“In our last discussion, Curmudge, we talked about Clayton Christensen’s book, The Innovator’s Prescription, and we introduced his concept called disruptive innovation. I see the book as a 441-page Lean exercise. He defines a problem and then develops countermeasures.”
“Good observation, Jaded Julie. The problem is that ‘the growth in health care spending in the United States regularly outpaces the growth of the overall economy.’ The insights of Christensen and his coauthors provide the basis for some mighty convincing countermeasures. Christensen even provides biblical justification for his efforts, ‘Where there is no vision, the people perish.’ (Proverbs 29:18)”
“Wow! This sounds ominous, and we’ve only written two paragraphs. Speaking of writing, we must remind our readers that what appear to be our statements and conclusions are actually the paraphrased or quoted words of Christensen and coauthors.”
“Here’s the thrust of Christensen’s thinking. While much of today’s political dialogue is focused on how to pay for increasingly expensive health care in the future, this book is aimed at reducing costs and improving health care’s future quality and accessibility.”
“As we explained last time, the first step in disruptive innovation is the development of sophisticated technology that simplifies. Shall we start with that?”
“We shall, and let’s consider how technology impacts diagnosis, the first step in one’s visit to the doctor. The human body’s vocabulary is pretty limited in telling us what’s wrong with it. Because there are many more diseases than there are symptoms, many symptoms have to be shared. If a man went to the doctor complaining of a headache, the symptom could indicate a problem ranging from a brain tumor to having too much to drink the night before. Many years ago the diagnosis would have totally depended on the doctor’s experience, intuition, and acquaintance with the patient. This is called intuitive medicine, which leads to trial-and-error therapies with the hope of mitigating the symptoms. Now, modern imaging techniques would take a lot of guesswork out of the diagnosis. As Christensen states, ‘the technological enabler for disruption in health care is the ability to diagnose precisely, which then opens the door for a predictably effective therapy.’ “
“Curmudge, we’ve certainly progressed in the diagnosis of infectious diseases. Identification of the microorganism in a throat culture will allow selection of an antibiotic to wipe out a strep throat pretty predictably.”
“That’s called precision medicine, Jaded Julie. It is ‘the provision of care for diseases that can be precisely diagnosed, whose causes are understood, and which consequently can be treated with rules-based therapies that are predictably effective.’ ”
“It would be really great if we could use this precision medicine for everything. Not only would the patient be cured, but it would cost less than trying this and that therapy with the hope that the symptoms would subside. I presume, Curmudge, that more definitive diagnoses will be matched by development of more directed therapies.”
“That’s the other half of the story, Julie. Recall our stating that the body can’t express enough gross symptoms to tell us what’s wrong? If fact, the body is quite articulate in terms of genetic expression. Although we wish there were more, there are a few specific molecular tests that can identify certain cancers quite specifically. These tests can be teamed with pharmacogenomics, a new branch of pharmacology that aims to develop rational means to optimize drug therapy, with respect to the patient’s genotype, to ensure maximum efficacy with minimal adverse effects. Of course, we’re looking a bit into the future for this kind of personalized therapy."
“Yes, but we already have a name for it. It’s called ‘Personalized Care.’ So how will these changes affect the practice of medicine?”
“We’ve seen examples of how many diagnoses will become more specific and less intuitive and therapies will be more precise and less trial-and-error. Retail clinics staffed by nurse practitioners already diagnose and treat lists of illnesses and conditions, and the lists will undoubtedly expand. Their diagnoses are straightforward, and their therapies are evidence based. One might expect that they will disrupt the primary care physicians, but because of the clinics’ speed, convenience, and affordability, Christensen feels that they compete predominantly against nonconsumption. For a variety of reasons, their patients would skip their vaccinations and tolerate their illnesses until they went away or became serious.”
“Our earlier postings on Information at Your Fingertips and Amazing Devices foretell big changes in the primary care physician’s office. Christensen suggests three innovations that will move primary care docs into the realm of specialists: (1) analytical and imaging capabilities at the point of care, (2) online decision tools, expert system software, and algorithms that guide diagnosis, and (3) telemedicine (remote consultation with an expert).”
“And what about the specialists?”
"They are likely to disrupt one another. Cardiologists doing angioplasty have been disrupting cardiac surgeons for years. Interventional radiologists are disrupting surgeons by their instruments’ enhanced ability to visualize the area requiring surgery.”
“Golly, Curmudge, with a surgical robot even I could perform surgery. So how might these big changes impact the hospitals?”
“Hang in there, Julie. We’ll talk about hospitals next time.”
Affinity’s Kaizen Curmudgeon.
Thursday, May 19, 2011
Thursday, May 12, 2011
The Crystal Ball 4
“Curmudge, I understand that you actually bought a book. Typically, you just read the reviews in Amazon and wing it from there. What inspired your investment in the real thing?”
“Well, Jaded Julie, we’re going to push our crystal ball into the somewhat-distant future, right? For that we’ll need some high-powered insight, and that doesn’t come free. So I dug down into my dresser, blew the lint off a credit card, and purchased The Innovator’s Prescription by Clayton Christensen and two MDs, Jerome Grossman and Jason Hwang.”
“We mustn’t forget that material in Kaizen Curmudgeon can’t be controversial. So how can we present Christensen’s forecasts without generating controversy?”
“For the most part, Christensen writes about several years into the future and supports his position with data from the fairly distant past. People tend to get riled up over the present, the immediate future, and the recent past. That, as well as Christensen’s compelling arguments, should keep the discourse civil. Additionally, we are going to simply convey parts of Christensen’s message and do it diplomatically and selectively.”
“The focus of Christensen’s earlier writings—and they were not about health care—was disruptive innovation. What is that, anyway? It sounds both disturbing and encouraging at the same time.”
“In Christensen’s words (signified by single quotation marks), ‘the disruptive innovation theory explains the process by which complicated, expensive products and services are transformed into simple, affordable ones.’ “
“Curmudge, even a mind as swift as mine would appreciate an example.”
“It’s coming at you, Julie. Back in the 1960’s (ah, it seems like yesterday) only a few talented engineers could build IBM’s room-sized, mainframe computers. They were sold directly by IBM to institutions for hundreds of thousands of dollars. Then along came a technological disruptor, the microprocessor, that simplified computer design and assembly and enabled personal computers to be assembled from parts in Michael Dell’s dorm room. Soon virtually everyone, like me who had never thought about computers, could afford a computer and had one on his desk.”
“But this transformation involved more than just the advent of the microprocessor, didn’t it?”
“Right. IBM set up a new business model to make money with low margins, low overhead, and high unit volumes. In addition, components became commodities, marketing was done by independent vendors, and software was developed for unsophisticated users. Lots of organizations could participate in and profit from this so-called economically coherent value network.”
“I think I have the basics, Curmudge. For successful disruptive innovation, the requirements are ‘(1) sophisticated technology that simplifies, (2) low-cost, innovative business models, and (3) an economically coherent value network.’“
“You got all of that from what I just said? You must have been reading the book. Come back next time and we’ll begin to explore how Christensen translates these concepts into health care.”
Affinity’s Kaizen Curmudgeon
“Well, Jaded Julie, we’re going to push our crystal ball into the somewhat-distant future, right? For that we’ll need some high-powered insight, and that doesn’t come free. So I dug down into my dresser, blew the lint off a credit card, and purchased The Innovator’s Prescription by Clayton Christensen and two MDs, Jerome Grossman and Jason Hwang.”
“We mustn’t forget that material in Kaizen Curmudgeon can’t be controversial. So how can we present Christensen’s forecasts without generating controversy?”
“For the most part, Christensen writes about several years into the future and supports his position with data from the fairly distant past. People tend to get riled up over the present, the immediate future, and the recent past. That, as well as Christensen’s compelling arguments, should keep the discourse civil. Additionally, we are going to simply convey parts of Christensen’s message and do it diplomatically and selectively.”
“The focus of Christensen’s earlier writings—and they were not about health care—was disruptive innovation. What is that, anyway? It sounds both disturbing and encouraging at the same time.”
“In Christensen’s words (signified by single quotation marks), ‘the disruptive innovation theory explains the process by which complicated, expensive products and services are transformed into simple, affordable ones.’ “
“Curmudge, even a mind as swift as mine would appreciate an example.”
“It’s coming at you, Julie. Back in the 1960’s (ah, it seems like yesterday) only a few talented engineers could build IBM’s room-sized, mainframe computers. They were sold directly by IBM to institutions for hundreds of thousands of dollars. Then along came a technological disruptor, the microprocessor, that simplified computer design and assembly and enabled personal computers to be assembled from parts in Michael Dell’s dorm room. Soon virtually everyone, like me who had never thought about computers, could afford a computer and had one on his desk.”
“But this transformation involved more than just the advent of the microprocessor, didn’t it?”
“Right. IBM set up a new business model to make money with low margins, low overhead, and high unit volumes. In addition, components became commodities, marketing was done by independent vendors, and software was developed for unsophisticated users. Lots of organizations could participate in and profit from this so-called economically coherent value network.”
“I think I have the basics, Curmudge. For successful disruptive innovation, the requirements are ‘(1) sophisticated technology that simplifies, (2) low-cost, innovative business models, and (3) an economically coherent value network.’“
“You got all of that from what I just said? You must have been reading the book. Come back next time and we’ll begin to explore how Christensen translates these concepts into health care.”
Affinity’s Kaizen Curmudgeon
Thursday, May 5, 2011
The Crystal Ball 3
“Do I detect, Curmudge, that we are slowly tuning our crystal ball to look further into the future?”
“What do you expect, Jaded Julie? Everything I do is done slowly. I even sleep slowly. One of my friends once said, ‘Sleep is just practice for being dead.’ I practice slowly so I don’t get too good at it.”
“I understand that today we discuss the last of the health care ‘knowledge purveyors’ on our list, Sg2. This is another organization supported by membership dues and fees for services they provide. Fortunately, Affinity is a member.”
“On the Kaizen Curmudgeon scale of consultancies, Sg2 is neither a supermarket nor a ‘mom-and-pop store.’ Their team includes MDs, PhDs, RNs and health care leaders with extensive strategic, operational, clinical, academic, technological and financial experience. According to their home page, they ‘help build a foundation for improving care delivery and overall organizational performance.’ Their logo includes ‘health care intelligence.’ That certainly suggests a forward-looking focus.”
“Sg2 offerings include meetings, courses, and web seminars. Their EDGE intelligence system provides in-depth reports, growth guides, and technology guides on a wide range of medicine-related topics.”
“Jaded Julie, if your aim is to be in health care administration, these statements by the CEO of Sg2 ought to catch your attention: ‘This is 2001 in the airline industry. Make no mistake, the Southwest Airlines equivalents in health care are going to wreak havoc on the mainline health care providers.’ ‘Growth is not going to come from performing more procedures and getting more referrals, it is going to come from providing a fundamentally better product at a lower price point.’ “
“The CEO of Sg2 is obviously a bit of a salesman, but Curmudge, what he said is enough to waken you from your afternoon nap.”
“You be sure to be awake next time, Julie, and we’ll try to conjure up some countermeasures for the day of reckoning.”
Affinity’s Kaizen Curmudgeon
Note: An observation on the practice of emergency medicine in a primitive location may be accessed via this link.
“What do you expect, Jaded Julie? Everything I do is done slowly. I even sleep slowly. One of my friends once said, ‘Sleep is just practice for being dead.’ I practice slowly so I don’t get too good at it.”
“I understand that today we discuss the last of the health care ‘knowledge purveyors’ on our list, Sg2. This is another organization supported by membership dues and fees for services they provide. Fortunately, Affinity is a member.”
“On the Kaizen Curmudgeon scale of consultancies, Sg2 is neither a supermarket nor a ‘mom-and-pop store.’ Their team includes MDs, PhDs, RNs and health care leaders with extensive strategic, operational, clinical, academic, technological and financial experience. According to their home page, they ‘help build a foundation for improving care delivery and overall organizational performance.’ Their logo includes ‘health care intelligence.’ That certainly suggests a forward-looking focus.”
“Sg2 offerings include meetings, courses, and web seminars. Their EDGE intelligence system provides in-depth reports, growth guides, and technology guides on a wide range of medicine-related topics.”
“Jaded Julie, if your aim is to be in health care administration, these statements by the CEO of Sg2 ought to catch your attention: ‘This is 2001 in the airline industry. Make no mistake, the Southwest Airlines equivalents in health care are going to wreak havoc on the mainline health care providers.’ ‘Growth is not going to come from performing more procedures and getting more referrals, it is going to come from providing a fundamentally better product at a lower price point.’ “
“The CEO of Sg2 is obviously a bit of a salesman, but Curmudge, what he said is enough to waken you from your afternoon nap.”
“You be sure to be awake next time, Julie, and we’ll try to conjure up some countermeasures for the day of reckoning.”
Affinity’s Kaizen Curmudgeon
Note: An observation on the practice of emergency medicine in a primitive location may be accessed via this link.
Wednesday, April 27, 2011
The Crystal Ball 2
“Jaded Julie, during my days in industry there was an organization, supported by the industry, whose mission was the development of knowledge regarding the industry’s impact on the environment. This knowledge was for use in the near term, and it was developed in response to process changes and proposed government regulations. Basic research was done elsewhere, and an industry association handled government lobbying.”
“That’s all very nice, Curmudge, but why are you telling it to me?”
“I thought that for once I’d start by discussing a topic about which I knew something.”
“Well, that’s a switch, and it’s better than your usual prattle. But what does it have to do with health care?”
“Fortunately, there are similar organizations—developers and purveyors of knowledge—serving health care. People in hospitals are too busy with patient care, daily management (ready-to-serve time), hoshins (discretionary time), and other local issues to contemplate a global near-term future. That has created the need for outfits like the Institute for Healthcare Improvement (IHI), The Advisory Board, Sg2, and others. They are supported by membership dues and/or fees for participating in educational offerings and consortia devoted to specific issues.”
“These groups sound valuable, Curmudge. I understand that they are staffed by highly competent people whose job is to study, think, listen, talk, and write on behalf of the health care industry. Health care administrators are probably aware of the problems they will be facing, but they might feel overwhelmed by all of the countermeasures they could be implementing. According to their literature, these specialized consultancies help support and steer our thoughts in the direction of viable results with evidence and data to support them. Can you give me more specifics about these outfits?”
“As we said once before, IHI’s web site is a bit like a supermarket. If you have a problem, push your cart down the aisle; and you might find a solution. On our crystal ball timeline, IHI deals mostly with the present. However, its teachings will help organizations improve their near-term future. ‘IHI focuses on motivating and building the will for change; identifying and testing new models of care in partnership with both patients and health care professionals.’ IHI’s work is funded through their fee-based program offerings and services, and also through the support of foundations. Their reports, such as White Papers and Improvement Stories, are available to the public. Among the many subject areas are Office Practices and Patient-Centered Care. Here is an example of one of their forward-looking, fee-based colloquia to be held in 2011, ‘Thriving in an Era of Health Care Reform.’ ”
“Curmudge, I like your term, ‘purveyor of knowledge.’ Did you ever get paid for ‘purveying’ knowledge?”
“Not much, Julie, and any knowledge that I still have is free to a good home.”
“So what other purveyors of knowledge for the near term do we have for health care?”
“According to The Advisory Board, they are ‘the leading provider of comprehensive performance improvement services to the health care and education sectors—including operational best practices and insights, business intelligence and analytic tools, management training, unbiased technology evaluation, and consulting support.’ Note that they don’t work for health care exclusively. They have recently acquired Southwind, a ‘management and advisory firm focused on hospital-physician alignment and physician practice management.’ “
“It’s been awhile since we reminded our readers that a blog is not an encyclopedia or a textbook; all we hope to do is stimulate the readers’ interest. We can put them ashore, but they will have to explore the island by themselves.”
“For example, Julie, these are some of the programs accessible to corporate members of the Health Care Advisory Board: Strategy and Operations Research, Clinical Research, Leadership Development, Business Intelligence and Analytics, and Physician Performance. In our case, an Affinity employee can simply guide his mouse to the information of interest.”
“Curmudge, I understand that The Advisory Board has developed a lot of information on accountable-care organizations (ACOs). What’s an ACO anyway?”
“Good question, Julie, to which the answer is not completely defined. Here is the March 28, 2011 Wall Street Journal’s answer: ‘In broad outline (ACOs) propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care. When the group can show that it is improving care and delivers it for less than the cost projected—arrived at by crunching historical patient data for that market—a share of the savings goes to the ACO’s bottom line.’ This concept is part of the 2010 health care law and is not yet fully developed. It initially only applies to Medicare patients and, you’ll note, contains some features reminiscent of the medical home.”
“So what’s next, Curmudge?”
“What’s next will be in our next posting on this topic. Anyone who has read much about accountable-care organizations looks forward to quitting for the day, and c’est moi (that’s me). See you next time, Julie.”
Affinity’s Kaizen Curmudgeon
“That’s all very nice, Curmudge, but why are you telling it to me?”
“I thought that for once I’d start by discussing a topic about which I knew something.”
“Well, that’s a switch, and it’s better than your usual prattle. But what does it have to do with health care?”
“Fortunately, there are similar organizations—developers and purveyors of knowledge—serving health care. People in hospitals are too busy with patient care, daily management (ready-to-serve time), hoshins (discretionary time), and other local issues to contemplate a global near-term future. That has created the need for outfits like the Institute for Healthcare Improvement (IHI), The Advisory Board, Sg2, and others. They are supported by membership dues and/or fees for participating in educational offerings and consortia devoted to specific issues.”
“These groups sound valuable, Curmudge. I understand that they are staffed by highly competent people whose job is to study, think, listen, talk, and write on behalf of the health care industry. Health care administrators are probably aware of the problems they will be facing, but they might feel overwhelmed by all of the countermeasures they could be implementing. According to their literature, these specialized consultancies help support and steer our thoughts in the direction of viable results with evidence and data to support them. Can you give me more specifics about these outfits?”
“As we said once before, IHI’s web site is a bit like a supermarket. If you have a problem, push your cart down the aisle; and you might find a solution. On our crystal ball timeline, IHI deals mostly with the present. However, its teachings will help organizations improve their near-term future. ‘IHI focuses on motivating and building the will for change; identifying and testing new models of care in partnership with both patients and health care professionals.’ IHI’s work is funded through their fee-based program offerings and services, and also through the support of foundations. Their reports, such as White Papers and Improvement Stories, are available to the public. Among the many subject areas are Office Practices and Patient-Centered Care. Here is an example of one of their forward-looking, fee-based colloquia to be held in 2011, ‘Thriving in an Era of Health Care Reform.’ ”
“Curmudge, I like your term, ‘purveyor of knowledge.’ Did you ever get paid for ‘purveying’ knowledge?”
“Not much, Julie, and any knowledge that I still have is free to a good home.”
“So what other purveyors of knowledge for the near term do we have for health care?”
“According to The Advisory Board, they are ‘the leading provider of comprehensive performance improvement services to the health care and education sectors—including operational best practices and insights, business intelligence and analytic tools, management training, unbiased technology evaluation, and consulting support.’ Note that they don’t work for health care exclusively. They have recently acquired Southwind, a ‘management and advisory firm focused on hospital-physician alignment and physician practice management.’ “
“It’s been awhile since we reminded our readers that a blog is not an encyclopedia or a textbook; all we hope to do is stimulate the readers’ interest. We can put them ashore, but they will have to explore the island by themselves.”
“For example, Julie, these are some of the programs accessible to corporate members of the Health Care Advisory Board: Strategy and Operations Research, Clinical Research, Leadership Development, Business Intelligence and Analytics, and Physician Performance. In our case, an Affinity employee can simply guide his mouse to the information of interest.”
“Curmudge, I understand that The Advisory Board has developed a lot of information on accountable-care organizations (ACOs). What’s an ACO anyway?”
“Good question, Julie, to which the answer is not completely defined. Here is the March 28, 2011 Wall Street Journal’s answer: ‘In broad outline (ACOs) propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care. When the group can show that it is improving care and delivers it for less than the cost projected—arrived at by crunching historical patient data for that market—a share of the savings goes to the ACO’s bottom line.’ This concept is part of the 2010 health care law and is not yet fully developed. It initially only applies to Medicare patients and, you’ll note, contains some features reminiscent of the medical home.”
“So what’s next, Curmudge?”
“What’s next will be in our next posting on this topic. Anyone who has read much about accountable-care organizations looks forward to quitting for the day, and c’est moi (that’s me). See you next time, Julie.”
Affinity’s Kaizen Curmudgeon
Monday, April 18, 2011
The Old Men's Table
“When I arrive early for the weekly meeting of our service club, I get my food at the buffet and find a spot at a table that’s occupied by other old guys who came early. Although it’s not official, this has become a sort of Old Men’s Table. Looking around the room, I can identify the unofficial Politicians’ Table, the Successful Women’s Table, and several tables of younger men and women on their way up in the community.”
“So, Curmudge, what’s so special about the Old Men’s Table? I presume that it is populated by old codgers like you.”
“Sometimes, Jaded Julie, I am the youngest. Sadly, our tablemates tend to die off. Then we hear, ‘Carl died on Saturday? But he was sitting right in that chair last Tuesday. I can’t believe he’s gone.’ Well, my wife died three months ago, and I can’t believe she’s gone. Then someone else says, ‘My wife died four years ago, and I think about her every day.’ “
“That certainly sounds depressing; but I suspect that you are headed toward some sort of lesson, so I’ll keep listening.”
“After a few more comments about Old Carl, we return to our old-guy jokes. ‘I’m so old that I have to pre-pay when I order a three-minute egg.’ ‘I never fill my car’s gas tank because I’m afraid I won’t live long enough to use it all.’ ‘Who wants to live to be 90? Someone who is 89.’ “
“Curmudge, I surely hope you live long enough to get to the point of this story.”
“Don’t leave yet, Julie. Our old-guys group is about evenly divided between widowers and those with a living wife. The outlooks of the two groups are dramatically different. Those with a wife are concerned about dying and leaving their wife to fend for herself.”
“Of course we all know that widows fare better than widowers, but it’s easy to appreciate why a husband would be worried.”
“I certainly was. My wife couldn’t even stand on a ladder and change a light bulb. And because she was almost three years younger, it never occurred to me that I might outlive her. We even joked about the traveling she would do with her second husband.”
“So Curmudge, how does one’s outlook change when he becomes a widower?”
“Death is always worse when it disrupts the ‘orderly march to the grave,’ i.e., older people are expected to die first. So when one loses a younger wife, his grief is doubled. But he also is freed from his worry about his wife living by herself.”
“Perhaps, Curmudge, that explains why you appear cheerful on the outside but are grieving on the inside.”
“Another difference in the widower’s outlook is that death has lost much of its sting. We don’t fear death as long as it is not slow. One of the ‘old guys’ recently suffered a disabling stroke; everyone fears that. But at the same time, we don’t seek death either. We are not like Job, who ‘long(s) for death but it comes not,’ (Job 3:21). We are more like my mother who said long ago, ‘It doesn’t matter when I die…but not today.’ “
“So do we have a lesson to take home, Curmudge?”
“A Muslim friend said to me a few years ago, ‘Death is a part of life.’ There will be times in your life when you’ll need to remember that simple truth.”
Affinity’s Kaizen Curmudgeon
“So, Curmudge, what’s so special about the Old Men’s Table? I presume that it is populated by old codgers like you.”
“Sometimes, Jaded Julie, I am the youngest. Sadly, our tablemates tend to die off. Then we hear, ‘Carl died on Saturday? But he was sitting right in that chair last Tuesday. I can’t believe he’s gone.’ Well, my wife died three months ago, and I can’t believe she’s gone. Then someone else says, ‘My wife died four years ago, and I think about her every day.’ “
“That certainly sounds depressing; but I suspect that you are headed toward some sort of lesson, so I’ll keep listening.”
“After a few more comments about Old Carl, we return to our old-guy jokes. ‘I’m so old that I have to pre-pay when I order a three-minute egg.’ ‘I never fill my car’s gas tank because I’m afraid I won’t live long enough to use it all.’ ‘Who wants to live to be 90? Someone who is 89.’ “
“Curmudge, I surely hope you live long enough to get to the point of this story.”
“Don’t leave yet, Julie. Our old-guys group is about evenly divided between widowers and those with a living wife. The outlooks of the two groups are dramatically different. Those with a wife are concerned about dying and leaving their wife to fend for herself.”
“Of course we all know that widows fare better than widowers, but it’s easy to appreciate why a husband would be worried.”
“I certainly was. My wife couldn’t even stand on a ladder and change a light bulb. And because she was almost three years younger, it never occurred to me that I might outlive her. We even joked about the traveling she would do with her second husband.”
“So Curmudge, how does one’s outlook change when he becomes a widower?”
“Death is always worse when it disrupts the ‘orderly march to the grave,’ i.e., older people are expected to die first. So when one loses a younger wife, his grief is doubled. But he also is freed from his worry about his wife living by herself.”
“Perhaps, Curmudge, that explains why you appear cheerful on the outside but are grieving on the inside.”
“Another difference in the widower’s outlook is that death has lost much of its sting. We don’t fear death as long as it is not slow. One of the ‘old guys’ recently suffered a disabling stroke; everyone fears that. But at the same time, we don’t seek death either. We are not like Job, who ‘long(s) for death but it comes not,’ (Job 3:21). We are more like my mother who said long ago, ‘It doesn’t matter when I die…but not today.’ “
“So do we have a lesson to take home, Curmudge?”
“A Muslim friend said to me a few years ago, ‘Death is a part of life.’ There will be times in your life when you’ll need to remember that simple truth.”
Affinity’s Kaizen Curmudgeon
Friday, April 15, 2011
The Crystal Ball 1
“Today we’re going to play one of our ‘Curmudge-and-Julie-make-believe’ games.”
“Ooh, Curmudge, the last time we did that I was seriously ill.”
“Don’t worry, Jaded Julie. This time the outcome will be better. Your role is to be a middle manager in a health care organization—one whose operating philosophy is command-and-control and where everything is done the way it has always been done.”
“Hey, that outfit is suffering from organizational obsolescence. They are really behind the 8-ball. Don’t they read or use computers? They must think that Google is a character (Barney Google) in a silly song. But say, Curmudge, I thought we were going to explore the future, and here we are talking about an organization living in the past.”
“We have to start somewhere, and even today there are probably command-and-control organizations out there. It wouldn’t be proper to just blow right by them. Their first need is to realize that employees are more productive when they are respected and that problems are best solved by the people in gemba…”
“…and that traditional hospitals tend to be wasteful, and that systems are best understood and improved after they are mapped. I’ve got it, Curmudge. Making these improvements is just common sense. Understanding this is where a traditional organization has to start if they want to join the rapidly changing world of health care.”
“One problem, Julie. People have their own, unique concept of common sense. We would have chaos if every person went his own way making improvements. People’s creative energies need to be harnessed and focused by using a structured program like Lean. We’ve talked about Lean in this blog for the past four years. However, for the total neophyte’s remedial reading we recommend a review of similar programs in the April 14, 2011 posting in Curmudgeon’s Wastebasket. ”
“People use lots of names for their improvement program, including those that are unique to their organization. Most of them are based on the principles of the Toyota Production System. But tell me, Curmudge, how should the wayward outfit whose role I am playing get their culture change under way?”
“Since Affinity began their Lean journey several years ago, a ton of books have been written and an army of consultants have come out of the woodwork. However, the absolute least expensive way to learn about Lean is to read Kaizen Curmudgeon. You’ll also want to benchmark organizations that have been describing their Lean successes at meetings. At some point you will probably want to contract with a sensei (honored teacher) for guidance. The best way to find such a person is to talk with people who have been where you want to go.”
“After I have done a lot of reading and become a dedicated change agent, what’s my next step?”
“Julie, leading from the middle of an organization is like pushing a rope. Nevertheless, it’s essential that those higher in the organization—especially at the top—become emotional, vocal, and physical supporters of the proposed new culture. However, your task should not be impossible if these (paraphrased) comments from a recent meeting of the American College of Healthcare Executives are valid: ‘They have heard, and hopefully understand, that they are going to have to change their organizations in major, cataclysmic ways especially if they haven’t started to do so already. Leaders in general are now much more knowledgeable about the steps they will have to take. They understand they have to adopt Toyota and Lean manufacturing strategies.’ “
“Whew! That helps. Let’s assume that I am successful and that the organization has set sail on its Lean journey. Can I sit back and relax?”
“No way! It may have taken herculean efforts to get the flywheel turning, but it is not frictionless. Maintaining a Lean program requires dogged determination and almost religious dedication. And ideally, it never ends.”
“Perhaps it’s a bit like marriage, Curmudge. You’d better hardwire the whole concept, because it’s going to be your partner for a long time.”
“In addition, Julie, as the resident futurist you will want to expand your horizon. Instead of thinking how better to organize a supply closet, you’ll want to know what’s coming down the pike that will impact your organization.”
“Wow! That’s a gigantic expansion. I assume we’ll talk about that next time. By the way, Curmudge, are you a futurist?”
“Of course I am, but for me the future is tomorrow. That’s why if I wake up in the morning, every day is a beautiful day.”
Affinity’s Kaizen Curmudgeon
“Ooh, Curmudge, the last time we did that I was seriously ill.”
“Don’t worry, Jaded Julie. This time the outcome will be better. Your role is to be a middle manager in a health care organization—one whose operating philosophy is command-and-control and where everything is done the way it has always been done.”
“Hey, that outfit is suffering from organizational obsolescence. They are really behind the 8-ball. Don’t they read or use computers? They must think that Google is a character (Barney Google) in a silly song. But say, Curmudge, I thought we were going to explore the future, and here we are talking about an organization living in the past.”
“We have to start somewhere, and even today there are probably command-and-control organizations out there. It wouldn’t be proper to just blow right by them. Their first need is to realize that employees are more productive when they are respected and that problems are best solved by the people in gemba…”
“…and that traditional hospitals tend to be wasteful, and that systems are best understood and improved after they are mapped. I’ve got it, Curmudge. Making these improvements is just common sense. Understanding this is where a traditional organization has to start if they want to join the rapidly changing world of health care.”
“One problem, Julie. People have their own, unique concept of common sense. We would have chaos if every person went his own way making improvements. People’s creative energies need to be harnessed and focused by using a structured program like Lean. We’ve talked about Lean in this blog for the past four years. However, for the total neophyte’s remedial reading we recommend a review of similar programs in the April 14, 2011 posting in Curmudgeon’s Wastebasket. ”
“People use lots of names for their improvement program, including those that are unique to their organization. Most of them are based on the principles of the Toyota Production System. But tell me, Curmudge, how should the wayward outfit whose role I am playing get their culture change under way?”
“Since Affinity began their Lean journey several years ago, a ton of books have been written and an army of consultants have come out of the woodwork. However, the absolute least expensive way to learn about Lean is to read Kaizen Curmudgeon. You’ll also want to benchmark organizations that have been describing their Lean successes at meetings. At some point you will probably want to contract with a sensei (honored teacher) for guidance. The best way to find such a person is to talk with people who have been where you want to go.”
“After I have done a lot of reading and become a dedicated change agent, what’s my next step?”
“Julie, leading from the middle of an organization is like pushing a rope. Nevertheless, it’s essential that those higher in the organization—especially at the top—become emotional, vocal, and physical supporters of the proposed new culture. However, your task should not be impossible if these (paraphrased) comments from a recent meeting of the American College of Healthcare Executives are valid: ‘They have heard, and hopefully understand, that they are going to have to change their organizations in major, cataclysmic ways especially if they haven’t started to do so already. Leaders in general are now much more knowledgeable about the steps they will have to take. They understand they have to adopt Toyota and Lean manufacturing strategies.’ “
“Whew! That helps. Let’s assume that I am successful and that the organization has set sail on its Lean journey. Can I sit back and relax?”
“No way! It may have taken herculean efforts to get the flywheel turning, but it is not frictionless. Maintaining a Lean program requires dogged determination and almost religious dedication. And ideally, it never ends.”
“Perhaps it’s a bit like marriage, Curmudge. You’d better hardwire the whole concept, because it’s going to be your partner for a long time.”
“In addition, Julie, as the resident futurist you will want to expand your horizon. Instead of thinking how better to organize a supply closet, you’ll want to know what’s coming down the pike that will impact your organization.”
“Wow! That’s a gigantic expansion. I assume we’ll talk about that next time. By the way, Curmudge, are you a futurist?”
“Of course I am, but for me the future is tomorrow. That’s why if I wake up in the morning, every day is a beautiful day.”
Affinity’s Kaizen Curmudgeon
Thursday, April 7, 2011
The Crystal Ball--Prologue
“Curmudge, in this turbulent world, how were you able to stay employed so long?”
“Well Jaded Julie, I kept reinventing myself. I was always looking for ways in which my experience matched my employer’s needs. Often it was difficult to anticipate what those needs would be. Ultimately I became ‘retired’ when I ran out of inventions.”
“The outlook for health care in the U.S. appears to be even murkier than what you experienced in industry. Nevertheless, are there people or organizations who are trying to foresee our admittedly cloudy future?”
“Of course, Julie. But forecasting becomes more risky as one tries to peer farther into the unknown. Let’s start with the near term. Because most everyone already knows that we must become more efficient tomorrow, next month, and next year, we can forge ahead with process improvements with no concern that we might be wasting our effort. But planning ten or twenty years ahead is much more difficult.”
“C’mon, Curmudge, at your age planning ten years into your future is overly optimistic and twenty years out would be a waste of time.”
“Regrettably, that’s true. As you already know, I don’t even buy green bananas. However, for those folks like you anticipating a long and successful career, let’s try to look ahead anyway. Of course, you are not going to make it into the future unless you can make it through today. So we’ll start by describing resources that every health care organization should be using right now. And along with being contemporary, this knowledge is used locally, i.e.; it’s applied by the workers in gemba.”
“It sounds as if you are talking about Lean, which all of our readers should understand pretty well. But why should I, a nurse, push my knowledge horizon out into the future?”
“Be optimistic, Julie. In health care, nursing can be the gateway to most anything in the organization. The business unit and corporate leaders of the future had better understand what will be going on around them.”
“I’m convinced, Curmudge. May I sign up for your trip over the rainbow?”
“Of course. Pack your carry-on; we depart in a week or two.”
Affinity’s Kaizen Curmudgeon
“Well Jaded Julie, I kept reinventing myself. I was always looking for ways in which my experience matched my employer’s needs. Often it was difficult to anticipate what those needs would be. Ultimately I became ‘retired’ when I ran out of inventions.”
“The outlook for health care in the U.S. appears to be even murkier than what you experienced in industry. Nevertheless, are there people or organizations who are trying to foresee our admittedly cloudy future?”
“Of course, Julie. But forecasting becomes more risky as one tries to peer farther into the unknown. Let’s start with the near term. Because most everyone already knows that we must become more efficient tomorrow, next month, and next year, we can forge ahead with process improvements with no concern that we might be wasting our effort. But planning ten or twenty years ahead is much more difficult.”
“C’mon, Curmudge, at your age planning ten years into your future is overly optimistic and twenty years out would be a waste of time.”
“Regrettably, that’s true. As you already know, I don’t even buy green bananas. However, for those folks like you anticipating a long and successful career, let’s try to look ahead anyway. Of course, you are not going to make it into the future unless you can make it through today. So we’ll start by describing resources that every health care organization should be using right now. And along with being contemporary, this knowledge is used locally, i.e.; it’s applied by the workers in gemba.”
“It sounds as if you are talking about Lean, which all of our readers should understand pretty well. But why should I, a nurse, push my knowledge horizon out into the future?”
“Be optimistic, Julie. In health care, nursing can be the gateway to most anything in the organization. The business unit and corporate leaders of the future had better understand what will be going on around them.”
“I’m convinced, Curmudge. May I sign up for your trip over the rainbow?”
“Of course. Pack your carry-on; we depart in a week or two.”
Affinity’s Kaizen Curmudgeon
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