GUEST POST from Arlen Meyers

Employers, employees, educators, workforce development professionals and policy makers are trying to figure out the future of work and how to adjust. Megatrends such as digitization, the rise of automation, and shifting demographics are altering the way we work, and the way companies relate to workers, including sick care workers. The 4th industrial revolution is raging and we are scrambling to find the right strategy to win it. Just doing everything faster won’t work.

Here is how Tesla tries to solve the problem.

Rework America, for example, notes that we have seen this movie before when the 2nd industrial revolution, powered by electricity, railroads and mass production, forced employers to create a workplace, education, pensions and benefits systems that would train, attract and keep workers and drive productivity. That was over 100 years ago. Those legacy systems are, in many instances, outdated and need reform.

What will sick care work look like in the next 25 years? Here are some possibilities and some themes are emerging about reforming our education system and the world of work to meet the challenges and be ready for multiple scenarios:

1. Cradle to career integration
2. Emphasis on defining and measuring emotional and social skills (remember, we used to call them “soft skills”) and using people and performance analytics to determine whether and how much they have an impact on job performance and retention.
3. Exposing students to experiential work opportunities in many different forms, be they mini-internships, internships or apprenticeships
4. Addressing the needs of the 70% of US workers who do not have a college degree
5. Migrating from a 4 year degree credential based system to an alternative, more flexible and user friendly competency based system
6. Pension and benefits reforms that are not employer based
7. Accelerating the speed and lowering the costs of education and training that is personalized and market driven
8. Altering HR functions and staffing as they presently exist
9. Closing the equity, diversity and inclusion gaps
10. Bridging the digital divide so that everyone has access to the information and communications technologies and skills that pervades the workplace.
11. Solving the productivity-pay gap

12. Figuring out how to train the trainers, pay them a decent wage and return respect to the teaching profession.

13, Entrepreneurial schools and universities

14. Teaching people how to play nice with machines and vice versa

15. Creating a workforce for true healthcare instead of sick care.

16. Changing how we work as teams.

17. Agile teams

18. Virtual international teams

19. Educational informatics

20. Market based learning objectives with formative assessment

21. Rural reshoring

As NY Times columnist, David Brooks, notes, Right now, we have a one-size-fits-all education system. Everybody should go to college. The problem is that roughly one-fifth of our students fail to graduate high school in four years; roughly one-fifth take no further schooling after high school; roughly one-fifth drop out of college; roughly one-fifth get a job that doesn’t require the degree they just earned; and roughly one-fifth actually navigate the path the system is built around — from school to career.

At its core, these changes will come the way they came before-by helping those people who are willing but unable to overcome structural and societal barriers and radically altering the systems that prevent worker freedom, equity sharing and entrepreneurial success. Maybe the inmates need to not just run the asylum , but own it too.

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GUEST POST from Arlen Meyers

In a previous post, I discussed the anatomy and physiology of remote sensing and wearable systems. It has an afferent, central, efferent, neuromuscular and end organ component. Unfortunately, given the evolving nature of the healthcare IT ecosystem and remote sensing in particular, we still don’t know what the HIT cyberbrain should look like, how it should work or how it should develop or evolve. In other words, we need more research about healthcare analytics processing and signaling systems and how they should develop from fertilization to birth i.e.remote sensing embryology.

The cyberbrain has been fertilized by the minds of technopreneurs and is developing quickly. Earlier this month, Elon Musk took the stage in a science museum in San Francisco and sketched out a bold vision of connecting a human brain to a computer.

The presentation was one of the first public unveilings of the technology behind his brain-machine interface (BMI) company Neuralink, which is trying to use robotically implanted super thin flexible “threads” in the brain to allow individuals to control computers and smartphones with their mind. An unpublished non-peer reviewed white paper credited to Musk and Neuralink lays out more of the technical details behind the technology. Others are giving chase.

Here is the research agenda:

1. What is the present state of central processing systems?

2. How did they evolve?

3. What are the evironmental and genetic factors that are at play?

4. Which ones work and which ones don’t

5. What are the causes of abnormal HIT brains?

6. Are their ways we can modify or minimize HIT dysgenetic systems?

7. What kinds of parents should produce these children and what should be their genetic make up?

8. Is there a way to do genetic testing to detect early abnormalities?

9. Should we allow HIT systems abortion and eugenics?

10. Should we pass laws and regulations protecting the HIT fetus against toxic influences?

11. What will be the unintended consequences of brain-computer driven interfaced?

12. How do we prevent brain hacking and how do we overcome the other IoMT challenges?

Intelliwebs are evolving organic interfaces between man and machine and will eventually be the central nervous system of remote sensing and the internet of things.

HIT brains are evolving every day. Our present understanding of them is rudimentary and it will take a lot more research and experimention before we understand how the HIT brain develops, evolves and functions. Until then, remote sensing and wearable embryology should be a required course.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

Now that there are more and more people who are older, lonely, socially isolated and depressed, we are seeing lots of articles encouraging people to mentor or do something that “leaves a legacy”. Consequently, intergenerational websites, platforms and organizations are growing. The lost tribe of medicine is no exception.

However, there are some problems with doing things to leave a legacy:

1. Like your business strategic plan, life gets in the way and we live under conditions of uncertainty. It is impossible to predict how what you do will leave an impact, if any. Socrates said “I cannot teach anybody anything. I can only make them think”.

1. Doing things so people will remember you once you are gone puts the focus on the future, not the present. It’s more fulfilling to live things, not leave them, and let the cards fall where they may. Plus, while you might have helped remove some people’s obstacles to success or happiness, most of their success can be attributable to them, not you. Maybe, for example, you helped awaken their innerpreneur. Truth be TOLD, most of your protege’s success probably has more to do with luck than anything you did.
2. It is unlikely that people will remember who you are 100 years from now
3. Mentoring is not always effective. Not everyone is cut out to do it and there are several reasons why mentoring fails. Sure, when it works, mentoring helps both the mentor and the mentee, like helping to soothe burnout.
4. Legacies are hard to scale. I think most are lucky if you make a difference in the lives of a handfull of people.
5. Leveraging your impact relies on someone you helped pass it forward. Many will drop the baton so it’s a numbers game. Like innovation, success in legacy leaving depends on how many times you try and that can be frustrating and disappointing.
6. Doing volunteer work to help others is admirable. However, while twenty-five percent of American adults volunteer, that number is at a 10-year low—putting extra strain on the 85 percent of nonprofits that rely exclusively on volunteer staff to manage the services constituents depend on. For this reason, it’s more important than ever that nonprofits figure out the best ways to attract and retain volunteers.Volunteers want convenience, time defined outcomes and demonstrable impact.
7. Entrepreneurial psychopaths run the risk of passing along bad behaviors instead of good ones. The result is the lonely leading the lonely
8. Dealing with narcissistic “successes” is hard. Here are some tips on technique.
9. There are few insulting or brutally truthful eulogies. They are not like failure resumes.

Helping other people is a good idea and doing well by doing good is not a sin and has a long history. When it comes to legacy leaving, focus on the now, not the next and new.

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GUEST POST from Arlen Meyers

The US is increasingly becoming a gig economy. Part timers and freelancers are creating portfolios, not careers. Corporate loyalty is dead and only a fraction of employed workers are engaged. The American dream is on life support, if not dead. The fundamental future of work is changing, wages remain stagnant for most and the workforce of the future need new skills and new ways to get them other than buying into a broken higher education model that comes with a questionable value proposition for most and a very high price tag for all.

A recent Intuit study estimates that 34 percent of the current workforce belongs to this growing pool of workers and predicts that 40 percent of American workers will be independent by 2020.

Online freelancing platforms are transforming work, organizations, and their business models. Ranging from start-ups to multinational enterprises (MNCs), platforms enable firms to tap into resources and expertise beyond their traditional boundaries. These platforms allow hiring managers to connect with millions of freelancers around the world—doing so at a speed and scale that was unimaginable just a few years ago. Between 2016 and 2017, there has been a 26% increase in the number of projects sourced via these platforms.

Career change for physicians used to mean changing specialties, whereas now, it means leaving medicine itself. A research study published in Mayo Clinic Proceedings reported that 9.7% of the 6,695 doctors surveyed between August 28, 2014 and October 6, 2014 planned to leave clinical work for an administrative position in healthcare, while 1.9% indicated that they planned to leave practice altogether to pursue a different career.

As we are all living longer, it is getting harder for older Americans to find well paying jobs, resulting in bigger retirement savings shortfalls.

Some think it’s time to rethink the social contract and let people work from anywhere. How about co-working spaces for radiologists, pathologists and all those bean counters and administrators that no one sees anyway?

Here are the problems with being a digital nomad.

A recent report by FlexJobs, an online resource for those seeking flexible work, found that opportunities in government and politics, engineering, project management, communications, and travel and hospitality grew on the website by over 50% between July 2015 and June 2016, more than any other career fields. According to FlexJobs, these are defined as professional-level jobs that have a telecommuting, flexible schedule, freelance, or part-time component.

A review by Linkedin showed that of all the users who list freelance work on their LinkedIn profiles, 20% have a full-time job in addition to their freelance business. That means full-time freelancing still dominates, but the side-gig model is quickly catching up. These are the top five industries for full-time professionals who freelance on the side:

1. Financial services and insurance
2. Professional services
3. Technology and software
4. Entertainment
5. Staffing

Most are full timers doing a side gig, which might be a stepping stone to portfolio careers or entrepreneurship. The difference between one and the other is that freelancers get paid to work in a business. Entrepreneurs create value by working on a product, model or process that adds user defined value.

Uber has not only changed the taxi business, it is part of the transformation of the future of work and laws and regulations that advance or impede it. As reported, all this comes alongside a heavily publicized proposal for the creation of a system of worker protection for the gig economy by two Democrat big hitters – Alan Krueger, a former chair of the White House’s council of economic advisers, and Seth Harris, a former labour secretary. It argues a hybrid category of “independent worker” is needed to accommodate situations in which an “employer” exerts control over much of what a worker does at the same time as the individual retains the right (like the self-employed) to work as much or as little as they want, when they want. Many doctors are pursuing portfolio careers and abandoning the full time practice of medicine.

Here are some of the benefits.

The opportunity is big in sick care to educate, train, recruit and develop low income workers using new teaching technologies. In addition, it is not just the lower skilled workers that are getting into the act. There are more 1099 Docs too.

The sick care work force of the future is being created every day, but several things are becoming clearer:

1. Digital health will create jobs that have yet to be defined

2. There is a gap for workers that can’t be filled by present offerings

3. Wage stagnation will persist until we figure out ways to replace exported manufacturing jobs that are unlikely to return

4. We need new business models for education that starts in k-12

5. Pension and benefits packages will need to conform to the new gig economy

6. Medicine will have to change its mindset and approach to using paramedical personnel to help doctors practice at the top their licenses.

7. Market based learning objectives should drive sick care gig learning

8. We need a different approach to defining competencies and using learing managment systems to measure life long learning and improvement. Doctors screwed up MOCs and we should not repeat their mistakes.

9. We need to use the experiences and insights of low wage minorities to deliver care, particularly when it comes to using community based resources to manage the crushing burden of non-communicable diseases

10. New gig workers need to have an entrepreneurial mindset. They also need to learn how to negotiate the terms of service agreements if they are agile talent.

11. Sick care gig workers have unique challenges when it comes to career development

12. All of these challenges will be opportunities for business process outsourcing, HR firms, policy makers and recruiters to meet the needs of potential clients with innovative product offerings and business models.

13. Like most other service dating service models, the intermediaries will be replaced with online matching platforms for much less. Think what happened to travel agents as a model for what will happen to locum tenens headhunters.

14. Older Americans are working more even as those under 65 are working less, a trend that the Bureau of Labor Statistics expects to continue. By 2024, 36 percent of 65- to 69-year-olds will be active participants in the labor market, the BLS says. That’s up from just 22 percent in 1994.

15. 54% of gigers say it takes too long to get paid. Insist on automatic fund transfers, negotiate the time (a week or two) or on a recurring basis if an advisor, and monitor payment. You might have to terminate your contract if you are repeatedly not being paid on time.

16. Gig workers have hard time affording health insurance and that is trouble for them and the people who care for them.

Increasingly, employers are looking or ways to trim full time payrolls and eliminating patient facing workers will be no exception.

There are many ways to participate in the sick care gig economy, so before you create your LLC, decide how you want to work and why. Do you want to be a freelance, an independent business owner or run a consulting company? Even if you have an MBA, here are some reasons to join the gig economy.

Remember there is a difference between a teacher (educates), a coach (teaches a skill), a mentor (helps you improve as a person) and an advisor (helps your company). Being a consultant and running a profitable consulting company has it’s own issues.

On the contrary, sickcare work means sacrifice and placing the needs of patients above your own. Many times there is little room for work-life balance, self-fulfillment and flexible work schedules so there will be a conflict between generational attitudes and the demands on the ground. Here are some stories about the dark underbelly of the contract workforce.

Here are some common reasons why your side gig, like your startup, is likely to fail.

Making money doing a side gig requires the 4P’s: product, pipeline, pitch and an engagement and marketing communication plan.

Product: How to build you personal brand

Pipeline: How to build a 30,000 member Linkedin group

Pitch: Your pick up line: what to know about value propositions

Plan: Do you have a strategic marketing and communications plan?

If you are thinking of “going gig” , here are the skills you will need to succeed.

The sick care work force is changing before our eyes. For many to succeed, the knowledge economy takes a brain and a computer with WiFi access. It can no longer be sustained by mostly rich white folks wearing white coats. We need to change the mix to close the gaps.

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GUEST POST from Arlen Meyers

We teach a lot to medical students and residents. One thing, however, we don’t teach is leadership and entrepreneurship. While some schools are trying to remedy that, there are still significant holes,particularly when you try to put both together and create leaderpreneurs.

Here are the top 10 mistakes we make when we try to create leaderpreneurs:

1. We try to manage innovation instead of leading innovators
2. We don’t select medical students based on their leadership and/or entrepreneurial mindset
3. We don’t train the trainers
4. We don’t reward leadership or entrepreneurship or create incentives to do it
5. We give a mixed message. One the one hand we want you to innovate and lead. On the other, we want you to conform and not be a disruptive (in the business sense) physician
6. We confuse management with leadership
7. We don’t give students leadership experiential learning and a place to fail
8. We don’t have enough physician leaderpreneur role models students can emulate
9. The followers don’t trust the leaderpreneurs because they don’t get sh$t done and they don’t do what they expect followers to do.
10. We don’t agree on the definition and intended outcomes of entrepreneurship and innovation.

Here’s why executive coaching doesn’t work.

Here’s why leadership development programs fail.

Creating leaderpreneurs in about changing mindsets. Most of that comes from experiential learning, not chalk talk. Until we provide that, what we are doing is simply leadership theater.

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GUEST POST from Arlen Meyers

Claiming status as the #1 digital health, bioscience, technology, finance or education cluster is new eco-devo blood sport. Should funding be the only KPI?

Innovation districts are the new clusters, and urban planners and stakeholders ask 5 questions during an audit:

1) Where are your region’s highest concentrations of innovation assets?

2) Is the district leveraging and aligning its distinctive advantages to grow and strengthen firms’ innovation capacity?

3) Does the district have an inclusive, diverse, and opportunity-rich environment?

4) Does the district have physical and social assets that attract a diversity of firms and people, increase interactions, and accelerate innovation outcomes?

5) Does the district have the leadership necessary to succeed?

There are two key principles to ecosystem value co-creation: 1) in order to encourage the active participation of ecosystem actors in the value co-creation process, efforts must be made to ensure a clear vision and a shared value base on which the ecosystem activities can be built and 2) facilitation is needed to support the ecosystem actors to make new connections and to share their knowledge and resources in concrete ways. Most importantly, the more diversity there is among the ecosystem actors, the greater the support for innovativeness within the value co-creation process.

Like bioclusters of yesterday, regional governments and elements of the ecosystem are knee deep in accelerators, investment funds, innovation districts and endless Meetups. But, how would you know a top tier digital health ecosystem when you see one? In other words, how do the outcomes of of clusters and innovation networks create economic impact? What should the key performance indicators? How do they align with your vision, mission and goals the value proposition to key beneficiaries, stakeholders or customer segments?

Impact and KPIs can be specific or broad. They can measure narrowly focused value,for example for the customer or entrepreneur, or more general like regional or US global competitiveness.

A recent analysis generated a list of more than 300 potential indicators. The authors sought to focus on a few key indicators that matter so they selected the subset most relevant in assessing the impact of programs on job quality/worker prosperity and business dynamics. In both cases, they considered whether a measure might also address greater economic inclusivity. They also separated program indicators with a direct link to economic development activities from those that represent broad economic outcomes. The presumption is that modest sized state or local economic development initiatives are more likely to influence specific business activities among a targeted group of firms than to “move the needle” on an entire economy. While economic development organizations focus much of their performance monitoring on tracking program outcome indicators, monitoring broad economic indicators can guide policy makers in determining which program activities are most relevant to current policy priorities

Here are some themes:

Connect metrics to program activity. Develop and document the logic model for each economic development program to articulate explicitly how inputs (investment or activity) are expected to translate into outcomes.

Consider adopting performance indicators that address job quality and business dynamics, where appropriate, such as:

• wage levels, benefits provided, occupations, and/or skill development and career pathways;
• business churn metrics in addition to year-over-year summary trends;
• indicators related to innovation, productivity, or global business activity among assisted businesses.

Report program-related outcomes as distinct from broader economic benchmark indicators.

Evaluate data source options, including the feasibility, quality, and availability of data when selecting indicators.

Determine which indicators can be used to understand economic inclusivity within the state’s overall economic development portfolio.

• capture relevant information about program impacts related to racial, ethnic or gender diversity and distress of the places where investments are made
• report data internally even if not required for external reporting

Create a communication plan to drive productive use (and accurate dissemination) of economic development program outcome data.

Here is a seven step guide for creating a strategic communications plan

Some suggest these metrics:

1. Is there a focus on creating digital health solutions in the ecosystem?

2. Do the members of the ecosystem have experience supporting large-scale initiatives?

3. Is the ecosystem partnered with healthcare providers?

4. Is the ecosystem partnered with corporations, academic and government researchers?

5. Is the ecosystem partnered with investors?

6. Is the ecosystem partnered with governmental and regulatory bodies?

7. Does support for the development and scaling of innovation exist within the ecosystem?

8. Does a virtual and physical support structure exist for the entrepreneurs within the ecosystem?

9. How accessible is information within the ecosystem?

10. What evidence exists to support the efficacy of the ecosystem in driving innovation?

I’d suggest several other domains in the scoring system:

Education and manpower development: Are you meeting the needs of the community?

Technology transfer metrics: Patents, revenues, spinouts

Economic development metrics: Taxes, new venture creation, employment numbers

Patient value metrics: How and how much have the products helped patients?

Firm and entrepreneur metrics: How much wealth has been created?

Contribution to US global competitiveness and international trade: Are we winning against our global competitors?

Value proposition: Are there multiple value propositions for each user segment or just one ?

Business model: Is it VAST?

Information flow: How easy is it for people and information to connect

Open innovation quotient: How open open is the network?

Quality of newcos: What is the likelihood that the companies in the cluster will generated substantial user defined value and be able to scale?

Survival rate: The estimated 5 year surival rate for new businesses is 50%. Is your cluster record better?

We’re halfway through 2017 and already a group of startups that together raised $1.48 billion have shut down. 

Building a digital health cluster requires leveraging public, private industry, academic and investor assets.

It is not enough to use vanity metrics to be #1. Fundamentally, the yardsticks need to go beyond process and structure and take a world view. The measurements need to be transparent determinants of value. Finally, we need ecosystem KPIs that measure impact, not just output. In most instances, that can only be defined by the patient end users.

Only then can you stand in the winner’s circle.

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GUEST POST from Arlen Meyers

Here was my schedule during residency training:

Monday: arrive 5 am and leave the hopital when everything that needed to be done was done, usually about 7pm. Since call was every other night, I worked on call until the following morning, sleeping the in the hosital on call room (my room mate was a opthalmology resident who had to get up at 3am to prepare pre-op patients.)

Tuesday: Wash, rinse, repeat. Leave hospital about 7pm to do my laundry

Wed: Same. On call

Thursday: Same. Off call

Friday: Same On call

Saturday: Conference morning from 7am-noon. Off call

Sunday: Same. On call

You do the math. I was usually too tired to. Then came work hours reform. Now residents can cruise through an 80 hour work week, and, at an average salary of $60K, doing it for minimum wage. Did I mention the median $200k in medical student debt?

A recent analysis of work hour reform and quality of outcomes, at a minimum, showed that the data suggests that the incremental experience gained from working more than 80 hours per week as a resident doctor doesn’t generally translate into improved patient outcomes later. And with rates of physician burnout increasing in recent years, it’s worth considering whether residency work hours could be reduced further, or restructured to address other causes of fatigue (such as electronic health records and insurance issues), without compromising clinical expertise and quality of care for patients downstream. Although there are no serious proposals to rethink residency training hours, it’s an open empirical question worth investigating.

I think we should pay attention to the quality not quantity of the work that gets done when we consider how to train the doctors of the future.

1. The doctor persona has changed.
2. The world has changed and we need to train people how to win the 4th industrial revolution
3. The pace of innovation has changed and what you learn in residency will increasing be obsolete in shorter and shorter times after completion of your residency. Life long learning cannot be measured in hours per week and is just part of the job
4. Physician productivity has been stagnant if not dropping
5. Administrivia and EMR compliance mandates are wasting precious learning and practice time and frying doctors
6. Medical schools and residency programs are facing these problems as well
7. Here are my principles of medical education reform
8. Technology is forcing us to confront the high tech-high touch tensions in care
9. Data might be the new oil but sick care is the new coal
10. Hospital based care compared to training in non-hospital care delivery environments is bcoming a smaller and smaller part of how the work gets done
11. The business of medicine should be another ACGME competency
12. Frustration and burnout are resulting in practitioners pursuing non-clinical careers or abbreviated clinical half-lives

The quality of a graduating resident has more to do with the quality of their training, not its quantity. Yes, case numbers are important, whether it be an internal medicine resident or a ear, nose and throat resident. However, case exposure is frequently random and competencies are variable no matter how many you see or do or how many hours you work. Scut work adds little to learning.

You never get it completely right no matter how many hours you clock doing it. That’s why it’s called practicing the art of medicine.

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GUEST POST from Arlen Meyers

Boomers are back on stage for an encore.Whether it’s for financial reasons or a chance to try something new, more baby boomers are embarking on an encore career—a second professional career that can bring in not only money but often the fulfillment that may have been lacking the first time around the career bend.

In fact, adults over the age of 50 comprise one of the fastest-growing groups of entrepreneurs in the United States, according to a new Gallup study. Among those people who don’t currently own a business, baby boomers are twice as likely as millennials to say they plan to start a business in the next year.

Here are 5 myths about boomers:

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GUEST POST from Arlen Meyers

Investment in fintech (financial technology) continues to boom — breaking records in 2017 with an 18 percent rise in venture capital investment across the globe, and 30 percent in the U.S., according to Accenture’s latest report. Here are 5 fintech trends.

At the same time, investors continue to have a strong appetite for digital health with investment in the sector totaling $4.2 billion across 180 deals through the first half of 2019.

If this pace holds steady, the sector is on track to raise $8.4 billion in 2019 and could top 2018’s record-breaking annual funding total of $8.2 billion, according to Rock Health’s midyear report.

Just in the first six months of 2019, the digital health sector is close to surpassing the $4.6 billion in funding raised in 2016.

The two are colliding-finsicktech

1. Here’s a conference on fintech opportunities in healthcare
2. Here’s a combined fintech/sicktech accelerator

3. Here are 5 fintech trends that will benefit digital health products

4. Here is a time stamping and synchronization technology for use use in finsicktech

5. Here are some lessons sicktech can learn from fintech

6. There are 3 key barriers to the fintech industry around the world

7. These are places where you can learn about fintech

8. Want a career in fintech?

9. Watch these fintech companies

10. 5G will impact fintech. 5G will impact sicktech

As finsicktech evolves, the goal should be to improve the patient revenue cycle management experience, reduce errors, make information portable and interoperable, inprove security and reduce admininstrative costs. A study published in The New England Journal of Medicine examined data from 1999 to project administrative costs of health insurers, employers’ health benefit programs, hospitals, practitioners’ offices, nursing homes and home care agencies. The study found administration accounted for 31 percent of healthcare spending in the U.S., compared with 16.7 percent of healthcare spending in Canada. According to the Times, the same estimates today would mean administrative costs in the U.S. account for $5,700 of the about $19,000 on average that this nation’s workers and their employers spend on family coverage annually.

Sickcare cannot be fixed from inside.

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