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From Elsewhere: more on the need to embrace millennials and start-up culture

melI’ve written before about the changing workforce and my concerns about healthcare’s readiness to accept those changes. This week, Tom Agan (from Riva) writes in The New York Times about Embracing the Millennials’ Mind-Set at Work:

To compete for the best millennial talent, companies are having to change in fundamental ways. … Goldman made the change partly because it was losing millennials to start-ups. But start-ups typically offer less pay and equally long hours, which suggests that providing more time off isn’t the only answer. If corporate cultures don’t align with the transparency, free flow of information, and inclusiveness that millennials highly value — and that are also essential for learning and successful innovation — the competitiveness of many established businesses will suffer.

Anecdotal though it may be, I’m seeing a trend in healthcare. Fewer and fewer bright young people are queuing up for the dark suit, long hour, old white men’s club of hospital administration. Instead they go to work for a healthcare startup, or other unexpected players like Walgreens, Target or SG2.

In short, I’m worried we’re facing something akin to a brain drain in traditional healthcare —an energy drain. We’re notoriously slow to change, particularly when it comes to culture. Paternalism is as strong in administration as it is in clinical care.

How do we get hip?

  • Embrace - Tom Agan suggests: “…rather than complaining, it’s time to embrace millennials for what they can offer, to add experience from older workers to the mix, and to watch innovation explode”
  • Launch a skunk works - the term skunk works* comes from of Lockheed Martin’s advanced development programs. The idea is a start-up inside a traditional company. What if hospitals offered millennials and others the opportunity to experience start-up culture?
  • Try Google’s 20% rule - Google’s famed 20% rule was the catalyst behind gmail. Googlers are encouraged, in some cases required, to spend 20% of their time working on a project unrelated to their core job. Can you imagine if health systems encouraged the same kind of time sharing?

*Via Wikipedia:

The designation “skunk works”, or “skunkworks”, is widely used in business, engineering, and technical fields to describe a group within an organization given a high degree of autonomy and unhampered by bureaucracy, tasked with working on advanced or secret projects.

stop thoughts: we need Maker culture in healthcare

note. introducing a new category on this blog: < /stop> thoughts. < /stop> thoughts are those ideas you hear that make you stop, cock your head, blink a few times and then feel goosebumps while your brain goes in a different than you had thought about before. In < /stop> thoughts, I’ll share concepts, often loosely defined, which I think have massive potential to disrupt, improve or otherwise positively effect healthcare.

Last week, I had the opportunity to speak to over 300 cardiac surgeons, cardiologists, nurses and their administrative partners at the Bon Secours Heart and Vascular Institute’s annual conference.


Anna Young was one of the other speakers. Anna represents MIT’s Little Devices Lab and its MakerNurse initiative. MakerNurse draws its name and inspiration from the maker movement.

Maker is all about DIY culture —making things, hacking things, inventing things. The movement an online magazine, Make, and several annual Maker Faire events, billed as the greatest show and tell ever. I often think my 90-something grandmother should be in the Maker movement. Not a day goes by that she doesn’t hack something, like adding a big rubbery grip to a fork to make it easier to hold. That’s what being a maker is all about.


MakerNurse draws on the realities of nurses and nursing. Every day nurses hack their environment to improve patient care. For instance, in Anna’s slide deck, she showed a picture of a nurse who figured out that office supply clips were perfect for holding small oxygen cannula to the beanies that babies wear in the NICU. The clips keep the cannula in place. In another example, nurses in some developing countries are using empty plastic soda bottles as spacers for inhalers.

And, we don’t have to stop at nurses.

Recently I spoke with a pharmacist friend who is most certainly a maker. She heard about a nurse in her hospital’s PACU who was using wintergreen oil to help patients overcome nausea (clearly a MakerNurse!). My pharmacist friend was inspired to incorporate her complementary medicine training into the hospital’s pharmacy. So she purchased bulk aromatherapy oils and dabbed a little onto cotton balls. She put the cotton balls in plastic sandwich bags. Then, she took the bags around the hospital and stopped people —environmental services, nurses, maintenance, execs —and had them test the aromatherapy. Now she wants to give them scented cotton balls-in-baggies to patients to help combat side effects from medications, or as a simple relaxation aid.

Here’s the < /stop> thought:

What if every hospital adopted a maker culture and rewarded new ideas, inventions and devices with as much emphasis as we reward a traditional career progression? What if hospitals provided employees, even patients and families, with tools and spaces to help them make new things and quickly test them out?

In healthcare, we often think vertically about careers and progressions. In the clinical environment we call it practicing at the top of the license. For instance, nurses should give injections rather than doctors, so doctors can use their time to do the things only doctors can do. When everyone is practicing at the top of their license —doing the things they are uniquely qualified to do —the system is, in theory, more efficient.

But, MakerNurse demonstrates is we can have a different type of value in our roles. For nurses, practicing at the top of their license means doing more direct patient care, clinical navigation, etc. Being a maker, by hacking processes and systems and building new things out of nicknacks, provides another avenue for nurses to contribute to improving healthcare; and that path is perhaps less limited by regulations and licenses.

If we, as an industry, valued that kind of DIY attitude, think about how many great ideas would be born, tested and put into practice? Might it also contribute to a different sort of career path or sense of professional fulfillment? What if patients were also encouraged and given tools to hack new things to improve their own care?

So, which hospital is going to be the first MakerHospital?

Are health start-ups creating cooler cultures than the hospitals they serve?

I’ve written before about my concerns about work environment in many hospitals. I looked at culture when applauding Evernote’s employe-centric policies and again recently when exploring the Bossless Office. Writing for the Washington Post’s Wonk Blog, Sarah Kliff looks at the trend of hospitals forming their own insurance plans. Us healthcare nerds call these risk-bearing entities, and it’s not a particularly new idea. Why be beholden to a third-party insurance company if you could cut them, and the associated overhead, out? That’s been a key component of Geisinger’s Proven Care program for years.

When I speak to hospital administrators about innovation, what I often hear about is new, experimental models for paying for healthcare.

I’m not sure that’s what the rest of the world thinks of when they hear the world innovation. I think many picture iPhones, Virgin America planes and Tesla sports cars. And when we think about those things, we imagine fun people in jeans gathered in glass-walled rooms imagineering (whatever that means).

What caught my eye in Kilff’s article was her descriptions of the third party company, Evolent, which helps large health systems set up their payor plans.

From the article:

… Evolent Health could be a movie set for a Silicon Valley start-up — the kind that starts with millions in venture capital funding, not in a founder’s grungy garage. An immaculate micro-kitchen, stocked with sodas and fruit, opens to a lounge with a plush white couch and big-screen TV. Two treadmill desks nearby are decked out with laptop workstations. [On a Wednesday morning, though, no employees were using any of these amenities. …[employes] were working, many with headphones on, at long rows of gleaming metal desks. Evolent has no offices, not even for its top executives. Glass conference-room walls are covered in scribbles from red, blue and green markers. “We wanted a sort of Steve Jobs feel,” Evolent co-founder and president Seth Blackley said, explaining the open landscape.

I’m admittedly mixed about what I see as a trend: the innovative, cool places to work aren’t hospitals but rather the companies who support them. On one hand, its nice to know there are places in healthcare to attract a workforce of engaged, creative and modern workers. On the other, will hospitals be left in the dust by millennials and others who desire a less conservative environment?

its not fair to expect a 60 year-old building to look like the inside of an Apple store. Really, space is really a proxy for the culture and nature of work in a given space. Inherent in my thinking is the idea that workplace culture, employee talent mix and innovative strategies are all tied together. I certainly don’t mean to suggest treadmill desks alone will produce the hospital equivalent of Virgin America planes. But is it reasonable to connect environment to talent attraction and thinking?

CancerGeek points out, on twitter, some hospitals do offer modern work environments. But its still pretty limited.

Will more join the fold, or will we see a brain-drain towards smaller, start-up style third-party players?


Here’s the original tweet from TEDMED to Kliff’s article:


what are your employees' trending topics?

Did you watch the Grammys this year? According to Twitter:

  • People sent 10,901 Tweets per second (TPS) as Adele won Record of the Year — the peak TPS moment of the night.
  • “Grammys” was mentioned in more than 5 million Tweets on Sunday between noon and midnight PT.
  • The most mentioned artists (in descending order) during that same 12-hour period were: @OfficialAdele, @ChrisBrown, @NickiMinaj, @Rihanna, Whitney Houston
What about the Super Bowl?
This year, the TPS peak was 12,233 Tweets. The spike took place in the final three minutes of the game, during which fans sent an average of 10,000 TPS. Madonna’s performance during halftime was a big hit, too—there was an average of 8,000 TPS sustained during her performance, with a peak of 10,245 Tweets.

Twitter has this concept of "trending topics". Simply put, when enough people are talking about the same thing at the same time, it is said to be trending. Twitter gives programmers some ability to slice and dice trending data. You can see what is trending in a local area, or at a specific time.

Trending topics serve a few crucial roles. First, they alert us to macro conversations and sentiments. In that regard, they are like instant focus groups on global interests, needs, concerns, and celebrations. The Broncos' inspired over 9,000 tweets per second. People went wild when Tim Tebow threw that winning pass. According to Mashable, twitter users mourned Whitney Houston's passing nearly 30 minutes before the news media shared the story.

The other day, a coworker suggested an idea which knocked my socks off. What if we could see the trending topics inside the organization? What if we could compare what the organization was talking about last year to this year? Could we learn to predict conversations and react to them - employee needs, concerns, excitements, joys?

That may be the single best ROI for an internal social media platform I've ever heard.

Google publishes their zeitgeist every year. It's a recap of the most popular searches. In 2010, the world was looking for information on the World Cup, the BP oil spill, Justin Beiber and iPads. In 2011 it was Rebecca Black, Battlefield 3 and Steve Jobs. Do all of those names or terms sound familiar? I bet your employees are also talking about things you might not be aware of.

Can you pull the same data on your organization? What were employees talking about in 2010? What kinds of information are they looking for today?

Leaders may want to say yes, of course, in 2010 we were going through a merger, I remember the messaging well. Others might point to employee satisfaction surveys. But those ideas are different. The Google and Twitter examples are grass roots data. They are reflective of the larger population, what the front lines are thinking and talking about.

I particularly like thinking about how internal trending topics might impact culture. During the Arhab Spring, words like Egypt and freedom trended. Those topics became more than news, they were rally cries for the feet on the ground. Would employees voice their ideas, creating a new vision for the organization? Trending topics could be a powerful tool for positive change within companies.

Its not what you do, its why you do it

My new friend Ashleigh, a branding/experience/design guru, recently shared a concept with me. She told me about the golden circle theory from Simon Sinek. He says: "people don't buy what you do, they buy why you do it." Sinek cites Apple as a prime example of the golden circle way of thinking. I'm pretty fond of the little California design company as well. If you've run out of Ambian and read this blog as a substitute before, then you'll know I frequently draw on Apple as a source for inspiration in healthcare innovation.

This isn't a tech blog so I'm not really interested in how many thunderwire ports the new iWidget has and why google's robophone is superior because it has 1.21 gigawatts of magic dust inside. Sinek takes the same approach, focusing on the culture of Apple (and others like the Wright brothers and Martin Luther King, Jr). Sinek says most of us, and most companies, think from the outside in. We think about what we do, then how we do it and finally, maybe we get to why we do it. In the video, Sinek argues innovators like Apple reverse the process, they think about why they do what they do and move outward towards what it is that they do.

Sinek says Apple first says 'we exist to think different, to make things better, we are a design company who happens to make easy to use computers.' As consumers we identify first with their core beliefs and secondly with their products. We think 'I like to think outside of the box too!' Apple could innovate, design and produce running shoes and they would probably be equally regarded as innovators in that space. It is not what they do, but how they do it. (I'm practicing, Sinek repeats that line over and over, its and effective technique.) He counters with Dell's attempt at making an MP3 player to compete with the iPod. Consumers reacted by asking ' why would I buy an MP3 player from a computer company?'

An un-named Wall Street analyst quipped General Motors is a "hospital that makes cars on the side." While that quote is clearly drawing attention to the employee benefit structure GM has cited as a source of financial hardship, it is nonetheless poignant. Could anyone say the same thing about a hospital or other provider - that they are something else first and care givers on the side?

I optimistically think most hospitals and providers really are in the business of caring for patients. Find me a provider who doesn't list patient services as the largest source of revenue. A senior hospital executive once told me he liked working in healthcare because you can run a cafeteria one day, be an architect the next and work with doctors on the third day. While I think that kind of diversity excites a lot of people (myself included), those are all things we do, not reasons to do them. I believe most hospitals and providers really have the core beliefe they exist to care for people, to make them well and bring them comfort. So why are we so bad at expressing that as an industry?

I've written about "healthcare highway" before. A stretch of road which had billboards for every major provider in the area. Dan Dunlop regularly posts examples of hospital ads on his great blog. All of these, the print ads, healthcare highway, all talk about what the providers do. Some have the best cyberknife for brain tumor treatment. Others boast their rankings and awards. Others are the fastest. Almost none talk about why they do what they do. There is biology at work too; we can understand the sign that says "top 50 hospital", but we don't have an emotional reaction.

The message to consumers, Sinek says, is filtered through our biology. We are programed to understand the complex ideas and statistics these "what we do" ads throw at us. However, none of them go past our brain's basic stage of reading the words and understanding them. When companies and individuals talk about why they do something we register it differently. It is what we call a "gut reaction." We resonate with beliefs because, for many of us, we believe the same thing.

As always, I'm not sure what the solution is. There are plenty of ads for providers which talk about how much they care. I'm not sure that is the same thing in Sinek's world as talking about what they believe, what drives them to care. Sinek does give credence to the importance of the message in who you hire and how they ultimately help drive those beliefs. That resonates with me.

What do you think? Do you have any examples of healthcare providers who speak and work from the outside in? Are there hospitals who first say "we exist to change the patient experience, and we happen to heal people in the process?" Is the opposite happening? Are consumer's looking at ads featuring healthcare technology and asking 'why would I get care from a technology company?'