Posts Tagged ‘Healthcare’

Higher-Order Consequences

The first-order consequence of driverless cars, when fully deployed and successful, is that humans will no longer drive cars.  That’s the whole idea.  Cars will be without drivers.  The many Uber rides that I take won’t change that much, except there will be no human driver. There are higher-order consequences of driverless cars being fully […]

Thoughts on Substance Abuse

The more I delve into substance abuse, the more my perceptions have evolved.  A few years ago, Lay’s Potato Chips threw down the gauntlet in a new advertising campaign, “Bet you can’t eat just one!”  I used to think that people happened, or were perhaps dared, to try some substance and were captured by the […]

Bubble Update

I have spent much time in recent years studying the possibility of transformation, fundamental change, of healthcare and higher education.  For many years, healthcare was the poster child for runaway costs.  That is still an issue, but cost control has received quite a bit of attention. Higher education is now the poster child for runaway […]

Population Health — For Cars

I have been thinking about population health for people.  Population health, in the fullest sense, requires integrating health, education, and social services to keep a defined population healthy, address their health challenges holistically, and assist them with the realities of being mortal.  It is a very ambitious idea. Why do I think this is possible?  […]

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 […]

Thoughts on Location

Does location matter?  It depends on what you are seeking.  If economic opportunity is your yardstick, here are some interesting statistics. Greater New York City generated $1.5 trillion in GDP for 2014.  Greater Los Angeles provided $0.8 trillion; greater Chicago $0.6 trillion; greater Houston and greater Washington, DC $0.5 trillion each; and greater Dallas, San […]

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 […]

It’s Really Tough

You are leading a very successful enterprise in airplanes, automobiles, mobile devices, healthcare — or perhaps higher education. The business model that got you to where you are — successful, profitable — seems to be faltering.  The growth of revenue is diminishing while costs are escalating.  The costs of infrastructure — physical, financial and human […]

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 […]

Controlling the Costs of Healthcare

We continue to anguish over escalating healthcare costs.  To gain control of these costs, we need to understand one essential equation.   The total cost of healthcare is Total Cost = Costs Per Use x Number of Uses Careful design of delivery processes to eliminate unwarranted care process variations can decrease the costs per use.  Variations […]

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 […]

On the Cutting Edge

Last week, I was a visiting faculty member as a Spine Symposium.  I gave three talks related to a systems approach to healthcare delivery.  The context of spine surgery was purely serendipitous, as the folks inviting me did not know in advance that I have spent several years doing my best to avoid spine surgery.  […]

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, […]

Types of Change

It is typical to think about change in terms of intentions and consequences.  We intend to exercise more or eat better to achieve the consequences of weight loss and improved fitness.  The President intends to move the country towards greater use of renewable energy sources to achieve the consequences of greater energy independence and decreased […]

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 […]

Unintended Consequences

Medicare limits reimbursement for healthcare procedures, often below the cost of delivery of these procedures.  Not surprisingly, healthcare providers figure out ways to compensate for these price controls.  They may, for example, bundle other, profitable services with those that they are forced to provide at a loss to get the overall profit margin to be […]

Healthy, Educated & Productive

Starting with the overarching objective of a healthy, educated, and productive population that is competitive in the global marketplace, what should be done?  Let’s work through this piece by piece. Start with healthy.  We are facing an epidemic of chronic disease, driven in part by an epidemic of obesity.  The eventual financial costs of diabetes […]

Transformation Archetypes — Part 4

A year ago, I bought an iPhone.  About six months ago, I switched from a PC to a Mac.  A few months ago, I began to use texting and now frequently rely on this means of communication.  Now, I am writing a blog.  My colleagues think that I have a chance of actually making it […]

Challenges in Healthcare Delivery

We are currently embroiled in two healthcare debates. One debate involves how the costs of making healthcare available to everyone should be apportioned among individuals, employers, and the government. The second debate concerns how to achieve reductions in the high costs of healthcare to provide the best value. Both debates have to be resolved effectively […]