Uncategorized | Hamid Ghanbari, MD, MPH

Although United States leads the world in health care spending, it lags behind its peers in many quality measures. To ensure a sustainable future for health care, it needs to be proactive, predictive, hyper-personalized, digical (seamless interplay of digital and physical), decentralized, continuous, integrated, people-powered and value based.

The transition for reimbursement from volume to value is inevitable, and disciplined innovation can drive it forward. Organizations that succeed in adopting to this landscape need to draw from diverse perspectives, including patients, families, caregivers and payers and continually innovate to deliver high value care.

Few healthcare organizations perform this in an orderly and reliable way. Innovations in healthcare typically occur in silos lead by faculty and staff champions armed with specific expertise who are uniquely positioned to innovate within their environment. These projects rely on luck and incredible efforts by innovation champions to succeed. Therefore, many innovative projects remain captive in the minds of the employees and ideas that are developed are not the consistent with the highest strategic priorities of their organizations. For innovation to succeed, there is a need for new organizational structures combined with substantial investment to ensure innovation occurs consistently and at scale.

The University of Michigan Frankel Cardiovascular Center (CVC) Value Innovation Program is an example of such successful initiative that leverages informational technology to engage the community within the cardiovascular center and develop innovation projects that maximize value within our institution. The program is supported by a generous foundation grant which allows for hiring a dedicated staff. The dedicated staff will develop a core modular educational curriculum that can be tailored based on the needs of the innovation project (innovation academy). The dedicated team will also help execute and implement the selected projects over the year following the innovation challenge.

What is Value in Health Care?

Value in healthcare should be centered around the needs of patients. Value is defined by healthcare outcomes achieved per dollars spent (value=outcomes/costs). Therefore, value in healthcare is defined by results (health outcomes) and not inputs (volume, process of care used). Health outcomes for each patient are condition-specific and no single outcome captures the results of care. When measuring outcomes, we will utilize measures that assess health status achieved or retained, patient/provider experience, process of recovery, and sustainability of health. Cost refers to the total costs of the full cycle of care for the patient’s medical condition, not the cost of individual services. We will utilize time-driven activity based costing to assess the cost of each innovation project.

What is innovation?

There is significant emphasis on ideas in healthcare and that is often mistaken for innovation. Innovation represents the implementation of new or significantly improved products, services or processes. The ultimate measure of success for innovation is the development of new products with a sustainable and profitable business model. A business model is sustainable if the products deliver value to customers (the product is desirable by customers) and are profitable (some value is captured by the institution).

We use a rigorous definition of innovation that emphasizes the ultimate goal of innovation which is creation of value for patients.

We will define healthcare innovation as the implementation of new or altered products, services, processes, systems, policies, organizational structures, or business models for the purpose of creating value for customers and financial returns for the institution.

Innovation= invention (ideas) X commercialization (create value in the world)

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The Hard Truth About Innovation Cultures

hamidghanbari — Sun, 30 Dec 2018 12:55:37 +0000

The Hard Truth About Innovation Cultures

From The Hard Truth About Innovative Cultures

The most common characteristics of innovative cultures are believed to be:

Tolerance to failure
Willingness to experiment
Psychological safety
Highly collaborative and non hierarchical

But these cultures are not all fun and games.

The easy-to-like behaviors that get so much attention are only one side of the coin. They must be counterbalanced by some tougher and frankly less fun behaviors. Innovative cultures are paradoxical and need to be carefully managed. These are the important paradoxes that need to be managed:

1. Tolerance for Failure but No Tolerance for Incompetence

2. Willingness to Experiment but Highly Disciplined

3. Psychologically Safe but Brutally Candid

4. Collaboration but with Individual Accountability

5. Flat but Strong Leadership

If you want your organization to strike the delicate balance required, then you as a leader must demonstrate the ability to strike that balance yourself.

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Why predictions about the future of AI are wrong

hamidghanbari — Tue, 25 Sep 2018 15:52:43 +0000

Why predictions about the future of AI are wrong

I came across this great conversation with Rodney Brooks on econtalk on why many people are wrong about the future of AI with his accompanying MIT technology article. He argues that the following seven reasons lead to wrong predictions about the future of AI:

Overestimating and underestimating (Amara’s Law: We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run)
Imagining magic (If it is far enough away from the technology we have and understand today, then we do not know its limitations. And if it becomes indistinguishable from magic, anything one says about it is no longer falsifiable. Nothing in the universe is without limit.)
Performance vs competence (People hear that some robot or some AI system has performed some task. They then generalize from that performance to a competence that a person performing the same task could be expected to have. And they apply that generalization to the robot or AI system)
Suitcase words (When people hear that machine learning is making great strides in some new domain, they tend to use as a mental model the way in which a person would learn that new domain. However, machine learning is very brittle, and it requires lots of preparation by human researchers or engineers, special-purpose coding, special-purpose sets of training data, and a custom learning structure for each new problem domain.)
Exponentials (When people are suffering from exponentialism, they may think that the exponentials they use to justify an argument are going to continue apace. But Moore’s Law and other seemingly exponential laws can fail because they were not truly exponential in the first place.)
Hollywood scenarios (The plot for many Hollywood science fiction movies is that the world is just as it is today, except for one new twist. They ignore the fact that if we are able to eventually build such smart devices, the world will have changed significantly by then. We will not suddenly be surprised by the existence of such super-intelligences. They will evolve technologically over time, and our world will come to be populated by many other intelligences, and we will have lots of experience already.)
Speed of deployment (Capital costs keep physical hardware around for a long time, even when there are high-tech aspects to it, and even when it has an existential mission. Almost all innovations in robotics and AI take far, far, longer to be really widely deployed than people in the field and outside the field imagine.)

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Data as labor

hamidghanbari — Fri, 21 Sep 2018 17:29:46 +0000

Data as labor

What if people paid for their data- Economist

Data labor: where you think about data provided by humans as a form of labor which powers artificial intelligence. But most individuals lack the bargaining power to negotiate a fair value for their data. The history of labour offers a hint about how things could evolve. Historically, if wages rose to acceptable levels, it was mostly due to unions. Similarly,“data-labor unions”, organisations that serve as gatekeepers of people’s data. They will negotiate rates, monitor members’ data work and ensure the quality of their digital output, for instance by keeping reputation scores. Unions could funnel specialist data work to their members and even organise strikes, for instance by blocking access to exert influence on a company employing its members’ data. Similarly, data unions could be conduits channelling members’ data contributions, all while tracking them and billing AI firms that benefit from them. Current obstacles to this include 1) lack of right legal framework 2) technology to keep track of data flows needs to be become better 3) development of class consciousness by people as data workers. It is likely that active forms of data labor (ex image labelling) and will be compensated better than passive forms of data labor.

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Fears, uncertainties and doubts

hamidghanbari — Tue, 19 Jun 2018 12:11:45 +0000

Fears, uncertainties and doubts

There are many reasons why people do not live a creative life but fears, uncertainties and doubts (FUDS) rank very high on the list.

I have learned through my career that FUDS can be disabling. But you can also harness their energy to transform negative ideas into a positive and creative reality. You cannot ignore them. You have to acknowledge them and then focus aggressively on what you want to replace them with.

Psychologist, Peter Lecky, found that there were two powerful levers for changing and overcoming beliefs (it is always a relief to remember that everyone struggles with fear even the most creative and successful people among us):

1. The belief that one is capable of doing one’s share by exerting a certain amount of independence (agency). The belief that you are the “hero” in your story.

2. The belief that there is something inside us that makes us equal in talent and ability to the rest of the world (creative confidence)

Practical tips for dealing with FUDS

Tick Tock Exercise

This is a powerful exercise designed to help you overcome FUDS.

1. Zero in on and write down those negative thoughts that are preventing you from realizing your goals. (Tick)

2. Sit quietly and examine the negatives. Learn how you are irrationally twisting things and blowing them out of proportion.

3. Substitute objective positive thought for subjective negative one. (Tock)

Tick	Tock
My idea is so stupid	This is all or nothing thinking. The idea does not have to be blockbuster. If I was in leadership wouldn’t i want all the ideas to come to me
I’ll never be able to do it	Just do a little bit at a time and get started

This fear setting exercise can help in all aspects of life but it is very important in creative life when FUDS shows its ugly head. This is very similar to what Tim Ferris talks about in his TED talk. He has a slightly different approach. He advocates a three page exercise. On the first page you define all the worst case scenarios (Define), what you could do to prevent/reduce the effects of worst case scenarios (Prevent), and what you could do to repair the damage if it occurs (Repair). On the second page you write down the benefits of an attempt or partial success. Lastly and perhaps the most important part is to think about the price of inaction (emotionally, physically, financially, etc). This can be a very powerful method if employed consistently when faced with FUDS.

https://www.ted.com/talks/tim_ferriss_why_you_should_define_your_fears_instead_of_your_goals

I often hear people saying that they are not the creative type. I used to believe that about myself for a long time. I never thought I was the creative type. But with time, this slowly changed. I realized that entrenched beliefs about the world can distort our perception of reality. There are a variety of ways to change the belief system of those who do not think they are creative. Here are a couple of proven methods:

1. Self-Affirmation: get in the habit of remembering your successes, good qualities, and characteristics. Forget your failures. Success breeds success. what matters is the successful attempt. Keep log and update it regularly. These successes can be all arenas of life: home, work, family, …

2. Creative affirmation: Human beings act, feel and perform in accordance to what they imagine to be true about themselves and environment. Start by writing a general statement (ie I am creative) . take a few moments and write several variations of this statement about creativity. Then take one and expand on it.

I think it is very helpful to have some useful tools and methods to deal with FUDS wherever you face them. So next time you face them you know what to do.

References:

Cracking Creativity: The Secrets of Creative Genius

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Test Your Assumptions the Amazon Way

hamidghanbari — Fri, 18 May 2018 18:01:19 +0000

Test Your Assumptions the Amazon Way

One of the most common reasons for project failure is not testing your assumptions prior to starting.

Prototyping is a great way of testing assumptions and there a multitude of tools and techniques for doing this. Amazon has a very interesting approach for testing ideas. Before releasing a product amazon makes its staff write a press release detailing how exactly the product solves a problem. Ian McCalister, a general manager at Amazon, notes

, “iterating on a press release is a lot quicker and less expensive than iterating on the product itself”. I think this process lends itself nicely to innovation in healthcare. This is an example of an outline of a press release (with an example related to one of our projects)

Heading- Name the product in the way reader (ie your target customers) will understand

Ex- mobile application to summarize patient reported symptoms

Sub-Heading- describe who the market for the product is and what benefit they get. One sentence only underneath the title.

Ex- Patients and Physicians

Summary- Give a summary of the product and the benefit. Assume the reader will not read anything else so make this paragraph good.

Ex- The app will let patients summarize their symptoms so their physicians can

devise a bette plan of care specific to each patient

Problem- Describe the problem your product solves

Ex- Currently the patients’ symptoms are recorded at a single clinical visit and it

does not represent a summary of symptoms over a period of time

Solution- Describe how your product elegantly solves this problem

Ex- Our mobile app combined with wearable sensors allows us to measure

symptoms and their psycoholigcal and physiological correlates in an ecologically

valid way

Quote from you- A quote from a spokesperson in your company

Ex- This represents a paradigm shift in the assessment of symptoms in patients

How to get started

Ex- build a simple prototype to show that baseline symptom reporting is not a

reliable way to measure symptoms

Customer quote- Provide a quote from a hypothetical customer that describes how they experienced the benefit

Ex- I was able to send the information on how the disease affects my life to my

doctor before the clinical visit, and as a result me and my physician were able to

spend the majority of our time discussing treatment options.

Closing call to action- Wrap it up and give pointers where reader should go next

Ex- All patients should start using this app to summarize their symptoms before

their next visit to their doctor

Jeff Bezos also uses his version of Lindy Effect (future life expectancy of some non-perishable things like a technology or idea is proportional to their current age, so that every additional period of survival implies a longer remaining life expectancy) to come up with new business ideas

“ I very frequently get the question: “whats going to change in the next ten years?” ….I almost never get the question: “what’s not going to change in the next 10 years?” And I submit to you that the second question is actually the more important of the two, because you can build a bussiness strategy around things that are stable in time.

In healthcare we know that consumers will want to be happier, live longer and pay less for higher quality services. Now, that is a good place to start

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Storytelling for innovation

hamidghanbari — Wed, 16 May 2018 13:48:59 +0000

Storytelling for innovation

For a long time I discounted the value of storytelling.

I kept on hearing about it from everyone, but it did not seem to be something that was worth all the efforts and resources that were put into it. This all changed as I started to notice how storytelling changed the life of some of patients. I started to notice that patients that were able to tell redemption stories about there disease were happier, did better and even lived longer than patients who did not tell those stories about their experience. This was true even when patients had a similar experienced but some were able to just tell a different story about their experience. This made me very interested in the power of storytelling and I started to notice it everywhere. All of the most successful movements have a great story that allows people to rally around the torch bearer and do what appears to be an impossible task.

In a way we are all storytellers. It is the one of the most important traits of human beings. It allows us to band together and do seemingly impossible things. It allows us to make sense of the world, our place in it and why things happen the way they do. The stories we tell about our lives reveal how we understand ourselves and how we interpret the way our lives have unfolded. Stories help us make sense of our experience and in doing so build meaning for our lives. We are are constantly taking pieces of information and adding layers of meaning to them.

So what makes a great story:

“Stories have to come from scars not wounds” They should have settled in the storytellers mind so he/she can reflect on the experience. The great stories are real. In storytelling for innovation you have to appeal to emotions. There can be opposing emotions that drive a story. For example, fear (what could happen if we do not do this) and inspiration ( imagine if this innovation can happen). Best stories take people on an emotional journey.
Best stories are defined by growth, communion, and agency. Always put the audience first. The best stories have real and personal stories that connect with the audience.
The best storytellers often have an immense sense of curiosity about the human emotion. Great writers are often the best students of human nature.
The storyteller bring his/her unique abilities and experiences in the narrative. It allows the audience to immediately connect with the story.
The great story allows your audience to imagine themselves in the narrative. It allows an emotional connection that otherwise would not be possible.

As with all things, best stories are developed through rapid prototyping and getting feedback form the audience. The best stories evolve through many different iteration cycles.

Reference:The Power of Meaning: Finding Fulfillment in a World Obsessed with Happiness

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Purpose Matters

hamidghanbari — Wed, 09 May 2018 18:36:41 +0000

Purpose Matters

All of us want to make a difference in the world and engage in meaningful work that has an impact beyond our own immediate self-interest.

That’s why I do what I do. My job lets me live out my purpose: To Make Healthcare Exponentially Better Through Innovation, Education, and Clinical Practice.

Why does purpose matter when thinking about innovation? Change is hard. Innovation is even harder. It requires a single minded focus when everyone tells you it can’t be done. Finding why we want to do something maybe the most important thing to consider because it gives us the motivation to push through the obstacles when the going gets tough. We need a “stable and far reaching goal” toward which we are always working. It is the goal that motivates us and serves as the organizing principle in our work. It highlights our desire to make a difference in the world and serve something larger than ourselves. So before doing any project, stop and ask: Why am I doing this?

References:

Start with Why Simon Sinek

Start with Why: How Great Leaders Inspire Everyone to Take Action

The power Meaning Emily Esfehani Smith

The Power of Meaning: Finding Fulfillment in a World Obsessed with Happiness

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