Category Archives: entrepreneurship

business, entrepreneurship, healthcare, policy, politics

Deborah Rhodes: A test that finds 3x more breast tumors, and why it’s not available to you

  • Not sure about this one – better diagnosis, no pecuniary interest, no business model vs GE and the entire RSNA cabal, very emotional
  • It is a good story of why good, disruptive ideas hit the wall

http://www.ted.com/talks/deborah_rhodes.html

Deborah Rhodes: A test that finds 3x more breast tumors, and why it’s not available to you

Working with a team of physicists, Dr. Deborah Rhodes developed a new tool for tumor detection that’s 3 times as effective as traditional mammograms for women with dense breast tissue. The life-saving implications are stunning. So why haven’t we heard of it? Rhodes shares the story behind the tool’s creation, and the web of politics and economics that keep it from mainstream use.

Deborah Rhodes is an expert at managing breast-cancer risk. The director of the Mayo Clinic’s Executive Health Program is now testing a gamma camera that can see tumors that get missed by mammography.

complex adaptive systems, cool, data saving lives, entrepreneurship, healthy habits, nutrition, policy, quantified self, rapid learning health systems, startup, storytelling

Fear + Clear Action = Effective Behaviour Change

  • people indulge in unhealthy behaviours to relieve stress and anxiety
  • ads that cause stress and anxiety can drive unhealthy behaviours
  • one solution is to couple compelling threats with clear and specific paths to behaviour change
  • another approach is to apply the adicitive rewards that video games create for real life challenges
  • SUPERBETTERLABS.COM build video games which build resilience and maintain motivation while working to overcome injuries, anxiety and depression

 

http://www.iodine.com/blog/anti-smoking-ads/

Why Graphic Anti-Smoking Ads Make Some People Smoke More Cigarettes

Jessica Goldband

If these images make you squirm or want to click away, you’re not alone.

get-unhooked-man-1anti_smoking130328_anti_smoking_ad_thumb

How, then, can this type of message change the choices you make? Can we really be motivated by something that turns us off, rather than on?

You’d think, perhaps intuitively, that the scarier the ad, the more powerfully it affects our behavior. And the research supports that argument. Indeed, since the classic 1964 Surgeon General report on “Smoking and Health” came out 50 years ago this month, that’s been the basic strategy for health communication around the issue. But there’s a catch. A BIG one.

While we’ve seen a significant drop in global smoking rates (down 25% for men and 42% for women) since those landmark reports in the 1960s demonstrated the link between smoking and lung cancer, many people continue to smoke: 31% of men and 6% of women. In the U.S., 18% of adults (down by half since 1964) continue to do something they know might kill them.

Public health agencies have spent years communicating the dangers of smoking. Their anti-smoking ads have grown increasingly disturbing, threatening us with graphic images of bulging tumors and holes in our throats — possibly to try to reach that last stubborn segment of the population that hasn’t kicked the habit.

Why aren’t these ads working?

Turns out, the most recent and comprehensive research on so-called “fear appeals” and attitude change says that this kind of messaging does work, but only if the person watching the ad is confident that they are capable of making a change, such as quitting smoking. Public health gurus call this confidence in one’s ability to make a change “self-efficacy” — and threats only seem to work when efficacy is high. (The reverse is also true.)

If someone lacks efficacy, ads with fear appeals don’t help. In fact, they make the behaviorworse. How? Many people engage in unhealthy behavior because it makes them feel better and relieves their anxiety.

If you threaten someone who has little to no confidence they can change their behavior, their anxiety goes through the roof. What do they do? Perhaps turn off the threatening ad, walk away, and light up a cigarette — the very behavior you were trying to prevent. This same principle applies to other coping behaviors, such as eating unhealthy types of food or just too much of it.

Unfortunately, anxiety is quite common in this country. According to arecent Atlantic article, 1 in 4 Americans is likely to suffer from anxiety at some point in life. Making big life changes is tough, and it seems as though fear and anxiety don’t energize people, they just paralyze them.

So what’s the solution?

A step in the right direction would be for ad campaigns to couple compelling threats with equally clear and specific paths to behavior change. Or why not apply the rewards built into reaching a new level in addictive video games to apps that people can use for real-life challenges? One great example of this is Superbetter, a social online game to help people build resilience and stay motivated while working to overcome injuries, anxiety, and depression.

Stand-alone threats implicitly assume that people don’t already know how bad their choices are, and can drive them to the very behaviors they wish they could change. Truly effective ad campaigns might still appeal to our fears, but they should also let us wash it all down with a confidence chaser that empowers the more anxious among us to act on our fears.

data saving lives, entrepreneurship, healthcare, rapid learning health systems, startup, technology

VCs investing in US Healthcare

  • US investment in health care was triggered by the affordable care act
  • health is a bigger sector than tech
  • investing in a health insurance start-up presents an interesting strategic level

http://techcrunch.com/2014/01/15/vcs-investing-to-heal-u-s-healthcare/

VCs Investing To Heal U.S. Healthcare

Posted  by  (@jshieber)
The U.S. healthcare system is sick, but increasingly early stage investors are spending money on new technology companies they believe can help provide a cure.

Earlier this week, Greylock Partners, one of the investors behind Facebook and LinkedIn, and the Russian billionaire technology investor Yuri Milner put together a $1.2 million round alongside a group of co-investors to back First Opinion – a consumer facing service selling a way to text message doctors anytime of day or night.

Greylock and Milner join a growing roster of technology investors focused on healthcare in recent years. The number of companies raising money from investors for the first or second time has skyrocketed since the passage of the Affordable Care Act, according to data from CrunchBase.

In 2010, the year in which President Obama signed the ACA into law, there were only 17 seed- and Series A-stage healthcare-focused software and application development companies which had raised money from investors. By the end of last year, that number jumped to 89 companies tackling problems specifically related to the healthcare industry, according to CrunchBase metrics.

Across all categories, investors spent over $1.9 billion in 195 deals with commitments over $2 million, according to a report from early stage investment firm Rock Health. Funding was up 39% from 2012 and 119% from 2011, the Rock Health report said.

And there’s plenty of room for the market to grow, according to HealthSoftwareAppsEarlyFunding0913Google Ventures’ general partner Dr. Krishna Yeshwant. “We’re still at the very beginning of what this is going to look like,” said Dr. Yeshwant.

Google Ventures is addressing the nation’s healthcare dilemma with investments in companies like the physicians’ office and network One Medical Group, which raised a later stage $30 million last March. At the opposite end of the spectrum in December 2013 Google invested in the $3 million seed financing of Doctor on Demand, which sells a service enabling users to video chat with doctors.

Unsurprisingly, the explosion in healthcare investments tracks directly back to the passage of the Affordable Care Act, investors said. “The incentives brought forward by the ACA shift what makes sense,” in healthcare, Dr. Yeshwant said.

“At the highest level there’s now a forcing function to take advantage of the efficiency technology provides,” said Bill Ericson, a general partner with Mohr Davidow Ventures, who led the firm’s investment in HealthTap, a service for consumers to message doctors with healthcare questions.

Overwhelmingly, Silicon Valley is leading the charge in these innovations, according to CrunchBase.

HealthSoftwareAppsTotalFunding0913
This flood of capital has pushed some investors like Founders Fund to re-think their strategy, and de-emphasize healthcare software in search of other, larger opportunities.

““The reason we have somewhat shifted focus away from healthcare IT is because there is so much investment going into that space.  So we think the problems there are being sufficiently addressed by the full market.” said Brian Singerman, a partner at Founders Fund.

The firm’s most recent investment was in Oscar, a new, New York-based insurance company. Yes… an insurance company.

“In healthcare there is a tech stack around genomics, digitization, biometrics, analytics, and actual cures; one of the things that ties that all together is insurance,” said Singerman.

“Launching a new insurance company is not something that happens very often. While you could launch a new insurance company without the Affordable Care Act, the catalyst it gives you by being on the same page as the big incumbents is unprecedented.”
At Google Ventures, Dr. Yeshwant thinks there will be more opportunities for tech-enabled companies like Oscar and One Medical to compete in these broad industrial categories rather than offering point solutions. “Instead of being a piece of the system, it’s being the entire entity,” he said.
“The thing to keep in mind… with the healthcare industry is that it is far bigger than tech. As an entity it is where we’re spending 17% to 18% of GDP, so any one segment is tens of billions of dollars,” Dr. Yeshwant said. “Increasingly you’re seeing IT investors who have a fine sense of disruptive opportunities enter the market.”
Photo via Flickr user BrickDisplayCase
data saving lives, entrepreneurship, healthy habits, musings, policy, quantified self, rapid learning health systems, technology

Location-based prevention services

OK, so here’s the idea:

Our physical environment is loaded with cues capable of triggering healthy and unhealthy behaviours…

  • walk past any take-away, and you might succumb to the call of a chicko-roll (or bottle of water)
  • approach the supermarket, and you might feel the urge to purchase a tub of ice cream (or bag of oranges)
  • do you take the escalator (or the stairs)

Rather than leaving it to fate, why not use a location-triggered message to steer away from temptation, and towards a healthy future.

The danger areas can be configured individually, crowd-sourced or pre-loaded, as can the messages.

data saving lives, entrepreneurship, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems, research methodology

HICCUP: Health Initiative Coordinating Council

This manifesto aligns tightly with my own vision of how preventive health funding should be financed – data-driven and in a for-profit context.

HICCup

 

The HICCup experiment: Manifesto

Just imagine:

It’s 2019 and the mayor is having a bad day.  She wants to spearhead a new community program for bike-sharing, but she’s not sure the town can afford it.  Meanwhile, one of the new council members is pushing for an overhaul of the school lunch program.  She sighs as the assistant deputy mayor walks in.  “What now, Henry?” she asks with a slight edge in her voice.  But Henry is cheerful: “Mayor, I think we may have a way to fix this. I was just reading about the HICCup Experiment in a town just like ours…. It seems that if we did both the bike program and the school lunches, and made some other changes..”

“But what about our rising health care costs?” asks the mayor.

“That’s the point,” says Henry.  “HICCup showed that we can actually reduce those costs if we do multiple interventions simultaneously…even though none of them by itself would make a difference. And there’s an investment banker who just called us that’s eager to work with us to finance the project.  They’re asking us to set up a meeting with the big employers and Mercy Saints Health. Using the HICCup data, they think they can finance it all out of the health-care cost savings that would result, as long as we commit to following certain protocols.”

And the vision:

Now it’s 2040.  The mayor’s teen-aged son, also called Henry, is discussing his history project on the HICCup Experiment with other members of his MOOC.  “Of course,” he concludes, “the HICCup Experiment proved that multiple interventions can dramatically include the overall health of a community.  But the Experiment itself wouldn’t work anymore, as a funding vehicle.”

“Why not?” asks Susan, who clearly hasn’t done her homework.

Henry responds patiently with the obvious answer: “Because there are very few places with inflated, unnecessary health care costs anymore.”

The background

It is hard to find anyone in health care who does not believe that spending an extra $100 now on healthy behavior – exercise and proper nutrition, counseling for pre-diabetics, risk monitoring, and so on – could yield more than $120 in lowered costs and improved outcomes later. The numbers are fuzzy, of course, and there are plenty of methodological caveats, but there is little dispute about the plausibility and desirability of such an approach.

Yet neither individuals nor communities seem to act on the basis of this knowledge. Moreover, it’s likely that spending $110 now has no impact, as other factors dissipate any gain, but spending $110 million now (vs. a health-care budget of $100 million) should indeed return savings of $20 million annually over time.  Individuals often lack willpower or access to healthy food or convenient exercise facilities, and are surrounded by poor examples that encourage instant gratification rather than effort and restraint. And, on a broader, institutional scale, the money spent and the money to be gained do not belong to the same pocket.

Enter HICCup!

The goal of HICCup, the Health Initiative* Coordinating Council, is to facilitate the launch of five to eight community-wide experiments dedicated to proving that this can work, and to learning from both successful and unsuccessful efforts.  HICCup is a self-appointed counseling service and will persuade and guide local institutions to embrace a long-term perspective and launch a full-scale intervention experiment in their communities. For practical reasons, there are a few guidelines – but anyone who wants to do this without following our rules is welcome to do so.   (*Yes, it used to be “health intervention…” but initiative is more friendly and positive, and still let us keep the logo!)

For starters, HICCup will focus on communities of 100,000 people or fewer. The majority of each community and its institutions must be enthusiastic for the initiative to gain traction. If the community members mostly work for just a few employers and obtain health care from just a few providers, that makes the effort of corralling the players easier. And, of course, you need community leaders – mayor, city council, and others – who will work together rather than undermine one another.

So, how will this be funded? Not by HICCup, which is only a coordinating body.  The trick is for an investor in each community to capture some of what is being spent already on health care. As a rough calculation, assume $10,000 in annual per capita health-care costs, or $1 billion per year in a community of 100,000. (There are also all the separate costs of bad health, which are much harder to count or capture.)  That money ultimately comes from individuals and employers who pay it in taxes, insurance premiums or direct payments; the place to intercept it is somewhere between the payers and the health-care delivery system.

Instead of spending $1 billion a year, imagine spending $1.1 billion the first two years, but, say, only $900 million in the fifth year (possibly a $300 million savings off projected costs of $1.2 billion by then). That sounds like an attractive proposition – but only if someone else will make that initial investment in return for a claim to those presumed later savings.  These numbers are just for illustration; figuring out actual and predicted numbers for each community will be a key task.

The first challenge is for each HICCup community to get the involvement of a benevolent but ultimately profit-driven billionaire or hedge fund, or a philanthropic fund that sees a way to do good while earning money for future goodness. There are a lot of billionaires out there, some with vision. There are health-care companies that might bite, hedge funds looking for large-scale projects, and so-called social-impact bonds. There also are large employers that might decide to work with other employers in certain communities.

The funder makes a deal with whoever is responsible for the health-care costs (buyers): The funder makes upfront investment in health interventions and pays the health-care costs, against continued payment from the health-care buyers of the $1-billion yearly baseline, with the funder to keep (most of) the savings against originally predicted rising costs in later years. The money may be paid by employers, private insurers (which collect it from individuals, who, in the United States, are now required to buy insurance) or from government health-care funds, which will be the trickiest source.

One way or another, the investor/experiment manager will need to figure out how to realign some of the sick-care facilities and workers to some other role, including prevention, serving outsiders or some other use entirely.  That’s the second challenge HICCup experimenters need to address – one that is being addressed in part by the creation of Accountable Care Organizations, but without community involvement in preventive health.

All together now!


All these entities will be taking a substantial leap of faith. But we believe they can succeed – especially if they work together through HICCup to figure out the numbers, study the effects of small-scale healthy-living/preventive health-care efforts, and encourage one another to move forward. Regardless, each investor must work with existing institutions – if only to get at the revenue stream initially and benefit from the lowered costs in later years.

Although grants are a nice source of funding for demonstration projects and research, the best way for HICCup’s vision to catch on and be widely copied is by adopting a for-profit approach that attracts broader investment once it is shown to work.  Indeed, if a benefactor makes a donation, they feel good when they send off the money. An investor feels good only after the investment actually pays off.

Community officials and voluntary organizations also need to sign on…or  they can drive the process and find the benefactor/investor. They will also contribute by implementing complementary changes in school meals and gym classes; enacting zoning and other changes to encourage cycling, walking, and the like; hiring health counselors and care workers; and perhaps working with local restaurants and food stores to subsidize healthy choices and discourage unhealthy ones.   Local media can report on the experiment’s progress, and each community will likely engage in healthy rivalry with other HICCup experimenters.

Though it won’t get to keep the direct health-care cost savings, each community will get all the ancillary benefits of a healthy population, including an enhanced reputation.  Indicators of population health include not just rates of obesity, diabetes, high blood pressure, and diseases and related costs, but also whether the elderly can live (and be cared for) at home, absenteeism, school grades and graduation rates, employment statistics, accidents, and the like. Although the funder keeps the reduction in health-care costs, the community gets the benefit in the many payoffs from a healthier population over time.

Open enrollment

HICCup will not choose which communities participate. They will be choosing them selves. HICCup’s role will be to advise them and help them to communicate and learn from other communities going through the same process. We also want to be a clearinghouse for vendors of health-oriented tools, services, and programs. There are many bargains to be struck between communities and vendors offering discounts in exchange for wholesale adoption of their tools or programs.

However, there is one unbreakable rule: To work with HICCup, communities must collect and publish a lot of independently vetted data (without personal information, of course). For starters, they will need benchmarks of current conditions and projected costs, and then detailed statistics on the adoption of the measures, their impact and costs, and what happens over time.  HICCup will welcome input from lawyers and actuaries!

It is now time to try this on a broad scale. Five years from now, we will wonder what took us so long to get started. So, again, who will those investors be?

entrepreneurship, rapid learning health systems, startup

Doximity bigger than AMA

Very clever… wonder if they’re coming out here?

http://venturebeat.com/2014/01/09/doximitys-social-network-for-doctors-now-has-more-members-than-the-american-medical-association/

Doximity’s social network for doctors now has more members than the American Medical Association

Doximity’s social network for doctors now has more members than the American Medical Association
Shutterstock
January 9, 2014 9:57 AM

A social network could actually help your doctor give you better care.

Doximity’s physician network doubled in size last year to 250,000 members,outstripping even the American Medical Association in terms of numbers.

Its free network now reaches 35 percent of all doctors in the U.S., which CEO Jeff Tangney said is a “significant tipping point.”

doximity“This essentially means Doximity will get doctors the answers they want faster, and more reliably, than a simple Google search,” Tangney told VentureBeat. “Doctors can ask a critical mass of their peers any number of questions ranging from drug interactions to specialist advice, and it points to the demand and hunger for specialized, vertical social networks that meet an unmet need.”

Doximity has consistently grown since its launch in 2011, and it’s added a number of new features to make it much more than a “Facebook or LinkedIn for doctors.” In 2013 alone, the company built a recruiting tool called Talent Finder, released an API to enable easy authentication, launched a “digital fax line,” and rolled out a continuing medical education (CME) platform.

Medicine is a collaborative profession. Doctors and other medical care providers rely on communication with their peers to get expert advice, ask questions, coordinate patient care, and discuss difficult cases. But medical communication is extremely sensitive and highly regulated, so it happened primarily offline for a long time.

That is beginning to change now as tech startups like Doximity create secure, HIPAA (Health Insurance Privacy and Accountability Act)-compliant, doctors-only places for them to connect online. Tangney said saves them “precious” time and reduces the “burden” of paperwork, which is increasingly important now that the Affordable Care Act is kicking in and millions more people have access to medical care.

“With Obamacare and baby boomers filling patient waiting rooms, maintaining a high standard of care demands ever greater efficiency from our health care professionals,” Tangney said. “Doctors need a secure way to connect and collaborate.”

More than 10,000 physician-to-physician messages are now sent daily through the site. Fifty-plus third-party sites use Doximity’s login API, and 200 paying clients are using TalentFinder, which facilitated 70,000 consulting and career offers to physicians. 

Tangney said most of the platform’s growth has been grassroots — doctors telling doctors .

Prior to founding Doximity, Tangney was the founder of Epocrates, a San Francisco Bay area company that develops mobile health applications. Doximity is based in San Mateo, Calif., and has raised just shy of $30 million from Emergence Capital Partners, Morgenthaler Ventures, and InterWest Ventures.

 

 

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.

business, entrepreneurship, management and leadership

20 solid business lessons

 

 

20 Business Lessons You Don’t Want To Learn The Hard Way

lessons

(Photo credit: Mashable)

A few months ago, we posed this question to ShortStack‘s Facebookfans: “What is one business lesson you learned the hard way?” It began as a simple question to garner engagement, but it led to a long list of business owners’ reminiscences that included some great advice.

Of course every business owner will have his or her own trials, but here are 20 reminders our community shared that just might save you a headache:

  1. You can’t do everything on your own. Building a team is essential because there are only so many hours one person can devote to a business. Exactly when you reach that limit depends on your other obligations. If you’re a young single person, you might be able to do everything for a year or two. But if you have a family, your dedication will eventually hurt those relationships. Build a team that can carry on when you’re not around.
  2. You may think your product is perfect, but your clients won’t. Listen to user feedback: Your opinion may not be the best one. The key takeaway here is “release your product early and release it often.” You won’t know if you have a great product until it’s in the field and users are beating it up. It’s like some of the contestants on American Idol. They think they’re talented, and their friends and family think so, too, but when they get on a bigger stage, their flaws become obvious.
  3. Do one thing really well. Entrepreneurs try to be everything to everyone, but it’s hard to be the store that sells bait and baby toys and vintage Beatles albums. Specialize, and you can charge for what you do provide. That said, if there is a skill or service that would make your core product better, provide it.
  4. Get paid before you hand over a project to a client. This is especially important if you provide a service. Once you turn over that contract or website or design project, you won’t have much bargaining power. When I was a graphic designer, I watermarked all my projects and hosted websites on a private domain until the bill was paid.
  5. Undercharging is not sustainable. You think, “I don’t need to charge $150 an hour, I can charge $70 and make way more than I was making as an employee!” But you might find out a short time later that your “great” rate is unsustainable. By the time you pay taxes, employees, business licenses, insurance, etc., that $150/hour is looking more realistic. Compete on quality, expertise and your niche focus (see #3) instead of price. When competing on price alone, the clients who are price-shopping will always leave for the person or company that undercuts you.
  6. Patience and flexibility help you survive the lean times. ShortStack started out as a side project at my web and graphic design studio. We weren’t a software development studio, but when a client asked us for a software product, we didn’t say no. We were patient, scaled slowly — partly out of necessity — and it allowed me to build with company without debt.
  7. Build for your actual market. All of my software-building experience so far has been in answer to a demand. It is purely opportunistic. If you’re an app developer and you think “Wow, I think xx industry could use xx,” you might be disappointed. Put another way: I would never start a restaurant without having worked in one…for a long time!
  8. Never enter a partnership without a buy/sell agreement. No matter how well you think you know someone, you just don’t know when he or she will want to retire or do something else. Even if it’s on amicable terms, know how you can get rid of one another when it’s time for one of you to move on.
  9. Be grateful. Appreciate loyal customers who show you there is a demand for what you do. There is no dollar amount you can put on brand advocates. Good will translates to loyal customers.
  10. Look after those who look after you. We offer referral commissions at ShortStack, but it’s very much under the radar. We want people to recommend the product because they like it, not because they’ll say anything for a dollar. If we notice someone said nice things about us publicly, we might send them a t-shirt as a thank you. If they do it again and again, we might say, “Hey, you should become a referrer and earn a percentage of the business you send our way.”
  11. It’s not a sale until it’s paid for. This sounds obvious, but I’ve known small business owners who get very excited about orders and/or meetings with prospective clients. But until the money for those products or services is in the bank, it doesn’t count.
  12. You’ll make more money being “wrong” than proving you are right. Rather than fight with an unhappy customer and say, “You’re using it incorrectly,” or “You don’t know enough CSS to use our product,” we just refund their money. In the long run, these people consume so much of the support team’s time and energy that it’s more cost effective this way. They’re not our ideal client, and that’s OK.
  13. People don’t leave companies — they leave management. This lesson goes for both employees and customers. A manager will lose staff if the employees think they’re not being listened to or valued. Customers will stop using your products or services if they are dissatisfied with them. The quality and reliability of your products and services is a reflection of management.
  14. The way you present your business should be a reflection of your audience. If you have serious clients, be serious. If you have hip, fun-loving clients, have a sense of humor. You have to find your niche and build your content to suit them. For example, Constant Contact and MailChimp do essentially the same thing, but their marketing content reflects very different client bases.
  15. Agree on scope in advance. Have a clear contract before work begins. Once a project goes beyond the documented plan, charge for it. If you agreed to build a website with 10 pages, but soon the site is 20 pages, the client should pay you for them. If your contract makes that clear at the outset, it is easier to control scope creep.
  16. If your company sells a variety of products, make sure you know how to use/operate every single one of them. It might sound like a tall order — depending on how many products your company sells — but learning to use what your company sells will help you look at things with fresh eyes.
  17. When you think you’ve tested your product enough, test it some more. Never release a product until it has been tested and tested and tested by people who don’t work for you.
  18. Understand how social media networks work. When Twitter was first available for businesses, I’d see people use it like an ad in a newspaper. If you go on a channel and use it the wrong way, it could do more long-term harm than good.
  19. Save up. You can operate at a loss for a number of years but you can only run out of cash once. Have a rainy day fund that has at least two or three months’ operating costs in it. And have a line of credit available, even if you don’t plan to use it. Having a CPA look at your books once a quarter is also a must.
  20. Always let the CFO pay for drinks. Cheers!

Have you learned any business lessons the hard way? Let me know in the comments section below.

complex adaptive systems, entrepreneurship, policy, politics, research methodology

Gruen: A unified economic theory of privately provided public goods and social capital

Nicholas delivers a terrific presentation (1hr 7mins) to The Australian Centre for Social Innovation about the private provision of public goods and the subsequent generation of social capital.

It is as crisply considered as it is thought provoking:

  • after all this time, I think I finally understand that economists believe themselves to be the purveyors and arbiters of well-being, and ultimately health – no wonder they’re so suspicious of, and have so much trouble relating to medicine and health care
  • it would be interesting to apply this prism to health care – I don’t think it will present favourably

The presentation wraps with a 5 min video of the Family by Family program – a compelling sounding intervention that generates an abundance of social capital by developing and then using resources embedded in the community.

Many references to Adam Smith, Hayek and Robert Putnam.

Great to see something not confined to the sub-20min constraint.

Bravo Nicholas!!


http://clubtroppo.com.au/2013/12/20/public-goods-privately-provided-the-video/