Good Health is Good Business
Good Health is Good Business
For the last couple of months I have been digesting the book Good Health is Good Business as I think through its implications for Patients Know Best. I had only thought of providers and patients as markets for my software, but now payers seem a significant possibility. I had originally dismissed this because insurance companies had the wrong incentives, and besides the more progressive ones were convinced they should build their own versions.
But the book discusses the incentives for employers to manage the wellness of their employees, and my software should support wellness. But enough about me. The rest of this post is about the points that I learned the most from.
First was the point that insurance companies have no incentive to improve the health of the patient, only to quickly process the claims for illnesses. By contrast, employers should pay to maintain their employees’ wellness because paying for illness is much more expensive, and maintaining wellness is possible. Here is the full list of reasons that Dr. David Rearick gives for employers to get involved, and its analogue in the UK is the government as payer rather than provider:
- You are the payer, and you have the incentive
- You are not big enough for anyone else to care (this is less the case in the UK)
- The health of your employees is the only factor under your control
- You have a captive audience
- You can motivate your employees
- Biometric testing
- Tobacco cessation
- Stress management
- Weight management
- Cholesterol reduction
- Hypertension management
- Physical exercise programs
- Substance abuse prevention
- Back care and injury prevention
- Health assessments
- Health risk counseling
- Nutritional interventions and supplementation
- Education on Aspirin Chemoprophylaxis for heart disease
- Being sure your dependent children are adequately immunized
- Establishing a tobacco screening and prevention program
- Providing brief counseling interventions for acute medical issues
- Encouraging appropriate colorectal screening
- Hypertension screening
- Providing Influenza worksite immunizations
- Providing Pneumococcal immunizations
- Providing problem drinking screening and brief counselling
- Providing vision screening
Socializing software
Book cover for The Social Life of Information
I am currently reading The Social Life of Information, another Harvard Business School text that critiques the IT industry. It is annoying me like IT Doesn’t Matter did, but is full of interesting historical background like The Big Switch is, so as a history junkie I am hooked. I guess the fact that I find the book annoying marks me as the techno-jingoist that they are critiquing.
The book’s main thesis, so far in my reading, is that there is a lot more social context around information and its technology than information technology enthusiasts (e.g. me) would claim. Furthermore, that social context is important and overlooked leading to problems in deployment. I will not be cruel enough to say that MIT invents the future while Harvard publishes scholarly critiques of it (oops, but Dan Bricklin’s audience agrees with me).
There are, as you might expect from the strong praise the book has received, lots of good stories and fair points. For example, there is the hilarious account of the attempt by Chiat/Day’s senior management to create the office of the future, documented by Wired News in issue 2.07, and then fittingly recanted in 7.02. The dystopian visionary CEO created office space with no offices, where hierarchy was “eliminated” as each employee had access to any desk at the beginning of the day that they wanted to take.
The reality was the employees had to rush to grab desk. Field staff would arrive in the middle of the day with no idea where the rest of their team had sat. Team members could not sit together, and turf warfare began as senior managers tried to pull rank over junior members of other teams so that they could get their own team members to sit together. These same post-hierarchical managers sent their secretaries to grab desks for them in advance. Amongst all this bullying the CEO would walk around asking people if they were sitting in the same place they had sat yesterday. If they answered yes, he would move them to another place.
And the computers, of course, were a pain to recustomize each day for each worker’s preference. No employee had any personal computer, instead they would pick up a fresh device each day. And it turns out that desks are more than just place on which to pile paper, instead the location of each pile of paper had meaning and value. You get the idea.
By contrast, I was surprised to learn how keenly socially aware Alexandar Graham Bell was with the new technology he invented, the telephone. His investors were dismayed at how useless the telephone seemed compared to the telegraph and tried to sell the patents to Western Union at rock-bottom prices. Western Union turned them down and I recently discovered (see Brunelleschis Patent in the sharing medical techniques post) that these are still the most valuable patents to date.
Instead, Bell tried to get his telephones into hotels and encouraged hotel guests to use the phones to call reception staff. He also put the phones into offices so that office staff would experience the advantages of telephones. Such social interactions must have been great for creating his market of home customers.
It is interesting to me to contrast Bell’s approach with Day’s when thinking about doctors learning and the Department of Health’s plans for modernising education. Six years ago, as I was beginning my residency, Modernising Medical Careers included bold talk of restructed teaching that fit the increasingly unstructured schedules of doctors. As junior doctors worked fewer hours with fewer overlaps with other doctors’ shifts the idea of time- and place-shifted teaching was attractive. Each doctor could watch each lecture alone.
At the time it sounded good and I was heavily in favour of it. But now, after reading this annoying book, I am annoyed to admit that I am rethinking the advantages.
As I read the rest of the book I am curious to see what else it covers. Certainly, the index does not include Google, and it has only one mention of GNU, and thus open source software, a highly social technology endeavour. And as far as I can tell, there will not be any mention of social software as the book was published in 2000, around the same time that web 2.0 began to crystalize. Social software may not fix the social problems that the book describes, but it does provide a variety of social solutions to problems that were previously intractable.
Reasons why women think men are disgusting: number 73
A charming example from the book Nudge: Improving Decisions About Health, Wealth, and Happiness describing the success of Amsterdam’s Schiphol Airport in reducing spillage at urinals by 80 percent.
There the authorities have etched the image of a black housefly into each urinal. It seems that men usually do not pay much attention to where they aim, which can create a bit of a mess, but if they see a target, attention and therefore accuracy are much increased.
It gets better.
According to the man who came up with the idea, it works wonders. “It improves the aim”, say Aad Kieboom. “If a man sees a fly, he aims at it.”
Self-deception: a how-to guide
If you think you do not know how to deceive yourself then you probably already know exactly how to do so. But, for the few innocents among us, I recommend the book “Mistakes were made (But not by Me)“. Frankly, I bought it for the name alone. Needless to say, politicians are over-represented, mainly because lying to others first requires a mastery of the ability to lie to oneself.
A shorter and funnier alternative is lecture by Robert Trivers (originally posted on IT Conversations). As Trivers recounts, there are three techniques for self-deception:
- Using the active voice for positive personal actions, and the passive for negative ones. For example, “I created this success” but “this failure happened”. This is a restatement of the principle that success has many fathers while failure is an orphan.
- Heaping general praise for positive actions by those in the in-group (e.g. “my friend did something great because he is a great person”) but only specific for out (e.g. “my enemy did something great”). Conversely, for negative actions, those in the in-group get specific condemnation (e.g. “my friend did something bad”) while general condemnation is reserved for those in the out-group (e.g. “my enemy did something because he is a terrible person”).
- Selective memory, including no correlation between confidence and accuracy. The latter point is particularly serious for the judicial system, where the degree of confidence of a witness is taken as an indication of the accuracy of their statements.
Trivers also mentions something that saddened me: the first world war was last in which the military died to protect civilians; since then, the reverse has been true.
Which brings us these statements:
- “I believe that success will be fairly easy.” — John McCain (9/24/02, CNN)
- “I believe that we can win an overwhelming victory in a very short period of time.” — John McCain (9/29/02, CNN)
- “The American people … were led to believe that this would be some kind of a day at the beach which many of us, uh, fully understood from the very beginning would be a very, very difficult undertaking.” — John McCain (8/22/06, CNN)
- “I knew it was probably going to be long and hard and tough. And those that voted for it and thought that somehow it was going to be some kind of an easy task, then I’m sorry they were mistaken. Maybe they didn’t know what they were voting for.” — John McCain (1/4/07, MSNBC)
Selective memory anyone?
What does Simon’s Travel Theorem Mean for your next trip?
Several threads are pointing me towards Herbert Simon’s book on decision theory, “Models of My Life“. A friend of mine who has created a documentary about Charles Moore has also made freely available his interview with Herbert Simon. What is driving me towards his book is its discussion of his Travel Theorem:
Anything that can be learned by a normal American adult on a trip to a foreign country (of less than one year’s duration) can be learned more quickly, cheaply, and easily by visiting the San Diego Public Library.
Of course, Simon wrote this before the web, let alone the Wikipedia. This is making me reconsider all site visits for my management consultancy research.
People react almost violently to my Travel Theorem. I try to explain that it has nothing to do with the pleasure of travel, but only with the efficiency of travel for learning. They don’t seem to hear my explanation; they remain outraged. They point out that I seem to be traveling all the time. Why shouldn’t other people travel too? After they simmer down enough to understand the theorem, they still attack it. It takes a long time to calm their passion with reason — and it usually isn’t extinguished, but temporarily subdued. Why, they think, argue with a madman?
So why bother making the trips? Of course, there are always the pleasures of travel, and Simon makes no attempt to deprive people of these. But I am now changing the focus of my trips to things I could never have found out from library, or the web. For example, I like to talk to the people who are hidden away, the ones who are so busy working that they do not respond to phone calls requests from management consultants. Those people will tell you truths that no library visit will get you.
Microtrends on Muslims
The first book I ever bought for my Kindle is “Microtrends” by Mark Penn. It is the perfect book for commuting because each of its chapters is a few pages long and is a self-contained microtrend about some aspect of American society. It makes for perfect information snacks but I must admit that I have almost missed my train stop a couple of times because I just wanted to sit down and read the next chapter.
What is fascinating is just how diverse this shows American society to be. “Cougars” and “Internet Marrieds”, “Stained Glass Ceiling Breakers” and “Pro-Semites”, “Southpaws Unbound” and “Hard of Hearers”, “Late-Breaking Gays” and “Dutiful Sons”, the book makes you want to “ask around or watch people on a busy street corner for a few minutes, and you will spot them soon enough”.
But for this post, I wanted to discuss the “Moderate Muslims” chapter. I read this at the time that Bush visited Bahrain and the other Gulf states. On the train, as I read my Kindle, I could see the front page of the “Express“, the local free daily, with photographs of (very cute) Israeli children waving Israeli and American flags. On page seven, however, was some masked gunman with a burning American flag. I am not sure what he was thinking (was he thinking?) but it was clear to me who I would prefer to discuss the Middle East peace process with. So it is no surprise that:
Almost half of Americans have a negative view of Islam. When asked to rate their views of all major religions, only Scientology ranks lower.
The book was written before Tom Cruise’s latest Scientology gem, so the Muslims may well have inched further ahead, but it is still a bad place to be. What is interesting, given the project I am currently working on, is that:
If one knows a Muslim personally, one’s views are moderated – but only a little more than one-third of Americans do know a Muslim personally.
Here is why knowing a Muslim makes a difference:
Nearly half (46 percent) of Americans believe that Islam encourages violence more than other religions – up from the 35 percent who felt that way six months after the 2001 attacks. More than half of Americans say Muslims are not respectful of wormen. Forty-four percent say Muslims are too extreme in their religious beliefs. Twenty-two percent say they wouldn’t want a Muslim living next door.
But if you look at an actual demographic portrait of Muslims in America, there’s quite a contrasting picture.
Americans think Muslims are violent? An overwhelming 81 percent of American Muslims support gun control, compared to barely half of Americans who do. Muslims are religiously extreme? Twenty-five percent of Muslims say they attend religious services on a weekly basis – virtually identical to the 26 percent of Americans overall who say they don’t.[...]
In fact, if I were to describe for you a cohort of Americans who got married at a rate of 70 percent, registered to vote at a rate of 82 percent, were college-educated at a rate of 59 percent, and were on average making more than $50,000 a year – what group would you guess they were?
Because that’s the average Muslim in America. Young, family-oriented, well educated, prosperous, and politically active.
What I want to do is to help ordinary Americans get to know these ordinary Muslims and their values.
The geek shall inherit the earth
Another character from “Justinian’s Flea” is Anthemius, one of the two architects who built the extraordinary Hagia Sophia. The building was one of the reasons for his wealth and thus in Constantinople he lived amongst notable neigbours like Zeno, a famous orator. Apparently the two quarreled over something, Zeno sued and won. Anthemius was a geek, however, and so “he took his revenge like a proper engineer, first simulating an earthquake with a steam line that he surreptitiously ran into Zeno’s apartment, then exploding noisemakers to mimic the sound of a thunderstorm”. What really made me laugh was his next trick:
[E]mploying a pivoting parabolic reflector to shine light at all hours into Zeno’s sleeping chamber. When Zeno asked Justinian to intervene, the emperor decline to punish his architect, writing that even he “cannot intervene against Zeus the Thunderer and Poseidon the Earth-Shaker”.
The world’s first Laffer Curve?
For my birthday this weekend my wife gave me a voucher for my Kindle. This gave me a blissful weekend reading “Justinian’s Flea: Plague, Empire, and the Birth of Europe“. It is full of charming anecdotes about characters from antiquity, including emperor Anastasius:
In what is almost certainly the first documented exercise of what would come to be called trickle-down economics, Anastasius abolished a wide range of taxes that fell heavily on the empire’s most productive classes, its craftsmen and merchants. The emperor had argued, it turns out correctly, that a prosperous merchant would pay even more in fees that the treasury lost in taxes. Thus, despite three major wars, and several revolts by subjects opposing the emperor’s Monophysitism, the treasury at Anastasius’s death was richer by 320,000 pounds of gold than it had been at his accession.
The Beer Game
Shortly after I started as my work a researcher at the National Institutes of Health, I joined the Biomedical Computing Interest Group, and co-founded the BCIG Book Club. I really enjoyed reading many of the books that my colleagues suggested, but one of the few that I did not recognize as worth reading was “The Fifth Discipline“.
Time heals, and occasionally it even teaches, so today I was interested to read about “The Beer Game“. It is worth following the link and reading the full story, but I want you to know that it is not really about beer.
The case is about the importance of communication in business and team work. Common sense, I guess, but common sense is surprisingly rare. And I can see now why The Fifth Discipline included this case, albeit in a section that I did not read far enough to get to, as it fits with the book’s message on communication.
Better late than never.
The entrepreneur’s dilemma
So, should you quit your job at a big company to start your own small company? The business press is full of examples of entrepreneurs that have done fabulously well from this, and Paul Graham had written several essays that explain starting a company as the opportunity to work incredibly hard for a few years to earn what you would earned over a whole career in a big company. Personally though, I suspected something different was at play. I read about it in the “Good capitalism, bad capitalism” which mentions:
[...] several reasons why radical innovations seem to emanate from entrepreneurs rather than large firms[...] For one thing, successful radical innovation, if undertaken by the entrepreneur, promises what might be call “mega-prizes” – hundreds of millions, if not billions, of dollars of wealth. Nothing comparably awaits the radical innovator in a large firm, who might get a special recognition award and a onetime bonus.
Beyond this, paradoxically, studies have found (for the United States at least) that the typical entrepreneur earns less monetary compensation than her employee counterpart. Why then do so many entrepreneurs willingly engage in what is inherently risky activity? Because the additional psychic rewards – being one’s own boss, pride in self-accomplishment, and so forth – make the entrepreneurial endeavor worthwhile even if the entrepreneur does not gain the mega-prize. This, in turn, explains why entrepreneurs have a comparative advantage relative to large companies in attempting to discover and commercialize breakthrough innovations. Because a not insignificant portion of the entrepreneur’s “income” from her activity is psychic, the entrepreneur is the low-cost provider of radical innovation. Often, therefore, it is more economical for the large firm to wait for entrepreneurs to develop the radical innovations and then buy them out.
Italics were in the original text. Folks, you have got to want to be an entrepreneur, not to be rich, to start your own company.
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