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Introducing Google for the Public Sector

<div>(Cross-posted with the <a href="http://googlepublicpolicy.blogspot.com/2009/09/introducing-google-for-public-sector.html">Google Public Policy Blog</a>)</div><div> </div>The 2008 elections demonstrated how technology can increase political participation, and now we're beginning to see the power of Web 2.0 come to government. On the heels of last week's <a href="http://googlepublicsector.blogspot.com/2009/09/transparency-technology-you-message.html">Gov 2.0 Summit</a> in Washington, D.C., we're excited to launch <a href="http://www.google.com/publicsector/">Google for the Public Sector</a>, a one-stop shop of tools and tips that local, state and federal government officials can use to help promote transparency and increase citizen participation. The site helps government agencies: <ul><li>Make your website, and the information it offers, easier to find. For example, in less than 50 technical staff hours, Arizona's Government Information Technology Agency <a href="http://www.google.com/publicsector/content/arizona.html">made hundreds of thousands of public records</a> and other webpages "crawlable" to search engines and visible in Google search results.</li><li>Visualize your information and tell your story in Google Earth & Maps to the hundreds of millions of people who use them. The State Department runs an <a href="http://www.state.gov/secretary/trvl/map/?trip_id=13">interactive Google Map</a> of Secretary Clinton's travels, which shows where she has been and includes photos and videos.</li><li>Use the power of online video to engage millions of potential viewers and give constituents a voice. In the U.S. alone, the Senate, House of Representatives, White House, and federal government, among others, all have YouTube channels. </li></ul>According to the <a href="http://www.pewinternet.org/">Pew Internet and American Life Project</a>, nearly four out of five American Internet users go online to find government information. Technology will help play a key role in making this information accessible, useful and transparent. Posted by Ginny Hunt, Public Sector Project Manager

Introducing Google for the Public Sector

(Cross-posted with the Google Public Policy Blog ) The 2008 elections demonstrated how technology can increase political participation, and ...

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Biovail Settles, and a Judge Explains Why Settlements in Which Only the Organization Pays a Penalty Do Not Deter Bad Behavior

Last year, we <a href="http://hcrenewal.blogspot.com/2008/05/biovail-pleads-guilty.html">posted</a> about the guilty plea by the US arm of the Canadian firm Biovail to charges that it paid physicians kickbacks to prescribe a long-acting version of the drug diltiazam. This week, the plea was formalized, <a href="http://www.reuters.com/article/rbssHealthcareNews/idUSN1452312520090914">per Reuters</a>, <blockquote> A U.S. unit of Canadian drugmaker Biovail Corp (BVF.TO) has pleaded guilty to conspiracy and kickback charges, ending a case over its Cardizem hypertension drug, the U.S. Justice Department said on Monday. Prosecutors said Biovail has been sentenced to pay $22.2 million in fines, formalizing an agreement reached last year. It also agreed to pay $2.4 million to settle civil claims. Both involved charges it improperly paid doctors and other prescribers up to $1,000 to recommend Cardizem. </blockquote> When we originally posted about this case, we focused on the unprofessional behavior of the physicians who accepted the payments apparently in turn for prescribing. However, this is also yet another in a string of cases in which charges of unethical behavior by a large health care organization (a drug company this time) are settled by the company paying a fine, but not by any penalties accruing to any people at the company who authorized, ordered, or implemented the unethical actions. We have written about many such cases (see <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">this</a>). Also this week, a US judge addressed another proposed legal settlement of an important parallel case in the world of finance, and how he ruled suggests what needs to be done to truly discourage unethical behavior by health care organizations. The background, <a href="http://www.nytimes.com/2009/09/15/business/15bank.html">summarized by the New York Times</a>, is: <blockquote> Giving voice to the anger and frustration of many ordinary Americans, Judge Jed S. Rakoff issued a scathing ruling on one of the watershed moments of the financial crisis: the star-crossed takeover of Merrill Lynch by the now-struggling Bank of America. Judge Rakoff refused to approve a $33 million deal that would have settled a lawsuit filed by the Securities and Exchange Commission against the Bank of America. The lawsuit alleged that the bank failed to adequately disclose the bonuses that were paid by Merrill before the merger, which was completed in January at regulators’ behest as Merrill foundered. </blockquote> Now consider some of the Judge's main points, and how they might apply to the many settlements of cases of unethical behavior of health care organizations. Per <a href="http://online.wsj.com/article/SB10001424052970203917304574413242609077958.html">an editorial in the Wall Street Journal</a>, <blockquote> Judge Rakoff was having none of it. In a 12-page opinion, he tore into the SEC for ignoring its own guidelines and penalizing shareholders rather than the individuals who supposedly acted improperly. The settlement 'does not comport with the most elementary notions of justice and morality, in that it proposes that the shareholders who were the victims of the Bank's alleged misconduct now pay the penalty for that misconduct.' </blockquote> Note that the settlement of nearly every health care case involved a payment by the organization, but none by the people who authorized, ordered, or implemented the unethical behavior in questions. In those cases involving public for-profit corporations, just like the current one, the shareholders were the ones footing the bill. In most such cases, the shareholders were also ultimately victims in that it was their money that ultimately paid for the bad behavior, just like in this case. So in those cases the shareholders, who were victims of the companies' managers' bad behavior, were penalized while the managers got off Scot free. (In cases involving not-for-profit organizations, in parallel, one could argue that it was the organizations' line employees and other constituencies who were both the payers of the penalties and the victims of the conduct.) Also, <blockquote> As for the SEC's argument that this shareholder punishment will result in better management, the judge called it 'absurd.' The judge also had little sympathy for the SEC's argument that it would be too difficult to pursue executives, since they had been guided by lawyers. 'If that is the case, why are the penalties not then sought from the lawyers? And why, in any event, does that justify imposing penalties on the victims of the lie, shareholders?' he asked. </blockquote> In most settlements of parallel cases in health care, the relevant government agency usually suggested that the settlement will lead to better behavior by the organization. As we have noted before, the take-away lessons for managers was more likely that bad behavior will at worst lead to increased costs of doing business, but no penalties to the people involved. Such lessons would likely reinforce managers' decisions to behave unethically when doing so would benefit the managers themselves in the short run. In parallel cases in health care, the relevant government agency has rarely explained why it did not pursue the managers who authorized or ordered the behavior, or the lawyers that advised them, for that matter. The current case suggests that there was no logical rationale for failing to hold the people responsible accountable, except... <blockquote> [The judge said] broadly the deal 'suggests a rather cynical relationship between the parties: the SEC gets to claim that it is exposing wrongdoing on the part of the Bank of America in a high-profile merger; the Bank's management gets to claim that they have been coerced into an onerous settlement by overzealous regulators. And all of this is done at the expense, not only of the shareholders, but also of the truth.' </blockquote> And it is likely in health care that previous settlements arose out of such a cynical relationship. The government agency got to claim it was exposing wrongdoing. The executives of the offending organization got to claim they were coerced into an onerous settlement by overzealous regulators. The main casualty was the truth. Again, in my humble opinion, until the people responsible for the bad behavior experience negative consequences from that behavior, they will continue to perform, direct, and condone bad behavior. We will not achieve real health care reform in the US until we effectively deter unethical, self-serving behavior by leaders of health care organizations.

Biovail Settles, and a Judge Explains Why Settlements in Which Only the Organization Pays a Penalty Do Not Deter Bad Behavior

Last year, we posted about the guilty plea by the US arm of the Canadian firm Biovail to charges that it paid physicians kickbacks to presc...

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Google Chrome after a year: Sporting a new stable release

At Google Chrome's <a href="http://chrome.blogspot.com/2009/09/google-chrome-turns-1.html">first birthday</a> just two weeks ago, we looked forward to an action-packed year for the browser and the web. Thanks to a full year of great feedback from our users, we're kicking off our second year of Google Chrome with a <a href="http://www.google.com/chrome/index.html?brand=CHNQ&utm_campaign=en&utm_source=en-et-chromeblog&utm_medium=et">brand new stable release</a>. This release comes hot on the heels of 51 developer, 21 beta and 15 stable updates and 3,505 bugfixes in the past year. For you, that means significant speed improvements for the browser as well as a fresh redesign of some of its most loved features. To walk through the top highlights in the spirit of a September of epic <a href="http://www.google.com/search?r&q=us+open">sporting</a> tournaments, here's a play-by-play comparison of our brand new release against our previous releases. A wicked serve, volley, and return: Fast, fast and fast This new release of Google Chrome is faster than ever, as we continue to provide a modern browser that starts up quickly from your desktop, and is fast to load web pages and web applications. Notably, we've improved by more than 150% in Javascript performance since our very first beta, and by more than 25% since the most recent stable release. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3cinIDOkTm2YM225-d-YCgSyIZln4nSMMN9BTD1ykl2BuU7RcjDesWtQOHQSQnJuOM8f03yCuI3y470ELEB4rWwtuYn-6UZDaW8arr1A9PGZjJ4UZKAVeAqjb87jWHAf90ZQxDeFk3VtD/s1600-h/Chrome3stableV8.PNG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5381739577095774418" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3cinIDOkTm2YM225-d-YCgSyIZln4nSMMN9BTD1ykl2BuU7RcjDesWtQOHQSQnJuOM8f03yCuI3y470ELEB4rWwtuYn-6UZDaW8arr1A9PGZjJ4UZKAVeAqjb87jWHAf90ZQxDeFk3VtD/s400/Chrome3stableV8.PNG" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 242px;" /></a> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixXGAlFGQ9SKi4APUvQoZLwMZpCItmEwdFPlwmag-HRzD9qP5xh_49KgMxYQXn0KbKZ2TRPA8h016hrBQ3B2t7MWwN_mAk5sMVD6R-1SpuCImCIvdTs1Z_sUWoJAuEXo2f4v2P0bBwLrbe/s1600-h/Chrome3stableSunSpider.PNG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5381739584191830898" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixXGAlFGQ9SKi4APUvQoZLwMZpCItmEwdFPlwmag-HRzD9qP5xh_49KgMxYQXn0KbKZ2TRPA8h016hrBQ3B2t7MWwN_mAk5sMVD6R-1SpuCImCIvdTs1Z_sUWoJAuEXo2f4v2P0bBwLrbe/s400/Chrome3stableSunSpider.PNG" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 241px;" /></a><div style="text-align: center;">The <a href="http://v8.googlecode.com/svn/data/benchmarks/v5/run.html">V8</a> and <a href="http://www2.webkit.org/perf/sunspider-0.9/sunspider.html">SunSpider</a> benchmarks measure Javascript performance for browsers </div> Your playbook for the web: The New Tab page When you download and fire up this latest release of Google Chrome, you'll notice that the New Tab page sports a new look: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZAhY5Y-EC0On_x181wM5O-U-t8zMLozBfKkRynrOdvN7N7SfVod4_y6wzm895G6WsSkU88lDzZW8rpGX7VCgpLfdYf7s_dOD_bdP_PGJhn5LFqZCLvIcVK2p2SqNr0qiIKbfFiUdQ0Pb3/s1600-h/Chrome-NTP-New.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5381741628890052706" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZAhY5Y-EC0On_x181wM5O-U-t8zMLozBfKkRynrOdvN7N7SfVod4_y6wzm895G6WsSkU88lDzZW8rpGX7VCgpLfdYf7s_dOD_bdP_PGJhn5LFqZCLvIcVK2p2SqNr0qiIKbfFiUdQ0Pb3/s400/Chrome-NTP-New.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 278px;" /></a><div style="text-align: center;">The redesigned, new New Tab page</div> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeOfLjJn1pF8OUr9UxXveh-R-hWI0o220PDJbNHAOcgh6lxk2jEQnv_kQqBDkweyb7iQpVQfhCf3ymhgLAWg6Ke6TMS4qlGFAi7IVWXjujbNoJlU45t_-ue-xLdwGLLxzL-bTgZvozkzpi/s1600-h/newtab_full.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5381741634522188370" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeOfLjJn1pF8OUr9UxXveh-R-hWI0o220PDJbNHAOcgh6lxk2jEQnv_kQqBDkweyb7iQpVQfhCf3ymhgLAWg6Ke6TMS4qlGFAi7IVWXjujbNoJlU45t_-ue-xLdwGLLxzL-bTgZvozkzpi/s400/newtab_full.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 333px;" /></a><div style="text-align: center;">The old New Tab page, which we're now retiring </div><div> </div><div>We've redesigned the <a href="http://www.google.com/support/chrome/bin/answer.py?hl=en&answer=95451">New Tab page</a> so that it's easy to use and easily customizable, following some rigorous testing on the most recent <a href="http://chrome.blogspot.com/2009/08/new-beta-why-slow-down-when-you-can.html">beta channel release</a>. Now you can rearrange thumbnails of your most-visited websites by simply clicking and dragging your mouse. Additionally, you can pin thumbnails to a spot so they don't disappear even if your browsing habits change. This way, you can easily get to the websites you care about with just one click. You can do even more to <a href="http://www.google.com/support/chrome/bin/answer.py?hl=en&answer=95451">customize your New Tab page</a> — for example, you can hide parts of the page you don't want to see, or even opt for a simple list view of all your most visited websites. In addition, we've added handy tips to the bottom of the New Tab page to help you get the most out of Google Chrome. As we bid adieu to the old, New Tab page, let us know what you think about the redesigned New Tab page — we'd love to hear your <a href="http://www.google.com/support/forum/p/Chrome?hl=en">feedback</a>. With just a few deft strokes: The Omnibox We've also improved one of the most used and loved features of Google Chrome, the <a href="http://www.google.com/support/chrome/bin/answer.py?hl=en&answer=95440">Omnibox</a>. Because it's a search bar as well as the web address bar, the multi-talented Omnibox helps you get to the sites you're looking for with just a few keystrokes. With this release, we've optimized the presentation of the drop-down menu and added little icons to help you distinguish between suggested sites, searches, bookmarks, and sites from your browsing history. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhySeK-pm7YdASu-c2wkhDYnrjC8d1QkfwC0HZe5QqE2HKOeJEsEzCdK5IfY_2KzRDO5uks0s7SU2GOqL1wd9eSrz9uwuniEMBo00DagswbGLGAy3kh0oR_baZGQ34MippNOnzZBOae8fqu/s1600-h/NewOmnibox_stable3.PNG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5381739600832815730" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhySeK-pm7YdASu-c2wkhDYnrjC8d1QkfwC0HZe5QqE2HKOeJEsEzCdK5IfY_2KzRDO5uks0s7SU2GOqL1wd9eSrz9uwuniEMBo00DagswbGLGAy3kh0oR_baZGQ34MippNOnzZBOae8fqu/s400/NewOmnibox_stable3.PNG" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 211px;" /></a><div style="text-align: center;">The new Omnibox drop-down menu </div> Bringing the cutting edge to the field: HTML5 capabilities We're very excited about <a href="http://en.wikipedia.org/wiki/HTML5">HTML5</a> becoming standard in modern browsers, and continued to add HTML5 capabilities to this stable release. We're particularly excited about the <video> tag in HTML5, which makes embedding videos in a page as simple as embedding regular images. The <video> tag also allows video playback without a plug-in. You can give the <video> tag <a href="http://tinyvid.tv/">a whirl</a> in Google Chrome and also check out our <a href="http://chrome.blogspot.com/2009/08/50-chrome-experiments-and-counting.html">50th Chrome Experiment</a>, which uses HTML5 <audio> and <canvas> tags. It's great to see the great innovations that come from the use of open standards, and we'll continue to bring the latest and greatest in web technologies quickly to users through Google Chrome. And finally, a photo finish with style: Deck your browser with Themes After testing out Themes for Google Chrome in the beta channel, we're finally releasing it in this stable release. Themes allow you to deck out your browser with colors, patterns and images. We'll be bringing more Themes for the browser soon, but in the meantime, you can <a href="http://www.google.com/support/chrome/bin/answer.py?hl=en&answer=148695">change the theme</a> of your browser by visiting the <a href="https://tools.google.com/chrome/intl/en/themes/index.html">Themes Gallery</a>. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwyhRXuccnrhiF1xkuX7NIdoEO5Yey8oMiqOAhE89FFpk5CQizRFVeJ7GeC5TgMns9dkABte56q9VgQ4C5ybxnsW7fK6ajl_sKiBJVEoP-dcVELZTqPcVEe8g6sE0oETWq9ZStIKtxSsp_/s1600-h/theme_stargazing.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5381739593682295442" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwyhRXuccnrhiF1xkuX7NIdoEO5Yey8oMiqOAhE89FFpk5CQizRFVeJ7GeC5TgMns9dkABte56q9VgQ4C5ybxnsW7fK6ajl_sKiBJVEoP-dcVELZTqPcVEe8g6sE0oETWq9ZStIKtxSsp_/s400/theme_stargazing.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 320px;" /></a><div style="text-align: center;">Theme preview: Star Gazing </div> If you haven't tried Google Chrome recently, we invite you to download and browse the web with this new stable release. Many of the improvements in this release were inspired by the responses from users, so we're all ears if you have any <a href="http://www.google.com/support/forum/p/Chrome?hl=en">feedback</a>. If you're already using Google Chrome, you'll be automatically updated to this new version soon, but if you're itching to try this right away, download the latest version at <a href="http://www.google.com/chrome/index.html?brand=CHNQ&utm_campaign=en&utm_source=en-et-chromeblog&utm_medium=et">google.com/chrome</a>. Posted by Anthony Laforge, Program Manager, Google Chrome</div>

Google Chrome after a year: Sporting a new stable release

At Google Chrome's first birthday just two weeks ago, we looked forward to an action-packed year for the browser and the web. Thanks to...

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Read news fast with Google Fast Flip

One problem with reading news online today is that browsing can be really slow. A media-rich page loads dozens of files and can take as much as 10 seconds to load over broadband, which can be frustrating. What we need instead is a way to flip through articles really fast without unnatural delays, just as we can in print. The flow should feel seamless and let you rapidly flip forward to the content you like, without the constant wait for things to load. Imagine taking 10 seconds to turn the page of a print magazine! Today we're adding a new experiment to <a href="http://www.googlelabs.com/">Google Labs</a>: Google Fast Flip, accessible at <a href="http://fastflip.googlelabs.com/">fastflip.googlelabs.com</a>. Fast Flip is a new reading experience that combines the best elements of print and online articles. Like a print magazine, Fast Flip lets you browse sequentially through bundles of recent news, headlines and popular topics, as well as feeds from individual top publishers. As the name suggests, flipping through content is very fast, so you can quickly look through a lot of pages until you find something interesting. At the same time, we provide aggregation and search over many top newspapers and magazines, and the ability to share content with your friends and community. Fast Flip also personalizes the experience for you, by taking cues from selections you make to show you more content from sources, topics and journalists that you seem to like. In short, you get fast browsing, natural magazine-style navigation, recommendations from friends and other members of the community and a selection of content that is serendipitous and personalized. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2En1L6b4GQOna3yd0PXWlMw_L7d96bDHVGsWAHilTU_4AujfA292ce0YmaH03XtKBag6_958i8mRkiq6mfNjjOCzVNIIZb1geQieiF2-p9yICRZSoSHVFwNk8l7-gtlyMUXsGhGdvReCv/s1600-h/Fast+Flip+scsh+for+blog+post.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5381460977566757442" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2En1L6b4GQOna3yd0PXWlMw_L7d96bDHVGsWAHilTU_4AujfA292ce0YmaH03XtKBag6_958i8mRkiq6mfNjjOCzVNIIZb1geQieiF2-p9yICRZSoSHVFwNk8l7-gtlyMUXsGhGdvReCv/s400/Fast+Flip+scsh+for+blog+post.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 234px;" /></a> To build Google Fast Flip, we partnered with three dozen top publishers, including the New York Times, the Atlantic, the Washington Post, Salon, Fast Company, ProPublica and Newsweek. These partners will share the revenue earned from contextually relevant ads. This gives publishers an opportunity to introduce new readers to their content. It also tests our theory that being able to read articles faster means people will read more of them, driving more ad revenue to publishers. The publishing industry faces many challenges today, and there is no magic bullet. However, we believe that encouraging readers to read more news is a necessary part of the solution. We think Fast Flip could be one way to help, and we're looking to find other ways to help as well in the near future. We've also made a mobile version of Fast Flip with <a href="http://fastflip.googlelabs.com/mobile">tactile page flipping</a> for Android-powered devices and the iPhone, so you can browse on the go. This is accessible at the same address. Go to Google Labs and give Fast Flip a spin. If you have suggestions to make the service better, please <a href="http://www.google.com/support/news/bin/request.py?contact_type=report_news&source=fastflip">let us know</a>. We'll keep working on new ways to improve your news-reading experience. Happy flipping! Posted by Krishna Bharat, Distinguished Researcher, Google News

Read news fast with Google Fast Flip

One problem with reading news online today is that browsing can be really slow. A media-rich page loads dozens of files and can take as much...

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Making Health Care More Representative and Accountable - the Example of the Thai National Health Assembly

On Health Care Renewal, we have often shown how the governance of health care organizations may be unaccountable, unrepresentative of relevant constituencies, opaque, and not subject to ethical standards. Conversely, we have repeated the need to make the governance of health care organizations accountable, representative, transparent, and ethical. Meanwhile, our US debate about health care reform seems to be driven by leaders of powerful health care organizations, while common citizens need to scream to be heard. Maybe we could benefit from a lesson from another country. As reported in the <a href="http://www.who.int/bulletin/volumes/87/2/09-030209/en/index.html">Bulletin of the WHO</a>, Thailand seems to have found a way to get ordinary citizens and members of civil society involved in a civil, organized health care discussion. <blockquote> For Dr Suwit Wibulpolprasert, chairman of the committee organizing Thailand’s first National Health Assembly (NHA), which took place from 11 to13 December 2008 in Bangkok, opening up the debate on public health is an essential part of developing effective national policy. 'In the past, health policy has tended to be drawn up by politicians and officials,' Wibulpolprasert says. 'But the National Health Assembly is a forum for the public to pool views and initiate health agendas that truly address people’s needs.' More than 1500 people attended the conference, the first of its kind to take place since the passing into law of the National Health Act of 2007, which also brought the NHA into existence. A broad cross-section of Thai society was represented, including 178 delegations from government agencies and provincial authorities, the private sector and civil society. In addition, groups including stateless people living near the Myanmar border gave presentations at technical briefings for participants. Dr Kumanan Rasanathan, from WHO’s Department of Ethics, Equity, Trade and Human Rights, described the meeting as 'a very interesting exercise in participatory governance'. The 12 topics that were up for discussion were distilled from more than 68, including such familiar ones as universal access to medicines and equal access to basic public health services. Also addressed were matters as diverse as agriculture and food prices in the current economic crisis and safe media access for youth and family – an agenda that included a proposal for addressing problems of children addicted to online games and television. 'The broad slate of topics reflects the intention to encourage input from everyone,' says Rasanathan, 'and improve public participation as well as intersectoral collaboration.' In other words, the assembly’s organizers actively encouraged the participation of stakeholders from outside the field of public health – from education, agriculture and industry, to name but a few. 'The Thais have adapted much of the machinery of the World Health Assembly [WHO’s supreme decision-making body] for their own context,' says Rasanathan, who noted that each of the 178 constituent groups had equal speaking rights. Briefing papers were produced and resolutions were passed on each of the agendas. As with WHA resolutions, these resolutions are not binding. According to Dr Amphon Jindawatthana, secretary-general of the National Health Commission Office, once the resolutions have been adopted they are considered by the National Health Commission, which reworks them for ministerial review and possible inclusion in national policy. Given the hurdles that still need to be cleared once a resolution is passed at the Assembly, one might be forgiven for dismissing the body as something of a talking shop. This is a charge that Wibulpolprasert firmly denies. He is convinced that NHA-formulated resolutions will certainly lead to policy, and policy that is closer to the needs of Thailand’s 63 million people. </blockquote> The 2009 Assembly will be held in December. Details can be found <a href="http://www.nhcthailand.com/aboutus_detail.php?id=00000000025">here</a>. I wonder if we would be having a more productive health care debate in the US if the way had been prepared by a US National Health Assembly? Maybe if the multi-million dollar a year leaders of health care organizations had to listen to the concerns of ordinary people, and some practicing health care professionals, a little common sense might penetrate into the bubble created by their <a href="http://hcrenewal.blogspot.com/search/label/superclass">superclass</a> membership.

Making Health Care More Representative and Accountable - the Example of the Thai National Health Assembly

On Health Care Renewal, we have often shown how the governance of health care organizations may be unaccountable, unrepresentative of releva...

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"A cadre of people who understand the science"

Here is a fascinating, spot-on exchange regarding biomedical information science between Bill Moyers on PBS and the new President of Dartmouth College Dr. Jim Yong Kim (<a href="http://www.pbs.org/moyers/journal/09112009/transcript3.html?print">link</a>). My comments in [red italics]: <blockquote>DR. JIM YONG KIM: My own particular take on it is that I think for many, many years, we've been working under the fantasy that if we come up with new drugs and new treatments, we're done.   The rest of the system will take care of itself. In my view, the rocket science in health and health care is how we deliver it. And unfortunately, there's not a single medical school that I know of that actually teaches the delivery of health care as one of the essential sciences.   In other words, what we've learned about organizations is that it is very difficult to get a complex organization, a group of people, to work consistently toward a goal. In the business world, if you don't do it well, the market gets rid of you. You go out of business. But many hospitals executing very poorly persist for a very, very long time. So my own view of it is that we have to rethink fundamentally the kind of research we do and the kind of people we educate, so that they'll think about the complexity of delivery as a topic that we can take on and study and learn about as a science. [And possess a broad and deep enough background to understand these issues at very fine-grained levels, which in my opinion includes a rigorous scientific background to start with - ed.] BILL MOYERS: What do you mean, complexity of delivery? DR. JIM YONG KIM: Well, just think about a single patient. So a patient comes into the hospital. There's a judgment made the minute that patient walks into the emergency room about how sick that person is. And then there are relays of information from the triage nurse to the physician, from the physician to the other physician, who comes on the shift.   From them to the ward team, that takes over that patient. There's so many just transfers of information. You know, we haven't looked at that transfer of information the way that, for example, Southwest Airlines has. Apparently they do it better than any other company in the world. [I would add that the nature of such transfers and the complexity of the information itself is far simpler in the Airline business than in medicine, so this is not the best analogy - ed.] BILL MOYERS: Computers? DR. JIM YONG KIM: No, they have taken seriously the human science of how you transfer simple information from one person to the next. [Note how Dr. Yong Kim wisely dismisses computers as the solution, in favor of people. He does not suffer the syndrome of inappropriate overconfidence in computers - ed.] And in medical school, and in the hospitals that I've worked in, we've done it ad hoc. Sometimes we do it well. Sometimes we don't do it well. But what we know is that transfer of information is critical. Now to me, again, that's the rocket science. That's the human rocket science of how you make health care systems work well   What we need now is a whole new cadre of people who understand the science, who really are committed to patient care. But then also think about how to make those human systems work effectively. We've been calling it, aspirationally, the science of health care delivery. And we do it at Dartmouth.   30 years ago, one of our great faculty members, Jack Wennberg, started asking a pretty simple question. Why is there variation, for example, in the number of children who get their tonsils taken out, between one county in Vermont versus another? 'Cause one of his children was in school at one place. Another of his children were in the school in another place.   And in one place, almost everyone had their tonsils out. And in another place, almost no one did. And of course, he found that there happened to be a doctor there who liked to take tonsils out and benefited from it. And he kept asking this question, you know, outcome variation. He called it the evaluative clinical sciences. And I think that's really the forerunner to what we're talking about in terms of the science of-- BILL MOYERS: Fancy-- DR. JIM YONG KIM: --health care delivery. </blockquote> I can add that part of that "cadre of people who understand the [information transfer] science" exists, in the form of Medical Informatics specialists (e.g., as produced by <a href="http://www.nlm.nih.gov/ep/GrantTrainInstitute.html">these organizations</a> and many others in the U.S. and <a href="http://www.amia.org/informatics/acad&training/international.asp">worldwide</a>). Understanding the complexities of information transfer also calls for understanding the clinical environment and, in my view, the biomedical science as well. However, you might never know this via reading statements from some of the <a href="http://histalk2.com/2009/08/31/being-john-glaser-83109/">non-clinical HIT </a><a href="http://histalk2.com/2009/08/31/being-john-glaser-83109/">leaders</a> such as "computers enable complexity" [as opposed to well-trained and experienced medical experts - ed.] It is indeed unfortunate that most hospital ads seeking Medical Informatics expertise are for "Director level" positions with little control of resources, i.e., they are "Director of Nothing" roles, diluting the contributions of such experts in the highly politicized and territorial environment of a hospital IT department. Unfortunately, most in hospital IT today are just repackaged business computing personnel of a management information systems (MIS) background whose lack of knowledge of these topics or cavalier attitudes about them has actually harmed the progression of health IT as a practical tool, as I've profusely documented on this blog (e.g., <a href="http://hcrenewal.blogspot.com/2009/03/reader-on-why-we-have-busywork.html">here</a>) and at my educational HIT site <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">here</a>. An example of just how difficult the "rocket science" of information transfer can be is this, from a psychiatrist: <blockquote>I work on an acute psychiatric inpatient unit. We see each patient on rounds each day, write a note in the chart each day and bill each day. However, the nature of psychiatric units are that patients wander freely around the unit. Consequently, whenever I walk onto the unit, I often have interactions with one or more patients, just in the short distance between the door and the nursing station. Some of those are brief but still give me a sense of how they are doing at that point, other interactions involve brief questions from the patients, still others involve walking to the patients' room and sitting down to discuss a particular issue in greater depth with the patient and/or family. Each of these involves a direct patient to clinician interaction and require that I exercise judgment (often a judgment that they're doing OK). Yet none of these are billable interactions and most are not documented. </blockquote> I was aware of this from my own medical school clerkship in psych. The fact that these valuable interactions are largely undocumented (except in the physician's gray matter) merely shows that modeling the real world of healthcare into neat, tidy little containers of information is harder than modeling the inventory and sale of widgets, due to the complexities of healthcare. One more of those "EHR as panacea" exceptions ... (And even the modeling of widgets isn't always done well. I went to my local MicroCenter last week seeking an EIDE-to-USB hard drive enclosure, to use the orphaned 80Gb hard drive I upgraded in my Mac Mini to serve as a Time Machine backup drive. Their inventory system showed they had a dozen on hand; nobody could find them, anywhere. A week later - yesterday - the same situation prevailed.) Finally, a quibble. Later in the exchange Dr. Yong Kim makes the statement that "Right now, the physicians who are running these hospitals have never been trained. Most of them have never been trained in system thinking, in strategy, in management." As most hospitals are not run by physicians, I'd have to disagree with that statement. It perhaps should be redirected to the non-medical businesspeople in the C-suite and on the hospital Boards who do run hospitals, to which I'd add "who have never been trained in biomedicine." -- SS

"A cadre of people who understand the science"

Here is a fascinating, spot-on exchange regarding biomedical information science between Bill Moyers on PBS and the new President of Dartmo...

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More On Healthcare Management By Domain Neutral Generalists: CIO's Running Hospital Pharmacies and Home Healthcare Divisions?

Both Roy Poses and I have written on a plague of healthcare mismanagement and perhaps malfeasance in part due to leadership by domain amateurs, i.e., healthcare leadership profoundly lacking in biomedical education and experience. Examples of recent posts about the risks posed by domain neutral biomedical leadership are: <blockquote> "<a href="http://hcrenewal.blogspot.com/2009/08/ny-times-proclaims-anyone-can-run.html">NY Times Proclaims Anyone Can Run a Health Care Organization with a Little Studying Up</a>" (Poses) "<a href="http://hcrenewal.blogspot.com/2009/08/health-care-leaders-dont-know-much.html">Health Care Leaders: Don't Know Much About Health Care</a>" (Poses) "<a href="http://hcrenewal.blogspot.com/2009/08/on-optimal-expertise-for-leadership-in.html">On Optimal Expertise for Leadership in Biomedicine</a>" (me) "<a href="http://hcrenewal.blogspot.com/2009/02/informatics-or-infomagic-health-it.html">Informatics, or Infomagic? Health IT Cannot Flourish When Everybody is an Expert</a>" (me) and "<a href="http://hcrenewal.blogspot.com/2009/01/pfizerwyeth-merger-and-sacrificing.html">Pfizer/Wyeth Merger And Sacrificing The Future: Laying Off Scientific Staff All Over The Place</a>" (me).</blockquote> I have also written of a <a href="http://hcrenewal.blogspot.com/2009/04/business-week-on-health-it-dubious.html">cross-occupational invasion</a> of healthcare by the IT profession, in the form of power and territorial grabs over clinicians with regard to the tools clinicians increasingly need in order to provide patient care. These leadership inversions, where domain neutral personnel are viewed as best able to lead any endeavor as if the world consists of interchangeable, faceless resources following equally interchangeable processes, are due to attitudinal laxity and permissiveness on the part of medical leadership, a takeover of healthcare by those with primary pecuniary interests, and perhaps a lack of appreciation for the value of domain expertise as sign of a waning western culture. In a <a href="http://histalk2.com/2009/09/10/histalk-interviews-avery-cloud/">recent hospital CIO interview</a>, in this case of CIO Avery Cloud at New Hanover Regional Medical Center in Wilmington, NC, we see both of these elements - supportive views towards healthcare leadership by domain amateurs, and towards a cross-occupational invasion of healthcare by IT personnel - combined: <blockquote> Q: Is that inherent in their background, though, when you’ve got a lot of folks who worked to move their way up through IT, which is the argument of “are you better off with someone who’s risen through the IT ranks”, or better off to get a visionary who just lets other people worry about the nuts and the bolts? A: That’s an interesting debate. I’ll just tell you about me: I came up through the technical ranks. I hold an MBA, but more importantly, I have an affinity to business. When people ask me about me and my job, I tell them I’m a business person who just happens to know IT. I’d like to think that I could run any of the departments in this hospital [wow - ed.] A good example is that nobody is surprised when the CFO runs the pharmacy department [i.e., nobody in this CIO's limited circles - ed.], or the CFO runs materials management. It should be no big surprise either that the CIO can do the same, or does the same [In fact, it likely would be a big surprise to many -ed.] A very good friend of mine in another hospital — he’s the CIO there — runs the pharmacy down there. Another friend of mine who’s a CIO runs the home care division [this is, in fact, stunning and should be a cause of great concern to healthcare regulators if true - ed.] </blockquote>I'm sure CIO's would like to think that they could "run any of the departments in a hospital." (How about: Legal? Risk management? Health Information Management a.k.a. Medical Records? Biomedical engineering? Nursing? Trauma? Diagnostic Imaging? Neurosurgery?) The question is this: is this a realistic view? Or, is it an extreme form of hubris and the <a href="http://gagne.homedns.org/%7Etgagne/contrib/unskilled.html">Dunning Kruger effect</a>? Can they run complex departments far outside their core competencies optimally? Or will they more likely be running an area they know little about by the seat of their pants? Further, do leadership roles in organizations such as NIH or the Centers for Disease Control call merely for an MBA and domain neutral backgrounds? If not, why not? Why are hospitals exempt from a requirement for domain specific expertise in their leadership? As to CIO's (and, for that matter, CFO's) running hospital pharmacies, let's show the knowledge gaps graphically by first exploring the prerequisite <a href="http://www.hsc.wvu.edu/sop/students/Curriculum/Curriculum2011_2012_2013_fall2009.htm">training of a typical Pharm.D. pharmacist:</a> <blockquote> Professional Degree (Pharm.D. Degree) Curriculum Class of 2011, 2012, & 2013 (Admitted Fall 2007, 2008 & 2009) First Year, Fall Semester <table class="alltrBodytext" cellpadding="0" cellspacing="0"> <tbody><tr> <td width="103">NBAN 301</td> <td width="400">Principles of Human Anatomy</td> <td width="135">3 credit hours</td> </tr> <tr> <td>PSIO 743</td> <td>Fundamentals of Physiology</td> <td>5 credit hours</td> </tr> <tr> <td>PHAR 700</td> <td>Pharmacy as a Profession</td> <td>1 credit hour</td> </tr> <tr> <td>PHAR 701</td> <td>Pharmaceutical Care Lab 1</td> <td>2 credit hours</td> </tr> <tr> <td>PHAR 702</td> <td>Physical Pharmacy</td> <td>3 credit hours</td> </tr> <tr> <td>PHAR 703</td> <td>Intro Pharmacy Practice Experiences 1</td> <td>1 credit hour</td> </tr> <tr> <td>PHAR 720</td> <td>Patient Health Education</td> <td>2 credit hours</td> </tr> <tr> <td> </td> <td class="bld">Total hours</td> <td class="bld">17 hours</td> </tr> </tbody></table> First Year, Spring Semester <table class="alltrBodytext" cellpadding="0" cellspacing="0"> <tbody><tr> <td width="103">BIOC 531</td> <td width="400">General Biochemistry</td> <td width="135">4 credit hours</td> </tr> <tr> <td>PHAR 708</td> <td>Pharmaceutics</td> <td>3 credit hours </td> </tr> <tr> <td>PHAR 709</td> <td>Immunology and Biotechnology</td> <td>2 credit hours</td> </tr> <tr> <td>PHAR 710</td> <td>Intro Pharmacy Practice Experiences 2</td> <td>1 credit hour</td> </tr> <tr> <td>PHAR 711</td> <td>Chemical Properties of Drugs</td> <td>2 credit hours</td> </tr> <tr> <td>PHAR 712</td> <td>Pharmaceutical Care Lab 2</td> <td>2 credit hours</td> </tr> <tr> <td>PHAR 737</td> <td>Disease Prevention and Health Promotion</td> <td>2 credit hours</td> </tr> <tr> <td> </td> <td>Elective</td> <td>2-3 credit hours</td> </tr> <tr class="bld"> <td> </td> <td>Total hours</td> <td>18-19 hours</td> </tr> </tbody></table> First Year, Late Spring – after spring term concludes <table class="alltrBodytext" cellpadding="0" cellspacing="0"> <tbody><tr> <td width="103">PHAR 714</td> <td width="400">Introductory Community Rotation (2 weeks)</td> <td class="bld" width="135">2 credit hours</td> </tr> </tbody></table> Second Year, Fall Semester <table class="alltrBodytext" cellpadding="0" cellspacing="0"> <tbody><tr> <td width="103">PCOL 743</td> <td width="400">Pharmacology 1</td> <td width="135">3 credit hours</td> </tr> <tr> <td>PHAR 715</td> <td>Pathophysiology & Therapeutics 1</td> <td>4 credit hours</td> </tr> <tr> <td>PHAR 716</td> <td>Chemistry of Drug Action 1</td> <td>3 credit hours</td> </tr> <tr> <td>PHAR 717</td> <td>Intro Pharmacy Practice Experiences 3</td> <td>1 credit hour</td> </tr> <tr> <td>PHAR 723</td> <td>Pharmaceutical Care Lab 3</td> <td>1 credit hour</td> </tr> <tr> <td>PHAR 727</td> <td>Medical Literature Evaluation</td> <td>2 credit hours</td> </tr> <tr> <td> </td> <td>Elective</td> <td>2-3 credit hours</td> </tr> <tr class="bld"> <td> </td> <td>Total hours</td> <td>16-17 hours</td> </tr> </tbody></table> Second Year, Spring Semester <table class="alltrBodytext" cellpadding="0" cellspacing="0"> <tbody><tr> <td width="103">PCOL 744</td> <td width="400">Pharmacology 2</td> <td width="135">3 credit hours</td> </tr> <tr> <td>PHAR 719</td> <td>Intro Pharmacy Practice Experience 4</td> <td>1 credit hour</td> </tr> <tr> <td>PHAR 724</td> <td>Pharmaceutical Care Lab 4</td> <td>2 credit hours</td> </tr> <tr> <td>PHAR 725</td> <td>Pathophysiology & Therapeutics</td> <td>4 credit hours</td> </tr> <tr> <td>PHAR 726</td> <td>Chemistry of Drug Action 2</td> <td>2 credit hours</td> </tr> <tr> <td>PHAR 728</td> <td>Pharmacy Management</td> <td>2 credit hours</td> </tr> <tr> <td> </td> <td>Elective</td> <td>2-3 credit hours</td> </tr> <tr class="bld"> <td> </td> <td>Total hours</td> <td>16-17 hours</td> </tr> </tbody></table> Second Year, Late Spring – after spring term concludes <table class="alltrBodytext" cellpadding="0" cellspacing="0"> <tbody><tr> <td width="103">PHAR 729</td> <td width="400">Introductory Institutional Rotation (2 weeks)</td> <td class="bld" width="135">2 credit hours</td> </tr> </tbody></table> Third Year, Fall Semester <table class="alltrBodytext" cellpadding="0" cellspacing="0"> <tbody><tr> <td width="103">PHAR 730</td> <td width="400">Pathophysiology & Therapeutics 3</td> <td width="135">4 credit hours</td> </tr> <tr> <td>PHAR 731</td> <td>Biopharmaceutics & Pharmacokinetics</td> <td>3 credit hours</td> </tr> <tr> <td>PHAR 732</td> <td>Non-Prescription Drugs</td> <td>3 credit hours</td> </tr> <tr> <td>PHAR 733</td> <td>Pharmacy Systems</td> <td>2 credit hours</td> </tr> <tr> <td>PHAR 735</td> <td>Pharmaceutical Care Lab 5</td> <td>1 credit hour</td> </tr> <tr> <td>PHAR 742</td> <td>Intro Pharmacy Practice Experiences 5</td> <td>1 credit hour</td> </tr> <tr> <td> </td> <td>Elective</td> <td>2-3 hours</td> </tr> <tr class="bld"> <td> </td> <td>Total hours</td> <td>16-17 hours</td> </tr> </tbody></table> Third Year, Spring Semester <table class="alltrBodytext" cellpadding="0" cellspacing="0"> <tbody><tr> <td width="103">PHAR 734</td> <td width="400">Pharmacy Law and Ethics</td> <td width="135">3 credit hours</td> </tr> <tr> <td>PHAR 736</td> <td>Pharmaceutical Care Lab 6</td> <td>1 credit hour</td> </tr> <tr> <td>PHAR 738</td> <td>Outcomes Assessment/Quality Improvement</td> <td>2 credit hours</td> </tr> <tr> <td>PHAR 739</td> <td>Therapeutic Patient Monitoring</td> <td>3 credit hours</td> </tr> <tr> <td>PHAR 740</td> <td>Pathophysiology & Therapeutics 4</td> <td>4 credit hours</td> </tr> <tr> <td>PHAR 741</td> <td>Clinical Pharmacokinetics</td> <td>3 credit hours</td> </tr> <tr> <td>PHAR 746</td> <td>Intro Pharmacy Practice Experiences 6</td> <td>1 credit hour</td> </tr> <tr> <td> </td> <td>Elective</td> <td>0-2 credit hours</td> </tr> <tr class="bld"> <td> </td> <td>Total hours</td> <td>17-19 hours</td> </tr> </tbody></table> Fourth Year Students complete eight five-week experiences beginning in the summer preceding their fourth year. Students will have required experiences, such as ambulatory care and acute care, and elective experiences. Students are required to complete at least 10 professional elective hours selected from an approved course list during their first, second, or third professional year and prior to fourth year experiential rotations. With the exception of Fall semester in the first professional year, one elective can be taken each semester of the didactic program. Electives are intended to complement the required curriculum and allow students to select courses based on professional interests. Students wishing to take electives during summer terms may do so after their first professional year on any of the campuses in the WVU system (Morgantown, Parkersburg, Potomac State, West Virginia Tech) provided the courses are selected from the list of professional electives or are deemed equivalent by the University. Students wishing to receive course credit for courses taken outside of the WVU system must have pre-approval by the Curriculum Committee.</blockquote> Of course, even assuming no requirement for a Dissertation defense (which is a typical Ph.D. requirement), the candidate needs to take state and/or federal exams for <a href="http://www.bls.gov/oco/ocos079.htm">licensure</a>: <blockquote>Licensure. A license to practice pharmacy is required in all States, the District of Columbia, and all U.S. territories. To obtain a license, a prospective pharmacist must graduate from a college of pharmacy that is accredited by the ACPE and pass a series of examinations. All States, U.S. territories, and the District of Columbia require the North American Pharmacist Licensure Exam (NAPLEX), which tests pharmacy skills and knowledge. Forty-four States and the District of Columbia also require the Multistate Pharmacy Jurisprudence Exam (MPJE), which tests pharmacy law. Both exams are administered by the National Association of Boards of Pharmacy (NABP). Each of the eight States and territories that do not require the MJPE has its own pharmacy law exam. In addition to the NAPLEX and MPJE, some States and territories require additional exams that are unique to their jurisdiction.</blockquote> (I can add that the typical M.D. curriculum, such as at the medical school I attended, is even <a href="http://www.bumc.bu.edu/admissions/curriculum/">more rigorous</a>. That is prior to the medical internship, residency, and postdoctoral fellowship(s) most physicians also must perform, where they become intimately familiar with the services of many hospital departments). Now, let's explore the comparable pharmacy science/biomedical training of the typical hospital CIO or CFO (or CEO for that matter): <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBqfEJsMhbThujn4qjQ-ZGDRwKAIs5mBKCFMQEyuL6A1O00AQGi4ASPA6hYitEmS9RhxTgGvWR3kc7hAhaKVUZLKepJ9HMSizizlkkfN_pD3RniLanguQEBx5h6kWaRv-oZSeStyz-egao/s1600-h/FC_NullSet_41726_lg.gif" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5380374871468209650" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBqfEJsMhbThujn4qjQ-ZGDRwKAIs5mBKCFMQEyuL6A1O00AQGi4ASPA6hYitEmS9RhxTgGvWR3kc7hAhaKVUZLKepJ9HMSizizlkkfN_pD3RniLanguQEBx5h6kWaRv-oZSeStyz-egao/s320/FC_NullSet_41726_lg.gif" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 85px; height: 112px;" /></a> (This, of course, is the mathematical symbol for the <a href="http://en.wikipedia.org/wiki/Null_set">null set</a>.)<div> </div><div>For comparison and contrast, see Roy Poses' post "<a href="http://hcrenewal.blogspot.com/2008/11/what-is-not-taught-about-leadership-in.html">What is Not Taught About Leadership in Healthcare</a>" for the healthcare MBA curriculum at a prominent School of Management, namely Yale's. Dr. Poses observed:</div><div> </div><div></div><blockquote><div>... So what is missing? There seem to be two obvious areas that are not taught. </div><div> </div><div>The first is health care. There are only two courses in this curriculum on "healthcare policy" and "healthcare management." ... The second area missing is ethics, particularly the business ethics of health care. There are simply no courses even remotely related.</div></blockquote><div></div><div> In the first of my posts linked above I wrote: <blockquote>... Those in charge [and who lack domain credentials -ed.] cannot see that which the domain specialist sees. They cannot see because they lack the training, experience, and what is described as 'meta-competence' (in <a href="http://gagne.homedns.org/%7Etgagne/contrib/unskilled.html">this brilliant article</a> on competence [the Dunning-Kruger effect - ed.]) essential to seeing that which is obvious. Obvious, that is, to those who do not lack these characteristics. In addition, I've also observed that some lack the fundamental analytical abilities essential to understanding and managing the complexities of biomedical R&D. Why those without domain expertise are in charge of organizations whose long term viability depends entirely on the most advanced and creative pursuit of biomedical 'miracles' [i.e., pharma - ed.] is another matter. I won't address this here, other than saying it reflects the adverse consequences of a bias that has evolved in management "science." That bias is the belief that all the world consists of faceless labor resources performing easily definable processes upon interchangeable widgets, and that management can therefore be done by generic managers, exclusively. Some of the world is like that [i.e., fast food chains - ed.], but some isn't, such as biomedical R&D. [And clinical medicine as well - ed.] <div style="text-align: left;">Management in the absence of domain expertise in this industry is, in fact, mismanagement. </div> There is nothing here to spin, there is nothing to debate. There is nothing to discuss. This is a first principle. Failure to accept this reality results in corporate failure.</blockquote> These views apply to hospitals perhaps even more critically than to biomedical R&D. In hospitals, mistakes in judgment can result in great patient harm, and far more rapidly than in an R&D organization. Finally, in the same CIO interview there's this: <blockquote> Q: If you’re talking to your CIO peers, what would you tell them is the key to know that you need to have this done and the thoughts to entertain before they start? A: I think, you know, customer’s king. The key is to evaluate the customer’s level of satisfaction with services being provided. You can’t do that without getting very involved and face to face with the customers. So that’s number one ... So I think that is really what IT leaders have got to strive for, the user viewpoint, the user view of the services that IT provides. </blockquote> The fact that this "customer is king" advice seems to merit constant repetition among healthcare IT leadership circles, especially when the “customers” are clinicians with patient care obligations and responsibilities, should be a cause of deep reflection and introspection among those in HIT. At the very least, they need to ask themselves - and healthcare professionals need to ask them - "who are you, and what are your motives for stepping foot in our hospital?" It is also such a fundamental first principal that its frequent repetition suggests typical hospital CIO's are not truly fit in 2009 to lead anything in healthcare where domain expertise and viewpoints are essential, healthcare IT included. Its need for frequent repitition - dating to many HIT publication I've seen since I entered the Medical Informatics field professionally in the early 1990's - suggests they don't truly recognize that the business of hospitals is taking care of patients, the clinicians being the enablers of that business, everyone else being facilitators. The <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/">known problems and failure rates of heath IT in hospitals</a> is corroborative of that view. Healthcare reform will certainly require healthcare leadership reform, and the first task of that reform should be a re-evaluation of expertise required to tamper with people's lives and well being in a hospital setting. -- SS</div>

More On Healthcare Management By Domain Neutral Generalists: CIO's Running Hospital Pharmacies and Home Healthcare Divisions?

Both Roy Poses and I have written on a plague of healthcare mismanagement and perhaps malfeasance in part due to leadership by domain amateu...

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