The Value of Oddball Data

Key Thought:

Solving complex, messy business problems by NOT ignoring data that does not fit.

Background:

Harvard Business Review published an excerpt of discussion between Roger Martin – author of “The Design of Business”, and Stephen Scherer, world-renowned autism spectrum disorder and genomics researcher where it illustrate the 3 stages strategy described in the book.  1) staring into the mystery, 2) developing a heuristic, or rough rule of thumb; and 3) creating an algorithm, or step-by-step formula for addressing the problem.

Summary:

Martin

- most problem solvers would start with a hypothesis, test it, and then look for data that confirm or disprove it

-  identify the mystery, then attacked the mystery by asking what is true, rather than what was true

- scientific method focus on creating reliable outcome, but major leap in knowledge comes from achieving a valid outcome

- using well-horned template saves time, but we can forget to look at the mysteries entirely

Scherer

– my belief is that answers to really difficult problems can often be found in the data points that don’t seem to fit existing frameworks

- quantitative measures that produce reliability often strip away nuance and context and thus sometimes even prevent the discovery of a valid outcome

My Comments:

A startling thought consider how well-drilled we are in the reliability reproduction of outcome as the bedrock for the scientific method.  In complex, messy problems, it is often better to look at the mysteries first.  In conclusion, read the book first, and try apply it to a problem we have – like how to improve profitability!

Reference: Conversation: two leading researchers discuss the value of oddball data, Harvard Business Review, November 2009, pg 26.

Planetree Conference 6 Part 3 of 3

Last installment!

3 Doctors – Dr. Davies, Jenkins, and Hunt.  3 young doctors who banded together and beat the odds (they grew up in the ghettos of Newark)

Dr. Davies

- “young minds aiming for something you can’t see is very tough” –

- They are not smarter than the rest, just teamwork

- Enjoy ER because he treat patients they way he would treat his mother – he imagine every patient is like his mother

- Nurses are always right!

Dr. George Jenkins

- 13 years old had bad crooked teeth, the dentist treated him so well, he aspire to be like him – you never know, one act of kindness can change someone’s life forever

- Started a foundation when graduated even though they were broke, because they remember where they come from

Dr. Hunt

- You never know when a little thing to do change someone’s life – that’s the point, you never know

- There were so many times this has happen

- The kid at the back who just need the extra attention

- Every time a patient look at the watch, it’s the most insulting thing, it means you are not on time

- When patient talks about their family wrote down on the margin, next time will ask them how they are, it’s just good medicine, because others has done that to him

- Patient story: she was a complainer, but a nurse who spend time talking to her, eventually she become a solid supporter of the hospital, sometimes patients just need some ‘love’

If we have these kind of doctors, we can all go home early and sleep well!

Planetree Conference 6 Part 2 of 3

Day 3 Keynote Speaker No. 2

Dr. David Katz – John Hopkins University – Life and Death, Knowledge & power: why knowing what matters isn’t what’s the matter

- It does us no good if the reason for death is disease of the coronary artery

- McGinniss, Foege – actual causes of death in the U.S (Journal of American Medical Association paper) 1993: 270.2207-12 – we have the knowledge to define these death.  What we know and what we do is to different thing

- Master levers of destiny is our feet, forks & fingers [choices we make with lifestyle, diet, exercise etc]

- Dean Ornish study was quoted, Potsdam study.  Are we living [a life] or just not dying?

- Medical prowess has delay death but what about living well?

- He claimed: Obesity is a cause for all cancers except for certain skin cancer and certain brain tumour

- Rise in diabetes, coronary disease, insulin resistant conditions

- We call type 2 diabetes, it’s just a euphemism for when children get adult onset diabetes before age of 10! – we have sanitized it, and make the disease not as serious

- We need to turn our knowledge into power

• 17 years old getting triple bypass
• The trend has to stop
• Teenage coronary artery looks like adults (a study of teenagers using ultrasound to scan their blood arteries)

- We live longer today but live with chronic disease

- Healthy lifestyle can do:

• 80% reduction in heart disease
• 90% reduction in diabetes
• 60% reduction in cancer

- The trouble with public health is there’s no ‘public’ involved.  Each health episode is delivered in person.  Think about that one particular person, what can we do for him/her?

- We have known all these for 17 years (refer to study reference above, first publish date), but we haven’t done anything.  Imagine if we have?

- Favorite symbolism – polar bear in the desert.  We are a product of our environment, we adapt in the calorie deficient environment.  But what happen when that environment no longer exist?  We have more food, we eat more.  Like the polar bear, the very thing that keep him alive in the polar region will cook him alive in the desert.  How about human beings?

- Read Michael Pollen’s [not sure spelling] book – In Defense of Food

- If it glows in the dark, you probably shouldn’t eat it – reference to artificial flavouring, colouring and process food

- Now we have an environment that condemn us to fail (conspire against us to succeed).  Supermarket aisle, abundance of food, all the wrong food in the supermarket etc

- We place all the emphasis on willpower, it should be skillpower

- He invented NoVal – a simple numbering system to rank supermarket food by nutrition value

- Also created Activity Burst in Classroom (ABC) – dramatic result in healthier school kids, better grades and less disciplinary problem.  How? By having recess (a novel idea suddenly)!  It’s been scientific proven and published now.

- Government created No Child Left Behind, but perhaps taking out recess, we are encourage our kids to ‘No Child Left (on their) Behind

- Story of ABC

• 5 ½ year old son was with him when he was giving a talk, he was so restless, he (father) ask the son to run around the hall.
• At lap 1 – he completed the lap and sat down, then with an impish grin, took off again
• At lap 2 – he wave and kept going
• At lap 3 – 3 other kids follow him
• At lap 4 – 35 kids were running around the hall!

- Rumbuctious kids should be treated with recess, not Ritalin

- ABC reduces asthma medication by 17%, reduces ADHD medication use by 33% - proven, see website for more details

- Only one place to grow a kid, food is the only way.  So do we want to build him/her out of junk or good food?

- Teach kids simple way to find good food.  Husband and wife invented Nutrition Detectives.  Teach them 5 clues

• Big letters, beware of them
• 1^st ingredient usually means the most content
• Beware of partially hydrogenated oil, corn syrup, trans fat
• Long list of ingredients usually means bad.  What’s the ingredient for broccoli?  Broccoli, simple
• Choose whole grain

- Fiber is your friend

- Program to train them as Certified Nutrition Detectives

Once again a particularly inspiring talk.  Check out the website: http://www.davidkatzmd.com.

More later…

Planetree Conference 6 Part 1 of 3

Day 3 of conference proper consisted of a series of keynote address.

James Canton, Phd – Futurist, Title: Extreme Future of Healthcare

- Question: is it possible to transform healthcare to become cost effective and high quality care?

- Key trends – asymmetric risk

• Eg. Alzheimer will affect 1/3 men over 70 years old

- At least 50 companies at working on retrieving memories in the brain

- Yesterday Wall Street Journal reported that the State of Pennsylvania will publish all quality data for all hospitals in Penn State

- We are in the era of consumer genomics – what we can do, what insurance co can do, government can do with the data is still largely unexplored

- Hospital can becomes the arbiter of information (overload) – we (hospitals that is) are already trusted to cure/disease management, why not extend the continuum

- With all these data and information, can we move to Predictive Medicine, instead of Reactive Medicine?

- Population is aging, different buckets of demographics uses technology different [important as we think about how to employ technology for patient-centered healthcare]

o 25% Gen Y (> 1976), 10% Gen X (1965-1975), 40% Boomers (1946-1964), 25% Mature (<1946)

- Health 2.0 – everything digital about healthcare, that’s where everyone is focus on right now

- 7 Characteristics of Healthcare in the near future

• Patient centered, humanistic (personalization)
• Predictive
• Preventive
• Wellness vs Disease focus
• Self-care & Personal Responsibility
• High Tech, High Touch
• Social networking

- What medical model will we be using?  We have a rare opportunity to re-think the healthcare model.  Can we take advantage of it?

- Early detection made possible through genomics, data warehousing, epidemiological data, all sorts of wonderful invention in predictive power, are we doing enough to take advantage of it and advance healthcare?

- Diagnostic future – patient wants more information

- Wellness Centers – the younger the demographic, the more they want to know the extent of probability of something happen to them

- Regenerative medicine – next big thing!

- Medicine will be personalized

- New class of pharmaceuticals coming up, personalized, targeted

- Personal bio-detection – do you know what that is?

- Design evolution for drugs, surgical devices, diagnostic equipment

- Tiger Woods have Lasik twice to have better than 20/20 vision

- Telerobotics – not just DaVinci, have you heard of nano surgical robots?

- Conquering disease at the atomic scale – the next frontier

• If we know how disease works on the atomic level, don’t you think the intervention will be different too?
• More than 100 companies working on this now

- Synthetic biology – merging engineering and biology – grow new limbs, new kidney, new heart?

- Designer genes – already coming

- The future of healthcare, can be summarize in 3 Ps

• Predictive
• Prevention
• Health Promotion

- Hospital is already a social network for the community regarding health

• How do we empower the patients?
• how do we partner with them to prevent disease?
• we need to think health management vs disease management
• somehow we have to integrate all these together, does your hospital know how?

- Every industry is moving to Cloud Computing, because it’s always on, anywhere, anytime

- Technology is a good thing, it integrates, it is cost effective, the biggest resistors are doctors unfortunately

- We can now move information faster, have better access to data warehouse, leverage all the extra information to provide better care

- Cloud computing means collaboration

- Did you know that there are 100s of medical apps for iPhone currently available

- Nutra genomics - Individual groups response to medical intervention

• Greek study – Normal way to lose weight did not work for them. Genomics research discover potatoes help them lose weight, not what you expect. 
• Only Europe is doing all this pioneering work, not happening in USA
• Speaker sees prime opportunity in helping people manage their health in pre-diabetes stage

- Insurance companies are like dinosaurs, still want to manage disease, we need to manage health

- Can we give people a glimpse of their future, use lifestyle information we have today, we can do it, could we do more?  It can be a source of new revenue!

- We are already patient-centered care for Planetree hospitals, we are already halfway there

- Look up this term, “Intuitive Awareness”, [I have no idea], googled it!

- Electronic Health Records – who owns them?

• It appears that hospital just need to ask permission from them to store it for them.  Ownership will need to be defined better. [we need to think about this when we go EMR, do our patient agreement covers use of data in EMR database?]
• this is a great opportunity to use the data for greater quality of care
• raise awareness of these trends to doctors
• link/collaborate with those working on it
• hospital as “trusted advisors” help navigate patient through all this.  The emerging role of patients in their health management will be dramatically change

- We are still medieval.  Why is it none of us know when we are going to die? Why??!!  Will all this information available, we still leave it to chance

- Insurance can play a different role

• Eg. His brother has retinal detachment due to genetic predisposition, but he himself has the same thing 15 years ago.  So there is greater genetic predisposition, but nobody tell him.  Information is there, we need to link it and use it. 
• Eg. If you are predisposed to renal failure, why not work with patient to put away $10 a month, and get ready to pay for a new kidney 15 years from now.  Hello insurance companies?  Isn’t this a better way?

- 50% of lumps we will know the timing of when it will turn cancerous.  Knowledge is available, are you using it?

• Repeat one last time, we need a different model of healthcare

I know there’s a lot here.  Each of the keynote speakers were great.  Hospital cannot stand still.  Time to think differently.

Enjoy reading…

Planetree Conference 5

Keynote address for Day 2 evening session:

Joe Tye, Values Coach, Inc, author of The Florence Prescription.

- If you have a job, you could lose it, but if you have a calling, you can lose it

- address open with a vide of a baseball being hit to the left field, the left fielder decides that the ball is too high to be caught.  The ballgirl, standing right out the boundaries, using her feet, climbing nearly 10 feet and caught the ball.  Have to see the video to believe it.  Then she shrugged and sits down on her chair waiting for the next ball.  Now who has a job, and who loves the game?  Who do you want to take care of you when you are admitted to the hospital?  The ball girl or Jake the outfielder?

- The left brain counts and the right brain matters

Nordstrom – they don’t have rules – one statement “in all situations, use your common sense, there are no more rules”

Left Brain	Right Brain
bean counter	poet
measured	seen
rules	values
plans	inspires
hardwire	softwire
what you do	what you are
boring	chaos
count beans	plant beans

I really like the comparison table, it summarizes what we are doing perfectly

- the invisible architecture we allowed to evolve haphazardly

- The foundation of the hospital is your core values, the spiritual side of our workplace

- What value do you think your senior leadership valued the most? Productivity or Compassion

- Values are not good intention, they are skills –> teach it!

- Corporate culture is the superstructure of the Invisible Architecture of the organization

- Culture eats strategy for lunch! –> any time, every time

- Emotional climate is the interior decor of your Invisible Architecture

- Where’s our blueprint for the Invisible Architecture?

we have masterplan for physical construction, now we are starting a masterplna for services, how about a masterplan for the Invisible Architecture – the culture of the hospital

- Spark plugs/zombies/vampires

Spark plugs make up about 25% of the staff, they are the ones engage

Zombies are on auto-pilot, still doing the work, but it’s a job, 60%

Vampires suck the life out of everyone they touch, the disengaged staff, about 15%

- BMW Club – bitching, morning and whining people

- Negative emotion is physically harmful, if we allow this in our - workplace, for our caregiver taking care of our patients, that’s medical malpractice!

 

8 values

1.  Commitment – a lightning strike and two delayed weddings.  Someone build a barn to hold weddings, a lightning strike it and burn it to the ground.  Because of what he represented, two weddings are postpone, the to-be-wedded couples help re-build the barn so that they can get married.  the barn builder does not have a job, he has a calling!

2. Engagement – how long does it take to finish a road?  Paul Newman’s film, where they decided to own the chain-gang work while in prison. 

Leaders are Storytellers.  Speaker is continuously amaze that so many leaders are not good storytellers, simply because they haven’t bother to learn the skills.  each leaders speech must have SEX (sic) with the audiences. SEX – significant emotional experience

3. Passion – nothing great was ever achieved without enthusiasm (Ralph Waldo Emerson)

Texas Roadhouse – have pep rally and singing the company song “I Love My Job”.  They realized that every store can have great food, but the customers will come back if they have fun, and they will only have fun if the employees have fun

4. Initiative – the antidote to learned happiness – “PROCEED UNTIL APREHENDED” – key phrase by speaker.  You can’t empowered people until they empowered themselves

5.  Stewardship – at home, at work, in the world

6. Belonging – fear excludes and creates enemies.  Courage includes and creates friends

7. Fellowship – put the cheer back into leading.  James O’Toole book “Leadership A to Z”, CEO stands for Chief Encouragement Officer

8. Pride – the classic icebreaker opener, “What do you do?”.  the most horrible answer, almost always given, “I’m JUST…”  why do we say that?

example: Industrial ventilation system company called High Volume Low Speed (HVLS) Fan Company.  sales was normal, and customers being calling it a different name, so they decided to adopt the name, Big Ass Fan Company.  Sales double every year!  They adopted a donkey mascot and started selling hats, t-shirts and pants.  They proceed goes toward – get this – Orphan Donkey shelter.  They have fun!

Case Study:

Tucson Medical Centre – Emergency Department was one of the worse place to work.  Speaker conducted focus group, and CEO authorized the entire report to be given to every single staff of the hospital.  Staff were told, fix the problems, don’t wait. 

- maintenance says they don’t have time to paint for the wards, the nurses went out, bought the paint and started painting, maintenance department suddenly have time to paint for them. 

- no security guard at ED, nurses called the Police Chief to help out with security at ED, suddenly security has the extra personnel to help

- they were taught Proceed Until Apprehended

- CEO directed all senior management staff to round the hospital from 8 to 10am every morning.  No senior mgt staff is allowed to check their  email, or a phone call before then

 

Empowerment is helping others be better than who they are

 

visit www.joetye.com/blog for free download on culture of ownership, invisible architecture, keeping people, values training, presenting yourself with power.

 

visit www.healing-tree.com.  can’t remember for what reason!

 

- end of day 2 keynote address report -

Planetree Conference 4

Only attended one workshop today.

The first keynote address of the day talks about the soul, which i thought was a bit New Age, so decided to work on my emails instead.

First workshop of the day talks about impact of Color in Healing Environments.

Husband and wife team, over 30 years experience in design acute care hospitals.  Husband was with US Navy (I think), lived in Bangkok for a few years building a hospital for the US Navy. familiar with South-east Asia.  Volunteer to give us any resource if we need help.  Good contact.  Barbara Huelat and Joseph Parimucha.

- Science haven’t been able to explain our emotional response to colors, but experientially there’s an impact, many books written about color psychology but not a lot of scientific evidences as yet

- the color schemes that will be easy on the eyes and last longer with jading the eyes are nature colors.  A very common method I see with all the interior designers here, is to use a photo (literally) of the local scenery, and match a palette of colors to the design.  Very effective.  This was also demonstrate to me by the firm that Loma Linda uses, Aesthetic, Inc.  The industry term is nature fractal

- Use colors by the 3 Ps – Palette, Placement, Percentages

1. Palette – monochromatic (do not recommend), analogous, complementary, double complements, neutral and full spectrum-balanced.

2. Color Placement – background should be light neutrals, ceiling for be light neutrals, flooring should be mid-tones, secondary accents – mid-tones and primary accents must be limited

3. Color Percentages – ceiling is usually the lightest color, primary accents limited to 2 to 5%

Other things to consider – avoid fashion trends, keep a balance between warm * cool, consider the function, adjacent color scheme, lighting, color reflectance, color temperature, getting close to the right color match is not good enough, the the science, nature, culture and emotion of color.

Quote” It’s a goo thing that when God created the rainbow he didn’t consult a decorator or he would still be picking colors” Sam Levenson.

 

Made contact with Hackettstown Regional Medical Centre (part of Adventist Healthcare system), they are working hard on Planetree ideas.  HRMC gave a workshop on shadowing program, bringing high schools student through the hospital during school holidays and hopefully interest them to become healthcare works.  Works very well, part of their ‘giving back to community’ project under Planetree initiatives.

 

Drove to Washington D.C. to see International Finance Corporation (IFC), the private sector financiers for World Bank.  Highlights:-

- Investment arm continuously match projects with investors, we can play both roles

- when IFC lend, they become active partners, whether as lenders or equity holders, this is a good thing because they can bring to bear their consider resources in best practices for financing

- The South-east Asia desk person-in-charge was not available, so I spoke with the South Asian officer.  She was very keen to know whether we have interests in Bangladesh, Sri Lanka, India or Pakistan.  Just 4 months ago, she had investors looking for a hospital management company to take up a project

- I spoke about setting up a for-profit entity, possibly in Singapore, raise funds from private equity, capital market to invest in the region.  She said she will source a resource person from their Private Equity Division to work with me on how to structure such an entity.

- Overall, they were very positive, and was sold on our philosophy and approach.  Their familiarity with Washington Adventist Hospital helps.

- I offer for them to meet with GC Health Ministries Department.  I will be in GC on Thursday morning, will see if I can dropped by to see Dr. Landless and make an introduction to IFC officers.  I also explain to them a little bit about AHI, Loma Linda.  I’m not sure if these will lead us anyway, but we never know would we?

All in all, a good meeting besides recovering from the shock of paying $15 for parking!

 

Back to Baltimore for the second Keynote address of the day.  Details in the next summary.

 

Right after, attended a gathering for the International delegates.  Spend a bit of time with the key officers of Planetree, who also happen to be Griffin Hospital officers, they are the sponsoring parent body, based in Derby Connecticut.  A must visit hospital if we are serious.  They have hosted 700 hospitals visit since they started.  The President/CEO Patrick Charmel gave a personal invitation to tour their hospital.  www.griffinhealth.org, www.planetree.org

 

- end of Day 2 report -

Planetree Conference 3

Highlight from first day Keynote Speaker, country singer fame, Naomi Judd.

First question is on who we are.  Do we know who we are? Be a detective on ourselves.  Unhappiness is because we do not know who we are.

“Pain is inevitable, but suffering is optional”

Planetree hospitals knows that there may not always be a cure, but there’s healing.

Mark Twain says that the only people who likes change is a wet baby

Human beings are hardwired to socialize, [but why so many problems expressing, communicating, relating etc]

Read Blair Justice book, how the sick stay well

FEAR – false evidence appearing real – when confronted with deadly disease, find out all you can about it

Dr Lisa Randall (?) says we live in 11 dimensions, and we only know of 4 so far, most already struggle with 3.  All the studies on physics, cosmology, biophysics actually proves the existence of God.

we are supernatural beings living a natural life

Read Eckhart Tolle – getting rid of ego – EGO stands for edging God out

All our behaviours driven by our emotions

Co-dependency taught her how to step back and observe how their behaviours affected her, then set healthy boundaries to cope

Like 12-step AA, say the serenity prayer everyday

When you change, others who see it will want it too, you will become the change agent

We all become a victim ONE time, after that we volunteer!  understand?

When we BLAME, it’s Be Lame

Illness means something out of bound

MOM upside down spells WOW :)

It’s not about what happen to us, but what we do with the information (in respond to her family secret)

“When we offer ourselves to someone broken, we make yourself whole.

Integrative medicine is the future. touch therapy, acupuncture, pet therapy.  music is very powerful – first sense to develop in the uterus.

Very important to detox

8 characteristic from American Psychiatric Association

1. Spiritual – faith factor, Dr. Dale Matthews (read his books and research)

2. Support System – people live longer nowadays

3. Sense of Humor – endorphin producing

4. Nature – nature is a healer

5. Having a purpose

6. Diets

7. Exercise

8. Open belief system – read the story of infection/sterility, invention of stethoscope

Change her name to Naomi at 30 because she wants to remember a retarded girl in her grade school.  Her real name is Diana.

My comments: Very interesting talk, we don’t have agree 100% with her, but she sure gets you to think seriously about things.

Planetree Conference 2

Day 1 Conference

· I asked hospital executives here regarding Studer Group.  They said it’s good, but it’s very much process based.

· Many recommend Values Coaches, Inc, Joe Tye, who I met last night, works on the soft-wired side, that’s attitude, values and personal ownership of core values.  Very interesting perspective from him.  He’s working on a project in Hanoi (first trip to Asia).  He has a few Asians working as coaches for him.  He explains it as Studer work on the Left Brain, he works on the Right Brain

· 5 certified Planetree architects and planners exhibiting here, their products are awesome.  Dare I say it, even better than TAHPI

· The designation process helps wrap JCI, Malcolm Balridge, HCAHPS, IHI, methodology like Studer, around a patient-centred framework/perspective

· I was thinking, Adventist should be leading the charge here.  We promote wholistic care, but others has done a much better job.  140 US hospitals are into this now.  Loma Linda, Washington Adventist leading the charge, but Florida hospital nowhere in sight (a very curious thing)

· Heavy promotion of aromatherapy, pet therapy, touch therapy, acupuncture – not just for patients, for staff as well (very important aspect)

· Planetree has design consultancy service led by an architect (I met her, and she will give us a proposal on how it usually happens).  She is also LEED certified

· All Planetree hospital aims for Open Chart, patients has a right to see their chart anytime, some even allow patients to write their own notes attached to the chart!  Not necessary part of the official chart, but it gives a way for patient to counter check the care plan, and also gives opportunity to correct errors, or if plan were not followed correctly by nurses

· 24 hours open visitation hours – no kidding

· Nutrition plays a big part – again here Adventist healthcare should be leading the discussion, but we are not

· Lights, colours, use all five senses, artwork, all plays an important role

· I met the interior designer for Marriott hotels, she said she’s not as expensive as we might think.  She just finished Tokyo Disney for 9000 piece of artwork, all without traveling from her Chicago office

· Music therapy is very big deal – I got a free example, very cool for pre-op surgery, dental surgery etc.  their research shows dramatic improvement in patient calmness and outcome

· Met the aesthetic designers for Loma Linda, saw the storyboard for loma linda new centre, it was better than anything I have seen out of TAHPI or Sylvia for that matter.  Met the director, they already doing Sonora, Glendale, Bollingsbrook.  You don’t have to explain Adventist Healthcare to them!  They will interpret our concept of wholistic health for you, imagine that!

· Planetree just established an international network, it’s at the pioneering stage.  Now is the time to get involved.  The big players are Brazil, Netherlands, Japan, Canada.  I meet one of the assessors, they love to go big in South-east asia, will talk to them about a pilot hospital project, we should get there before Singapore or Hong Kong does

· Met Wendy Leebov, computer self-directed learning materials for patient care and patient customer service.  I thought the materials were very good, comprehensive, useful to help our nurses.  Googled wendy leebov to see for yourself

· Meet Sharp Coronado Chief Nursing Officer, one of the first Planetree Designated hospital in the country.  We can visit them anytime.  Good contact, very generous with her time

Planetree Conference 1

Things I learned today from my hospital visit…

- learn from the best.  Bayhealth hospitals are award winning hospitals, it’s a Studer hospital as well.  We can learn a lot from them

- heavily promote what Planetree advantage is for the patients in public areas

- Planetree is about distraction for patients, using colours & senses, in addition to good customer service initiatives etc.  Lots of natural light, keep hallway and rooms bright

- hospital created their own distraction booklet

- create space for personal therapy for staff (Planetree is not just for patients)

- getting patient involve in their own care

- every service unit has a patient resource center

- encourage everyone to think about patient centered care and staff wellness, i guess goes hand-in-hand

- patient/family advisory council

- open chart (wow!)

- name their corridors! (i like this)

- rehab floor was awesome, lots and lots of space, has mock apartment to learn how to cope when go home, patient also learn things because at hospital everything is provided for like handrails, specially designed toilets etc

- all care is deliver in the patient room, like physio

- touch therapy, pet therapy very widely practice

- aromatherapy for maternity patients (optional of course)

- labour, delivery, recovery, discharge LDRC (forgot the exact acronym) in one room for maternity patients

 

source: Milford Hospital, Bayhealth System, Delaware

The Role of Finance

Key Thoughts:-

Once in a while, an article that summarizes my thoughts. Here’s one I just read. The article mainly mentioned the CFO specifically, but I think no one person can do a job, it’s a whole team. So I believe it’s applicable to all of us.

Summary:-

The article opened with a declaration that Finance bring a unique view to the table – ‘a broad, objective perspective on costs, cash, and capital, with the long-term best interest of the organization in mind.’

However, near-term pressures to ‘reduce costs, better manage cash and working capital, and monitor capital expenditures’ cause some Finance function to shift focus.

Areas Finance should focus on includes:-

1. Information Management. Management is about making decision, and we can’t make decision if we have no information. Or if we have bad information, we make bad decision. The need for greater accuracy and control over the ‘development and use of information’

2. Enterprise Risk Management. Awareness of risk means that the risk management processes will require greater, broader, and more frequent effort.

3. Cash Management. A recent survey shows that the CFO’s agenda has shifted from ‘value preservation’ to ‘value creation’. Needs to be front and center in discussions of growth opportunities. The need to develop scenarios planning means we need competencies in cash forecasting.

4. COO’s area of responsibilities. The consolidation of COO role in some hospitals means more areas come under Finance, facilities management, human resources performance management, regulatory affairs, and general operations.

My Comments:

It’s heartening to note that at PAH, Finance is already doing a lot of the area listed, this serves as a reinforcement that we are on the right track. What we need is increase the effectiveness of what we are contributing.

Reference: Finance Needs to Sit At the Head Table, Edward J. Giniat. HFM, May 2009, pg 80-82.

Opportunities in the Downturn

Key Thought:

The author’s premise for this article is that ‘of the many opportunities that arise out of troubled times, the most valuable of all for many businesspeople are the opportunities for personal growth, particularly for developing as a leader.’

Summaries:

What does true leadership under unimaginable stress look like?

1. Be seen early and often. People want to be led.

2. Act fast. It’s amazing how people who would be at one another’s throats in good times will accept that in a crisis, decisions have to be made. leaders in a crisis must not lose their rare opportunity to act. Every instinct tells you to decide more slowly than usual, yet it’s vital to decide more quickly.

3. Show fearlessness. we want our leaders to show us that they’re not afraid. The effective leader announces trouble in unvarnished terms, then explains confidently how it will be defeated. “Show fearlessness, not be fearless” – you should be terrified in such situation, but it didn’t matter.

4. Tell a story that puts the crisis in context. There are two groups of people, those who see stressful events as bad – suffers more, those who see stressful events as normal – do better. The leader helps everyone to respond like the second group.

My Comments:

Opportunity like a crisis pushes leaders to become great from average. It’s up to us to step up and make the difference. In normal times, your superior is not interested in your failure, so we tend to be save. But a crisis offers that chance, it’s up to us to take the chance.

Reference: The Upside of the Downturn, by Geoff Colvin, Fortune Asian Edition, June 8, 2009, page 42-46.

East Versus West

Key Thought:

A very un-politically correct article on how research is showing that Asians thinks different from Westerners. The article profile Richard Nisbett, University of Michigan professor.

Summaries:

In one experiment, the Americans went ‘for the biggest, brightest moving object and focused on that and on its attributes’. The Japanese would describe the stream, the water, the rocks and shells…and then there were three big fish swimming off to the left.’

In another study, Nisbett discovered that East Asians have an easier time remembering objects when they are presented with the same background against which they were first seen. By contrast, context doesn’t seem to affect Western recognition of an object.

East Asians	Westerners
see things in context	focus on the point at hand
dependent	independent
holistic	analytic
collectivistic	individualistic

The article goes on to describe more difference. The stock market, Westerner’s preference for lawyers over engineers, Asians higher score in Math in Westerners (no, it’s not Asians are smarter), a lot of Asian would be concert pianists, but fewer opera-singers, and what it means for marketers of consumer goods.

My comments:

The differences are real, they might now always be for the better, but they matter. The final sentence sums up the article well - Nisbett believe that those who will be most successful in the 21st century are the ones who grasp what’s best about both worldviews. The Americans should temper their optimism, Asians their reluctance to take center stage.

Reference: East Versus West: A psychology professor dares to compare how Asians and Americans think, by Hana R. Alberts, Forbes Asia, May 11, 2009, pg 64-65.

Lesson from Delhi Metro

Key Thought:

Best practices can be found in the most unlikely places, because it’s not the place, people or culture that makes the difference, it’s the leader. Time and time again, I have seen this validated.

The article in question profile Delhi Metro’s MD Elattuvalapil Sreedharan. His claim to fame in the article - ‘finish building the initial $2.3 billion subway system in 2005 under budget and almost three years ahead of schedule.’

Summaries:

- weekly inspection of expansion, solve problems on the spot

- deeply spiritual man, meditate every day, does yoga and walks at least 45 minutes in the evening

- plaque in his office quotes from the Indian scripture Yog Vashist: “Work I do; not that ‘I’ do it.”

- More than 800,000 people use Delhi Metro each day, and it remains clean and punctual, with 99.9% of all trains running on time since it began operating (eat your heart out, KTM!)

- digital clocks that counts down to the days before the next line must be completed are found throughout Delhi Metro’s offices and construction sites

- it’s one of the few subway systems in the world that is operationally profitable without government subsidies

My Thoughts:

Just the above few points tickle the imagination. What’s going on here? We see intensity, passion, detailed minded, relentless focus on the goal, manage efficiently and effectively. It’s also balanced with personal development (spiritually). There’s no doubt a lot of the achievement is due to the leader himself. Look at it simplistically, it would seem it’s reachable for most people to achieve what he had achieved, it’s a matter of execution.

Reference: Delhi’s Subway Is Cheap—and Early, by Amy Yee, Forbes Asia, May 11, 2009, pg26-27.

My Readings: Labor Day Long Weekend

I thought I will jot down what I finished reading this past long weekend.  Yes, many of them I started long before this weekend, this is just a record of what I finished reading.

The New Gold Standard: 5 leadership principles for creating a legendary customer experience courtesy of The Ritz-Carlton Hotel Company, Joseph A. Michelli, McGraw Hill, 2008.

Lost in the Amazon: the true story of five men and their desperate battle for survival, Stephen Kirkpatrick, W Publishing Group, 2005.

Forbes Asia magazine, Global 2000, April 27, 2009.

A mixture of theoretical, good story, light business reading for the weekend.

For the record, I also started a couple of new books.  Details to follow when I finish them!

This week’s goal is to get the summary of the above 3 resource out to the blog page.  Let’s see how we go…

When knowing the customer isn’t enough

Key Thought:

What can we learn from the retail industry that will apply to a hospital setting? Does it even make sense? Is it that important?

Below is a summary of an article on retail analytics and some of it, I think, is instructive for a hospital trying to move from basic services to a five-star hotel service level (or at least try to :-P)

Summaries:

1. “Know the customer” is a retailing mantra. Retailers evaluate ‘consumers from multiple sources to understand who the best customers are, then combine that information with what and how they like to buy’.

2. ‘Unfortunately, just knowing the customer isn’t enough in today’s retail world.’

3. ‘Retailers need to anticipate and shape future demand to come as close as possible to satisfying each customer’s unique needs. Achieving this at such a detailed level requires automated processes enabled to solutions with the latest in predictive analytics and optimization capabilities.’

4. ‘The ultimate goal is more than having the right product in stock at the right price; it’s about tailoring the entire shopping experience to create an emotional bond with the customer. In effect, this means turning today’s multichannel retail enterprise – in a consumer’s eyes – from “the store” to “my store.”’

5. ‘Did you know? Your favorite retailers use analytics to know not just what to put on the shelves, but also where to put it.’

My comments:

While this article is discussing decision process automation (DPA), a lot of what was said can be translated, some indirectly I admit, to healthcare.

1. In a hospital, we don’t just open a new clinic, and hope patients would show up. Or we just gathered materials from the doctor, and hopefully that is what patients wanted. Do we need to spend more time understanding our patients? It’s a fact that hospital are organized for the efficiency of the process, and not the patient. When was the last time we ask ourselves, how can we make it simpler for the patient?

2. After the mantra, ‘know your customers’, it seems that it is not enough. As competition heats up, yes, even in healthcare, discerning patients looks for more. How much do patients value transparency, honesty, fair prices, competence, and environmental consciousness in a hospital? How much before patients will make a different choice in selecting a different hospital?

3. Automation will be required to analyze the endless permutation of needs, but building that capability organization-wide will not be easy. The concept itself is not well understood by decision makers. Getting care-givers to come on-board will be the key to succeeding.

4. Yes, we are in the experience economy. Same goes for healthcare.

5. It will get even more specific as tools become affordable.

When are we ready for the change? Can we afford to wait longer?

Reference: When knowing the customer isn’t enough: decision process automation is the key to delivering jus the right offer to each retail consumer by Alexi Samevitz, SASCOM magazine pg 7-8, First Quarter 2009.

Creating Value in a Down Economy

Key Thought:

The dominant topic in conversation these days is who got laid off.  As usual, the book titles in the book shop has adjusted accordingly too. There are a lot of opportunistic penmanship out there, but I did come across a very relevant, practical and solid write up.  It's about customer profitability.

Is there a way to improve profit without increase revenue or laying off staff? Apparently there is.  Read on...

Summary:

Quotes:

- Potentially, 400 percent of the figures listed on your profit-and-loss statement could be recovered as profit

- ...best 20 percent of customers contribute profits equal to 500 percent of earned income, while 60 percent breakeven at best; the worst 20 percent destroy 400 percent of earned income.

- ...if market segmentation analysis relies on incorrect information about profitability, efforts to grow sales could be directed toward the 20 percent of customers that are unprofitable.  In reality, these efforts will accelerate the destruction of profit.

The article helpfully define what Activity-Based Management (ABM) is.  It's not a financial system, it's an organizational cost-and-profit-analysis too.  It attributes costs to processes, and process costs to the products and services that benefit, and ultimately to the customers that receive those benefits.  ABM pinpoints, in a highly understandable way, the top areas for action and the changes that will maximize profits and minimize costs.

ABM can be used to resolve budget constraints, fight price wars, re-engineer processes, consolidate overlapping organizations, optimize customer acquisition and retention, reduce unused capacity.

Top 3 barriers to adoption of ABM:

1. Failure to convince management that change is needed. Resolution requires leadership, communication, learning and the ability to build a broad-based coalition of the willing.

2. Failure to define a clear business purpose for ABM.

3. Failure to plan for and capture a significant ROI. If the business purpose of ABM is to change decisions for the better, it should be possible to anticipate where the returns will be.  And, once the system is in place, you should be able to compute the returns from the resulting decisions.

Often, the ROOT CAUSE of barriers to adoption is lack of knowledge about ABM. So to start, we must build a coalition of the willing in order to get ABM adopted in our organization.

Additional input from SAS blogs:

- champion from Finance/Accounting is needed

- start focused and small

- firms have to be aware of the necessity to track...how much to spend on each customer to retain them as profitable customers

- the company with the best cost information wins

My Comments:

It is in our mid-term plan to implement ABM.  This is the first shot in our quest to get ready for this.  We should take heed of the last paragraph, let's learn as much as we can about the theory, the tools and the lessons learned from those who have done it, then we start.

Two links to SAS website provides more information.

www.sas.com/sascom-profitablecustomers

www.sas.com/sascom-abmtour

Reference: Creating Value in a down economy: want to turn losses into profits? identify your most - and least - valuable customers, Interview with Peter Turney, CEO of Cost Technology, by Jonathan Hornby, SASCOM magazine, First Quarter 2009.

IHI Triple Aim

Key Thoughts:

IHI (Institute of Health Improvement) is an educational institution that promotes improvement in the delivery of healthcare. They became famous after their successful Save 100,000 Lives campaign, and just recently finished their Save 5 Million Lives campaign. Today, I just came across their many other new initiatives. It's call Triple Aim. Each of this initiatives has something that our hospital can benefit even if we do not participate in the campaign officially.

The Triple Aim are-

• health of the defined population
• Enhance the patient care experience (including quality, access
and reliability)
• Reduce, or at least control, the per capita cost of care

You will notice straight away that this is a much broader initiative involving other stakeholders in the healthcare delivery continuum. In 2007, IHI translated the Triple Aim into specific action plans-

1. A focus on individuals and families
2. Redesign of primary care services and structures
3. Population health management
4. A cost-control platform
5. System integration and execution

Summary:

Obviously, there's so much to explain on this noble but massive change management campaign. I am going to deviate from the usual by not summarizing a topic, but to point you towards the Triple Aim main page to read for yourself.

There are several links which provided much in-depth details. There's a case study CareOregon, concept design paper, and an overview of the model.

My Comments:

As I mentioned earlier, each initiative from IHI provides us with something worth implementing. To fully live the mission of serving the community, we must stay on this journey, there are challenges no doubt, there's also vast opportunities to do something of significant for the community. What if we can significantly improve the healthcare delivery for our community without increasing the cost of providing it? That's worth fighting for, isn't it?

Do spend time today to understand what this is all about.

Reference: The Triple Aim, Institute of Healthcare Improvement, http://www.ihi.org/IHI/Programs/StrategicInitiatives/TripleAim.htm, accessed: 18 Jan 2009.

The Breakthrough Company

Key Thoughts:

I'm reading another strategy book, this was a gift by our Financial Management vendor during our signing ceremony. Strategy is a complex subject, having read at least a dozen books on strategy, I think I had only one tenth of it down.

I will list down some of the most profound questions raised in this book. An incredibly fitting book for our organization as it's a research based on small companies who had made the breakthrough to greatness. Here's the incredible numbers, 7,000 companies over 5 years, spoke to over 1,500 key executives, and reviewed & cataloged more than 5,600 articles, annual reports and studies. And from the list, they conducted 90 day in-depth studies with 52 firms. The author goal "was to conduct the most exhaustive research ever undertaken on the subject." As empirical as it gets.

Questions:

Keith started with 3 questions that started him on his journey (page 3).

1. Why do most companies start small and stay that way?

2. What is special about the handful of companies that successfully "break through" the entrepreneurial stage of development?

3. What can a leader do to ensure that his company maximizes its chances for breakthrough?

A Few Squirts from the Grapefruit:

Surprises uncovered from their research (p18-22).

1. The most interesting companies may not operate in the markets that Wall Street and the business press consider interesting or "cool".

There's 3 types of breakthrough companies, 1) in hot markets dominate those hot markets 2) in dud markets igniting their sector 3) in stalled/dead markets that figure out a way to transition into more attractive markets.

2. Sticking to the knitting won't always get you there. They ignore the experts and re-define their business.

3. Don't look for extraordinary people; build a place where ordinary people can do extraordinary things. While hiring talent is a must, they also 'creating systems that helped their people grow along with the business.'

4. It's not about where (or whether) you went to school. The leaders in the breakthrough companies ranges from PhDs to high school graduates. It has less to do with qualifications than to do with 'how they see the world, and what they do with those insights.'

5. You don't always need other people's money.

6. How employees feel about working in a place is a significant driver of success. Many of the 9 featured companies won awards for best workplace.

The rest of the book is illustration of what the above means and MORE!

My Comments:

There are many common sense insights in the book, each of them is worth a 'deep think' on. Chapter 10 sums up what to do after all the 'thinking'! A leader 'can influence a business via 1) crafting and adapting strategy, 2) getting the most out of people, and 3) driving execution. (p202)

Another 'take-away' for me was to ask these questions during our strategy review every quarter (p210):-

1. What have been our most important strategic accomplishments during the past ninety days?

2. What are the most important ways we fell short of our strategic potential during the past ninety days?

3. What are the most important things we have learned about our strategy during the past ninety days?

For PAH, strategic review always look forward, there's very little looking back and LEARN. The strategy learning cycle (p209) should be adopted.

Despite stating that this is not intended to be a recipe book, chapter 10 was like a prescription to me, we suckers certainly love that, and I certainly didn't mind having it. Seriously though, strategy making is as elusive and uncertain as ever, however, we can take heart from the book that if we learn from the best, there's a greater than even chance that we can breakthrough. As the subtitle of the book says, "how everyday companies become extraordinary performers", do we want to join the rank? Dare we dream?

For all the details in between the introduction and the conclusion, read the book! It's in the Finance Library.

Reference: The Breakthrough Company: How everyday companies become extraordinary performers, Keith R. McFarland, Crown Press: 2008.

Risk Management Workshop on Key Risk Indicators (KRIs) and Risk Framework

Key Thoughts:

The implementation of risk management strategies is more pertinent today than ever before. The speaker, Marc Ronez is well-experienced in this field. His insight and knowledge helps provide the foundation to build a sound risk management framework for the organization.

Summary (sound bites):

- risk assessment is very much sentiment dependant, eg. subprime - 12 months ago, CEO: why aren't we doing more?, now, CEO: why are we in it? - same data, different conclusion

- Risk management sophistication doesn't guarantee safety - eg. Societe General

- tendency to jump to conclusion. CEO: Don't bring me problem, bring me solution. When majority of the report focus on justifying, then it's not risk analysis, it's rationalization

- vast majority of corporate failures is in strategies and implementation, not financial risk

- Business Continuity Planning is part of Enterprise Risk Management, not the other way round

- The most important risk mitigation for charitable organization is REPUTATION!

My Comments:

- PAH does a reasonable done with clinical risk management, but Enterprise Risk management is much broader -- Change the Emphasis.

TO DO LIST

- map risk and choose techniques to mitigate risk

- build Key Risk Indicators into Riskman and SAS FM

- Calculate cashflow to finance potential losses, especially several exposures at once

- setup Risk Register

- build Riskman for decision making

- link Risk Management to incentives payment

- use Event Tree to identify consequences

- derive KRIs and KCIs from KPIs/CSF/KFRIs

- explore further education from Asian Risk Management Institute

Conclusion: a most valuable session to understand the latest thought leadership in Enterprise Risk Management.

Reference: Risk Management Workshop by CCH, 15 December 2008. March Ronez, Asian Risk Management Institute, www.amiri.org.

A Complaint Is A Gift

Key Thoughts:

2009 is the year we get serious about actively managing our customer experience. This updated book by Janelle Barlow and Claus Moller was a very exciting read.

The book detailed tonnes of knowledge of why customer feel/react the way they do, each point backed by scientific research. In addition, great stories of service recovery helps emphasize the points and helps reinforce it (besides being a good read! As the authors alluded, complaints are far more entertaining to hear/read than good service).

The most stand out thing I learned from the book is 'Complaining customers are often the loyal customers, disloyal customers are more likely to not say anything and into the arms of your competitors'. I have used this phrase to good effect the last two weeks.

The gist of the book as described in the Foreword by Tony Hsieh of Zappos.com is our loyalty to a company is influenced by how someone at that company respond or didn't respond to our complaints or service issues.

Short Summary:

The book is organized into 3 sections (taken from Introduction).

1. Complaints: Lifeline to the Customer - outlines strategy that will help maintain a positive mind-set toward complaining customers. It emphasis the value of listening to customers, using the opportunistic encounter to cultivating more business, talks about why most dissatisfied customers rarely complain. Finally, it talks about what's on the mind of the customer when he/she complains.

2. Putting the Complaint Is a Gift Strategy into Practice - focuses on how to handle the complaints you do receive. There's an Eight-Step Formula (outlined below). How to deal with the Internet phenomenon in terms of customers airing their dissatisfaction directly to the world and use the Web to our own advantage.

Eight-Step Gift Formula

1. Say, "Thank you."

2. Explain why you appreciate the feedback.

3. Apologize for the mistake.

4. Promise to do something about the problem immediately. Take responsibility.

5. Ask for necessary information.

6. Correct the mistake - promptly.

7. Check customer satisfaction.

8. Prevent future mistakes.

3. Dishing It Out and Taking It In: The Personal Side of Complaints - apparently applying to your personal life can save marriages! Common strategies includes listening to their complaints, learn to notice when 'someone is upset and to respond in a way to leads to resolving the conflict'.

'You can't take your girlfriend for granted, and you can't take your customer for granted. Every time, it always works out the same way. Somebody else gets them' Gordon Bethune, former CEO of Continental Airlines.

As mentioned earlier, many good examples were presented. 'Ideas that are almost sure to work are the best practices of other companies in your industry. But the breakthrough ideas often come from outside, from an industry that routinely solves a problem that's new to you.' Wally Bock

My Comments:

An excellent resource from TMI as usual. As in keeping with anything worth it's place in the marketplace, plenty of additional materials are available on the website. www.tmius.com

I am re-reading the book the second time starting this week, so more detail summary may be posted in a later post. In the meantime, the book is in the Finance Library. I'm also going to propose a daily briefing sheet for each Pillar for Daily Stand Up Meeting (as mentioned last week in our monthly meeting), expect to see materials presented in this book to be on the briefing sheet.

Reference: A Complaint Is A Gift: Recovering Customer Loyalty When Things Go Wrong, Janelle Barlow & Claus Moller, Berrett-Koehler Publishers.