Posts Tagged ‘Incentives’

A Real Train System

What if the US had a modern state of the art train system like other developed countries?  The trip from New York to Washington would take one hour rather than three plus hours.  The trip from Atlanta to Washington would take three hours rather than thirteen hours.  This would be a great boon to personal […]

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 […]

The Academic Job Market

Engineering and science account for roughly three quarters of all PhD graduates, with half of these degrees awarded to US students and the other half to international students. Many of these graduates aspire to tenure-track faculty positions at universities. However, the percentage of faculty openings that are tenure track has been steadily decreasing for quite […]

Autonomous Vehicles

Various pundits are projecting that by 2020 – just four years – the driving of cars and trucks will be completely automated.  Vehicle services, whether for consumers or businesses, will be readily available for very reasonable prices.  I will not need to own a personal vehicle and my business can dispense with its fleet of […]

The Big Short

Just watched this movie this week, after having read many of the books published on the Great Recession, as well as having served on a National Academy study committee of what happened.  During this study, I had a chance to chat with the second most senior executive at one of the major banks involved, one […]

NFL Denies Referee Conspiracy

There is growing evidence that NFL referees have been instructed to make calls – particularly pass interference calls and false start calls – to control the outcomes of NFL games.  The NFL vehemently denies these accusations, but the data are very clear.  The NFL knows the outcomes that will maximize television revenues as well as […]

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 […]

Leading a University Research Center

University research centers are delicate organizational systems.  They bring together faculty, research staff, and graduate students for several reasons.   Centers are often formed as a result of a large NIH or NSF grant or because of a large gift or grant from industry or wealthy alumni.  So, there is money on the table and researchers […]

The Economics of Retirement

My last post addressed my frustration with a 60% taxation rate that left me wondering if my role was mainly to provide resources to be redistributed to other, undoubtedly needy, people who do not pay taxes.  The 40% that I get to spend barely covers my financial commitments.  So, how do I ever get ahead […]

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.  […]

Airlines and Quality of Service

The latest debate on air travel concerns whether a person should recline his or her seat if it inconveniences the long-legged person behind them.  Further, should the person behind be allowed to use the Knee Defender device that blocks a seat from reclining?  There have been thousands of impassioned opinions posted on the overall issue. […]

How Great Companies Transform — Then Fizzle

From many years in Atlanta, I have known many UPS executives, including CEO Mike Eskew who led the transformation of UPS from a package delivery company to a global supply chain services company.  I use a case study of this transformation in my classes and workshops on enterprise transformation.  It is one of my favorite […]

What to Keep

Enterprise transformation involves redesigning or creating new work processes that enable remediating anticipated or experienced value deficiencies.  This implies that some aspects of the enterprise have to be discarded.  Why not discard everything?  That is certainly as option, but it is called liquidation rather than transformation. A central question is what do you keep and […]

Execute, Execute, Execute

The lack of committed visionary leadership will doom any transformation aspirations.  However, will the presence of such leadership assure success?  The simple answer is, “No!” Great aspirations and ideas need compelling plans to succeed.  Further, these plans have to be successfully executed to realize these aspirations.  Quite often, plan fall prey to inabilities to execute.  […]

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 […]

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 […]

Worst Practices

I have recently been involved with an enterprise that has somehow managed to embrace just about the worst transformation practices possible.  It all started with the vocabulary the leaders chose to employ.  They managed to paint a transformation picture that they apparently had no intention of pursuing.  While they portrayed fundamental change, their actions totally […]

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 […]

The Toughest Problem

Over the past two decades, I have often asked executives about their toughest problem.  Not surprisingly, they use many different words to answer this question.  However, there is quite a consensus around, “Running the enterprise I have while trying to create the enterprise I want.” Keeping the existing enterprise running tends to be a very […]

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: Energy

Most people seem to agree that we need to be more conservative when it comes to energy.  We need to conserve our stocks of fossil fuels while also investing in renewable energy sources.  Our electrical grid is rife with inefficiencies, ranging from transmission losses to power-hungry devices in our homes.  The notion of a Smart […]

Transforming Public-Private Enterprises: Defense

National defense, and acquisition of weapon systems in particular, has long been a target of transformation.  The Packard Commission in 1985 provided a very reasonable set of recommendations for reforming defense acquisition processes.  These recommendations resulted in relatively minor changes.  Blue ribbon committees both before and after the Packard Commission had comparably minor impacts. President […]

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, […]

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.  […]

Invention and Innovation

Invention is the creation of a new device or process.  Examples include computers, software products, chemical processes, junk foods, and kitchen gadgets.  Innovation is the introduction of change via something new.  Cable television and video rental stores were innovations, as were overnight mail and communication via fax and the Internet.  Each of these innovations took […]

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 […]

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 […]