by Rob Paterson
April 28, 2011 at 6:08 am · Filed under
Adoption, Clayton Christenson, Healthcare, Innovator's Dilemma, Paradigm, Social Media, Social Objects

Once upon a time there were department stores that sold everything. They hardly exist anymore. Why? because we get a better deal from specialty stores. Once upon a time there were record albums where many songs were in one package. We don’t buy albums anymore. If we buy any music we buy songs.
We used to rely on advertising. Increasingly we use our trusted personal networks to help us navigate the market.
It used to take millions to make complex things but more and more we are seeing new tools that can do big things for very little cost.

The world of Macy’s and Mad Men is over. But not in health care

Today we have a department store model for healthcare. Today we use all the old models of business in healthcare.
So what might a truly modern view of health care look like?
This is where Clayton Christensen’s new vision for Healthcare makes so much sense to me.

Here in one page is the guts of CC’s case. All of these models are combined today in the healthcare model and are rooted in the most expensive part of the system – the doctor’s office and the hospital. It’s all Macy’s in the 1950’s. It’s big and aggregated into one high overhead system that has massive organizational friction and so low quality.
Clayton Christensen is advocating that we break this up as happened to the department stores. Then each part of the mix woudl get the best deal!
Imagine each part of this mix being pulled out as CC suggests:
- Fee for Service – Here you pay a lot to get the best shot at finding out what the problem is when what is wrong is not clear. ”House” on steroids. The McKinsey model.
- Fee for Outcome - Specialized units that focus on doing one proceedure well – we see this already with hernia operations – you are much better going to a specialist clinic – lower overhead – better operational process – better outcomes.
- Membership as the Model – A social network aggregated around similar issues. Such as Type 2 Diabetes etc. Here prevention and living with a diease or the life changes needed to cure us will take place. None of these tasks can be done by a doctor as we currently organize health. Nor should they. They can best be done by us the pubic. For here the issue is how we live and of course getting off our addictions.
How to do this?
CC offers the playbook here too. It is very unlikley that the system will reform itself to do this. Systems don’t do that. The system will have to be disrupted from below.
Diagnosis – Most GP’s refer complex cases of all kinds up the line as it is. They are in reality traffic directors. They can treat only very minor problems. Most of the time they simply write a prescription. They are so time pressed that they cannot help with prevention. They are not paid for that anyway. The real issue for most of their patients is that they have a chronic disease such as heart disease or type 2 diabetes. All of these diseases are based on lifestyle. Not the Dr’s forte. Drugs are the proxy for health.
CC is suggesting that we see high end diagnosis as a field in itself. This does not have to be based in one hospital.
Just as a hospital or a Dr’s office has low skills and high overheads – Specialty Clinics have high skills and low overheads.
In Canada we have a start here in specialty clinics such as the Shouldice Clinic – If you have a hernia you would be silly to go anywhere else. This is what CC means as fee for outcome and this type of clinic can generate such process expertise as to all but guarantee a good result. The Shouldice is the specialty retailer that replaced the department store.
Changing all this above is hard work as it involves changes to the system as it is.
What interests me the most is the largest group at the bottom where groups of people with say Type 2 Diabetes can get together an help each other.
The new frontier for health that can grow up in spite of the system is “Community Health”. Where you and I take charge of our health and use simple and powerful tools and each other to stay healthy, get healthy and help each other at rock bottoms costs.
- In using diagnostic and measurement tools – as with all other tools more and more diagnotic tools that used to ve expensive and hard to use are available at prices and levels of complexity that you and I can use.
- In learning more about their condition – as with the publication of the bible in the 16th century, information that was restrricted ony to Dr’s is widely available to all of us now. Many know more about their condition that theur GP who has to be so broad.
- In learning about diet – we are learning that diet is at the heart of most of the diseases of medern life. Dr’s know nothing abut this. Changing our diet is often beyond our power alone. We need the help of our peers.
- In helping each other makes the hard lifestyle changes they need to take back control. No expert can help here – only peers.
Here the skilled part is in Facilitation. This is where 85% of the system will reside.
Here is I think where the power of social media combined with what we are learning about the true causes of most modern disease offers us so much.
We could all get more healthy at a fraction of the cost of the current system – cost to us as individuals and as societies.
This is the revolution that is ahead.
by Rob Paterson
November 14, 2009 at 9:22 am · Filed under
Adoption, Clayton Christenson, Posterous, Twitter
Here is a very special interview between Robert Scoble and the founders of Posterous. The interview I think highlights many issues that seem to escape most of us in North America and Europe as we think about the 2.0 world.
There are billions of people who are now connected but whose primary tools are handsets, texting and email.
These people are very poorly served by our western tool sets – computers, the web and social software.
While the uptake of Facebook is impressive at around 300 million – this is nothing compared to the universe who rely on the handset, text and email.
Like Twitter, Posterous is amazingly simple to use. It gets around many of the barriers for the hesitant. Billions know how to text or use email. Now they can have a place to share and show what interests them without having to learn anything new or to buy anything more.
I suspect that the Posterous guys have spotted something huge here. They have truly been thinking about the “underserved” Clay Christenson concept. They also know that it is best to start with “Good enough”.
But Posterous also helps the Western Hard Core Blogger.
As a long term blogger and user of the western tool set – my use of Posterous has transformed my own participation on the web. I find it sooooooooooo easy to use. In particular it enables me to aggregate the best material that I can find on my blog and to ensure that what I post gets the widest distribution.
Here I think is the nub.
Aggregation in focused areas - mine would include the emergence of the network (local and global) in all sectors – such as in organization of all kinds, food, media and energy – is where content value is enhanced. I have my own ideas but they are made better when I add related ideas of others – not just as links – but in large chunks – for after all I have a lot of real estate. You can see in a second whether you wish to read on or not. A set of links is more of a mystery ride.
I am finding that my blog has much more depth for very little added effort – my readership is up both in terms of views and time on the page. So others seem to agree.
The other part of the value is in giving me better distribution. With one simple action on Posterous – I not only post to my blog but to Twitter and to Facebook where I have overlapping but often different readers. As the social web becomes every more real time, I can throw a bigger rock into the river and cause more ripples.
These features I think can help those in media who are also seeking more focus on their web offerings and who seek a wider following. Posterous will enable hard pressed TV and Radio staff add more value and widen their reach.
Like Twitter, Posterous is deceptively simple. But also like Twitter, I think that we will see that this simplicity is key to its potential power.
Is this not a lesson for all adoption? To own a car in 1900 was to demand that you also had a mechanic. Over time, cars inside became ever more complex, but using them became ever more simple. The more simple, the cheaper, the more people adopted them.
Simple isn’t it!
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by Paula Thornton
August 27, 2009 at 12:32 pm · Filed under
Clayton Christenson, Emergent, Enterprise 2.0
Andrew McAfee released a post today about challenges to his definition of Enterprise 2.0. In it, he made the statement featured in the title here. Because I’ve often stood by the statement that “it’s not about the technology”, I felt it reasonable to share here some clarifications to such a position, as was detailed in my response to Andy on his blog.
Andy: I agree that it’s ‘not not’ about technology. And as I always like to point out, we’d all be a lot better off if we understood and embraced the non-digital aspects of technology, especially as noted by Clayton Christensen “the processes by which an organization transforms labor, capital, materials, and information into products and services of greater value”. But we don’t.
Due to the imperfections in language as a representation, we have to deal with common interpretations. The message “it’s not about the technology” does not infer that the technology is not necessary — it suggests that it’s not sufficient. In a reality where so many see and buy technologies as ‘finished products’, this mindset has to be overcome with a strong perspective. The common belief has to be challenged to start the conversation in earnest.
Yes, the digital technologies hold great potential. But they are ‘lost’ without the balance of all the components that make a sound technology, by Christensen’s definition. Because so few hold this understanding, anyone who is championing core principles must also champion the details of the broader definition of technology, else the story is only partially true. You speak of technology and then you specifically mention software. While software is a technology, not all technology is software. Even if we were to embrace, as you suggest, the technological aspects of Enterprise 2.0, software itself is a small part of it.
“A definition is not a discussion”. I would guess you’re suggesting that a definition is a placeholder, around which discussion can ensue (I believe the ‘contrarians’ are suggesting they’re not seeing a venue for such discussion). The essence of all things 2.0 is the recognition that ‘facts’ are contextual. The purpose of the flexibility that is borne of 2.0 is to accommodate growth and ever-changing conditions that are the reality of business.
Ever-changing has always been part of the business landscape, the difference now is the rate of change — which is forcing us to move away from the side of the Design Thinking continuum where lives “binary code” and “algorithms”, more toward “heuristics” and “mystery”. While there will be conditions for which all will be relevant, the focus has to be more in the tradeoffs between the heuristic and the algorithm. We are constantly learning and seeing things from different perspectives. A definition that is ‘locked down’ would be an embracing of ‘binary code’. That’s just not part of a 2.0 reality which embraces the need to facilitate the dynamic middle — providing the ability to harness the crest of the wave, capitalizing on kinetic energy (energy in motion) and order for free…the birthplace of emergence.
We offer gratitude and respect for your trailblazing this category. As well I offer as evidence other trailblazers: John Zachman originally only had 3 categories in his now 6 category Enterprise Architecture Framework (the other three came from the ‘masses’); Bill Inmon did not embrace data marts as part of data warehousing. Both evolved.
I look forward to the continued growth in our collective understanding of this topic as we seek to leverage its potential and improve the means by which we work together.
by Rob Paterson
July 2, 2009 at 7:55 am · Filed under
Adoption, Clayton Christenson, Culture, Enterprise 2.0, Innovator's Dilemma, Interview, Media, Movie Making, Organizational Design, Public Media, Social Media
One thing I know is true- real innovation – the disruptive idea that declares independence from the old system – can only happen at the edge.
So this spring when I got a call from Howard Blumenthal CEO of MiND, in Philadelphia, my instincts told me that this was a very very important call.
No TV operation is more unique than MiND (or, properly, MiND: Media Independence).
MiND is not a PBS affiliate. It broadcasts a stream of 5-minute programs, many made by MiND’s staff producers, some made by members of the public who attend MiND’s production Boot Camps. MiND is both on air and on the web. The staff have their own voice in a way that I have never seen anywhere before in media or ANY other place of work. It was not only a novel TV operation – it was a novel organization. It was what a 2.0 organization would be like- inside and outside. As an independent community licensee, MiND makes the most of its freedom–and engages everyone who walks through the door.
So I booked my flight and flew down to see Howard and his team.
So what did I find? How to make TV, the Gutenberg of our time.
You don’t believe me? Please invest 5 minutes in this film.
Did you get it? I found it compelling. A beautifully crafted story. Here is a heartfelt comment on IMDB. Made by a real pro – right? No – made by a regular citizen, Leontyne Anglin, whose passion is the topic but who had never made a film before.
The impact of Gutenberg’s technology in the 1500’s was to give people a voice. If video and TV are the main means of communication today, then the “New TV” must give people a voice. This is surely more than uploading to YouTube or adding comments to a web video. Merely pointing and shooting does not make you a filmmaker. When you have the ability to tell a story well – then you need a place where your early work reaches an audience with an already-established relationship with a trusted brand.
This is what happens at MiND. Day-in and day-out. It’s the reason why the system was built. And it’s working.
The key to MiND is found in its willingness to help the public learn how to be real video storytellers. MiND’s core members have joined a tribe of filmmakers with something to say. MiND’s eagerness to provide every storyteller access to its Trusted Space makes all the difference—MiND is a branded space that adds real depth and texture to the word “public” in the term “public television.”
How does MiND do this?
First of all, MiND employs a production staff drawn from the public and not from the priesthood. It has attracted such a staff by its culture and by its remarkable intern-and-volunteer system. While many stations regard interns as more trouble than they are worth, MiND has transformed coping with, and training, more than 200 interns into common practice. As such, the keen are fed into the system and the cream rise to the top. Nearly a third of MiND’s current staff members started as either volunteers or interns.
Secondly, MiND has built a transformational training system modeled on and called ‘Boot Camp.’ It is transformational in that a citizen comes in with all sorts of wild expectations about television and media; after six hours of intensive training, she is on the path to making a real MiND program that will go on the air and become part of MiND’s extensive internet library of 5-minute programs. In time, she becomes an enabled storyteller.
Leontyne went to a MiND Boot Camp. She was a doubter – MiND’s promise seemed too good to be true. But Leontyne and two others at the Boot Camp took up the challenge. They developed an idea, checked back with MiND to make sure they were on the right track, and made a terrific MiND program.
As a result, Leontyne is a new person–and now, one of MiND’s most vocal advocates. On her own terms, she has become video- and story- literate. She possesses new power in the most powerful medium of our age.
She is not an anomaly.
Here is a short documentary film made by another MiND intern. It’s broadcast quality in every way – a strong story line and intricate editing combine old and new footage. The person who made this film has become an accomplished filmmaker–and is now a teacher at a small college in New England.
MiND is creating a core of accomplished story/film makers who can help their community as storytellers. In time, with MiND’s support, Philly (and in time, other cities that may carry a local version of MiND as their own service) can develop a cadre of the new, media-literate creative workers engaged in the betterment of their home, their neighborhood, their city. It does not take much to imagine what they could do.
The incentive that MiND offers its “students” and interns is that not only will they gain the skills that they will need for our time, but that the work will be showcased on TV and the web–by a Trusted Brand.
All artists want their work to have an audience. TV is 1.0 but it offers a reward like no other. “Hey Mom my work is on TV!” So MiND is expanding its reach to other markets. It is building a national alliance in most of the key markets of the US – details here. The bigger the audience, the greater the impact.
So what next?
It is no secret that all the public stations in Pennsylvania are under pressure because their Governor plans to cut all state funding. MiND’s low cost approach makes it especially vulnerable–just completing its first year, MiND has focused on operational efficiency, programming and community; MiND’s first revenue programs are just beginning, and are insufficient to cover a 40% cut in the total budget. MiND will not stop–but it will slow down as resources disappear.
This is the reason for my post today–to encourage the public television community to consider what MiND has done in its first year, and how its ideas might be used to reinvigorate a tired system. MiND is not the full answer but it contains most of the DNA for the full answer and so I felt compelled to tell its story now.
What can we all learn from this?
Set up a new organization to do this – The station culture is key. MiND is a 2.0 Culture. Here is how it sees itself. These are not simply words on a page. With 30 plus years in the field of culture – I observed first hand that this is no bull – what they say is how they are. So you cannot change all your station culture to be like this. I also know that to be true. So what can you do? Clay Christenson is clear – set up a separate organization to house this aspect of the new - your transformational organization. I know of several stations that are thinking along these lines. You cannot make this shift inside the old–but you can make the shift if the new is allowed to grow alongside the old.
The Goal Is Self Reliance – The goal is to transform your community to be self-reliant – to do that you have to be able to tell the collective story of how people are bringing about change in your community. To do that you need to develop real storytellers by teaching them how to tell stories– and you have to imbue their stories with the added value of your brand. Create a “school” for the new literacy. Bring in the people as interns and volunteers. Bring in the young. Use your digital channels and the web as the “channel.” Or, let MiND show you how; they are willing and capable guides. And, please, don’t get caught up in the validity of five-minute programs–not before watching MiND or considering the sheer number of unique five-minute programs that can be produced in a year.
Gain strength and power by connecting. Connect to the institutions organizations in your community who need this kind of help – use your storytellers to give them a voice. How might non-profits be involved? How about schools (K-12 and higher education)? What if everyone really did have a voice–and what if that voice defined the future of public media? Imagine connecting with other stations across America and the world–perhaps create a national network with MiND at the core – and jointly build MiND as an initiative that engages people at the local, regional, national, even global level. It’s clear that MiND was built with precisely that strategy at its core. Increase the power of the collective story by comparing what’s happening in Philadelphia with what’s happening in Chicago or Denver, and ultimately, with Mumbai or Warsaw.
MiND benefits from a wonderful gift–it is one of the few truly independent agents within public media–in fact, the company’s official name is (you guessed it) Independence Media. From that independence has grown true innovation. Make no mistake–this is not a play by a tiny public TV station operating at the edge of reality. Instead, it is likely the center of a new solar system with increasingly powerful gravitational pull.
We will not get through the turbulence of our times by relying on the status quo in any part of our lives. So I do my bit to tell the story of Howard and his band of sisters and brothers at MiND.
Bless them all. And for my American friends, about to celebrate their annual holiday, do consider the value, opportunity and responsibilities associated with independence.
by Jim McGee
June 27, 2009 at 12:22 pm · Filed under
Clayton Christenson, Enterprise 2.0
A dozen years ago, at the height of the dotcom boom, Harvard Business School professor Clay Christensen published The Innovator’s Dilemma. It started from a simple observation that transformative innovations that reshaped competitive landscapes and created new industries almost invariable came from new organizations. Conventional wisdom held that this was a reflection of poor management and decision making on the part of incumbents. Christensen started with a more interesting, and ultimately more productive, question. What if it was sound management practice on the part of incumbents that prevented them from investing in those innovations that went on to create new industries? This question and Christensen’s research led to his distinguishing disruptive vs. sustaining forms of innovation. I originally reviewed the book in the Spring 1998 issue of Context Magazine. It became the bible of consulting firms working in the dotcom space. Every proposed idea was labeled as disruptive. Who knows, some of those consultant’s might even have read the book.
Meanwhile, Christensen and his colleagues and collaborators continued to work out the ideas and implications of his emerging theoretical framework. The Innovator’s Dilemma was followed by
The Innovator’s Solution: Creating and Sustaining Successful Growth.
In this book, Christensen begins to lay out how you can take the notions of disruptive innovation and use them to design a reasonable course of action in the absence of the kind of analytical data strategy consultants desire. Disruptive innovations attack either the lower ends of existing markets where there are customers willing to settle for less performance at less cost, or new markets where a new packaging and design of available technologies creates an alternative to non-consumption. The example I found easiest to understand here was Sony’s invention of the portable transistor radio. Compared to vacuum tube radios the first transistor radios were crappy, but good enough for teenagers and others on the go whose alternative was no music at all.
Seeing What’s Next: Using Theories of Innovation to Predict Industry Change.
In this third effort to work out the implications of distinguishing between sustaining and disruptive innovation, Christensen and his collaborators shift their attention from individual competitors to industry level analysis. They take their theoretical structures and apply them across several industry settings and ask how those particular industries (education, aviation, health care, semiconductors, and telecommunications) are more or less vulnerable to disruptive innovation strategies. What Christensen and colleagues are doing here is to begin integrating their innovation theories and Porter’s theories of competitive strategy. This is not so much a case of seeing whether their new theoretical hammer can pound strategy nails as it is of whether they are making progress in creating a new and robust toolkit for strategy problems.
The Innovator’s Guide to Growth: Putting Disruptive Innovation to Work, Anthony, Scott D.
This volume is written by Scott Anthony and several other collaborators of Christensen who are putting his ideas to work at the consulting firm Innosight. They develop the next level of operational detail to transform strategic insights into execution details. If you’re an organization seeking to develop its own disruptive strategy, the authors here have worked out the next level questions and identified the supporting analyses and design steps you would need to answer and complete. This volume is not a teaser; it’s complete and coherent. You could pretty much take the book as a recipe and use it to develop your project plans. On the other hand, the plans by themselves won’t guarantee that you can assemble a team with the necessary qualifications to execute the plan successfully. The other thing that this book does quite nicely is identify the kinds of organizational support structures and processes that you would want to put in place to institutionalize systematic disruptive innovation.
This core of books would equip you with a robust set of insights and practical techniques to begin thinking about when and where you might attempt to develop and deploy new products, services, and business models in disruptively innovative ways. The one area that is underdeveloped in this framework is that of design. There is an implicit bias in the material that tends to keep design in the "perform magic" category. I believe this is part and parcel of the general execution bias of business literature in general. Design is flaky, creative, stuff and real managers distinguish themselves on execution. But that is a topic for another post. These books belong on your shelf and the ideas belong in your toolkit.