This is a shout out to some cool people and a group from which I have lately been drawing a bit of inspiration and hope. What’s cool is that they just forge ahead despite the absurdity and craziness that seems to surround us at every turn. As I sometimes struggle with cynicism or feelings of hopelessness about the state of the world (often as a result of just hearing the news), I find it helps to remember some newly emerging organizations, right here in our city. They seem optimistic and determined despite what happens in Washington, Wall Street, Harrisburg, Philadelphia City Council—and a whole bunch of other places.

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In 1997, the U.S. unemployment rate had fallen to a 27 year low of 4.9% and McKinsey’s coined term of “War for Talent” described the challenges that organizations were expected to have over the next 20 years  with attracting and retaining staff. Fast forward to 2010’s global unemployment situation and many wonder if the “War for Talent” is still relevant.

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The health reform debate is over—sort of. Thank goodness the President was able to sign into law a version of health reform that has enough going for it that it feels like a positive development. That may sound like a lukewarm endorsement. For someone who in his heart of hearts wanted single payer and at the very least a strong public option, my “endorsement” does come with a partial lack of enthusiasm.

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I am in Washington, DC this weekend for the annual American College of Nurse Practitioners policy conference. As you might guess, health care reform is a big part of the agenda. Many are disappointed that reform has not yet been achieved, and are unsure what the next steps are going to be. We heard a troubling statistic about how many Americans are forced to declare personal bankruptcy as a result of health care related costs. That and any number of other stats should be enough to encourage any of us to put aside our political disagreements and come to together to make something happen. I don't think anyone (or at least no one that I know) would contend that the legislation that was working its way through Congress was a perfect solution. But what is troubling is the extent to which its demise appears to be a function of politics more than true philosophical concern for its potential impact. For instance, consider that the individual mandate was actually originally, in the early 90s, a creation of the Republican party (see this piece from NPR). However, once the Democratic party adopted it as a cause, the Republicans rather suddenly and completely opposed it. And both sides are guilty of such partisanship. It's very discouraging, even for a dedicated policy wonk. It's one thing to disagree based on actual principles. It's another entirely to disagree just because your party affiliation dictate that you do so.

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Toyota has long been the gold standard among business world thought-leaders for how it has managed to exemplify a seemingly impossible collection of achievements: optimal efficiency, optimal quality, and optimal profit. As it turns out, Toyota's seemingly impossible success may be turning out to have been actually impossible. Without commenting too deeply on the issue, because I don't know enough about it to come to any reasonable conclusions, it appears as though something in their famously regimented production and control systems fell by the wayside. With Toyota's image terribly tarnished for years and years to come, what companies do you think might take up the place at head of the line for quality and accomplishment? What do you think are the likely lessons to be learned from this experience?

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Did you ever watch those science fiction movies where someone goes through a black hole ending up in an alternative universe where everything is reversed? That’s a little bit how I felt when I woke this morning and found out that a republican had won Ted Kennedy’s senate seat in Massachusetts. My initial reaction was one of shock and awl. Why?... How could this happen?... Massachusetts hasn’t had a republican senate since 1979 and the last time a republican held this particular seat was 1953. It’s a bit like the New York Yankees loosing to my brother’s old tee ball team.

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I don't know if this strictly falls within the framework of "disruptive innovation," but I have been struck by all of the news accounts about the volume of charitable giving via text message since the earthquake in Haiti. At least one report I've listened to on NPR has referred to this trend as a "game changer" in how individual people can participate in charity.  This is a great example of how technology can be leveraged and applied in innovative ways to simplify and enhance a practice that is as old as time.  One of the stories I heard last night noted that text-based donations are a huge boon to smaller organizations, which may lack the infrastructure to engage in broad online, telephone or direct mail charitable drives the way their larger counterparts are able to.

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I had the opportunity yesterday to attend the Forum on the Future of Nursing: Community Health, Public Health, Primary Care, and Long-Term Care, which was hosted by the Institute of Medicine and the Robert Wood Johnson Foundation as part of a series those organizations are conducting. Following the conclusion of the series, a committee convened by the IOM will issue a report on elements such as:

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I just stumbled upon a really interesting article published in the Online Journal of Issues of Nursing (under the auspices of the American Nurses Association), and wanted to share it on this forum. The authors (three nurses and one MPH/MBA) set out to discuss how process innovation is crucial to health care practice. It is always invigorating to know that these conversations are happening around the country. The article highlights several specific examples of how innovative practices are being constructed and implemented. There seem to be concentrations of innovative energy in the Boston area, already a hotbed of medical, scientific and health-related activity, as well as within the Kaiser Permanente system. Related, also worth reading is a recent article in the NY Times Magazine about the fascinating work going on at Intermountain Health.

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In my last post (Part 1), I raised some questions about the theory that social programming should be premised on scientific evidence.  I raised the concern that erecting a science barrier around resources could threaten innovation, because only “proven” programs would receive funding, leaving potentially valuable ideas undeveloped, and resulting in self-fulfilling prophesies in which well-funded programs succeeded because of the resources garnered and the continued investments in developing and proving efficacy.  I also raised concerns about the cost of “proving” social strategies with scientific experiments, and pointed out that policymakers would still have to allocate scarce resources (in the absence of scientific evidence) to determine which competing program models to investigate.  I suggested that major firms would have an incentive to validate only a few models and then restrict innovators from the field, hording available public and philanthropic resources.  I questioned how it would be possible to prove that a particular model was more efficient than all the others without having tested all the competing models.  I raised questions about the feasibility of generating valid and stable scientific knowledge about highly fluid, evolving social situations in which the placebo effect and observer bias are difficult, if not impossible, to eradicate.   Finally, I suggested that there are cases (for example, information technology) in which significant, valuable innovations have evolved without resort to expensive, scientific investigations of efficacy.

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