The End of Professional Snobbery

By Neil Seeman

Imagine if no prestige attached to professions. Nobody cared about old-world credentials…MD, PhD, JD, MBA, MPH, MHSc: the letters would mean nothing, zip, in this alternate world.

It’s not so far off. Welcome to 2015, the year the Facebook generation is married with kids. This is when Mark Zuckerberg, 24-year-old billionaire, Facebook founder and Harvard dropout, turns 30.

The era of post-professional snobbery will be a very agonizing time…for boomer-generation grandparents. How will they boast about their over-educated children’s accomplishments as quantifiably as they can today? For the rest of society, it will mean a boon to human creativity.

The End of “Perfect Outputs”

In one of the most downloaded videos on the Web – Sir Ken Robinson explains, to roaring applause at a TED conference, how our educational system kills creativity in young people. Our system, he says, is geared to producing one “perfect output”: the university professor. Robinson blames the post-industrial age educational model for vaporizing creativity from children, promoting a culture where test-taking ability, rather than intellectual agility and ingenuity, reigns.

Young people under 30 – the Google Generation, the Facebook Generation, whatever title you fancy – really are different. They care more about social good, and less about status. This is not an original hypothesis. Leading thinkers on innovation - Gary Hamel, Don Tapscott and Jeff Jarvis – have written books on this. What has been less explored is what this means for healthcare.

In the era when newspapers drove the climate of public opinion – about two years ago – OpEds on healthcare were written by PhDs and MDs. Nowadays patient-experts write many of the most popular blogs (with clinically accurate content). Google controls health-seeking behaviour, with at least 70% of all searches on healthcare information originating from the Google search box.

When MDs and PhDs carry less prestige…

Today, the only job titles that earn real respect at cocktail parties are “social entrepreneur” and “artist” (though I admit I attract a fair deal of intrigue when I tell people that I’ve taken up boxing). Why does this matter for healthcare? Why does it matter for governments?

As Gary Hamel has trenchantly written, “Thanks to Enron, WorldCom, Adelphia, FEMA, Lehman Brothers, AIG, Fannie Mae, et al, the generation now joining the workforce has an extraordinarily jaundiced view of authority. They are deeply (and often rightly) suspicious of large organizations and those who run them. In their view, it’s not titles and credentials that make a leader worth following, but mission, self-sacrifice and world-class competence.”

Line management in both the delivery and organization of healthcare will need to get flatter. This means wider scopes of practice – for all members of the care team, which includes patients and their families. Further, CEOs will need to learn how to admit their mistakes. This is the signature virtue of the Facebook generation: humility. I always laugh when people tell me that social networks such as Facebook and MySpace and micro-blogging tools like Twitter show that the “younger generation” is self-centered. In fact, the average age of a user on Linkedin is 41; Linkedin is the fourth-most popular social networking site on the World Wide Web, with 40 million users. People under 30 demonstrate both humility and ego in equal measure. These are not mutually exclusive personality characteristics.

They can chest-thump like the rest of us (witness the scores of Facebook pages boasting about winning beer-chugging contests). But they can also confess to being wrong. Mark Zuckerberg, Facebook’s CEO, did exactly this when he responded to a storm of user protest and removed Beacon, a Facebook application. Zuckerberg famously wrote on his blog in December 2007:

“About a month ago, we released a new feature called Beacon to try to help people share information with their friends about things they do on the web. We've made a lot of mistakes building this feature, but we've made even more with how we've handled them. We simply did a bad job with this release, and I apologize for it. While I am disappointed with our mistakes, we appreciate all the feedback we have received from our users. I'd like to discuss what we have learned and how we have improved Beacon.”

…we will start to measure innovation and good governance differently

Today, we measure “innovation” through reference to numbers of publications, the impact factor of journals, academic citations, numbers of degrees after one’s name, and other proxies of knowledge translation. But if ingenuity and agility are what matters – we are currently preparing our children for jobs that may not exist as we know them. The US Department of Labor predicts that the average learner will have 10-14 jobs by the time they are 38. Niche licensing, already commonplace in healthcare, will intensify. At the same time, there simply won’t be enough people with the requisite prescribed credentials (e.g. health records, information management, and health information technology) to satisfy the HR managers.

And so we will need to recruit very differently. Memo to management: drop the “fast-track executive model”; reward the curiosity-seekers, even if they fall flat-footed on their first, second, or third time round. Beware job applicants who have had perfectly linear career paths.

What is more, we may need to measure innovation capacity in the workplace differently, especially in healthcare (where the jobs will be) by qualities such as tolerance for failure; willingness to admit mistakes; and, most crucially, ability to learn from those mistakes.

Few will ever accuse Facebook’s Mark Zuckerberg of modesty, but his apologia for his Beacon debacle is emblematic of the new age. Imagine if a hospital admitted in a CEO’s blog that its big-budget technology implementation failed miserably? And then have the CEO tell her clients how she had learned from her mistake? That is good governance, Facebook-style.

About the Author

Neil Seeman is Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College, University of Toronto.

It’s Good to be Alive: Limericks in Bloom

By Neil Seeman

The economy crashes, and falters, and fails
You utter the wildest, most hair-raising wails,
“Should I buy, should I sell?”
But there’s no one who’ll tell.
It’s chaos around you and panic prevails.

Yet holiday weekends were meant to have fun
To warm weary bones in the heat of the sun
To soak aching toes
Forget all your woes
And bask in successes laboriously won.

Forget the travails; you are, thank God, alive
You know that, no matter, you’ll always survive
You know you have friends
Who will go to all ends
To be there for you till your spirits revive.

I’d always liked poking some innocent fun,
Joking when others were morbidly glum.
My friends would be crying
I’d smile at their sighing
And tell them that grieving was clearly “too dumb.”

So welcome the spring, when the world is ablossom
The view from my window’s amazingly awesome
Pansies, impatiens
In stunning variations
I think I will go and attempt now to grow some.

It’s spring, and you look, and you can’t fail to notice
That purple-blue buds have come out into focus
When the first bluish hue
Makes its yearly debut,
It’s time to rejoice at the birth of the crocus!

I exult at our hedge with its gorgeous azalea
It brightens our garden in splendid regalia
It’s pink, red and milky
Luxuriant and silky,
Each spring it parades its new paraphernalia.

When you see that your garden’s outfitted in frocks
Whose beauty just happens to knock off your socks
I bet that you’ve planted
Something enchanted -
Polychromatic and plentiful phlox.

Like gardens, we humans are, thank God, alive
We’re fruitful, productive and yes, we’ll survive!
We’ll laugh at our ills and our trifling distress
With humour and beauty we’ll battle our stress
It’s springtime, the season to thoroughly thrive.

It’s the springtime of hope and it’s time for good cheer
Now is the loveliest time of the year
Forget your finances
And broken romances
It’s time to rejoice with the ones you hold dear.

About the Author

Neil Seeman is Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College, University of Toronto.

India On My Mind

By Neil Seeman

I have never visited India. I know little of its culture, geography, history, or politics. One thing I know is that lots of smart people are writing about healthcare innovation in India. In Canada, more smart people have been thinking about how best to measure innovation. To be sure, measuring innovation is slippery: it’s hard to quantify “accidental triumphs” or “successful failures” in healthcare. We often revert to measuring interesting, but limited, output indicators: patents, publications, citations.

What if we could measure a country’s agility to innovate? This leads me to India.

India’s Healthcare Innovation Pivot

A pivot is the central point, or pin, on which a mechanism turns or oscillates in a new direction. Can we measure a region’s ability to “pivot” – to bridle the horse and gallop off in a new direction? The Indian healthcare economy is pivoting.

As the Wall Street Journal’s Peter Wonacott reported last month, rural India is defying the global economic slump. He wrote: “In poor and largely rural states from Orissa in the east to Rajasthan in the west, many new leaders have invested in health, education and infrastructure. That has set the stage for the creation of industry and consumer markets and enabled upward mobility.”

Nitish Kumar, chief minister of Bihar, India – where only one in ten people can read – has recruited private-clinic doctors from rich regions to public hospitals in the country’s poorest state. In an alliance led by his Janata Dal party, Mr. Kumar champions “Government 2.0” – the low-tech variety. He hosts Monday open houses at his home, where ministers must respond to public complaints. Bureaucrats travel with him to town-hall meetings across the most impoverished areas of the state, where they pitch tents in mud fields.

India’s economy is standing up boldly athwart the global downturn, and pockets of innovation in rural India are leading the country forward. Speaking at a recent meeting on “India's Future” organized by the Confederation of Indian Industry in Coimbatore, Gurcharan Das, author of India Unbound and former CEO of Procter and Gamble (India), said India’s economy will recover faster than others’. The International Monetary Fund projects India’s economy will grow 5.1% in 2009 (versus 0.5% for the rest of the world).

In Bihar, there are auspicious signs: The number of people migrating out of the state dropped 27% in the 2006-08 period compared with 2001-03, according to the Bihar Institute of Economic Studies. This, despite the fact that more than half of Bihar’s 83 million residents live below the international poverty line of about $1 dollar (US) a day.

Writer Vijay Vaitheeswaran has noted how India is better-equipped than many richer nations to embrace healthcare innovations. Fewer than 20% of US surgeons in America use health information technology (HIT). In contrast, according to Technopak Healthcare, a consulting firm, nearly 60% of Indian hospitals take advantage of HIT. India is fast becoming a hub for clinical research. Admittedly, India has a long, long, long way to go: tens of millions of Indians go without healthcare despite the country being a global hotspot for “medical tourism.” India owes much to its destitute: the level of malnourished children is higher than that of sub-Saharan Africa.

Yet, over the last decade, India has also emerged as the destination of choice for US healthcare organizations that take HIT seriously, in part because of India’s low-cost labour force – but also because of the ingenuity the country has shown in its embrace of new business processes. Recognizing the scarcity of trained e-health professionals in America, India has jumped in. The Nittany Institute in Chennai is suddenly overflowing with Indians taking courses in medical coding, IT Infrastructure management, even “e-talk” – the jargon of e-health.

The Diaspora Returns to Lead the Pivot

“India has always had access to intellectual capital,” says my colleague Amol Deshpande, “but it has lacked good infrastructure and abundant early capital funding.” Amol recently returned from Mumbai where he met Indian-born entrepreneurs at healthcare expos. He recalls some revealing conversations. “I was born in India,” conference attendees would tell him, “but I just came back after 12 years in Silicon Valley.” “The return of non-resident Indians with entrepreneurial minds, their own capital (from the US) and relatively cheap access to good technological infrastructure has begun to change the innovation landscape,” Amol tells me. “Combined with increased demand from a growing middle class and rising rural economy, innovation will begin to flourish.”

The Indian healthcare economy is pivoting thanks to money, brainpower and raw ingenuity. The poorest regions of India are leading this bottom-up revolution; they have the most to gain.

Can Canadian Healthcare Pivot?

It is the “bob and weave” of the Indian economy that impresses me. As the global economic punch arrives, India bends its legs quickly and simultaneously shifts its body. Will Canada pivot or buckle? I don’t know. Manny “Pac-Man” Pacquiao, the Filipino boxer who is emerging as the next all-time great, “slips” from opponents with beauty; hand-speed is what makes him special. Ali’s magic was in footwork, not his punch. My own boxing trainer, Theo Asante, always tells me “anyone can throw a punch”; it’s avoiding the punch that matters. People who measure innovation should consider how to measure agility. Look to India.

Some additional links of interest:

• www.strategy-business.com/press/freearticle/06306
• www.canada-indiabusiness
• www.ideas-innovation.blogspot.com
• www.principledinnovation.com/blog
• www.endlessinnovation.typepad.com
• www.howardwright.com
• www.innosight.com/blog/353-cherish-failure---paul-saffo-world-innovation-forum.html
• www.mootee.typepad.com/innovation_playground/2009/05/the-new-age-of-innovation-when-every-global-industry-will-be-restructure.html
• www.blog.julielenzerkirk.com
• www.getfreshminds.com
• www.innovation.fleishmanhillard.com/?p=3071
• www.pbconnect.com/blog
• conferences.ted.com/TEDIndia/program

About the Author
Neil Seeman is Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College, University of Toronto.

p.s. More on ‘I don’t Know’
Last week’s essay on “I don’t know” was “tweeted” on Twitter. Trisha Torrey, a globally renowned patient advocate and writer for About.com, picked up the discussion and asked her readers if their doctor had ever told them, “I don’t know”. See the results of the poll here.

The Power of “I don’t know”

By Neil Seeman

Saying “I don’t know” can be a deeply liberating experience. People in healthcare – and in virtually all service industries – do not say this nearly enough. The client ends up suffering.

I learned the power of this phrase in law school; I hadn’t read the course notes, and, upon being fingered by the lecturer for an answer, I couldn’t fake it. Saying “I don’t know,” then pledging to the teacher to learn the answer, made me feel at once authentic and committed.

Trouble is, “I don’t know” is an alien phrase for many information elites – including everyone from lawyers to accountants to insurance salespeople to what Deepak Chopra calls “Medical Deities” (aka MDs). My colleague Carlos Rizo has suggested an entire course be taught in medical school on how and why and when to say “I don’t know.”

In a talk called “Empowering Patients” at a spectacular conference – “One Patient, One Record,” organized by Kevin Leonard and colleagues of the University of Toronto and patientdestiny.com – speaker Doug Gosling twigged me to the power of “I don’t know.” When chronically ill patients have access to their full medical record, Mr. Gosling explained, it is very hard to hoodwink them. If a clinician fails to say “I don’t know,” a patient detects evasiveness.

Perhaps “lie” is the right word. Lawyers will make a fancy case that in rare instances “saving” a patient from the truth is worth the lie. Maybe so. But here’s our reality: In 0.2 seconds – the time it takes to blink – it is possible for anyone anywhere with access to the Web to type in a health term into Google and for Google to send back a solid answer.

When you’re chronically ill, you are Googling about your illness several times a day. There are many who say we still need “information curators” to sift through the “noise”. Not always. I believe Google is making most of us a whole lot smarter about our healthcare. I think most people with chronic illness can learn enough accurate information online in 24-48 hours about any disease to be able detect whether their care provider is faking an answer.

An example: It is difficult at first to distinguish between obsessive compulsive disorder (OCD) and ritualistic behavior in young children. Many young girls (and boys) like to line up their dolls and pillows in a pre-ordained way every evening before bedtime. Insisting that food be organized in a circumscribed pattern on their dinner plate is also normal for a child. OCD is very different, and research published last year in the Journal of Psychopathology and Behavioral Assessment suggests the condition can develop in children as young as four.

When I asked a pediatrician to explain the difference to me one day, his eyebrows rolled sideways, he touched his left upper brow with his forefinger, and gave me a song and dance about how absurd it was to imagine that a four-year old could exhibit signs of OCD. I lost trust in him because he failed a basic humility test: to say “I don’t know but I’ll try to find out.”

Memo to doctors (and lawyers) everywhere: we pretty much always know when you don’t know (especially when it comes to our children or aging parents). This was probably true before 1995, when there were a few thousand websites, but far more so today when there are billions. And yet, in a paradox, many professionals today – perhaps to legitimize their existence in an age of ubiquitous information – feel they have to know *everything*. To say “I don’t know” is an unthinkable utterance, as if to break honour with a fraternal pledge of feigned knowledge.

True knowledge begins with “I don’t know – but I’ll try to find out.” Ask a patient.

About the Author

Neil Seeman is Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College, University of Toronto.