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.

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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 it shows throughout their analysis in the many real world examples of reforms gone right and wrong drawn from across the globe.

The book is meant as a hands on guide for those involved in reform on the ground, so it’s very much a practical, almost how-to guide. I say almost because, as they remind the reader throughout, there is no easy solution to the problem of health care reform, no one size fits all prescription. In every case, in every country, reformers need to take the specifics of the particular national situation into account if they want to have a chance to succeed.

The authors slice up the formidable challenge of health care reform into manageable chunks using the idea of control knobs, i.e., the big bucket categories of health care elements that reformers can address to affect change in the overall system.

They identify the following five control knobs (pp. 27-28):

  • Financing – all mechanisms, such as taxes, insurance premiums, and direct payments by patients, for raising the money that pays for activities in the health sector.
  • Payment – methods for transferring money to health care providers (doctors, hospitals, and public health care workers), such as fees, capitation, and budgets.
  • Organization – the mechanisms, such as measures affecting competition, decentralization, and direct control of government providers, that reformers use to affect the mix of providers in the health-care markets, their roles and functions, and how the providers operate internally.
  • Regulation – the use of coercion by the state to alter the behavior of actors in the health system.
  • Behavior – includes efforts to influence how individuals act in relation to health and health care.

The lion’s share of the book is spent addressing these five control knobs, and the authors do a solid job explaining them fully as well as illustrating how they affect a nation’s overall system of health care.

But as, if not more, valuable is the first section of the book that sets up their discussion of the control knobs with an analysis of health systems in general. Here they tackle the health reform cycle, how ethical theory intersects health care reform, political strategies for reformers, and strategies for selecting appropriate goals and performance measures for health system reform.

These chapters should be mandatory reading for anyone who wants to better understand the current debates on health care reform in the U.S. The generalized, international (or better yet, multinational) perspective allows the authors to set health care reform in a larger context, one that I think makes it easier to see the contours of the U.S. debate than the noise coming from all sides through the media.

And as those of you who visit here regularly know, the book is also chock full of insights for leadership generally: the problem of health care reform is so large and so complex that what leaders need to do to address it will have wide applicability to more narrow corporate challenges.

As usual, would love to hear from folks out there who’ve read the work or who have thoughts about my take on it—jump in and let’s get the conversation started!

Make sure you tie your carrot to a stick

Changes in external incentives and in internal management are powerfully complementary. Giving managers incentives without also giving them the skills, authority, and resources they need to respond to those incentives is likely to be quite ineffectual. The same is true in reverse. Increased managerial authority is not likely to lead to improved care if managers have no incentive to do so. This is why various writers on organizational reform in health care have seen a need for “consistent” change (Harding and Preker 2002). It is not aesthetics that lies behind their observations, but rather the need to combine reasons to do better with this capacity to do better–in the same reform package.

Getting Health Reform Right, p. 215

I’m still finishing up Getting Health Reform Right, so a review is a week or so off. But in the meantime, I came across this passage on the plane last night and thought it held wonderful insight into leadership generally.

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It’s not enough to lead

I was sitting in a doctor’s office over the weekend and picked up the latest copy of Rolling Stone to page through the interview with President Obama. And leaving aside my opinion on the president and his tenure to date, I found the article fascinating on a number of levels, the most important of which for this blog is the implications it had for leadership.

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Review of Health Care Will Not Reform Itself, by George Halvorson

George Halvorson is the CEO of Kaiser Permanente, the largest not-for-profit health plan and care system in the U.S., and has been a leader in the industry for over 30 years. Health Care Will Not Reform Itself is his attempt to spell out what he thinks are the key problems and most promising solutions to the health care problems we face.

For Halvorson, as the title of the book suggests, we cannot expect our health care system (which he calls a “nonsystem”) to spontaneously, organically transform to become more efficient, less expensive, and more effective. He would disagree with Christensen that disruptive innovation is acting like some invisible hand, making care more affordable and effective day by day over the long haul. The only invisible hand Halvorson sees at work in the U.S. health care nonsystem is profit…and our nonsystem is structured to reward things most folks would consider less than desirable for the country as a whole and its citizens as individuals.

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Review of The Innovator’s Prescription, by Clayton M. Christensen

So, at long last, I’ve finished The Innovator’s Prescription by Clayton Christensen. This was a bit of a slog, but worth it. In every section, Christensen delivers solid ideas and compelling frameworks to understand and address some of the main problems facing health care in the U.S. I definitely recommend it to anyone looking to dig in more deeply to this issue.

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The banality of health care reform

Insurance…will pay for the amputation of a limb to treat diabetes-related gangrene, but not for the conscientious follow-through that can lessen the probability of needing such costly and tragic remediation. This is not the fault of physicians or insurers. The fault is in the misapplication of a business model that was designed for the practice of acute medicine long ago.

Christensen, The Innovator’s Prescription, p. 164

I’m almost finished with Christensen’s The Innovator’s Prescription, and I still can’t shake the feeling I had 75 pages into the book: although I agree with his assessment of health care in the technical sense, I feel that there’s a moral/ethical dimension to the health care problem that he ignores that simply can’t be ignored.

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