Work Matters

Category: Current Affairs

  • On Saving the American Health System: Dr. Donald Berwick’s Farewell Speech

    Don Berwick is an American hero and also a victim of the obscene stalemate in Washington; the one being heaped on us by our Congress that has a 9% approval rating.  Most people that I know with a score that low would have the self-respect to quit rather than to point fingers at others.  Well, as part of this mess, Congress wouldn't approve the appointment of Dr. Don Berwick, who is a true American hero because he is among one of the real leaders of the movement to save American health care.  Before coming to Washington, the organization he led, a small non-profit called the Institute for Health Improvement, organized and guided an effort in American hospitals that — by doing simple, evidence things like hand washing, raising the bed when people are on a respirator, and other small but effective things — saved more than 100,000 lives by some estimates.  This little non-profit recruited over 3000 hospitals that had over 70% of the beds in the U.S. to participate in this effort to reduce preventable deaths.

    Obama, recognizing his greatness, appointed him as head of the Centers for Medicare and Medicaid Services. Or he tried to. Our do nothing — or actually do nothing but screw the other side — Congress opposed his appointment, so Obama did one of those sneaky interim appointments that Berwick to keep the position for 17 months before being forced out.  The New York Times Joe Nocera did a great piece on him, check it out. 

    The thing I would especially emphasize is that Berwick is not and has never been about ideology, he is about effectiveness and cost-cutting is central to everything he does and advocates.  Perhaps he wasn't mean and tough and selfish enough for our broken system; it is a shame that a guy who does everything possible to put patients first would be fired by people who do everything they can to put themselves first.

     I urge you to read his amazing farewell address. Get it here: Download Ihi forum don berwick 12-15.dat.Consider a few key parts. Here are his five principles — and unlike people in Congress who TALK about doing things — Berwick's organization has already led efforts to DO such things and continues to do so every day. He gets fired and they keep their jobs?  I quote:

    This is our task… our unwelcome task – if we are to help save health care from the cliff. To reduce costs, by reducing waste, at scale, everywhere, now.

    I recommend five principles to guide that investment:

    1. Put the patient first. Every single deed – every single change – should protect, preserve, and enhance the well being
    of the people who need us. That way – and only that way – we will know waste when we see it.

    2. Among patients, put the poor and disadvantaged first –those in the beginning, the end, and the shadows of life. Let us meet the moral test.

    3. Start at scale. There is no more time left for timidity. Pilots will not suffice. The time has come, to use Göran Henrik’s
    scary phase, to do everything. In basketball, they call it “flooding the zone.” It’s time to flood the Triple Aim zone.

    4. Return the money. This is the hardest principle of them all. Success will not be in our hands unless and until the parties
    burdened by health care costs feel that burden to be lighter. It is crucial that the employers and wage-earners and unions and states and taxpayers – those who actually pay the health care bill – see that bill fall.

    5. Act locally. The moment has arrived for every state,community, organization, and profession to act. We need mobilization – nothing less.

    To show these aren't just theories or pipe dreams, look at these examples from Dr. Berwick's speech:

    It is not possible to claim that we do not know what to do. We have the templates.

    If you doubt it, visit the brilliant Nuka care system at Southcentral Foundation in Anchorage, which just won the Baldrige Award. I visited in October. Thoroughly integrated teams of caregivers –physicians, advanced practice nurses, behavioral health specialists, nutritionists, and more – occupying open physical pods in line-of-sight contact with each other all day long, weaving a net of help and partnership with Alaska Native patients and families. The results: 60% fewer Emergency and Urgent CareVisits, 50% fewer hospitalizations, and 40% less use of specialists, along with staff turnover 1/5th as frequent as before the new care.

    If you doubt that we know what to do, visit Denver Health or ThedaCare or Virginia Mason, and see the Toyota principles of lean production learned, mastered, adapted, and deployed through entire systems and into the skills and psyches of entire workforces. The result, over $100 million in savings at Denver Health while vastly improving the experience and outcomes of patients.

    If you doubt that we know what to do, contact George Halvorson at Kaiser Permanente and ask him how they have reduced sepsismortality – sepsis is the cause of death in 24% of seniors who die in California hospitals. Kaiser-Permanente has driven down sepsis mortality by nearly half – to 11% in less than three years.

    Then, Berwick said to the colleagues he was leaving at the Centers for Medicare and Medicaid Services:

    Let me put it simply: in this room, with the successes already in hand among you here, you collectively have enough knowledge to rescue American health care – hands down. Better care, better health, and lower cost through improvement right here. In this room.

    The only question left is: Will you do it?

    Shame on us as a country for allowing this man to be fired and for bickering and backstabbing while the solutions appear to be at hand.  Can't we join together to do the right things?

  • Get a Free PDF of My HBR Essay “Stepping Down Gracefully”

    I wrote a short essay for the June Harvard Business Review on why it is so important for leaders to step down gracefully, whether they are leaving voluntarily or not.  It was inspired by some leaders I know who have not stepped down gracefully, and in the process, have done moderate damage to their organizations and severe damage to their careers.  Here is how it opens:

    Some CEOs of long tenure must have gotten a slightly queasy feeling as they watched the recent events in the Arab world. Even if they bear no resemblance at all to Hosni Mubarak or Muammar Gadhafi—even if they are the most competent and benevolent of leaders—they may well feel horror at how rapidly the fortunes of a comfortable autocrat can disintegrate. They may wonder at the frightening human tendency, when the writing is on the wall, to resort to the denial, delusions, anger, and antics we’ve seen from despots in Africa and the Middle East.

    If you would like a free PDF of this little essay, you can find get it here: https://archive.harvardbusiness.org/cla/web/pl/product.seam?c=11746&i=11748&cs=1e30763be64402b7a624de281722f66b.  They only give 100 free ones so, when they are gone, they are gone. 

    P.S. Please forgive my lack of new posts lately, I am focused on trying to get a new book started and have not been in the blogging mood!  I am hoping to start blogging a bit more soon, but can't predict my mood or motivation very well. 

     

  • Kurt Vonnnegut on “Having Enough” A Reminder From The No Asshole Rule

    Yesterday, I was talking to a pair of very smart and very ambitious friends.  As I told them, I am all for high performing teams, excellence in performance, and I love the restlessness that drives creative people at places like Apple, Pixar, and Facebook.  But there is a negative underbelly to this human drive toward achievement.  It can become a disease where, no matter how much some people get, they keep wanting more, and the result is not only chronic unhappiness for themselves and those around them, it is also often propels unethical and otherwise inhuman behavior. 

    The worst examples are seen in the power poisoning and associated delusions among the worst of political leaders, with Libyan leader Muammar Gaddafi and his sons disgusting antics currently playing starring roles on the international stage.  But my focus has been on more mundane crimes against humanity.  In particular, if the charges are true, the insider trading and other unlawful actions taken by Galleon Group's  Raj Rajaratnam, whose trial just started, reflect a similar human flaw. Even more shocking to me is the news this week that Rajat Gupta — former board member at Procter & Gamble and at Goldman Sachs, and former Managing Director of McKinsey — was charged with insider trading.  Procter & Gamble and McKinsey are two firms I know pretty well, and while there is a strong focus on excellence in both places, I was troubled because — each in their own way — they are among the most ethical and non-greedy cultures I have ever encountered. 

    The fact that such a central player in both places fell victim to such apparent bad judgment and greed means, to me, that no matter how wonderful you may think you are as a human-bring,and no matter how good the people around you might be,  we are all at risk of falling prey to own greed, status insecurities, and that feeling that comes with power that "the rules are for the little people."   Apparently, part of Gupta's defense will be that, if he did leak inside information to Raj Rajaratnam, he personally did not benefit financially (See this New York Times column).  To me, this defense is meaningless — at least from a moral perspective –  because it simply suggests that Gupta was trying to get more status from Raj Rajaratnam, pay back some old favor, or set the stage for a future one — all signs of greed (and perhaps some insecurity too — often a hallmark of very successful people).

    The lesson for all of us, as I emphasized in The No Asshole Rule, is that sometimes it can be remarkably useful to tell yourself "I have enough."  Here is an excerpt from a longer post I put-up in early 2007 on the official publication day of The No Asshole.  Current events suggest that this lesson from the late Kurt Vonnegut  is worth bringing it out again (I edited it lightly for clarity):

    The process of writing The No Asshole Rule entailed many fun twists and turns.  But the very best thing happened when I wrote for permission to reprint a Kurt Vonnegut poem called "Joe Heller," which was published in The New Yorker.  I was hoping that Vonnegut would give me permission to print it in the book, both because I love the poem (more on that later), and Vonnegut is one my heroes.  His books including Slaughterhouse Five and Breakfast of Champions had a huge effect on me when I was a teenager– both the ideas and the writing style.

    I wrote some anonymous New Yorker address to ask permission to reprint the poem, and to my amazement, I received a personal reply from Vonnegut about two weeks later (see it here).  The postcard he sent me was not only in his handwriting. He gave me permission to use the poem "however you please without compensation or further notice to me."  It remains one of my favorite things.

    The poem fits well in my chapter on how to avoid catching asshole poisoning.  Here is how I set it up in the book:

    'If you read or watch TV programs about business or sports, you often see the world framed as place where everyone wants “more more more” for “me me me,” every minute in every way. The old bumper sticker sums it up: “Whoever dies with the most toys wins.” The potent but usually unstated message is that we are all trapped in a life-long contest where people can never get enough money, prestige, victories, cool stuff, beauty, or sex – and that we do want and should want more goodies than everyone else.

    This attitude fuels a quest for constant improvement that has a big upside, leading to everything from more beautiful athletic and artistic performances, to more elegant and functional products, to better surgical procedures and medicines, to more effective and humane organizations. Yet when taken too far, this blend of constant dissatisfaction, unquenchable desires, and overbearing competitiveness can damage your mental health. It can lead you to treat those “below” you as inferior creatures who are worthy of your disdain and people "above" you who have more stuff and status as objects of envy and jealousy.

    Again, a bit of framing can help. Tell yourself, “I have enough.” Certainly, some people need more than they have, as many people on earth still need a safe place to live, enough good food to eat, and other necessities. But too many of us are never satisfied and feel constantly slighted, even though – by objective standards – we have all we need to live a good life. I got this idea from a lovely little poem that Kurt Vonnegut published in The New Yorker called “Joe Heller,” which was about the author of the renowned World War II novel Catch 22. As you can see, the poem describes a party that Heller and Vonnegut attended at a billionaire’s house. Heller remarks to Vonnegut that he has something that the billionaire can never have, "The knowledge that I've got enough." These wise words provide a frame that can help you be at peace with yourself and to treat those around you with affection and respect:

    Joe Heller  

    True story, Word of Honor:
    Joseph Heller, an important and funny writer
    now dead,
    and I were at a party given by a billionaire
    on Shelter Island.

    I said, "Joe, how does it make you feel
    to know that our host only yesterday
    may have made more money
    than your novel 'Catch-22'
    has earned in its entire history?"
    And Joe said, "I've got something he can never have."
    And I said, "What on earth could that be, Joe?"
    And Joe said, "The knowledge that I've got enough."
    Not bad! Rest in peace!"

    –Kurt Vonnegut

    The New Yorker, May 16th, 2005

    (Reprinted with Kurt Vonnegut’s permission)

    To return to Rajat Gupta, if the charges against him are true, it might have spared him and his former colleagues much pain if he had repeated  "I have enough"  to himself over and and over again at key moments.  While this lesson may come too late for him, it isn't for many of us.

  • My First Time Attending the World Economic Forum at Davos

    I am in the final throes of getting ready for the World Economic Forum, which takes place this week in Switzerland.  I have never attended before and some of the famous people on the list are rather daunting.  There will be sessions involving world leaders like David Cameron from the UK, Angela Merkel of Germany, Bill Clinton from the U.S., lots of CEOs including Google's Larry Page to Heinken's Jean-François van Boxmeer, and a session by "miracle on the Hudson" pilot Sulley Sullenberg.  You can read about it here in the The New York Times, which has a wonderfully cynical opening paragraph.  

    I am among the many academics invited and will be participating in three sessions. First, I am moderating a session on design thinking and business, which should be interesting as it is becoming ingrained in the positions and practices of so many organizations now.  Second, I am participating in a session on what leaders of the present can learn from leaders of the past.  Third, I give a talk on "the no jerk rule."  The WEF is sufficiently respectable that the organizers thought it was best to refrain from using the world "asshole" in the title.  But I plan to use it a few times in the talk, although perhaps fewer times than usual.   In addition to the sessions I am part of, I am going to focus on learning about scaling, my current primary project, as several sessions focus on the topic and there will be a lot of people there who have a lot of experience with this challenge.

    The place is just buzzing with interesting people and sessions, but I have been warned by the people who run the event and by experienced participants like IDEO CEO  Tim Brown to pace myself as it can get overwhelming.  They also have warned me to bring warm clothes and good snow boots as it is a ski resort.

    I will do some tweeting and blogging.  I don't know quite how much, as I expect I will be busy and distracted. But let me know if there is anything you are especially interested in hearing about, and I will try to address it.

  • What Bankers Can Learn From Girl Scouts and First Year Law Students

    I haven't been blogging much lately, but expect to get back in the swing of things this week as the worst of my writing and teaching pressures seem to be slowing down.

    Meanwhile, my better half, Marina Park, put up a great post (I confess to being biased) over at SF Gate, where she blogs at the online home of the San Francisco Chronicle.  Marina has a lot of experience dealing with highly paid people who suffer from fits of greed and self delusion (she spent 8 years as managing partner of a big law firm, and I can tell you, that law firms are great settings to study self-enhancement bias — the notion that people are prone to seeing themselves as "better than the rest" regardless of the actual evidence).  But what she saw among highly paid attorneys is nothing compared to how greedy the bankers are now acting and how blind they seem to the damage they did and that still persists.  In her view, the behavior of the Wall Street Titans clashes with the lessons that she learned as a young lawyer and now as CEO of the Northern California Girl Scouts.

    As Marina argues at the outset of her post:

    Always leave a place better than you found it — that's from the Girl Scouts.

    You are responsible for the reasonably foreseeable consequences of your actions — that's from the First Year Law Students.

    The bankers don't seem to quite accept these values or logic.  Check out the rest of her post.  I am all for paying talented people what they deserve.  But I am also all for requiring people to take responsibility for their actions, even if they didn't mean to hurt anyone. 

  • Oh, So That Is God’s Work

    Today's New York Times has an encouraging article about the things that Goldman Sachs is doing to cleanse its image as a greedy and destructive force in the U.S. economy and society. Apparently Warren Buffett is teach their senior team a bit of humility, or at least how to feign it.

    This is all old news, but I can't stop thinking about the comparison between how the Rolling Stone described Goldman versus how CEO Blankfein did (a statement that got him in big trouble, by the way).

    In July, a story in the Rolling Stone called "The Great American Bubble Machine" started out:

    The first thing you need to know about
    Goldman Sachs is that it's everywhere. The world's most powerful
    investment bank is a great vampire squid wrapped around the face of
    humanity, relentlessly jamming its blood funnel into anything that
    smells like money. 

    In contrast, here is what Goldman CEO was quoted as saying about his job in The Times of London last week: 'I'm doing God's work."

    I am really trying to avoid the temptation to engage in mindless bashing of Goldman Sachs as I have met many people from the company I admire and in many ways it is splendidly managed company.  But the thing that gnaws at me can be gleaned from the Kurt Vonnegut poem that was published in The No Asshole Rule and that I have reprinted on this blog, called Joe Heller (read it here). When people act if no matter how much money, status, goodies, and other material goods pile-up, it is never enough for them, I start to squirm. I am glad that Goldman is reaching out to help small business , offering some 3% of their 16.7 billion in bonuses to do so.  That is a start. My gut feeling is that something closer to 50% would be more appropriate — especially for the top 100 or so people in the firm.  But I think they ought to read Vonnegut's poem, as it is a message they need to hear — especially at a time when over 10% of the U.S. workforce is unemployed, most of whom shelled-out tax money to help save Goldman and their ilk from their own greed, arrogance, and misleading statements — a new government report rebukes their claim that they didn't much benefit much at all from the massive AIG bailout (see this story in the Wall Street Journal).

    I am glad that Goldman is starting to grovel a bit and is giving a bit more back after their arrogance failed them, but I would I think they owe their fellow Americans more than a lousy 3%. I know they will be paying whopping taxes on all this money, but for me, they need to do more to help all those people who saved their ass.