Archive for the ‘Health’ Category

Beyond the Affordable Care Act

What are we trying to do by rethinking the ACA?  Perhaps we are seeking an ideologically acceptable ACA, one that the Republicans get credit for rather than the Democrats.   On the other hand, is insurance coverage really the ultimate goal?  I don’t think so.  We want a healthy and educated population that is competitive in […]

Disruptive Service Innovations in Healthcare

A recent issue of The Economist provided an in-depth review of how high technology financial startups are poaching high-margin financial services from large banks.  The large banks are not standing still; they are often acquiring these startups once they prove viable.  This may keep them in the game, but high margins are being substantially eroded […]

Five Million Jobs

A few years ago, I co-chaired the National Academies Healthy America Initiative.  The members of this committee came from both the Institute of Medicine and the National Academy of Engineering.  Our assignment was to wrestle with issues surrounding the effectiveness and costs of healthcare delivery.  However, we wanted to put this in a larger context.  […]

Fully Understanding

I have been lately digesting an enormous amount of material on biological systems and urban systems.  For both systems, I am interested in their health.  The focus in biology has been on cancer and understanding the signaling mechanisms whose aberrations allow uncontrolled cell growth.  Within cities, I have been exploring urban resilience, including historical narratives […]

Three Strikes and You Are Out

The poor performance of the US healthcare system can primarily be attributed to three things.  First, the “fee for service” payment model incentivizes providers to provide as many services as possible to maximize reimbursements from insurers, either private or public.  Second, the lack of integration of archival and operational information systems undermines the delivery of […]

The Transformation Debate

Who is more American?  Is it the Kenyan or the Mormon?  Who created or destroyed more jobs?  Is it the community organizer or the private equity economizer? The candidates are focused on attacking personalities and circumstances rather than reality. But, what really happened to blue collar jobs?  This answer is straightforward. Our blue-collar laborers became […]

Technology-Driven Change

Change tends to be very difficult, but it does happen.  Technology is one of the key drivers of change.  Technologies enable new possibilities, such as typing this post on my iPad early Sunday morning, sipping coffee and listening to the rain. The iPad means that I can be productive any time, any place. This capability […]

Report From the Front

Over the past two semesters, I have been helping Georgia Tech undergraduate teams to contribute to transforming healthcare delivery.  Their senior “capstone” projects have focused on patient in-flow (Emergency Department), in-patient operations (Operating Rooms) and patient out-flow (Discharge and Bed Turnover).  Three eight-person teams addressed each of these areas of hospital operations. The problems these […]

Why Transformation Is So Difficult

It is fairly common for the perceived benefits of current market offerings to fade and new value propositions to displace older offerings.  As noted in earlier posts, Schumpeter called this process “creative destruction.”  Steel ships replaced iron ships, which replaced wooden ships.  Microprocessors subsumed transistors, which replaced vacuum tubes. Change happens and creative destruction causes […]

Creating the Future

I am a student of history, particularly economic history.  Lately, I have been immersed in reading about technological innovation in the late 19th and early 20th centuries.  Transportation was transformed from stagecoaches and steamboats to railroads, automobiles and airplanes.  Electricity transformed communications from mail, telegraph and telephone to radio, television and now Internet. In the […]

Market Forces

Change happens when it is forced.  The force can be an opportunity or a threat, perhaps embodied in a crisis.  In many domains, the forces for change are manifested as market forces.  Competitors, large or small, recognized or unrecognized, are the sources of market forces.  Thus, change happens when there is competition to meet market […]

Disrupting the Status Quo

A few months ago, a colleague asked me, “What if our big idea does not get approved by the powers at be?”  I said, “We will start an insurgency and just do it anyway.”  We are still waiting for approval, and may get it, but we are quickly progressing despite the lack of formal blessing.  […]

Stewards of the Status Quo

There are many impediments to addressing and solving executives’ toughest problem – see my last post.  Resource limitations – time, money, and people – can obviously be impediments.  Less obvious, and often much more troublesome, are the stewards of the status quo.  These stewards include people and organizations who are determined to keep everything as […]

The Current Communicator

I recently visited the Ronald Reagan Presidential Library.  One can question the whole “City on the Hill” imagery, but the Great Communicator was undoubtedly able to evoke a positive emotional response from me three decades after the original narrative. How does this compare to the Current Communicator? Both Presidents inherited troubled economies– one could easily […]

What Is or What If

Much of contemporary analytics focuses on tabulating and portraying characteristics of existing systems, whether they are for energy supply, health delivery or a wide range of other complex systems.  This type of analytics addresses “what is” or in many cases “what was.” This approach is backward looking, which makes a lot of sense if there […]

Transforming Public-Private Enterprises: Education

We often see dire assessments of our educational systems.  K-12 is judged to be quite poor compared to other developed countries, as reflected in comparisons of educational achievements across countries.  This is particularly true for STEM — science, technology, engineering, and mathematics.  More broadly, our high school graduation rate of roughly two thirds means that […]

Transforming Public-Private Enterprises: Healthcare

Healthcare presents a major challenge for the U.S.  We pay twice as much per capita as any other country; yet achieve much poorer results in terms of health and longevity.  The current system can be characterized as a federation of millions of entrepreneurs with no one in charge.  Even assuming that everyone is well intended, […]

Transforming Public-Private Enterprises: Introduction

It is difficult to transform a large enterprise.  Leaders of many private sector enterprises have told me that their toughest job is managing the enterprise they have while trying to create the enterprise they want.  Not surprisingly, the failure rate is very high, as illustrated by 200% turnover in the Fortune 500 in the past […]

People and Organizations

I have worked with well over 100 enterprises and several thousand executives and senior managers, often focused on initiatives that have the potential to fundamentally change their enterprises.  Somewhat simplistically, these initiatives depended on three ingredients – technology, people, and organizations.  Frequently these executives and managers commented that technology was the easy part.  People and […]

Investing in People

I am pleased to report that this week John Wiley released “The Economics of Human Systems Integration: Valuation of Investments in People’s Training and Education, Safety and Health, and Work Productivity.”  I edited this book with contributions from many economists, systems engineers, and behavioral and social scientists.  The overarching question that motivated this book was, […]

Engineering Healthcare Delivery

I am pleased to report that IOS Press released “Engineering the System of Healthcare Delivery” this week in Amsterdam.  Denis Cortese and I edited this 500-page compendium of the insights and ideas of a wide range of luminaries in healthcare.  Our goal was to bring together in one place the thought leaders who are transforming […]

Value of Prevention

Last August, the Director of the Congressional Budget Office (CBO), Douglas W. Elmendorf, sent a letter to Congress informing them that most preventative health interventions tend to expand utilization of services with costs that far exceed the eventual cost savings due to avoiding disease or detecting it earlier.  In other words, he reported that prevention […]