HBR on Managing Health Care

I’m not saying anything new when I say the health care industry in the US is a mess. I like medicine, and I like technology, so I recently picked up the Harvard Business Review on Managing Health Care for inspiration on how I might make my own contribution to the industry. This book is a compilation of 8 case studies on the health care industry. While it’s a bit dated (it came out in 2007), I think it still does justice to the absurdity of things happening in health care.

I come from the technology side, where all of the engineers and scientists are eagerly developing the next breakthrough in medicine. Coming from such an environment, this book was almost a slap in the face of reality for an engineer like me. There are much larger problems than the nitty-gritty of developing a medical technology—problems that can halt the proliferation of even great technologies that work well. Problems aside, I think these case studies give some great solutions to the issues. Here are the three solutions that seemed the most important to me:

  1. Make “focused factories” instead of integrating vertically. “Factories” are organizations that focus on specific diseases (e.g., a kidney center for all cases stemming from renal problems). These factories are more efficient at delivering better, integrated care to patients than systems in which patients are given fragmented care, rife with referrals and inefficient information transfer about the patient/case. Hard data indicates that the costs per case, length of hospital stay, and patient outcomes improve with focused factories.
  2. Switch to consumer-driven healthcare. Consumers aren’t stupid. Before people were given control over their retirement funds, it was feared that the general public wasn’t “sophisticated” enough to make their own decisions about their finances. Some argue that the same fears are undermining efforts to put people in charge of their own medical care. Consumer-driven healthcare would allow people to have flexible spending accounts with which they can pay for care specific to their needs, rather than enrolling in one-size-fits-all managed care plans that effectively make major care decisions for their enrollees.
  3. Enable disruptive and simplifying technologies. What would have happened if a regulatory agency in the 1980s declared, “microprocessors are inferior to logic boards, so all PCs must use logic boards”? The word, “iPhone”, would be nothing more than a typo today. The book’s final case study on disruptive innovations in health care suggests that regulatory bodies are doing something similar to the health care industry today, legally requiring highly specialized clinicians to make diagnoses that could easily be done by “less expensive” people. Basically, doctors are diagnosing the sniffles even though nurses have sufficient training to do the same. Since this case was published, perhaps the increase in physician’s assistants is gradually alleviating this problem. Nevertheless, the authors call for the need to invest in simplifying technologies that reduce the complexity-driven overhead of medicine. If the government, insurance companies, hospitals, doctors, and patients embrace such technologies, then clinicians’ skill levels will be more appropriately matched to the complexity of the medical problems they’re given.

These are the three things I’ll be thinking about while I’m on the drawing board next time. This was a great book that was a quick read, so I highly recommend it. It not only gave me a better (albeit general) understanding of the health care industry, but also a perspective on its future.

Science is Great, but Sometimes Boring

I love science and engineering, which is why I’m in grad school for biomedical engineering. I have to admit, though, science can get boring sometimes. As awe-inspiring as science can be, scientists have some bad habits. As much as I try to avoid them, I’m guilty of having them too. I think the key to fixing them lies in a great 20-minute TED talk I saw recently. In this talk, Simon Sinek explains the difference between normal people/organizations and those who find themselves in positions of leadership. He frames his argument using the idea of the “golden circle”:

Taken from Yule Heibels blog at http://blogs.law.harvard.edu/yulelog

Taken from Yule Heibel's blog at http://blogs.law.harvard.edu/yulelog

Sinek explains that most individuals and organizations are stuck at the “What” or “How” level, and usually work from outside to inside the circle. Meanwhile, successful organizations like Apple and individuals like Martin Luther King, Jr. begin at the “Why” and work from inside to outside the circle.

The reason the latter group has so much success, Sinek says, is because people identify with the “Why”. He cleverly points out that MLK Jr. didn’t rally support by saying “I have a plan“, but rather by saying, “I have a dream“; Apple doesn’t say “we make great computers”, but rather, “we challenge the status quo and think differently about how we can live and be happy.” Such sentiments are things people can relate to more than a banal 12-step program for change or a list of technical specs for a computer.

I bring this up because in all the time I’ve spent in science and engineering, sometimes the field seems to get lost in the “What”. This is dangerous because that’s when things get pedantic. I’ve been to so many talks that describe some sophisticated new technology; to my chagrin, I often leave such talks still having the question, “so what? What can I do with this technology?” This is a common theme I’m seeing across labs I’ve worked in, science classes I’ve taken, and scientific talks I’ve attended. Additionally, some scientists are so focused on publishing papers. As a result, the applications of their work are mere afterthoughts.

Perhaps this is just the nature of research and development, as experiments often need to be run ad infinitum, slightly varying conditions each time for the most comprehensive results. Because of the volume of experiments performed, scientists get lost in the “What”. So when they talk about it to other people, they may omit their work’s context or applications simply out of habit, or even because they’ve begun to focus so much on making the experiment work instead of the original problem they were trying to solve. This is a bad habit that us scientists and engineers must drop, however, otherwise we risk becoming too pedantic! We should always strive to describe and think about our work in terms of the “Why” that drives it in the first place.

I’ve had conversations about this topic with my classmates before, and a lot of people feel this way. If you’re in science or engineering, what’s your experience with this? Do you think it’s hard for scientists to focus on the “Why” just because of the nature of science itself? Do we have the capacity to approach it differently?

Adjusting to Globalization: Why is the US Falling Behind?

In the New York Times article, “It’s a Flat World, After All,” Thomas L. Friedman writes:

“These are some of the reasons that Bill Gates, the Microsoft chairman, warned the governors’ conference in a Feb. 26 speech that American high-school education is “obsolete.” As Gates put it: “When I compare our high schools to what I see when I’m traveling abroad, I am terrified for our work force of tomorrow. In math and science, our fourth graders are among the top students in the world. By eighth grade, they’re in the middle of the pack. By 12th grade, U.S. students are scoring near the bottom of all industrialized nations. . . . The percentage of a population with a college degree is important, but so are sheer numbers. In 2001, India graduated almost a million more students from college than the United States did. China graduates twice as many students with bachelor’s degrees as the U.S., and they have six times as many graduates majoring in engineering. In the international competition to have the biggest and best supply of knowledge workers, America is falling behind.

“We need to get going immediately. It takes 15 years to train a good engineer, because, ladies and gentlemen, this really is rocket science. So parents, throw away the Game Boy, turn off the television and get your kids to work. There is no sugar-coating this: in a flat world, every individual is going to have to run a little faster if he or she wants to advance his or her standard of living.”  

While I agree with Friedman about the world’s flatness and the danger of America becoming mediocre, I disagree with his message that we must work harder. Don’t get me wrong — I’m not afraid of hard work. My objection lies in the fact that Mr. Friedman’s recommendation reflects our society’s short-term mentality that working “harder” (by studying for more hours, sleeping less, etc.) will get us ahead; what he critically neglects to discuss is the consequences of “working harder”: the increased stress and drastic decrease of quality of life that is becoming a reality for today’s students.Instead of changing how hard we work, we must totally overhaul our education system so that it encourages interdisciplinary approaches to solving problems, as well as creative thought and reasoning. Right now, Bill Gates is right — science and math education is obsolete in this country. These subjects need to be taught in a more practical manner if this country wants to increase production of scientists and engineers! The main problem with science education today is that it leaves kids wondering, “so what? why should I care?” (I certainly felt this way throughout much of the coursework for my chemistry degree at Boston University.) It’s pedantic to the point of disgust. School should be just as fun as picking up the Game Boy, so fixing the education system will automatically draw kids away from playing games excessively.

Science in high schools and undergraduate universities is no longer empirical. It is textbook-based. Even in the laboratory for science classes, there is little room for tinkering and scientific adventure because everything is dictated by a stifling lab manual procedure that doesn’t communicate the importance of the particular experiment being conducted. The exception is independent research projects, which only a fraction of science students actually pursue; and that too, you usually start it late in your undergraduate career. Before many science students even reach that point, they leave because they were not given any opportunity to apply what they learned in class to a real scientific problem.

Additionally, the humanities cannot be forgotten — as the world becomes flat, appreciation for humankind is vaporizing. It’s okay that we need to work harder to produce more scientists and engineers to compete in the world, but not at the cost of our human element. Scientists and engineers are notorious for their apathy towards language, literature, and the rest of that “fluff.” What they miss is the fact that the humanities help you learn how to interact and communicate with your society — a skill that is important regardless of your career path. Not only that, but you develop an appreciation for people as individuals (in practical terms, your reasoning and ability to analyze a person’s character are strengthened). We have to get away from our divisions of study into individual subjects, and present an interdisciplinary approach to learning science — perhaps pairing biology with poetry, or engineering with music. These approaches will not only increase the retention rate of science and engineering majors, and allow students to enjoy science more, but will also allow them to appreciate science within the broader human context from which it originated. THAT will help interest more into science and engineering; not throwing away the game boy, or “working harder.” If science students are going to be spending so much time to learn all that is necessary to become scientists, their educators need to make it worth their efforts and sacrifices.

Adapting to a flattened, globalized world is a bigger problem that transcends the lack of parental guidance: the root lies in a flawed and impractical education system.