Category: Strategy

Design Principles – Creating Systems that Work

Monday, 13 February, 2012 10:59 Written by Vijay Goel, MD
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Design Principles Must Flow Across OrganizationI’m the co-owner (with my wife) of a los angeles catering company, Bite Catering Couture.  As I straddle the gap between strategy, understanding, and execution, I’m increasingly aware that “Design” is a fundamental skill any company requires to make its efforts efficient and effective.  The gap between great design and new initiatives is often where I’ve seen customers lost and initiatives fail.

To build this foundational capability, I wrote the following memo that will be used (in some evolving form) to evaluate every initiative we launch from this point forward.  Would be great to hear if others of you out there have come across better examples I can borrow/ steal to improve my team’s understanding of great design from a business / systems standpoint.

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Summary: Bite’s systems are the bedrock that enables us to scale our operations while guaranteeing that each customer will experience the extraordinary events that our brand stands for.  Good design ensures that our systems will be:

  • easy for our people to understand,
  • execution will occur automatically (post-implementation)
  • results-oriented and self-correcting

 

Objective: Lay out the key design principles that will be used to evaluate every process proposed at Bite.

Goal: To eliminate predictable delays and errors in implementing Bite processes.  We will always start with:

  • a clear vision of the desired future state
  • a clear metric for how we will track and measure success
  • a solid understanding of the likely challenges we will need to solve for
  • an understanding of the interdependencies with other existing initiatives and operations at Bite
  • an understanding of the resources required to execute on an ongoing basis and those required to plan and implement

Criteria utilized to evaluate design:

  1. Clear vision of the desired future state:  What does the successful implementation and execution of this system enable Bite to do?  What will it look like?  How is this different from today?  What choices or tradeoffs were made in selecting this vision for the future?    What is the business case/ expected return on investment?
  2. Clear metrics for tracking and measuring success:  How will we measure success? Do we currently track this metric today?  If not, what needs to be done to track it and who needs to be involved?  How will we ensure we’re accurately tracking results?  What is an acceptable score?
  3. Understanding of the likely challenges to be addressed: Where is this initiative likely to fail?  How will the planning and implementation steps reflect the difficulty of successfully reaching automatic execution?  What elements can be utilized to mitigate likely failure points?  What tracking/ piloting needs to take place to improve the likelihood of success/ key learnings. What checks and balances exist to ensure successful implementation?
  4. Interdependencies: What existing processes and initiatives does this system need to incorporate to work at Bite? Are we asking people to be in different places at the same time?  Does the proposed process reflect the connections to other operational requirements or realities?  Does this work for the Bite operating model and facilities? How will this be assigned to accountable individuals in a way that fits in with how they receive instructions today?
  5. Resourcing: Is there a clear and realistic (bottoms up)  projection for the resource impact to execute on an ongoing basis?  Is there a realistic timetable and resource requirement for planning and implementation/ piloting?  What is the cost and is it worth the return?
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Clay Shirky on Collaboration and Institutions

Tuesday, 14 June, 2011 23:25 Written by Vijay Goel, MD
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Terrific Clay Shirky talk on how the reducing cost of communication will change the dynamics of institutions — namely that the coordination cost of large institutions will become higher than the connecting and collaboration costs of small teams and volunteer individuals.

How does an institutional model (thinking in the world of FTEs) begin to understand the contributions of individuals on a power law curve? Competing organizational structures are going to be interesting…

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Using Technology to Transform Education – Salman Khan at TED

Wednesday, 23 March, 2011 17:51 Written by Vijay Goel, MD
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Salmon Khan offers an inspiring TED Talk highlighting his approach to transforming education through technology.  He founded Khan Academy after realizing that his cousins preferred his YouTube video interaction over his actual interaction.  By enabling students to learn at their own pace and review things they didn’t quite get, his platform give students the flexibility to achieve mastery in every topic before moving on.  In a normal classroom, you get your grade and move on regardless of your mastery of the subject covered.

By focusing on proven mastery of a subject (get it right 10 times in a row) over one-size-fits all, Khan has leveraged technology to create a disruptive model of education.  I think it’s a great starting point and I look forward to seeing competition around student mastery of education over the current metrics we use today.

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Measuring Health Value – A “Personal Vitality Score” | Health Information Economy

Wednesday, 16 February, 2011 12:15 Written by Vijay Goel, MD
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This is the 3rd post in the Health Information Economy series.  We are outlining a number of elements outlining a vision for a robust health information economy as we put together a submission for the Economist-Innocentive Health Information Economy Idea Challenge.

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Measuring Health Improvement

As we discussed in the previous post, the fundamental value of health services are things that improve our health.  As we define the foundations of a Health Information Economy, information that has intrinsic value includes:

  • our current and future health status
  • our current and future health-related capabilities
  • the personal  impact of any health product or service under consideration
  • total cost of any health product or service utilized or under consideration

Having this information at an individual level enables the appropriate decisions to be made for each specific individual.  In a rational system, one would expect that an aggregate of the decisions to improve the health of each individual would move the needle on a community level index.

Defining the Personal Vitality Score

The Personal Vitality Score is analogous to a “FICO” score for your health.  It is a single number that synthesizes the various elements of your health status, risks, and capabilities into a number that goes up as your health improves and declines as your health deteriorates.

Today, we do not have a Personal Vitality Score to help us understand where we stand and how important potential interventions may be for us.  The implication is that we are inundated with things that might save our life or may be wildly irrelevant, and yet we are told to “ask our doctor”.  Since our doctor can’t keep all the relevant factors for you in his/her head, we often do not prioritize the interventions, tests, or activities that have a disproportionate impact on our health.

The requirements for an actionable Personal Vitality Score are the following:

  • Dynamic: updates as our health status changes (for good and bad), and as new data comes out
  • Auto-populating: data continually updated without need for additional data entry (e.g., accepts feeds)
  • Accurate: take in enough relevant data points, with good enough processing algorithms, to appropriately report current and future health status
  • Actionable: outline concrete things individuals can do to improve their status
  • Comprehensive: takes into account elements spanning wellness to specific illnesses

Implications of a Personal Vitality Score

As we think about a health information economy, a Personal Vitality Score is one starting point in terms of creating the currencies that enable companies to capture the full value of the “healthstreams” produced for each individual and across populations.  This becomes a foundational block for rewarding Accountable Care models, creating actionable “comparative effectiveness” maps for individuals facing treatment choices, and creates a currency and value curves for companies that want to make a business out of superior real-world impact.

Creating Fundamentally Valuable Information in Health | Health Information Economy

Saturday, 12 February, 2011 12:34 Written by Vijay Goel, MD
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This is the 2nd post in the Health Information Economy series.  We are outlining a number of elements outlining a vision for a robust health information economy as we put together a submission for the Economist-Innocentive Health Information Economy Idea Challenge.

What is Fundamentally Valuable in Health?

Those who find better, cheaper approaches to improve health should be rewarded, right?  Therefore, there should be a market for information that enables these systems to be put in place.

Unfortunately, the marketplace in healthcare (with a focus on the US) does not measure nor reward the improvement of health.  Today’s fragmented health systems are dominated by the needs of large players, each attempting to maximize their share of the pie for the specific transactions and services they perform.  In such an environment, the actual value of the services delivered to any individual matter much less than the negotiating clout of each of the players and structure dictated by the biggest payer — the government, regardless of the impact to the health of any specific individual or community.

For the purposes of this exercise, we will not start from this current model as a given.  Instead, we will assert that each individual would value the best possible health outcomes for them at the lowest total cost to them and their family.  As individuals aggregate into groups, the same standard should hold, but at the group level.  By this definition, value would be created as organizations discovered how to maximize the outcomes for individuals along some pricing curve.

Health Value Curve

As we look to create a sustainable Health Information Economy, we assert that in order for this new economy to exhibit rational and ethically consistent behavior, there must be rewards for those that can demonstrably improve the health of individuals and populations while holding down cost.  A Health Information Economy based on a currency of improved health value creates rational incentives down the line.

How would one measure this currency?  We’ll explore some possibilities in our next post.