The email conundrum

Incessant email, ugh.

The misuse of email is tremendous.  Clive Owen at Wired writes, “Everyone complains about ‘e-mail overload’ — getting so much stupid corporate e-mail that you miss out on important messages.”

Two solutions.

The more practical and organizationally implementable makes email gamelike, from Wired:

Every employee is given virtual tokens — say, 100 a week, — that they can attach to e-mail they write. If you really want someone to read a message now, you attach a lot of tokens, and the message pops up higher in your correspondent’s Outlook inbox.

Turns out, it works.  “When a work group at IBM tried [it], messages with 20 tokens attached were 52 percent more likely to be quickly opened than normal. E-mail overload ceased to be a problem.”

The second possibility is one that has been visited before, from Edward Gottesman at Prospect:

The time has come for a public sector remedy: a tax, perhaps no more than 2p, or 3c, on every email sent. Opponents will argue that collecting the tax is impossible or unfair. Yet the status quo is unworkable.

Has your organization thought about trying to reduce the amount of email?  It needlessly keeps people behind their desks or inattentive on their Blackberrys/iPhones.

Households pay for health care

Remember, no matter how we “pay” for health care, the money always flows from households.  Greg Mankiw makes an oft-ignored point when he writes that American business’ international competitiveness will not improve should they stop providing health care as a fringe benefit.  He cites the CBO (pdf):

Replacing employment-based health care with a government-run system could reduce employers’ payments for their workers’ insurance, but the amount that they would have to pay in overall compensation would remain essentially unchanged. Even though changes to the health care system could have various effects on the supply of labor, the underlying amount of labor supplied at any given level of compensation would hardly be affected by a change in the health care system. As a result, cash wages and other forms of compensation would have to rise by roughly the amount of the reduction in health benefits for firms to be able to attract the same number and types of workers.

Compensation could take some time to adjust to its market-clearing level (the point at which supply and demand are equal). During that time, firms that formerly provided health benefits—especially firms that employ workers under multiyear contracts—could experience substantial reductions in labor costs, which would boost their profits temporarily. But those firms would experience no permanent change in their competitive status.

Update: Here’s a retort by Ryan Avent.  Economists may say that the amount we spend on health care will be equilibrialized by the competitiveness of the international market.  Job lock is awful, but my feeling is that it is peripheral to the argument.  An employee exodus should make a firm more competitive, save for Darwin working his magic.

It’s still, and always will be, about the costs; required reading

More care, worse outcomes.  Misaligned incentives.  Complete ignorance of the macro view.  Buckets of waste.  Gaps in medical education.  Lack of coordination and accountability.  Solving health care locally.

In other words, Atul Gawande’s most recent dispatch in “The New Yorker” is, in my opinion, required reading.  A snippet:

When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes.

Wrong-incentive health care

Health care pontificators like to talk about incentives.  Who can blame them/us?  Health care pays its players (or, all too often, doesn’t pay them) to do some funny things.

Today’s example is from The New York Times.  Background info, “One in five Medicare patients, for example, returns to the hospital within 30 days. Over all, readmissions cost the federal government an estimated $17 billion a year.”  Wrong-incentive health care:

Medical providers all too familiar with the financial double bind include Park Nicollet Health Services, a hospital and clinic system based in St. Louis Park, Minn. Park Nicollet started tackling the readmission problem four years ago, spending as much as $750,000 annually on more nurses and on sophisticated software to track heart failure patients after they left the hospital. It reduced readmissions for such patients to only 1 in 25, down from nearly 1 in 6.

But the reduction has been a losing proposition. Although the effort saved Medicare roughly $5 million a year, Park Nicollet is not paid to provide the follow-up care. Meanwhile, fewer returning hospital patients mean lower revenue for Park Nicollet.

Short-term Social Networks

Last week Jeff Jarvis pointed to Bluenity, a new social network for AirFrance and KLM passengers.  It’s a tremendously neat idea: interact online with other passengers on your trip, receive travel tips from the community, and meet them in person if you want.

This social network is interesting because:

  • it’s built to function around a short span of time
  • hibernation is okay; lack of activity with other social tools might get you defriended; use it only when you travel
  • it has a defined, controlled purpose
  • it’s targeted toward a defined audience
  • though not necessary for use, it facilitates/encourages in-person meet ups

Privacy concerns put aside for a minute, short-term social networks hold possibility in health care.  Patients might enjoy meeting others in the same hospital for companionship or finding support from those with similar diagnoses.  Rural hospitals could band together allowing all rural patients to connect with each other.  Or those patients being treated in academic medical centers could find others with similarly rare conditions across the country.  Or all patients in all settings could have the opportunity to interact.

Then, when the hospital stay is over, the profile would go into hibernation and be awakened only if a patient should return to the hospital.  The network could interact with other social networking tools so that friends made in the hospital could be transferred to traditional networks (e.g., Facebook).  An import option from a site like Patients Like Me might also improve functionality.

44. The Levy Rule

A regularly linked-to (by this blog) health care CEO provides sage advice from previous non-profit work:

If a member of our Board proposed that we should do something, it became that person’s responsibility to get it done. 

The rule may hinder idea formulation at the get-go.  (Which may be a good thing; health care has plenty of ideas, the implementation part is where many hit the skids.) However, it will improve accountability (by proxy, execution) down the road.  And because our culture is based upon participation, those keeping quiet on the necessary changes need no longer be a part of the team.

Harsh?  Hopefully not.  It has the ability to empower the change makers in the organization, to free them from the everyday barriers preventing progress in health care organizations.

Principle #44: Your suggestion, your responsibility.