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the best practice

A new book about building better practice.

Review
The Best Practice is a timely and important contribution to the nation’s ongoing struggle to make the best in modern health care available and affordable for all Americans. Charles Kenney introduces us to the pioneers at the forefront of this movement, highlighting the remarkable progress they are making, and illuminating the challenges that remain as they strive to improve the quality of health care in communities across the country.”—Senator Edward Kennedy

“The quality movement in healthcare did not just happen on its own. It is the result of the insights, intelligence, idealism, creativity, and resilience of a handful of heroes. The Best Practice is their story, and Charles Kenney tells it in fast-paced, absorbing prose.”—Thomas H. Lee, M.D., network president of Partners Healthcare System, and professor of medicine at Harvard Medical School

“[Kenney’s] telling of the health care quality movement has all the elements of a great story—human interest, compassion, inspiration, drama, and valuable insights into one of the most significant causes of our age.”—Helen Bevan, director of service transformation, NHS Institute for Innovation and Improvement

“The Best Practice illuminate[s] how we can all work towards the goal of high-quality health care for all Americans. For those of us committed to achieving this goal in our lifetimes, this book shows us how much we need the visionaries profiled in these pages.”—Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO, Robert Wood Johnson Foundation

“The Best Practice is a must-read for anyone who cares about the state of American medicine…. [It] provides much-needed understanding of the complexity of ensuring the delivery of reliable, consistent, and high-quality medical care [and] shows how even small design flaws within the system can have serious ramifications for patient safety and care.”—Marshall N. Carter, former CEO, State Street Bank and Trust

“a great read”—U.S. News and World Report, June 17, 2008

New York Times, July, 29, 2008
“the first large-scale history of the quality movement”

Product Description

Americans have always thought their healthcare system was the best in the world. But starting in the late 1990s, shocking reports emerged that showed this was far from the truth. Treatment-related deaths or “complications” were found to be the fifth leading cause of death for Americans, and hundreds of thousands of patients were being harmed by botched medical procedures.

Spurred by the quality crisis, a group of visionary physicians led by Donald Berwick and Paul Batalden embarked on a study of industrial “quality improvement” techniques, daring to apply them to the practice of medicine despite resistance from the medical community. The Best Practice tells the story of this burgeoning movement, and of how the medical landscape is being radically transformed—for the better.

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marketing the invisible

The transformation from a manufacturing-based economy to one that’s all about service has been well documented. Today it’s estimated that nearly 75 percent of Americans work in the service sector. Instead of producing tangibles–automobiles, clothes, and tools–more and more of us are in the business of providing intangibles–health care, entertainment, tourism, legal services, and so on. However, according to Harry Beckwith, most of these intangibles are still being marketed like products were 20 years ago. In Selling the Invisible, Beckwith argues that what consumers are primarily interested in today are not features, but relationships. Even companies who think that they sell only tangible products should rethink their approach to product development and marketing and sales. For example, when a customer buys a Saturn automobile, what they’re really buying is not the car, but the way that Saturn does business. Beckwith provides an excellent forum for thinking differently about the nature of services and how they can be effectively marketed. If you’re at all involved in marketing or sales, then Selling the Invisible is definitely worth a look.

From Library Journal
“Don’t sell the steak. Sell the sizzle.” In today’s service business, author Beckwith suggests this old marketing adage is likely to guarantee failure. In this timely addition to the management genre, Beckwith summarizes key points about selling services learned from experience with his own advertising and marketing firm and when he worked with Fortune 500 companies. The focus here is on the core of service marketing: improving the service, which no amount of clever marketing can make up for if not accomplished. Other key concepts emphasize listening to the customer, selling the long-term relationship, identifying what a business is really selling, recognizing clues about a business that may be conveyed to customers, focusing on the single most important message about the business, and other practical strategies relevant to any service business. Actor Jeffrey Jones’s narration professionally conveys these excellent ideas appropriate for public libraries.?Dale Farris, Groves, Tex.
Copyright 1997 Reed Business Information, Inc. –This text refers to an out of print or unavailable edition of this title.

a book to change your business

From Publishers Weekly
The world is changing ever more rapidly, and the rules of marketing are no different, writes Godin, the field’s reigning guru. The old ways-run-of-the-mill TV commercials, ads in the Wall Street Journal and so on-don’t work like they used to, because such messages are so plentiful that consumers have tuned them out. This means you have to toss out everything you know and do something “remarkable” (the way a purple cow in a field of Guernseys would be remarkable) to have any effect at all, writes Godin (Permission Marketing; Unleashing the Ideavirus). He cites companies like HBO, Starbucks and JetBlue, all of which created new ways of doing old businesses and saw their brands sizzle as a result. Godin’s style is punchy and irreverent, using short, sharp messages to drive his points home. As a result the book is fiery, but not entirely cohesive; at times it resembles a stream-of-consciousness monologue. Still, his wide-ranging advice-be outrageous, tell the truth, test the limits and never settle for just “very good”-is solid and timely.
Copyright 2003 Reed Business Information, Inc.

Book Description
You’re either a Purple Cow or you’re not. You’re either remarkable or invisible. Make your choice.

What do Starbucks and JetBlue and KrispyKreme and Apple and DutchBoy and Kensington and Zespri and Hard Candy have that you don’t? How do they continue to confound critics and achieve spectacular growth, leaving behind former tried-and true brands to gasp their last?

Face it, the checklist of tired ‘P’s marketers have used for decades to get their product noticed -Pricing, Promotion, Publicity, to name a few-aren’t working anymore. There’s an exceptionally important ‘P’ that has to be added to the list. It’s Purple Cow.

Cows, after you’ve seen one, or two, or ten, are boring. A Purple Cow, though…now that would be something. Purple Cow describes something phenomenal, something counterintuitive and exciting and flat out unbelievable. Every day, consumers come face to face with a lot of boring stuff-a lot of brown cows-but you can bet they won’t forget a Purple Cow. And it’s not a marketing function that you can slap on to your product or service. Purple Cow is inherent. It’s built right in, or it’s not there. Period.

In Purple Cow, Seth Godin urges you to put a Purple Cow into everything you build, and everything you do, to create something truly noticeable. It’s a manifesto for marketers who want to help create products that are worth marketing in the first place.

Hospital ….. by Julie Salamon

One thing is clear from Hospital, an account of a year in the life of Maimonides Medical Center in Brooklyn: Running a hospital isn’t much fun.

It’s a million chores made worse by financial worries, ethnic rivalry, bureaucratic infighting, personal avarice, unreasonable expectations and near constant complaint. True, it also means saving lives, relieving pain, restoring health, serving the truly needy and, once in a while, celebrating the human community in a transcendent way. It’s a necessary job, and therefore an important one.

Former New York Times and Wall Street Journal reporter Julie Salamon spent a year taking the D train from her home in Lower Manhattan to the almost century-old, 700-bed hospital in Brooklyn’s Borough Park. (It’s a symbolic journey, as Maimonides both resents Manhattan’s higher-status medical community and is constantly trying to lure stars from it to cross the East River.) The hospital’s historical mission has been to serve the Orthodox Jews who make up about one-quarter of the patients. They function (as one person in the book describes them) as “unionized patients.” They have their own ambulance service, Hatzolah, that carries as many patients to Maimonides as the city’s emergency medical services. The difference is that Hatzolah’s male-only attendants stick around to cajole doctors and nurses and try to get their clients seen quickly.

The head of the Emergency Department, Steve Davidson, at one point got into trouble inside and outside the hospital for hiring someone that a Hatzolah coordinator didn’t like. This required elaborate fence-mending.

“Later he told me,” writes Salamon, “he finally grasped the farcical nature of his situation. . . . Hatzolah didn’t work for him, he worked for Hatzolah. How had he missed this salient point until now?”

But serving the rest of the patients is no easier. Brooklyn teems with immigrants, many of them illegal, newly arrived, non-English-speaking, uninsured, medically unsophisticated and ill. An estimated 67 languages are spoken there. Immigrants are now most of Maimonides’s patients, both in the hospital and in a network of clinics throughout the borough.

“Urdu was the main language on Newkirk Avenue, Spanish in Sunset Park, Russian at the Fifty-seventh Street site, and Chinese (in several dialects) on Eighth Avenue, a few blocks from the new cancer center,” Salamon writes. “About eighty-five thousand patients a year — more than double the number who were admitted to the hospital — were treated at the clinics. The hospital made an effort to install doctors and staff who spoke the same language and, when possible, were from the same background as the patients.”

This would seem a rich (if difficult) vein to mine, and Salamon chips away at it on occasion. But mostly she spends time with people in the executive suites and department chair offices. They include (among others) the hospital president, a woman who suffered a life-threatening car accident soon after taking the job and had to fight to regain her strength as she fought to establish her power; the thoughtful new head of hematology and oncology, who is determined to have his colleagues and trainees think of the spiritual needs of their patients; the West Virginia-reared head of nursing and hospital operations who carries a Curious George lunchbox as a totem that makes her endless inquiries more palatable; and the vice president for patient relations, a politically savvy former assistant to a New York State assemblyman known in the hospital as “Mitzvah Man.”

These people have interesting stories, and they tell them to Salamon, who carries a tape recorder. But focusing the book on them distances us from the more engaging crises taking place every day in the clinics and hospital rooms. It becomes too much an account of administrative events and conflicts described, not observed. And, frankly, there’s just too much kvetching.

One wonders how much a part (if any) HIPAA — the excessively restrictive Health Insurance Portability and Accountability Act of 1996, which governs patient privacy, among other things — played in steering her away from real-time encounters with doctors, nurses and patients. That’s where Maimonides’s — and every hospital’s — real story lies.

There are exceptions. Salamon recorded snippets of clinical encounters in a daily journal, and she reprints some of them in the book. She tells a few long stories as well. One of the more memorable is about “Mr. Zen,” a solitary, Chinese-speaking, undocumented restaurant worker with a cancerous tumor that weighed at least five pounds. For various reasons he managed to stay in the hospital for eight months, a symbol of resistance to life’s misfortunes, one of which was the hospital’s desire to move him out. As he was dying, with more than $1 million in bills racked up, a physician read to him from the Heart Sutra. Although Mr. Zen was an atheist, the doctor, a Buddhist, figured “that was the least I could do for him.”

Medicine has lots of honest, hard-earned pathos and no small amount of drama. Not enough of it is in this Hospital.

slow down with a good read

Tempted by a book of “one-minute bedtime stories” to read to his son and thereby save time while fulfilling, albeit barely, the paternal role, Honore had a moment of truth. Speed, he realized, was a cultural addiction that, far from enhancing his life, was eroding his pleasure in it. He set about finding those swimming–slowly, of course, but strongly–against the tide. Prime among them is Slow Food, started in Italy to support that nation’s time-honored approach to making cheeses, wines, and other regional foods. Now promoting the joys of the table and connection to regional agriculture internationally, Slow Food is one of a growing number of organizations urging us to slow down to enjoy life more. Whether advocating gentle alternative medical therapies (e.g., massage), tantric sex, musical compositions that take ages to perform, or the deceleration of childhood, these organizations share the beliefs that faster isn’t better, and more is rarely enough. Honore’s engaging report on the tortoises among the hares should be embraced by those with quality-of-life and environmental concerns.

the art of pricing


Critical Praise for The Art of Pricing

“The key to getting that additional profit, Mr. Mohammed contends in a clear, conversational tone, is to offer customers a variety of pricing options and allow them to pick the one that works best for them…What is clear from Mr. Mohammed’s book is that it might be easier to produce greater margins by concentrating on the numerator (price) – what you charge – instead of obsessing about costs.”
− The New York Times

“The Art of Pricing is an entertaining primer on how to unlock ‘hidden profits’ and growth by aligning your product’s price with the value customers place on it”
− BusinessWeek SmallBiz

“This conversational, easy and informative read is worth paying attention to.”
− Entrepreneur Magazine

“Here is a book that is really “where the rubber meets the road” pricing…I enjoyed this book because the author…wrote a book full of real world examples–which is rather unusual.”
− 800CEOREAD

Included in the Forbes’ Entrepreneurial Library (10 books that no entrepreneur should be without). “Pricing products and services is one of the most crucial, and difficult, decisions that an entrepreneur will make…he (Mohammed) finds psychological and macroeconomic rules to help readers set prices effectively as they enter the marketplace.”
−Forbes.com

measuring your business

Hubbard explains how to “find the value of intangibles in business.” An excellent book and one which should be on every manager’s book shelf.

Hubbard has made what can be a deadly dull subject interesting and accessible. I found several examples for measuring exactly what I needed and always felt I could not measure. This book is a must read for leaders including the Master Six Sigma Blackbelt on your staff. Finding the value of intangibles in business has always been a challenge. How to Measure Anything is full of practical ideas for getting to a measurement.

Measurement: reducing the uncertainty. As long as we are not willing to accept a best guess, or educated estimate, or range of possibilities for a difficult to measure item we will not move forward. Our decisions will be flawed. Hubbard put forth these four assumptions which I found to be most useful when thinking about measuring:

1. Your problem is not as unique as you think
2. You have more data than you think
3. You need less data than you think
4. There is a useful measurement that is much simpler than you think.

Numbers can be used to confuse people; especially the gullible ones lacking basic skills with numbers. Therefore we, as leaders, must be committed to making sure the whole organization is data driven and understands the way we can reduce uncertainty through the straight forward techniques Hubbard explains. As he states, “The fact is that the preference for ignorance over even marginal reductions in ignorance is never the moral high ground.”

Hubbard gives us a very useful check list for a Universal Approach to Measurement:
1. What are you trying to measure? What is the real meaning of the alleged “intangible?”
2. Why do you care — what’s the decision and where is the “threshold?”
3. How much do you know now — what ranges or probabilities represent your uncertainty about this?
4. What is the value of the information? What are the consequences of being wrong and the chance of being wrong, and what, if any, measurement effort would be justified?
5. Within a cost justified by the information value, which observations would confirm or eliminate different possibilities? For each possible scenario, what is the simplest thing we should see if that scenario were true?
6. How do you conduct the measurement that accounts for various types of avoidable errors (again, where the cost is less than the value of the information)?

I especially enjoy the approach Hubbard takes to quantify the cost of making measurement based on the value of the information obtained. Too often, I have seen projects founder on either inaction to get data which would be of great value and little cost or, perhaps, the exact opposite — spending great amounts of time and money to obtain relatively useless information.