Enough.

A similar transition has taken place in the medical profession, where the human concerns of the caregiver and the human needs of the patient have been overwhelmed by the financial interests of commerce: our giant medical care complex of hospitals, insurance companies, drug manufacturers and marketers, and health maintenance organizations (HMOs).

John Bogle, Enough.

That from the chapter titled Too Much Business Conduct, Not Enough Professional Conduct in Mr. Bogle’s recent book.  It’s a reminder of a discussion had this summer: should health care administrators be licensed?  Still not a fan, but there’s no doubt there has been some loss of professionalism compared against an environment of the 1950s.

The book is an indictment of the financial industry and it’s many issues—Mr. Bogle makes it seem that it has more troubles than health care!  His solution: focus on the investor; for far too long the industry has extracted value from the system instead of adding to it.  Explains a lot of what we’re going through.  Well worth a read.

The time to brilliance

Consider what this means for your health care career (whether it be a reformer, innovator, provider, manager, entrepreneur, etc.) or for any other endeavor in your life:

In the early 90s, the psychologist K Anders Ericsson and two colleagues set up shop at Berlin’s elite Academy of Music. With the help of the academy’s professors, they divided the school’s violinists into three groups. The first group were the stars, the students with the potential to become world-class soloists. The second were those judged to be merely “good”. The third were students who were unlikely ever to play professionally, and intended to be music teachers in the school system. All the violinists were then asked the same question. Over the course of your career, ever since you first picked up the violin, how many hours have you practised?

Everyone, from all three groups, started playing at roughly the same time – around the age of five. In those first few years, everyone practised roughly the same amount – about two or three hours a week. But around the age of eight real differences started to emerge. The students who would end up as the best in their class began to practise more than everyone else: six hours a week by age nine, eight by age 12, 16 a week by age 14, and up and up, until by the age of 20 they were practising well over 30 hours a week. By the age of 20, the elite performers had all totalled 10,000 hours of practice over the course of their lives. The merely good students had totalled, by contrast, 8,000 hours, and the future music teachers just over 4,000 hours.

The curious thing about Ericsson’s study is that he and his colleagues couldn’t find any “naturals” – musicians who could float effortlessly to the top while practising a fraction of the time that their peers did. Nor could they find “grinds”, people who worked harder than everyone else and yet just didn’t have what it takes to break into the top ranks. Their research suggested that once you have enough ability to get into a top music school, the thing that distinguishes one performer from another is how hard he or she works. That’s it. What’s more, the people at the very top don’t just work much harder than everyone else. They work much, much harder.

This idea – that excellence at a complex task requires a critical, minimum level of practice – surfaces again and again in studies of expertise. In fact, researchers have settled on what they believe is a magic number for true expertise: 10,000 hours.

The above from the Guardian, go read the rest…very interesting.  The ideas come from Malcolm Gladwell and his soon-to-be-released book “Outliers: The Story of Success.”

Why a nursing shortage is bad and not because of why you think

Waiting to fly on Tuesday, I was lucky enough to find myself in front of a CNN Airport Network TV when this story about the nursing shortage crisis was aired.

Primary care shortages, lab tech shortages, nurse shortages.  News stories can be found daily with updates on health care worker crises.  One begins to wonder if anyone takes notice any more.

Well they should.  And not just for the consequences of an insufficient number of workers to care for patients—but for what solving the problem is going to do to our economy.

From Richard Florida‘s new book Who’s Your City? (worth the read):

Many regions that have lost manufacturing jobs have rebuilt their economies around education and health-care.  In former manufacturing hubs like Detroit, Cleveland, St. Louis, and Pittsburgh, the largest employers are colleges, universities, and hospitals.  This is seemingly good news—it means, at least, that residents of these cities can find work.  But according to my team’s analysis, high concentrations of these sectors ultimately do not bode well for cities’ economies.  Although they may employ many people and provide great services, education and health-care add relatively little to regional income.  That is even truer when we look at education and health-care jobs as a share of a region’s creative economy.  As the share of education and health-care jobs rises, regional earnings falls.  The more creative class members take jobs in education and health-care, the lower their region’s wages tend to be.

Why might this be? For one, education and health-care sectors tend to monopolize a region’s workforce—because the demand for employees is so great, it leaves other sectors with smaller hiring pools.  Education and health care–like police and fire departments–are basic necessities.  Every region must devote some of its workforce to them.  They also bring in relatively little money from outside the region.  Aside from out-of-state tuitions and government research grants, most of their income comes from within the region.  Contrast that with an innovative and creative company, or cluster of companies, that brings in money from clients worldwide.  Growing regions tend to have relatively higher concentrations of other key occupational groups—and it’s those other jobs that are concentrating geographically.

“Take two Matisses and call me in the morning”

Creativity is king.

From Dan Pink:

American medical schools, those bastions of left-brain muscle-flexing, continue their march toward whole-mindedness. Yesterday’s Boston Globe reports that Harvard Medical School has followed the lead of places like Mount Sinai Medical College and begun taking its students to art museums. The goal: To improve young physicians’ observation and diagnostic skills.

This isn’t about the artsy-fartsy or touchy-feely. It’s about dollars and cents — and sometimes life and death. As The Globe notes:

A study in the Journal of General Internal Medicine show[ed] that after completing the class, [the Harvard] students’ ability to make accurate observations increased 38 percent. When shown artwork and photos of patients, students were more likely to notice features such as a patient’s eyes being asymmetrical or a tiny, healed sore on an index finger. Observations by a control group of students who did not take the class did not change.”

For more insight into the power of right-brain thinking, pick up a copy of A Whole New Mind.

“No Margin, No Mission”

To be added to your summer reading agenda: “Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids” by Julie Salamon.

Here is the New York Times review.

It seems to be an ultra-insider look at the innerworkings of a hospital—Maimonides Medical Center in Brooklyn.

From the review:

To me, the big surprise in this book — I can hear the doctors out there laughing — is how much hospitals, even nonprofit community hospitals like Maimonides, think about money. As administrators there say, “No margin, no mission.” I was under the impression that hospitals have to treat anyone who comes to the emergency room, but there are many definitions of “treat.” Hospitals have to stabilize patients, it seems, but they do not have to cure them. If patients can walk and their wallets are empty, they can be walked to the door. Administrators track the performance of all the doctors. Operations are a gold mine and admissions are good, but only if the patient doesn’t stay longer than insurance permits. “We don’t want more of the elderly, complicated patient,” the head of the cancer center says — actually says! — at a meeting.

Money-Driven Medicine

Recently finished Money-Driven Medicine: The Real Reason Health Care Costs So Much by Maggie Mahar who, as you may know, blogs at the Health Beat.

I recommend the book.  Ms. Mahar does a wonderful job exploring the many different facets of our health care system; each component is responsible for some sort of wasteful spending.  The book also gives good history lessons on a variety of topics including for-profit hospitals (which I found quite interesting).  The many interviews provide a look into how individuals throughout health care feel about current standard operating procedure with some very insightful opinions.

From the jacket:

Why is medical care in the United States so expensive? For decades, Americans have taken it as a matter of faith that we spend more because we have the best health care system in the world. But as costs levitate, that argument becomes more difficult to make. Today, we spend twice as much as Japan on health care—yet few would argue that our health care system is twice as good.

Instead, startling new evidence suggests that one out of every three of our health care dollars is squandered on unnecessary or redundant tests; unproven, sometimes unwanted procedures; and overpriced drugs and devices that, too often, are no better than the less expensive products they have replaced.

How did this happen? In Money-Driven Medicine, Maggie Mahar takes the reader behind the scenes of a $2 trillion industry to witness how billions of dollars are wasted in a Hobbesian marketplace that pits the industry’s players against each other.

An interesting tidbit from the Publishers Weekly review on Amazon, “[Ms. Mahar] wants to show why the most common economic assumptions about health care—especially those that extol the magic power of free markets—are false and stand in the way of real reform.