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.

Far-Reaching Developments

Offshoring isn’t just a manufacturing decision

by Joe Flower

From H&HN Most Wired, May 10, 2006

The core meaning of offshoring is shifting, and that shift is about to penetrate health care on a FedEx timetable.

In the past in high-income countries, offshoring assumed that workers in not-so-high-income countries were malleable and eager to labor for next to nothing. Today, offshoring looks different. Foreign workers, still willing to work hard for less, are just as smart and creative as their U.S. counterparts, and their markets are untapped and growing like mushrooms.

Shifting work to other companies has five significant stages, and each one has different meaning for health care IT development in high-income countries. Notice, as we move down the list, the shifting center of gravity for intellectual, creative and financial capital and control.

1. Offshore manufacturing: We buy from manufacturers in high-income countries who outsource parts to low-income countries.

2. Offshore services: We buy services from companies whose back office, phone banks and other labor-intensive service work is performed in such places as Bangalore or Manila.

3. Offshore intellectual service work: We buy the services of highly trained professionals in low-income countries to read radiological images, write contracts and run clinical trials.

4. Offshore creative work: Directly or indirectly, we pay for research and development work and software, business models, work processes and training regimens designed overseas.

Companies will increasingly outsource not only manufacturing and clinical trials, but also R&D, to lower-cost countries. For instance, both Siemens and General Electric have set up major R&D centers in India. Philips Electronics, already one of the largest health care technology suppliers in China (with more than $8 billion in sales there in 2004), is forming a joint venture with the Chinese company Neusoft to develop and manufacture X-ray, CT and ultrasound equipment.

Companies that pursue this strategy may be able to significantly underprice their competitors, holding the line on inflation and following the pattern of consumer electronics: over time, consistently offering greater value for lower prices.

But there is a fifth stage, in which the core meaning of offshoring disappears.

5. We’re just the market: Soon, it will be common for North American health care centers to buy software and devices designed, built and marketed by companies in China and elsewhere.

This stage starts now. For instance, look at Sobha Renaissance Information Technology, a 30-year-old, $1 billion company with 8,000 employees based in India that has operations in a dozen countries, a number of Fortune 250 clients and partners, and a full suite of health care software. It has no U.S. installations yet. It is so eager to enter the U.S. market that it is willing to offer major discounts to early adopters, yet it meets skepticism because it is unknown in this market.

This is more than a marketing problem for one company. It is a piece of the shape of the future.