Chasing the Rabbit: Official Blog by Author Steven Spear

High velocity organizations relentlessly compare actual experience against expected experience and rapidly adapt their approaches based on the gap analysis.  This way, they improve, innovate, and invent incessantly, thereby crushing rivals, even in the most competitive industries.  Denise Grady details just such fantastic behavior in “Autopsies of War Dead Reveal Ways to Save Others” about this closed loop learning in the military (NY Times, May 25, 2009). Read the rest of this entry »

Sandeep Jauhar writes (”Referral System Turns Patients Into Commodities,” NY Times, May 25) about a challenge facing specialists:  Without referrals from primary care docs they don’t have sustainable business.  The result?  Odd ball, counterproductive incentives–doctor to doctor and doctor to patient that drive the wrong care to the wrong people at too much cost.

The problem? Patients and payers cannot determine where to acquire the best care at the best cost.  When my daughter broke her arm, I picked an ED based parking ease.  Absurb?  Of course! But…  I had no information to find the most efficient, effective care.

No one else does, either.  Patients don’t have the information to determine the best source of wellness, prevention, diagnosis and treatment.  Without transparent information allowing informed decisions, choices are determined in convoluted fashions.  This is the linchpin to any health care reform.  Lacking that, our whole discussion will be how much to spend, and who pays? Not how to get more better care at far less cost.

The swine flu scare and the financial pandemic were similar in the dynamics they provoked and the treatment they necessitated.  This is not coincidental.  Both where characterized by  injections of risk into a tightly coupled ’system,’  risk unknown in location and magnitude.  Until that uncertainty was resolved, normal interaction couldn’t occur. Both offer insight for evaluating the response to these crises and for guiding crisis response (e.g., health care, autos) in the future and creating regulatory/screening structures that prevent it in the future.  Both crises highlight the need for increased transparency going forward, so infections are seen sooner than latter and perhaps coupled with tests of health that are ongoing and not episodic (read more below, for details). Read the rest of this entry »