Engagement

Regulation vs. Ethics

Can the healthcare industry self regulate?

I had a discussion recently with a CEO to fortune 1000 companies about the need for proper regulation. At the start of the conversation, he asked what I meant by regulation. So to ensure that we’re all on the same page for this discussion, let’s start with the definition of regulation.

Definition: A regulation is a rule or directive made and maintained by an authority.

Regulations are tricky to get right because they need to be protective but not restrictive – and somehow, they need to be efficiently and effectively enforced to work well. It takes a lot of work to strike the right balance. That may be why some politicians and business leaders would like to do away with all regulation and let the markets self regulate. 

AdvaMed


The AdvaMed Association for medical technology is taking on a self regulation initiative for 2020. They are developing a new code of ethics that is values based to better engage everyone in and involved with the organization in compliance. To do so, they have been reportedly working with all of their stakeholders including teaching hospitals, hospitals, clinicians, device and diagnostic companies to develop the new code.

At this point, they have identified six [6] key values for the new code of ethics:

1/ Innovation
2/ Education
3/ Integrity
4/ Respect
5/ Responsibility
6/ Transparency

It’s not clear yet how they plan to operationalize the values. What we know is that member companies will need to have policies and programs in place signed by the CEO demonstrating compliance in order to be awarded the AdvaMed seal of approval.

There is a carrot for member company participation. The seal will help business partners and customers identify organizations who are in compliance. That may also give companies selling solutions an edge in competitive bid opportunities.

There is no stick for non-compliance. AdvaMed will not initiate investigations or bring any action for non-compliance. 

The question that remains unanswered is whether ethics can protect consumers from corporate wrong doing and greed better than regulations?

However, the industry should welcome the attempt to self regulate even if it’s an added regulatory measure. With all the advances in medicine that are raising new ethical questions and concerns for the healthcare industry, ethics need to be ingrained in the culture for companies to earn the trust of partners, customers and patients around the world.

Relativity applies to physics not ethics.
~ Albert Einstein

Startup Comp

What is the value of your time and risk tolerance?

A member of the Female Founders Network shared her story of working for a successful startup that recently became a public company. She was an early employee but was never offered shares or options and questioned whether or not it was fair.

With the amount of pay inequity in the market, it would be easy to chalk it up to another example of gender inequality. Without knowing the numbers, I have to generously assume it has more to do with risk and reward.

Startups are high risk. It’s easy to look back at a successful startup and wish you were paid in equity. But how would you feel forgoing cash and benefits for a stock vesting plan if the company failed after 4 years? My guess is that the experience gained would not feel like adequate reward for most. That’s the risk – reward relationship of startup.

My advice to the Female Founder Network and you is to know the value of your time and your risk tolerance. Everyone deserves to be fully compensated for the value of their time. The method of compensation needs to reflects your risk tolerance. Methods include:

1/ cash + benefits
2/ stock + options
3/ blended

Time is one of your most precious resources that can only be valued by you. The method of compensation should be negotiated.

From a leadership perspective, we need to think about the person not just the position when offering stock and options. Doing so will help address pay inequity.

Stand Up?

Should you take a stand on important issues?

It’s something many leaders are rubbling with right now.  Eric Topol MD wrote an article for the New Yorker recently about the potential for a new doctors’ organization that would enable physicians to take a stand on important issues affecting the health and wellbeing of Americans. Issues such as vaccines, drug pricing, climate change, stem cell clinics and false health claims spread by celebrities involved in lifestyle medicine businesses. 

In the article, he noted several female physician leaders who took on the NRA and claimed the lack of adequate gun control regulations not only as their lane but as their highway. What gave them the courage to stand up to the NRA?

Dr. Topol hypothesized that their courage was attributable to dealing with long-standing gender inequities in medicine. Possibly but it likely has more to do with their values and their frustration with the lack of change. 

Organizing to take a stand on important issues is commendable but also challenging. The values and interests of the group need to align for the group to have a powerful voice.

Whether physicians organize or not, they should be encouraged to bring their whole self to work as employees in leading edge companies do and to speak out on issues affecting the health and wellbeing of Americans. Otherwise, how can doctors be held accountable for the cost of healthcare if they can’t speak out on the biggest drivers of cost?

Daring leaders who live into their values are never silent about hard things.~ Brené Brown

Valeant

There is a good documentary called the Drug Short that tells the story of Valeant to explain the problem with drug pricing in the US.

Valeant reportedly operated more like a hedge fund than a pharmaceutical company. The model was pretty simple:

1/ Buy companies that have a drug with a monopoly.

2/ Strip out the R+D so that the typical 18% spent on R+D goes to the bottom line.

3/ Raise prices on existing drugs.

The problem is that many of the drugs were life sustaining drugs for people in middle America who couldn’t afford to pay for them.

The company took extraordinary measures to bilk insurance companies for payment. To keep patients quiet about the issue, they provided just enough financial support to them through their advocacy efforts. 

Hillary Clinton started tweeting and talking about the issue during her campaign. Investors and board members could have looked into it and taken action, but they didn’t. They were reportedly paid large sums to look the other way. The company’s stock eventually tanked.

The returns on biotech companies now are largely due to price increases. The company’s can’t afford to lower their prices and profits. So nothing has changed yet.

Change in 2020 is likely because even though the pricing strategy is not illegal, many leaders feel that it is morally wrong.

Hiring for Fit

Have you ever wondered why 80% of Americans are in jobs that they don’t enjoy?

The easiest answer is that they have the skill and need the money to support their family, pay off their school debt, buy their dream home or maybe it’s just about survival.

Whatever the case may be, the way companies hire may be compounding the problem. Why? Companies often recruit based on past job title, education, school etc. They don’t understand why people did those jobs, why they chose their school or their major.

Chances are people made those decisions early in life when they didn’t really know what they wanted to be, how they wanted to apply their skill or where they wanted to live. Their decisions were likely influenced by their parents or a teacher or life circumstance.

If they’re trained in something that they don’t enjoy and they’re continuously recruited for that skillset, they’re probably not going to be happy doing the job. They’ll do it but they’ll also keep their options open.

Understanding WHY they made certain decisions and WHY they are interested in a certain company and job, might be better ways of understanding fit.

Unless deep functional knowledge is needed to do the job well, skills and knowledge can be developed – motivation and satisfaction can’t.

Living your Values

If you’re thinking which values are you referring to – personal or company values? I’m actually referring to both because there should alignment in your personal and professional life.

If you need to google your company values or call human resources, chances are your company’s values have not been operationalized. Only 10% of companies have a short list of memorable values that they’ve associated with behaviors to reinforce their values.

Salesforce has done a good job of honing the values list to four [4] values and associating behaviors with each value. It’s how they are able to walk their talk in everything they do despite being a very large company.

Whittling down the values list from 100+ takes some time and careful thought. Most companies have a list of 10-15 values but within that shortlist there are usually 2-4 that encompass the company’s core beliefs. 

Operationalizing values is a process of linking values to behaviors so that people understand what’s an acceptable behavior as well as what’s not an acceptable behavior. Providing three [3] examples of each type of behavior is usually enough.

Once the values are operationalized, the company culture will develop to support and enforce those values.

If you’re questioning whether or not it’s worth your time, think about how much easier it will be for everyone in your organization to:

1/ Hire the right people 

2/ Manage customer relationships 

3/ Work collaboratively with people throughout the organization

4/ Make good decisions for the company

Defining and operationalizing your values is not something you want to put off until you’re the size of Salesforce. There are a lot of steps in the journey to realize that level of success. That’s why I think of it as one of those “the sooner the better” activities.

“Daring leaders who live into their values are never silent about hard things.” ~ Brené Brown

Our Values

I’ve been working on refining the values for Rush360 too.

Innovation is the heart of what we do. There are 4 steps in our process [Learn, Engage, Design and Transform].

So I started with the steps and thought about the values we need to have in order to do those things well and support the people on our team.

These are the four values that resonated the most with what we do and why:

1/ Courage: It takes a lot of courage to step into a new environment and to get up to speed quickly especially when people see you as a change agent.

2/ Open: It takes an open mindset to be constantly working with new people, new process, new system and in new environments.

3/ Creativity: We get the benefit of having a fresh perspective on the problem but it takes a lot of creative energy to work with all the stakeholders and to design a solution that works for them now and in the future.

4/ Innovation: It takes someone who loves to innovate because the stakes are high and the risk of failure is real. Failure on any scale is disappointing and tough on the ego.

That leads me to balance. I think everything in life – from our bodies to our businesses – needs balance. In Dare to Lead, Brene talks about daring leaders having a strong back and a soft front. It seemed like a good framework to test the balance of our values… it takes a strong back [courage and love for innovation] and a soft front [open and creative mindset].

Improving Quality

I’m reading Stephen Pinney‘s book called How Hockey can Save the Healthcare System and highly recommend it. Why?

The section on Quality addresses one of the most important lessons for Administrators….don’t always trust your reports. Dr. Pinney highlights the problem in his example with the Pre-Operative Surgical Checklist.

According to the Administrator, the checklist was preformed consistently for two years without issue. The problem was that it wasn’t performed correctly. Significant errors resulted and were unreported.

One of the most important lessons that I have learned from working closely with Medical Directors is that they know the business. When they say something is wrong, something is likely wrong. Administrators need to dig into the details to get to the bottom of the issue rather than dismissing them.

Interestingly, Dr. Pinney and I have uncovered the same issue. Data is often missing and when data is missing – the reports are wrong. Administrators need to understand why the data is missing and take the steps needed to ensure it is consistently captured. It’s a matter of life and limb – literally.

According to Dr. Pinney, these types of quality and process improvements are key to systematizing medicine and achieving the third aim. However, it all starts with accurate data.

Trust

Transparency is the key to consumer engagement in healthcare. Why? In one word – trust. 

Yesterday I participated in a film being made by a US physician who’s trying to wrap his brain around the patient – physician relationship. The film is being presented at a US Public Health event later this year. I’ll be sure to share the link.

Trust is one of the themes that has come up in several interviews that he’s had with both patients [aka: healthcare consumers] and professionals. Reportedly, no one knows who to trust when it comes to healthcare.

Trust has been eroded in both Canada and the US but for slightly different reasons. 

In Canada, the lack of choice and ability to actively participate in treatment decisions is eroding patient trust. Canadian physicians have no financial incentive to invest the extra time needed to educate their patients. 

In the US, the lack of pricing information and network participation is eroding patient trust. American physicians need to educate and almost sell their patient on their plan but patient trust has been undermined with various out-of-network and billing strategies.

When I ask people if the 80/20 rule [80% right thing done] applies in healthcare – most don’t agree. The responses are pretty dismal.

Trust is clearly a problem. Transparency will help to re-establish trust.

Progress

After 20 years of talking about consumerism in healthcare it’s easy to loose site of progress made and the benefits realized.

I spoke with an executive of Infoway yesterday and realized that Canada and the US are in much the same spot.

EHRs have for the most part have been purchased and implemented across the US and Canada. It’s taken longer than most of us in the industry expected. There have been a lot of mistakes made, lessons learned and yes – successes!

One thing that I really enjoyed is reading are the benefit studies done in Canada that highlight how the EHRs and other solutions have reduced the number of redundant tests, negative drug interactions, ER visits and admits.

Professionals in both countries are tasked with doing more with less. However, both countries are still struggling to get the financial incentives right to improve access and outcomes.

The US is shifting to more risk based models to reduce over utilization and improve outcomes. While in Canada, they need incentives to increase thru put and reduce the waiting times for non-emergent services.

The engaged consumer is the answer to both challenges. The problem is the word consumer doesn’t resonate with Americans or Canadians in the context of healthcare.

Millennials+Healthcare

Millennials may be rejecting the ACO model.

As prices for comprehensive health insurance increase, millennials seem to prefer on demand service purchased at time of service [aka: fee for service].

Primary care physicians work as the coordinator and gatekeeper in the ACO model. They care for, triage and refer patients to specialists as needed.

However, new reports indicate that most millennials don’t have a primary care physician. Instead they seek care on demand from walk-in clinics and urgent care centers as needed. Both are fee for service business models.

Millennials seem to be cost conscious healthcare consumers that will likely engage in care decisions and explore self-care solutions over traditional healthcare.

What we expect from millennials in 2019:

1/ Many millennial purchasing health insurance on the exchanges will purchase the Copper Plans over comprehensive coverage.

2/ They will continue to use the healthcare system as needed and pay on a fee for service basis.

3/ They will leverage technology to the fullest extent possible to manage their health, direct their care and store their health records.

What’s the impact to the exchanges?

The cost of comprehensive coverage is going up. Reportedly, the population covered is again using more healthcare expenses than expected.

The concern about the viability of the ACA comprehensive insurance plans seems to be playing out as many expected.

Post: Workplace Wellness

Fundamentals of wellness in the workplace.

Wellness is for companies of all sizes. It doesn’t take a lot of money to provide employees with a workplace that promotes wellbeing and empowers them to do their best work.

1/ Environment: The workplace itself matters. Fresh paint that enhances the light and a well organized space will promote a feeling of calm.

2/ Tools: Get creative. White boards and colorful markers are great tools to engage people in problem solving.

3/ Location: Reduce travel time. Incorporate collaboration tools to enable remote work and work from home programs.

4/ Travel: Reimburse and reward healthy choices. Allow for expenses the promote walking, healthy meal choices and exercise.

5/ Education: Provide a path for growth. Online education is an affordable way for companies to promote continuous learning.

6/ Coaching: Provide diversity and equality training. Appropriate behavior and conduct for the workplace needs to be defined so that people are clear about what movements like metoo means to them.

7/ Compensation: Provide equal pay for equal work. Compensation is the foundation of health.

Everyone wins with the fundamentals.

Post: Networking

How often are you networking with intention?

Why do I ask? New opportunities often come from the people you know and who know what you do.

I started thinking about this after meeting with another small business owner who told me his entire business comes from referrals.

I couldn’t help but do a little research into networking and how people are getting referrals. I’ll share a few things that I’ve learned so far about networking with intention.

Tips for Intentional Networking:

1/ Networking Groups. Find a business group serving the same industry or types of people that you would like to meet. Regular attendance matters.

2/ Schedule 1:1’s. Schedule a one hour meeting with everyone in the group to develop a more meaningful connection. During the meeting, share your name, what you do, the types of clients you serve and the types of connections that would be meaningful to you.

3/ Connect people. Some people make connections naturally and others have to be prompted. Don’t be scared to ask for a referral.

Social Networks:

LinkedIn is a great way to research people and build a network. It’s pretty meaningless if you don’t use the connections.

Start with a message about why you want to connect as part of your request and follow up with a call or meeting. If you don’t know why you want to connect, don’t send the request.

Follow them to get insight into who they are and what they do. Then if you think it would be valuable to connect with them, send the request to start the conversation.

Health and Fitness: Hello Workout is another good way to network if you’re in the business of treating and caring for others. Get more information or sign up Free.