Sunday, January 30, 2011

Fun Theory

This is a bit of cool marketing from Volkswagen (the same folks that introduced me to Nick Drake), sent on by a colleague. It is a competition to positively change behavior using fun. Given all the challenges we have in healthcare, there is something to this as a design principle. This ties in nicely with my general love of games as as a method of fun and education.

Saturday, January 29, 2011

Why Work Doesn't Happen At Work- Crosspost from TED

Jason Fried gives an excellent presentation on why work is so difficult to accomplish... at work.  I have to say that returning to the hospital this week on Cardiology feels like his description magnified.  One could argue that the entire day of a medical intern or resident is to be interrupted, with the intern having the additional challenge of having to complete baseline paperworks tasks.  Enjoy...

The Problem with Scale

Below is a very interesting look at the relative scale of our federal budget versus sums of money that any of us will ever see or understand.

Friday, January 21, 2011

Guest blogging!

Check out my guest spot on Progress Notes, the blog of Primary Care Progress.  Primary Care Progress is a grassroots organization started here at Harvard Medical School in the wake of changes (elimination actually) of the primary division at the medical school.  Fortunately, it has evolved over time and is working to promote primary care education and careers by bringing together a community of students, residents and practicing physicians.

-Better link for the Gawande Article about Iora Health.

Friday, January 14, 2011

Days 3 & 4: Excellence in Action

Sorry for the delay, I have been so deeply engaged in class (and doing the homework) that it has been hard to come up with a central idea for a post. Then it occurred to me that the topic is excellence, and how it differs from perfection. We been looking at a variety of organizations that focus on excellence through action and iteration. While this may seem obvious to those of you not in health care, specifically academics, we tend to operate on the precautionary principle... Know every possible risk before taking a step. This obsession with starting perfect is what has hindered so much value. But where does it come from?

School. In order to be a doctor in America, you have to get a lot of test questions correct. It is actually the single biggest requirement for medical school entry: good grades. While most of us hang on to humanity through this mechanical process, we do become quite perfection-centered and risk averse. Not exactly the type of person we would expect to be an innovator. Wiser thinkers than I have opined on how to reform school, but this is a root cause of our slow starts in health care, and one that will pay dividends in ways we cannot imagine.

Back to school!

Tuesday, January 11, 2011

The Forest for the Trees

Day 2 of Value Based Health care. 
Today was a particularly enlightening day as it focused on a big success story in primary care and another in employer based health care.  I also had some foreknowledge of the organizations which helped enrich the cases for me.  One thing that I did notice is that we as health professionals might have a tendency to hold the delivery of health care to the same standards as our actual therapies.  While high standards in and of themselves are a good thing to have, working with humans in a complex social, medical, business, regulatory and legal environment is tricky to do and even trickier to study.  It is important to remember the current state of health care delivery innovation.


Current research projects, ideas and companies in changing the way health care is delivered are remarkably young.  Given the restrictions placed by government regulating practices, insurance, payment, and their own involvement via Medicare/Medicaid, that there is any innovation at all amazes me.  The key takeaway here for me was to celebrate what is actually being done, and what it can lead to, rather than lament the shortcomings of the research methods used to validate the success of innovations. 

It actually strikes me that perhaps our current research methods to "prove" that medicines are effective, are themselves the problem.  We are using the wrong tool for the wrong job, and the implicit suggestion is that reality must be broken down and remade so that it fits within our current research methods.  Perhaps innovation of research methods are actually required to deal with the chaotic business of health care delivery. 

This class is quite exciting, and the level of debate is quite sophisticated.  I am very fortunate for the stars to have aligned so that I may be a part.
More tomorrow!

Monday, January 10, 2011

First day of Business School

Today I had the pleasure of starting a one week seminar at Harvard Business School entitled "Value Based Health Care Delivery Intensive Seminar.". Taught by health care strategist Michael Porter, author of Redefining Health Care, it is a collection of about 80 business students, medical students and health care providers brought together to learn about how focusing on value across the entire care cycle of a disease cane improve health care delivery. This is a unique opportunity to learn an approach to innovation in health care delivery. From the first day's events, each day wlll consist of two case discussions, for which Harvard Business School is well known. The Case Method is an interesting way of working through material that draws on a written case and experience from the class. The professor's job is to draw out and organize the discussion, rather than provide the information. It is *very* different than medical school.

Continuing the theme of the small world of Health care, I am sitting next to a friend of a friend that I have not seen in years, and know at least 5 more people in the room by name or face.

More each day...