GUEST POST from Arlen Meyers

How many times have you been encouraged to “think out of the box”? It generally means you should challenge the status quo, innovate, disrupt and a multitude of other buzzwords. For example, here are 3 ways to do it.

But, there are hazards to out of the box thinking:

1. If you are a bad rebel instead of a good rebel, it will result in career suicide.
2. Whether you are an entrepreneur or an intrapreneur, you will need a supportive ecosystem to make you ideas work. Building a new one from scratch takes lots of time, money and courage.
3. Most innovations are evolutionary, not revolutionary. building and modifying existing predicates
4. Thinking out of the box will usually result in followers thinking you are out of your mind and will stiffen their resistance to change
5. It doesn’t work. The term “out-of-the-box thinking” came from solutions to the so-called “nine dot problem” — where there are three rows of three dots and the problem is to connect all the dots with just four lines. The solution lies in drawing a line that goes outside the imaginary “box” formed by those nine dots. “Thinking out of the box” has come to mean thinking of a solution that is somehow outside of what you already know and do, coming up with something wholly new. Sounds great, but does it work? Studies have shown that, when you tell people to think out of the box in solving the nine-dot problem, they don’t do any better than when you just let them go at it. Pushing people harder to think out of the box doesn’t work. Many of the revolutionary ideas in the technologies and arts don’t come from the person who solves the problem by thinking out of their box. It comes from the person who has seen the right solution already somewhere else — who has other boxes to think in.
6. Ideas are not inventions are not innovations. Most of the latter are old ideas used in a new way or with a new or different business model.
7. We live in a VUCA world (volatility, uncertainty, complexity and ambiguity). Making a successful product that is entirely new is probably more about dumb luck and timing than imaginative out of the box thinking. New product failures speak volumes.
8. If you get too far out ahead of your troops you are likely to be confused as the enemy
9. The challenge is to spend the right amount of time on the now, the next and new.

10. “It’s tough to make predictions, especially about the future.”-Yogi Berra

Don’t get boxed out by out of the box thinking. Innovation is about connecting dots, even if if some of them are outside of the imaginary box. Sickcare cannot be fixed from inside so maybe you need to look in someone else’s box.

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GUEST POST from Arlen Meyers

One way to put a toe in the water of physician entrepreneurship is to become an advisor to a startup founder or client or simply someone who wants your opinion. However, being an advisor that creates value means you have to deliver the 7Ms. You will have to deliver the value that startup CEOs are looking for: money, marketing, making something, management, manpower, mentors, monitoring the environment and mergers and acquisitions.

When you get that gig, though, you will have to learn when and how to give advice and how much to give. You also have to deal with founders who have founders syndrome and those who suffer from other entrepreneurial syndromes. In short, many won’t take your advice and you will be left with the feeling that you have wasted your time.

Here’s some advice on giving advice:

1. When you sign on, clarify expectations about when, how and how often are the best ways to communicate-face to face, email, text or phone, videochat?
2. Have an agenda focusing on the next critical success factor you need to help achieve. Is it finding money? How about helping to recruit talent to execute the plan and scale?
3. Avoid having to spend time giving the same advice over and over again by authoring a blog, post or eBook, like this one. Like the flipped classroom, read the assignment and then let’s discuss in class.
4. If you get ghosted (you haven’t heard from the person who hired you in a while), don’t take it personally. Instead, talk about whether there is a problem, recalibrating your advisory role and whether it should be changed or eliminated.
5. Use technology to block your time and synchronize schedules
6. Understand your role as an advisor v a mentor, coach or sponsor. The expectations are different for each.
7. Don’t work with people you can’t trust, like those who don’t pay you what and when they promised to do so, those who bad mouth you behind your back or those who make you feel unappreciated or ignored or won’t lead when there is inevitable team conflict.
8. Focus on adding continuous value and delivering results
9. Assign as much credit for results to others on the team
10. Here are some tips on how to give advice.

Both the advisee and the advisor have responsibilities so be careful how you pick someone’s brain.

Remember Socrates who said “I cannot teach anybody anything. I can only make them think.” By it’s very nature, advice is just that and can be accepted or ignored. Make it personal, just don’t take it personally when it’s the latter.

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GUEST POST from Arlen Meyers

We owe a lot to K-12 teachers. They, like others who work in mission critical industries, like sick care, have to deal with many issues to help their students. In fact,according to a recent survey,the greatest barriers to school success for K-12 students have little to do with anything that goes on in the classroom, according to the nation’s top teachers: It is family stress, followed by poverty, and learning and psychological problems. In many ways and in many places, the same is true for doctors helping patients.

Approximately 1.2 billion people in the world live in extreme poverty (less than one dollar per day). Poverty creates ill-health because it forces people to live in environments that make them sick, without decent shelter, clean water or adequate sanitation. While the official US poverty rate is 14.5%, some differ and claim it is as low as 4.5%. Still, a lot of people.

In addition,More than 16 million children in the United States – 22% of all children – live in families with incomes below the federal poverty level – $23,550 a year for a family of four. Research shows that, on average, families need an income of about twice that level to cover basic expenses.

After 50 years, The War on Poverty has been a stalemate, and , as you would expect, poverty rhetoric takes the stage every four years.

Between 2000 and 2015, the number of people living below the poverty line rose 36 percent, from just under 34 million Americans to over 46 million, and the poverty rate increased by two percentage points. But where one lives matters. High-poverty neighborhoods, defined as places in which at least 20 percent of residents are poor, can lock families and children into a cycle of poverty because they lack good schools, nearby jobs, and are often fraught with high crime. Unfortunately, the number of high-poverty neighborhoods has more than doubled in the nation’s 100 largest metro areas, with the bulk of that growth occurring in the suburbs.

I’ve worked for many years in “safety net” hospitals-city and county hospitals, university hospitals that take care of a disproportionate share of poor patients, VA patients who are homeless, and native American facilities located on reservations with a culture of poverty. In most instances, health success has little of nothing to do with what goes on in the examining room. Instead, the psycho-social and behavioral health context usually is a predictor of treatment success or failure. In most instances, doctors are ill-prepared to deal with those issues and live at the epicenter of medicine, the legal system, medical sociology and a very dysfunctional mental and behavioral health pseudo-system.

There is growing awareness and acknowledgment in the health care community that health outcomes and disparities, more often than not, are driven by social determinants of health than by medical care. Social determinants of health include social, economic, physical, or other conditions where people live, learn, work, and play that influence their health. Poverty and food insecurity are social determinants of health, and are associated with some of the most serious and costly health problems in the nation. 

With the elimination of net neutrality, the internet becomes another social determinant.

The loss of net neutrality will force healthcare organizations to rely more on electronic health record (EHR) vendors like Cerner and Epic to provide them with the technological support they need to be able to move health records electronically, and consumers will pay for that cost, says Beatrice Mallory, SVP and managing director at Sensis Health.

It will also exacerbate the rate at which internet access is a social determinant of health, because there will now be entire communities with less access to preventive care, prenatal care and chronic disease management, she tells Healthcare Dive. “What you’ll see is more reliance on episodic care” and use of emergency rooms, she says.

These days, a lot of people are telling doctors what they should be and do. As if practicing state of the art medicine is not enough, clinicians are expected to be experts in health economics, population health, data analytics and business intelligence, spiritual medical sociology, behavioral health, community resource management, law enforcement, addiction medicine and much more. They are being measured and compensated using measures over which they have little or no control. And we haven’t yet gotten to the chief complaint.

In fact, doctors are no longer expected to just do what’s “right” by the patient. Now they are expected to serve two other masters-their employers and society at large.

I remember in medical school learning about taking a history from a patient. One part was the social history, inquiring about such things as education, occupation, marital status and a few things that regulators required later on, like being the victim of domestic abuse. I rarely asked about whether the patient had food and shelter for the night. Some medical schools are changing that, with the understanding that your ZIP code is a more important determinant of your health than your genetic code.

The two biggest contributors to rising global health costs are the aging population and poor health habits contributing to non-infectious chronic disease. Here are the factors thatcontribute to the success of public health interventions:

The factors that affect the successful implementation of such programs are: • national planning, political factors and capacity; • availability of data about the target population and intervention impacts; • influence of socio-economic factors and special considerations regarding the age of target population; • burden of the health problem to society, family and individual; • use of intervention in a multifactorial setting; • communication strategies through media and school to reach vulnerable and minority groups; and • engagement of all levels of the society (from government to individual) in the process.

Policy considerations

The research evidence shows that the most effective programes for children and young people are carried out at the government level, supported by society in general, and promote national policies to decrease poverty and increase social equality. The second most effective interventions are coordinated government policies such as pricing, legislation and other policies. (E.g. the most effective interventions against tobacco use are increasing the price of tobacco, banning tobacco product advertising, banning smoking in public places and legislation prohibiting the sale of tobacco products to young people.) There is also evidence that simultaneous, multi-dimensional inputs at national, local and individual level increase the effectiveness of general health promotion campaigns. The health promotion interventions that are least likely to work are ones that deal with single issues, are ‘negative in the message’, and delivered at only one level of society.

The research on social services, health spending, and health outcomes suggests strongly that it is no coincidence that the U.S. has this unusual combination of spending and mediocre outcomes.

Studies that focus on non-clinically directed health promoting interventions such as tobacco or sugar taxes, or placement of urban greenways are in short supply in spite of the fact that a robust literature has documented that health care’s impact on population health is dwarfed by social and environmental factors. Here is a research agenda to fill the gaps

Value-based care (VBC) is necessary to significantly improve health outcomes and to lower costs for children and others with chronic illness and complex medical conditions. One hospital reports, though, that a VBC approach can decrease the direct costs of care for a group of children with a chronic condition. However, transitioning to a VBC approach involves added infrastructure, training costs, and complexity of delivering care in an environment that mixes fee-for-service and value-based reimbursement. In addition, in order to deliver on the promise of improved health and reduced spending, VBC must be augmented with a structured approach to eliminate waste and be delivered in conjunction with a broad-based effort to address factors that are outside of the traditional boundaries of healthcare. The results might also mean less revenue for a hospital since it reduces fee for service interventions.

Here how different organizations are solving the problem.

Experts offer the following advice to leaders who want to reduce health disparities in their communities.

Use the community health needs assessment. Hospitals are required to complete the assessment every three years and can use the process to identify which health inequities to target, Weiss says. MaineHealth identified substance-use disorder as a priority after reviewing its own assessment. Leaders may want to conduct this assessment jointly with other providers in their community.

Ask for help. Health system and health plans may want to reach out to community stakeholders like criminal justice, transportation, and business organizations to talk about potential solutions. For example, leaders at Maine Behavioral Healthcare work with law enforcement to train officers on how to identify individuals with mental health needs, including substance-use disorder, Merz says.

Think about the next generation. In addition to helping adults by funding stable housing, CareOregon aims to change the trajectory for children affected by homelessness. Hunter says that homeless children often have higher scores in Adverse Childhood Experiences testing, which raises their future health risks. “Housing is a big piece of a family’s economic security and helps to change the long-term dynamic,” he says.

Be a catalyst for collaboration in your own organization. In many provider organizations, internal leaders in finance, population health, and community benefits may not have had opportunities to interact. But a health equity project can be a good place to start. “What financial leadership can help do is bring some of those conversations together,” Weiss says.

Focus on the problem and then think about incorporating technology. Providers need to consider their clinical needs before they purchase technology platforms to address health disparities, UMMC’s Adcock says. In addition, they should realize that one product will not address every issue.

Build healthy cities Most city leadership, urban policymaking or action on the ground prioritises the safe and efficient delivery of formal healthcare services in hospitals and the community rather than a wider focus on public health and healthy lives. This is cure rather than prevention. The Foresight Future of Cities project has identified a broader perspective that could be adopted – one that looks at urban health and wellbeing as a total ‘ecosystem’ to be embraced, rather than urban healthcare as a complex system to be managed and resourced.

Newark Beth Israel has hired 169 city residents for full- and part-time jobs during the past year and will hire locally for 250 more full-time positions over the next two years. The hospital plans to spend $610,000 this year with local women and minority-owned businesses. It also has invested $5 million in a Newark venture-capital project to develop local tech entrepreneurs and provided a $150,000 grant to a commercial-redevelopment program.

Population health is more about providing clean water, housing, mental and behavioral health intervention, opportunity equity, education and adequate nutrition than big data. The sick care system generally ignores it. Those that don’t not only improve care but save money doing it.

We need to do a better job of rebuilding civic social support systems and linking the sick care system with the public health and other social service ecosystems However,without seeing care in context, we’ll be missing the forest for the trees.

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GUEST POST from Arlen Meyers

Doctors are unhappy about electronic medical records.

• Nearly 70% of physicians say electronic health record (EHR) systems have not been worth it
• EHR usage is accounting for 48 minutes of lost free time per day.
• 73% of the largest practices would not purchase their current EHR system
• 45% of respondents say patient care is worse since implementing an EHR

The healthcare digital ROI is not meeting expectations. Only the vendors making billions seem happy.

When it comes to communicating, it seems, techologists are from Venus and doctors and other end users are from Mars. The present offerings are not meeting the needs of users, are too complicated and filled with features, not benefits, and they offer smokestacked parts of a solution. Instead, we need a whole product solution that would include the next generation EMR.

The whole product

The whole product bridges the gap between the marketing promise your company makes to customers and your product’s ability to deliver on that promise. It includes all the products and services that are necessary to augment or complete the product so that it becomes a complete solution and lives up to its value proposition.

The four layers of the whole product

• Generic product: the product that ships when a purchase is made
• Expected product: the product the customer believes he buys when he orders the generic product
• Augmented product: the idealized form of the product that provides the greatest chance that the customer will achieve his stated buying objective
• Potential product: the apparent growth path of the benefits demonstrated by the product as it is improved, and as it is complemented and strengthened by other products and services

We are now in the ecosystem economy.

TVs were worthless without a network. Electric cars won’t scale until there is a national electic charging grid. Digital health won’t mature until there is a coordinating cyberbrain.

So, what’s your strategy? Can you answer these five questions?

Customer jobs, pains and gains describe problems. Gains describe all the customer’s wanted and unexpected benefits and desires, and may span personal, functional, or economical etc. For example, this box could include positive emotions, functional requirements, or specific cost savings and can be rated as “WOW, I sure didn’t expect that” to “not having this is a deal breaker”.

So, what would a whole digital health product look like?

1. Interoperable with other whole products. For example, suppose all EMRs and the internet of things were interconnected? What impact would that have on the global aging population?

2. Intuitive user interface with minimal workflow disruption.

3. Designed to achieve the Quadruple (includes the doctor experience) Aim of improved quality, reduced per capita costs and an improved patient nd doctor experience.

4. Validated that it achieves #3

5. Incorporates modules that include not just EMR, revenue cycle management and business process/practice management support, but eCare as well, including decision support, telemedicine, remote sensing and other parts of digital health.

6. Accessible anywhere, any time, using any mobile device.

7. AI support to avoid unnecessary data entry requirements by the user.

8. Accessible to the community of care, not just closed loop providers, anywhere in the world.

9. Ability to modify security and confidentiality requirments to suit the needs of the care team and patient team.

10. Inexpensive or. preferably, free

11. As population health management demands increase, so is the demand for an information and communications health solution. For example, in an attempt to expand its population health footprint, Siemens Healthineers — the healthcare unit of Siemens AG — has signed an agreement to acquire Medicalis Corporation, a company based in San Francisco, California, and Kitchener, Ontario, Canada. Components of the platform include decision support, referral management and patient and doctor parts designed to improve the patient experience and engagement.

12. Cybersecure

Here are some more benefits, not features:

1. A whole product solution that integrates telemedicine, social media, etc

2. Voice to text entry

3. Better UI/UX

4. Better decision suppport

5. Interoperabilty

6. Patient owned

7. Integration with IoT

8. Automated bill generation based on data mining

9. Patient friendly format for patient participation that does not interfere with workflow during the visit

10. Better biometric activation across multihospital systems. Eliminate passwords

11. Translation function for clinical summaries for non-English speaking patients

12. Clinical translator for patients who don’t understand medical terms

13. Cheaper, smaller, better systems for independent practitioners who can’t afford to and don’t need to buy the whole enchilada

14. Change the billing rules that are driving ecosystems that create ridiculously complex and costly systems to operate

15. Include costs of prescribed tests, medicines and other therapeutic interventions in real time at the point of care and other options to reduce them. Give us the answer when the patient asks, “What will all this cost, doctor?”

We are starting to see some evolution from a sick care billing solution to a healthcare IT whole product solution.

A hospital centric EMR is not a long term viable model given the multiple points patients generate sick care and disease prevention data from non-traditional sources. Some have suggested the need for more robust pipelines, delivering data to a central repository and directed by middleware.

Here are some EMR trends that are likely to drive the continuing evolution of a health IT/EMR whole product solution. Another is integrating decision support science tools into the EMR, instead of relying on free-standing websites or apps.

We are getting closer. It’s been fewer than two months since Apple announced its pilot with a handful of vendors, allowing patients at certain provider sites to download their EHRs directly through the iPhone Health app instead of using a provider portal. But it’s not clear yet how the partnership is going – vendors and providers have generally been reluctant to share details about user numbers during the beta phase.

Dribbling out bits and pieces of a complete health information technology solution is causing more problems that it solves. Administrivia, reporting requirements and having to jump through burdensome and expensive hoops to get paid is causing unintended consequences and there is little evidence that it is meeting the Triple Aim goals.

We need to stop making things a la carte. We need the whole enchilada.

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GUEST POST from Arlen Meyers

Surthriving in the brave new world of sickcare requires not just a new playbook, but players with new skill sets to execute the plans. Knowledge technicians are as obsolete as an NFL team with a running game but without a passing and special teams plan. Unfortunately, HR managers are getting it wrong.

But, do you know how to recruit for creativity and imagination? What will you support creative people once you have?

If you are looking to employ physicians, you need to recruit physician intrapreneurs. not knowledge technicians. Physician intrapreneurship has particular challenges.

Those responsible for hiring and managing the new sick care workforce should factor these things into the hiring decision:

1. Knowledge technicians will eventually be replaced by AI and other technologies, placing special emphasis on a doctor’s comunication and empathy skills

2. There are many reasons why doctors don’t play nice with others and they need to be addressed.

3. Only about 1% of doctors have an entrepreneurial mindset

4. You need to give knowledge technicians the knowledge, skills and attitudes necessary to evolve into managers, to leaders, to leaderpreneurs

5. It is almost impossible to pick identify and select people with a real or nascent entrepreneurial mindset. Most hide their innerpreneurial tendencies for fear of being eliminated by the BIG MEDICINE corporate immune system

6. Creating strategic alignment between the patient and profit mission is a full time job

7. Entrepreneurship or intrapreneurship is not about starting companies. It is about creating user defined value through the deployment of innovation.

8. Doctors matter. DISing them won’t work

9. Intrapreneurs are employed physicians trying to act like entrepreneurs in their organization. They are fighting a two front war. Don’t make it any harder than it already is.

10. You won’t find many who fit the bill, so be sure you celebrate the champions and use them as role models for others. Don’t make these mistakes when it comes to overlooking internal talent.

11. Renters act differently than owners

12. Quality of care is not improved in employed physician organizations.

The characteristics of the intrapraneurial mindset are:

1. Action trumps ideas and more analysis every time. Real change comes from people who are obsessed with action, not ideas. Thinking and analysis without execution feels like zero cost to existing organizations, but it actually ignores the opportunity cost lost. If you act, you learn from other people, especially customers, and you build momentum.
2. Focused on progress rather than process. Most entrepreneurs realize that for early stage startups, process is the enemy of progress, slowing you down when you’re trying to move forward. But more mature companies have learned that scaling a business requires process, so the focus changes. Intrapreneurs have to always think like entrepreneurs.
3. Relishes the opportunity to learn from problems. Corporate environments tend to treat problems as failures, rather than opportunities. People are trained to avoid change, and stick with the safer status quo. True entrepreneurs, like Thomas Edison, realize that the biggest innovations come from solving problems, such as failing light bulb filaments.
4. Loves to “hack” new outcomes from existing systems. In software, hackers love the intellectual challenge of confronting a system designed to do one thing and cleverly exploit it to achieve something different. That’s the essence of innovation, and good intrapreneurs need to find new opportunities by bending existing strengths in new ways.
5. Reach out across the aisle for complementary talent. Smart intrapreneurs know they can’t do it alone, and know how to enlist the help they need by making it clear “what’s in it” for others. They enjoy engaging in informal partnering and co-design solutions with other stakeholders, while making the total opportunity as much possible about others.
6. Married to a mission, but not just to one way to do it. The people you desire know the “what” and the “why,” but don’t want to be told “how.” They are always looking for gaps and misalignments, and thrive on changes, even radical changes, so the organization performs better. In this context, strategy deviations can keep the company on track.
7. Frugal by nature, and don’t ask for much to proceed. Even though they see huge budgets all around, they prefer to start on the cheap (like an entrepreneur), reusing existing resources, working on the side, and employing messy, make-do methods over expensive sanctioned systems that have long approval cycles and much oversight.

How change agents respond to frustration is based on 1) whether they feel they have the ability, status or power to change things, and 2) whether they are committed to do so. In other words, depending on whether they are willing and able to engage, they will lead (attacker), follow (defender), get out of the way (disengage or be a sabateur) or quit.

Here are 7 reasons why your best docs might quit. Here are some danger signs that they are headed for the exits:

1. Their work productivity has decreased more than usual.
2. They have acted less like a team player than usual.
3. They have been doing the minimum amount of work more frequently than usual.
4. They have been less interested in pleasing their manager than usual.
5. They have been less willing to commit to long-term timelines than usual.
6. They have exhibited a negative change in attitude.
7. They have exhibited less effort and work motivation than usual.
8. They have exhibited less focus on job related matters than usual.
9. They have expressed dissatisfaction with their current job more frequently than usual.
10. They have expressed dissatisfaction with their supervisor more frequently than usual.
11. They have left early from work more frequently than usual.
12. They have lost enthusiasm for the mission of the organization.
13. They have shown less interest in working with customers than usual.

As your organization grows and becomes more and more corporatized, you can expect your workforce to lose motivation, particularly the highest performers. Here are the main reasons why and how you should address them.

OK. Hopefully, I’ve convinced you to hire physician intrapreneurs. Now what should you do next?

1. Provide them with the knowledge, resources, networks, mentors and experiential learning they need to succeed.

2. Create a transparent innovation leadership system. Give them some PEARLS

3. Support champions, facilitate team building and develop Physician Intrapreneurs in Residence (PIIRs) to support peers.

4. Set strategy, define the vision and get out of the way

5. Let them fail without labeling them as “disruptive physicians”

6. Be sure they are integrated into your regional innovation ecosystem

7. Absolutely, positively, walk the walk. Never promise something you can’t deliver. If you do, you will break the trust you are trying to create and never regain it.

8. Be sure you have the structure, process and culture that fertilizes imaginative physician intrapreneurs. Do what it takes, within reason, to make your doctors happy. Happy doctors are safer, more enjoyable to work with, make happy patients , and , according to positive psychologist, are more creative, imaginative and entrepreneurial.

9. Not everyone is motivated by the same things. Some want time. Some want money. Some just want revenge, driven by anger to make things right based on their values.

10. Think big, but seek and leverage small wins.

Pay attention to these 10 reasons why your doctors will quit:

1. They are not respected as people at work. They are viewed as production units, rather than valued collaborators.

2. They don’t have the right tools, equipment, information and basic operational requirements they need to do their job. When they ask for tools or guidance they get yelled at or ignored. What kind of company would impede its employees’ ability to do their jobs, then get mad at them for asking?

3. Their employer disregards their personal life and has no compassion for their obligations outside of work.

4. Their immediate supervisor is a tyrant, unqualified for their job, or both.

5. They are tired of being lied to.

6. They have no visibility into the future and no confidence their leaders will do the right thing, either from a business standpoint or a human standpoint.

7. They are tired of dealing with the politics in their workplace.

8. They are underpaid and overworked.

9. They go to work every day and push a rock uphill, trying in vain to get forward motion on their projects. They’re tired of pushing.

10. They have to watch every word they say and every move they make, because the knives are out and they could get in trouble — or get fired — for almost any reason.

The face of intrapreneurship is changing in many industries other than medicine.

You also need to dial back your corporate innovation immune system.

There is a reasonable chance that the physician intrepreneurs you hired are already looking for another job. Many probably already have side gigs, which is something you should encourage, not discourage. In fact, you should encourage them find another job or create their own.

Here are 10 mistakes to avoid if you want to prevent losing our best physician intrapreneurs.However, losing your best is actually good for you for many reasons.

Recruiting, developing and retaining physician intrapreneurs is a difficult task. Here are some ideas on how to recruit for group creativity.

Despite all this, try not to buy into some myths about intrapreneurship. As noted, to start, innovation must be recognized as a permanent function of a successful company, just like other business functions such as accounting, operations, sales, and finance. It’s hard to imagine a large company without a marketing department or division, yet less than 50 years ago marketing as a business function, profession, and department did not exist. The same is true of innovation today. If companies want to be able to consistently innovate, they need dedicated innovation professionals to carry out the functions of discovery, development, incubation, acceleration, and scaling.

But this innovation division can’t be siloed off from the rest of the business. Company incubators and innovation labs that are isolated from the rest of the organization tend to have limited success, because they are disconnected from a larger system. Game-changing innovations require a holistic approach across the organization.

Simply hiring doctors does not improve the quality of care. To thrive, however, HR managers and recruiters need to to have new tarkets in their sights and provide recruits with the tools they need to add value not just to themselves, but to their organizations as well. It’s the only way to get to the playoffs.

What gets you up in the morning?

 
Image Credit: Pixabay

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GUEST POST from Arlen Meyers

Imagine you are at a cocktail party and, inevitably, at least in the US, one of the first questions will be, “So, what do you do?”

NB: Do not ask this as the first question when in Europe or Asia.

The answer: “I’m a physician entrepreneur”. Now what?

Consider it an exercise in cultural competence with a dose of psychology thrown in too. Here are some things you should know about narcissistic personality disorder.

You might want to start off with the assumption that you are talking to a narcissist and all that comes with it, both the light and the dark sides.

Here are the five myths of everyday narcissism. You might be talking to someone who suffered from childhood emotional neglect or who had parents who made that person feel that, since their feelings didn’t matter, neither did they.

Research indicates that:

Student entrepreneurs score higher on the Narcissistic Personality Inventory than other vocational groups.

Narcissism is positively correlated with general self-efficacy.

Narcissism is positively correlated with locus of control.

Narcissism is positively correlated with risk propensity.

Narcissism plays a significant role in explaining entrepreneurial intentions..

Past research shows that narcissism is often tempered by adversity and failure 

It may be possible to contain and control the downsides of narcissism. For example, what if those grandiose self-views could be redirected to become focused on others, such as being the best helper, advice giver, or team member? The narcissists who do this naturally are called communal narcissists. They are self-appointed saints who have unrealistic views of their contributions to others. While, like all narcissists, they are driven to maintain unrealistic, inflated self-views and crave positive feedback, their narcissism can be channeled toward productive ends because their self-image is tied to helping others. Whereas traditional research has examined agentic narcissists, those who think their abilities are far grander than others’ and are focused on achieving things in the world for themselves, communal narcissists are more likely to share credit and resources in group settings in order to support their self-perceptions as heroic helpers — and they could just be the narcissists your organization needs.

Then, there is a category of humble narcissists. There are three kinds of humility that matter: ideas, performance and cultural.

That is not the only entrepreneurial psychopathology they exhibit. Then, throw in the doctor part, like a high producing surgeon, and things start to get sticky.

Here are some tips on how to spot and speak to a narcissistic entrepreneur:

1. Forget about changing the stripes on a tiger. Narcissist entrepreneurs think they got as far as they did because of who they are and you are not about to convince them otherwise. They have been told most of their lives how exceptional they are. They prey at the altar of the meritocracy and think luck has absolutely nothing to do with their success and they have little empathy for those who simply put, just don’t work hard enough.

2. Plan to spend no more than 5 minutes talking to them, because they will only talk about themselves and the more you encourage them, the worse the conversation will get.

3. Beware of the narcissist in sheep’s clothing. They know it’s all about them and so they try to compensate and only ask questions about you without sharing anything about themselves. You can tell they are faking interest because they are looking over your right shoulder during the conversation.

4. They are the only ones in the room overdressed

5. They answer very short questions with very long answers, particularly if they are men and deliver a manologue.

6. They incessantly post on Linkedin Pulse and other social media. Beware of anyone with over 500 posts.

7. They have mostly superficial relationships and expect you to pay your part of the bill since most of their money is going for alimony and child support.

8. They like the limelight and make good leaders

9. They value validation

10. They like to use lingo, jargon and bizspeak

Here are some more tips on how to deal with people who have big egos.

One thing you can count on , though, as Uber stockholders are discovering, is that therapy for CEOs displaying toxic behavior will have to wait until there is a substantial impact on profits.

The next time you run into a narcissist entrepreneur, just smile and say, “Wow, did you do that all by yourself?” Then take a sip of your Chardonnay, listen for the next 5 minutes and then politely excuse yourself. Millenials self promote because they have to. Maybe in the new economy we all do. Or , if you are a narcissist yourself, just hang out together for a while and ride the career ladder together.

I’ll bet you think this post is about you, don’t you.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

AI, machine learning, neural networks and deep learning are the new, new thing. Applications in medicine are potentially vast and, as most things on the upside of the hype cycle, there is a proliferation of papers, conferences , webinars and organizations trying to stay ahead of the curve. Doing so , however, means you are on the leading edge to the trough of disillusionment.

Despite advances in computer technology and other parts of the 4th industrial revolution, there are many barriers to overcome before machine learning crosses the chasm. Here are some things you should know about dissemination and implementation, and innovation diffusion basics.

There are four basic categories of barriers: 1) technical, 2) human factors, 3) environmental, including legal, regulatory, ethical, political, societal and economic determinants and 4) business model barriers to entry.

TECHNICAL

A recent Deloitte report highlighted the technical barriers. Here are the vectors of progress:

Explainability, for example, is a barrier. Say one can predict the onset of Type 2 diabetes. It’s one thing to say that we think there’s a propensity but, typically the next question is “Why?” Most algorithms don’t, but we make sure that if we provide a prediction we can also answer those types of questions.

In a paper published in Science, researchers raise the prospect of “adversarial attacks” — manipulations that can change the behavior of A.I. systems using tiny pieces of digital data. By changing a few pixels on a lung scan, for instance, someone could fool an A.I. system into seeing an illness that is not really there, or not seeing one that is.

Software developers and regulators must consider such scenarios, as they build and evaluate A.I. technologies in the years to come, the authors argue. The concern is less that hackers might cause patients to be misdiagnosed, although that potential exists. More likely is that doctors, hospitals and other organizations could manipulate the A.I. in billing or insurance software in an effort to maximize the money coming their way.

Measuring and reporting results is another barrier since there are lies, damned lies and AI statistics.

HUMAN FACTORS

Human factors, like how and whether doctors will use AI technologies, can be reduced to the ABCDEs of technology adoption. Research suggests the reasons more ideas from open innovation aren’t being adopted are political and cultural, not technical. Multiple gatekeepers, skepticism regarding anything “not invented here,” and turf wars all hold back adoption.

Attitudes: While the evidence may point one way, there is an attitude about whether the evidence pertains to a particular patient or is a reflection of a general bias against “cook book medicine”

Biased Behavior: We’re all creatures of habit and they are hard to change. Particularly for surgeons, the switching costs of adopting a new technology and running the risk of exposure to complications, lawsuits and hassles simply isn’t worth the effort.

Cognition: Doctors may be unaware of a changing standard, guideline or recommendation, given the enormous amount of information produced on a daily basis, or might have an incomplete understanding of the literature. Some may simply feel the guidelines are wrong or don not apply to a particular patient or clinical situation and just reject them outright.

Denial: Doctors sometimes deny that their results are suboptimal and in need of improvement, based on “the last case”. More commonly, they are unwilling or unable to track short term and long term outcomes to see if their results conform to standards.

Emotions: Perhaps the strongest motivator, fear of reprisals or malpractice suits, greed driving the use of inappropriate technologies that drive revenue, the need for peer acceptance to “do what everyone else is doing” or ego driving the opposite need to be on the cutting edge and winning the medical technology arms race or create a perceived marketing competitive advantage.

In addition, medical schools, graduate medical education and graduate schools are not doing enough to train knowledge workers how to be more effective.

ETHICS/LEGAL/REGULATORY/IP

The UK House of Lords Select Committee on Artificial Intelligence has asked the Law Commission to investigate whether UK law is “sufficient” when systems malfunction or cause harm to users.

The recommendation comes as part of a report by the 13-member committee on the “economic, ethical and social implications of advances in artificial intelligence”.

One of the recommendations of the report is for a cross-sector AI Code to be established, which can be adopted nationally, and internationally. The Committee’s suggested five principles for such a code are:

1. Artificial intelligence should be developed for the common good and benefit of humanity.
2. Artificial intelligence should operate on principles of intelligibility and fairness.
3. Artificial intelligence should not be used to diminish the data rights or privacy of individuals, families or communities.
4. All citizens should have the right to be educated to enable them to flourish mentally, emotionally and economically alongside artificial intelligence.
5. The autonomous power to hurt, destroy or deceive human beings should never be vested in artificial intelligence.

The Nuffield Council on Bioethics identified the ethical and societal issues as:

1. Reliability and safety
2. Transparency and accountability
3. Data bias, fairness and equity
4. Effects of patients
5. Trust
6. Effects on healthcare professionals
7. Data privacy and security
8. Malicious use of AI

Finally. the parts of the environmental SWOT analysis are more wild cards in the game.

Here are the issues under discussion about patenting AI products and services.

Here are some other legal concerns.

ENVIRONMENTAL AND BUSINESS MODEL BARRIERS TO ENTRY

Startup developers of commercial AI applications operate in a competitive market. They compete with the data available to them and meet a market need for AI applications for midsize companies, which, in turn, enables those companies to compete with larger companies that often develop AI applications internally.

Some healthcare organizations contend that it’s financial constraints that provide limitations. Lack of dollars makes it difficult for all but the most advanced and lucrative healthcare organizations to put machine learning or artificial intelligence in place to make the most of the data. There are many more practical barriers contributing to the AI divide.

Here are some regulatory and reimbursement issues.

AI dissemination and implementation faces some NASSSy hurdles (The acronym stands for Nonadoption, Abandonment and Challenges to the Scale-up, Spread and Sustainability

Artificial intelligence in medicine is advancing rapidly. However, for it to grow at scale and provide the promised value will depend on how quickly the barriers fall.

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GUEST POST from Arlen Meyers

Steve Blank describes how companies grow in three phases-search, build and grow. In the first step, the goal of a startup is to search for a repeatable and scalable business model.Building means changing into a company that can scale by growing customers/users/payers at a rate that allows the company to:achieve positive cash flow (make more money than it spends) and/or generate users at a rate that can be monetized.Grown up companies have achieved liquidity (an IPO, or has been bought or merged into a larger company event) and is growing by repeatable processes. The full suite of Key Performance Indicators (KPI’s) processes and procedures are in place.

I describe it as Fail it. Nail it. Scale it. Sale it.

Unfortunately, when founders and start up entrepreneurs grow up, they have few places to turn and are on their own. Most start up accelerators kick them out the nest after 90 days. Accelerators seem work when they follow best practices. Some don’t.

Many confuse accelerators with incubators (sometimes called generators or some other kind of whateverators). Here are some differences.

According to a recent analysis, we need scalerators now more than ever, since while the number of new businesses created since the Great Recession is increasing, the number that reach scale are not those that do hire fewer employees than in the past.

The share of private firms less than a year old has dropped from more than 12% during much of the 1980s to only about 8% since 2010. In 2014, the most recent year of data, the startup rate was the second-lowest on record, after 2010, according to Census Bureau figures released last month, so there’s little sign of a postrecession rebound.

To fill that gap, we need scalerators, designed to provide the knowledge, skills, attitudes, resources, networks and mentors entrepreneurs need to build and grow their companies. Biomedical and health scalerators can be mostly virtual, inviting participants back home from time to time for a home cooked meal gathered around the dinner table.

The core components of the Lean Startup methodology are 1) creating a minimal viable product, 2) using the customer discovery process, and 3)creating and validating the business model canvas. Here are the parts of the Lean Scaleup methodology:

The Lean Scaleup Methodology:

1. Maximally profitable product

2. Customer optimization process

3. Business model sensing and modification

4. Not so smart money to fuel growth

5. Letting people on the bus off at the next stop

6. A new way to keep score

7. Wardrobe change

8. Profitable growth KPIs/scorecards/dashboards

9. A new org chart

10. From testing to traction and avoiding the distraction of traction.

11. Building high performance teams. Sometimes they are virtual, sometimes they are global.

12. Corporate governance and founder-board-investor issues

The business model would also be different from accelerators, since the model has already been validated, requiring innovative investment schemes to provide the right incentives for growth given the more advanced stage of risk and reward potential.

Finally, given the unique requirements for human subjects trial design and execution, the participants in biomedical and health scalerators need to come from expanded domains like public health, biostatistics, epidemiology and translational reasearch in addition to the business and investment communities. Growing companies have different needs when it comes to leadership, manufacturing at scale, sales and marketing, human resources and financing.

Here are some differences between the two:

Startups:

• Have one goal: hit p/m fit
• Must take big risks
• Make you feel directly responsible
• Have higher highs and lower lows
• Are a lifestyle, not just a job

Big companies:

• Have “made it” to some extent
• Focus on growing what’s already successful
• Will be more risk-averse
• Wear the burden of higher expectations
• Take more time to try and do things for the long-term

Startups need people who:

• Operate with good intuition
• Are well-rounded, jack-of-all-trades
• Are proactive, don’t mind ambiguity
• Possess a healthy dose of optimism

Big companies want people who:

• Are team players
• Will raise the bar in a specific dimension
• Are high potential in the long-term
• Are strong connectors, good at aligning and connecting groups

Startups make you feel awesome when:

• You move like a synchronized swim team
• You continuously launch shit
• You witness direct impact of your creation
• You realize how much you’ve learned

Big companies make you feel awesome when:

• You realize you’re having an impact on millions of people
• Your company invests in ambitious missions because it has resources to
• Someone spends time to invest in your career growth
• You get to try a lot of different projects

Startups make you feel sucky when:

• No one uses what you build
• There are struggles because no one is an expert
• Nobody invests in you
• There’s personal drama / conflict
• You are constrained

Big companies make you feel sucky when:

• There are too many involved in decision making, and it feels hard to get anything done
• You feel a looser connection to what your company is shipping
• You no longer have context on everything going on
• There will be decisions that have ripple affects that affect you negatively

Accelerators need to rethink their models and practice what they teach. Many have peaked at their life cycle and risk going out of business. Maybe we need more euthanators instead.

Building a start up is like designing and manufacturing a machine that works and does what it is supposed to do. Scaleups are machines that have high performance. Grownups are machines that run faster than all the other machines. So, building scalesups takes:

1. Making sure all the parts are working
2. Synchronizing all the systems
3. Maintaining the parts to be sure they don’t wear out
4. Finding the right driver and high performance mechanics
5. Putting the right OILS and lubricants in the machine
6. Being sure that the machine gets the most miles/gallon as possible
7. Insuring the machine against risks and accidents
8. Building a better machine as time goes by
9. Building value into the machine since someone might want to buy it from you some day
10. Money to run the machines

Life science technology commercialization, like medicine, is a series of hand offs. In the present environment, incubators hand off to accelerators/clinical “innovation centers” who can then hand them off to scalerators . However, like clinical medicine, there are gaps that lead to dropped handoffs with resulting morbidity and mortality.

Millenials have been living in their parent’s basements for too long. We need to provide a place for scaleups to live on their own without cutting the essential parental bonds and guidance they desperately need to be successful. The good news is that some are on board already.

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GUEST POST from Arlen Meyers

Analysts are abuzz about deals like the acquisition of AOl by Verizon. The conventional wisdom seems to be the synergies will be around using AOL videostreaming delivered over Verizon pipes using mobile devices. Looming in the back ground is the question of how this platform can be used in sick care and preventive medicine.  The next shoe has dropped with the announcement that Verizon is buying Yahoo for $4.83 billion. They want the advertising revenue for their video platform.

The next big consolidation happened when AT & T bought Time-Warner. Then, CenturyLink acquired Level 3.

Here is how 5G will impact sick care.

In a bid to make a bigger telemedicine play, telecommunications giant Comcast decides to move from merely being a Doctor on Demand customer to buy the business. It will offer telemedicine as a premium cable service so that customers can communicate with healthcare professionals in their homes, with chronic conditions and mental health being of particular interest. Comcast is teaming up with one of the nation’s largest Blue Cross health insurers, Independence Health Group, to launch a new consumer-oriented health-care technology platform.

Will other cable companies follow suit?

This is probably not the last news we will hear about consolidation and convergence of  healthcare, telecommunications, media and mobile. With medicine moving from bricks and mortar to an expanded digical model-digital and physical- health communications and media companies will become integral parts of care delivery, information and education. After all, 6.8B people in the world have a cell phone.

Digital health is over. Sickcare ICT has taken it’s place and new models have emerged to claim market dominance.

Global Verizoncare will create both challenges and opportunities and open up many markets in developing countries with emerging middle classes demanding access to state of the art care and technology. Particularly for those in remote and difficult to access areas outside of the megacities, the hope is that Communicare will improve access, reduce costs, raise quality and the human experience.

PwC research suggests that information and communications technology companies (ICTs) have created value using 5 different strategies:

1. Category leaders.These companies focus on building a dominant position in a relatively narrow product or service category. They use that position to shape and influence the supply markets and sales and delivery channels in that category. A key indicator of this strategy is the positioning of a company’s products and services.

2. Consolidators.These companies lead their category through repeated acquisitions. They roll up other companies to provide consumers with access to a platform of products and services, or simply to offer a product lineup that could be assembled no other way.

3.Innovators. These companies continually develop and introduce new and creative products or services to the market. Investment in R&D is the primary indicator of this strategy.

4.Solutions customizers. Companies following this strategy make use of insight and market intelligence to offer tailored products or services that address customers’ specific

5. Value players. These companies seek enterprise business by lowering the costs of competitive services.

In addition, videoanalytics will become an integral part of monitoring and changing doctor and patient behavior.

Do you have an innovation strategy?

As interface technology companies like Google, Apple, AT&T, and media content and delivery companies, like Comcast and Dish, get more involved in sickcare, it will present many challenges and opportunities:

1. Integrating different business models. Some suggest that if you want to see the future of sickcare, then look at the changing business models of newspapers and cable. Why pay for channels you don’t watch?

2. Resolving the cultural differences of disparate industries

3. Educating and training Doctors 2.0 in how to use evolving technologies

4. How to address the data issues and implement solutions.

5. Cybersecurity, confidentiality and security

6. Overlapping, and sometimes, conflicting ecosystems

7. The legal and regulatory environment of disparate industries and trying to resolve them. The FDA is not the only or most imporant regulator. Get inside the head of the FCC instead.

8. Intellectual property conflicts

9. A new investment landscape that will take time to take hold

10. Barriers to adaption and penetration in the medical community

11. Closing the sick care digital divide

12. Integrating ICT into the EMR whole product solution

So far, US telecom carriers have struggled to make it work, while others have seen more success.

The impact will not stop at sick care. Google has already made an impact on crowdsourced public health and epidemiology.

How would Microsoft design EMRs?What does Apple have in mind in buying personal health data startup Glimpse?

Other interface collaborations are positively electrifying

Sick care coherence and convergence will continue to evolve across industries, technologies and markets and doctors will have to learn how to practice medicine using many new tools and delivery channels. Practicing Coherentcare will be challenge.

Sick care is starting to look a lot more like a pumps and pipes business. The doctor treating a patient will be only the first episode of what will probably be a long running prime time show. The goal is to consolidate broadband care and make it anywhere care, moving from telesickcare to telehealthcare.

Here is what Verizon is thinking about the customer experience.

Sickcare is no longer one industry, but many and will continue to grow as such.

You’ve got telehealth, shopgirl.

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