The FCC, Net Neutrality and Hell

It's difficult to see the FCC's Net Neutrality decision as anything other than an anti-Comcast vote. Maybe I'm unique, but I side with companies making my life easier and better - Google, Amazon, NetFlix, e.g., and against companies making my life a living hell.

What consumers want from Comcast, in no particular order are (1) fast connections, (2) fair prices and (3) problem-solving customer service. Welcome to hell, Comcast style.

It's a good lesson for CEOs everywhere: suck badly enough and publicly enough, for long enough, and nobody will take your side when big decisions are made on the national stage. And it doesn't matter who might benefit.  What's important is revenge and YOU LOSE, Comcast.

Yes, this means siding with the FCC and a gaggle of collectivist nitwits, but my distaste for them and their nitwittery pales against my utter loathing for Comcast.

12:52 PM

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 stop calling me.

And that $1,400 of "recommended" service items?  Bite me.  Next time I'm going to Jiffy Lube.

6:59 AM

Why Can't Healthcare Solve Its Own Problems?

An interesting question posed at HealthLeadersMedia.com. 4 health leaders offer wide-ranging suggestions, including building trust and collaboration, reducing the number of stakeholders yet finding ways to work together, and reforming the tort liability system.

Hard to argue against 'more trust' isn't it? Yet it's axiomatic in healthcare that one person's 'waste' is another person's 'income stream.' You mess with my income stream and I may have a problem trusting you.

"Go get some trust..." sounds a little like comedian Steve Martin's promise to teach us how to be rich. Says Martin, "First, go find $1 million dollars!" Umm, OK. I'll go find some trust while I'm at it and fix healthcare's problems too.

Maybe it's fair to consider the requirements for more trust. What preceeds trust? What creates the right conditions for trust to occur? There's no tried-and-true formula, no "add two parts water, stir and presto! Trust!"

No, but a strong sense of leadership COURAGE is my personal formula.

As a herd-driven industry, healthcare suffers from an acute lack of courage. We're more comfortable doing things once they've been validated by a Modern Healthcare cover story (think most of what passes for healthcare strategy) or the Federal government bribes us to do them (think EMRs.)

(As an aside, I've always wanted to conduct an experiment with the strategic plans of 50 randomly-selected healthcare organizations, I'd rip off all the covers, mix up the plans and then challenge the assembled executives to pick THEIR plan out of the pile. I'd offer an award to the few who could and free consulting to the rest. But I digress...)

Yes, trust is in the problem-solving mix. But instead of an initial condition, might trust be an outcome of courageous problem-solving? Of courageously and correctly identifying the problem? Positing strong if initially unpopular countermeasures? Stepping out, taking action? Of showing courage in acting on a compelling "...make no small plans" vision, a vision with which others can enthusiastically engage?

Nobody trusts who or what they don't respect, somebody who minimizes the challenges in favor of business as usual. Nobody trusts the Captain saying "We're taking on a little water" when all the passengers know the iceberg tore a huge gash in the hull and the ship's listing 30 degrees to port.

Say what you want about lemmings and 'Fraidy Cats, fuzzy, lovable critters all. But would you trust one sufficiently to follow?

8:21 AM

Going Rogue: A Fable, But True

Lest you think my last post overstated the case FOR "rogue" employees and AGAINST all you IT traditionalists, let me tell you a story.

Recently, my team and I searched for a way to connect ourselves and a dozen or so vendors - designers, agencies, printers and consultants.  Something like Dropbox or Google Drive.  "No go" said IT.  Not secure enough.
What alternative(s) were we offered?   SharePoint of course, assuming that my modest little corner of the empire would fund the expense (ranging anywhere from a few tens of thousands to the low six figures.)  I countered with a fast "No thanks.  At that price point, I'd have to sell a kidney or something."
But without knowing it at the time, IT's response was a blessing in disguise.

Now I'm (quietly) using iDoneThis (free) to track projects and team and vendor accomplishments,  IdeaScale (free) to generate engagement around innovative ideas and strategies,  Evernote (free) to organize snippets of information, and Delicious (free) to create and share my very own knowledge base about important issues and trends.

Notice anything?  Well, yes, I'm using FREE versions of all four.  I bet that got your attention.  But more than that, none took more than 10 minutes to set up and less time to learn.  I didn't waste months with RFPs, pilot projects or controlled roll-outs.  A short discussion, decide, do it.

Decide this morning, implement this afternoon.  Repeat.

Could someone hack me?  Sure, but I don't traffic in PHI and I doubt my cryptic project summaries, creative work plans and budget discussions would be of much interest to anybody.  Heck, sometimes even MY eyes glaze over!  

Maybe hearing "NO" from IT is the best answer you can get.  Maybe it means, TIME TO THINK DIFFERENT, as the man once said.

12:27 PM

Healthcare's Biggest Problem Is...

...too much money.  Wait.  What?

Interesting opinion yesterday from the blogosphere, that healthcare's biggest problem is too much money.  Too many resources, leading to too many people, too much time spent deliberating and too few imperatives toward action.

That's why, in our best leisurely fashion, we approve capital budgets just once a year.  Miss the cycle and it's 'wait 'til next year.'  And that's OK; it's not like it's life & death or anything.

Making the cycle, especially in IT, means launching RFP processes lasting another year and pilot projects lasting one more.  And system-wide rollouts lasting two more...assuming everything goes as planned, which it seldom does.  (Can you count to five?)

That's why off-the-shelf solutions costing 'a little' are rejected in favor of customized (yet corporate-approved) offerings costing twice as much and taking thrice as long.

That's why $8.99 iPhone apps are pooh-poohed as "not serious" and "risky" while the entry-level price for "real" software seemingly starts at $250k, rising rapidly after that.  (Ask me sometime about Voxie vs. the IT geeks.)

That's why our systems for cancer care are confusing messes yet our answer is to add yet another layer of staffing and expense - "Nurse Navigators" they're called.  I guess we'll start on that whole cost reduction and process simplification thing sometime tomorrow. 

And so we have armies of bureaucrats and analysts and process sponsors, technicians, project managers, coordinators and specialists.  We need them all to churn the system...and still we think of ourselves as understaffed.

And thus committees proliferate, PowerPoint becomes the organization's lingua franca, and, typically, the "back of the house" systems (Finance, IT, HR) are far more modern than "front of the house," customer-facing offerings.  When did YOU start offering patients an on-line portal and how many revenue cycle systems came and went before the portal's go-live?

Take away that money, most of the people and all of the committees.  Remove the luxury of time.  What's left? A startup mentality where cheap is better than expensive and free is best of all.  Where costs avoided mean making payroll...or not.  Where new customers this afternoon are better than impressive forecasts two years out.  Where a bias to action always trumps endless discussion.

What's Out: big checks to license Microsoft's crappy software (oops, is my bias showing?)  What's In: free Google apps.

What's Out: elaborate performance monitoring and benchmarking systems.  What's in: free daily tracking from iDoneThis.

Money gives you the luxury of time and lessens the pressure of deliberation.  That's not always a good thing.  And it's why a million little, ankle-biting startups are about to eat hospitals for lunch.  I'm just sayin.'

UPDATE:  Don't believe me?  Read "What We Can Learn From Third-World Health Care" by Pauline W. Chen, M.D., writing in the New York Times:

"The key to their success is an unabashed disregard for some of our most cherished assumptions about what constitutes good care. Instead of providing antibiotics, CT scans and high-tech interventions, Partners in Health considers basic necessities like food and housing as critical components of the group’s medical work. Instead of asking patients to travel miles to the only clinic and see only the doctor or nurse, they train cadres of community health workers who can monitor, administer and advise in the heart of local villages and in people’s homes.

"Applied to organizations in the United States, this approach has proved startlingly effective, as the Prevention and Access to Care and Treatment, or PACT, program has demonstrated. PACT targets some of the poorest and sickest patients with H.I.V. and other chronic illnesses in the greater Boston area. Just like Partners in Health, PACT relies extensively on community health workers who are trained in tasks like helping patients take their medications and make it to clinic appointments as well as reviewing their pantries and teaching them to prepare healthy meals. Applying these broad definitions of care, PACT has significantly decreased the number of emergency room visits and life-threatening opportunistic infections, cut hospitalization rates by 60 percent and yielded a 16 percent savings for Medicaid."

8:21 AM

Et Tu Facebook?

As of today, and assuming you haven’t already given enough of your life to the social networking juggernaut, you can double down with a share or two of Facebook’s common stock.  Now I’m not a licensed investment advisor so I can’t tell YOU what to do. But I will tell you what I’M going to do.

One word: FLEE.

Listening to CNBC while driving to an appointment yesterday, I heard a commentator rave about this “historic investment opportunity,” saying something like:

“Even at this valuation level, Facebook’s stock is cheap.  With that huge behavioral database, they'll find a way to monetize their 900 million users...”

Notice the choice of language.  It's not “They've FOUND a way..."  It's "They'll FIND a way..."  In the future.  Someday.  Hopefully.

But the future's a tricky thing.  All along, I’ve assumed the right sequence of events is this:

1. Find a way to make money (i.e. a business model.)
2. Make money (i.e. prove that your business model actually works.)
3. Go public.
4. Get rich.

Apparently I’ve been misinformed, and the correct sequence actually is:

1. Go public.
2. Get rich.
3. Find a way to make money.
4. (Optional) Make money.

Sounds eerily like the first dot-com bubble back in the 1990’s, when it was all about eyeballs and hits, and investment bankers tossed bushels of cash at every twerp entrepreneur who correctly (if accidently) spelled ‘www,' assuming that, somehow, somewhere, eyeballs would magically turn into earnings.

We all know how well that turned out, yet here they are again, telling us that a good story and hope matter more than bottom line results.

Flee.

7:57 AM

A Small Rant

A major teaching hospital (that shall remain nameless because I don't belive in giving the terminally clueless even more attention) has a Twitter account with 1,200 followers. So far so good.

Yet this hospital follows NOBODY. That's right. Apparently in the vast Twittersphere, there's absolutely NOBODY from whom this organization cares to hear. Nobody whose thoughts and ideas matter nearly as much as the hospital's own.

It's as if they're saying "We're not about listening. We talk, you sit up straight and pay attention.  We're about US and that's how we like it!"

How smug. How institutionally narcissistic. How utterly last century-ish.

I wonder what they find unclear about 'social media' - the 'media' or the 'social?'

7:05 AM

"What a bunch of clueless chumps"

Fox News: "Facebook users heap baggage on Spirit Airlines after dying vet refused refund."

That we're living in the age of the Facebook mob assures Spirit Airlines that they'll lose far more in business and customer goodwill than the $197 refund would've cost. And somehow I doubt that many of Spirit's customers are, today, saying "Thanks for looking out for us and keeping fares low."

More likely they're saying "What a bunch of clueless chumps."

There's following policies and procedures to the letter, and then there's doing the right thing. Frequently the two converge. Not this time.

UPDATE:  The chump caves.

1:39 PM

The News and Nothing But the News

Well, maybe a snide comment or two. In the news today:

• Fox News: Hospitals are making progress in reducing the spread of care-related infections.
• Reuters and CBC News: Meanwhile, thanks to the vaccination-averse among us, cases of measles hit a 15-year high in 2011 and a whooping cough outbreak is expanding in Canada's Fraser Valley.
• WTVG: Another reason to exercise: lower Alzheimer's risk.
• And from the Commonwealth Fund (via U.S. News & World Report): "One in four working-age Americans went without health insurance for at least some time in 2011. And the majority of those people—nearly 70 percent—lacked coverage for more than a year..."
• Finally, from CBS News: researchers successfully grew hair on a bald mouse.

So many things I could say, but for now I'll just thank all those researchers hard at work on such an important medical mystery. I mean, c'mon, why work on things like CANCER when there's toupee-wearing mice out there needing our help?

1:45 PM

You Need To Get Out More!

"The trouble in corporate America is that too many people with too much power live in a box (their home), then travel the same road every day to another box (their office)." - Faith Popcorn, The Popcorn Report, 1991 

Many pundits and more organizations are, rather suddenly, talking about innovation - what it is, how to do it, whether it offers a cure to what ails health care.

It's a long-time theme here on Health Care Strategist and if I could offer would-be innovators one bit of free advice, it would be this: get out more.  You'll never get where you want to go from where you are.   Boring, predictable, comfortable, sameness and routine are deadly to innovative thinking.

So see the world. Read voraciously and widely. Confront challenging ideas. Blow through your comfort zones. Chat up strangers (not counting new members at the country club.)

In fact, if you're serious about innovation and ideas, resign from the CC and hang out at a soup kitchen. The food's better and so are the people.

4:54 PM

I'm Sorry Mr. President

I'm sorry Mr. President. I know a little something about Teddy Roosevelt and you're not him.

He fought for this country. You wrote law review articles.

He was a true outdoorsman and naturalist. You play golf, summer on Martha's Vineyard and wouldn't know a morel from a moral.

He said "Speak softly and carry a big stick." You deliver great speeches and, well, that's pretty much all.

Next time you channel someone, pick a lesser light.  You won't suffer so badly by comparison.

(Image from here, based on Creative Commons search.)

10:20 AM

Seth Godin: "If Committees Told the Truth."

That truth would be:

"Hi, we're here to take your project to places you didn't imagine.

With us on board, your project will now take three times as long.

It will cost five times as much.

And we will compromise the art and the vision out of it, we will make it reasonable and safe and boring."

Or as I always say, committees are where ideas go to die.

10:57 AM

Why The Next Steve Jobs Will Never Work For Your Hospital

Your hospital has thousands of employees, but could you use your very own version of Steve Jobs?  Probably, but don't kid yourself. He'd never get past your H-R department's first line of defense, with his attitude and his iconoclastic views and his wardrobe. Someone would scrawl "Weird and Possibly Dangerous" across his resume and that'd be that.

But don't fret.  I'm pretty sure the feeling would be mutual.  And that's why your hospital's branding tagline really ought to read "We're no worse than anybody else."

The NY Times' David Pogue on Steve Jobs: "Imitated, Never Duplicated:"

"Here’s a guy who never finished college, never went to business school, never worked for anyone else a day in his adult life. So how did he become the visionary who changed every business he touched? Actually, he’s given us clues all along. Remember the “Think Different” ad campaign he introduced upon his return to Apple in 1997?

“Here’s to the crazy ones. The rebels. The troublemakers. The ones who see things differently. While some may see them as the crazy ones, we see genius.”

"In other words, the story of Steve Jobs boils down to this: Don’t go with the flow.

"Steve Jobs refused to go with the flow. If he saw something that could be made better, smarter or more beautiful, nothing else mattered. Not internal politics, not economic convention, not social graces.

[...]

"Suppose, by some miracle, that some kid in a garage somewhere at this moment possesses the marketing, invention, business and design skills of a Steve Jobs. What are the odds that that same person will be comfortable enough — or maybe uncomfortable enough — to swim upstream, against the currents of social, economic and technological norms, all in pursuit of an unshakable vision?

"Zero. The odds are zero."

Hospitals are dangerous places.  Lives hang in the balance and there's no place for freelancing.  But couldn't you use just ONE cranky visionary, just ONE person reminding everybody that going with the flow sometimes means you're in the sewer?  One lone voice holding mediocrity hostage, screaming "Dammit!  Life is too precious!  We can be BETTER!  Lead, follow or leave!"

"Zero.  The odds are zero."

Depressing.

And lest you think that Jobs' legacy offers no lessons for hospital leaders, consider this:  for all his innovative vision and creativity, his ability to distort reality in "insanely great" ways, Apple remains one of the planet's most disciplined and focused organizations.  Disciplined around process and philosophy.  Focused around doing a few things exceptionally well and NOT doing whatever detracts from those few things.

Those are lessons worthy of ANY organization.

1:25 PM

Poor Warren Buffet

Words you don’t often see juxtaposed – ‘poor’ and ‘Warren Buffet.’ But perhaps some sympathy is in order.

Omaha’s Oracle has had a few misfires recently, first offering some patently stupid tax  advice to the White House’s current occupant. You know of whom I speak - the leader of a clique believing any tax rates short of 100% are an opportunity-in-waiting.

Next he invests $5 billion in Bank of America. With the check’s ink barely dry, BofA says ‘See ya!’ to 30,000 jobs. Isn’t it swell being an Oracle?

He should’ve allocated that $5 billion among several dozen innovative startups, staying far away from the old-money banking triumvirate of fat, dumb and clueless. Some startups would have crapped out (just ask the White House…cough…Solyndra…cough.) but there’s no way the ensuing wreckage would’ve cost 30,000 jobs.

Now THAT’S change we can ALL believe in.

3:03 PM

A Modest Rant

I know I've said something like this before, but it bears repeating. I use a Mac all weekend. It's my time and my money and I'll spend both however I like, thank you very much.

Returning on Monday to Windows XP feels like someone chopped open my skull and removed half my brain with a sharp stick.

4:13 PM