Archive for November, 2007

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Is there a health-care crisis in the US? The averages may say no… but the stories say yes

Friday, November 30th, 2007

I’ve been drawn to write about the health-care situation in the US for some time. There have been very powerful proposals, such as this one by Michael Porter and Elizabeth Teisberg a few years ago, that I thought deserved advocating (link – $$).

In addition, for the past year I have bought my own health insurance (instead of having it provided by an employer) and with my wife managed the resulting insurer/caregiver/patient relationships. And, let me tell you, doing it yourself opens up a whole new window onto the health-care world. Buying your own insurance and managing your own care allows you to see deep into the sausage factory that is today’s US health-care ecosystem.

Nonetheless, I held back. Perhaps our situation and experience were unique. Perhaps struggles and issues we had were due to our own mistakes. (We made some, perhaps many.) I also resisted the overheated rhetoric and drastic solutions proposed by some politicians. In addition, economists like Greg Mankiw provided analysis showing public concern about the issue is overblown.

The I read the front-page story in yesterday’s Wall Street Journal by John Carreyrou (link – $$). It was horrifying to read about the gentleman who, despite better-than-average health-care coverage, ended up owing more than $1 million to hospitals, doctors, etc. And while the dollar figure was astonishing, more intriguing to me were the problems and issues he and his wife ran into while trying to understand and manage the bills. These problems and issues were very similar (though larger, of course) than issues my wife and I have run into in trying to manage health-care for our healthy family.

Typical issues include:

  1. Difficulty in getting billing and reimbursement details from caregivers and insurers
  2. Coding of invoices to maximize caregiver insurance reimbursement–not always accurately reflecting what was done
  3. Frequent rejection of charges by insurers, causing the patient to intervene to try to not pay more than is appropriate (a difficult task–see issue #1)
  4. Onerous collections procedures (at my former company, we used more care and respect in trying to collect a $10 phone bill than many caregivers and hospitals use in trying to collect bills amounting to hundreds or thousands of dollars–bills which are usually in dispute)
  5. 200-300% price differences between insurer-negotiated prices and those consumers must pay for the same product or service

In the Journal article, there is a happy ending–sort of.

Earlier this week, Mrs. Dawson was contacted by a CPMC official with surprising news. The hospital said Mr. Dawson had qualified for financial assistance under its charity-care policy and wrote off his entire bill. Asked why the Dawsons hadn’t been told they could qualify for charity care before a reporter contacted the hospital, CPMC said Mrs. Dawson never gave it the opportunity to explain its policy to her.

Of course, blame the customer. That is an old strategy which my wife and I have encountered often in working with the health-care system.

So while I can’t argue with Prof. Mankiw’s math, his figures reflect broad averages which bleach out the real pain and injustice suffered by many. (Prof. Mankiw has been fortunate enough to have two of the world’s great health-insurance providers–the Federal Government and Harvard University–as employers.) And, I would wager, given that companies are pulling back more and more on their health-insurance benefits, more people are becoming responsible for management of their own health care–meaning an increasing number of people will get to experience that pain and injustice, unless the system gets some real reform. (Politicians, please read the Porter/Teisberg paper!)

The averages say the situation is fine. The stories paint a very different picture.

We expect from the health-care system compassion, fairness, respect and dignity. Often, in the doctor’s office or the hospital, we get them. Once the subject shifts to money and payment, however, they vanish into the air like smoke.

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Posted in Wall Street Journal, customer service, healthcare, hospitals, insurance, reform | Comments

Religion and science both require faith

Thursday, November 29th, 2007

I’ve been thinking all week about a New York Times Op-Ed article from Saturday, by the cosmologist Paul Davies of Arizona State University, which stated that if you’re a scientist you have to have faith–faith in there being an order in the universe sufficient to support the laws of physics, chemistry, biology, etc. Beneath every testable theory we’ve developed, there is a point at which the greatest scientists say, “It is that way just because.” or “We take that as a given.”

Writes Davies,

Clearly, then, both religion and science are founded on faith — namely, on belief in the existence of something outside the universe, like an unexplained God or an unexplained set of physical laws, maybe even a huge ensemble of unseen universes, too. For that reason, both monotheistic religion and orthodox science fail to provide a complete account of physical existence.

It’s humbling to think, with all the discoveries we’ve made, all the rules we’ve constructed about the universe, at the base of it is a vast, possibly infinite number of things we don’t know and won’t ever know. It made me think that maybe religious faith and science are more reconcilable than they might seem.

(Photo: N81 in the Small Mag from NASA’s GRIN site.)

Voice-to-Screen messaging – powered by SpinVox

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Posted in New York Times, cosmos, faith, religion, science, spoken post | Comments

A Hollywood producer’s master class on business storytelling

Wednesday, November 28th, 2007

Following on to yesterday’s post on political storytelling–in the December Harvard Business Review, Peter Guber, best described, I guess, as a Hollywood mogul (former head of Columbia Pictures, producer of “Batman” and “Rain Man,” among others), writes about “Four Truths of the Storyteller” (link – $$).

It’s an excellent article, and encapsulates in seven pages most of what it takes “Made to Stick” 200 pages to describe. Appropriately, he starts with a story, about charming Fidel Castro into allowing his team to shoot a documentary in Havana harbor. But he goes much further, to illustrate why storytelling is important in business–”for the leader, story-telling is action-oriented – a force for turning dreams into goals and then into results.”

Guber’s four truths are as follows:

  1. Truth to the Teller – in other words, authenticity, via candor and revealing of emotion. One of the biggest assets stories bring is the light they shine on the teller herself. (One frequent criticism I’ve heard in story workshops–”this reveals more about the author than the characters”–isn’t all bad.)

  2. Truth to the Audience – Guber defines this as “the promise that the expectations of the listener, once aroused, will be fulfilled.” As one of my writing teachers once put it, “a good ending is both surprising and inevitable.”
  3. Truth to the Moment – a good story adapts to the context in which it is told. This does not mean that it is synthetic, but that it absorbs the energy and atmosphere of its surroundings. Perhaps a detail that was not important in one telling becomes vital in another. This is one way in which a good story differs from a bad story–a good story can be retold many times without becoming trite or cliched. Guber emphasizes the need for preparation–a story is like an iceberg: some information is revealed, but far more information lies beneath the surface. And the storyteller must know all of it.
  4. Truth to the Mission – finally, the story must be bigger than the storyteller. As Guber puts it, “mission is embodied in his stories, which capture and express values that he believes in and wants others to adopt as their own.” He mentions as an example Nobel Laureate Muhammad Yunus, whose storytelling ability helped grow a modest idea, microfinance, into a worldwide phenomenon. (Here’s a Yunus story that was particularly inspiring to me.)

In his introductory column, HBR editor Thomas Stewart wrote, “‘Four Truths of the Storyteller’ [is] one of the smartest leadership articles you’ll have read in some time.” I agree.

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Posted in Harvard Business Review, business, communication, leadership, narrative, storytelling | Comments

Political storytelling and authenticity

Tuesday, November 27th, 2007

In the business narrative/storytelling corner of the blogosphere, there’s been some discussion of the role of stories in the recent Australian election. On the one hand, Shawn Callahan has discussed the value that stories had in presenting and communicating the virtues of Prime Minister-elect Kevin Rudd, and of Parliamentary candidate Maxine McKew. On the other hand, Dave Snowden dismissed most political storytelling, including Rudd’s, as insincere propaganda.

My thoughts? Storytelling and narrative are powerful tools. Within them is the power to communicate deeply–and to manipulate. I view the narratives of politicians, especially those running for high office, with a great deal of cynicism. Why? Because a story of a politician deeply moved by an encounter with an ordinary citizen doesn’t square with the counter-story of the politician’s well-researched and market-tested “message,” spin doctors, and the careful stage-managing of campaign events.

The most memorable story I recall of an American politician was President George H.W. Bush (I believe; it might have been Reagan) attending a baseball game, ordering a hot dog, and looking sheepishly to his Secret Service men to pay for it, since he never carried any money on him.

I remember another story about a Cabinet secretary whose biggest adjustment, after leaving office, was losing his chauffeur and having to drive himself around for the first time in six years.

These stories say a lot to me about how Presidents and Prime Ministers relate to the constituency. There’s nothing wrong with it, per se, but the “My world is a lot different from your world” stories drown out the down-to-earth stories they tell about themselves.

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Posted in marketing, narrative, politics, storytelling | Comments

Shop Talk Podcast #4 – Tony Ulwick on Determining What Customers Really Want from New Products

Tuesday, November 27th, 2007

The podcast is back, this time featuring Tony Ulwick, author of the book “What Customers Want” and CEO of Strategyn, a consulting firm helping companies improve their innovation processes.

We’re talking about how to gather information from customers to drive innovation. Most companies have “voice of the customer” programs, but few know how to extract quality information from those programs. It takes asking the right questions, and removing ambiguity from the answers. In the podcast, Tony states that it’s wrong to assume that users can’t tell us what they want; instead, the problem is that “companies don’t know how to listen to customers.”

You can access the podcast here.

Here are links to companies, people, etc., mentioned in the podcast:

Clayton Christensen – “focus on the job the user wants to get done“
Theodore Levitt’s “Customers don’t want a 1/4″ drill“
Apple
Strategyn White Papers

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Posted in innovation, management, marketing, podcast, product management | Comments

Innovative companies must excel at partnering

Monday, November 26th, 2007

There’s a fascinating interview at Harvard Business School Working Knowledge with HBS professor Alan MacCormack, covering innovation and how it’s moving away from Corporate R&D and into a collaborative web of partnering & alliances. (You can find a working paper on the subject here.)

According to MacCormack, there are several reasons why this is so:

  1. Products are becoming more complex, and therefore it’s impossible to retain all the competencies in house to create them.
  2. Open standards and architectures help allow work to be more readily distributed to partners.
  3. The growth of developing economies means that competitive, at times distinctive work is available at lower prices.

The implications of collaborative innovation fascinate me. It means that R&D professionals will need more negotiation and management skills than technical skills, and that the ability to manage internal politics will be less important than the need to bridge corporate & geographic cultures.

I’m not aware of anything in business-school curricula to prepare the next generation of managers for this challenge. (HBS students should seek out courses by Bazerman and Malhotra, as well as MacCormack.) There certainly was nothing of this sort that I learned for my MBA–any learning was entirely OJT.

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Posted in HBS Working Knowledge, alliances, innovation, negotiation, open innovation | Comments

IT Risk – platform and architecture matter

Monday, November 26th, 2007

Once, in my days running sales and marketing for a software company, the VP of Technology was growing agitated with my complaints about our product’s hardware and database architecture. “OK,” he said in exasperation, “if you don’t like [proprietary platform], what platform do you want the product to run on?”

In imitation of a Qwest ad from that time, I said, “I want it to run on any operating system, on any database, from any provider.” I then glanced at him to make sure he wasn’t winding up to smack me in the head. “You asked.”

What I was trying to get across is that fighting the platform battle with customers is a certain loser. If they are a Unix shop, and you are trying to sell them Linux, or OS400, it’s a nearly impossible task. It’s better, frankly, to cut your losses and find another prospect for which your product is a good architectural fit.

Why is that so? A new book helps sort it out. “IT Risk,” by George Westerman of MIT’s Sloan School and Richard Hunter of the Gartner Group, discusses how companies can and should manage risk within their information-technology infrastructures.

And one of Westerman and Hunter’s key points is that a company’s foundation architecture must be simple and standardized. Such an architecture can be more easily protected from disaster, can adapt more quickly to changes in the business, and can limit data access to authorized parties more easily than a hodgepodge of separate systems, platforms and applications.

Like it or not, when you are trying to sell a nonconforming software product into a company that has built a simple, standardized IT foundation, you are trying to force them to accept a hodgepodge. And they won’t do it.

Product managers need to manage the lifecycle of their architectures as well as the lifecycle of their functionality. It can be painful and expensive, but not as expensive as a good product that loses its market due to an outdated architecture.

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Posted in IT, architecture, books, information technology, product management, reading list, risk | Comments

I like the Kindle

Tuesday, November 20th, 2007

…at least what I’ve seen of it. No, it doesn’t look like Apple made it (perhaps not in itself a bad thing). But it’s got lots of titles, easy ordering/buying/downloading, and an easy-to-read screen.

I also like that they bundled the network charges into the cost of a book.

I don’t like… the name. It seems nobody does. Nor the purchase price–US$399. It’s a lot of money for something that I can’t guarantee I would use religiously. Paying for blogs is weird, never mind the small selection (you mean I can’t read Shop Talk on my Kindle?). I would happily pay for single newspaper copies, though, especially when I’m traveling.

But what I like most is a portable, easily reloadable eBook. I think about that often, when I’m schlepping through an airport terminal with my backpack laden down with a laptop and two or three books. My shoulders ache just thinking about this.

I also think of every kid carrying a too-heavy backpack to school. Which is all of them.

So, something I can carry in my backpack, which holds hundreds of books, which I can reload anywhere (at least, most anywhere in the US), which I can read as easily as a printed book. That’s a beautiful thing.

Now, Mr. Bezos. About that price tag…

(Read a summary of what other folks are saying about the Kindle here.)

(See a video demonstration of the Kindle here.)

(Kindle image courtesy of Amazon.com)

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Posted in books, gadgets, technology | Comments

Greenwashing is a marketing worst practice

Monday, November 19th, 2007

Following on to the posts from last week on using marketing in bad faith (here and here), today I read Joel Makower’s excellent post on “Greenwashing” (a great turn of phrase)–the incomplete or untrue attribution of environmentally-friendly characteristics to products.

Joel assesses a report from TerraChoice Environmental Marketing, which analyzed marketing claims on behalf of green products. They identify six worst practices, such as “the sin of the hidden trade-off,” which “suggest a product is ‘green’ based on a single environmental attribute (the recycled content of paper, for example) or an unreasonably narrow set of attributes without attention to other important, or perhaps more important, environmental issues.” This neat trick was the most prevalent “sin,” found in 57% of the claims studied.

Such misbehavior will only serve to heighten the public’s cynicism toward all green claims, with the possible result that green content gets devalued, and therefore companies stop taking pains to create it.

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Posted in environment, marketing, worst practice | Comments

More on using the Cynefin framework

Friday, November 16th, 2007

If you found value in Dave Snowden’s and Mary Boone’s recent Harvard Business Review article (discussed in an earlier post), you should read Dave’s post on “safe-fail probes”–it’s sort of a second chapter to that article focusing on applying the Cynefin framework.

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Posted in Harvard Business Review, business development, complexity, decisionmaking, leadership, management, organizational behavior, product development, sales, sales process | Comments

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