Systemic Complexity in Service Creates More, Well, Complexity

People are having serious difficulty understanding the selection/purchasing process for vital products/services.

Exhibit A: The subprime mortgage meltdown (hold on to your 401ks ladies and gents -we'll revisit the issue in Q3 of '08).

Housing is one of the biggest investments we can make, and some of us are bumbling it in our semi-blind pursuit of the American Dream -accepting more risk than we can reasonably afford with ARMS and negative amortization plans.

Exhibit B: A hospital stay.

This isn't yet a right (still a privilege for those who can pay except for "emergency" care), but it will be interesting to see how politicos in the coming year frame healthcare for all. If the founding fathers wanted to tack something else onto the Constitution, it might read life, liberty, the pursuit of happiness, and the pursuit of health. Our physical/mental/spiritual health influences every aspect of our lives, and yet most of us are woefully out of touch with how to keep our bodies tuned up and running like a well-oiled machine.

What do the mortgage market and the H/HC market have in common?

If you look at the two markets on a conceptual level, similarities emerge.

First, both are services we undoubtedly need. And there are plenty of providers for those with money to spend.

Second, both the mortgage lender and the hospital may 'talk' consumers into products and services based on a one-size-fits all approach that doesn't suit the needs of each individual.

Third, both industries are under fire. Some point the finger of responsibility for crisis at the lenders and hospital systems, some comment that consumers aren't taking enough responsibility for the weight of their own choices. Both observations are partly correct.

The reality is that there's plenty of blame to go around, and blaming is usually an exercise in futility. Yes, these systems have problems - big ones. Yes, consumers need to take more responsibility for educating themselves about the choices they make. Yes, providers must take on additional time/expense burdens related to creating a more knowledgeable, informed base of customers.

Can you educate all consumers all the time and expect each to make logical decisions prior to purchasing? Heck no...not in theory, and certainly not when it comes to hot ticket items like homes and health. However, it also doesn't mean you stop trying.

Complex services and markets require complex solutions. Hospitals don't have an invisible hand of oversight similar to that of the Federal Reserve which pulls market-controlling strings, although The Joint Commission is certainly trying to achieve similar lofty status.

So what to do? Educate, educate, educate.

Make information available to your consumers. Have staff dedicated to shepherding them through the process. If I was an MBA student right now interested in a healthcare career, I'd seriously consider a business plan for outsourced patient advocate corps that could be replicated at hospitals nationwide (if anyone's interested, let me know - this is a concept I'd love to flesh out). Read this great post by Dr. Malpani, aka The Patient's Doctor, for one idea of how to bring this concept from page to stage.

A Week's Worth of Must-Reads

Every once in a blue moon so many good H/HC articles pile up in my Inbox that I can't address all of them in a timely fashion.

So here are a few of this week's (and last week's) best for your edification:

1. Aging Japan Struggles to Rein in Healthcare Costs
(aka The US Outlook in 10 Years)

"Other ageing nations will be watching closely to see how far the heavily indebted
government can rein in costs especially as the number of elderly in Japan creeps up with
projections that 40 percent of the population will be aged 65 and over by 2055."

2. One-Third of US Lacked Health Insurance
(aka The Reason We Need More Organizations Like MEDBANK)
Blogger's Full Disclosure (aka Always Read the Fine Print: I sit on the BOD at Medbank of MD)

"The report found that more than 79 percent of those without insurance were in families in which at least one person had a job, 70.6 percent were themselves employed full-time, and 8.7 percent were employed part-time."

3. Do You Know Where Your Next CEO Is?
(aka Well Punk, Do Ya? Forget Having Two Successors Handpicked - Try 4 Per
Generation...MINIMUM)

If you're having difficulty recruiting administrators/execs/BOD members from outside the industry NOW, imagine the conundrum you'll have 10 years from now when those with the most desirable experience have been promoted to C-level positions at established
organizations before the age of 40...try snapping us up then.

4. 70% of Churches Provide Healthcare Services
(aka Forget Retail Clinics - Churches May Be Your Biggest Competition...and If You Thought JCAHO Was Tough, Just Try Taking on an Active Congregation)

"...churches said that they provided counseling or support groups for mental health or
substance abuse problems, tests for medical conditions such as hypertension and high
cholesterol, flu vaccinations and sponsorship of health clinics for members or the community. In addition, 65% of churches said that they provided health care education
programs, and 51% said that they offered financial assistance for medical bills.."

An Invitation, Dear Readers...

You may have noticed the Innovation Challenge judge logo on the left frame of Health Mgmt Rx recently.

The good news? Idea Crossing wants more talented judges - I'd love for you to get involved, dear readers.

Each year, top MBA teams from all over the states gather at the Darden School of Business (UVA) to address business-case issues for 5 top organizations at Idea Crossing's "Innovation Challenge."

The thinking is team-based. Resultant plans are creative and implementation-oriented. This is one of those great opportunities where teams learn by planning (and presenting) in a pressure-cooker atmosphere.

If you like HBS case studies, McKinsey Quarterly Articles, and Trump's show The Apprentice, judging The 2007 Innovation Challenge is a great way to spend a few evenings.

There's a dinner for judges at the conclusion of the contest and other perks, including HHonors points. Plus, the judge who recruits the most OTHER judges wins a lesson on a Harley. In addition to my altruistic motivations, and in the interest of full disclosure - let's be honest here - I'd love that ride...

2007 sponsors include:
Hilton Hotels
OPEN from American Express
Whirlpool
Lexmark
Harley-Davidson
Shell

Hope to see some of you at Darden in November...any takers?

www. innovationchallenge.com

Random Schtuff II - Wellness Plans

Why are many businesses, especially hospitals and healthcare orgs, waiting to design wellness programs?

We already have much of what we need on-site or close at hand...fitness facilities (Rehab medicine, etc.), dietary plan assistance (dining/food services and dieticians), a large area to walk (indoor walk plan, doing stairs, etc.), etc.

If complications related to chronic conditions eat up 90 cents of each healthcare buck (according to Dr. Feld's blog here), and the American Journal of Health Promotion metrics show you might expect a 3 to 1 payback on each dollar spent on a wellness program, what are we waiting for?

The Journal studied the plans of 200 companies and set average 3- to 6-year return on investment on those plans at 348 percent. THREE HUNDRED FORTY EIGHT PERCENT.


Provant Health Solutions says a firm will see improved absenteeism in the first 6 to 18 months of putting a wellness plan into action, according to HR Daily Advisor, an e-newsletter published by BLR.com.

If I was interviewing, I'd also count a company with a wellness plan as a top-notch competitor for my work-time and talent. They make me healthy, I work well for them - that's a partnership I can live (and work) with.

Cost improvements aside, don't we as H/HC business leaders and managers have an obligation to manage our resources efficiently (paying attention to the overall 'health' of our organization) and demonstrate ethical concerns for the health and well-being of our employees?

Am I being hopelessly idealistic here or does enacting a wellness policy represent best-practice good management?

Random Schtuff I

Random Schtuff #1:

According to Investor's Business Daily (some issue from last week that was a soggy delight of a pile on my stoop today), the Boston Museum of Fine Arts is the first US museum
making money repurposing its collection as cell phone art. Talk about a brilliant stroke of
newtech marketing. For a buck ninety-nine you can download a single copy of famous works
like Houses at Auvers by van Gough (for all of you out there in the mental health field) or
Monet's Water Lilies. If that's not enough culture for your celly, for less than a latte and
muffin at Starbucks ($4.99) you can get a months subscription with five backgrounds.

Next gen hospital advertising is only a nanostep behind; I can see the hospital silhouette backgrounds now...and if I was really ambitious I'd figure out how to put a
cool xray image of my ankle with an ex-fixator on my Berry background.

Also if I was on staff in charge of acquisitions on Ebay I'd get in on this yesterday...

Couldn't Have Said it Better Myself...

Yesterday Carolyn, a loyal reader and commenter (thank you!) who is enrolled in an MBA program somewhere out there in brick-and-mortar land, left this comment.

I'm posting it as a stand-alone entry because it sums up proper consumer behavioral research processes perfectly.

Before postulating what your consumers want/will use/will buy, you need an accurate snapshot fleshed out with quantitative metrics to back up your theories.

CK - I couldn't have said it any better:

"It sounds as if a lot of quick assumptions are made about consumers without any sort of market research behavior to support or refute such assumptions. Any successful customer experience begins with first knowing your customers (demographics - literacy levels would be included in this category), and then understanding them (psychographics - behavior patterns and expectations).

Until you have a solid grasp on these two items, you should never presume to know what consumers would do and what would succeed/fail."

Point taken Carolyn - Research first, blog/talk and implement later.

Underestimating the Consumer

It's true - Parkland Hospital in Texas has installed airline-type kiosks in its ED area.

I'm not sure I'd go that far...in my vision of a dream hospital yesterday I imagined using these self-check in machines for surgery pre-registration.

Criticism from the medical community in the blogosphere has raised several key points about the use of consumer-controlled tech in the hospital setting, namely:

• What are they NUTS? Asking ED patients to self-identify and map out symptoms? They might as well put out a candy jar with pre-signed scripts for Demerol...

• Patients with 'true' emergencies will be bleeding all over the touch screens, and I can just see the sentinel event/M&M report now: "Patient expired trying to type last name while bleeding out post MVA."

• Non-emergency patients with communicable diseases, nasty flus, flesh-eating bacteria, or other disgusting things will smear their grossness all over the screen, making it unusable for anyone else (hello? have you people SEEN the public bathrooms in EDs lately?)

• And my personal favorite (drum roll please)..."Consumers" with an average literacy level little above a middle-schooler will not know how to use this new-fangled technology, so it won't work.
  

All are interesting points, no doubt about it.

And obviously if you're using kiosks in the ED, a patient's self-entry of symptoms shouldn't supercede a good ol' fashioned triage.

But it's the last bullet I want to focus on for now; the one that assumes consumers will not be able to figure out the system and employ it efficiently.

This is the worst kind of hypocrisy from medical staff members who use a 1-10 pain scale with emoticons and expect consumers to successfully navigate the managed care environment and rabbit warrens that are most hospital floor plans.

To those who underestimate consumers, I offer these examples that 'overestimated' consumers and successfully innovated for new products and services that have become market leaders (or just pretty darn nifty):

• Starbucks: Who the heck would order a double whip skinny triple whatever with sugar free vanilla before this Seattle chain took over the world (literally)? They created a market for 'luxury' coffee drinks where consumers were happy (relatively speaking) with convenience store sludge. If you build it they will come...

• Apple: I-what? Who wanted a mini player that just regurgitated songs you'd already bought in a random order? The Shuffle and other iPod models again created a market where one didn't exist. And guess what? The consumers figured it out just fine.

• Google Earth: Pictures of the planet? Outside a National Geographic back-issue? Google Earth has enthralled thousands with satellite images of our Big Blue and Green. Does it make them money? Who knows. Who cares? It's pretty darn cool.

• Your local library: Now most of us can hop online for free at local libraries and renew books, search the card catalog, and bypass that tricky Dewy Decimal thingie. Pure brilliance. This faculty was formerly available only to highly educated librarians, who have masters and doctorates related to all this good bibliophile stuff. But even elementary-schoolers who are first generation Americans and speak very little English are picking up this system using foreign language versions (Spanish).

Let's simplify things a bit though.

No matter whether you can read or write in English (or speak), all of us not visually impaired can head into a McDonald's and pick what we want from the menu and order. And there are systems to accomodate the sensory-challenged.

How? Using the most basic of human communication - picture and point.

With check-in kiosks we just switch up the format a bit...it's not picture and point but rather picture, point, and click.

For us to believe consumer based innovations in the hospital setting won't work is a form of underlying elitist bias that underestimates the consumer and simultaneously reduces the chance of patients and consumers advocating for system-level change.

Give us our fair share of responsibility. Or, if you prefer, give us more thingies to buy. With choices we've never seen before we tend to reach for wallets faster. Even with bloody fingers.