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From Elsewhere: The Bossless Office

Bossless Office (Photo: Illustration by Marc Boutavant)

…“Management is a term to me that feels very twentieth century, … That 100-year chunk of time when the world was very industrialized, and a company would make something that could be stamped out 10 million times and figured out a way to ship it easily, you needed the hierarchy for that. I think this century is more about building intelligent teams.”

—Simon Anderson, CEO of DreamHost

One of my biggest concerns about the future of healthcare is the industry’s attractiveness to bright young people. Let’s face it, unless you are doig cutting edge clinical work, there’s not a lot in healthcare which compares to Google’s sushi bars, segways and wifi-blanketed busses.

The hospital workplace is still one of the most conservative environments in corporate america. Dark suits, wood paneled board rooms and hierarchy are the norms. I haven’t spoken to many college-aged young adults who are anxious to flock to that kind of workplace.

Enter the Bossless Office. A feature this week in New York Magazine looks at an emerging trend in management, or the lack of it.

There’s a lot to like about this idea and its application to the healthcare environment. Could it help entice more of the start-up, rapid pace, rapid reward crowd? I think so.

This structure—largely flat and very flexible—is especially appealing to those new to the workforce, twenty-somethings who tend to approach work differently from their parents. “The way workers are motivated is changing,” says Anderson of DreamHost. “Twenty years ago, it was about higher pay. Now it’s more about finding your work meaningful and interesting.” As more and more millennials enter positions of power in the business world, Anderson believes we will soon reach a point where hierarchy itself is “passé.”

From Mayo: Building a Process to Accept Feedback from your Social Media Audience

Note: I'm not writing much on this site about healthcare and social media lately. However, over on Mayo Clinic's Center for Social Media I contributed a piece on social health strategy. One of my concerns about any business which uses social media is how they will manage feedback. It's easy to setup a facebook page, but it's another thing entirely to connect all the right processess and people within the company to help address feedback from fans and friends. Yet, without that process, your social strategy can fall flat on its face if audiences don't think you can help them with anything other than marketing info.

You can download a pdf of the article here.


Healthcare's digital divide: consumers vs providers

Last week, I wrote about embracing niche use cases, or what is known as the long tail. I referenced a William Gibson quote: The future is here…it’s just not evenly distributed.  If we are defining the future as processess, ideas, or technologies which sound far fetched to most, but in actuality exist in niche areas, then there is another way to consider their distribution. These processess, ideas or technologies can be widely accepted by some groups but still dismissed as "the future" by others. Consider mobile health technology.

According to the Pew American Life Project, nearly half of US adults have smart phones. Float Mobile Learning suggests there are 186 phones for every hospital bed in the US. They also suggest health apps is the 3rd fastest growing area on Apple's App Store. In 2011, South by South West, the popular interactive and music festival in Austin added a healthcare track. This year, the Health Track drew thousands, including big brand names like Qualcom, Cisco, and more.

But wait, there's more.

I created my own infographic... actually, it's part of a slide deck I use internally from which I've stripped the branding and strategy parts. Still, it shows how online and mobile health have tipped, and for consumers, are no longer niche areas.

See the trend here? If 80% of US Adults (including 56% of seniors) are going online for health information, can we really say the distribution is uneven?

The Digital Divide

There is a term, the digital divide which speaks to the rift between those with internet access and/or tech skills, and those without. Examples include the elderly and underserved communities, though there are certainly exceptions in those demographics.

There is another digital divide. When we consider the relatively wide adoption of online and mobile health ideas, processess and technologies, there is still a group for whom this is the's out of reach, or not part of the plan: provider organizations.

Here, the future is evenly distributed among the general population, but very sporadically adopted by providers.

I'm not pointing fingers. This isn't easy stuff. 80% of doctors may have smart phones, according to Float, but how many are also advanced programers and IT gurus? And should we expect them to be? Nor should we expect them to expend their precious margins - believe me, they aren't as high as pop culture would suggest - on developing a state-of-the-art application.

Nevertheless, I suggest there are ways for providers and health systems to start embracing the future:

  • Use what is already available - if you have an EMR with a patient portal, then encourage patients to upload data from health apps. Likely, it will start as CSV attachments which will not immediately be discrete data. Nevertheless, it is engaging for patients, helpful to providers and forward thinking.
  • Share your expertise online - 80% of US adults want health information online, be part of filling the vacuum. When I give talks to clinical folks this is the point I stress the most. There is a powerful difference between hearing your local doctor's reaction to a new study and reading a national, disembodied by line on a national news site. Be the local expert!
  • Partner - if the idea of building your own app, accepting patient data, or starting a youtube channel is daunting, find someone who can help. This is part of a consumer's decision making process, how savvy, available and with it is my doc or health system? Would you fly an airline that didn't let you book online or bank with a bank that didn't have online banking?
  • Embrace cost reduction - If you are a primary care provider, do you really want to ask people to wait in your waiting room for 40 minutes to see you for 10 to get a refill on allergy meds? Building a process for reimbursable eVisits isn't nearly as hard as it sounds. Patients want them. We can FaceTime or Skype around the world, but not our doctors? How's that for uneven distribution?
  • Self-scheduling - finally, in the no-brainer category, nearly all airline tickets are booked online. OpenTable dominates dinner reservations via the web and mobile app. Why does it take a 10 minute call to get a doctor's appointment at a horrible time on a day that doesn't work for me?
One thing is clear, if we consider the uneven distribution of mHealth in terms of consumer vs provider, the idea is already mainstream for a huge segment of the market. With prospects like that, it doesn't take much to find gold. Embracing online tools and mHealth is going to be a major differentiator for providers and health systems who get on the band wagon early.

Mobile Medicine & Mobile Health Care: Float Mobile Learning.


Blue Ocean Strategy

There is a longstanding beliefe about how patients chose their healthcare providers and services. "[P]atients [are] passive health care consumers of physician services..." We go to a doctor a friend or someone at work tells us about, and if we need a specialist or study, we go where that doctor suggests. Is that the case because people want to be passive? Or is it because the "system" is structured in a way which makes consumer choice too difficult to contemplate?

Sometimes the universe gives you subtle hints, and sometimes it smacks you upside the head. Within the last four weeks, I've been inundated with references to Kim and Mauborgne's Blue Ocean. Blue Ocean is book and way of thinking about strategy.

When I first read Blue Ocean a few years ago, I didn't have a context for it and consequently didn't fully appreciate it.

Among other hints, we've been studying Blue Ocean in our graduate program which has given me a renewed interest. So, I'm re-reading it. Or rather, re-listening to the audio book on runs. Same difference.

The biggest lesson for me, to boil it down, is the need for any business to understand its market and its customers.

Understanding customers and markets isn't the same as asking them what they want. It's more about designing strategies, products, processess and services which addresses needs, even if they are unspoken, or even unknown.

Patients (and we're all patients aren't we?) would gladly chose their healthcare in a consumer directed world.

We've built a system around monolithic hospitals with radial arms touching pockets of outpatient care. Imagine if we reversed today's design. What if, instead of one huge epicenter, we had storefronts everywhere? Family medicine, internests, and other primary care practitioners, operating as a unified, front-line brand under consistant quality expectations which could be deployed around the service area as the face of the brand.

What if:

  • Care and experience were top priorities for providers (I'd be willing to be compassion is the biggest unmet, unspoken need)
  • Going to the doctor was as easy as going to Starbucks
  • Patients could schedule their own appointments, on mobile devices.
  • We could use FaceTime rather than waiting in waiting rooms.
  • Healthcare data belonged to patients, and providers would access it, with our permission, as they need it.
  • There would be navigators who's job would include making sure meds were picked up and appointments scheduled.
  • Docs would follow up about tests and treatment directly. And, they'd be accessible (within reason) by email or phone or twitter or text...

I know what you are thinking, many of these things are happening now. But not as a cohesive strategy for provider organizations. Providers are not thinking about designing strategies around emerging consumer wants. Why? The perception is the money is in the old school way of operating.

Remember when coffee used to come in a can from the grocery store? Did we think we wanted a coffee store on every corner? Starbucks tapped into that consumer desire and it seems to have worked out for them.

From the Blue Ocean site:

If the value and profit propositions are strong but the people proposition does not motivate the organization to move forward with focus and commitment, it will result in execution failure. Alternatively, if the people proposition is powerful but the value and profit propositions are weak, the company’s performance will be lackluster due to formulation failure.

via Blue Ocean Strategy.