Why is there no Chinese Football team at the World Cup?

The China team is so bad it can barely beat middle schoolers
http://mobile.shanghaiist.com/2009/04/17/how_terrible_is_the_chinese_footbal.php

but seriously why so terrible? It’s not cuz they don’t have the resources, just look at how much they spent on the olympics. It’s not because Asians are too short or physically unfit just look at South and even North Korea or Japan. That leaves politics and economics. The CFA is under the Chinese State Council while also being supposedly a nonprofit with profit seeking subsidiaries like the China Superleague. This leaves it vulnerable to mixed mission and profit motives, thr nowhere land for effective organizations!

Concept of Leverage

Was chatting with Eric today and thought his idea of leverage was really interesting. Basically, the idea is that operationally there are three types of leverage in increasing order of potency: rules, tools, people. Interestingly we seem to always gravitate toward the least potent form of leverage to solve our problems by throwing people at it. However, people are often the source of the problem due to their inconsistency, irrationality, etc etc. Interestingly in medicine similarly to other industries, we have tried to solve the problems of poor quality and increasing costs by throwing more people at it when in fact what we might need are better rules in the form of evidence based checklists and procedures and tools in the form of diagnostics that would help to risk stratify patients.

The Best ____ are the Best people

Who knew one could learn something about being a good venture capitalist, healthcare delivery scientist, doctor, leader from former NBA player Chris Webber?

I was listening to the ESPN preview Lakers-Celtics game 1 (whoo hoo) and I heard Webber say “the best coaches are the best people” referring to Doc Rivers, coach of the Boston Celtics who believed in his team when they didn’t believe in themselves and has coached a #5 seed to the NBA finals against conventional wisdom.

This is so true about so many things related to leadership. Its about caring about the end state not promoting oneself that makes good leaders who they are. I have absolutely learned this from the key leaders I have had the pleasure of working with and the ones I gravitate towards are the ones who combine being a genuinely good person with a track record of effectiveness in the organizations they lead: Jim and Steve leading a University, Errik and Tillman running a biotech firm and others have all show amazing track record with being genuinely good people and its these people that I hope to be like someday.

Different theories on the bottleneck in Healthcare

Jim Kim has a slide that he likes to use in his talks about what is wrong with the healthcare system. The logic goes something like this: we spend billions on high tech R&D for new drugs and devices when we don’t yet utilize our current technologies in a judicious and cost effective way. In fact, we don’t even know how well we use our current technology because that data on outcomes and the quality of patient care is often not even collected. Thus the need is for a science of implementation aka the science of healthcare delivery to go alongside the traditional basic and clinical sciences.

I learned the other point of view today which can probably be best illustrated through an example of two conditions which are both treated by antibiotics: Cdiff infection vs Cellulitis. Cdiff may well be an area in which the value of healthcare delivery can be easily seen. Both the diagnosis using a highly sensitive and specific test Cdiff toxin in stool as well as  the outcome, cessation of the cardinal symptom (diarrhea) supported by laboratory evidence from stool samples of negative Cdiff antigen is quite clear. This is an area where providers can be assessed on the proper diagnosis and the outcome of treatment. Perhaps this is an area amenable to the science of healthcare delivery.

On the other hand, take cellulitis, an area where the diagnosis is often by expert opinion and prescribing patterns are highly variable. Science of HCD people may argue, well thats exactly where we should apply the science to systematize the expert opinion and measure improvement in outcomes. However, one may also see this as an area in desperate need of better diagnostic and treatment modalities.

Thus the alternative point of view is that until a disease can be diagnosed and its natural history predicted with 90% accuracy and its treatment is 90% effective, there will always be a need for further products.

Which one is right? I personally intend to hedge myself so that I can learn about and participate in both as an academic physician working in healthcare delivery and life science entrepreneur building disruptive innovations.

Greece – who cares?

1) Eu growth slows demand for US products
2) Depreciated euro will compete in exports with US/China
3) Will capital markets crisis devolve into 2008 style crisis? Niall Ferguson

When gov outspends taxes choices
-sell debt to private investors
-default (in 3yrs?)
-transfers from other gov (145bn bailout)
-inflate away value of debt by selling to central bank print money (ECB buying Greek debt)

Greece has funded large CA deficit with capital account surplus which is savings of other countries vs Japan who funds their large debt/GDP with their large savings rate

Happiness is cheap!

I’m sitting on the steps of Collis on a perfect sunny New England day, sipping a smoothie getting ready to read all about how the Brits got massacred in Kabul in Peter Hopkirks book the Great Game. I had lunch at Yamas with Kevin and I think his passion for the topic really inspired me to want to read about blood gore and adventure. I am still looking for that job where I can make relationships for a living with interesting people. I suppose that is why I chose medicine and business but even in those there really isn’t a perfect function where all you do is build relationships without the crap of staying up all night filling out forms and writing notes all night. Sigh, maybe life is all about being able to be on vacation or unemployed . . .

Medicine is one large decentralized organization

It occurs to me that healthcare suffers from a simple issue that many large organizations face. Namely as individual practitioners are given autonomy over major decisions that affect quality and costs, of course you will have variation in outcomes. The management solutions in this situation are simple, to centralize decision making (lobbying medicare to require certain algorithms of care), changing performance system (Pay for Performance), change accounting system to take into consideration poor outcomes.

Stop apologizing

I am taking a course called Communicating with Presence in my last term at Tuck. We did an exercise recently called “Conversation with your Inner Critic” that I found illuminating. It basically consisted of assuming one’s critical voice when it comes to public speaking and voicing ones own doubts about oneself. It was a strong example of how we are all our own worst self critics. I remember being suprised at how critical I was when we role played in class going so far as to tell myself to “go home” since I was never going to be a good public speaker. Pretty crazy.

What I found quite interesting in all of the relaxation and self reflection exercises is this. In finding one’s confidence, one’s voice, one only has to overcome ones own fears and self doubts. For me, I have decided that this means to STOP apologizing for things I do and just try to be myself and accept both the good and the bad decisions I make.

Let’s see how we do! :)

Insights from the Dartmouth Summit

I just organized what looks like the first of many Dartmouth Summits on Healthcare Delivery.

http://mba.tuck.dartmouth.edu/healthcare/summit.html

It was a big success highlighted by Michael Porter teaching a roomful of business, medical school, graduate school and undergraduate students an HBS case about the Dartmouth Hitchcock Spine center. We even had a faculty workshop in which three of the top professors from TDI, Tuck and Dartmouth Hitchcock will be leading case-writing teams of faculty and students.

This was a very revealing event to me in terms of my own leadership in many ways. Most of all, it helped me to realize that the reason why all the grey-hairs keep telling us juniors that “its all about finding your passion”. Passion leads to ownership and commitment to what you are doing and enables you to have the energy and ability to move people. It doesn’t matter if you are an engineer, a doctor, or a student trying to move an institution forward, passion is always your best competitive advantage.

It also made me realize that when you do something significant, there is enough credit to go around so it almost doesn’t matter who gets the credit. This has not been easy for me at times because I often felt like I had to take on disproportionate work yet deferred the credit from myself to the students who will be staying behind and taking on this event next year. Taking my leadership to the next level will depend on my ability to subjugate my own ego for the objective to create something that sustains and goes on.

I also realized that having a platform matters. Having a position of influence buys you credibility such as being an MD/MBA student at Dartmouth or a future resident at Hopkins. However, credibility must be paired with delivery of an outcome for you to realize the value from that relationship. You can get anyone in the world to help you by having the right introduction, appealing to their interests and a demonstration of competence.

I learned how much one’s gut really does matter in choosing the right people and that giving people an opportunity to declare their abilities and motivation early is key.

Finally, I realized the importance of knowing one’s environment, knowing the players, knowing where the levers are as well as which to pull is critical. I think I am starting to see the advantage to settling down somewhere and building a network which will allow me to build things and have an opportunity to lead.

A framework for career decisionmaking

I recently thought up a good way to frame decisionmaking about what I would like to do with my life. I think I value 3 qualities in a profession. In no particular order these are:
1) Impact meaning the impact of my work on people’s lives as defined by some measure of quality improvement in someone’s life times number of lives affected.
2) Independence – by this I mean both the personal and professional flexibility to be creative with my day and as Krishna would say determine the “texture” of my day.
3) Wealth and Profit – I am a big believer that value can always be measured in $ and that no matter what people say about the advancement of nonprofit, it takes the profit motive to really add the scale, permanence and continuous innovation and competition that we see in mature markets. Take adoption of Hospice care for example which was a movement by nursing to make end of life care reimburseable and when the route of advocacy, changing government legislation and endless policy briefs. It took approximately 40 years starting in the 50s and to finally get reimbursement in 1995 and full adoption of Palliative care as a field is still ongoing process. Then take microfinance which discovered an untapped market which took almost as long 30 years to become mainstream starting in the mid seventies and culminating with Muhammed Yunus winning the Nobel in 2006. Compare this to the launch of the iphone in 2007 which this year projects to hit 58million units just 3 years later.

So using this framework, I have analyzed the following career options Academic physician, Entrepreneur, Venture Capitalist, Corporate Exec.
AP VC E CE
Impact H L M M
Freedom H H H L
$$$ M H L M

The conclusion? I should be an academic who is also a VC.