Businesses and Healthcare Solutions

Businesses and Solving Healthcare Problems

We often overlook businesses when we think about the problems in American healthcare and how we can fix the issues that plague our system. But about half of all American’s receive their health insurance as a benefit provided by their employer. Businesses purchase and provide health insurance for millions of Americans, and must think about employers and the plans they offer when we think about the problems in the American healthcare system.

 

Everyone will tell you that healthcare is complicated. We know that insurance is hard, getting to a doctor can be hard, understanding what you have to pay is hard, and trying to guess what kind of plan you need for the next year is hard. All of this makes the solutions to our healthcare problems hard, but for a majority of Americans, the person who is shaping the structure in which they will make these decisions and figure out what is available to them is someone at their job. And for a lot of those Americans, the person at their job is probably in HR, and their main goal is not to find a great healthcare solution for the employees, but to just not get yelled at by the CEO for raising health insurance coverage costs and to avoid being yelled at by unhappy employees. Nevertheless, businesses can step up and play a role in making changes for the positive in the American healthcare system.

 

Dave Chase in his book The Opioid Crisis Wake-UP Call writes, “The opioid crisis is a complicated issue over 30 years in the making. But companies have played a major role in creating and sustaining the crisis. And a vanguard of employers are realizing that they have a major role to play in solving it, and that the solutions fall well beyond what the government alone can do.”

 

Companies, since they control the healthcare of half of Americans, can start making real changes to the care available to people. Employers who set up their own plans can make primary care access, physical therapy, and nutrition services virtually free to their employees. By providing a greater selection of preventative services, they can improve employee well-being and reduce the likelihood that an employee will deal with chronic pain and develop an opioid addiction. This is an over-simplified example of what companies can do, but it is important that we realize that the employer is a major player in the fight to improve the American healthcare system, and if we don’t step up to demand better from our employers, we won’t see the changes we want.
The First Value of Deep Work

The First Value of Deep Work

“Deep work is not some nostalgic affectation of writers and early-twentieth-century Philosophers,” writes Cal Newport in his book Deep Work. “It’s instead a skill that has great value today.”

 

A tension that I think a lot of us face (I know its true for me) is that we are pulled in two different directions when it comes to media and information. The news cycle moves so fast today that it feels hard to keep on top of whats happening in the world. We all want to feel connected and feel like we are in the know, and we like being the person at the water-cooler who has the latest information about some nationwide or global event. We have a drive to constantly stay on top of what is happening right now.

 

Pulling against this urge is the desire to know interesting things and to consume media that is thoughtful, thorough, and interesting. It is one thing to know what is happening in the world right now, but it is an entirely different thing to truly understand the context and antecedents that gave rise to the current news cycle.

 

The first desire we have is to know new things about the world, the second desire is to truly understand the world. One desire encourages shallow quick headlines, while the other desire encourages deep thoughtful engagement. It is very challenging to do both.

 

Cal Newport’s suggestion is to shoot for the latter. Learning and engaging with complex topics requires real focus and deep work. The value from the second will far outlast the first. The first value of deep work that Newport shares in his book reads, “We have an information economy that’s dependent on complex systems that change rapidly. … To remain valuable in our economy, therefore, you must master the art of quickly learning complicated things.”

 

Staying on top of the news simply requires that we flutter around on Twitter, absentmindedly distracting ourselves and taking in a few headlines and quotes without thinking critically about how it all links together and exactly why people are reaching the conclusions they reach. This is does not develop the skills that are necessary for quick learning, even thought it is a quick way to sort through information.

 

Learning complex things quickly requires that we be able to engage in deep work and focus on the most important items. Failing to build these skills and abilities means that you won’t be able to truly master changing technologies and markets. You will be left behind reading headlines about changes, without actually understanding changes and adapting to them. Deep work is valuable because learning and critical thinking are both becoming more valuable, and both require deep work in order to be done well and timely. The answer then to how we should handle the tension I mentioned above is to more or less abandon the headlines and give up on staying on top of the news. We might look a little uninformed to others about current world events, but we will have a better background and understanding of what is shaping the world today than the others around us, and we will be able to learn the important lessons faster.

Temporal Landmarks

My general sense the last several years is that people are starting to sour on the idea of a new year’s resolution. People that I have talked the last few years seem to be getting away from the idea of making a big change for the upcoming year, or at least if they are planning on making a change, they are not admitting it. Generally, I have been supportive of killing off the new year’s resolution tradition, but Dan Pink’s book When challenged my thoughts on the usefulness of such resolutions.

 

I have had the mindset that people shouldn’t wait for a specific date to try to make a change in their life. I am also skeptical of trying to implement a resolution on January first, since it is immediately after the Christmas holiday in the United States and many people likely still have family hanging around, still have extra pie in the fridge, and its a cold and dark time of year. Trying to start a big change during this time, when the weather is demoralizing and you are not on track with a routine schedule, seems like a poor idea to me. As a result, at least as long back as I can really remember, I have never made any substantial new year’s resolution and I have not been one to encourage people to adopt a resolution.

 

The reality, however, is that people find it helpful to make a change when there is something that can delineate a new starting line for them. Pink describes it this way, “The first day of the year is what social scientists call a temporal landmark. Just as human beings rely on landmarks to navigate space – to get to my house, turn left at the Shell station – we also use landmarks to navigate time. Certain dates function like that Shell station. They stand out from the ceaseless and forgettable march of other days, and their prominence helps us find our way.”

 

I had not thought of navigating the space of time the way we navigate the space of the world around us. But it is accurate to say that days and time can blend together, and since we can’t control time, it can feel as though it relentlessly races forward. I have heard people in the Bay Area in California talk about the disorientating nature of their climate. The Bay Area doesn’t have pronounced seasons the way other parts of the country do. Most days are ok, and the temperature and weather doesn’t vary dramatically across the year. The passage of time feels different when you don’t really have a spring, summer, fall, and winter.

 

Using temporal landmarks helps us make sense of the passage of time and gives us a place to plant ourselves for our upcoming life pivots. Just as we might use another wall or a step to brace ourselves if we are pushing a heavy piece of furniture, a specific date can be a brace for us to push for a new habit. It can provide a reference point for how far we have moved and how successful (or not) we have been with any changes that we want to make.

 

So rather than looking down on the idea of new year’s resolutions or being unhelpful in telling people to just make the changes they want to see in their lives today, I can help encourage people to use temporal landmarks in a smart way. I can encourage people to think about the obstacles they will face and how long after their temporal marker they think they might face those obstacles. I can encourage people to think in time chunks with more temporal landmarks to navigate the time landscape they traverse as they implement new lifestyle goals.  Time landmarks are not just random and arbitrary, they are social constructs that can help establish shared meaning and goals across time and space.

Taking Issues of When Seriously

I wrote earlier about moving school start times to a later hour for high school students. In most school districts across the United States, our high school students start the day the earliest, and our elementary school students start the latest. Research, however, shows that swapping that order and pushing high school students’ start times back would improve learning as measured by test scores, reduce traffic accidents, and help high school students get more sleep.

 

Nevertheless, changing school schedules so that high school students start the day later would be inconvenient for adults, and we also have the idea that we need to push high school students to start their day early to prevent them from being staying up all night long with video games and social media. We choose not to consider the when of school start times, even though we will spend hours debating what books should be read in English class and whether art should be a requirement.

 

As Dan Pink writes in his book When, “We simply don’t take issues of when as seriously as we take questions of what.”

 

School start times are only one instance where we deprioritize the when. As far as I can tell, we operate with many inefficient whens in our lives without anyone taking much action to really change them. Many of us are now knowledge or service workers, and we often work 8 hour shifts for no obvious reason. Our work start times are all pretty uniform, and with our consistent 8 hour shifts, we also end at the same time, putting a huge strain on infrastructure for just a few short hours every morning and evening.

 

I see only a few whens that really seem to count for a lot in our daily lives. The start time of our work, the duration of our work, and the end time of our work. These whens are crucial and often inflexible. Every other when in our lives seems to be crammed around those three.

 

What I find disappointing, however, is that we don’t actually ask if those three whens make any sense. We focus on the whats all the time: did a report get finished, did we reach a sales target, what did the student learn? But we don’t often ask these questions in a meaningful way in relation to time: could the report have been finished in half the time, when should we reasonably expect to reach a sales target, what is the best time for student engagement with math versus art?

 

Asking if someone was at their desk at 8 a.m. and if they stayed at their desk for a full 8 hours doesn’t really tell you if they were effective or efficient. This isn’t a valuable way to look at time in our modern world and economy. Our when can be a lot more flexible, and increased flexibility, I would argue, can help improve the outcomes we actually want to see. Thinking differently about the when would help us to do better work and interact better with our world. We don’t need to hold on to rigid expectations about the timing of work or school, what we need is to find avenues to help people produce the best work and learn the most effectively.

We Should Give Our Desire for Normalcy and Incrementalism More Attention

I think the idea of political stability is generally underrated and under-explored in the context of current American political discussions. We are in the midst of deep demographic changes in our country, we seem to be at a real inflection point in jobs and automation, and inaction on several major policies have driven support for massive upheavals in some aspects of American public policy. Boring incrementalism seems to be very out of favor within both Republican and Democratic sides of the political divide, and the likelihood of clicking a news article with a headline applauding an incremental approach to a policy solution or a marginal change in anything is laughable.

 

But incrementalism is probably what most Americans would actually prefer. Many of us would just like a stable equilibrium, rather than a wholesale confusing and controversial change. The candidacy and relatively strong polling from Joe Biden seems to support the idea that a lot of people, despite news coverage of big events and potential systematic changes, really just want normalcy. The idea that stability itself could be a good thing and a desired political outcome feels undervalued to me.

 

This idea of incrementalism and normalcy isn’t 100% related to the quote that got my mind working in this direction this morning, but I think I can tie things together. In his book The Complacent Class, Tyler Cowen writes that the idea that increasing economic growth and equity will reduce social tensions is wrong. He writes,

 

“The 1950s and 1960s are considered a golden age for middle-class income growth in the United States. The same is true for black income growth, as the decades leading up to the 1960’s saw the greatest gains in African American income in the history of the republic. Yet many of the 1960s riots were motivated by race, and many African Americans were prominent participants. In short, income gains are no guarantee of peace.”

 

In the 1950s and 60s, inequality sparked outrage and action by those who were excluded and those who felt a visceral sense of injustice. Rising wages gave people the belief that they could strive for more and reach a better future. People didn’t simply enjoy a rising tide, but used a surge in income to demand that the tide rise equitably for all.

 

Today, in contrast, we have flattening wages and a sense of complacency around most things for most people. I think the majority of American’s would say they are not happy with the status quo, but most are simultaneously too complacent to take action. Some small-ish groups are extremely upset and outraged over the current political and economic dynamics of our country, but their voice is likely overplayed relative to their size and influence. While some energy is swelling for massive changes, as can be seen by the candidacy of Bernie Sanders, an equal mass is pushing for boring incrementalism and stability.

 

Cowen continues, “In the 1960s, Americans expected more, they didn’t quite get what they had set their eyes on, and so they became more restless.”  In a sense, we have just accepted that we won’t get what we have our eyes set on. Five years ago it was common to hear people lament, “we were promised flying cars, and what we got was 140 characters,” in reference to Twitter being our best innovation as of late when we all wanted flying cars. In 2020, we seem to have just given up, and we are waiting for our electric cars, which won’t really have any cataclysmic shifts in our auto industry. Perhaps it is stagnant wages, perhaps it is something else, but I think that Cowen is correct in stating that we have lost our restless spirit. I think the desire for normalcy and incrementalism should be more explored and receive more focus than it does in our current media environment.

Solving the Wrong Problem

I work for a growing but still small tech start-up in the healthcare space based out of the bay area. The company has a great mission and is amazing to work for, but we have certainly had a lot of growing pains and unanswerable questions over the last four years that I have worked for the company. One of the biggest challenges we have faced is making sure we answering the right questions and getting the right solutions to the right problems in place.

 

Michael Bungay Stanier looks at these types of problems and takes them on in his book about coaching, The Coaching Habit. His book is full of recommendations to be a more effective coach and manager, and one of the benefits of his techniques is an improved understanding of the problems and questions that organizations must face. In the company I work for, things have always been in flux, and that means that sometimes it is hard to know what the real issue is and where we should be focusing all of our energy. If you polled the entire office about what the biggest problem is right now, you would get different answers from everyone. Bungay Stanier described the situation like this:

 

“You might have come up with a brilliant way to fix the challenge your team is talking about. However, the challenge they’re talking about is most likely not the real challenge that needs to be sorted out. They could be describing any number of things: a symptom, a secondary issue, a ghost of a previous problem which is comfortably familiar, often even a half-baked solution to an unarticulated issue.”

 

Effective leaders don’t just jump in when a team is discussing the issues they are facing and they don’t just take on all the problems in an attempt to solve everything themselves. Good leaders try to drill deeper to understand what is really at the heart of the collective issues facing the team, and then work to empower the team to tackle the problems they face. In my next post I’ll describe the conversation that Bungay Stanier recommends to help us find the right problem to solve, but for now I’ll describe the question he uses to get to the heart of the issue, “What’s the challenge?”.

 

In my career I have solved a lot of problems and fixed a lot of issues, but often times I have spent a lot of energy on problems and issues that end up not being very important. Something might be a little bit off and something might be an inconvenience, but that doesn’t necessarily mean that I need to spend a lot of effort fixing that individual thing. Perhaps what everyone complains about is frustrating and annoying, but it may just be part of a larger problem or something that would go away altogether by solving a bigger picture item. This is definitely an area where growth is possible for me, and is something that all organizations struggle with, especially if we are quick to action and don’t make real efforts to dive further. Asking ourselves and our team, “What’s the real challenge?” and looking upstream from the stated problems to possible larger causes is one way to make sure the work we do matters and is one way to galvanize our team around the most important solutions.

Building Habits

In my last post, I described the ways in which much of our life happens on auto-pilot in habitual decisions and actions that often don’t register with our conscious mind. Not everything we do needs to be a conscious action (think about how tired your brain would become if you had to focus on every step you took and how annoyed you would be if you had to think about every blink), but becoming more aware of our unconscious decisions is incredibly valuable for making changes in life. Michael Bungay Stanier looks at the ways we can actually change our habits in his book The Coaching Habit and he identifies five specific components to changing behavior. He writes, “To build an effective new habit, you need five essential components: a reason, a trigger, a micro-habit, effective practice, and a plan.”

 

If we think about our habitual actions that we barely notice, we can see that we will never actually change those habits if we don’t first build self-awareness around our actions and behaviors. It is not enough to just think to ourselves that we want to write more, exercise more, or have a more tidy home. We have to actually recognize what habits are shaping the end state that we want to change. We have to have awareness of a problem, issue, or what could be different, and then we have to dive deeper to understand what it is that causes to the thing we want to change. It all begins and is shaped by a self-awareness that is like pancake batter poured in a single spot. You focus on one thing but your awareness and recognition slowly spreads outward around that one thing.

 

Changing a habitual action requires a reason to change. You may recognize that your house is messy and that it stresses you out. From there you have to recognize something that leads you into the original habit that you want to change. Do you automatically roll out of bed and grab your phone as a flashlight and then find yourself checking emails or Facebook for 30 minutes instead of making your coffee? What can you do to prevent yourself from grabbing your phone? For me, purchasing a flashlight allows me to leave my phone in another room, helping me keep away from habitual morning distraction. This solution is somewhere between a micro-habit and an environmental modification to try to replace the trigger (my phone) that lads to the habit I want to avoid (wasting time online). An important step toward change might be small and may not even seem related to your original habit, but can still shape your behavior in a powerful way. Thinking through these changes and building this awareness is what allows you to create a plan to actually make the changes you want to make.

 

This is a very quick and simplified version of changing a habit, but throughout, you can see the importance of self-awareness in making changes in your life. Habits stick because they go unnoticed. We don’t recognize what it is that drives our unconscious habitual decisions, so we end up with the same habits shaping our same behaviors and actions. We must be aware enough to recognize the change we want, what leads to the behaviors we want to avoid, and think through our actions to plan ahead.

Change for Others

Michael Bungay Stanier gives his readers some advice for making the changes in their lives in his book The Coaching Habit. His first piece of advice is to become self-aware of what you want to change, and his second piece of advice is to understand exactly why you want to make that change. When thinking about a change that you want to make, it is helpful to think through the benefits and to turn the change into something positive that you are doing for other people. Simply making a change because it will benefit yourself may not bring you the mental impetus to move forward with the challenges of actually changing your behavior.

 

Bungay Stanier describes one of his take-aways from Leo Babauta’s book Zen Habits, “He talks about making a vow that’s connected to serving others …think less about what your habit can do for you, and more about how this new habit will help a person or people you care about.”

 

This is a powerful strategy for making important changes in our life and becoming the person that we want to be. Making a change just for ourselves is hard, because we can tell ourselves lots of lies that justify and excuse the behaviors that we made. But if our reason for change is connected to helping someone else, improving our life to further improve another person’s life, or is rooted in improving the world experience of another person, then we have another layer of complexity to justifying why we did not adopt our new habit or break our old habit.

 

I believe this strategy is powerful because it gets us thinking about the kind of person we want to be and the behaviors of people who are like the person we want to be. If we tell ourselves we are trying to live more healthy lives to set better examples for our family and to be able to participate with our kids in athletic activities or live longer with our family, then we can start to think about the traits that a healthy person may adopt. We tell ourselves we want to be healthy and that healthy people don’t eat donuts at work. The same doughnut temptation exists, but now we envision ourselves fitting in with the healthy group that does not eat donuts, and we compound that with our accountability to our family and our desire to be healthy for them.