cowboys doctors or... comforters doctors

David Cutler from Harvard University, et. al in 2015 published a working paper to test whether patient demand-side factors or physician supply-side factors explained regional variations in health care spending. They founded that:

1. Patient demand was relatively unimportant in explaining variation in spending after accounting for physician beliefs.
2. Physician organizational factors matter,
3. The single most important factor is physician beliefs about treatment: 35 percent of end-of-life spending, and 12 percent of U.S. health care spending, are associated with physician beliefs unsupported by clinical evidence.

The authors differentiated two types of doctors.

• "cowboys": Physicians treating a critically ill patient may decide either to provide intensive care beyond the indications of clinical guidelines (such as implanting a defibrillator to counter severe heart failure),
• "comforters": Physicians treating a critically ill attempt to make the patient more comfortable by administering palliative care.

The cowboy doctors push the frontier of medicine by going above and beyond clinical evidence showed little or no marginal benefit derived from the extra procedures, resulting in wasteful spending.

The authors say that the healthcare system’s current incentives often do not prompt doctors to ask the right questions, such as whether a proposed treatment truly benefits the patient. “If doctors restrict themselves to performing what is evidence-based, “we can save hundreds of billions of dollars a year.” Doctors tend to follow their own beliefs about the right treatment to use, leaving patients little say in the process. How to treat a patient is often a multiple-choice question without a straightforward, single “correct” answer. Doctors should pay more attention to the patient’s preferences, instead of relying on their own experience.

The research suggests that it’s time for the cowboys to rein themselves in, and learn to listen.

Access to the article (pdf) Physician Beliefs and Patient Preferences (wp 2015)

photo: Leonard McCombe LIFE Magazine
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some controversies about competition in health care

 

Vicente Ortún Professor and former Dean of the School of Economic and Business Sciences, University Pompeu Fabra of Barcelona and founder and member of the Center for Research in Economics and Health (CRES), published on 16 of September and article titled "public and private in Health". 

One of the ideas of the article, that he is suggesting since long time ago, is the introduction of "yardstick competition (competence by comparison)" among health care organizations.

For those politicians, journalists, trade unions, associations, experts in talk shows, and people who want to read, learn and study before to make statements without any idea here you have some literature to read.

Competition in UK health care sector by Nuffield Trust (2013).
Competition in hospital sector by OECD (2012)
Competition and market mechanisms in health care: SEMINAR  (2013)

photo: (*) Photosolde
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When organizations are growing

Larry Grainer wrote this article in 1972. In 1998 it was republished in Harvard Business Review as a Classic. The author removed some outdated material from the opening sections. He also wrote a commentary “Revolution is still inevitable,” to update his observations.

He described in the article how organizations develop and he designed 6 phases of growth that includes in each phase a period of relatively stable growth (evolution) followed by a stage of crisis (revolution) when major organizational change is needed if the company is to carry on growing. This crisis period it's not a bad thing it's a "change period or turning point".

1. Phase 1: Creativity. Crisis: Leadership
2. Phase 2: Direction. Crisis: Autonomy
3. Phase 3: Delegation. Crisis: Control
4. Phase 4: Coordination. Crisis: Red Tape
5. Phase 5: Collaboration. Crisis: Internal growth crisis
6. Phase 6: Alliances

This is still a useful model, however not all businesses will go through these phases and crisis in this order. We could use this as a starting point for thinking about our business growth, and adapt it to our circumstances.

Access to the article (.pdf): Larry Greiner (1998) HBR Classic

photo: (*) Photosolde
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Health economics in Spain: two recent interesting articles

Health Economics (2016)

Editorial written by David Cantanero Associate professor at the Department of Economics, University of Cantabria and Juan Oliva Associate professor at the Department of Economics University of Castilla la Mancha

The editorial puts the focus around the eight categories described by Alan Williams in the 1987-plumbing diagram (determinants of health; measurement and valuation of health; economic evaluation of treatment; demand for insurance and healthcare; supply of healthcare; market equilibrium and rationing; system evaluation; planning, budgeting and monitoring).

They put some Spanish papers as an example of how health economics is a powerful tool to evaluate public programs and policies.



Health Care System in Spain (2016)

Written by Guillem López-Casasnovas Professor at the Department of Economics of the Pompeu Fabra University of Barcelona and Beatriz González López-Valcarcel Professor at the Department of Economics of the University of Las Palmas de Gran Canaria

The article overviews the Spanish healthcare system and its idiosyncratic interconnected sources of problems including, a deficit of good governance, inadequate incentives for agents to take proper responsibility, and a lack of a consensus model for articulating the public and private sectors. In this paper the authors propose some antidotes in order to improve the future prospects of the system: to combine governance with autonomy, to change copayments and to modify the institutional architecture in making coverage decisions, by creating an independent agency, along the line of NICE in England. This latter country as well as the Netherlands provides reform lessons from which the Spanish system may learn.

photo: bansky
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Three Dialogues in: Ethics applied to companies and organizations

The Fundació Factor Huma in collaboration with the Obra Social "la Caixa", organized three workshops related to Ethics applied to companies and organizations.

The purpose was to create a common ethical reflection shared between the academic and business worlds. The 3 workshops where about:

• Ethics and Governance
• Ethics and Management
• Ethics and People

The workshop was conducted by the expert Begoña Roman, who in every session focused the topic to be deliberate.

• Begoña Román Maestre holds a PhD in philosophy from the University of Barcelona. Between 1996 and 2007 she headed the Department of Ethics at University Ramon Llull (Barcelona) and she is currently professor in the Faculty of Philosophy of the University of Barcelona. In addition, she is Chairperson of the Ethics Committee of Catalonian Social Services and member of Bioethics Committee of Catalonia. Her area of specialization is Bioethics and Ethics applied to professional and organizational environments.

Access to sessions: Diàlegs

You will find the videos of each session with the Begoña Roman speeches and access to document with an abstract of the key note speech and the conclusion of the workshop.

photo: (*) Photosolde
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Social media and the worldwide leadership crisis

Article: Beyond Viral (2016)

"The proliferation of social media usage has not resulted in significant social change". Information spreading is key to the formation of collective beliefs, opinions, and attitudes. But incentives play an equally important role. Convincing someone of an idea is one thing. Recruiting them to incur substantial time, effort, and risk toward supporting a cause requires much more.

Authors:

• Manuel Cebrian is Research Group Leader with the Data61 Unit at the Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia.
• Iyad Rahwan is an associate professor of Media Arts and Sciences at the Media Lab, Massachusetts Institute of Technology.
• Alex “Sandy” Pentland directs the MIT Connection Science and Human Dynamics labs and previously helped create and direct the MIT Media Lab and the Media Lab Asia in India.

Video support:

photo: (*) Photosolde
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A High Performance Organization

"A High Performance Organization (HPO) is an organization that achieves financial and non-financial results that are better than those of its peer group over a period of time of at least five to ten years"

The characteristics of a HPO

Organizational design characteristics
D1. Stimulate cross-functional and cross-organizational collaboration.
D2. Simplify and flatten the organization by reducing boundaries and barriers between and around units.
D3. Foster organization-wide sharing of information, knowledge and best practices.
D4. Constantly realign the business with changing internal and external circumstances.

Strategy characteristics
S1. Define a strong vision that excites and challenges.
S2. Balance long-term focus and short-term focus.
S3. Set clear, ambitious, measurable and achievable goals.
S4. Create clarity and a common understanding of the organization’s direction and strategy
S5. Adopt the strategy that will set the company apart.
S6. Align strategy, goals, and objectives with the demands of the external environment and build robust, resilient and adaptive plans to achieve these.

Process characteristics
P1. Design a good and fair reward and incentive structure.
P2. Continuously innovate products, processes and services.
P3. Continuously simplify and improve all the organization’s processes.
P4. Create highly interactive internal communication.
P5. Measure what matters.
P6. Report to everyone financial and non-financial information needed to drive improvement.
P9. Strive for continuous process optimalization.
P8. Strive to be a best practice organization.
P9. Deploy resources effectively.

Technology characteristics
T1. Implement flexible ICT-systems throughout the organization.
T2. Apply user-friendly ICT-tools to increase usage Leadership characteristics

Leadership characteristics
L1. Maintain and strengthen trust relationships with people on all levels.
L2. Live with integrity and lead by example.
L3. Apply decisive action-focused decision-making.
L4. Coach and facilitate.
L5. Stretch yourselves and your people.
L6. Develop effective, focused and strong leadership.
L7. Allow experiments and mistakes.
L8. Inspire the people to accomplish extraordinary results.
L9. Grow leaders from within.
L10. Stimulate change and improvement.
L11. Assemble a diverse and complementary management team and workforce.
L12. Be committed to the organization for the long haul.
L13. Be confidently humble.
L14. Hold people responsible for results and be decisive about nonperformers.

Individuals & Roles characteristics
I1. Create a learning organization.
I2. Attract exceptional people with a can-do attitude who fit the culture.
I3. Engage and involve the workforce.
I4. Create a safe and secure workplace.
I5. Master the core competencies and be an innovator in them.
I6. Develop people to be resilient and flexible.
I7. Align employee behaviour and values with company values and direction.

Culture characteristics
C1. Empower people and give them freedom to decide and act.
C2. Establish strong and meaningful core values.
C3. Develop and maintain a performance-driven culture.
C4. Create a culture of transparency, openness and trust.
C5. Create a shared identity and a sense of community.

External orientation characteristics
E1. Continuously strive to enhance customer value creation.
E2. Maintain good and long-term relationships with all stakeholders.
E3. Monitor the environment consequently and respond adequately.
E4. Choose to compete and compare with the best in the market place .
E5. Grow through partnerships and be part of a value creating network.
E6. Only enter new business that complement the company’s strengths.

An analysis of 290 studies into high performance organizations yielded characteristics with regard to the organizational design, structure, processes, technology, leadership, people, and culture, and the external environment which seem to influence the ability of organizations to achieve high performance.

These characteristics can guide managers as to which actions they need to take to lead their organizations to superior results.

Acess to the article: Waal, A.A. de, (2010). The Characteristics of a High Performance Organisation 

photo: jupiterfab
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Could an Integrated Delivery System be a cure for fragmentation in Catalonia?

An Integrated Delivery System (IDS) defined by Alain C. Enthoven  is an organized, coordinated, and collaborative network that:

(1) links various healthcare providers, via common ownership or contract, across 3 domains of integration—economic, noneconomic, and clinical—to provide a coordinated, vertical continuum of services to a particular patient population or community

(2) is accountable, both clinically and fiscally, for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them.

With all of the following  characteristics:

1. Shared values and goals; 
2. Aligned incentives; 
3. Physicians leadership; 
4. Comprehensive records; 
5. Shared practice guidelines; 
6. A culture of teamwork; 
7. Integration across care settings; 
8. And a focus on populations as well as individuals.

Here there is the article explaining what is an IDS. A. Enthoven (2009) Integrated Delivery Systems: The Cure for Fragmentation*
*acces to pdf on the last page

Alain C. Enthoven said in 2007 in a Nuffield Trust (UK) seminar:
"Integration is about relationships between people. These relationships are not informal friendships. They have to be worked on and built professionally if clinical integration is to be meaningful and sustained through good and bad times. Effective integration takes years to develop, and is not a quick fix".

We should explore more this idea in Catalonia.

photo: (*) Photosolde
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don't give up to read original articles

The goal of this blog is to share information tendencies about health, innovation, evaluation, data and how to manage organizations.

With only a small synthesis of the information, trying to give you an impartial perspective, I share the link that will take you directly to the original article.

Are not used reading a scientific or technical paper? Don’t worry!

Here there is an interesting article written in Science that give you some ideas how to read and understand a paper: How to read a scientific paper

Photo by Alfred Eisenstaedt, 1963 LIFE.

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open data in health care organizations

Open data definition: Data that is easily accessible, machine-readable, accessible for free or at negligible cost, and with minimal limitations on its use, transformation, and distribution.
See the video: #opendatafilm 12m

Why Open Data in health care organization?

Transparency. 
In a well-functioning, democratic society citizens need to know what their health organizations are doing. To do that, they must be able freely to access data and information and to share that information with other citizens.

• Transparency isn't just about looking for what the managers or the personnel are earning (an old fashioned idea). It is also about people empowering themselves to be better able to make decisions about their lifes: choosing the hospital with better treatment outcomes after analyse and compare different data procedures.
• Transparency isn’t just about access, it is also about sharing and reuse — often, to understand material it needs to be analyzed and visualized and this requires that the material be open so that it can be freely used and reused. Open data helps organizations to create data more efficient.

Participation.
Citizens are not able to engage with their health organizations.
By opening up data, citizens are enabled to be much more directly informed. This is more than transparency: it’s about making a full “read/write” society, not just about knowing what is happening in the process of governing or managing a health care organization but being able to contribute to it. Patients, their families and citizens in general push the organization to be more responsive.

[Want to know how a Catalan Health Care organization are tackling open data?: SAGESSA Open Data]

Other useful information: 
Health Open Data Catalan Health Service
The Open Data Era in Health and Social Care NHS England (2014)

photo: galaxy IDCS 1426 (NASA)
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Great teams: exploring, engaging and breaking down the silos

Building great teams the article written in 2012 by Sandy Pentland, one of the 7 most powerful data scientist in the world, explores using data the patterns from great teams.

Successful teams share several defining characteristics:

1. Everyone on the team talks and listens in roughly equal measure, keeping contributions short and sweet.
2. Members face one another, and their conversations and gestures are energetic.
3. Members connect directly with one another—not just with the team leader.
4. Individual reasoning and talent contribute far less to team success than one might expect.
5. The best way to build a great team is not to select individuals for their smarts or accomplishments but to learn how they communicate and to shape and guide the team.
6. The most valuable form of communication is face-to-face.
7. The best-performing and most creative teams sought fresh perspectives constantly, from all other groups in (and some outside) the organization.
8. Successful teams, especially successful creative teams, oscillate between exploration for discovery and engagement for integration of the ideas gathered from outside sources.

Nowadays some of these ideas should be used inside organizations and inside "political parties". Why do we not try to breakdowm the silos?

photo: (*) Photosolde

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