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Culture, Not Who Pays, Is Real Problem in Healthcare

The New York Times columnist David Brooks just came out with his Sidney Awards for the best magazine essays in 2009.  I always read them because Brooks is among the very best writers/thinkers in journalism today.  One of the award winners is “The Cost Conundrum” by Atul Gwande, the surgeon, author and MacArthur genius award recipient.  Brooks describes Gwande’s essay as the most influential essay written this year.  I highly recommend that you take the time to read it.

What I found especially interesting in Gwande’s essay is that he concludes that culture — or more specifically, the values of doctors — is at the heart of America’s heathcare cost crisis rather than who pays the costs.  Gwande takes us to McAllen, Texas where in 2006, Medicare spent nearly $15,000 per enrollee, twice the national average, but achieved no better than average quality of care.  Like a good investigative reporter he roots out the truth by conducting qualitative interviews and looking into quantitative data.  He discovers that the average doctor in McAllen orders more procedures than the average doctor in America.  Upon further investigation he learns that in towns like McAllen it’s a handful of doctors who drive up the cost per patient by ordering unnecessary procedures. He explains how these doctors benefit financially from ordering unnecessary procedures. The financial benefits come in the form kickbacks to admit patients to hospitals and revenue to partnerships of physicians who own diagnostic equipment such as MRI and CT-scans.  He sums it up this way:

“When you look across the spectrum from Grand Junction to McAllen–and the almost threefold difference in the cost of care–you come to realize that we are witnessing a battle for the soul of American medicine.  Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor.  And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.”

In some ways, this is a matter of identity.

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Message of “Christmas Carol,” “Wonderful Life” Critical Today

The 1951 movie “A Christmas Carol” is based on Charles Dickens’ classic novel.  It’s the fictional story of  Ebenezer Scrooge, a business owner who idolizes wealth and mocks charity.  Scrooge’s values, and the behavior emanating from them, isolate him from family and friends and make him miserable. Scrooge gets a wakeup call in the form of a nightmarish visit from the ghosts of Christmas past, present and future.

“A Christmas Carol” highlights how certain character vices lead to relational isolation which results in dysfunction and death.  This is in contrast to virtuous character that leads to human connection, thriving and life. Charles Dickens understood just how powerful human connection is and that it comes from the character strengths of compassion, empathy, generosity, kindness and magnanimity. These are character strengths and virtues we celebrate during the holiday season (and hopefully live year round).

The same themes of connection and character are explored in the 1946 holiday classic, “It’s a Wonderful Life.”  

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NY, NJ & CT Last in Happiness, Why?

The New York Times reported that a recent research study rated the tri-state area (New York, New Jersey and Connecticut) dead last of the 50 states when it came to the self-reported happiness of state residents.  The survey points out there is a high correlation between self-reported happiness and objective measures of happiness such as congestion, time spent commuting, housing prices, air quality, etc.  No doubt there is some truth to this.  I have another theory, however.

The tri-state area is the achieve-aholic capital of America.  Remember Frank Sinatra’s ode to New York: “if you can make it there, you can make it anywhere.” New York attracts the ambitious and often, ambition is about status.  People with a burning desire for status come to New York to prove themselves as media stars, bankers and traders on Wall Street, performers on Broadway, etc., etc., etc.  The problem is that chasing status is a never ending game.  There’s always someone above you and the achieve-aholic can’t get enough.  Personal wealth is the primary measure of status on Wall Street.  Many Wall Streeters have a number — referred to as the “F— You number” — they want to reach so they can tell their firms “I’m outta here.”  Research has shown that the FU number is always going up because they need more houses, more art in their collection, more money for philanthropy to build their legacy.  Of course they don’t really need these things but a sense of continuous status anxiety makes them feel the never ending need to boost their status relative to others.  Once again it comes back to status and having more than the next guy.

Psychology research has shown that extrinsic motivators — doing something to impress someone else such as status-chasing — fail to provide happiness.  Only intrinsic motivators such as meaningful work that contributes to society and meaningful relationships (i.e. connection) produce happiness. With so many people in the tri-state area working such long hours and commuting to and from work, it’s no wonder that they’re not so happy. The wise perspective is one of balance. The good life includes meaningful work and meaningful relationships. At times there will be imbalance among the two needs. If imbalance becomes chronic, however, it’s a recipe for disaster. This applies to individuals and organizations.

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Michael Lee Stallard speaks, teaches and writes about leadership, employee engagement, productivity and innovation at leading organizations including Google, GE, NASA, Lockheed Martin, General Dynamics and the Darden Graduate School of Business at the University of Virginia. Most recently, Michael and his colleague Jason Pankau filmed a 90-minute program for Linkage’s Thought Leaders Series that will be released in January of 2010. Michael wrote the guest editorial for Talent Management magazine’s January 2010 edition and last month his article on how the force of connection boosts productivity and innovation was featured as the lead article in the UK’s Developing HR Strategy Journal. Click on these links to learn more about Michael and Jason in the media and their speaking engagements.

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Why “Up In the Air” is a “Must See”

The issue of human connection at work and in life takes center stage in the hit movie “Up In the Air.” The plot follows a business executive played by George Clooney who is continuously traveling to fire people. He views meaningful relationships as excess baggage and his primary aspiration is to become a 10 million mile traveler on American Airlines. A new, hot shot, young, female co-worker proposes virtual firing rather than in-person. Ironically, this same woman confronts Clooney’s character for his vacuous life style that lacks meaningful relationships. It’s a must see movie that is hilarious and tragic. It criticizes the values of today that idolize task excellence but give short shrift to the human need for relationships (or to achieve “relationship excellence” in organizations as I written in the past).

Artists always have their finger on the pulse of culture change. The favorable response to this movie is yet another sign to me that people feel the pain from diminished human connection in the workplace and in life. The evidence is overwhelming that connection = thriving and life, disconnection = dysfunction and death, for individuals, families, organizations and nations. It’s why I believe Connection Cultures are the next step in the evolution of organizations and civil societies. Do you agree? If so, why? If not, why? Do you have meaningful relationships in your life? If not, reach out to others this holiday season and begin the new year by developing more and deeper relationships in your life.
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Michael Lee Stallard speaks, teaches and writes about leadership, employee engagement, productivity and innovation at leading organizations including Google, GE, NASA, Lockheed Martin, General Dynamics and the Darden Graduate School of Business at the University of Virginia. Most recently, Michael and his colleague Jason Pankau filmed a 90-minute program for Linkage’s Thought Leaders Series that will be released in January of 2010. Michael wrote the guest editorial for Talent Management magazine’s January 2010 edition and last month his article on how the force of connection boosts productivity and innovation was featured as the lead article in the UK’s Developing HR Strategy Journal. Click on these links to learn more about Michael and Jason in the media and their speaking engagements.

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Connecting Up: Our Need for Transcendence

What do many scientists at NASA and engineers at Google have in common with a doorman at Memorial Sloan-Kettering Cancer Center (MSKCC)?  The answer: they are fired up about the importance of their work and have a passion and energy that drives them to be a force for the cause.  Employees at NASA are fired up that they are exploring space.  Google employees are fired up because they are organizing information and making it accessible to the world.  I learned  this when I met employees at NASA and Google.   I spoke at both organizations earlier this year.

The doorman I refer to at MSKCC is named Nick.  When my wife Katie and I were walking down 53rd street in NYC in 2004 and we got within eyesight of the MSKCC  entrance, Nick locked his eyes on her and greeted her like a returning friend.  This in in Mid-town Manhattan where no one makes eye contact! Nick knows cancer patients when he sees them, probably from the wigs they wear.   It felt like the healing began within eyesight of MSKCC.

Katie was at MSKCC for high dosage chemo treatments she needed to treat advanced ovarian cancer.  Late last year her oncologist told her it that given favorable test results and five years in remission it was unlikely she would have a recurrence.  Words can’t express how overjoyed we were to hear that news. When we told Nick, he gave Katie a big hug and said how proud he was that she persevered.  We learned that Nick was a cancer survivor too and he attributed his survival to the treatments he received at MSKCC.  Is it any wonder then that this man is so passionate about his work at MSKCC.  You have to see Nick to believe it and you can if you stop by MSKCC’s entrance on 53rd Street across the street from the Citigroup building.  He’s a big guy with a dar complexion and blue eyes. Tell Nick you read about him.  Don’t worry that it may seem strange.  Former cancer patients and their family members regularly stop by to say hello to Nick. That’s how beloved he is.

Nick’s example shows that people are fired up if their work reflects the eternal values of the transcendent: truth, beauty and goodness.  MSKCC’s work reflects goodness and is expressed in it’s tagline “The Best Cancer Care, Anywhere.”  Apple’s passion for the aesthetic design and ease of use of its products reflects beauty. Work in the fields of journalism, research, theology and the academy reflect truth-seeking.

Truth, beauty and goodness are eternal values that reflect transcendence.  Human beings need the truth, beauty and goodness of transcendence to meet our need for meaning in life.  If you can find time over the holidays, reflect on the need for the transcendent values of truth, beauty and goodness in your own life. Below are links to some of my favorite essays, speeches and articles that touch on transcendence. Let me encourage you to print them out, read them and consider their relevance to your life and the lives of those you love.  

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Connection Preserves Brain Power

Evidence continues to mount that social connections help us survive and thrive from the time we are infants to the twilight years of our lives.  This excerpt from an article I recently discovered that appeared in The New York Times earlier this year suggests that it may be the degree of cognitive function used during social interactions that strengthens and preserves cognitive ability:

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Closing the Reputation-Character Chasm

Frank Rich, The New York Times’ columnist, wrote in his column today that Tiger Woods should be the person of the year because so often we’ve been “spun silly” into believing that a leader or organization’s character is stellar only to discover it wasn’t.  Tiger, Enron, Eliot Spitzer and athletes on steroids are a few of the examples Rich sites.

Earlier I wrote about LRN’s Dov Seidman and his view (expressed in his book How) that in today’s connected and wired world it has become increasingly important for individuals and organizations to get their “hows” right.  In other words, it’s difficult to manage your public reputation these days so character matters more than ever.  Dov encourages organizations to out-behave the competition.  I couldn’t agree more.   (As an aside, reading the Times this morning I could see that the late Iranian cleric Ayatollah Montazeri was a fierce critic of Iranian hardliners because they were getting the “hows” wrong. Montazeri wrote “a political system based on force, oppression, changing people’s votes, killing, closure, arresting and using Stalinist and medieval torture, creating repression, censorship of newspapers, interruption of the means of mass communications, jailing the enlightened and the elite of society for false reasons, and forcing them to make false confessions in jail, is condemned and illegitimate.”  Read more about Montazeri in his obituary at this link.)

No doubt, the connected world is improving transparency and rooting out the bad behavior of individuals, organizations and nations.  It provides another much needed check on power.

Last week while having lunch with Jay Morris, the head of Yale-New Haven Health System’s Center for Excellence, the topic of Tiger came up.  

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‘Tis the Season

This morning I was a guest on Jim Blasingame’s nationally syndicated radio show “The Small Business Advocate.” You can hear the interview by clicking on the “listen now” button above. On Jim’s program, we talked about how a company interacts with its customers is becoming more important to competitive differentiation. I believe the past century was about achieving task excellence but the century ahead will be about developing relationship excellence in organizations, including strong relationships with and among an organization’s customers (more on that later).

At the heart of relationships is “the force of connection.” If ever there is a time to connect with people, it is now during the holiday season. I say this for my own benefit too. I’m an achieve-aholic who compulsively lists things I must do and who derives pleasure from crossing items off my list. Attending to the tasks in my life — writing articles, speaking, blogging, teaching workshops, making calls, meeting with people, reading articles and books, checking my email and iPhone (now with 100,000+ apps), etc., etc., etc. — develops an addictive rhythm.

Tomorrow afternoon when my daughter Sarah arrives home after completing her first semester in college at TCU, I want to break free of the rhythm of tasks and spend time with her, my daughter Elizabeth and Katie, my wife. My hope is that I can be present with them and not be seduced by the allure of thinking about my next article, speech, blog post, etc.

Katie talks about “making memories.” That should be the priority of this season. Being together. Doing memorable things together. Connecting with those we love.

That said, I want to wish you happy holidays. May the time you have this holiday season be well spent.

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Michael Lee Stallard speaks, teaches and writes about leadership, employee engagement, productivity and innovation at leading organizations including Google, GE, NASA, Lockheed Martin, General Dynamics and the Darden Graduate School of Business at the University of Virginia. Most recently, Michael and his colleague Jason Pankau filmed a 90-minute program for Linkage that will be released in January of 2010. Michael wrote the guest editorial for Talent Management magazine’s January 2010 edition and last month his article on how the force of connection boosts productivity and innovation was featured as the lead article in the UK’s Developing HR Strategy Journal. Google just posted on YouTube a talk Michael gave at Google earlier this year. Click on these links to learn more about Michael and Jason in the media and their speaking engagements.

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Out-behave Your Competitors

John Wooden, the legendary UCLA basketball coach, once said character is more important than reputation because reputation is who people think you are but character is who you really are.  Last night at a packed event in Manhattan I heard LRN’s Dov Seidman make the case that in a connected world “how” we do what we do is every bit as important as what we do.  In other words, with everyone able to blog, take pictures or shoot video of you on their phones then upload the content on the world wide web (that becomes easily accessible via Google), an organization’s character (or “how” an organization does what it does) has become much, much more important.   Dov went even further and said that wise organizations will out-behave their competitors to gain a competitive advantage.

Following are some points I wrote down during the discussion Dov Seidman had with New York Times columnist Tom Friedman:

Historically we never imputed character to an organization but in a flat, connected world we can.

Today you can’t manage your reputation as you could in the past. You must earn it.

New leaders know you can’t have power over people.  Today you can only have power through people.

Out-behave is not presently a word in the dictionary.  Dov encouraged the audience to help change that.

The paradox of success.  When you pursue success, happiness eludes you.  When you pursue significance, you discover happiness.

I’ve been working on an article about Wall Street entitled “Goldman Is Great, But Is It Good?”  The article explores what it would take to make a better, healthier, more effective Wall Street.  Many of Dov’s ideas about getting the “hows” right are germaine to Wall Street’s future.

What do you think?  Has the internet made corporate character more important?  Should organizations strive to out-behave their competitors?

Michael Lee Stallard speaks, teaches and writes about leadership, employee engagement, productivity and innovation at leading organizations including Google, GE, NASA, Lockheed Martin, General Dynamics and the Darden Graduate School of Business at the University of Virginia. Most recently, Michael and his colleague Jason Pankau filmed a 90-minute program for Linkage’s Thought Leaders Series that will be released in January of 2010. Michael wrote the guest editorial for Talent Management magazine’s January 2010 edition and last month his article on how the force of connection boosts productivity and innovation was featured as the lead article in the UK’s Developing HR Strategy Journal. Click on these links to learn more about Michael and Jason in the media and their speaking engagements.