Does Your Strategy Account For the Future?

"Your rearview mirror is so small and your windshield is so large because what lies ahead is much more important than the past." (@CHRISVOSS)

What can we say about the future? 

• It's uncertain and the end is always near. (Jim Morrison) 
• The future is much like the present, only longer.  (Dan Quisenberry) 
• The future is here.  It's just not widely distributed yet. (William Gibson) 

Uncertain. As near as tomorrow. Long duration.  Limited (and uneven) distribution.

Think about how hospital strategic plans account for future competitor decisions.   If they do at all,  it's little more than simple extrapolation of past performance, a technique which, though understandable since that's where the data reside, is nothing more than crafting strategy in a vacuum.
It's much easier to track competitor performance retrospectively than to forecast future decisions.

Volume trends, market share, patient satisfaction, quality indicators, financial performance, major capital investments are all in the public domain if one knows where to look.  A strategist's job is to synthesize all that data so that a few important, future-oriented questions receive sustained attention:

1. The Benchmark Question: 
What is our competitive position relative to the competition?

2. The Trendline Question:
Are we improving? I.e. what's the slope of our trend line? How do we know?

3. The Speed To Market Question:
Are we improving as rapidly as those around us? Are our improvement cycle times fast enough?

4. The Marketplace Expectations Question:
Are we improving as rapidly as the market demands, now and in the future? I.e. is our projected performance sufficient to succeed as customer expectations grow and evolve?

11:16 AM

"5 Trends Digital Marketers Should Not Ignore"

5 Trends Marketers Should Not Ignore from Ekaterina Walter

7:30 AM

What Tech Trends Do CIOs See As Overrated?

From Chris Murphy, Editor at InformationWeek.com: "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. 

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Shared on Google+. creativecommons.org.au

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 to improving the quality of care. Up to two decades may pass before the findings of original research becomes part of routine clinical practice."

It's not for lack of data, big or otherwise, that this pattern remains.  No, it's culture trumping data. 

What happens when your Chief of Cardiology says "Nah.  I disagree with those research findings.  That's not what I learned in medical school and I'm not gonna do it."  Who wins?  Her or the data?  I think we've all been around hospitals (and cardiologists) long enough to know the answer.

So work on that culture thing first.  In fact, get the culture right and the rest follows.  Otherwise you're just writing big checks to big IT companies, expecting big things and setting youself up for big disappointments.

1:07 PM

"Enterprise IT has plenty of room for improvement..."

"Rogue IT" is about to wreak havoc at work" is Fortune's headline.  Not a moment too soon, I might add. 
From the article:

"Rogue IT is the name given to the informal, ad hoc software and devices brought by employees into the workplace. If you've ever taken your own iPad to work or used cloud-based software like Evernote or Dropbox in the office, you may well be an offender. And you're not alone. Some 43% of businesses report that their employees are using cloud services independently of the IT department, according to a recent survey of 500 IT decision makers.

"In the past, these enterprise software and hardware decisions were often the exclusive domain of a company's chief information officer or CIO, the senior executive in charge of information technology and computer systems. "Sitting in his high chair in a grey suit barking orders, [the CIO would make] product decisions for big companies with even larger user bases," explains Peter Fenton of tech investors Benchmark Capital. Rogue IT turns that model on its head, effectively crowdsourcing IT choices to employees. So where does this leave the venerable CIO? And what does it mean for the future of IT at the world's largest enterprises?

"The good news is that enterprise IT has plenty of room for improvement. "[Traditional IT] carries connotations of interminable rollouts, bewildering interfaces, obscure functionality and high prices," writes CIO.com's Bernard Golden. Security, compliance and back-end compatibility have traditionally topped CIO wish lists, not usability. As a result, employees have sometimes been left with programs that are anything but intuitive. This exacted a heavy toll in terms of time, money and organizational well-being.

[...]

"Bloated, enterprise software no longer cuts it. Seduced by Facebook (FB) and similarly intuitive platforms at home, millennials balk at staring down monster spreadsheets or decoding web 1.0 UIs at work, writes Fast Company contributor Marcia Conner. Increasingly, they expect their work suites and software to be just as user-friendly as the apps they know and love in their personal lives, a trend known as the consumerization of IT. And they're willing to go outside company walls to find products that work best for them."

So do we still need a CIO?  Apparently we do, but with employees and customers doing the heavy lifting, voting with their feet (to mix a bunch of metaphors,) the CIO will finally have time for the big, important, profitable stuff.  OK.

But if you think it's just your employees (and maybe a few physicians) going rogue, well, your customers went over that wall a long time ago.  You probably didn't notice or care until that first iPad appeared in your waiting room.


Read the whole thing, here.

And, here, from HootSource, HootSuite's blog.

6:58 AM

Wearable technology market to exceed $6B by 2016

Computerworld - Demand for real-time data, including personal health information, is driving the market for wearable, wireless devices that will grow from 14 million items this year to as many as 171 million in 2016.

In four years, the market for wearable wireless devices is expected to achieve minimum revenues of $6 billion, according to new research from IMS Research, a subsidiary of IHS.

8:55 AM

Doctors vs. Algorithms?

Do We Need Doctors or Algorithms, asks Vinod Khosla.  The answer may surprise those of you spending your days worrying about an impending physician shortage.

"Eventually, we won’t need the average doctor and will have much better and cheaper care for 90-99% of our medical needs. We will still need to leverage the top 10 or 20% of doctors (at least for the next two decades) to help that bionic software get better at diagnosis. So a world mostly without doctors (at least average ones) is not only not reasonable, but also more likely than not. There will be exceptions, and plenty of stories around these exceptions, but what I am talking about will most likely be the rule and doctors may be the exception rather than the other way around.

...

"What is important to realize is how medical education and the medical profession will change toward the better as a result of these trends. The vision I am proposing here, though, is one in which those decades of learning and experience are used where they actually matter. We consider doctors some of the most learned people in our society. We should aim to use their time and knowledge in the most efficient manner possible. And everybody should have access to the skills of the very best ones instead of only having access to the average doctor. And the not so “Dr. House’ doctors will help us with better patient skills, bedside manners, empathy, advice and caring, and they will have more time for that too. If computers can drive cars and deal with all the knowledge in jeopardy, surely their next to next to next…generation can do diagnosis, treatment and teaching in these far less uncertain domains and with a lot more data. Further the equalizing impact of both electronic doctors and teaching environments has hugely positive social implications. Besides, who wants to be treated by an “average” doctor? And who does not want to be an empowered patient?"

In just a few paragraphs, Khosla defines healthcare's future. Though I happen to agree, what I find somewhat depressing is that hospitals will sit, wait and have it done TO them, missing out entirely on the future's new, exciting value streams. Missing the opportunity to participate, to benefit and to re-envision the hospital as something beyond a massive, expensive and now-empty acute care cathedral.

Because if algorithms replace doctors, will doctors (and patients) still need hospitals?   Read the whole thing.

7:19 AM

Lies, Damn Lies and Statistics

Except these statistics aren't lies, more of a messy, grim reality.  Forbes' Dan Munro on healthcare's continuing crisis:

"These are the (statistics) that struck (Munro) as among the more compelling:

1.  Medicare spends about $50B on the last 2 months of a patient’s life.

2.  Medicare/Medicaid fraud is estimated at $70B per year .

3.  21% of Americans smoke – The American Cancer Society claims that “tobacco use remains the single largest preventable cause of disease and premature death (estimated at 443,000/yr) in the U.S. 45M smoke cigarettes; 13.2M smoke cigars; 2.2M smoke pipes.

4.  Obesity Epidemic – in 1985 there was no state that had an obesity rate greater than 10%. By 2010 there was no state with an obesity rate lower than 20% and 36 states have an obesity rate higher than 25%. Obesity is the second leading cause of preventable death in the U.S. (estimated at 112,000/yr).

5.  23-30% of prescriptions never get picked up at the pharmacy – Surescripts study on 40M prescriptions from 2008 to 2010 .

6.  There are more MRI machines in Pittsburgh than Canada.

7.  80% of healthcare bills contain errors.

8.  Insurance claim errors are estimated at about $17B per year.

9.  The Milliman Medical Index measures the total annual cost of healthcare for a typical family of 4 covered by a preferred provider plan (PPO). In 2002 it was $9,235. For 2011 it was $19,393.

10.  By 2025 the average annual cost of family healthcare insurance will equal the average annual household income.

11.  Ohio spent about $600M in 2009 on Medicaid, Foodstamps and Welfare for employees of that states 50 largest employers (including WalMart, McDonalds, Wendy’s and Krogers.)

12.  The Census Bureau reported 49.9M uninsured for 2010 (roughly 16.3% of the population and statistically unchanged from 2009.)

13.  The Census Bureau Report on Poverty indicates about 100M – basically 1-in-3 Americans – either in poverty or the zone just above it (annual income less that 50% above the official poverty line). This one’s not directly healthcare related – but affordable healthcare is most definitely a relative term as it applies to (or is mandated by) any healthcare system.

Safe to say it’s a mess – or as Tommy Lee Jones said in No Country For Old Men “if it ain’t … it’ll do ‘til the mess gets here.”

Let's be clear.  #9 and #10 are EFFECTS, dependent variables if you will.  The rest are basically CAUSES or independent variables.  Address THEM and #9 and #10 begin to improve.

Focus for a moment on #10:  " By 2025 the average annual cost of family healthcare insurance will equal the average annual household income."   That's if current trends continue, with health care inflating at, say, 7% per year (i.e. doubling roughly every 10 years) and little-to-no household income growth.   It's easy math to forecast the former overtaking the latter.

Anybody with me in saying that neither trend is sustainable?  Anybody with me in saying our poets, pundits and politicians are overly optimistic in thinking about healthcare's ability to change that far, that quickly?

The mess is on our doorstep.  It ain't pretty.  Stay tuned.

9:57 AM

The HBR List of Audacious Ideas

I'm wasn't sure 2011's waning days needed yet another list of some kind, but Harvard Business Review's list of audacious ideas is pretty good.  Why audacious ideas?

"(Because) even though (businesses are) sitting on $2 trillion in cash, they’re risk-averse, strategically incremental, and notably lacking in fresh ideas.

"We think this stinks. The world needs invention and daring now more than ever.  Now is the time for audacity, not austerity. "

So here's HBR's list (the full article requires registration.)

• Tackling the World Economy
• Give People Shares of GDP, by Robert J. Shiller
• Double Down on Start-ups, by Bruce Gibney and Ken Howery
• Partner with China in Afghanistan, by Wayne Porter
• Enroll the World in For-Profit Universities, by Parag Khanna and Karan Khemka
• Tackling Science Challenges
• Give NASA a Real Mission, by Gregg Easterbrook
• Declare 20% of the Ocean Off-Limits, by Enric Sala
• Electrify the Bottom of the Pyramid, by Arun Majumdar
• Tackling Social Problems
• Die the Way You Want To, by Ellen Goodman
• Pay Businesses to Keep People Out of Prison, by Eric Schmidt
• Grow More Apples and Less Corn, by Ellen Gustafson
• Tackling Business Problems
• Stop Tying Pay to Performance, by Bruno S. Frey and Margit Osterloh
• Crowdsource Management Reviews, by Linda A. Hill and Kent Lineback
• Stop Collecting Customer Data, by Doc Searls

Were it up to me, there's about 10 ideas on the list that beg for immediate implementation.  Or, at a minimum, pointed questions of each Presidential candidate (including the incumbent.)

Let the arguing and ox-goring begin.

3:30 PM

The Challenges Facing Low-Quality Universities

From The New Republic: "A Much Needed Challenge To Low-Quality Universities."  Higher education is in crisis.  Out of touch thinkers and policymakers. Skyrocketing costs (even faster than healthcare.)  Mounting student loan debts.  De-emphasized teaching and research while administrative layers grow without limit.

Despite the serenity of most college campuses,

 

"...the reality of higher education is that most students today don’t have access to..an idyllic (and expensive) college experience, never have, and never will. Instead, many get stuck in big, low-cost lecture courses of indifferent quality provided by institutions that treat students like anonymous tenants. Those are the places that are going to be transformed by technology.

"These disruptions will take many forms. While it’s impossible to predict exactly what the typical college student’s educational experience of the future will look like, the changes will almost definitely include a decline in the number of students living in or commuting to physical locations to attend classes. Instead, students will accumulate credits from a range of different online providers, each specializing in different subjects and programs. Some firms will focus on tutoring, some on career counseling, some in assessing knowledge and skills. Students will increasingly use the fast-growing library of free content being generated by the Open Educational Resources movement. The component parts of the traditional conglomerate university will be picked off by specialty providers, just as newspapers have seen different pieces of their business model attacked by Craigslist (classifieds), blogs (op-eds), Groupon (local advertising), and more.

"The institutions likely to get hit earliest and hardest include a lot of relatively non-selective regional four-year universities, many of which are continuing to raise prices in vain attempts to climb the U.S. News & World Report status ladder. They also include many high-flying for-profit institutions. The brave new world of online higher education isn’t necessarily one where everyone goes to the University of Phoenix. Publicly-traded for-profits like Phoenix, Kaplan University, Corinthian, and others have been successful primarily through innovations in marketing, business processes, harvesting federal financial aid dollars, and scale. Their actual educational programs, even those conducted online, are often quite traditional—and expensive. When technology does to higher education what it has done to scores of other industries—empower consumers, create new markets, and rip huge amounts of cost out of the system—the least innovative for-profits could be the first to fall."

Empower consumers.  Create new markets.  Rip huge amounts of cost out of the system.  Of course it happens AFTER my daughters have graduated.

6:43 AM

Sun Comes Up, It's Tuesday Morning

Not very organized today, so you'll have to put up with a few random things catching my eye...

1.  Distrusting their government's message on nuclear safety, Tokyo residents self-organize and go looking for radioactive hot spots.  Guess what they find?

Watch this "self-organization" trend.  It's coming to a health care neighborhood near you.  Maybe they'll self-organize into a booster club for your current business model...though I wouldn't bet on it.

2.  The Regenstrief Institute (IN) launches an initiative to encourage innovation, naming John Duke, M.D., the Institute's first Innovation Officer.

"We are encouraging everyone associated with the Institute to come forth with ideas. Traditionally researchers develop ideas and then pursue funding. Learning from successful organizations such as Google, Facebook and Netflix, we are both accelerating and democratizing the idea process. We are encouraging everyone, from established researchers to fellows-in-training to software developers to research assistants to affiliated clinicians to let us know what they think has potential," said Dr. Duke, an internist and informatics specialist.

Democratizing the idea process.  I like that, having once worked with a hospital CEO whose idea of innovation was "I think big thoughts.  You do what I tell you."

3.  And Dr. Westby Fisher asks what would a doctor's version of Occupy Wall Street look like?

"Must doctors accept the pervasiveness and intrusiveness of the inside game in health care? If they didn’t, I wonder what doctors’ placards might say?"

Whatever they say, I'll bet the spelling improves (though not the handwriting.)

4.  Mother Jones' Kevin Drum  says the future is brighter than you think.  (Thanks for the heads-up to LongForm.org's "weekend reads for wonks.")

6:21 AM

“You’re looking at a generation of 20- and 30-year-olds who are used to self-organizing,”

NY Times:  "As Scorn for Vote Grows, Protests Surge Around Globe."

Political and financial institutions are seen as clueless at best, venal at worst.  A new generation vents their frustration through self-organizing, decentralized coalitions.  

Many health care strategists will read this article with a sense of detachment.  That's a mistake because, above all, successful strategists are trend-aware.  

So be aware of this:  

A trend driven by economic frustration and doubt about the future may start in the political arena, but that's seldom where it stops.

From the article:

"Increasingly, citizens of all ages, but particularly the young, are rejecting conventional structures like parties and trade unions in favor of a less hierarchical, more participatory system modeled in many ways on the culture of the Web.


"In that sense, the protest movements in democracies are not altogether unlike those that have rocked authoritarian governments this year, toppling longtime leaders in Tunisia, Egypt and Libya. Protesters have created their own political space online that is chilly, sometimes openly hostile, toward traditional institutions of the elite.


"The critical mass of wiki and mapping tools, video and social networking sites, the communal news wire of Twitter and the ease of donations afforded by sites like PayPal makes coalitions of like-minded individuals instantly viable.


“You’re looking at a generation of 20- and 30-year-olds who are used to self-organizing,” said Yochai Benkler, a director of the Berkman Center for Internet and Society at Harvard University. “They believe life can be more participatory, more decentralized, less dependent on the traditional models of organization, either in the state or the big company. Those were the dominant ways of doing things in the industrial economy, and they aren’t anymore.”

What are health care's "dominant ways of doing things" and what happens when they aren't any more?  Do we adjust only when the bonds of trust are irrevocably gone and our customers are fed up with our crap?  For now, we in healthcare are seen as the good guys - expensive, but good.  For now...

UPDATE: In all the media coverage of Steve Jobs' passing, there's this from the NY Times: "What Steve Jobs Understood That Our Politicians Don't."

"After all, if you wanted to really get a picture of how the national culture has evolved in the last few decades, particularly in the urban areas that drive economic growth, you could do a lot worse than to study Apple’s string of innovations. (Steve) Jobs understood, intuitively, that Americans were breaking away from the last era’s large institutions and centralized decision-making, that technology would free them from traditional workplaces and the limits of a physical marketplace."

[...]

"And no politician wants to really innovate without focus groups, to make a sustained argument for any solution that might entail risk or imagination. Our parties are less like Apple and more like General Motors, churning out this year’s streamlined model of the same cars it was asking you to buy 20 years ago. Even the circuitry of the democracy remains essentially unchanged; a nation of voters who can find their cars and pay their mortgages online still can’t envision the day when they can cast their votes from an iPad."

Politicians aren't the only ones "not gettin' it."

8:29 AM