Drinks have WHAT?!

Day 95: Friday

Morning, Tim!

I’m in a class on the US Healthcare system with students from numerous academic areas — business, law, public policy, social services, and medical. It’s a remarkable experience to have each of those perspectives represented in a dialogue.

We recently had a delightful conversation about social determinants of health, particularly within a rural setting. Social determinants are all of the things outside of your actual health that impact the person — their ability to retain housing, get transportation as needed, obtain food, clothing, etc. Coming from the business side of things, I’m always pleased when I hear others so passionate about others — thinking about how to set up society for human flourishing on a macro level while making a significant difference on particular individuals on a micro level.

Our dialogue around social determinants quickly turned to responsibility (and for good measure, genomics was brought in to make sure we had clinical determinants!). Questions ranged from personal responsibility — how much should the individual be held accountable for their own health — to that of a society, which naturally had substantive dependencies on the answer to personal responsibility.

Responsibility is fascinating. We each want to believe we have so much control, and act accordingly. We take credit for our actions (at least when good!) and blame others for theirs. We hand out awards for success, perhaps even a shiny medal. Yet, at the same time, we recognize that this responsibility might be overstated. When pushed, we recognize that there are myriad factors that impact each of us, shaping how we act, shaping who we become.

One of those factors for me was my childhood spent in a rural setting. I learned a lot there. I learned about simplicity, about living within means and not in abundance. I learned about working with your hands, about hard work. I learned about taking care of others in the community, because that’s what neighbors do.

There were also things I didn’t learn. Like that drinks had calories.

Tim, I didn’t learn drinks could have calories until I went to college.

Yes, we are shaped by much around us. And for some, that impact is particularly negative, and something we should strive to recognize and address. Yet the story doesn’t end there — for others, there are opportunities to be uniquely positioned to make an impact.

I’m feeling a weight to think more about rural healthcare. There’s got to be a way to bring health and vitality to rural communities.

Or at least let them know that drinks have calories…

Until Monday,

Zak

It’s like Uber for Healthcare

Day 89: Wednesday

Morning, Tim!

Though not feeling poetic today, I love when I have enough energy and mental capacity to thoroughly enjoy my work.

I’ve been working on Non-Emergency Medical Transportation (NEMT) solutions recently.

A bit of background, followed by why I’m interested:

NEMT has traditionally been provided by an array of parties — ranging from taxis to shuttle buses, volunteers to high-priced ambulances. These services are needed not only for patients but for health systems, insurers, and tax-payers. Because transportation to and from an appointment can be a binary limiter on whether someone is able to receive care, the patient certainly has a stake. Importantly, though, because the patient’s health might otherwise deteriorate, health systems and insurers should also care, as handling sickness before it worsens is in almost every case less costly — even if it means multiple visits. Surgeries, scans, lab tests — they are all more expensive than a simple office visit to ensure someone maintains health. Tax-payers in turn should care, as their dollars are going to providing services and care for substantive portions of the population, both young and old.

The challenge of providing transportation fascinates me. Not only because I can throw out tons of transportation puns, getting on a good roll before someone tells me to put on the brakes because they can’t handle it and I have to stop (That derailed quickly). And not just because everyone in my line of work is talking about ‘the next Uber for healthcare’ when in fact, Uber could be the next Uber for healthcare. No, it’s in part because there are substantive operational considerations (i.e. if a patient is late to an appointment and backs up everyone else; if a patient is sitting in a bed waiting to be discharged but doesn’t yet have a ride, and so the hospital cannot use that bed; etc.). Yet the above stakeholders could also be interested for numerous other reasons — perhaps brand (look at how convenient we are!), patient experience (no one likes to wait around), or to better keep a broad population healthy and happy (taking patients to the pharmacy, community center, or beauty salon). It can be not only an issue of ‘sexy’, new solutions like Uber to make headlines to further a health system’s reputation, but also applying that same technology to address the social issues arising as barriers for those who often need care the most.

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There are tons of companies flooding the space, and it’s an exciting time to be looking at this work. I think it’s most exciting because of it is so broadly applicable, with the ability to interest so many.

Until tomorrow,
Zak

Control Freak Who

Day 74: Monday

Morning, Tim!

I really appreciated your capturing of The Importance of Being Named Ernesto – hilarious.

I wanted to start today with a knock-knock joke.

Knock-knock

Who’s there

Control freak, now you say control freak who

It’s tough to not be in control. I tend to think I can do it better than others. Oh, you’re looking something up on your phone? I should too — just in case. Or research that purchase. Or find it in the cabinet myself (…after you already said we didn’t have any left…). I’ll make the decision on when a work product is good enough, when and if we should meet to get further input. If people would just let me do it, it’ll turn out better!

But come on, that’s not even close to true. First, I don’t have the time to be that great at everything. Second, even if I did, I’ve proven myself time and again to be terrible with control, as evidenced by my waistline, grades, or lack of recognition by Todd, the front desk guy at my gym. I make mistakes times and again, and yet grasp for control all the more.

“Autonomy and control are cardinal virtues of the west” – David Brenner

There are gobs of self-help books. We also have a pretty good idea of the things we should be doing — be it exercise, education, sleep, putting down our phones more often, caring about others more (and not just in an academic or theoretical way…). So why aren’t we able to do these things, simply by ‘willing’ them?

I’d propose that by ‘willing’ we often mean lacking desires that are often against what’s ultimately best for us, and, when they do appear, be able to deny them anyway. In the case of cake, wow is that stuff good. But I probably shouldn’t eat 3 pieces. In fact, it would be best (…at least easiest…) if I didn’t have a desire for 3 pieces, but rather just one. Moreover, if I did desire 3 pieces, it would be great to say no. That would be control, an exercise of will.

Within that example, we need two things. The first we already noted was a sense of control, the ability to act on the ultimate desire. The second, then, is the actual desire we want to act in accordance with. I think that’s a confusing piece — because if we have ever changing second-order desires (the things we want to desire), then we don’t have time to build the habits necessary to actualize those.

Changing our second-order desires is ultimately like building habits. They take time and commitment, and only truly change if built over a period of time.

As a Christian, this is actually a beautiful thing. It means that we get to set our second-order desires once — in alignment with Christ — and then spend the long hours, full of falling short, in relationship with God ever-marching on. It’s by ceding our control that we actually might change into what we’d like to become.

Until tomorrow,

Zak

Costing a leg

Day 54: Thursday

Morning, Tim!

Silly Josephine…

Tim as you well know I work in healthcare. Thinking about healthcare as a business feels kind of grimy at times — you are making money off of those who desperately need help, many times in order to live. That said, having worked with a lot of Catholic hospital systems, the usual saying goes “No margin no mission”. In order to operate, in order to help all of those people, they need to have the financial backing to do so. They certainly have a lot of write-offs each year, essentially donating care back to communities; but it’s no news that in the U.S., healthcare is expensive, and many people are paying all they can afford in medical bills.

I’m not sure how I’m supposed to think about making money off of others’ misfortune. In one hand, I’m helping them extend life; in the other, the cost of that extension is often a poor quality of life, constantly fretting about bills and work.

I recently came across some articles about financially backing legal cases. I asked a friend of mine with a law degree to explain in a bit more detail, but the gist is that there are many wrongs done to people – e.g. abuse, discrimination, etc. – done by a corporation that has quite a bit of money. If the individual were to sue, there are legal ways for the corporation to spend those dollars quickly prolonging and “drowning” the individual, making it effectively impossible to sue in many cases. There are some lawyers who will work on a contingency basis, not getting paid until the individual does — but they typically have caps far smaller than would be necessary to take on a corporation.

The linked article discusses financially backing some of these cases. Now I certainly don’t have enough money to bankroll anyone’s legal case, but the idea still intrigues me. If real harm was done, shouldn’t there be some recompense paid? The same problem we saw above begins to arise, though – in order to operate like this, the financial backer would need some form of compensation, thus taking a portion of what would go to the individual. There’s this feeling of doing good while simultaneously lessening the good done.

I’m not sure there’s any way around it within healthcare. Hopefully make it cheaper to deliver care, I suppose. It’s just unfortunate that there’s a cost to doing good.

Until tomorrow,

Zak

Volcanos and Good (Women) Doctors

Day 34: Wednesday

Morning, Tim!

Today I defend your cacophony of structuralism with (giant [and well drawn…]) earplugs!! I then attack your base (well played) with a giant bottle of vinegar (I contemplated having a man jumping on the bottle to squirt it out as if it were a water blob, but wasn’t able to accurately portray that…). So yeah…take that.

Day 3: Under siege

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My base is defended by earplugs (alternatively it could be headphones and listening to all about that bass…). Your “base” is being attacked by a spritzing bottle of vinegar. 

While fun to draw on my phone, I may need to print out next time…silly big fingers…


One article that has received a fair amount of attention the past couple days calls out disparities in physicians, most notably a quality of care gap favoring female physicians.

“Salaries for female physicians average some $19,879—eight percent—lower than male physicians. At academic hospitals, male physicians receive more research funding and are more than twice as likely as female physicians to rise to the rank of full professor.”

Justified by something, perhaps quality? Nah…

Female physicians actually tend to provide higher-quality medical care than males, according to research released today. If male physicians were as adept as females, some 32,000 fewer Americans would die every year—among Medicare patients alone.

An interesting find. I’m not a clinician, but were I to pursue that route I’d easily be a part of the higher paid statistic – I’m male. Not a part of this study, but I’m also white and tall, each giving me undeserved advantages, privileges. Something isn’t right about that.

But the interesting piece about the article isn’t just the observation that the pay gap is obviously undeserved. At the end of the day, it’s better for patients – they get better results. What is it that brings this about? Is it a communication style? Perhaps an intelligence level of the subset of women self-selecting into the field? Time spent with the patient? Compassion? Less ego?

It’ll be interesting to learn more as they dig in to this.

Until tomorrow,

Zak

First and best, for 100 years

Day 28: Wednesday

Morning, Tim!

I work with a lot of entrepreneurs. Most of the companies I interact with have been around for less than 5 years, many for only 1, and each are in ongoing development mode. They are passionate about the work they do and, being in healthcare, oftentimes have a personal story about why they do the work they do. It is wonderful work – entrepreneurs have said they want to make a difference, that the current way of doing things wasn’t good enough on it’s own, and that they want to contribute to making it better.

In thinking about what makes at least some of these companies successful as they scale, I’ve been primed to look at Amazon first, and recently received another example in Patagonia that is similar, yet with some key differences. I recognize the immediate thought may (should) be “But Zak…those aren’t startups”. Correct. But they are both led by entrepreneurs who have control and who have established what success looks like for their companies.

Taking Amazon first, Bezos saw Amazon wasn’t great at working internally when one team needed access to what another team was working on. Perhaps the means of getting there are a bit unsettling, but Bezos mandated that teams had to create interfaces to connect with one another, and that all communication must be through these interfaces. For context, Bezos was taking away any shortcuts – it was more work to create these interfaces (particularly backwards, in many cases). When your vision is to be around after 100 years, though, you build it right – no need for shortcuts, you build it to last and to scale. By forcing teams to create this infrastructure to support Amazon.com, they had also built it for the rest of the world – AWS allows for Amazon to build tech infrastructure that others would use, and they know others will use it because they use it. They are their first and best customer (and…it’s nice when your best customer is the largest online retail giant). Amazon has also done this with their distribution infrastructure, figuring out how to fulfill 2-day delivery all across the US. By building it to meet their own needs, they can just as easily meet others (because they intimately know the needs and challenges faced).

Turning to Patagonia, Yvon Chouinard founded the company because he didn’t like the equipment available to him for climbing. Wanting better gear, he made it – realizing others would want it, he made more and sold it. He did the same for clothing, finding that he couldn’t find elsewhere the clothes he himself would want to wear. The jackets not built to last, nor built for quickly changing weather. The shirts were too bland, the shorts not sturdy. As he created, he also brought on others who, like him, did the activities he wanted to create a company to support. Who better to know what the surfer needs than the guy who, rather than be in his job, mostly just wants to surf all day. While not a clean comparison (Patagonia employees aren’t themselves a best customer in the way that Amazon.com is for AWS, not supporting with nearly the same size/scale) and I’m over-simplifying, but the end-result is similar – Yvon created a company that values doing it “right”, as if they were going to be there in a 100 years, and made products that they themselves wanted in order that they might better do their passions/jobs.

I’m not sure what this looks like for healthcare. In advising health systems, it looks like first and foremost creating a system that the individuals themselves would want to go to. Perhaps that means there is more personalization – whether genomics or simply knowing I prefer Zak to Zakary when I come in. Perhaps it’s a focus on making things safer – perhaps by reducing unnecessary variation in supplies so people can become better experts, perhaps by enforcing hand-washing. Perhaps it’s building a workplace that supports its employees – a workplace that clinicians want to go to, even though the work they do every day is physically and emotionally taxing. I’m not exactly sure how to put this into practice for entrepreneurs within healthcare, but it’s something I think about. Perhaps making medical records more accessible, or innovating within chronic disease or mental health is relevant.

Anyway – I like the idea of creating things that will last, not because of “legacy” but because it’s inspiring to act in a way that is rewarding – to “do it right” and feel satisfied in the work done because it wasn’t for short-term gain or one that took shortcuts. It’s admirable to put in the work, having the discipline to do it right – even more so when empowering others to do that work in their daily lives with you.

Until tomorrow,

Zak

Grappling with others – as rational actors?

Day 6: Monday

Morning, Tim!

I hope the weather has improved, and, if you are sick, I hope you feel much better. If you are writing about not admitting to sickness just for fun, and aren’t sick at all…well I suppose I hope you stay well, but more importantly want you to know how truly impressed at the boldness and reach for a good bit to write about.

Not sure what kind of sickness you might be experiencing. But, particularly in light of you being in Italy, I hope it’s not a stomach bug, as I’m just going to leave this here.

Visiting family was lovely. Weather, you’ll be pleased to hear, was beautiful.

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Is it good for us to disagree? Not you and I, specifically; I mean it more in the the Royal us (is there such a thing?) Weather is fairly agreeable in fact, but not in kind – while we both likely have a phone app that tells us the temperature, you may think it pleasant at 80°F. For me that would make my walk to work an absolute disaster. Similarly, your enjoyment of rain and clouds may be understandably disliked by others (at least those who, again, like me, don’t always bring an umbrella and sit at work for hours with drinched clothes). It seems we should try to disagree more, Tim. By forcing ourselves to confront differences in others (and, by logical extension ourselves), we have the opportunity to see life from their perspective.

I’m in school, currently studying negotiations. My professor, discussing some of the differences in psychologists’ and economists’ viewpoints on rationality brought up the rational actor. I have read behavioral economists and can appreciate the perspective brought by psychologists on how individuals’ actions are not necessarily in line with economists predictions; however, the interesting piece I hadn’t fully grappled with was a counterargument that these individuals may well be acting rationally, if only we understood their full perspective. While I’m not sure how well that counterargument holds up (and will continue to read to further understand), it has kept me thinking. While it’s obviously impossible to truly understand all that is impacting another, it seems that part of being human is to be relational with others; if that is the case, better understanding their actions may mean better understanding the circumstances leading to that action, understanding the differences in background or opinion that have lead to that choice. Despite male or female, urban or rural, national or foreign, race, height, aesthetic beauty, marital status, talent for sports, or ability for humor (among countless others), perhaps making diversity a priority (a pillar, if you will) isn’t such a bad thing after all.

Until tomorrow,

Zak

p.s. the Swordfish fighting video was so far under half of what I was hoping for. I would have preferred Knifefish fighting to that. Or a grape Blow Pop. Man those things are good…