Studer Q. Results That Last: Hardwiring Behaviors That Will Take Your Company to the Top. 1st ed. Wiley; 2007

I decided to read this book because I have been a fan of Quint Studer’s philosophy ever since reading some of his blog writings (here’s a great example, and note the power of blogs to bring in a new audience).
Results That Last is written from the perspective of a seasoned health care executive. I love stories, and Quint puts some very good ones in here. I appreciate that (a) he’s an optimist (”I believe that life rewards action more than inaction”) and that he shares his successes and his mistakes.
I think this book is especially good reading for a person starting a new position (that would be me) in that discussion on good leadership behaviors and creating a transparent plan are a great foundation for integration into an organization with a lot going on (aka every organization).
I agree with the commentary on striving for breakthrough performance - I especially like this quote that we should all remember:

Great companies must have at least 70 percent in the 5s

There are few things I didn’t like/agree with, and these could be chalked up to “controversial ideas” because I have heard them in mainstream health care. A lot. And we should rethink them:

Controversial idea #1: “I had to keep two groups of customers happy: patients and physicians.” On this one I worry that duality of customership creates confusion and doesn’t distinguish the best health care organizations, in my opinion. i understand that physicians refer patients to hospitals and need to tools to deliver great care for them. This is different than saying that they are a customer group like patients are. I prefer the approach that organizations like Park Nicollet use: “The patient is our only customer.”

Controversial idea #2: Making employees happy results in making customers happy. I’ve done a little research on this which I need to dig up (but, please help me here if you know of some) and I think the two are more comingled than people think. It’s possible that when an organization works hard to keep it’s customers happy, this results in employees being happy because ultimately they come to work to deliver for customers. The converse is also true, that an organization can keep employees very happy and have unhappy customers.

Controversial Idea #3: Focus on low vs high performers as opposed to functional vs dysfunctional processes. I think the book excels in demonstrating some baseline leadership behaviors like honesty and standard work like rounding, but I worry that there’s excessive attention paid (right up front, in the first chapter no less) on dealing with “low performers.” This is a bit antithetical to what people like me do in applying Toyota Management strategies - I suggest asking “why?” five times to see if a person is performing poorly or whether their environment is performing poorly for them.

There are two really great things mentioned in this book as well:

Impact of pre-visit and post-visit calls: Great data about the value of these, and in a system that has a personal health record, we just do “pre-visit and post-visit e-mail”. Wonderful.

Key Words at Key Times: Loved this as well. I used to do it in clinical practice - start every visit with “Welcome to our medical office” and end every visit with “Thank you for coming in to see us.” (It is interesting to me that some doctors/nurses don’t think to say “welcome” to a patient when the patient comes to see them!)

Overall, I think the book is actually a very good baseline/starter for more discovery about leadership approaches. Since I tend to be ahead-of-my-time-guy/person/citizen I’d probably recommend following this with something on LEAN or Toyota Management.

• A Chronology of Brands that Got Punk’d by Social Media - Nice summary of the brands that experienced challenges because of social media

• The Motrin Moms Backlash by the Numbers - Nice analysis, with graphics, of the MotrinMoms issue.

• Blog growth slows; more bloggers are bringing home the bacon - Latest on the growth of the blogosphere, it's slowing. That’s just blogs though, social media penetration is picking up.

• Technorati: State of the Blogosphere 2008 - Annual State of the Blogosphere Report From Technorati. It looks like they are changing the measurement of blog growth (or stopping to measure it), but there are less daily postings now than there were in 2007.

• Workers Get Health Care at the Office - WSJ.com - Some employers, such as Intel Corp., Walt Disney Co. and Toyota Motor Corp., are opening fully equipped on-site medical centers staffed by physicians and nurses that offer primary-care-type services. At these centers, employees often don't have to pay any fee for annual physicals or blood-pressure and cholesterol screenings. Getting treated for, say, a cold or stomachache might cost you $5 or $10, well below the typical co-payment for a doctor's office visit.

  What are they doing to share data?

Cook S. The Contribution Revolution [Internet]. Harvard Business Review. Oct ;86(10):[cited 2008 Nov 16]

This is a short article written by Scott Cook, who happens to be the cofounder and chairman of the executive committee of Intuit, a company whose products many of us use to manage our finances.

The lead in to the article is dramatic enough:

Earlier this year, I spent an intense half-day closeted in a room with the top 70 executives at Intuit. Our aim was to come up with ways that people outside the company could volunteer their time, energy, and expertise to make life better for our customers. Sound odd? Well, if you’re not conducting an exercise like that at your organization, you risk missing the boat on a sea change that’s transforming business.

Cook follows these words with semi-well known case studies of customer contribution, from the likes of Unilever, Honda, Hyatt, and the standards, eBay, Amazon, etc.
The article is useful in that it is written from the executive perspective and so is easy to digest from that leadership level. Scott’s team has also taken the initiative to set up a Wiki on Intuit’s web servers to help others get started (http://usercontribution.intuit.com).

I can personally attest to Intuit’s courage in this realm, as I was recently looking at their product Quickbooks 2009 for Macintosh. If you look at the customer reviews, displayed prominently on the splash page, it’s clear that total honesty is permitted here. The concerns raised are probably already known by the mac user base, and maybe the fact that Intuit posts the reviews lets us know that they know, too.

Mr. Cook provides some evidence and leadership for change agents in other organizations who might need some fuel to take the next step. From that perspective, this article is very useful. Specifically, it lends support to the idea that an organization needs to give this idea adequate mindshare for it to take off.

Speaking of which, there are no health care examples cited. Is health care waiting to leverage user contribution, or is health care waiting for the right organization to leverage user contribution first? The types of patient contribution that I have seen are also much deeper than the ones cited by Cook; however, the ideas here seem like a good start.

By coincidence, I wrote this post in the background of the controversy surrounding Motrin.com. Here’s an example of a problem that might have been prevented if customers were checked with first. The speed of the Twittersphere is less forgiving than even blogs. Even more reason to involve customers throughout the development process.

• Insurers Embrace Online Physician Visits, But Doctor Participation Slow To Catch On - iHealthBeat - “Aetna is agressively marketing the tool to its contracted providers” - some information about the support for patient-physician messaging in the fee for service sector. Also some information from Kaiser Permanente’s work. California Medical Association provides a distinctive perspective on change. See what you think. Why isn’t this catching on in the fee for service healthcare community? (Audiocast)

• Technology, the Workplace, and Obama’s Example - For companies that are launching internal social networks this is a potential taste of the future. If anyone here has experience working in an organization that is launching or has launched an internal social network, plese post your experiences/links.

I received this query from fellow family physician, and now successful implementor of an enterprise-wide electronic health record, Matt Mulder, MD, who practices and works at The Everett Clinic, in Everett, Washington:

Hey, I am starting to toy with the idea of E Visits, and getting paid for them. I have heard of few other groups that are making these fly. From your travels, have you come across any fee for service group that is making these work. It appears some third party payors are paying for them - up to $35 per visit. Hope all is well, Matt

I had some ideas of people who I could refer this question to, but wanted to refer it to the readers here, for their ideas. Matt said OK to post here with his name and organizational affiliation. Do you know of groups who are providing reimbursed e-visits and how is it going? Patient, staff, doctor perspectives are welcome…

Let’s help Matt support a patient-centered, results-only patient experience. Please post your ideas in the comments.

Congratulations to the patients and staff at The Everett Clinic on completing their EHR implementation - I see that they now have a link to “My Medical Record” at The Everett Clinic. Great job! Let’s see if Matt can also tell us how that part of things is going…