Imagine What If

Here’s the goal:
To change healthcare as quickly as possible,
from the inside out,
so that it works for everyone.

We have reached a hinge point.
We finally have the tools.
We can ask the right questions.
It can be done.

It can be done today
- and we don’t have to wait for the leaders to lead. Once we understand the problem, we can do something from wherever we stand - in the industry or outside it, as clinicians, as executives, as patients and families, as voters and consumers, as investors, as legislators or regulators.

“Must Read” Classic Report

The Role of the Physical Environment in the Hospital of the 21st Century:

A Once-In-A-Lifetime Opportunity

From Roger Ulrich, Craig Zimring and the Center for Health Design, truly the one “must-read” document for anyone involved in planning a healthcare facility.

“Must Read” Classic Interviews by Joe Flower

Jim Collins:

Good to Great

John Seely Brown:

We Participate, Therefore We Are

Two must-reads for anyone running an organization. Collins shows how a run-of-the-mill organization becomes a truly great one. Brown shows how organizations learn, and how we can get out of the way.

Humans need not apply

Plenty of health care processes are ripe for automation

by Joe Flower

From H&HN Most Wired, November 10, 2006

When I buy an airline ticket online, I specify a seat and check the box for a vegetarian meal. At the airport, I use a credit card or anything with an identifying magnetic strip at one of the airline’s kiosks. The machine identifies the owner of the card as the owner of a specific ticket, all because it is networked with the airline’s main computers.

The system now “knows” that I have checked in and prints the boarding pass. When I get to the gate, I stick the boarding pass into another machine. If my identity, itinerary and seat assignment all line up, it spits out the ticket stub and I go on board. If not, it beeps to notify the human crew member who is watching.

During my entire trip, I only talk to human agents for security purposes or to say, “I’ll have some coffee, thank you.” Every aspect of getting me from point A to point B has been handled by networked, intelligent machines.

This kind of networked, intelligent automation is appearing here and there in health care. With robotic pharmaceutical distribution systems, for example, a robot picks unit dose drugs off of racks, seals them in bar-coded or RFID-encoded packages and routes them to the correct floor. There, another robot distributes the drugs to pharmaceutical kiosks that ensure that the dose, patient and proper time match the order before the drawer unlocks to allow drug administration.

Important as they are for patient safety, accountability, proper billing, inventory control and many other aspects, such systems are still limited to particular aspects of health care.

To imagine the wired future of health care, we have to imagine such systems throughout health care. Every provider organization is a sea of transactions, cross-linked handoffs of information and physical materials, all connected to different kinds of ownership, permissions, restrictions and access requirements.

Now think your way through that sea of transactions and ask yourself, “Could this transaction possibly be handled by a machine? Could the instructions for it be reduced to an algorithm or decision tree? Could the inputs come directly from some other computer or machine?”

Any process for which you answer “yes” could be computerized, automated and networked and probably eventually should be as part of our continuing quest to clean up the daunting, bottomless inefficiency of health care.

Many outside of health care react negatively to the notion of automated care, imagining that it would remove the human touch from the very moments when we most need it. But the true human touch, with compassion, careful judgment and real connection, is already in short supply. In fact, automation can free up caregivers for those most human tasks. And if a process being done to me as a patient truly is mechanical, such as ensuring the accuracy of a dosage, I would rather it be performed by intelligent machines. Credit card transactions have a far higher accuracy rate than health care transactions. For the truly mechanistic processes, treat me like a credit card.