What are reasonable aspirations for a human-centered health system? In my forthcoming book, Beyond Quick Fixes (Oxford, 2024), I propose a ten-year, multi-stage plan to transform population health in the US. The plan includes five elements: Starting Point (Status Quo): High costs & poor outcomes Baseline Initial Success: Information sharing Leveraging Baseline: Care coordination across […]
Human-centered design, as elaborated last week, is a key enabler of human-centered systems. The elements of human-centered systems include: Efficient & effective ecosystem services Integration across service systems Equitable & affordable access the services Continuous learning & improvement of services Leveraging lessons learned broadly My central premise is that everybody wants our societal systems to […]
We have of late experienced an accelerating infodemic of misinformation and disinformation. The former relates to erroneous information that is forwarded without the sender realizing it is erroneous. The latter concerns information that is intended to deceive. In this post, I highlight a reading list of a dozen sources that, in effect, provide a short […]
My first posting on Rouse on Transformation was on November 5th, 2009 – more than 13 years ago. I am now a bit under one month into my 14th year. Last Monday was my 300th post, roughly once every two weeks, although the pandemic has given me time and motivation to post weekly – every […]
We often compare ourselves to the other 36 countries in the Organization for Economic Cooperation and Development (OECD). The US spends the most per capita on healthcare, but achieves much poorer outcomes than most OECD countries. The US is among the largest spenders on education in terms of costs per student. Yet, the US achieves […]
According to the US Department of Health & Human Services, “Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Thus, there is a spectrum of attributes that characterize SDOH, […]
We seem culturally opposed to long-term solutions. Our healthcare system is dramatically underperforming, as is our education system. Perhaps an infusion of targeted incentives would fix things. It hasn’t and won’t. The consequences of climate change and global warming include fires, storms and flooding that are massively destructive. We provide billions of dollars in disaster […]
So, what’s going on? The Covid 19 pandemic still kills about 500 people per day. Monkey pox is surging. The chronicle of the January 6th insurrection continues to astonish. Hordes of classified documents are turning up in Florida. Roe v. Wade was overturned. Inflation is frustrating, and the Fed is trying to cool the economy. […]
Joseph Tainter’s The Collapse of Complex Societies (Cambridge University Press, 1988) presaged Jared Diamond’s Collapse: How Societies Choose to Fail or Succeed (Viking, 2004). Both books provide vivid explanations of how societies fail and why. Societies create mechanisms to deal with new challenges. Walls are built to thwart Mongol hoards. Regulations are created to deter […]
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 […]
We know quite a bit about human well being, broadly defined to include the physical, behavioral, social, economic, and political elements of the concept. We seem to lack the will and the resources to pursue broadly based improvements in the well being of everyone. Many of us feel that everyone is on their own, and […]
I find it very interesting how easily people are convinced to behave in ways in conflict with their own self interests. Advertisements for low-quality junk foods and vehicles that really will not increase your sex appeal are good examples. Advertisements for prescription drugs that may benefit a few, but are not beneficial for most people […]
The time that I can devote to reading has soared over the past two years. I spend much less time getting to and from meetings – typically zero. Here are my four favorite books of the past two months. I highly recommend them. Top of the list is Andy Norman’s Mental Immunity: Infectious Ideas, Mind-Parasites, […]
Our society is amazingly complex. It serves an enormous number of purposes. An overarching goal is to persist. Without persistence, society could not serve all its other purposes. However, these purposes often compete and conflict for attention and resources. I have spent much time trying to improve defense systems from my commissioning as an Air […]
A recent email brought notice of four impressive National Academy reports. Two were 2021 reports on High Quality Primary Care and The Future of Nursing. One was a 2017 report on Pathways to Health Equity and the other was a 2012 report on Primary Care and Public Health. These are all impressive pieces of work. […]
The world seems to be coming increasingly complicated. Everything seems connected to everything. It seems reasonable to argue that this has long been the case. Diseases migrated from the old world to the new world, as did social and cultural norms. However, this process took years or decades. Now, accelerated by technology, it takes days […]
As I have discussed many times before, a compelling overall goal is a healthy, educated, and productive population that is competitive in the global marketplace. Anyone who is not healthy is a drag on the national economy Anyone who is not educated is a drag on the national economy Anyone who is not productive is […]
We have, of late, been focused on federal policies to assure and enhance the STEM talent pipeline in the US. There is a widespread sense that the pipeline is not as robust as the economy and competitiveness requires. Are we trying to “fix” STEM? Maybe, but we need to keep priorities in perspective. As I […]
For many years, my research related to design, operations, and maintenance of national security and space systems. Over the past two decades, I have added healthcare delivery, higher education, urban systems, as well as energy and transportation. These complex ecosystems interact in myriad ways. In particular, they interact in terms of claims on societal resources. […]
I began my career as an engineering assistant at Raytheon over 50 years ago. Since then, I have founded and managed five high-tech companies, and held faculty positions at six universities. These experiences led to working with 100+ companies, agencies, foundations, etc. What has changed over the course of this journey? Increased computing power at […]
The 2020-21 “multi-demic” of the coronavirus, economic disruption, and racial unrest has prompted a wealth of promising ideas for how to improve everyone’s lives in terms of health and wellness, economic security, and racial equity. As appealing as these ideas may be, they will face enormous implementation challenges and hurdles. We have been here before […]
According to Wikipedia, “Critical race theory is an academic movement of civil rights scholars and activists in the United States who seek to critically examine the law as it intersects with issues of race and to challenge mainstream liberal approaches to racial justice. Critical race theory examines social, cultural and legal issues as they relate […]
Many problems and potential fixes are being considered and debated to address the pandemic, associated economic slump, and economic and social inequities. Climate change is hovering in the wings. How do all these potential initiatives fit together? I think we can integrate all of these ideas by thinking about how they all support pursuit of […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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. […]
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 […]
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 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 […]
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, […]
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 […]
