Let’s say a university needs revenue of $25,000 per year per student. What tuition should they charge? Let’s assume there are three equal populations of students. One third can afford to pay full tuition. Another third can afford to pay 20% of full tuition. The last third cannot afford to pay anything. What should tuition […]
Wicked problems defy formulation and resolution. They involve conflicting values, concerns, and perceptions that lead to conflicts, strong positions, and perhaps even hatred of the “others” who have opposing views. We are faced with roughly 50% of the country being in fundamental conflict with the other 50% of the country. Actually, Biden-Harris won 51.3% of […]
How do people envision the future? How do they consider uncertainties? How do they think about investing today to have a better tomorrow? People seem willing to invest in their personal futures, e.g., retirement. They seem willing to invest in their children’s futures, e.g., education. The further they look into the future, the more difficult […]
“Everything will work out in the end and, if it doesn’t, it is not the end.” This was a theme in the movie The Best Exotic Marigold Hotel (2012) but attributed to Paul Coelho and John Lennon much earlier. I am an inveterate optimist, but I am reconsidering my inclinations. Look how we have handled […]
How can innovation be cultivated in the public sector? Consider defense, education, and healthcare. These three primarily public sector systems are ripe for disruption and innovation. Enormous improvements of services and decreased costs are undoubtedly achievable. The key question is how to disrupt the status quo. Let’s first consider how a direct approach might work, […]
We have in the US over 400 years of injustice in our country. Native Americans, African-Americans, and more recent immigrants have all been abused. We have taken advantage of them for the benefits of mainstream Americans at the time. What was this mainstream? Initially it was immigrants to Massachusetts and Virginia. Over time, we added […]
When all the days seem the same and the patterns of daily life endlessly repeat, you can begin to feel that time is gone. The clock has stopped. Nothing progresses. Everything is now. The future, even the past, is on hold. Everything will repeat, again and again. Of course, repetition has always been true. Birth, […]
This is a very risky time. What does that mean? Risk equals the probability that something unfortunate happens times the consequences of it happening. It seems like both sides of this equation are working against us. So, what to do? First, we need to differentiate risks to you and the general public. If you have […]
Recent challenges suggest that the complexity of society in the US has become increasingly difficult to understand and manage. We seem to have great trouble agreeing on anything. Consequently, we do not act to quickly understand what is happening and competently develop and execute compelling courses of action. Let’s explore the sources of the impasse. […]
We have been awash in protests of racial inequality. Assuming we agree inequality is bad — not everyone does — what can be done to greatly diminish this inequality? Those who have suffered this discrimination are poor, unhealthy, and uneducated. How can we address these discrepancies? We could just give everybody money. This idea has […]
Two months or one sixth of a year limited to once a week early senior mornings at the grocery store with 6-8 other older folks stocking up. Everybody is in masks. Feels like a heist. I am getting used to the routine of every day being the same as every other day. Actually, it has […]
Zoom and other online platforms are working out pretty well. Teaching class this way is better than many people expected. Many types of doctor’s appointments are much easier logistically and are more satisfying than driving, waiting, etc. Social get-togethers using these platforms are not as good, but they are much better than social isolation. Once […]
Over the past two days I was immersed in two Zoom meetings, one for 6 1/2 hours and another for 7 hours. The first was a National Academy of Engineering convocation, which I helped organize. I was one of the two speakers who wrapped up each half day. The second was a Division of Behavioral […]
We have recently learned that blacks have been disproportionately dying from the coronavirus. This is not because the virus is sensitive to the race of its victims. It is because blacks are much more likely to have health issues that undermine their abilities to survive the virus – asthma, diabetes, obesity, etc. A recent study, […]
Unregulated capitalism developed a strategy in the 19th century, if not earlier, of the big players putting the small players out of business, either by acquiring them or cutting prices below which the smaller players could not survive. Vanderbilt, Rockefeller, and Carnegie excelled at this, often financed by JP Morgan. Once the small, possible innovators, […]
I have lately been delving into substance abuse, suicide, and mental health in general. This past weekend, I used an AI-based platform to digest 250 journal articles on these topics. The resulting panorama of mental health is really astounding. I have earlier focused on hypertension, diabetes, heart disease and, most recently, cancer. My sense is […]
We are trying our best to physically distance ourselves from risks of the coronavirus. Along with washing hands and not touching your face, this practice seems to make much sense. Everyone I know seems to be doing these things. However, the phrase “social distancing” got me thinking. Most of us have been social distancing for […]
The coronavirus started when a person ate a bat or another wild animal infected by a bat – both being in the same neighborhood market where wild animals were sold. This person became “patient zero” in what has blossomed into the coronavirus pandemic. Of course, the bat cannot be faulted. The behaviors of the human […]
The government has delivered on its promise, via statutes and regulations, that every building in the US be heated by coal-fired electricity by 2050. All buildings – residential, commercial, and industrial – are required to have coal-fired electrical generators within the building. Every building now has a coal bin and coal deliveries are ubiquitous. All […]
Within much of engineering, and particularly, operations research, the goal is often the “best” decision that maximizes or minimizes a well-defined criterion or objective function. One can then, for example, employ mathematical programming to calculate the lowest cost routes for delivery trucks. Often one can even mathematically prove that these routes are best. Over the […]
Over the past couple of decades, I have invested my energies in understanding complex enterprises in terms of the multiple levels of phenomena that underlie corporations, cities, countries, and even climate. These levels include people, processes, organizations, and society, all of which both enable and constrain each other. Ignoring any of these levels risks devising […]
In my last post, I argued that everyone is cognitively unique. Others have argued that everyone is genetically unique. Can we really tailor assistive technologies and medical care to each individual? Is it feasible? Is it affordable? Of course, there are many examples of how we tailor technology to our personal preferences. We adjust the […]
In my early 50s, I changed my research focus from engineered systems — such as airplanes, ships, and power plants — to healthcare delivery. The central question was how to make the fragmented system in the US more effective and efficient. Now in my early 70s, I have for the past couple of years been […]
We have this apparent predilection to want too much of a good thing. Painkillers have their place, but not as a way of life. Smart phones are enormously helpful, but do we really need 24×7 texts on every aspect of life? Of course, this is not new. Radio and TV talk shows have long captured […]
I couldn’t tell whether the inquiry related to an opportunity for entertainment, adventure, or travel. To my complete surprise, the inquiry led to a possible offer of employment. The employer wanted me to join a team that would be exploring complexity. I asked what that meant. They said, “It is difficult to explain, but we […]
There is much concern lately that AI will displace human workers and perhaps eventually discard humans entirely. I suppose such scenarios are imaginable. However, I have been thinking about the potential of AI to do work that I currently do poorly. I almost always under invest in this work, often resulting in poor performance, wasted […]
I have been studying various treatises on our platform economy – how Alphabet (Google), Amazon, and Apple, as well as Facebook and perhaps Microsoft, have become so central in our economy. These companies provide platforms on which many other services are delivered. Of course, the Internet enables almost all of this. It is a platform […]
This has been quite a week for dealing with technology. It started with submitting a revised journal article using a web-based publishing platform. It was unhappy because the zip code for one of my coauthors was missing. It wanted me to add this information but I did not know the user name and password for […]
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 […]
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 […]
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 […]
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? […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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. […]
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 […]
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 […]
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 […]
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 […]
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 […]
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, […]
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 […]
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. […]
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 […]
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, […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
