Innovation

Think end-to-end

When you change a process, you have to think about the entire experience of the new process. Why?

In short, you want people to follow the process and have a good experience of your service.

I experienced a very broken process yesterday that saved the owner of it money but put additional burden of both time and money on the user. In my case it was a government process with no way around it but those types of broken processes in the corporate context are ripe for a workaround.

In healthcare there are a ton of workarounds. For example:

– EMR design problematic. Turn off the field requirements.

– Staffing model problematic: Adjust the acuity of the patient population.

– Contracted rates problematic: Drop out of the network.

– Billing and payment problematic: Bill the patient.

Each problem and every workaround has an impact to the patient and their experience of the healthcare system.

The problems with the experience have been compounded by the number of solutions that are not integrated into the system. When everything is piecemeal it makes the system feel more fragmented and difficult to use.

To make the system feel less broken, we need to think about the end-to-end experience of how patients are expected to discover/access, use and share their results with the professional that needs them.

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.

Digital Transformation

The Canadian healthcare system is undergoing a similar digital transformation as the US.

Even though the healthcare systems are different in how they are financed, the triple aim of the transformation is for the most part the same.

The triple aim:

1/ Enhance the patient experience

2/ Reduce the cost of care

3/ Increase population health

A couple of differences to note:

1/ Patient vs. Consumer experience: The US has been trying to engage patients in consumer type behavior to help lower the cost of care. The jury is out on whether it’s having the intended effect or not. However, the word consumer resonates even less in a Canadian healthcare context even though many also have private insurance and pay some healthcare costs out-of-pocket.

2/ Clinical experience and productivity: The 4th aim in Canada whether official or not, is about making things easier for clinicians in order to utilize their time effectively and to reduce the risk of errors. Given the number of reported issues with EHRs and physician burnout, most US physicians would likely sign on to that aim.

Regardless of country, it’s hard to manage risk in large scale transformations without stifling innovation. There are differences in how the risk is being mitigated and managed. I’ll touch on that next.

AI in healthcare

One of our clients would always say “think about sitting in your big easy chair.” I definitely thought about it but never experienced it. Why?

For reasons similar to the premise behind AI. I streamlined and automated a lot of workflows for the organization so that the staff focused on the more complex issues and higher value work.

Today automation replaces about 25% of the routine transactions. AI may replace another 20%. There will always be work to be done which is why you shouldn’t put too much thought into that big easy chair yet.

The difference is that automation and AI increases productivity so that companies have the resources needed to do more. So the long story short, is that AI won’t replace jobs but it likely will change what people do and how they do it. The win is that higher value work pays more.

Non-clinical tasks will likely change first because the health and safety risk for AI is lowest. Leaders should start considering the potential impact on non-clinical workflows now and plan accordingly.

The aim of medicine is to prevent disease and prolong life; the ideal of medicine is to eliminate the need for a physician.

Dr. William W. Mayo

Now – Near – Far

Now – Near – Far is a strategic framework that some executives of legacy healthcare systems are using now.

The framework was developed by James Hackett, CEO of Ford to assemble and align the resources needed to deal with disruptive market forces.

1. Now – Assembling and aligning resources for the Far.

2. Near – Executing on the strategic plan in a way that continuously meets the expectations and needs of patients.

3. Far – Imagining who your patients are, what they will need, what they will expect and how you can serve them.

The problem for some executives is that they are not thinking about the Far and may in fact be brushing it off as something they have seen before. However, the consolidation and emerging technology will eventually result in disruption to the status quo.

The threat for the legacy healthcare systems is the vertical consolidation of outpatient providers and insurers. The resources of the combined entity and the lucrative services provided will make them hard to beat.

Uber didn’t start with Pool. Uber started with a resource some people already used and made it easier to use. Then they offered cheaper options to capture more marketshare.

If something sounds too crazy to work. Don’t brush it off. Think about the possibility.

Doubling Down

Why are Americans doubling down on a broken healthcare system?

The current healthcare system is commonly referred to as broken, it’s rife with fraud and abuse, it has little transparency – yet we expect people to act as consumers.

Here’s just a few clips from Axios that has to make you wonder.

1/ Both Democrats and Republicans support Medicare Advantage, so the enrollment wave likely won’t subside in the near term. But there are still deep concerns about insurers gaming the program.

2/ The entire Medicare Advantage industry — estimated to cost the federal government $250 billion in 2019 — remains under the microscope for gaming the payment system. Dialysis chain DaVita agrees to pay $270 million to settle allegations of fudging claims billed to Medicare Advantage plans.

3/ Getting an unexpected bill for thousands of dollars is a gut-level problem. Yet that problem is a product of the health care system’s complexity, and every potential solution runs into roadblocks: from an industry that wants to protect its profits; or skepticism from policy experts; or political opposition.

4/ Balance billing is especially common for emergency-room care, where patients are often in no position to inquire about their insurance networks.

5/ Putting a stop to balance billing requires shifting the cost to someone else, or reducing the size of the bill, or both.

Thoughts?

 

The definition of insanity is doing the same thing over and over again, but expecting different results. ~Albert Instein

 

 

 

Automation + Motivation

Learn what you should be doing now as automation changes the way people work and get rewarded.

Last week I read about a recent Bain & Company report estimating the automation of 40 million jobs [25-30% of US jobs] within the next decade. White color jobs are not immune from outsourcing or automation.

That’s eye opening but technology has made the world feel a lot smaller since the dot-com boom. When I first started my online training business in 2000, a healthcare CEO asked me where my colleagues were located. Everyone was scattered around the US. It seemed to make him feel uncomfortable, but even then high speed internet access enabled my development team to communicate and collaborate in real time.

The tools are better now but technology is also getting smarter. In 2009, I closed my online training business for two reasons:

1/ Much of the revenue cycle work and financial reporting in healthcare could be automated.

2/ The companies that needed a training program were more focused on extrinsic rewards.

Algorithmic Work:
Revenue Cycle work for the most part is algorithmic work or in other words, work that requires routine processing. At least 90% of revenue related transactions can be automated now if companies have invested in their systems. Old patient accounting systems that relied heavily on data entry as a source of information are now the problem because much of the information contained in them is dated and incorrect. There are better ways to obtain, use and store the patient data needed for transacting business.

Heuristic Work:
Automating revenue cycle transactions also changes the skillsets needed to manage the systems and do the remaining 10%. The work becomes less about routine processing and more about creative and analytical problem solving also referred to as heuristic work. Given the nature of the work, heuristic work typically cannot be outsourced or automated.

Motivation:
Many healthcare companies still rely on incentive based reward structures to motivate people to work. Productivity goals made sense when much of the work involved routine processing. Unfortunately, it doesn’t work the same way for people intrinsically motivated by the work itself. In fact, “if then” rewards are often counter productive because it turns something that people enjoy doing into the drudgery of work. Worse yet, decreases in intrinsic motivation can lead to destructive behaviors.

Goals may cause systematic problems for organizations due to narrowed focus, unethical behavior, increased risk taking, decreased cooperation and decreased intrinsic motivation. ~Drive by Daniel Pink

 

Referring back to #2 of my reasons, companies led by people who are driven by immediate extrinsic rewards underperform over the long term simply because they underinvest in training, systems, research and development. Same is true for publicly traded companies who provide the most earnings guidance to Wall Street analysts.

Drive
Drive by Daniel Pink is a book about Motivation that does a good job of connecting the dots of several leaders in modern behavioral research.

Extrinsic rewards are addictive particularly for type A personalities but at a certain point, they don’t make people happier. In fact, people driven by extrinsic rewards are more likely to feel anxious and depressed than intrinsically motivated people.

Three Ingredients of Motivation:

1/ Autonomy: According to Tony Hsieh, founder and CEO of Zappos and author of Delivering Happiness, perceived control is an important component of one’s happiness. When performance goals are tied to compensation it become more about the money and less about the work. Plus when performance metrics are varied they are harder to finagle.

2/ Mastery: Tony Robins recently posted on LinkedIn “All my past failure and frustration were actually laying the foundation for the understandings that have created the new level of living I now enjoy.” That’s mastery. It’s a lifelong period of effort to improve performance in a specific domain. According to Carol Dweck author of Mindset, the effort that it takes to master something meaningful [aka: pain] is what gives meaning to life.

3/ Purpose: The most deeply motivated people – not to mention those who are most productive and satisfied – hitch their desires to a cause larger than themselves.” There are some good examples in Drive of companies leading with purpose. One of which is Toms shoes and another good example not in the book is Patagonia.

For me, our online training program was about giving our students a career path to better job opportunities and a brighter future. That’s why I remained so passionate about it for so long.

So what do you need to do now:

1/ Figure out what type of work motivates you.

2/ Invest in your skillset rather than relying on your employer for training.

3/ Deliberately practice so that you improve.

4/ Identify your Why or in other words, your purpose.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

 

Foundation for Growth

Invest in fundamentals and growth to move forward

Scarcity mindset is toxic to you and companies. It is a result of something lacking in your life that causes you to do things for short term relief rather than taking actions that provide long term benefit.

I had several exchanges with colleagues recently and scarcity mindset came up in every exchange whether the topic was foreign investment or potential business partners taking information for their own gain. When people feel their job or survival is threatened they tend to protect their turf with short sited decisions.

It’s hard to make any meaningful progress in business when people are protecting their turf because it limits their ability to think creatively and resourcefully. People need a certain level of support to shift their mindset to growth. It’s why leading edge companies provide employees with continual learning opportunities and benefits that support health and wellbeing.

Processes will be automated and jobs will be eliminated. As leaders we need to be thinking ahead, making investments in people and supporting their transition in the workforce. There is always something better when people can imagine their role in a brighter future.

Reframing mistakes, screw ups and failure all have a seemingly negative impact but they are not all the same and shouldn’t be treated the same way.

Screw Ups are just simple mistakes that happen even though you normally get whatever it is right. Don’t beat yourself up over a screw up. Just make amends and move on.

Failure is a necessary part of growth. If you try something new and it doesn’t work as expected, don’t get caught up in negative self talk. Grow from the experience and achieve something even better.

Representation matters. You might not agree with what was done in the past but when you see opportunity, you can change the future.

A few years ago, colleagues questioned my decision to work with a certain client. Admittedly, that client operated with business practices that were definitely questionable in terms of ethics, but that were not illegal. I had even struggled with the decision at the time because the practices didn’t fit with my own moral code of conduct and later wondered if I made a mistake.

However, watching the interview with Bozoma Saint John, Chief Brand Officer for Uber her words confirmed for me that I made the right decision. Accepting the client didn’t mean that I condoned their past business practices. Rather I saw the opportunity at the time to move the client forward in a way that created a win for everyone.

Some health plans have been developing narrow networks that are economically credentialing some providers out of their networks for past behaviors. Unfortunately, no one really wins with that strategy because patients value choice and penalizing providers usually forces more consolidation which drives up the cost of healthcare.

No one can change the past. We have to look for the opportunities to correct past wrongs and move forward in a way that serves everyone’s best interests.

You don’t have to cheat to win. Healthcare is a tough business but investments in the fundamentals pay off over time and ready your organization for the future.

1. Market Assessment: Assess your value to the patient population you serve in terms of the 3 P’s of marketing: product [your service], place and price.

2. Invest in your People: Too often healthcare companies only provide required training to professionals. They forget that every single person within the organization affects the overall patient experience. Leading edge companies that routinely invest in their people perform 45% better than their competitors.

3. Automate all Routine Processing: Streamlining and automating processes increases accuracy, increases cash flow and enhances the experience for healthcare consumers [patients] by giving them more control. Training investments make it easier for people to transition up or out of the organization when the time comes.

4. Manage your Contracts: Use data from your market assessment to negotiate ‘fair value” rates with commercial payers and mange those contracts. 3–5% annual increases may not seem like much but when you compound it over time, it adds up.

Laying the foundation takes some upfront work and investment but the pay off is long term financial success.

More change ahead is likely as patients demand more transparency and become sophisticated healthcare consumers.

Reference pricing offers way to engage healthcare consumers that allows for more choice and full access to providers. What is it?

The allowed amount for a specific service is limited to a defined contribution or in other words, a flat amount for a specific service. If a more expensive provider is chosen, the employee/patient has to pay the difference. The employee receives the full benefit when treated by low cost providers.

A reference price gives employees/patients more control over the entire experience in terms of their providers [facility and physicians], setting, implants, drugs etc. which is what most people want. The challenge is the lack of pricing transparency.

The prices available to most patients now are estimates based on historical claims data. The data fails to reflect real time market changes resulting from consolidation, new contracts and new technology or services. The only way to get accurate prices is from the providers involved and the health plan contracts with those providers.

We have standard transaction sets for authorization and claims submission but for some reason we’re not using them to facilitate estimates. The question is why not? Current revenue cycle costs exceed $52 Billion annually and do little to serve the healthcare consumer.

Collection Risk is a real problem for healthcare providers especially when patients are underinsured. Who should pay for the collection risk?

Policy benefits are assigned to the provider when care is provided. Assignment of benefit was meant to protect the provider from patients who fail to remit insurance payments made for their care.

The problem now is that providers may or may not get paid even when they have been assigned the benefits. In many cases, the first dollars under many policies are now due from the patient not the commercial payer.

There are new solutions to help providers collect from patients but it’s adding more time and effort to the process. Many small retailers cringe at the thought of a credit card transaction fee which is a drop in the bucket compared to the cost of collection in healthcare. Even with the new tools and increased effort, collection risk is increasing because patients don’t have the money to pay or just don’t pay.

Should insurers selling the policies and/or companies providing the policies be required to reinsure the underinsured? Technology being used to help people select policies can probably also predict the reinsurance need. So should premium dollars be set aside to cover the collection risk?

Gravity Problems: Watching “ObamaCare” twist in the political winds has not been easy especially for those directly impacted by the changes.

I have started reading a new book called Designing your Life. It breaks life down into 4 aspects: Work, Play, Love and Health and uses a metering like system to help you evaluate what areas are working and what areas need improvement. I like the simplicity of the framework.

One idea that has stuck with me is “gravity problems” and the fact that you can’t change gravity. You have to work with gravity or work around it to achieve whatever it is that you want. Gravity problems can be environmental, circumstance related or even political.

So tackle the problems that you can solve, change your tact on some and prepare for others that are likely in the future.

Innovation: Companies that want to innovate and perform better need to accept that failure is part of the process. The learnings are as valuable as the result if you allow people to harness the insights into doing or creating something better.

Not everyone is prepared or willing to take on the risk to chart a new path or create a new product. So people willing to take the risk should be rewarded not punished when they fail especially when they can explain and act on their learnings.

Innovation is about experiments. The very nature of experiment is about trial and error. The concept of innovation gets lost when people make huge bets that don’t pan out. Don’t make a huge bet until you know what works.

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About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, telehealth appointments with Sports Medicine experts and other tips to help you achieve more success in work and life.

New Healthcare Services

New healthcare services that are user-friendly and cost effective for when you’re in pain.

Judging whether a medical issue is “emergency room worthy” isn’t always easy. A bad tummy ache could be gas or something more urgent such as appendicitis. Your pain level is usually a pretty good indicator of whether it’s something that needs immediate medical attention or a home remedy. If your pain level is off the charts, it’s best to go to your local emergency room and get checked out. It may cost a pretty penny or two but it’s better to be safe than sorry. If your pain level is tolerable, you’ve got some time to triage your situation.

Now there are several new healthcare services available to you that are user-friendly and cost-effective.

Telehealth

Rather than calling your mom for advice or searching the web for answers, you can now chat with a licensed physician on demand via phone, teleconference or a mobile app about your medical issue and get professional advice on what to do next. The cost runs about $50 per appointment and may be covered by your insurance.

If you’re new to working out, a weekend warrior or an athlete, having on demand access to a Sports Medicine physician is not a bad idea. Chances are you will have more aches and pains than the average person. It’s good to know what’s causing the issue and whether it’s something that needs medical attention, modification or just recovery time. Injury prevention is key to improving performance and your health.

Home Visit

Physicians are making house calls again. If you or someone you love has a medical condition that makes it difficult to leave the house than a home visit might be just the ticket. Home health visits for people who are older, handicapped and/or really sick are usually covered by Medicare and/or Medicaid.

Cheer up if you’re too young and healthy to qualify for home health! There are also concierge services offering house calls for anyone feeling too sick to get out of bed [think bad cough or flu] or too busy to squeeze in a check up or annual flu shot. The cost runs about $99 which is about the same as an office visit and may be covered by your insurance.

Urgent Care

Urgent care centers are popping up in every neighborhood and are a great resource to help you rule out more serious medical issues or confirm a potential diagnosis. Rapid tests, exams and x-rays are performed on the spot to help diagnosis contagious things like strep throat and pink eye, evaluate tummy and chest pain and test for and splint broken bones. From there, healthcare professionals will direct you for any needed follow up care. The base cost starts at $250 and goes up with each test, exam, x-ray and/or service performed.

Now you know when and how to use the new healthcare services and roughly how much they will cost. The exact prices depends on who owns and operates the services, geographical location and whether or not discounts are offered by insurers and to patients who pay at time of service.

 

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About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, telehealth appointments with Sports Medicine experts and other tips to help you achieve more success in work and life.

Power of Habits

Your habits are the key to your success in business and life.

A habit is something you do when triggered by something that only you know when you crave the reward.

The Anatomy of a Habit:

A habit has four (4) parts. Once you understand the parts, you can change any habits that is limiting your success.

Cue: The cue is the trigger which can be a feeling, time of day, specific event or anything else that makes you start a specific routine.

Routine: The routine is the action or series of actions you take when triggered. The routine is specific to the trigger and is almost an automatic response.

Reward: The reward is something you get at the end of the routine such as a sense of calm, satisfaction, connection, belonging, completeness, control or whatever you feel from completing the routine.

Craving: The craving is your need for the reward.

 

The Problem:

The routine is the problem. It’s the action or series of actions that you take when you crave the reward that is limiting your ability to achieve your goal. To change the routine and your outcome, you have to identify the cue and the reward so that you can replace the routine with something equally rewarding.

We all have some habits that may not be serving our wellbeing or limiting our success. I have been referring to my need for innovation as a “nasty innovation habit” for the last several years. Like other bad habits, my innovation habit affects my wellbeing in a number of ways and it’s hard for me to break the cycle because it’s so automatic. Let me explain why…

Cue: What drives me to innovate?

It all starts with a problem or at least something that seems harder than it needs to be [cue]. I crave the challenge of adventuring into something new, something that challenges my thinking and the status quo. I’m not as satisfied by the nuance of refining one skill over the lifetime of a career as many others do.

Routine: Develop a solution to solve the problem

I ventured into e-learning during the dot com boom because it seemed like the best way to make a big impact on the industry. I didn’t know anything about the technology or methodologies for developing courses at the time. However, I hired consultants to collaborate with me.

At the time we launched, Health South missed their numbers by more than $2 billion which materially misstated their financials and caused the dissolution of the company. Unlike the other CFOs who had unintentionally misstated their numbers, Health South executives intended to deceive investors and succeeded for a long time. Several of them ended up in jail.

The contractual write-offs are still a big problem for most healthcare companies because the system is fragmented, the contract terms for payment vary from payer to payer, systems lack the needed sophistication to administer the payment permutations and the people doing the day-to-day work and reporting the numbers rarely get the needed training.

Outsourcing only solves part of the problem. Every step of the process and very transaction posted into the billing system makes a difference to the accuracy of the numbers. Rather than fixing the problem, the industry added more solutions to address the consequences and shift the blame. The revenue cycle industry generates more than $52 billion annually and is still not satisfying any of the stakeholders – especially patients.

My first solution addressed the training deficit of the people doing the work and reporting the numbers. I thought it would be kind of like writing a book in that it takes an upfront investment of time and effort but then pays off over time. Like Starbucks, our courses provided professional credits that could be used for college courses. With a 10% initial pass rate, I worked harder than I ever imagined. It wasn’t like a book at all because clients transferred performance expectation to me. I tried to be really inspirational during virtual meetings and relatable in our marketing collateral. Our messaging was on the right track but we missed the need for teaching basic life skills.

Starbucks’ program reportedly teaches skills such as “how to live, how to focus, how to get to work on time and how to master emotions”. My sister who is a psychologist identified that her clients at the time were similar to my students. She was just trying to get them through life whereas I was trying to turn them into star performers. I connected the dots, but still couldn’t close the gap.

It was a missed opportunity because we’ve created more problems since then. Offering people a way forward in life empowers them with keystone habits that makes it easier to change other habits to improve their lifestyle and live their best life. In short, education has the power to change lives.

Reward: What do I get for solving the problem?

I often joke with people that I got the whole employment equation all wrong. When you innovate with your own money it often requires significant sacrifice and for some, it seems like unnecessary hardship.

The reward while on the journey are all the “small wins” that reinforce the belief that the goal is achievable. I can actually feel the pleasure center of my brain light up with a win. Another entrepreneur who I met early in my career used to talk to me about progress. The concept of progress stuck but I didn’t fully appreciate the value of it then.

It took experience for the value of progress to really resonate. As with any big goal it takes months or even years to achieve and there are many setbacks that make you question whether you can get through another week or month. I have a sticky note on my monitor with the words “Do whatever it takes”. I move it to eye level on those days when I need a constant reminder to get out of my comfort zone. Of course there are some ethical limits to the “whatever” but I have had to do things and have had conversations that were way beyond my comfort zone. It’s something that needed to be done. Everyone has the power to bust through their self imposed limits.

Carving: What makes me keep going?

My friends and family wonder what drives me to keep innovating. I do well as a consultant and consulting without personal projects provides for a more balanced life. Truth be told, there are times when I crave more balance. Some days I can even hear my subconscious saying “I want my old life back” as though a pouting child. However, the craving to feel the “rush” of solving a bigger problem is more compelling. So I just keep going.

Goals: What are your goals?

I have always wanted to have a “positive impact” on healthcare. Those words alone have served as a guiding force for the type of work that I do as a consultant, the way that I conduct myself within the industry and the types of problems that I tackle on my own. It’s kind of like Google’s “do no evil” mantra.

When Paul O’Neil became CEO of Alcoa, he focused the company on safety. When he spoke about safety at his first annual meeting, investors thought he had lost the typical Republican plot of “synergy, rightsizing and co-opetition”. However, what the investors didn’t understand was that by focusing on safety he united the company around a common goal. As safety improved, productivity and profit improved.

We need a common goal to unit the healthcare industry. The triple aim lacks identity and is hard to remember. I like Patient Wellbeing because it encompasses safety, outcomes, experience, cost and wellness. I’d love to hear your thoughts.

Power of Habit

If you haven’t read the Power of Habit by Charles Duhigg yet, I encourage you to do so. It was enlightening for me on many levels and provided food for thought about how I want to approach my work and life going forward.

If you’re struggling to loose a few pounds, I’ll leave you with the two most important things from the book that you can do everyday:

Eat Breakfast — It will help to keep you full throughout the day and eat less.

Weigh yourself Everyday — It will help inform you which foods make you gain weight and which foods make you loose weight.

Of course, if I was to add a third it would be exercise.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, advice from professionals and other tips to help you achieve more success in work and life.