Awhile back I wrote several posts (rants?) on healthcare problems and some of the really terrible things that make my blood boil.

Over the last couple of weeks several new article caught my eye and I wanted to bring them to your attention.

1. Following up a February post on doctors and medical researchers extensive conflicts of interest resulting from pharma industry funding and gifts.

Amazingly enough, two industry giants, Pfizer and Zimmer, which manufactures hip, knee, and elbow implants, are concerned about a potential conflict—although not about funding or gifts. This one is about ongoing physician education, often funded by industry players.

“At the center of this controversy are medical communications firms paid by pharmaceutical and device companies to produce physician-education courses. Critics say the manufacturers hire the marketing firms as intermediaries to help them influence doctors’ prescriptions and procedures.”

Gee maybe all the articles, investigations and general negative publicity coupled with a consumer revolt that might force action in Washington are having an effect.

2. It’s disgusting that financial institutions buy the debt of the un/under insured and then charge exorbitant interest rates on it.

Now the light is being shined on a practice that drives one more nail to the inability to buy insurance—assuming that you can even afford it.

“An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases. … Most consumers and even many insurance agents are unaware that Humana, UnitedHealth Group, Aetna, Blue Cross plans, and other insurance giants have ready access to applicants’ prescription histories. These online reports, available in seconds from a pair of little-known intermediary companies at a cost of only about $15 per search, typically include voluminous information going back five years on dosage, refills, and possible medical conditions. The reports also provide a numerical score predicting what a person may cost an insurer in the future.”

3. We all know how important it is to wash our hands, but many of us are careless about doing it—including healthcare providers.

“Despite recommendations, nearly 60 percent of health-care workers do not wash hands while on duty. … Why? … For one thing, rigorous hand washing is time-consuming. Guidelines advise that we first rinse, then soap for 20 seconds, then rinse again for 30 seconds; after this, we paper-dry our hands and turn the faucet off using the paper towel. For health-care workers, the procedure is supposed to be followed before and after every patient encounter. That means two minutes per patient visit, which adds up to an hour for a doctor who sees an average 30 patients a day, and 2 1/2 hours per shift for an ICU nurse.”

Now, in an effort to force improvement, “Starting in October, hospitals will be penalized for the consequences of unwashed hands: Medicare will no longer pay for complications arising from certain hospital-acquired infections, which in many cases result from poor hand hygiene. This will be a powerful incentive for health executives to improve hand-washing compliance.”

Will it be an incentive? Or will the hospitals just bill the patient for what Medicare doesn’t cover and then sell the receivables to the highest bidder?

4. A possible bright spot—at least for those who work in large companies. It’s on-site medical clinics driven by the very best motivator—vested self-interest.

“[Toyota’s] medical center, which cost $9 million to build in 2007, could save the company many millions over the next decade. Managed by Take Care Health Systems whose business is running medical clinics, the program has helped Toyota slash big-ticket medical items including referrals to highly paid specialists, emergency room visits, and the use of costly brand-name drugs. Plus, there are big productivity gains because workers don’t have to leave the plant and drive to a doctor’s office for routine medical matters. … A recent study by benefits-consulting firm Watson Wyatt Worldwide found that 32% of all employers with more than 1,000 workers either have an on-site medical center or plan to build one by 2009. “We’re talking about a microcosm of health-care reform,” says Hal Rosenbluth, president of Walgreen’s health and wellness division. “Companies can take control and understand their health-care costs.””

In spite of a few bright spots, I honestly believe that the state of healthcare in the US is a mark of shame on the global stage.

What do you think?

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Chapter Three from IBM’s The Enterprise of the Future (a steady Saturday feature since July 12; be sure and download your free copy) is about being “globally integrated.” It may sound as if it’s strictly for giant multinationals, but it’s not.

“It was striking that CEOs of companies of all different sizes and geographic coverage were engaged and enthusiastic about these topics, which suggests optimization is crucial whatever the current geographic scale.”

Integration isn’t about selling products or outsourcing work or even doing lots of business in China and India—it’s about connecting, both internally and externally.

According to one US CEO, “We need to move away from an operational focus to a client interface focus.”

That translates to connecting and listening to your customers, even when you find it disruptive or just don’t like what they’re saying, because the one thing you can count on is that someone, some where, is listening and responding.

To spark global integration in your company focus on size-appropriate variations of these five questions

1. “Are you effectively integrating differentiating capabilities, knowledge and assets from around the world into networked centers of excellence?
2. Does your organization have a globally integrated business design (even if it does not have a global footprint)?
3. Do you have a detailed plan for global partnering and M&A?
4. Are you developing leaders that think and act globally?
5. Do you nurture and support social connections to improve integration and innovation?”

The answers to these are more than operational, they are attitudes that must be embedded in your corporate culture, but ‘corporate culture’ must expand in a global workplace.

As one Japanese CEO said, “The key for doing business abroad is not to seek homogeneity. Instead, we must be able to work effectively with people of different cultures and from different countries. We can learn this by working collaboratively with them.”

This is doubly important for micro biz to remember. Your market may be local, but your customer base is still multi-cultural—even in those rare areas where it isn’t multi-ethnic.

How is your organization addressing these questions?

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Doing more for less. Productivity is always important, but it’s especially critical as the economy toughens.

The 40 year-old Institute for Corporate Productivity (i4cp) is the world’s largest private network of corporations focused on improving workforce productivity.

Although i4cp requires membership to access much of its data, the Trendwatcher archives are free and loaded with useful information.

The research that caught my eye shows that “the most productive organizations furthest outstripped the average ones in four areas:

• Culture: 79% of the most productive organizations say that, to a high or very high degree, the cultures of their organizations help raise employee productivity.

• Leadership: 76% of highly productive companies said that, to a high or very high extent, leadership in their companies raises productivity.

• Employee engagement: 59% of highly productive organizations use engagement practices to a high or very high extent. Engagement means that workers are mentally and emotionally invested in their work and in contributing to their employer’s success.

• Employee health/wellness programs: Although It could be an anomaly, “People like to work for organizations that send strong signals that they care for their employees. These particular programs may be sending those signals more than most other types of initiatives do,”

How does your company rate in each of the four areas?

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I thought we’d have some fun today.

I’ve arranged the following lyrics with no annotations to tell a story.

Trading my time for the pay I get, living on money that I ain’t made yet. – Vogues, Five O’Clock World

I get my sticks and go out to the shed, and I pound on that drum like it was my boss’s head. – Todd Rundgren, Bang The Drum All Day

Keep your day job, ’til your night job pays. – Grateful Dead, Day Job

A big break better happen soon cause I’m pushing 21. – The Who, Success Story

Do your job and do it right, life’s a ball, TV tonight. – Frank Zappa, Brown Shoes Don’t Make It

Whipped the world and beat the clock, wound up with their share of stock. – King Crimson, Happy Family

I’m never gonna work another day in my life. The gods told me to relax. – Monster Magnet, Powertrip

Now you tell me what the story is.

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Post from Leadership Turn Image credit:  soldiersmediacenter    CC license

Whatever you think of the war—I happen to be vehemently against it—has nothing to do with our troops. The war is about politicians and politics—the troops are about the men and women who serve and all too often die.

I wonder what our government spends $700 million dollars a day on, but apparently it’s not for necessities such as sox, boots, feminine products, razors, body wash, etc., let alone “luxuries” like Ramen noodles that our troops need.

I just learned about a website called Any Soldier and it’s a way you can help for very little money.

Not generic help, but very personal help. Read through the requests, choose based on what you can do and do it.

Finally, remember that there are a lot of troops there who get no mail and would appreciate receiving letters all year, not just at the holidays when it’s a major topic. Monthly letters from a class is a great school project—heck, it might even teach the kids here to communicate instead of text.

So step up, DO something yourself and DO what you can to get the word spread. Any Soldier needs all of us all and they need us now.

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Yesterday I asked, “What else does Wall Street and the financial industry do besides cripple corporate strategic efforts?”

They fight for self-regulation, assuring watchdog agencies and Congress that they are good guys that should be trusted to do the best thing and that the economy will tank if any kind of control or regulation is enacted—and they win.

They win based on the money spent to focus the efforts of well-connected lobbyists on stopping cold, or at least significantly watering down, any legislation or rules that might offer protection to us—the people who keep them all in BMWs and champagne.

Wall Street and the other financial services industries aren’t alone in this, every industry does it, but the money guys seem to be exceptionally successful—until something blows up. Then, when public outcry is loud and tempers are hot, Congress has the leverage to pass anything—whether it fixes the problem or merely makes them look like they care.

Deregulation was one of the prime factors in the S&L mess in the eighties; earnings pressure combined with personal greed fueled many of the recent corporate financial fiascos—think Enron, WorldCom, Adelphia Communications, Citigroup, Goldman Sachs, J.P.Morgan Chase, Deutsche Bank, and others.

And now, of course, we have the Sub-prime debacle with which to contend.

And after each of these, Congress, the SEC and others all run to add laws and rules to prevent it from happening again.

The repercussions from the latest snafu (Navy term meaning ‘situation normal—all f*ked up’) are reverberating through the credit markets making it more than difficult for corporations, small business and just plain folks to access it.

Who will step into the breach to provide investment and liquidity?

Private equity and big hedge funds—both with even less regulation and even larger egos and greed factors than more traditional Wall Street firms.

“But a landgrab by big hedge funds and private equity firms might create new problems. The Securities & Exchange Commission and the Finance Industry Regulatory Authority oversee investment banks to some degree, and the Federal Reserve is moving in that direction. But hedge funds are largely unregulated and aren’t bound to make any disclosures to anyone but their investors. Even that information is often incomplete. A move by hedge funds into traditional corporate finance would mean even less transparency than exists on Wall Street now.”

It’s a sad fact that the 214-year-old force that was instrumental in building the most powerful industrial nation on the planet could be just as instrumental in presiding at its demise.

Understand, it’s not that I have much faith in government regulation, but have seen little-to-no proof that self-regulation works—it’s too much like having the fox care for the hen house.

So-called government intrusion is the result of the inability of various industries to “self-regulate” for any reasons other than short-term profit, doing as much they can get away with and pushing the boundaries beyond what’s reasonable.

So you tell me, how can we get well-reasoned laws that aren’t defeated or seriously watered down by special interest groups and industry lobbyists before the crisis?

Your comments—priceless

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(CandidProf is chained and sleepless over his computer in order to meet a Friday publication deadline, he’ll return next week.)

Tuesday Wes Ball asked if Wall Street’s demands for shot-term performance undercut leadership performance; last November I wrote and When leaders can’t practice leadership and said,

“We live in a ridiculous world where Boards, in fear of investors, give CEOs six months to turn around multi-billion dollar companies that have been drifting, if not actually plunging, downwards for years; expect them to do it no matter what the situation or economy; where the slightest miss is considered grounds for firing; and long-term is a quarter.

Even when Wall Street recognizes the need to change a deeply entrenched culture they still demand that it be done in a quarter and analysts not only want perfect visions of future direction, but also exact execution plans, preferably grounded in heavy cost-cutting (read layoffs).

So, like the politicians who once elected spend much of their time fund-raising, CEOs and the senior managers below them spend much of their time focused on immediate numbers, which they must produce quarterly by hook or, more and more frequently, by crook.”

And when it’s not immediate enough, the leaders are fired.

GE’s Jeff Immelt is fighting that attitude now

“Along with the burden of replacing the most celebrated CEO of his generation, Immelt inherited an inflated stock price—the so-called Welch premium—that fostered unrealistic expectations. Yet he has still managed to produce 14% growth in annual earnings and 13% annual revenue gains, on average, over the last five years.”

But that’s not enough.

In the holy name of “maximizing shareholder value” corporations are raped, workers brutalized and communities trashed.

What else does Wall Street do besides cripple corporate strategic efforts?

(Pssst. Come back tomorrow for a look at the fiasco of self-regulation.)

Your comments—priceless

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Don’t miss my other WW: a world of choice

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Post from Leadership Turn  Image credit: Liquid Scenarios

I was unable to attend the Stanford Summit this year, so I prevailed on Emanio CEO and M3 Foundation founder KG Charles-Harris to go and share a story or two about the people he met.

From KG:

At the Stanford Summit I met a Lorenzo Carver, who impressed me quite a bit.  He’s 40 years old, plays base and studied music at Berkeley as a film score major.  His working to pay for school was affecting his playing and studies and as a consequence he started a business that did well and sold it after 18 months, then started another one that tanked.

Lorenzo’s entrepreneurial zeal didn’t end and when he returned to school to study finance he put together a leveraged buyout for a company in bankruptcy and used his portion of the profits to pay for graduate school. He ended up with a MS in Accounting, plus and MBA and CPA; all received while he was working.

During those times Arthur Andersen was the premier firm, but after a short stint there Lorenzo wanted to return to his entrepreneurial roots.  His new business was advising entrepreneurs; he wrote more than 200 strategic plans for biotech and software and assisted in raising more than a billion dollars in funding for these companies.

Then came the dotcom collapse, which gave him the seeds for his present company, Liquid Scenarios.  They are now 14 people and self funded, growing from the profits they produce.  The strange thing is that, instead of coming to the conference to seek investors, he came seeking investors as customers. (Liquid Scenarios’ tagline— “Because Time is Money”)

Liquid Scenarios is based on his having developed complex algorithms for calculating funding scenarios, especially for high-growth companies.

Anyone who has spent time calculating scenarios for more than one class of stock realizes the value of this tool for real estate, venture capital, private equity, and private investors.

The problem he solves is one that faces many investors (and entrepreneurs) in disparate industries—how to calculate funding structures that reduce uncertainty.

Previously there has been no simple-to-use software that helps reduce uncertainty for investors, entrepreneurs and creditors in financing situation by enabling modeling of complex scenarios and outcomes.

After reviewing his software, it is clear that it reduces the calculations from dozens of hours and days to just a few minutes.

(Pretty cool! Check out the product demo to really understand why this is so hot. Miki)

The reason I’m excited is because I’ve been on all sides of the table, as a venture capitalist or private equity investor, investment banker and entrepreneur and I know that calculating all this is so tedious and difficult that only experts can do it.

Liquid Scenario’s tool creates equality between the people on different sides of the table and is especially useful to entrepreneurs who may not have the training to work complex spreadsheets.

But what I found most interesting was Lorenzo’s comment on the most important lesson he’s learned as a manager or entrepreneur.

“This startup is the easiest one I’ve done of twelve where half were started by me.  The difference this time is that I’ve been exceedingly careful about the people I work with—I’ve only chosen the ones that are passionate and competent.  There is no B-team this time.”

(For more of KG’s impressions click here.)

Do you “settle” when you hire or do you slog on until you find an A-team member?

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Continuing last weeks conversation about change based on IBM’s The Enterprise of the Future.

Let’s start with the fact that change isn’t easy and well-managed change is even more difficult.

“CEO s rate their ability to manage change 22 percent lower than their expected need for it — a “change gap” that has nearly tripled since 2006. While the number of companies successfully managing change has increased slightly, the number reporting limited or no success has risen by 60 percent.”

The problem isn’t just change per se, but

• the speed of change;
• relentlessness of change; and
• how it’s approached.

Global competition and the need to address fast moving targets, with Wall Street/your stakeholders demanding immediate results, puts still more pressure on CEOs and the executive team.

And underlying it all, you must constantly change MAP (mindset, attitude, philosophy™)—your own, your people’s and your culture’s.

But it’s not just about managing change; it’s about creating a desire for it. It’s about creating an environment where changes are being driven by your workers, not just by you and your execs.

How do get your people to want/love/demand change?

Your comments—priceless

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