is one of the ultimate validations the bustling, chaotic marketplace of ideas can bestow upon one of its denizens. A TED-talked idea is a validated idea. It is, in its way, peer-reviewed.

But the ideas spread through TED, of course, aren't just ideas; they're branded ideas. Packaged ideas. They are ideas stamped not just with the imprimatur of the TED conference and all (the good! the bad! the magical! the miraculous!) that it represents; they're defined as well -- and more directly -- by the person, which is to say the persona, of the speaker who presents them. It's not just "the filter bubble"; it's Eli Pariser on the filter bubble. It's not just the power of introversion in an extrovert-optimized world; it's Susan Cain on the power of introversion. And Seth Godin on digital tribes. And Malcolm Gladwell on spaghetti sauce marketing. And Chris Anderson on the long tail.

It wasn't until the the printed book came along that ideas could be both contained and mass-produced -- and then converted, through that paradox, into commodities.

For a platform that sells itself as a manifestation of digital possibility, this approach is surprisingly anachronistic. (Even, you might say, Chautauquan.) In the past, sure, we have insistently associated ideas with the people who first articulated them. Darwin's theory of evolution. Einstein's theory of relativity. Cartesian dualism. Jungian psychology. And on and on and on. (Möbius' strip!) Big ideas have their origin myths, and, historically, those myths have involved the assumption of singular epiphany and individual enlightenment. 

But: We live in a world of increasingly networked knowledge. And it's a world that allows us to appreciate what has always been true: that new ideas are never sprung, fully formed, from the heads of the inventors who articulate them, but are always -- always -- the result of discourse and interaction and, in the broadest sense, conversation. The author-ized idea, claimed and owned and bought and sold, has been, it's worth remembering, an accident of technology. Before print came along, ideas were conversational and free-wheeling and collective and, in a very real sense, "spreadable." It wasn't until Gutenberg that ideas could be both contained and mass-produced -- and then converted, through that paradox, into commodities. TED's notion of "ideas worth spreading" -- the implication being that spreading is itself a work of hierarchy and curation -- has its origins in a print-based world of bylines and copyrights. It insists that ideas are, in the digital world, what they have been in the analog: packagable and ownable and claimable.

A TED talk, at this point, is the cultural equivalent of a patent: a private claim to a public concept. With the speaker, himself, becoming the manifestation of the idea. And so: In the name of spreading a concept, the talk ends up narrowing it. Pariser's filter bubble. Anderson's long tail. We talk often about the need for narrative in making abstract concepts relatable to mass audiences; what TED has done so elegantly, though, is to replace narrative in that equation with personality. The relatable idea, TED insists, is the personal idea. It is the performative idea. It is the idea that strides onstage and into a spotlight, ready to become a star.

Image: Wisconsin governor Robert LaFollette addressing a Chautauqua, via the Library of Congress.

I absolutely love TED talks to help inform me and think about things in a new way. I realize, obviously, that much of the discussion is stuff people already know. But a lot of information is stuff that people already know, just repackaged. I often read business books and realize that most of the information is common sense. But it is good to be reminded of the common sense. Ms. Garber also mentions that book printing is when mass commoditization of ideas began. But isnt that ok?

Fear of punitive response to hospital errors lingers

Most health professionals remain reluctant to discuss problems or report mistakes freely, despite appeals to hospitals that they stop pointing fingers when things go wrong.

By Kevin B. O'Reilly, amednews staff. Posted Feb. 20, 2012.

...

"This is a major problem in hospitals, that we still have this residue of a pretty punitive culture," said James B. Battles, PhD, social science analyst for patient safety at AHRQ's Center for Quality Improvement and Patient Safety in Rockville, Md. "We have our work cut out for us."

Hospitals get poor marks on handoffs and workload

Lack of open communication and fear of retribution are not the only ways health professionals rate their hospitals poorly. In a recent survey, the following percentages listed other areas that have the potential to hurt safety efforts:

59%: Things "fall between the cracks" when transferring patients from one unit to another.

56%: Problems occur in the exchange of information across hospital units.

55%: Shift changes are problematic for patients.

50%: Workers are in "crisis mode," trying to do too much too quickly.

44%: There is not enough staff to handle the workload.

39%: Hospital management seems interested in patient safety only after an adverse event happens.

38%: It is just by chance that more serious mistakes don't happen around the hospital.

These hospital stats (through interviews) can scare anyone. Who is making sure healthcare is healthy? Hospitals need help - observe, discuss and develop solutions to make their lives easier. After all, they are making sure we get better when we're sick. We need to help them do that.

The past decade has seen a surge of interest in patient safety issues affecting hospital inpatients, spurred in large part by a landmark Institute of Medicine report in 1999 that reported the widespread occurrence of preventable medical errors each year in U.S. hospitals.

Since that IOM study, public policymakers, patient advocacy groups and others have been clamoring for more attention to be paid to the all-too-often deadly problem of inpatient medical errors. Increased research funds in this area -- undoubtedly a good response to such a crisis -- have followed.

But every physician knows that the need to be vigilant about protecting every patient's life and well-being doesn't end at the hospital's sliding doors. After all, there are about 300 patient visits conducted in ambulatory care settings for every one hospital admission. Medical errors can and do happen in physician offices, ambulatory surgery centers, skilled nursing facilities and other places where patients receive outpatient care.

We are still have a severe crisis in the US re:patient safety. Two main problems still exist: (1) as this article mentions, the data on patient safety issues in both tertiary hospitals and in other healthcare delivery settings is very poor - it is ambiguous, incomplete and only comes in pockets. (2) The culture of hospitals is still not to report information to both patients and to a general Board at the hospital. The potential fallout from an error is still much worse that the good of reporting it.

People often say we must have National Transportation Safety Board (NTSB) like culture. But its harder than you think - no one can ignore a plane crash. Its a large event, with charred metal broken into pieces and with 100's of people on board. It cannot be ignored.

In healthcare delivery, often times people dont even realize a mistake is made. More important: we must help the caregivers. Let them focus on the patient. We need to watch and observe, come up with suggestions to improve processes, and deliver tools that make their lives easier. That is the best way to improve safety in hospitals, and I see its working already.

Recently, I made a house call to a 92-year-old man to deliver some important news: He needed a blood transfusion to treat an unexpected anemia. Usually, I sit on his couch, about 6 feet away from his recliner. This time, I made a point of kneeling in front of him.

One of the nurses I work with arrived a minute later. She kissed the old man on the top of his head and rubbed his back as they listened to me explain how the transfusion would work. My patient's shoulders relaxed and his stress melted away. I'm sure this had little to do with me kneeling and a lot to do with the nurse's touch.

Doctors and nurses know that touch can improve blood pressure and decrease stress. Touch lowers levels of cortisol, a stress hormone, and may increase oxytocin, a hormone that plays a role in trust and emotional bonding.

The obvious time for doctors to touch their patients and create a sense of trust is during the physical examination. But the old-fashioned physical exam — in which the doctor methodically studies the body, looking, listening, pressing and tapping — has become a relic. These days, few doctors have time to perform thorough exams, and a good number barely touch their patients at all. Or, worse, they snap on a pair of gloves. Gloving up for a pelvic or rectal exam is obviously de rigueur, but wearing them during the rest of the physical exam sends a clear message: I don't want to touch you.

So it's particularly unusual for doctors to be comfortable touching their patients outside of the physical exam. And when we do it, it feels strange. Even shaking a patient's hand doesn't come naturally to all of us, much less a gentle pat on the shoulder. After all, our traditional role as physicians is more about diagnosing and treating than comforting.

When I was in my residency training, I taught a medical student named Laurie who had been a nurse before she started medical school. One day, we were called to see a man whose heart jerked in a life-threatening rhythm. Six or seven of us frantically inserted IV lines and catheters, panicked over his electrocardiogram readings and hollered blood test results back and forth.

For a minute, I couldn't find Laurie amid the chaos. Then I saw her. She sat by the patient's head, stroking his forehead, whispering. Thanks to her nursing background, she knew how to use her hands to calm him.

I'm not saying that doctors — or nurses — should be touching their patients 24/7. Nor am I suggesting that doctors imitate the way some nurses smooth their patients' hair or massage their shoulders. In many settings, touch just isn't appropriate. It may make a patient uncomfortable, especially when the doctor is male and the patient female.

But there are times when it can make a huge difference. Doctors can learn plenty about the art of friendly touch from watching nurses, so many of whom have an innate sense about vulnerable moments and the right instant for the laying on of hands.

When I next saw my 92-year-old patient, he was in bed, lacking the energy to haul himself to his recliner. On my way out, I squeezed his shoulder and bent down to give him a noisy kiss on the cheek.

We laughed. And I couldn't resist reaching for his hand before I said goodbye.

This is the lovely secret of touch: It soothes both patient and doctor.

This article is so similar in nature to the one I just posted from the Harvard Business Review. In all walks of life, in all businesses, there is nothing more appreciated than simply showing love in the details.

The world confronts vast uncertainty, from unrest in the social climate to accelerating shifts in the climate itself. The economy faces huge challenges, from public-debt crises in Europe to the overhang of mortgage debt in the U.S. The business community faces an ongoing series of stops and starts, from the loss of an icon like Steve Jobs to the rise of new-economy giants like Amazon and Facebook.

There is a temptation, amidst the turmoil, for pundits to conclude that the only sensible response is to make bold bets — new business models that challenge the logic of an industry, products that aim to be "category killers" and obsolete the competition. But I've come to believe that a better way to respond to uncertainty is with small gestures that send big signals about what you care about and stand for. In a world defined by crisis, acts of generosity and reassurance take on outsized importance.

I've written before about not-so-random acts of kindness that humanize companies and offer an uplifting alternative to a demoralizing status quo. Earlier this year, for example, a Southwest Airlines pilot delayed a flight from Los Angeles to Tucson to accommodate the needs of a distraught grandfather who was racing to the hospital bedside of his toddler grandson, the victim of criminal abuse. Despite the obvious security concerns and schedule pressures, the pilot, who had gotten wind of this late-arriving passenger's urgent situation, refused to budge until he made it to the plane.

"They can't go anywhere without me," the pilot told the grandfather, "and I wasn't going anywhere without you." The story immediately went viral, with travel writers and bloggers celebrating the stubborn pilot and his values. His genuine kindness was a welcome change of pace in an industry known for lousy service, surly passengers, and miserable conditions.

I experienced something similar myself not so long ago, and found it a striking enough to devote an entire HBR blog post to the experience. In an entry called "Why Is it So Hard to Be Kind?" I told the story of my father, his search for a new car, a health emergency that took place in the middle of that search — and a couple of extraordinary (and truly human) gestures by an auto dealer that put him at ease and won his loyalty.

"Nobody is opposed to a good bottom-line deal," I concluded at the time. "But what we remember and what we prize are small gestures of connection and compassion that introduce a touch of humanity into the dollars-and-cents world in which we spend most of our time."

We remember the lack of connection as well. A month or so ago, I visited my optometrist, who was troubled about something she saw in my routine eye exam and sent me to a renowned retinal specialist for a more in-depth look. This doctor did an utterly competent exam, explained my situation, and offered a sound course of action. So I'm fine.

Yet I keep thinking back to the experience, not because of the quality of the medical care I received, which was superb, but because of how uncaring the experience felt. As I sat in the waiting room, it seemed more like the offices of a payday lender or a bail bondsman than that of a highly credentialed surgeon. "If you arrive late, your appointment may be rescheduled," one sign warned. "Copay is due upon arrival," another signed explained. "We accept Visa, MasterCard, Discover, and American Express." However, a different sign warned, "If you do not have your copay, your appointment may be rescheduled." Finally, blared another sign, "If you have an overdue balance, your appointment may be rescheduled."

Since I had to wait an hour past my appointment time to see the doctor (there was no sign about what happens when the doctor is late), I spent a lot of time thinking about the surroundings, and the bizarre messages all these signs were sending. My fellow patients and I were nervous, anxious, worried about our eyesight. Yet it felt like the doctor thought of us as a collection of truants, tightwads, and general layabouts. Were we visiting a healer, or the ocular equivalent of the "Soup Nazi" from Seinfeld, for whom one wrong move means "No appointment for you!"?

Two weeks later, by the way, I got a call from the doctor's office. "Does the doctor want an update on how I'm doing?" I asked the staffer who placed the call. "No," she said. "Insurance did not cover the full cost of the exam, and we need to know if you want us to charge the credit card we have on file or use a different card."

Oh, right.

It's always risky to look to great humanitarians for lessons about business, but something Mother Teresa said long ago strikes me as a pretty good epitaph for our disruptive times — and for dispiriting experiences of the sort I had with this doctor. "We cannot do great things," she famously told her followers, "only small things with great love."

Yes, success today is about price, features, quality — pure economic value of the sort that requires you to rethink your strategy and business models. But it is also, and perhaps more importantly, about passion, emotion, identity — sharing your values. And all that requires is a way of doing business, a strategy for connecting with customers, that communicates who you are and what you care about.

As the value proposition gets rewritten in industry after industry, it's organizations with an authentic values proposition that rise above the chaos and connect with customers. Few of us will ever do "great things" that remake companies and reshape industries. But all of us can do small things with great feeling and an authentic sense of emotion.

What's your values proposition?

I think of the recent nixed trade between the NFL Detroit Lions and the Philadelphia Eagles, involving Detroit running back Jerome Harrison. The trade was nixed because Jerome Harrison did not pass the physical. But this wasnt the memorable part of the deal gone awrye (that, in a minute, you will see was the best trade of Jerome's life). As part of any trade, players must pass a physical test. During the physical Jerome complained of headaches to the Philadelphia Eagles team doctors. They scheduled him for an MRI. In the MRI, they found a brain tumour. Needless to say, a procedure was scheduled immediately to remove the tumour, and as an aside the trade was nixed.
The memorable part of the trade / non-trade was that if it wasnt for the trade happening, Jerome would have never found out early that he had a brain tumour. Its this humanization of the NFL and the players, from the machines we tend to think of them as, that made this so memorable. People are looking to be treated like humans. Differentiate yourself through loving customer service and acts of kindness. Though not always thanked for, they are usually remembered.