What This Blog is About

A long time mentor and friend, Cicely Berry, often says: "all we do comes from our need to survive".

Cis is the Voice Director of The Royal Shakespeare Company. Her profound work and deep appreciation of the human spirit has affected diverse communities all over the world.

Will take you to my current work.

This blog is dedicated to the belief that the overall health of a community or organization is a clear reflection of their ability to communicate.

"Cada cabeza es un mundo" - Cuban proverb

"Every head is a world"

Friday, February 29, 2008

EMR Pushback

Here's another perspective on this important health care topic.


"Bruce Landes, MD, is a confirmed skeptic when it comes to electronic medical records. But he insists he is no technophobe. “I am not a Luddite,” Landes says, working up some steam on a topic he knows well. “Physicians are people who have been through the development of CT, MRI and robotic surgery. We are not afraid of technology, but we are afraid of bad technology.”

By that he means EMR technology. Landes is the president and chief executive officer of Southwest Physician Associates, a Dallas-based independent physician association that encompasses some 1,300 physicians, most of them in small practices with fewer than five members. Like their peers across the country, these physicians primarily use computers for their practice management functions—the scheduling, registration and billing functions that are the lifeblood of their small businesses. But they have resisted adding clinical documentation to the technology mix, relying instead on paper charts".

Published by Health Leaders Media


Wednesday, February 27, 2008

(Just About) All Innovation is Local

"At an innovation conference in Mexico in November of 2006, the Colombian journalist Alejandro Santos reminded us, in his eloquent summary, of the advice that the great Leo Tolstoy gave to prospective writers: "Describe your village, and you will be universal." Santos illustrated Tolstoy's maxim with the Colombian writer Gabriel Garcia Marquez, winner of the 1982 Nobel Prize in Literature, whose world-renowned novel One Hundred Years of Solitude takes place in Arataca, the small river village of his childhood.

In other words, to come up with a successful innovation, capable of being appreciated by people around the world, you need something very compelling to offer those global markets. And where do you find such innovative, compelling ideas? Sometimes the answer is in world-class research labs. But often, the best new ideas are found in those areas that you know best—right around you".

AlwaysOn Daily [enewsletters@alwayson-network.com] February 27, 2008

Friday, February 22, 2008

Change Comes From Unexpected Places - Maybe

I recently heard an interview regarding genetic medicine where an expert researcher posed a provocative notion regarding the initial benefactors of her work.

She said, the investigations would be very helpful to our health. However, we need to understand, that much of our well-being still remains within our ability to control and provide good decision making based on solid information.

This researcher went on to suggest that the people who will benefit first from genetic data and inquiry, will be software developers and providers. It's about business as much as it is about health.

No surprise, that in a health care system that seems to inhibit EMR (electronic medical records), there are many reasons that may be driving such lack of integration. Unlike the automotive parts world, sharing of information is difficult. Automotive information connectivity is excellent.

We all know it's not only about privacy and that statement is not meant to be cynical. However, wellness involves a complicated set of continuous agreements between patients, medical experts and payer communities. And, the creation of new and different roles and responsibilities for health care workers.

We don't have the tolerance for a two week replacement of a front bumper. However, we easily agree to wait for appointments and medical records that take too much time to be helpful.

Here's an announcement that demonstrates where representative change is being accelerated.

Google To Store Patient Medical Records
SAN FRANCISCO, Feb. 21, 2008 AP

Pilot Project Could Involve Up To 10,000 People; Concerns Surround Security Of Information

"Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service that's likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.


Thursday, February 21, 2008

Boundaries: Fixed & Not Quite Fixed

Yesterday was an interesting day in America.

In one day, we experienced:

1. A Lunar Eclipse

2. Firing a missile to destroy an orbiting satellite so it would not plunge upon the earth

3. The Georgia State government pushing ahead to re-define the borders of Tennessee and Georgia to augment water availability during a time of environmental crisis

4. The New York Times reporting a current presidential candidate may have had a questionable relationship with a lobbyist


Monday, February 18, 2008

Innovation and Survival

We often think of innovation as an "initiative". What company does not pursue/embrace it from a corporate policy point of view?

Innovation was not born in the boardroom
or invented by analysts. It is the foundation of our need and ability to survive. And that, is not a negative concept.

Yesterday, I was watching a report on the Current television channel regarding the deadly cyclone Sidr, that affected people in Bangladesh and other areas, in 2007.

It is not unusual to have cyclones occur in this area. Sidr was unusual in size however, and this time, the consequences are different for a number of reasons.

A young architect in Bangladesh, has innovated to deal with the sudden crowding issues of "climate refugees" and accelerated warming tendencies in the Himalayas that are causing flooding. All of this complicates the terrible results of the cyclone.

"Climate refugees"
is a new term for many of us.

In response, the architect has helped to build schoolrooms on boats in selected waterways.

His point is: "To live with the water".
He is going forward to say that an entire educational system can exist on water and so can farms and other services.

Children are now effectively working in these water schools in a place that remains devastated in many ways.

Like a scene out of the 1995 post-apocalyptic movie “Water world,” in which the continents are submerged after the polar ice caps melt and the survivors live out at sea, the boat schools and libraries are a creative response to flooding that scientists largely agree has been worsened by global warming.

Melting glaciers in the Himalayas are already causing sea levels to rise here, and scientists say Bangladesh may lose up to 20 percent of its land by 2030 as a result of flooding. That Bangladesh is among the most vulnerable countries on the planet to climate change is a tragedy for its 150 million people, most of whom are destitute.

The need for a Bangladeshi Water world, experts say, has never been more urgent.

“For Bangladesh, boats are the future,” said Abul Hasanat Mohammed Rezwan, an architect who started the boats project here and who now oversees it as executive director of the nonprofit Shidhulai Swanirvar Sangstha, a name that means self-reliance. “As Bangladeshi citizens, it’s our responsibility to find solutions because the potential for human disaster is so huge. We have to be bold. Everyone loves land. But the question is: Will there be enough? Millions of people will have nowhere to go.”

http://current.com/items/77475961_real_life_waterworld will give you an overall picture of the devastation.

What does innovation seem to mean in your work environment?



Friday, February 15, 2008

A Note Aboute Music and Health Care

Recently, I have been able to speak with some experienced doctors about innovation in their workplace and what they see as critical to improving health care. Some of these doctor talks occurred during December and January, in busy hospitals, when my wife was in need of their skills and compassion.

The doctors seem to focus on breaking silos that inhibit communication. It's a cultural issue they say, that starts in medical school, while targeting specialization and hopefully, being recognized for expertise with documented work.

This "cultural issue" seems to permeate the way hospitals and other health care environments actually work. Teams of great expertise that cannot easily connect. And, it seems some are conditioned not to share information from early on in their careers. Don't get me wrong. I am on the side of these doctors. In our current system, I don't believe anyone enjoys the full benefits of their tremendous abilities. Including the doctors.

This perspective also joins the issues of technology. Lack of shared platforms and the somewhat partitioned software development that has inhibited talking across working boundaries.

More than one person referred to Michael Porter's book, Redefining Health Care: Creating Value-based Competition on Results.

When talking about innovation, several doctors suggested that medical staffs have a fundamental confrontation. "They must remember why they exist". And that's not easy in today's overworked and insurance directed workplace. Innovation is layered with payer requirements, certain incentives and the need to constantly deal with an overwhelming volume of information, work, and not enough people to help. Recognizing what's innovative is a risk.

However, innovation is critical to improvement, as this recent NY Sun interview points out.

"First of all, what we're doing is we're trying to maximize our innovative ability. We don't only give care, we try to develop better care tomorrow".

How Dr. Pardes Learned, the Hard Way, To Run a Hospital

Dr. Herbert Pardes now oversees a hospital system that includes 11,673 beds and employs about 82,000 doctors, nurses, and other employees.

By ELIZABETH SOLOMONT, April 20, 2007 http://www.nysun.com/article/52864?page_no=2

Like Dr. Pardes, the doctors I spoke with connected this need for a cultural change (which will take time),with overall performance improvement, and getting in better tune with the patient. They were talking about deep re-engineering on a social and bureaucratic level. And, the ability for people to share knowledge.

Today, medical staffs have to constantly meet new co-workers and achieve over and over again. They are not really conventional teams with time to hear theories about motivation and organization. They are more jazz than that. And I use the term with respect for the art form.

When thinking about how complicated it is for health care workers to participate as teams today, these conversations make me think about music.

Musicians have the abiltity to share experience and offer it to others spontaneously. Timing and discovery. Jazz, is an important collaboration of moments where preparation and instinct meet. Jazz musicians, like health care professionals, work very hard to reach a level of dexterity that allows them to listen and respond. They practice all the time.

Here's a thought.

When a classical orchestra begins their performance, the audience is first engaged in the tradition of witnessing the musicians “tuning up”. The oboist plays a concert A and each section of the orchestra sounds a note to join in sync and prepare to play. It is expected and necessary. It is a part of the preparation that the audience expects.

When a jazz “Big Band” begins a performance, the tuning ritual is quite different. The musicians actually tune with one another during the first song.

The tuning for a jazz band is the discovery of one another’s sound. This collaboration leads to continuous innovation that results in the virtuoso soloist moments, that are also discoveries. These moments are not random. Just the opposite. Journeymen musicians regularly collaborate with the staff players of renowned band leaders like Basie and Ellington. These musicians understand their responsibility to preserve the integrity of the leader’s vision (the compositions and arrangements).

The innovations during Big Band performances arise because the players have a fundamental understanding of why they exist and what their collaboration is to accomplish.

What’s underneath these conversations with doctors is interesting.

In the complicated set of relationships that hospitals have with doctors of different specialties and self interests (as well as payer demands), the medical staff does not have time for ritualistic “tuning”. Why they exist as a medical staff and how they might collaborate to produce continuous innovation may be lost, as the doctors suggest.

We can all influence this for the better.


Wisdom, Wherever You Can Find It

While keeping up with the news this week, I happened to come across this quote.

"It takes two to lie. One to lie and one to listen".

Matt Groening, The Simpsons
US cartoonist & satirist

Thursday, February 14, 2008

A Great Memory of a Gifted Person

Kirk Browning

We remember Kirk Browning at work: "...and dissolve..." The shot would be climactic, or full of tension. It would set up an expectation that flowed from the music. Then would come the payoff: the next shot that seemed to arise organically, naturally; and the path from one shot to the next was illuminated by that gentle, soothing voice, caressing the transition: "...and dissolve..."; and sometimes we would all join in, six or eight people in the TV truck, all crooning along with our Maestro: "...and dissolve..." NY Times February 13, 2008 from several of Kirk Browning's friends and colleagues.

I was fortunate to have once worked with Mr. Browning. We filmed The Gospel at Colonus for a PBS Television special that Mr. Browning directed. The stage production was an extraordinary version of the original Greek Oedipus text, set in a modern day Gospel service. The work was conceived and directed by Lee Breuer and the music composed by Bob Telson. I spent several years working on this project before PBS became interested. The ensemble included Morgan Freeman and the Five Blind Boys of Alabama.

http://www.imdb.com/title/tt0497914/fullcredits#cast Will give you more information on the wonderful cast.

On the day we were to film at a university theater, the fire department arrived to pronounce the stage unworthy for the performance unless we were able to make a number of safety changes.

When the fire department asked me if we had a small cast, I had to tell them that we had an ensemble of more than sixty people. Several woman were pregnant and four of the performers were blind. It was a morning of impossibilities to prepare for the scheduled filming.

I was the production stage manager and assistant director to Lee Breuer and responsible for the live staging logistics. Mr. Browning spoke to me with a sense of collaboration and equality that was overwhelming with his spirit of going forward. He loved the work and intended to transpose the original stage performance onto television with integrity and vision. Not an easy achievement with the Lee Breuer present, recognized as one of America's greatest theater artists. Somehow, we made the needed changes to be able to perform. We also faced a collaboration of two large teams from two different worlds. Stage and television.

When we began filming, with a full audience ready, something went wrong on the headsets we were assigned for communication. In my headset, I could here all the channels. This made it almost impossible for me to call the lighting, audio and special effects stage cues. I could here everything that was going on in the mobile truck where the television cues were being directed by Mr. Browning. It was a potential constant collision of numbers and visual results. My cues also affected the safety of the performers as there were moving parts to the stage.

Somehow, and I believe, because of his state of being and how he viewed complicated situations where people needed to collaborate, I got through it. His team helped me, as I helped them move through the performance. The show was nominated for an Emmy as Best Public television Special of the year.

My time working with him was brief and I do not mean to exploit his name. I simply want to remember his style and how collaboration is really connected to the respect one has for people and their work.

That, I can honestly say about the experience of working with Mr. Browning -- as brief as it was.


Tuesday, February 12, 2008

Who Determines Knowlege Flow?

In the work place, we are very accustomed to discussing information sharing and knowledge flow issues.

Knowledge Management is a category that some experts now argue to be obsolete. It's also one of those business terms that to me, dehumanizes our ability to communicate.

Here's an interesting vote going on at Harvard, regarding free publishing. Interestingly, the starting point is the faculty of the arts and sciences.

At Harvard, a Proposal to Publish Free on Web

Published: February 12, 2008

Publish or perish has long been the burden of every aspiring university professor. But the question the Harvard faculty will decide on Tuesday is whether to publish — on the Web, at least — free.

Faculty members are scheduled to vote on a measure that would permit Harvard to distribute their scholarship online, instead of signing exclusive agreements with scholarly journals that often have tiny readerships and high subscription costs.

Although the outcome of Tuesday’s vote would apply only to Harvard’s arts and sciences faculty, the impact, given the university’s prestige, could be significant for the open-access movement, which seeks to make scientific and scholarly research available to as many people as possible at no cost.

“In place of a closed, privileged and costly system, it will help open up the world of learning to everyone who wants to learn,” said Robert Darnton, director of the university library. “It will be a first step toward freeing scholarship from the stranglehold of commercial publishers by making it freely available on our own university repository.”


Thursday, February 7, 2008

The Retailing of Medecine Takes a Step Up

Wal-Mart Expands In-Store Clinics

Posted: 2008-02-07 08:29:48
(Feb. 7) -- Wal-Mart Stores Inc. will open its first in-store medical clinics under its own brand name after leasing space in dozens of stores to outside companies that operate the quick-service health stops.
Wal-Mart plans to open 400 cobranded walk-in clinics by 2010. "The Clinic at Wal-Mart" will jointly bear the names of Wal-Mart and its partners and have an identical look, prices and record keeping system.

Friday, February 1, 2008

What Happens to the Value Chain?

Isuzu Leaving the US Passenger Vehicle Market in 2009

Isuzu Motors America, Inc. will discontinue distributing new Isuzu passenger vehicles in North America effective 31 January 2009. The discontinuation of passenger vehicles results from the prospective cessation of production by GM of the Ascender sport utility vehicle and the i-290 and i-370 pickup trucks.

It has always been our intention to remain in the US market. However, we were unable to secure any commercially viable replacements for these vehicles.

—Terry Maloney, president and COO

Although Isuzu will cease supplying passenger vehicles in North America, it will continue to stand behind its customers and dealers. Specifically, Isuzu will continue to honor all product warranties and roadside assistance programs and will maintain its owner-relations call center.

In addition, to assure long-term service to its customers, Isuzu will be offering all current, US Isuzu vehicle dealers the opportunity to continue on as service dealerships for Isuzu.

30 January 2008 http://www.greencarcongress.com/2008/01/isuzu-leaving-t.html

From Sal: Like Shakespeare, there is always a story within the story. What does this announcement tell us about the Integrated Value Chain that Isuzu counted on? Indeed, what part of that chain did not really deliver? There are dealers who say they were caught totally by surprise. And, what gap in the chain will be left for the auto business and the U.S.?

I had the privilege of working with Stephan Garelli several years ago, for some interesting IBM work.

Each year, Professor Garelli, a senior consultant to the International Management Development Center (IMD) in Switzerland, publishes the World Competitiveness Yearbook. The book analyzes and ranks different countries for characteristics like technology or ease of doing business.

In addition, he states several categories that will affect business in the next year. Several years ago, Garelli added a dramatic category for the first time. Vulnerability.

I wrote Garelli and asked him why he added the category of "Vulnerability" to his list.

Here is his response:

Dear Mr. Rasa,

I am indeed highlighting the fact that vulnerability is a key concern for CEOs today. The outsourcing policies that we have seen during the past decade have lead to a value chain that is leaner but longer. It means that every company is now confronted with a multiplication of partners to work with. As a consequence, the level of complexity has increased and also the level of vulnerability. In the latter case, it means essentially that if a link of the value chain is exposed to a breakdown, it can stop the entire value chain. Even a small business partner can stop a larger company from operating.

I hope that this will be useful.

Any thoughts?