Category Archives: management and leadership

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Health Care Value

There’s a lot of good buried in this post, but it’s all starting to sounds like the development of a perfect map… not that inspiring.

The data is already there. At a national level, it can be used to inform a national increase in health funding… functioning like a CPI.

——-

Michael Porter defines value as “health outcomes achieved per dollar spent.” … An efficient business gets the most output possible, given current technology, from every dollar spent.

Porter and colleagues adapt microeconomics to health care through their definition of output: patient-centered health outcomes. These are results that individual patients desire: survival, speedy and uncomplicated recovery, and maintenance of well-being over the long term. These are also things that clinicians, payers, and purchasers should seek for their patients, employees, and customers.

The value movement’s definition of outcomes treats the patient as a whole person, insists that measures of outcome transcend disease-specific indicators to account for all of the patient’s conditions, and include data collected over time and space to produce comprehensive measures of patient well-being. Value proponents further insist that inputs be measured comprehensively to include all the costs of producing desired outcomes.

Widely adopted, the concept of value would provide a north star toward which health care providers could navigate.  Its emphasis on the whole patient and comprehensively measured costs would encourage teamwork among clinicians and coordination of care across specialties, clinical units, and health care organizations. The focus on patient-centered outcomes would support increased effort to measure patient-reported outcomes of care, such as their level of function and perceived health status over time.

[…] the lack of data systems to support outcome measurement.  Producing the holistic assessments needed requires the aggregation over time and space of data from multiple clinicians and health care organizations, as well as patients themselves. The health care system’s electronic data systems are just now entering the modern age.

To turn the promise of value measurement into the reality of better care at lower cost, a few short-term actions seem prudent. First, the nation needs a plan to turn the concept of value into practical indicators. Since government, the private sector, consumers and voters all have a vital stake in health system improvement, they should all participate in a process of perfecting and implementing value measures, preferably under the leadership of a respected, disinterested institution. The Institute of Medicine comes to mind, but others could be imagined.  This process should produce an evolving set of measures that will be imperfect initially but improve over time.

Second, both government and the private sector need to invest in the science and electronic data systems that support value measurement. Investments in systems should focus on speeding the refinement of standards for defining and transporting critical data elements that must be shared by patients, providers, and insurers to create patient-centered outcome measures.

 

 

http://blogs.hbr.org/2013/09/getting-real-about-health-care-value/

via

http://www.commonwealthfund.org/Blog/2013/Sep/Should-Value-Be-the-New-Mantra-in-Health-Care.aspx?omnicid=20

Getting Real About Health Care Value

by David Blumenthal and Kristof Stremikis  |   12:15 PM September 17, 2013

Words can spearhead social transformation.  Let’s hope that’s true for “value” in health care. Where other mantras – such as quality or managed care – have failed to galvanize the system’s diverse stakeholders, value may have a chance.

What seems special about the term is that, seemingly simple, it is actually complex and subtle. Under its umbrella, a wide range of interested parties can find the things they hold most dear, from improved patient outcomes to coordination of care to efficiency to patient-centeredness. And it is intuitively appealing. As Thomas Lee noted in the New England Journal of Medicine, “no one can oppose this goal and expect long-term success.”

The question, of course, is whether the term will help spur the fundamental changes that our health care sector so desperately needs. In this regard, a closer examination of the value concept confirms its appeal but also exposes the daunting challenges facing health system reformers.

Michael Porter has defined value as “health outcomes achieved per dollar spent.” Any survivor of introductory microeconomics will hear echoes in this phrase of one basic measure of economic efficiency: output per unit of input. An efficient business gets the most output possible, given current technology, from every dollar spent.

Porter and colleagues adapt microeconomics to health care through their definition of output: patient-centered health outcomes. These are results that individual patients desire: survival, speedy and uncomplicated recovery, and maintenance of well-being over the long term. These are also things that clinicians, payers, and purchasers should seek for their patients, employees, and customers. The value movement’s definition of outcomes treats the patient as a whole person, insists that measures of outcome transcend disease-specific indicators to account for all of the patient’s conditions, and include data collected over time and space to produce comprehensive measures of patient well-being. Value proponents further insist that inputs be measured comprehensively to include all the costs of producing desired outcomes.

Widely adopted, the concept of value would provide a north star toward which health care providers could navigate.  Its emphasis on the whole patient and comprehensively measured costs would encourage teamwork among clinicians and coordination of care across specialties, clinical units, and health care organizations. The focus on patient-centered outcomes would support increased effort to measure patient-reported outcomes of care, such as their level of function and perceived health status over time.

Promising as it is, the emphasis on value also raises illuminating and challenging questions. The first is: why all the fuss with defining it? In most markets consumers define value by purchasing and using things. In the 1990s, personal computers had considerable value. We know that because consumers bought lots of them. Now, with the arrival of tablets, personal computers seem to be losing value.  And so it goes for untold numbers of goods and services in our market-oriented economy. Eminent professors don’t wrack their brains defining the intrinsic value of electric shavers, overcoats, or roast beef.

We need to define the value of health care, however, for a simple but profound reason explained in 1963 by Nobel-prize-winning economist Kenneth Arrow. Arrow showed that health care markets don’t work as others do, because consumers lack the information to make good purchasing decisions. Health care is simply too complex for most people to understand. And health care decisions can be enormously consequential, with irreversible effects that make them qualitatively different from bad purchases in other markets. Americans are therefore reluctant to let the principle of caveat emptor prevail. One reason to define value carefully and systematically is to enable consumers to understand what they are getting, an essential condition for functioning health care markets.

The compelling need for a good definition of health care value highlights another fundamental challenge. We have not yet developed scientifically sound or accepted approaches to defining or measuring either patient-centered outcomes of care, or – surprisingly – the costs of producing those outcomes. The scientific hurdles to defining patient-centered outcomes are numerous. Outcomes can be subtle and multidimensional, involving not only physiological and functional results, but also patients’ perceptions and valuations of their care and health status.  The ability of health care organizations to measure costs is primitive at best and doesn’t meet the standards used in many other advanced industries. Equally challenging is the lack of data systems to support outcome measurement.  Producing the holistic assessments needed requires the aggregation over time and space of data from multiple clinicians and health care organizations, as well as patients themselves. The health care system’s electronic data systems are just now entering the modern age.

Given the value of measuring value, and the current obstacles to doing so, still another urgent question arises: what should we do now? Despite recent moderation in health care costs, our health care system is burning through the nation’s cash at an extraordinary rate and producing results that, by almost every currently available measure, are disappointing.

To turn the promise of value measurement into the reality of better care at lower cost, a few short-term actions seem prudent. First, the nation needs a plan to turn the concept of value into practical indicators. Since government, the private sector, consumers and voters all have a vital stake in health system improvement, they should all participate in a process of perfecting and implementing value measures, preferably under the leadership of a respected, disinterested institution. The Institute of Medicine comes to mind, but others could be imagined.  This process should produce an evolving set of measures that will be imperfect initially but improve over time.

Second, both government and the private sector need to invest in the science and electronic data systems that support value measurement. Investments in systems should focus on speeding the refinement of standards for defining and transporting critical data elements that must be shared by patients, providers, and insurers to create patient-centered outcome measures.

Third, in consultation with consumers and providers, governments need to develop privacy and security policies that will assure consumers that their health care data will be protected when shared for the purpose of value measurement.

Last, and perhaps most important, the trend toward paying providers on the basis of the best available value measurements needs to continue. These payment policies motivate providers to use value measures to their fullest extent for the purpose of improving processes of care and meeting patients’ needs and expectation.

To some observers putting value at the forefront of health care reform may seem obvious and non-controversial.  As Lee notes, who can be against it?  To use an American cliché, it seems a little like motherhood and apple pie: comfortable and widely endorsed. But the value movement could be much more than that.  When value does become a well-accepted principle, we’ll be much closer to making health care better for everyone.

Follow the Leading Health Care Innovation insight center on Twitter @HBRhealth. E-mail us athealtheditors@hbr.org, and sign up to receive updates here.

business, management and leadership

How to really disrupt an industry: Get personal, make enemies, stay focused and delight customers

cute and semi-convincing…

http://www.startupsmart.com.au/growth/start-up-profiles/how-to-really-disrupt-an-industry-get-personal-make-enemies-stay-focused-and-delight-customers/2014011711517.html

How to really disrupt an industry: Get personal, make enemies, stay focused and delight customers

Friday, 17 January 2014 | By Rose Powell

Andy Sheats’ two-year-old, private health insurance start-up, health.com.au, has over 40,000 customers and is turning over $46 million each year. After cutting his entrepreneurial teeth at realestate.com.au, the start-up that transformed the property market, disrupting has become a tactic and a way of life.

Sheats spoke to StartupSmart about his top tips to disrupt industries in useful and profitable ways.

Disruption will always be volatile, so embrace it

Likening industry disruption to the French Revolution, Sheats says start-ups need to embrace the power shifts and volatility of creating change.

“What does industry disruption have in common with the French Revolution? The rich and comfortable get what’s coming to them when the people who are the foundation of their success realise they’ve been treated with contempt and act on it,” Sheats says.

For start-ups, the monarchy and upper class to be disrupted are high-margin industries resting on their laurels, who according to Sheats, need to be toppled.

“Why? Because complacency means they are not continually adjusting their products and services to meet the evolving requirements of their customers. Here’s news: this complacency plants the seed that will become a disruptor, and when it blooms those customers will leave.”

Use being little to your advantage

Describing disruption as “business model judo”, Sheats says start-ups need to pick their battles and make the most of their capacity to be nimble and responsive.

“Use the strength and power of a challenger against them – to turn a complacent business’s size, fat margins and momentum into a liability. An industry experiences disruption when this judo results in complacent businesses unable to economically respond due to their revenue or cost-structure,” Sheats says.

Large companies can struggle to change their products, services or processes as trends change and customer expectations evolve. Those who dominate less competitive industries are the most precariously placed for a smart start-up to take market share away from.

“An industry where there’s healthy competition and a lot of change and innovation is not flat enough to disrupt. Disruption only works because the incumbent is inadequate and enough customers are dissatisfied to switch to the new player, who offers something different,” he says.

Focus on the issue or gap, not the hefty competitor

As the virtue of disruption is better outcomes for customers, start-ups need to be smart about getting personal. By focusing on the people they want to serve, not the companies they’re trying to take them from, you’ll find the energy to keep going.

“A disruptor is a new player that identifies areas where current players really let customers down and finds a way to turn these chinks in the armour to their advantage,” Sheats says, adding sometimes what needs to be disrupted is people’s expectations about what’s possible.

“Use a new approach that unlocks untapped customer sentiment to reshape the industry in your favour. How you do that is by changing the status quo and continuing to challenge the status quo, even when you are the incumbent,” Sheats says, adding doing a thorough investigation of what your big competitor doesn’t do that your future customers want is a great starting point.

“We started by identifying what the incumbent insurers weren’t doing: with health.com.au, it was making health insurance more transparent and easier to understand and allowing customers to manage their policy online,” he says.

Below are Sheats’ five ways to do business like a disruptor:

  1. Question everything: The ‘it has always been done that way’ mentality should be a red rag to a disruptor. Don’t be afraid to probe and find out why. You can change ‘that way’.
  2. Focus on the customer: The people who switch from the incumbent to you do so because you serve their needs better, they are central to your continuing success.
  3. Do different things, and do them differently: Having a very clear unique selling proposition immediately becomes a hook that helps customers in their decision to switch to you.
  4. Fight on your ground: You’ll never win against the incumbent if you fight by their rules; they’re established and they have deep pockets. Change the rules by using their strengths against them, and then fight the battle in a context where you have the advantage.
  5. Keep innovating: As a disruptor you need to move faster, learn faster, and change faster than the incumbent. Your ability to continue to meet the needs of your customers this way is key.
management and leadership

Composure in leadership

1.  Don’t Allow Your Emotions to Get in the Way
2.  Don’t Take Things Personally
3.  Keep a Positive Mental Attitude
4.  Remain Fearless
5.  Respond Decisively
6.  Take Accountability
7.  Act Like You Have Been There Before

http://www.forbes.com/sites/glennllopis/2014/01/20/7-ways-leaders-maintain-their-composure-in-difficult-times/

Glenn Llopis, Contributor 

1/20/2014 @ 10:18AM |86,841 views

7 Ways Leaders Maintain Their Composure in Difficult Times

leadership-composureLeaders need to show more composure than ever before in the workplace.   With the change management requirements, increased marketplace demands and intensifying competitive factors that surround us, leaders must have greater poise, agility and patience to minimize the impact of uncertainty.   How leaders respond to these and other growing pressures is an indicator of their leadership preparedness, maturity and acumen.

The composure of a leader is reflected in their attitude, body language andoverall presence.   In today’s evolving business environment, it is clear that leadership is not only about elevating the performance, aptitude and development of people – but more so about the ability to make people feel safe and secure.   Employees have grown tired of working in survival modeand thus want to be part of a workplace culture where they can get back to doing their best work without the fear of losing their jobs.

I worked with a colleague that lacked composure and was always in a panic.  Though he had tremendous credentials, he lacked the ability to remain calm and thus often made his employees feel uneasy. His leadership role was just too big for what he was capable of handling.   He was often too dramatic and the smallest of problems  launched him into crisis management mode.   Needless to say, his wasn’t an effective leadership that could deal with real crisis and change.    Because he was unable to reinvent himself and adapt to the unexpected, his tenure was short-lived.

The 21st century leader sees adversity through the lens of opportunity.  Rather than panic, a leader with composure takes a step back and begins to connect the dots of opportunity within adverse circumstances.   These types of leaders quickly detect the causes of adversity and solve for them immediately.  They then enable the opportunities previously unseen that could have avoided the adversity to begin with.  Many times crisis results when composure is missing.

The next time a problem arises, ask yourself if you or your leader could have shown a greater sense of composure and avoided the problem from surfacing.

When leading – especially during times of uncertainty and adversity, crisis and change – you must avoid showing any signs of leadership immaturity or lack of preparedness that will make your employees feel unsafe and insecure. Here are seven ways to maintain leadership composure during the most pressure-packed moments:

1.  Don’t Allow Your Emotions to Get in the Way

Seasoned leaders know not to wear their emotions on their sleeves.   They don’t yell or get overly animated when times get tough.  These types of leaders have such emotional self-control that even their body language does not give them away.

When you allow your emotions to get in the way, employees interpret this as a sign you are not being objective enough and too passionate about the situation at hand.  Strong-willed leaders can maintain their composure and still express concern and care, but not to the point that their emotions become a distraction – or that they can’t responsibly handle the issues at hand.

2.  Don’t Take Things Personally

Leaders shouldn’t take things personally when things don’t go their way.   Business decisions and circumstances don’t always play out logically because office politics and other dynamics factor into the process.    As a leader, remain calm and don’t get defensive or think that you always must justify your thinking and actions.

When you begin to take things personally, it’s difficult to maintain your composure and make those around you believe that you have things under control.  In fact, when leaders take issues too close to heart, they allow the noise and politics around them to suffocate their thinking and decision-making capabilities.

3.  Keep a Positive Mental Attitude

Employees are always watching their leader’s actions, behavior, relationships and overall demeanor.   During the most difficult of times, leaders must maintain a positive mental attitude and manage a narrative that keeps their employees inspired and hopeful.  This is where your leadership experience and resolve  can really shine – by staying strong, smiling often and authentically exhibiting a sense of compassion.

Leaders set the tone for the organization they serve.   A positive attitude can neutralize chaos and allow a leader to course correct through any negativity.    Employees feed off the attitude of these leaders during times of uncertainty.   Keep a positive mental attitude and never stop moving forward.  Stay focused on building positive momentum for the betterment of the healthier whole

4.  Remain Fearless

When leaders project confidence, they instill it in others.  During uncertain times, leaders must remain fearless and project a cool persona that communicates composure to those they lead.

I’ve been through ups and downs in my career and have learned that when you begin to fear adverse circumstances, you not only put yourself in a position of vulnerability, but it becomes extremely difficult to act rationally and objectively.    When you panic, you mentally freeze and your mind loses focus.

When you begin to get fearful, ask yourself:  What is the worst possible thing that can happen?  If you are objective about it and have the will and confidence to face it, you will eventually realize that the situation is manageable and can be resolved.  Faced with adversity several times over, your fears will eventually vanish and uncertainty will become your best friend.

5.  Respond Decisively

Leaders who maintain their composure will never show any signs of doubt.  They speak with conviction, confidence and authority – whether they know the answer  or not!  With their delivery alone,  they give their employees  a sense that everything is under control.

Recently, Mack Brown, the former coach of the University of Texas (UT) football team, was put under a lot of pressure to resign as a result of his team underperforming in 2013.  Though the University handled his forced resignation poorly  – considering Mr. Brown had coached the team successfully for the past 16 years – his decisiveness the day he announced his resignation made you feel that his transition out of the job was a positive thing for the university.  Human nature will tell you that he must have been hurting inside, but his decisiveness and presence of mind made those that were watching him speak believe that the future looked bright for UT football.

6.  Take Accountability

Leaders are most composed during times of crisis and change when they are fully committed to resolving the issue at hand.   When you are accountable, this means that you have made the decision to assume responsibility and takethe required steps to problem solve before the situation gets out of hand.

When leaders assume accountability, they begin to neutralize the problem and place  the environment from which it sprung on pause – much like New Jersey Governor Chris Christie did when he announced that he did not have any prior knowledge of the decision his aides made to close down access lanes to the George Washington Bridge.  Though there may be legal woes to come, the manner in which he handled the initial news conference (temporarily) neutralized the crisis – as he answered all of the reporters’ questions and took full responsibility and accountability to punish the perpetrators and keep something like this from happening again.  

7.  Act Like You Have Been There Before

Great leaders know that one of the most effective ways to maintain composure during difficult times is to act like you have been there before.   Leaders that act to show they have been through the problem solving process numerous times before are those with strong executive presence who approach the matter at hand with a sense of elegance and grace.    They are patient, they are active listeners, and they will genuinely take a compassionate approach to ease the hardships that anyone else is experiencing.

Just ask any technical support representative.  When you are on the phone with them, their job is to make you feel that even your most difficult challenges can be easily resolved.     They are there to calm you down and give you hope that your problem will soon be solved.    Pay attention to their demeanor and how they are masters at soothing your frustrations.  They always act to show that they have been there before; their composure puts your mind at ease.

It’s easy to lose composure during times of crisis and change if you let concern turn into worry and worry turn into fear.  By maintaining composure, the best leaders remain calm, cool and in control – enabling them to step back, critically evaluate the cards that they have been dealt and face problems head-on.  A show of composure also puts those you lead at ease and creates a safe and secure workplace culture where no one need panic in the face of adversity.

As the saying goes, “Keep Calm and Carry On!

management and leadership

Specilising in being a generalist

Totally agree with this assessment… you do have to work really hard to be a generalist. Am relieved to hear I have a future…

If someone says to you “I specialize in being a generalist,” it’s not actually a crazy claim. Most people cannot be a generalist, and you have to work really hard at a bunch of particular things to be good at it. You’re specializing in doing that. These are people who integrate and understand the contributions of others — that’s a lot like managing. So what you call generalists — I would not oppose them to specialists — there’s a big and growing role for them.

http://blogs.hbr.org/2013/12/algorithms-wont-replace-managers-but-will-change-everything-about-what-they-do/

Algorithms Won’t Replace Managers, But Will Change Everything About What They Do

by Walter Frick  |   12:00 PM December 20, 2013

Workers more and more will come to be classified into two categories. The key questions will be: Are you good at working with intelligent machines or not? Are your skills a complement to the skills of the computer, or is the computer doing better without you? … If you and your skills are a complement to the computer, your wage and labor market prospects are likely to be cheery. If your skills do not complement the computer, you may want to address that mismatch. Ever more people are starting to fall on one side of the divide or the other. That’s why average is over.

But what about management? I interviewed Cowen last month about his vision of the future, and where he sees managers fitting into it. An edited version of our conversation follows.

WF: What do you see as the main career lessons of the book?

TC: One thing the book suggests is that only being technically skilled may not be that useful, because those jobs can be outsourced or even turned over to smart machines. But people who can bridge that gap between technical skills and knowing some sector in a way that’s more creative or more intuitive, that’s where the large payoffs will come.

A classic example is Mark Zuckerberg with Facebook. Obviously a great programmer, but had he just gone out to be paid as a programmer he wouldn’t be that well off. He was a psychology major — he understood how to appeal to users, to get them to come back to the site. So he had that integrative knowledge.

For people who are not technically skilled, marketing, persuasion, cooperation, management, and setting expectations are all things that computers are very far from being good at. It comes down to just communicating with other human beings.

WF: Where does management fit into this?

TC: In any company, you need someone to manage the others, and management is a very hard skill. Relative returns to managers have been rising steadily; good managers are hard to find. And, again, computers are not close to being able to do that. So I think the age of the marketer, the age of the manager are actually our immediate future.

WF: I was talking recently with Andrew McAfee of MIT, whom you reference the book, and he mentioned the way software might even replace some pieces of management, though not managers themselves. Do you see algorithms and software encroaching majorly into that area?

TC: If it’s just measuring how hard people work, how long they’re at their desks, how good a job they do, how good a doctor or a salesman is adjusting for quality of customer, there’s a huge role there for software. But to actually replace managers, for the most part I don’t see that. At least not for the time horizon I’m writing about, 10 to 20 years out.

WF: One thing that McAfee talks about is the idea that people want to get their information from a human; they can be very distrustful of a computer just spitting out a recommendation.

Do you see that being true in a management context as well? That part of my job, if I’m running a company or division, is being able to understand machine intelligence and deliver it personally?

TC: That’s right. You will translate what the machine says and try to motivate people to do it. Professors and teachers will be more like coaches or tutors, rather than carriers of information. They’ll steer you to the program, tell you which classes to take, and be a kind of role model to get you excited about doing the work.

It’s a very important skill, and hard to learn. But I think you’ll see this kind of pattern again and again.

WF: How else do you see management changing?

TC: Management — for all the change we like to talk about — has actually been pretty static for a while. But smart machines and smart software are going to change management drastically, and in general we’re not ready for this. We will need truly new managerial thinking, not just new in the cliched sense of repackaging with new rhetoric and new categories.

WF: I wanted to ask you a little more about the machine-human teams. Freestyle chess — where human and computer teams play together, and outperform either on their own – is the example throughout the book.

What skills does the freestyle chess master have that the grandmaster doesn’t?

TC: The program, of course, does most of the calculations. The one skill the human needs when playing freestyle is how to ask the program good questions. Knowing what questions to ask is how you beat a solo program playing against you, and you don’t even have to be very good at chess. You need to understand chess at some core level, and you need to understand what different programs can and cannot understand.

It’s a kind of meta rationality. Knowing not to overrule the programs very much, but also knowing they’re not perfect, and knowing when to probe. And I think that, in management, those will be the important human skills.

WF: How do you determine where the line is between when the employee is able to add value above and beyond what computer intelligence is giving them, and when the software itself can replace them?

For example, I’m imagining some analytics software. Someone is very skilled at using it, they’re drawing some conclusions, they’re presenting them to people. But the next version of software may have built-in the ability to make those inferences. What skills keep that human from being replaced?

TC: People who can judge that there’s more to the matter than the software can grab; people who can judge the fact that there’s a need for a different kind of software for the problem; people who know when to leave the software alone and get out of its way.

Those are difficult to acquire and often quite intangible skills, but I think they’re increasingly valuable. You can think of other professional areas, like law or medicine, where you let the software do a lot of the work but you can’t uncritically defer to it. Software is bad at common sense in a lot of ways and it misses a lot of context. It’s people who can provide context.

WF: You have an interesting section in the book with respect to specialization in science. Do you see the path towards greater specialization as the path to career security? Or is there still a role for generalists?

TC: There’s a role for both, but you need to ask whether these terms lose some of their meaning. If someone says to you “I specialize in being a generalist,” it’s not actually a crazy claim. Most people cannot be a generalist, and you have to work really hard at a bunch of particular things to be good at it. You’re specializing in doing that. These are people who integrate and understand the contributions of others — that’s a lot like managing. So what you call generalists — I would not oppose them to specialists — there’s a big and growing role for them.

WF: You can’t go a day without seeing a story about who should learn to code or not learn to code. The same thing with respect to statistics. Given the way you see the labor market breaking out, are there specific things you advise people go out and learn?

TC: Statistics will be an increasingly big area. And even knowing a little can have a pretty high return. Coding’s tricky. If you can learn it, great. But if you can’t do it right, you really shouldn’t bother. There’s no half way.

But if you’re a manager or you work in health care, you might not ever be doing statistics, but if you can grasp some basic stuff that you can teach yourself, there’s a very high return. And it’s really quite feasible, unlike coding where it’s a major undertaking. If you’re a doctor trying to figure out which parts of the hospital are bringing in the money and someone hands you statistics — if you’re helpless, that’s really bad.

WF: One area that strikes me as one of the more difficult for machine intelligence is strategy. Where to position your business in a marketplace seems like on the far end of what machines can tell us.

TC: Yeah, that’s all humans, though you might consult machines for background information. But in no sense are machines close to being able to do that. That’s a very long way away.

All of our sectors are all on different paths, and the differential timing actually will be useful because we won’t have to figure it out all at once. We’ll get lessons from different areas sequentially and adjust. Humans will switch into the sectors they’re still good at in a rolling way. And that will make this socially more stable and better for most people.

If you woke up one morning and the machines were better than you at everything, that would be pretty disconcerting. That’s the science fiction scenario but it’s not that realistic.

business, management and leadership

Netflix Culture: Freedom & Responsibility

Great HBR article on  HR as it should be… agreed with nearly every point, save the brutal culling of people if their jobs became superfluous.

  • The best thing you can do for employees is hire only “A” players to work alongside them. Excellent colleagues trump everything else.
  • If we wanted only “A” players on our team, we had to be willing to let go of people whose skills no longer fit, no matter how valuable their contributions had once been. Out of fairness to such people—and, frankly, to help us overcome our discomfort with discharging them—we learned to offer rich severance packages.
  • Hire, Reward, and Tolerate Only Fully Formed Adults and then rely on common sense instead of HR policies
  • Salaried employees were told to take whatever time they felt was appropriate.
  • Expenses policy: “Act in Netflix’s best interests.”
  • asked managers and employees to have conversations about performance as an organic part of their work
  • Managers Own the Job of Creating Great Teams
  •  let employees choose how much (if any) of their compensation would be in the form of equity
  • Leaders Own the Job of Creating the Company Culture
  • Good Talent Managers Think Like Businesspeople and Innovators First, and Like HR People Last

Source: http://hbr.org/2014/01/how-netflix-reinvented-hr/ar/1

PDF of article: How Netflix Reinvented HR – Harvard Business Review

Slideshare: http://www.slideshare.net/reed2001/culture-1798664

PDF version of deck: netflix_culture

 

netflix culture

management and leadership

The importance of social skills vs results focus in leadership

  • chance of a results focused leader being seen as a great leader: 14%
  • chance of a leader with strong social skills being seen as a great leader: 12%
  • chance of a leader with strong social skills and results focus being seen as a great leader: 72%
  • percentage of leaders with both social skills and results focus: 1%

http://blogs.hbr.org/2013/12/should-leaders-focus-on-results-or-on-people/

Should Leaders Focus on Results, or on People?

by Matthew Lieberman  |   8:00 AM December 27, 2013

A lot of ink has been spilled on people’s opinions of what makes for a great leader. As a scientist, I like to turn to the data.  In 2009, James Zenger published a fascinating survey of 60,000 employees to identify how different characteristics of a leader combine to affect employee perceptions of whether the boss is a “great” leader or not. Two of the characteristics that Zenger examined wereresults focus and social skills. Results focus combines strong analytical skills with an intense motivation to move forward and solve problems.  But if a leader was seen as being very strong on results focus, the chance of that leader being seen as a great leader was only 14%. Social skills combine attributes like communication and empathy. If a leader was strong on social skills, he or she was seen as a great leader even less of the time — a paltry 12%.

However, for leaders who were strong in both results focus and in social skills, the likelihood of being seen as a great leader skyrocketed to 72%.

Social skills are a great multiplier.  A leader with strong social skills can leverage the analytical abilities of team members far more efficiently. Having the social intelligence to predict how team members will work together will promote better pairings.  Often what initially appear to be task-related difficulties turn out to be interpersonal problems in disguise.  One employee may feel devalued by another or think that she is doing all the work while her partner loafs – leading both partners putting in less effort to solve otherwise solvable problems. Socially skilled leaders are better at diagnosing and treating these common workplace dilemmas.

So how many leaders are rated high on both results focus and social skills?  If this pairing produces especially effective leaders, companies should have figured this out and promoted people to leadership positions accordingly, right?  Not hardly.  David Rock, director of the Neuroleadership Institute, and Management Research Group recently conducted a survey to find out the answer.  They asked thousands of employees to rate their bosses on goal focus (similar to results focus) and social skills to examine how often a leader scored high on both.  The results are astonishing.  Less than 1% of leaders were rated high on both goal focus and social skills.

Why would this be?  As I describe in my book, Social: Why our brains are wired to connect, our brains have made it difficult to be both socially and analytically focused at the same time.  Even though thinking social and analytically don’t feel radically different, evolution built our brain with different networks for handling these two ways of thinking.  In the frontal lobe, regions on the outer surface, closer to the skull, are responsible for analytical thinking and are highly related to IQ.  In contrast, regions in the middle of the brain, where the two hemispheres touch, support social thinking.  These regions allow us to piece together a person’s thoughts, feelings, and goals based on what we see from their actions, words, and context.

Here’s the really surprising thing about the brain. These two networks function like a neural seesaw. In countless neuroimaging studies, the more one of these networks got more active, the more the other one got quieter.  Although there are some exceptions, in general, engaging in one of the kinds of thinking makes it harder to engage in the other kind.  Its safe to say that in business, analytical thinking has historically been the coin of the realm — making it harder to recognize the social issues that significantly affect productivity and profits.  Moreover, employees are much more likely to be promoted to leadership positions because of their technical prowess.  We are thus promoting people who may lack the social skills to make the most of their teams and not giving them the training they need to thrive once promoted.

How can we do better?  For one, we should give greater weight to social skills in the hiring and promotion process.  Second, we need to create a culture that rewards using both sides of the neural seesaw.  We may not be able to easily use them in tandem, but knowing that there is another angle to problem solving and productivity will create better balance in our leaders.

Finally, it may be possible to train our social thinking so that it becomes stronger over time. Social psychologists are just at the beginning stages of examining whether this kind of training will bear fruit.  One exciting prospect, one that would make the training fun, is the recent finding that reading fiction seems to temporarily strengthen these mental muscles.  Wouldn’t that be great — if readingCatcher in the Rye or the latest Grisham novel were the key to larger profits?

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80-matthew-lieberman

 

Matthew Lieberman PhD is a Professor and Director of the UCLA Social Cognitive Neuroscience laboratory. He is author of Social: Why Our Brains Are Wired to Connectand a TEDx speaker. He also consults with companies to leverage neuroscience techniques in industry. Follow him on Twitter @social_brains.

business, entrepreneurship, management and leadership, startup

Characteristics of successful innovators

Oaaahhh shucks… had the strange feeling he was talking about me throughout this post, seriously.

http://blogs.hbr.org/2013/10/the-five-characteristics-of-successful-innovators/

[ALSO THIS RELATED POST:  http://blogs.hbr.org/2013/12/entrepreneurs-brains-are-wired-differently/]

The Five Characteristics of Successful Innovators

by Tomas Chamorro-Premuzic  |   1:00 PM October 25, 2013

There is not much agreement about what makes an idea innovative, and what makes an innovative idea valuable.

For example, discussions on whether the internet is a better invention than the wheel are more likely to reveal personal preferences than logical argumentation. Likewise, experts disagree on the type and level of innovation that is most beneficial for organizations. Some studies suggest that radical innovation (which does sound sexy) confers sustainable competitive advantages, but others show that “mild” innovation – think iPhone 5 rather than the original iPhone – is generally more effective, not least because it reduces market uncertainty. There is also inconclusive evidence on whether we should pay attention to consumers’ views, with some studies showing that a customer focus is detrimental for innovation because it equates to playing catch-up, but others arguing for it. Even Henry Ford’s famous quote on the subject – “if I had asked people what they wanted, they would have said faster horses” – has been disputed.

We are also notoriously bad at evaluating the merit of our own ideas. Most people fall trap of anillusory superiority that causes them to overestimate their creative talent, just as in other domains of competence (e.g., 90% of drivers claim to be above average — a mathematical improbability). It is therefore clear that we cannot rely on people’s self-evaluation to determine whether their ideas are creative or not.

Yet there are relatively well-defined criteria for predicting who will generate creative ideas. Indeed, research shows that some people are disproportionately more likely to come up with novel and useful ideas, and that – irrespective of their field of expertise, job title and occupational background – these creative individuals tend to display a recurrent set of psychological characteristics and behaviors. As summarized in a detailed review of over 100 scientific studies, creative people tend to be better at identifying (rather than solving) problems, they are passionate and sensitive, and, above all, they tend to have a hungry mind: they are open to new experiences, nonconformist, and curious. These personality characteristics are stronger determinants of creative potential than are IQ, school performance, or motivation.

Creativity alone, however, is not sufficient for innovation: innovation also requires the development, production, and implementation of an idea. This is why the number of “latent” innovators is far larger than the number of actual innovations, and why we all have at some point generated great ideas that we never bothered to implement. Here are a couple of mine: rent-a-friend – a service that enables tourists to hire locals for advice or simply some company – and location-based dating via an app that finds your nearby matches based on personality profiling. As with most of my ideas, these have since been successfully implemented by others, who also happened to have them.

The key difference between creativity and innovation is execution: the capacity to turn an idea into a successful service, product or venture. If, as William James noted, “truth is something that happens to an idea”, entrepreneurship is the process by which creative ideas become useful innovations. Given that entrepreneurship involves human agency – it depends on the decisions and behaviors of certain people – a logical approach for understanding the essence of innovation is to study the core characteristics of entrepreneurial people, that is, individuals who are a driving force of innovation, irrespective of whether they are self-employed, business founders, or employees. The research highlights several key characteristics (in addition to creativity):

  1. An opportunistic mindset that helps them identify gaps in the market. Opportunities are at theheart of entrepreneurship and innovation, and some people are much more alert to them than others. In addition, opportunists are genetically pre-wired for novelty: they crave new and complex experiences and seek variety in all aspects of life. This is consistent with the higher rates ofattention deficit hyperactivity disorder among business founders.
  2. Formal education or training, which are essential for noticing new opportunities or interpreting events as promising opportunities. Contrary to popular belief, most successful innovators are not dropout geniuses, but well-trained experts in their field. Without expertise, it is hard to distinguish between relevant and irrelevant information; between noise and signals. This is consistent withresearch showing that entrepreneurship training does pay off.
  3. Proactivity and a high degree of persistence, which enable them to exploit the opportunities they identify. Above all, they effective innovators are more driven, resilient, and energetic than their counterparts.
  4. A healthy dose of prudence. Contrary to what many people think, successful innovators are more organized, cautious, and risk-averse than the general population. (Although higher risk-taking is linked to business formation, it is not actually linked to business success).
  5. Social capital, which they rely on throughout the entrepreneurial process. Serial innovators tend to use their connections and networks to mobilize resources and build strong alliances, both internally and externally. Popular accounts of entrepreneurship tend to glorify innovators as independent spirits and individualistic geniuses, but innovation is always the product of teams. In line, entrepreneurial people tend to have higher EQ, which enables them to sell their ideas and strategy to others, and communicate the core mission to the team.

Even when people possess these five characteristics, true innovation is unlikely to occur in the absence of a meaningful mission or clear long-term vision. Indeed, vision is where entrepreneurship meets leadership: regardless of how creative, opportunistic, or proactive you are, the ability to propel others toward innovation is a critical feature of successful innovation. Without it, you can’t attract the right talent, build and empower teams, or ensure that you remain innovative even after attaining success. As Frances Bowen and colleagues recently noted, there is “a vicious circle [whereby] innovation leads to superior future performance, but such investment can also give rise to core rigidities and hence less innovation in a future time period.” In other words, innovation leads to growth, but growth hinders innovation… unless innovation is truly ingrained in the organizational culture, which requires an effective vision.

In short, there is no point in just hoping for a breakthrough idea – what matters is the ability to generate many ideas, discover the right opportunities to develop them, and act with drive and dedication to achieve a meaningful goal.

Ideas don’t make people successful – it’s the other way around.

80-Tomas-Chamorro-Premuzic

Dr Tomas Chamorro-Premuzic is an international authority in personality profiling and psychometric testing. He is a Professor of Business Psychology at University College London (UCL), Vice President of Research and Innovation at Hogan Assessment Systems, and has previously taught at the London School of Economics and New York University. He is co-founder of metaprofiling.com. His book is Confidence: Overcoming Low Self-Esteem, Insecurity, and Self-Doubt.

business, entrepreneurship, healthcare, management and leadership, policy, politics

HBR Blog: Resolving Health Care Conflicts with a walk in the woods

4 step process to resolving conflict:

  1. Have each stakeholder articulate their “self-interests” so that they are heard by the others. What does each need to get from this exchange?
  2. Look at where the overlap among these self-interests reveals agreement, what we call the “enlarged interests.” In our experience, these agreements always outnumber the disagreements.
  3. Collaborate to develop solutions to the remaining disagreements, or “enlightened interests.” This is the time for creative problem solving.
  4. Certify what has now become a larger set of agreements, or “aligned interests.”

Any outstanding disagreements are held to the side for future negotiations.

[…….]

The inclusion of all stakeholders is essential because people only truly embrace solutions that they help create. Anytime that one party tries to impose something on another, the natural inclination of the imposed upon party is to resist. A little time spent upfront engaging in joint problem solving saves many hours — and headaches — that come with a mandate.

http://blogs.hbr.org/2013/10/four-steps-to-resolving-conflicts-in-health-care/

We have been engaged in health care negotiation and conflict resolution for two decades. We have worked on conflicts as mundane as work assignments and as complex as hospital mergers. We use and teach a simple four-step structured process that works in cases ranging from simple one-on-one interactions to extended multi-party discussions.

After assembling representatives of all stakeholders in a conflict, the first step is to have each stakeholder articulate their “self-interests” so that they are heard by the others. What does each need to get from this exchange? The second step is to look at where the overlap among these self-interests reveals agreement, what we call the “enlarged interests.” In our experience, these agreements always outnumber the disagreements.  The third step is to collaborate to develop solutions to the remaining disagreements, or “enlightened interests.” This is the time for creative problem solving. The fourth step is to certify what has now become a larger set of agreements, or “aligned interests.” Any outstanding disagreements are held to the side for future negotiations. We’ve taught people in as little as 30 minutes how to use this approach. (See our book Renegotiating Health Care for more detail on the process.)

We call this process the Walk in the Woods after a play that dramatized a well-known negotiation over nuclear arms reduction. The delegations from the United States and the Soviet Union were at loggerheads. During a break, the two lead negotiators went for a walk during which they unearthed their personal as well as each nation’s deeper, shared interests in peace and security. This understanding enabled them to break the deadlock and move forward.

The same negotiation principles that can reduce nuclear stockpiles can be effectively applied even at the front lines in health care. For example, there is often pressure to change who does what when new technologies are deployed or initiatives are undertaken to lower costs. Consider the situation in a traditional orthopedic practice where a physician sees every patient who comes through the door. Is this really best for the patient, the practice, and the larger system?

Most patients who arrive at an orthopedic office suffer from straightforward conditions such as a simple, non-displaced fracture or a sprain. These can be adequately treated by a properly trained physician’s assistant (PA), and patients can typically be seen much more quickly by a PA than by a specialist. If outcome quality and patient satisfaction can be maintained and costs lowered, this should be an easy move to make. Such shifts in responsibility, however, are often resisted and the resulting conflict can be acrimonious. Why?

Both physicians and patients have come to expect to interact with each other. Doctors prize their clinical autonomy and their relationships with those they treat, and the fee-for-service model rewards them for taking care of patients themselves. Patients, meanwhile, want to be treated by an “M.D.” and often a board-certified specialist rather than their primary care physician (PCP). The PCPs value their relationships with the specialists in the network and focus on their gatekeeper role rather than stretching the scope of care they provide. Insurers want to control costs, of course, and they and others exert pressure to divert simple cases from high-cost specialists to less expensive physician’s assistants or other non-specialist care-givers. No one is happy with the resulting conflict: Orthopods fear losing their patients; patients are anxious about getting lesser care; PCPs worry that their relationships with specialists will erode; and insurers and administrators find the resistance by all parties frustrating, time-consuming, and expensive.

Now, imagine that the physicians in our orthopedic practice host an open house Walk in the Woods discussion that includes referring PCPs, patients, and representatives from insurers. Engaging in the four-step process, the parties would find that high outcome quality, patient satisfaction, and keeping care affordable are on everyone’s list of self-interests. Through the process, the orthopedists could educate both the PCPs and patients on when a specialist’s expertise is truly needed. Patients could articulate how they weigh the trade-off between waiting time and the provider they would see. The insurers could explain some of the cost implications of different options. One can envision the idea of physician’s assistants treating routine injuries emerging from the process as each party identifies the benefits that meet their combined and self-interests:  The orthopods may be freed up to see a greater number of more complex and interesting cases; the PAs are able to work to the level of their ability; the PCPs expand their relationships with more members of the orthopedic practice; the insurer reimburses less for uncomplicated treatments; and patients would get appropriate care, save time, and help keep premiums down.

The two aspects of this approach that can be extrapolated to myriad other conflicts are the use of a structured process and inclusion of all key decision-making stakeholders. The structured process minimizes the ego battles and tangential scuffles by keeping all parties focused on productively resolving the central issues. Depending on the number of parties and complexity of the negotiation a Walk can take from 10 minutes to 10 days or more.

The inclusion of all stakeholders is essential because people only truly embrace solutions that they help create. Anytime that one party tries to impose something on another, the natural inclination of the imposed upon party is to resist. A little time spent upfront engaging in joint problem solving saves many hours — and headaches — that come with a mandate.

facts & data points, healthcare, management and leadership, rapid learning health systems

Health management self-delusion stats…

 

  • Humans are not wired to seek contradictory perspectives.  Instead, we seek to reinforce what we already believe to be true.  No surprise, therefore, that 80.6% of healthcare leaders believe the quality of care at their hospital is better than at the “typical” hospital.  And only 1.2% believe their hospitals are below average in performance.  As a result, most leaders in health care are slow to react to their changing environment because they are convinced that they already outperform their peers.

[NOTE THIS RELATED OBSERVATION: 
We are also notoriously bad at evaluating the merit of our own ideas. Most people fall trap of anillusory superiority that causes them to overestimate their creative talent, just as in other domains of competence (e.g., 90% of drivers claim to be above average — a mathematical improbability). It is therefore clear that we cannot rely on people’s self-evaluation to determine whether their ideas are creative or not.
FROM: http://blogs.hbr.org/2013/10/the-five-characteristics-of-successful-innovators/]

From: http://blogs.hbr.org/2013/10/bringing-outside-innovations-into-health-care/

Bringing Outside Innovations into Health Care

by Mike Wagner  |   9:00 AM October 28, 2013

Spurred by government reforms and market expectations, healthcare leaders are being forced to reinvent their organizations. The model for healthcare is being flipped upside down — from decades of focusing on acute care episodes and encouraging utilization to a future where successful organizations are able to reduce utilization, manage population health, and activate patients in the consumption (and delivery) of their own care.

But, most organizations are likely to fail in this pursuit. History shows that 65% of transformation efforts yield no improvement while 20% of efforts result in worsened outcomes.  Even when there is improvement, performance usually returns to previous levels within a few years.

This failure is not for lack of effort — health systems are making massive investments in new infrastructure, technology, processes and managerial approaches designed to manage change, such as electronic health records, Six Sigma and Lean Management.  But, all of these efforts are dependent on people for both initial implementation and long term execution. The only organizations that will prosper in this environment of disruptive and massive change are those that build a resilient and adaptive culture in which staff members:

  • Welcome and seek change, rather than resist it;
  • Experiment and innovate, rather than maintain the status quo; and
  • Make hard decisions without relying on approval from senior leaders.

There is no simple or single approach to building such a culture. But in our experience helping hundreds of hospitals and health systems manage this transformation, we have found three disciplines that are essential to the effort:  Importing new knowledge, strategically deploying existing skills, and disseminating leadership across the ranks.  This and posts to follow will explore each of these disciplines.

Importing New Knowledge

While businesses in other sectors have become adept at bringing in ideas from outside their walls, health care has lagged behind. A key reason is that healthcare leaders are often blind when it comes to creatively responding to the industry’s challenges.  The source of this blindness is twofold.

  • Humans are not wired to seek contradictory perspectives.  Instead, we seek to reinforce what we already believe to be true.  No surprise, therefore, that 80.6% of healthcare leaders believe the quality of care at their hospital is better than at the “typical” hospital.  And only 1.2% believe their hospitals are below average in performance.  As a result, most leaders in health care are slow to react to their changing environment because they are convinced that they already outperform their peers.
  • The second blinder is more common in health care than in other sectors — leaders often actively isolate themselves from the outside world, believing that their industry’s challenges are entirely unique.  These leaders resist the idea of learning from exemplars outside of health care.  As a result, they are often ignorant of the managerial advances being made in other industries.

To respond to disruptive change, health care leaders need to first acknowledge their blindness and then actively overcome it by learning how other industries are addressing similar challenges. This requires developing creative approaches to finding new ideas from outside of healthcare. While this concept has been around for some time (pioneers like Virginia Mason started importing lean six-sigma practices into health care at least a decade ago) it is still not widely accepted and is rarely done as a matter of routine.

One hospital that has done this well is Memorial Hospital of South Bend, Indiana. They introduced the concept of the “Innovisit” — a routine and structured outreach that sends staff members to visit businesses in other industries.  Support from the top is critical to the success of such initiatives, as it has been at Memorial where president and CEO Phil Newbold has championed the program.

At Memorial, each Innovisit involves a cross-functional team of “Innovisitors” who have been specially recruited and prepared for these events.  Visits are carefully planned with the host organization and key questions are crafted in advance.  Upon their return, innovisitors share their observations during special conferences and educational sessions offered at Memorial’s own “Innovation Café” — a dedicated space that was remodeled to support creative thinking and sharing.  The “Innovation Café” itself is the result of an innovisit to a Whirlpool Corporation facility that included an Innovation Training Center.   

The development of Memorial’s Heart and Vascular building is another example of ideas inspired by innovisits. While on one such visit, the innovistor team learned of a design consultancy whose architectural approach seemed like a much better fit with Memorial’s needs than the approach in development. The fact that the planning process was well underway did not deter Memorial from tapping the design consultancy to experiment with new design principles that resulted in a more patient-friendly center, replete with a meditation garden.  Memorial further supports the organization’s innovation effort through its “Wizard School” that trains the entire staff — from parking lot attendants to C-suite executives — to think creatively.

Kaiser Permanente has sponsored similar excursions.  For example, during a tour of a flight school, Kaiser staff took note of the “sterile cockpit” concept — specific times during a flight when no conversations are allowed between pilots unless they are necessary for safely flying the plane.  This concept was adapted to create safer medication administration protocols that reduced interruptions and errors.

At Kaiser, spreading new ideas is a massive undertaking due to the size of the organization — more than 175,000 employees. To meet this challenge, Kaiser’s Innovation Consultancy — an internal consulting group — will routinely run pilot projects in order to test and prove a concept.  The Consultancy will then use the results of those pilot projects to encourage other departments to adopt new ideas and improvements as well: its input in developing the Nurse Knowledge Exchange is an example of that. Working with nurses and patients, and tapping new tracking software for data input, the Consultancy team helped develop a quick, reliable and efficient process for transferring patient information between nurses at a patient’s bedside during shift changes. The impact of the Nurse Knowledge Exchange in boosting the quality of the information exchange and enhancing patient care soon led to its deployment at all Kaiser hospitals. In effect, the Consultancy accelerates the adoption of new ideas by doing much of the legwork required to implement new practices across multiple locations: Line managers are not burdened with the effort and work required to share and spread ideas with others.  (Here’s more on the Consultancy’s approach.)

A leadership team that has been constantly bombarded with mind-stretching ideas from other organizations and disparate industries will possess a treasure trove of proven and practical ideas ready to be adapted and implemented.  Many of the challenges that healthcare leaders will soon face — collapsing prices (consider Blu-Ray players now selling for $49); disruptive technologies (digital photography supplanting film); fierce competition (iPhones stealing the market made by Blackberry); and entirely new business models (Netflix doing what Blockbuster could not) — have already been seen in other industries, and have given rise to adaptive new strategies. Health care leaders would be unwise to repeat the mistakes of others; they would be foolish to overlook strategies and solutions that have already been developed and proven effective elsewhere.