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Archive for June, 2010

Applying Excellence by Design…for Healthcare

Much of my professional time over the last few months has been focused on the area of Healthcare and considering the application of Excellence by Design techniques to it.

Here’s a look at Healthcare using just some of the Excellence by Design model facets:

  • Environment: Challenging! The Healthcare industry is perhaps the leading example today of a challenging Environment that exhibits the paradox of Chaos vs Control.  (Control) The industry is facing unprecedented standardization and regulatory pressures driven by government entities.  These cover things like basic interoperability of protocols based on the National Information Exchange model (NEIM) in which the US will guide the development of a  health information exchange framework.  There is also new content standards for specifying clinical diagnosis and procedures, among others.  These new standards will/are significantly affecting the Environment that all players must live in, whether they be software product vendors, information value added services vendors, hospitals, insurance carriers, or others.  (Chaos) Of course at the same time the desire to drive new competitive innovations marches on, in medical devices, in information (i.e. business) intelligence services, and in solutions that drive cost down and effectiveness up.  But don’t forget that many/most Healthcare systems are based on pretty antiquated technology.  So all this change is occurring against a landscape that badly needs modernization of basic infrastructure.  From my perspective it seems the Healthcare industry, which has been a laggard in IT evolution compared to other industries (in particular Manufacturing, Finance, and Travel) in both optimization (Control) and innovation (Chaos), now seems to be paying the piper by having to face simultaneous pressures from multiple directions, in a shorter (government imposed, politically energized) timeframe.
  • Systems as Strategy: A Paradox. A key facet of Excellence by Design is the use of ‘systems as strategy’ (meaning structured approaches to problems and design of systemic solutions to them).  The Healthcare industry has a dual personality it seems in this regard.  The medical/clinical side of the industry is the poster child for developing structured approaches to disease discovery, diagnosis, and treatment.  It is a hallmark of the industry.  Yet IT has not adopted this same level of rigor.  Why?  Typical reasons given are underinvestment in IT in general, relatively low competency (in staff and even in CIO roles, which are being posted with a flourish these days, as if it never was regarded as important before!) a lack of cross-industry driven desire to solve some of the broader IT challenges like Automotive did with CAD and Supply Chain, or like Finance took on with bank funds transfer interoperability and stock trading processing.  The Healthcare industry and its functional organizations have generally tended to remain ‘islands’ that did not seek to cooperate among competing entities, technology providers, and even across functions within a company.  There was with little application of broad ‘systems’ of execution as a strategic approach to business process design and technology solutions planning.
  • Product as Platforms: An Opportunity (again). As an industry, the IT solutions employed for Healthcare are very ‘siloed’ both in design and in implementation.  Other industries have shown the advantages of greater integration of IT solutions into broad platforms that enable a wider class of functionality and information insight, in a more consistent and approachable (same UI, same interface, etc.) form.  Of course the classic examples are the ERP vendors, although their offerings have become so bloated and complex they are not the model I would recommend.  Better examples are Salesforce.com, Amazon, and e-Bay.  These have become very successful not only due to their function and content, but because of the capability to provide as ‘platforms’ that are extendable.   Other companies are following this trend.  Facebook and Twitter are among the many social networking offerings that are trying to grow beyond being ‘an app’ to become a ‘platform’.  So what is happening in Healthcare?  Not clear yet.  While there is some noise in this direction I cannot say I have been overly impressed that what I have seen is more than marketing spin.  Just adding function to an existing offering, or rebranding/bundling of applications, does not a platform make.  In my forthcoming book (or a future blog post) I’ll provide some general characteristics that I believe define a great product-as-platform.

In summary, Healthcare is either a scary place to be, or the best game to be in right now.  The industry is facing great change, ripe for all kinds of improvement, forced with a sense of urgency by government, and has a noble mission to improve the lives of people.  It can be a great podium for those wise and skilled enough to apply smart approaches to meet the challenge. It can also be a vast graveyard for the those who are unable to think broadly, and try and save the patient by applying the ‘one more band-aid and pray’ approach.

I am optimistic that, driven by the forces of today, the industry (and IT especially) will leverage the good capabilities that abound, to improve efficiency of operations, as well patient outcomes.  But of course I also believe a key to most effectively doing this is not brute force but Excellence by Design.

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Simplicity and Design

I have emphasized the issue of Complexity in Design before in this blog.  It is an ongoing and critical aspect of understanding Excellence by Design.

In the talk above, George Whitesides does a nice job of providing a very simple introduction to Simplicity and Complexity. Excellence by Design requires the designer to be adept at using simplicity to create complex capabilities through what George refers to as stacking. A not new concept, he just reminds us of the basic value of using small elements to build bigger things.  He also tries to define what ‘simplicity’ is.  Interestingly he defines it as:

  • Cheap (low cost, so easy to reuse on a massive scale)
  • Functional (must provide some utility)
  • Reliable (does what it says with extreme predictability and consistency)
  • Stackable (has some characteristic to enable easy combination/connection with other things)

Although George claims little study has been made of the subject of simplicity in general, the use of stacking is certainly not new.  It is a basic concept that engineers (whether mechanical, chemical, or information technology) strongly use as a fundamental part of their jobs.

I might say however that typically engineers strive to 1) ‘shorten the distance’ from building blocks to complex solutions by using the highest level building blocks they can (use a light switch off the shelf instead of redesigning and manufacturing your own light switch) and 2) seek to build complex designs that are predictable and stable not emergent.

Said another way, the traditional (engineering) way man has viewed simplicity and complexity is to SHORTEN the ‘distance’ between the two needed to accomplish a SPECIFIC result.  What this yields is less understanding of the truly simple building blocks, in favor of using a more complex one.  No problem if the issue is of some type that lends itself to a ‘static’ goal, like building construction.

But below is a vastly different presentation discussing the effects and factors that have contributed to the destruction of ocean life.  The ‘distance’ between the most simple elements of ocean life, and the ultimate effects it will have on life on our plant, is obviously a huge challenge to understand because it is a dynamic, emergent system without fixed,  predictable results.

Moral of this post: In business, when considering how to achieve Excellence by Design, the designer must be careful to understand whether the solution they are designing is really

  • one best served by shortening the distance to a specific/static solution

or

  • one that must enable dynamic/emergent behavior

or some combination of the two…

This ability to determine what level of ‘simplification’ to use, and how, and the effects it will enable, is a very challenging task.  It would frankly, be a great subject for a college course in advanced design…but perhaps we’ll get to that level of detail another day.