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
April 21, 2011 at 7:52 am · Filed under
Adoption, Innovation, Organizational Design, Paradigm, Workplace
One of the greatest challenges for a small and growing company is to make that shift from a small “tribe” of say 8 early employees to 15 or 25 or 35 staff.
Here is Microsoft at that moment.
The culture changes and has to become more formal. Rules have to be made. Employment law understood. How to hire and fire learned. You just cannot avoid this step.
You can easily outsource things like payroll and EAP. But what about HR expertise?
What kind of risk does a small organization run? Hiring is such a vital process – do you know how to do this well? With 5 employees you can rock and roll but with 25, what about the request to take time off to look after a sick relative? What about the poorly performing employee – or worse the employee who is acting out? What about Health and Safety?
But at this stage you have no money! You may pay for a good lawyer and an accountant but all your staff are coding or contributing to the business. So you often ask your PA or your book keeper to do their best.
You simply cannot hire full time the best expertise.
But now you can have access to an HR “Cloud” where you can have the kind of expertise that exists only in a very large organization with thousands of employees. Now you can have this level of expertise at a price that you can afford. Just as you can now have the level of data storage and security in the cloud.
My HR Department is a partnership of 3 of the top HR professionals in Canada. I knew them all back in the day when this was my field too – they are the cream of the crop. Their target market is the new and the small and the fast growing organization.
I think that this is the start of a new organizational structure. Just as many employees themselves are now virtual – soon most of the staff functions that used to cost so much to have in place will be virtual as well. You will “rent” the expertise when you need it – just like you will soon rent most software.
What this means of course is that an organization of 25 people can have the level of staff support of an organization of 50,000. It will make small organizations very powerful.
by Rob Paterson
April 20, 2011 at 9:49 am · Filed under
Adoption, Business 2.0, Business Intelligence, Business Model, Innovation, Innovator Interviews, Measurement, Media, Paradigm, Relationships, Science, Social Media, Trust, Trusted Space
In the old economy that still lingers you could buy “Attention”. A large advertising budget could force you into the minds of others. But we are becoming numb to this assault. Increasingly we only trust people that we know. “Attention” is shifting from the Institution with the budget to the “Person” with personal reputation or “Clout”.
This transition from the Institution to the Personal is surely one of the most paradigm shifting aspects of the time we live in?
Here is the “Godfather” of the idea of the Attention Economy – Michael Goldhaber back in 1997 explaining this shift from Attention that you could buy to Attention that you could only Earn!
“.. money now flows along with attention, or, to put this in more general terms, when there is a transition between economies, the old kind of wealth easily flows to the holders of the new. Thus, when the market-based, proto-industrial economy first began to replace the feudal system of Western Europe, in which the prime form of wealth was aristocratic lineage and inheritance of land, both the noble titles and the lands that went with them soon ended up disproportionately in the hands of those who were good at obtaining what was then the new kind of wealth, namely money.
With considerable ease, the rising merchant and industrialist class could buy old titles, induce governments to grant them brand new ones, or marry into the old impoverished gentry. The parallel today, again, is that possessors of today’s rising kind of wealth, which is attention, and whom we label stars of every sort, have an easy time getting money.
But now let me point out that the other way round doesn’t work nearly as easily. Contrary to what you are sometimes urged to believe, money cannot reliably buy attention. Suppose it did work that way. Then you could have been paid to sit here and listen closely even if I were to read you something as boring as the phone book or an unabridged dictionary. Presumably it wouldn’t even matter if I kept repeating the same few syllables over and over. If money could reliably buy attention, all I would have to do is pay you the required amount and you would keep listening carefully through all that, not falling asleep en masse, nor allowing your minds to wander. In truth, even if you had been paid a huge sum, this would be most difficult, and if you did it, it would be a testament more to your own deep sense of principle than to a general condition in which another roomful of similar people could be expected to do equally well.
Someone who wants your attention just can’t rely on paying you money to get it, but has to do more, has to be interesting, that is must offer you illusory attention, in just about the same amounts as they would if you had instead been paying money to listen to them — which by the way is closer to the case here. Money flows to attention, and much less well does attention flow to money.”
Attention that people will trust – about an idea, a product, a service, a politician, will come from “Trusted” people in your life and in your network.
Defining and measuring Personal Clout will therefore be very important in the future.
That is why I wanted to speak to the CEO of Klout, Joe Fernandez who very kindly spent time with me on the phone yesterday talking about “Attention” what it is now – how it builds from Robin Dunbar’s research. We also touched on how today’s kids may be having their brains rewired to be able to use a much larger network than was possible face to face.
Here are some of the ideas that we batted around:
- It’s all about how you are as a person - Many newbies still think of Social Media as a big megaphone – they still shout out to the crowd – “look at me” aren’t I great!!!!” – But they most important aspect of the new world is what “Others say about you” and who those others are and how large your and their network is. To get their attention demands that you have something good to say and that you have also won their trust. This then is not easy environment. There can be no instant success.
- It’s all about how you are related in network terms – This is why Klout have set up their algorithms to measure True Reach or the value of your content - Amplification Probability or how we you are related to the people in your network – how large and diverse is your network – do they find you interesting, safe, or a bore - and Network Influence or do you influence people with influence. This makes a lot of sense to me. I think that Klout is trying to get a handle on the playing field. I also liked it that Joe kept reminding me that they are at the start of a voyage of discovery. That they may be ahead of others but know that there is so much to discover.
- The online world is likely larger than the personal world - Klout will fond out how much larger. The Dunbar numbers still operate in the personal world and for adults my age I think. But Joe made a case based on observation that he is seeing online Trusted Networks maxing out at about 500 (144 is the max Dunbar number) His own floats between 150 – 350 but he still relies on about 150. The really interesting point he made is that he is seeing a new world emerge with kids.
- Kids have a new social reality – they never lose a friend! – When I was a boy, we moved a lot. So at every move to a new place, a new school etc, I lost touch with 98% of the then friends. Over time they faded from memory. But now, a kid moves or changes school and stays in touch with most of her friends. Even now as an adult, I am regaining touch with old friends long lost. Joe and I thought that decades of staying connected must have an effect on the wiring of the brain. After all print had that effect by making the left hand side more powerful. The brain is very plastic and can change very quickly as we see with say stroke victims. It is very likely that a child of 5 today who is a keen user of social media, will have a very different brain than I do when they are 25.
This new world is literally unfolding before us. Joe thinks that Klout now is about where Google was in 1997 – the key algorithms are in their infancy but are already able to tell us interesting things. Much more will be possible over time – especially when there is more data to observe.
But 2 things are clear to me – understanding how Clout works is core to the new economy. And that measuring Clout as Klout is doing is going to be very important.
Your reputation is your capital. You and not the institution will have the power.
by Rob Paterson
February 28, 2011 at 3:51 pm · Filed under
2.0 Design Thinking, Adoption, Paradigm
Of course everybody gets 2.0 now don’t they. After all even the Oscars were designed for Social Media. Large organizations are piling in.
But is this true? Certainly everyone is on board with the tools now. God I recall Jevon and I talking to CIBC 6 years ago and they thought we were martians. Now everyone is on Facebook!
But how many people “get” what is underpinning these tools? Not many and I have little hope for many too.
Why?
Because underneath all the hype, most of us see the world the same way as before. We see what we see with our eyes. Just like most people saw the world 500 years ago. Then, if you used your eyes, the world seemed flat. This perception allowed to you to do a lot of useful things. You also saw that the sun came up every morning and circled the Earth. This did not ruin your day and was also a useful observation. That is of course unless you wanted to sail a long distance. Or calculate a trajectory or build a complex building or in fact do almost anything that we take for granted in the modern world. Imagine Watt explaining the steam engine to the Vatican? Imagine trying to build a suspension bridge? Imagine anyone doing chemistry – see where I am going.
But we are not so stupid today are we? We don’t rely only on our eyes to tell us about reality?
Well here is your test. Can you see that all these things are in fact a fractal scaling of the same thing?
Can you see that what appears on the surface to your eyes as being unique, different and discrete are in reality the same and that all co-evolve and affect each other? Do you see them therefore as all obeying the same rules, the rules of networks? Can you see how with this perspective everything becomes actually quite simple to understand? All we need to know is how nature governs networks.
Or do you see them all as Objects that are are different – that interact only directly as objects do? That are therefore so complex that we can only know tiny bits of them. So medicine and science are all about the bits and the direct interactions. That we inhabit a Newtonian world where the geometry of nature’s interactions do not apply?
For is this not the prevailing paradigm?
This is why people seek to have masses of followers – this is a Newtonian idea about mass and gravity. It has nothing to do with co-evolution and true influence.
This is why it’s still ALL ABOUT ME! So long as I am OK it’s OK!
This is why medicine makes no sense and each week a new contradictory idea is floated. This is why science is lost in minutiae. This is why our organizations are so toxic. We have designed them to be Newtonian but we are fractal co-evolving networks. This why our mass education system is such a mess. This is why even how we fight our wars means that we have to lose them. This is why we think that there is a conflict between the planet and our economy.
We have been captured by a simple and wrong idea of us all being objects that bounce off each other like tennis balls whereas we are really magnetized iron filings.
No amount of Facebook Strategies will help you if you don’t get this.
The world is not flat and you and I are not an object.
If you want to know more about this new paradigm of reality – I have the great honor to introduce you to the work of Alexei Kurakin – a genius – a Galileo of our time.
