Review of Redefining Health Care, by Porter and Teisberg

Looking back through my records, it appears that I began Porter and Tesiberg’s Redefining Health Care last November, so it’s a bit embarrassing that I’ve only now, in March, managed to finish it. In my defense, about halfway through it, I left it on a plane, and that initiated a bit of an odyssey to get it back, but really it’s just a long book and I’ve gotten a bit sidetracked with other books over the last two months. But enough excuses…

Results

I’m about 50 pages into Redefining Health Care by Michael Porter and Elizabeth Olmstead Teisberg, and while I’m a long way off from a review, it’s already providing lots of food for thought about leadership generally.

The most significant thing that’s struck me so far is the strong, almost relentless, focus on results in the book, and it’s gotten me thinking about the role of results in corporate decision-making and execution

Review of Getting Health Reform Right

I was excited to read Getting Health Reform Right because it approached the problem of health care reform from an international, public policy perspective. The authors all have deep experience working internationally to address health care, and that shows throughout their analysis in the many real world examples of reforms gone right and wrong drawn from across the globe.

Oblique influence

I just finished a long section of Getting Health Reform Right about the role of regulation in health care that was, to say the least, eye-opening. And as usual, I want to leave aside discussions of health reform and talk more about the implications for leadership generally.

My biggest take away was that changes in health care can rarely be legislated directly: if you want to lower the costs of services, it’s not feasible to just mandate lower costs; if you want more people to seek preventative care, you can’t make a law that they do so; if you want better providers in under-served communities, you can’t just tell them to go there. This kind of direct approach will ultimately fail, either because the link between cause and effect is too complex or because compliance with the law is difficult to enforce.

Leadership and the feasible

Although I’m still only early on in Getting Health Reform Right, there’s food for thought in every section. The following quote is from their chapter on the politics of reform, and although the political context of health care reform (particularly in third world countries) is an animal unto itself, this quote got me thinking about what makes a successful first-world corporate leader.

Talented political leaders, like talented generals, can win battles and campaigns that would overwhelm those less able or less energetic. So, asking if a policy is feasible is, in part, asking a question about the advocates of reform, especially their creativity, commitment, and skills—and about their opponents. (Getting Health Reform Right, p. 6)

The execution cycle

I’ve cracked the next book in my quest to better understand the health care problems facing the U.S.: Getting Health Reform Right, by Roberts, Hsiao, Berman, and Reich. This is another long one, so a dedicate review is a ways off, but I came across an interesting framework in the opening chapters, one that, with some slight changes in emphasis, could have applicability beyond government policy to include corporate decision-making.

Individuals and systems

Although my review of Christensen’s The Innovator’s Prescription is still forthcoming (I have about 100 pages left to finish the book), I keep finding gems along the way that raise important issues for leadership. This post looks at his distinction between individual motivations/drivers and systemic ones. As a leader, you have to understand both perspectives if you’re going to effectively get lots of individuals to act in ways that accomplish organizational goals.

Be careful what you wish for

I’m hitting the real meat of The Innovator’s Prescription by Clayton Christensen, and came across an example of disruption that I think poses an interesting challenge for leaders in general. It occurs in his larger consideration of the future of the pharmaceutical industry on pages 261 – 309, and concerns supply chain disruption.

Christensen believes that the trend among big pharmas to outsource R&D, clinical trials, manufacturing, and marketing is a mistake–it essentially amounts to emptying an organization of its value-adding activities and handing them over to smaller firms who will emerge as market leaders.

As usual, I’ll leave weighing in on this kind of stuff to the experts. But what I do want to discuss is Christensen’s story of the relationship between Dell and ASUSTeK, because I think it’s emblematic of challenges many leaders across a rage of markets face.

Morality versus the marketplace

.This post may be jumping the gun a little, because I haven’t finished The Innovator’s Prescription yet, but I found myself drawing some interesting contrasts already between Christensen’s work and T.R. Reid’s (see my review of The Healing of America for a fuller consideration of his ideas).

The most striking contrast to me so far has been the different grounds from which each writer believes health care reform will emerge.

Centrifugal and centripetal leadership

I’m reading The Innovator’s Prescription, Clayton M. Christensen’s excellent analysis of the health care problem facing the United States. It’s a long book (almost 500 pages), and I’m only 30 or so pages into it, but already it’s turned out to be thought-provoking.

One concept in particular caught my attention so far: the idea of decentralizing versus centralizing product development.