“You know, Curmudge, if a reader surfed onto this posting without having read those that preceded it, he/she would think, ‘who are those two presumptuous people who write as if they know so much?’ Of course, those who have read our postings all along realize that we are just messengers trying to convey the teachings in Clayton Christensen’s book, The Innovator’s Prescription.”
"Don’t worry, Jaded Julie. Anyone acquainted with us knows that we more closely resemble copy-cats than visionaries. So let’s pick up the story where we left off. Christensen proposed that in the future precise diagnoses and predictably effective therapies will move providers upward on the scale of medical practice. Nurse practitioners will disrupt primary care physicians; primary care physicians will disrupt specialists, etc. Next, Christensen considers how changes of this sort will impact hospitals and other health care institutions.”
“Even in my lifetime, Curmudge, there will remain some afflictions that can’t be diagnosed and treated by precision medicine. Patients with these problems will go to hospitals that specialize in intuitive medicine, which Christensen (inelegantly) calls ‘solution shops.’ The Mayo Clinic is a modern-day solution shop where a team of world-class specialists—paid a salary—will diagnose your illness and then use state-of-the-art therapies to test their hypothesized diagnosis and hopefully effect a cure.”
“Actually, a large part of most of today’s general hospitals is, effectively, a solution shop. Their diagnostic efforts require large laboratories, an array of advanced imaging instruments, and specialists of (almost) every description. Christensen calls the other part of a general hospital’s business their ‘value-adding process (VAP) activities.’ Here they fix problems after definitive diagnoses have been made. Things like hip and knee replacements, CABG and angioplasty heart repairs, and hernia and cataract surgery.”
“I’ve read about dedicated VAP facilities, Curmudge. Everything is standardized and focused on doing a limited number of procedures very efficiently and for a flat fee. Shouldice in Canada does only hernia repair, and there are others that patients travel to in Asia (‘medical tourism’). In Pennsylvania, Geisinger charges insurers a flat rate for heart bypass surgeries and effectively provides a 90-day warranty.”
“Christensen sees general hospitals as attempting to implement two different business models under one roof, i.e., acting as a solution shop as well as a VAP facility. He suggests that the high overhead of the low-volume solution shop part of the hospital is subsidized by the hospital’s high-volume routine surgeries. Typically, a solution shop bills on a fee-for-service basis, while a dedicated VAP facility can charge a flat rate because their outcomes can be forecast.”
“So put it all together, Curmudge, and tell me how disruptive innovation can at some point in the future impact today’s general hospital.”
“A dedicated VAP facility using standardized procedures is likely to be more efficient and effective and less costly than a general hospital. ‘Toyota taught the world that if we do a task differently every time, it’s very hard to improve the result.’ “
“That sounds like an endorsement for standard work in health care.”
“In the future, a general hospital’s solution shop business is apt to get pinched from both sides. Recall, Julie, our discussion of the enhanced diagnostic power that technology and telemedicine will bring to the primary care physician’s office. That will disrupt the solution shop side of the hospital for the more straightforward diagnoses. Finally, the tough diagnoses that remain will be best tackled by a focused solution shop like the Mayo Clinic or the Texas Heart Institute. For his own diagnosis Dr. Grossman, Christensen’s coauthor, went to National Jewish Medical Center in Denver. The cost of traveling to such a place will be trivial compared to ‘thousands of dollars spent on the wrong prescription drugs and devices that were the result of inaccurate, incomplete diagnoses by a stream of individually operating specialists.’ “
“Let’s move on to the next subject. What did Christensen say about chronic diseases? And who will be able to pull off these disruptive changes in health care?”
“That will be next time, Julie. Don’t go away.”
Affinity’s Kaizen Curmudgeon
Tuesday, May 31, 2011
Friday, May 20, 2011
Happy Fourth Birthday
“Curmudge, did you forget that May 23 will be the fourth birthday of the Kaizen Curmudgeon blog? Here, blow out the candles that I put on this cupcake.”
“Pooof…”
“Hey, you missed one.”
“At my age, three out of four isn’t bad. So by way of celebration, let’s reflect a bit on what we have done and what we are doing. Four years ago you, Jaded Julie, were just a straight man for Curmudgeon.”
“Straight person, Old Guy. A little political correctness, please.”
“Now you are a valued colleague with a growing vocabulary and a tolerance for an occasional profundity in a foreign tongue. You even read the same books that I do, and you waken me when I fall asleep in mid-sentence.”
“I must admit that we occasionally stray from our original subject, Lean in health care. At least we adhere to our plan of sharing the essential lessons of books and papers that our readers are unlikely to have time to read.”
“And sometimes we discuss things we have experienced that just cry out to be shared.”
“You are of course referring to universal concerns like the end-of-life issues in our postings on Way to go! and The Old Men’s Table. It would be unfair to our readers to depict life as always a rose garden. They need to understand that we at Affinity are thinking about serious things.”
“Speaking of serious things, Julie, do you realize that our birthday has popped up right in the middle of our series on the future of health care, which we have termed The Crystal Ball? Let’s cut out of this birthday frivolity and get back to work on health care’s future.”
“I’m right with you, Curmudge.”
Affinity’s Kaizen Curmudgeon
“Pooof…”
“Hey, you missed one.”
“At my age, three out of four isn’t bad. So by way of celebration, let’s reflect a bit on what we have done and what we are doing. Four years ago you, Jaded Julie, were just a straight man for Curmudgeon.”
“Straight person, Old Guy. A little political correctness, please.”
“Now you are a valued colleague with a growing vocabulary and a tolerance for an occasional profundity in a foreign tongue. You even read the same books that I do, and you waken me when I fall asleep in mid-sentence.”
“I must admit that we occasionally stray from our original subject, Lean in health care. At least we adhere to our plan of sharing the essential lessons of books and papers that our readers are unlikely to have time to read.”
“And sometimes we discuss things we have experienced that just cry out to be shared.”
“You are of course referring to universal concerns like the end-of-life issues in our postings on Way to go! and The Old Men’s Table. It would be unfair to our readers to depict life as always a rose garden. They need to understand that we at Affinity are thinking about serious things.”
“Speaking of serious things, Julie, do you realize that our birthday has popped up right in the middle of our series on the future of health care, which we have termed The Crystal Ball? Let’s cut out of this birthday frivolity and get back to work on health care’s future.”
“I’m right with you, Curmudge.”
Affinity’s Kaizen Curmudgeon
Thursday, May 19, 2011
The Crystal Ball 5
“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.
“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 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
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