Healthcare Stagnation

Healthcare Stagnation

We are facing a disastrous healthcare stagnation in the United States. Our hospitals are getting older, Medical providers are aging with too few young providers to replace them, and the quality of care that many of us experience is not getting much better. Despite this, the cost of healthcare has been soaring. Healthcare expenditures, including the costs of our deductibles, co-pays, and what our insurance pays out, has been going up at a rate reliably above inflation.

 

In The Opioid Crisis Wake-Up Call, Dave Chase writes the following about our healthcare stagnation, “Unlike virtually every other item in our economy, where the value proposition improves every year, the norm in health care for decades has been to pay more and get less. Also, unlike nearly every other industry, healthcare hasn’t had a productivity gain in 20 years.”

 

Productivity is how much we produce per unit of time spent on production. A factory that makes 5,000 widgets per hour is more productive than a factory that makes 1,000 widgets per hour. Automation and new technologies have helped factories and offices become more productive, but our healthcare stagnation is evidence that we are not seeing the same gains in healthcare. Technology has improved, but not in areas that seem to produce more healthy patients given the same amount of time and effort from our medical providers. We have some new technologies, but somehow those technologies have not translated into a healthcare system that supports the same number of people with fewer resources.

 

Chase continues, “In other words, for the last two decades, there has been a redistribution tax from the working and middle class and highly efficient industries to the least productive industry in America.” 

 

As your job has become more efficient and more productive, your healthcare costs have risen. Chase equates this healthcare stagnation price increase to a tax. Factories that can work with fewer employees, software engineers, and other employees form highly productive sectors are paying more in healthcare for services that haven’t kept the same pace as the industries of the patients they treat. This is the cost of healthcare stagnation that chase wants to push back against by demanding better systems and structures from healthcare providers, insurance companies, and benefits brokers. Chase believes we can find a way to improve our healthcare system and help people live healthier lives for less cost, if employers are willing to make real investments in their employees healthcare, and are willing to hold their brokers and insurance providers accountable for the value their products provide.
Deciding Which Tasks to Own

Deciding Which Tasks to Own

In the knowledge economy, many of us have a thousand things we could do with our time at any given moment. Email (as I have written about previously) is always an available option to us, we usually have a lot of reports we could work on, and there is always another meeting we could be doing more to prep for. How do we decide which activities are the most important, which tasks we will own, and which things will be left behind?

 

One answer, is to think about how specialized the task is to your own skill set. This gives us a question to ask when considering the work that is the most important, and what should be our priority. The question comes from Cal Newport in his book Deep Work, “How long would it take (in months) to train a smart recent college graduate with no specialized training in my field to complete this task?”

 

Responding to a bulk of emails, creating a PowerPoint slide, and plugging some data into an Excel file are examples of activities that don’t require much thoughtful training. Sure, your emails need your insight and decision-making for response, but a smart college grad could plug through a bunch of emails just as well as you could. They could also throw together a decent PowerPoint, and enter a bunch of info into a spreadsheet without a much specialized knowledge and training. They could easily replace you if that is what your day consists of.

 

Newport would suggest that you start to focus your day around those tasks which rely on your specialized knowledge and abilities if you don’t want to be easily replaced. If you want to maximize your value, produce at a high level, and get important stuff done, then you should look to delegate those tasks that a recent college graduate could complete and spend more time deliberately working on the challenging tasks. You will get better at doing the things that matter the most, and you will have a greater impact in your organization.
How We Think About Our Digital Tools

How We Think About Our Digital Tools

In his book Deep Work, Cal Newport contrasts two types of approaches to the digital tools that we use and create. We have a lot of powerful social media and network messaging applications, and these tools and applications are often given to us, or seemingly forced onto us, without much choice on our end. If everyone we know is using Facebook, then we feel left out without it. If everyone in the office is using Slack for communications, then we feel that we must join in so that we don’t miss any important messages and updates. The tools we create put pressure on us to use them, even if we never wanted the tools to begin with.

 

Newport calls this standard approach to network tools the Any-Benefit Approach and he defines it this way, “You’re justified in using a network tool if you can identify any possible benefit to its use, or anything you might possibly miss out on if you don’t use it.”

 

We don’t want to be left out of conversations at the water cooler, so we download social media apps to talk about what other people have said. We don’t want to miss a message about something in the office, so we join all the Slack channels at work. We might get an early insight into something our favorite sports team is doing, so we install the Twitter app. We don’t think critically about whether we get a lot of value from these network tools, we only ask if there is some potential benefit we might receive from the tool.

 

Newport describes the opposite strategy for determining what network tools we use as the Craftsman Approach to Tool Selection: “Identify the core factors that determine success and happiness in your professional and personal life. Adopt a tool only if its positive impacts on these factors substantially outweigh its negative impacts.” 

 

With this frame, we don’t add twitter unless we think it is going to really make our lives better to know what our favorite sports stars are up to. We don’t install social media apps if we think we will waste time with them or if we think that we will become jealous looking at all the cool things others are doing. Rather than worrying about what we might miss out on if we don’t get the app, we worry about what we might miss out on if we lose time and attention to the app. We bring in new applications at work if they help us perform better, not if they help us stay up on office gossip or give us a few popular tidbits to chat about during our breaks. Switching to the Craftsman Approach to Tool Selection matters if we want to do meaningful work and be present with our families in meaningful ways.
Lead Measures

Find a Lead Measure and Drive Toward It

Cal Newport describes the difference between lead measures and lag measures in his book Deep Work. The lag measure is generally the thing we are working toward. A promotion, a book publication, and a down-payment are all lag measures. They follow our actions and are the outcome that we can measure for success or failure. Lead measures are all the smaller inputs that build toward the success or failure of the lag measure. It is lead measures that are the most useful for us when thinking about our day to day productivity and progress toward goals.

 

Having a good lag measure is important, but achieving or failing in regard to your lag measure is a downstream consequence of upstream actions. It is hard to adjust based on lag measures because the activity that produced the outcomes being measured has already happened. Cal Newport explains the advantages that lead measures have over lag measures because of this fact:

 

“Lead measures turn your attention to improving the behaviors you directly control in the near future that will then have a positive impact on your long-terms goals.”

 

Newport explains that his personal lag measure for success as an academic is the publication of academic journal articles, and the lead measure he selected to drive toward that lag measure is hours spent in deep work. By measuring how much time he spendings in concentrated focus on work related to academic journal article publications, he ensures that he makes progress toward his publication goal, even if every single moment itself didn’t directly produce a new publication. Good lead measures provide the fundamental building blocks of the success we seek and are more within our control than our larger lag measures.

 

If you work in sales, you likely have a lag goal of a certain number of sales per quarter. A lead measure might be the number of pitches that you make per day or the number of cold calls that you make per day. If you are writing, then the number of hours spent writing is a good lead measure to back up a publication lag measure. And if you are a parent or spouse, a good lead measure might be the number of caring things you did for your spouse or child with the lag measure of having a stable family. Thinking through a reasonable lead measure will help you identify what important actions are within your control that you can do to increase the likelihood of success on your big goals. Failing to pick a lead measure leaves you aimless in your day-to-day, and can have consequences when it comes time to measure your overarching goals later.
Workplace Design

Workplace Design

One of the things I am secretly fascinated by is workplace design in our modern knowledge work economy. I’m not so interested in where the copy room is located, how the office kitchen is built out, or what furniture/decorations are around, but the big high level design question: where will our employees sit to do their work? (or stand sometimes if your company is cool like that)

 

A lot of companies today are trying to get away from standard cubicle models for offices. The traditional work-space where senior team members have their own office while junior members are in cramped cubicles feels anachronistic, especially for modern tech companies. The alternative has been open office spaces, where dividers between employee workstations are minimized. Companies want to be innovative, to spur conversation between creative individuals, and they also want to create environments where employees would actually want to be, rather than soul sucking cubicle farms.

 

However, thinking and focusing in open work-spaces can be challenging. As Cal Newport writes in his book Deep Work, “Both intuition and a growing body of research underscore the reality that sharing a work-space with a large number of coworkers is incredibly distracting – creating an environment that thwarts attempts to think seriously.” When it comes time to buckle down and focus to get an important project done, an open work-space can become a major hurdle.

 

In his book, Newport encourages more of a hub and spoke style office. He doesn’t say if he thinks everyone should have their own office or be in a dreaded cubicle farm, but he thinks that people should be split by departments/teams into hubs where people can get a little more quite space to do deep work. He encourages developing open pathways to the bathroom, kitchen, or conference rooms that encourage serendipitous connections with others, to help spur some creative encounters that might otherwise not happen in individual offices. He doesn’t think we should all just be isolated away in our little hubs, but in a sweet spot where we have space to think as well as chances to interact and share different ideas and perspectives. “Isolation is not required for productive deep work. Indeed, their example [Bell Labs] indicates that for many types of work – especially when pursuing innovation – collaborative deep work can yield better results.”

 

I’m still not sure exactly what the perfect office space would be for different types of companies based on Newport’s thoughts. Should a CPA firm have a hub and spoke style office, or do they really need their own walled off offices? How exactly do you balance the need for focus spaces with the need to actually interact with other human beings, to prevent employees from going to work but never interacting with anyone? Space for deep work is important, but Newport also advocates for bumping into other creative people at reasonable intervals to foster creativity and heighten innovation and productivity. I’m not sure where exactly we will end up with workplace design, but I don’t think it will be in a space where everyone has their own office or a space where no one has an office.
work and craftsmanship

Think of Your Work as a Craft

In his book Deep Work, Cal Newport highlights the work of Ric Furrer, a modern day blacksmith creating historical themed swords, knives, and weapons in his own modern day forge. His work is important in Newport’s book because it is a true craft that demands focus. He can only do his work, and do it well, if he is constantly focused and aware of the small details of what he is doing. He can’t afford to be distracted, to take micro-breaks to check a tweet, or bounce between his metal-work and an email or two.

 

Craftsman working with their hands have an advantage over modern day knowledge workers. They create something tangible that they can hold and see. People working construction and landscaping have the same advantage, a tie back to our early ancestors and human evolutionary past – their work can be seen. Knowledge workers’ reports, emails, and reading can’t actually be seen. As a result, we make efforts to be very visible with our work, responding to every email, posting witty tweets, and Instagramming our pile of books.

 

What ends up happening, in way that Newport describes it, is that we forget to focus on what is important with our work, and allow ourselves to be distracted.  Our work starts to lack purpose and meaning, and we take on shallow tasks. We do visible yet unimportant work rather than the important but sometimes invisible work that is required for us to really be great at what we do.

 

Newport writes, “Craftsmen like Furrer tackle professional challenges that are simple to define but difficult to execute – a useful imbalance when seeking purpose. Knowledge work exchanges this clarity  for ambiguity. It can be hard to define exactly what a given knowledge worker does and how it differs from another: On our worst days, it can seem that all knowledge work boils down to the same exhausting roil of emails and PowerPoint.” 

 

The challenge for us is to understand what is truly important and focus on that work. We can’t worry about being seen as productive. Instead, we have to focus on ensuring our time is spent on the most important issues, even if we don’t have something tangible to tell everyone that we did at the end of the day.

 

I have found tracking my work to be helpful in this regard. At the end of the day, we can forget just how much time we spent on a given project, and we can have trouble seeing the progress we made. If we think more deeply about what we need to do to make progress on important goals, we can identify smaller targets, and document, for our own sake, what we have done to reach those targets. This gives us a sense of craft, even in a knowledge economy. The more we can tie what we do to a feeling of craftsmanship, the better we can be at recognizing how important it is that we bring our best focus to our work.
Clarity on What Matters

Do You Know What Matters?

For a while I worked in the healthcare tech start-up space, and two of the biggest challenges we often faced was knowing what was the most important thing to work on, and how to be productive to accomplish our goals. I was in a role where I interfaced between multiple teams and a lot of my day was spent with email. I didn’t spend my entire day producing reports, working on spreadsheets, or creating new policy documents. Much of my day involved putting out minor fires that popped up for people working across the teams I worked between. This left me in a position where it was hard to measure my productivity. If I wasn’t producing a report of one type, and was just going to meetings and responding to emails, how did I demonstrate that I was working continuously and trying to accomplish things?

 

The easy answer which I often fell into was email. The quicker I responded to email, the more email I responded to, and the more visible I was in those emails, the more everyone would know I was working hard. The problem, however, is that responding to a ton of emails often isn’t very productive, and it often doesn’t address the most pressing problems. When I started to recognize this and shift my activity, a lot of emails fell aside (not to mention Slack Channels), and I started to actually be better at my job.

 

In Deep Work Cal Newport writes, “Clarity about what mattes provides clarity about what does not.”

 

For the first couple of years I didn’t have good clarity about what mattered. I spent a good amount of time on projects that were never going to go anywhere, and I spent a good amount of time responding to emails that really never needed a response. I looked productive, but what I worked on didn’t help drive toward the company’s biggest objectives.

 

In our work lives (and really in our lives in general) we need to start focusing on what truly matters. The better we can be at asking what is important and the better we can understand the why behind that importance, the more we can accomplish. As we practice this we will see what things are unimportant in our lives, and we can take steps to cut those things out, leaving us with more space and time for the important things. If we don’t stop to ask what things really matter, we won’t see which things don’t matter, and we won’t be able to move those things to the periphery.
Don't let standing meetings become too much

Watch Out For Standing Meetings

For teams working on diverse projects and diverse tasks within projects, standing meetings can be important. It is often necessary to get the important decision-makers in a room to discuss updates, progress, hurdles, plans, and challenges. At the same time, however, these meetings can overwhelm our schedules leaving individuals with too many meetings and not enough time for work.

 

Cal Newport, in his book Deep Work, answers the question: Why do these meetings persist even when they have become overwhelming and overbearing on our schedules?

 

They’re easier. For many, these standing meetings become a simple (but blunt) form of personal organization. Instead of trying to manage their time and obligations themselves, they let the impending meeting each week force them to take some action on a given project and more generally provide a highly visible simulacrum of progress.”

 

Rather than really working on goals and objectives, standing meetings allow us to pick marginal work targets on a flexible, rolling weekly basis. The work done (or planned) from week to week might not actually be an important step forward, but it can feel like something and we can vocalize that we have at least done something during the previous week.

 

Newport doesn’t suggest killing all meetings, but rather using our meeting time more wisely and cutting meetings when they are in the way. If we find that meetings are not really providing us much useful planning, and if the topics discussed at a regularly scheduled meeting don’t seem to have much weight, we should remove it from the schedule. If it is helping us with planning and staying on track, and if we are using the meeting to its full potential, then it is worth keeping. The key is planning and focusing outside of the meeting, ensuring that when we do meet, we are not wasting time but actually addressing important topics and setting concrete steps to make meaningful progress on our objectives.
Solving for Productivity

Solving For Productivity

My general sense, from working at a health-tech start-up to my time in government, is that we under-invest in how to be productive. I recognize that everyone will have different preferences, different abilities, and different thinking styles, but I have seen plenty of areas in which we could improve the how and when of our schedules to make ourselves more productive. We can level this up from individual level decision making around productivity into group levels of productivity to really improve our organizations.

 

In the start-up world I saw individuals who were incredibly productive, but who also seemed to work for 12 or more hours every day. This is impressive, but not very sustainable and not something that could scale. In government I have seen people face mountains of work, but fail to prioritize and schedule appropriately to focus their work. Both examples highlight the importance of how we approach our productivity and why we should have more discussions about planning, schedule design, and deep work if we are going to improve our productivity as individuals and organizations.

 

In his book Deep Work, Cal Newport addresses these issues directly. He shares a story about a business school professor named Adam Grant, who produces a prodigious amount of work in terms of New York Time’s best selling books, academic journal articles, and award winning courses at his University. Newport met Grant who shared with him a PowerPoint outlining strategies for academics to become highly productivity and effective. As Newport states it, Grant, and the professors who developed the PowerPoint, “See productivity as a scientific problem to systematically solve.”

 

This is the exact opposite of the productivity strategies I have seen in my two careers. The commendable start-uppers burning the midnight oil seemed to mostly just throw themselves at every project until they were spread too thin and slowed down other operations. Conversely, many of the people I have seen in government simply give in, arguing that there is too much work and not enough manpower to manage it all. Neither see their effectiveness and productivity in a scientific sense, adding variables and completing formulas to find their maximum (sustainable) productivity.

 

Newport encourages us to think about how we do our work and what work we prioritize. His suggestions also seem to be in line with recommendations from Dan Pink’s book When. From Grant, Newport learned, “batching of hard, but important intellectual work into long, uninterrupted stretches.” This can take place at “multiple levels” according to Newport who demonstrates how an academic can batch teaching into one semester and research into another semester. In our own lives, we can batch important analytical work into our productive and focused mornings, and we can save emails and rote paperwork for our afternoon struggle-bus hour.

 

We might be tempted by Newport’s advice to just double down on our hard work and extend our working hours. But this is not the best strategy for the best performance. Newport explains a lesson he learned while researching his book How to Become a Straight-A Student, “The best students understood the role intensity plays in productivity and therefore went out of their way to maximize their concentration – radically reducing the time required to prepare for tests or write papers, without diminishing the quality of their results.”

 

If we see a mountain of work and shrink from it, or if we see a mountain of work and blindly throw ourselves at it, our end result is not going to be the best possible outcome. What we need to do is think about how we can be the most productive in tackling the task in front of us. We need to think strategically and scientifically about our approach, batching the complex focus work into periods of productivity, and saving the less important work for the time when our brains have maxed out on their focus ability. This is something that leaders of all organizations should be encouraging and teaching to those they lead, otherwise they hold onto the secrets of good work, and allow those who work with them to flounder about in front of the challenges of work in the 21st century. By adding a little more time to planning and thinking strategically for how we work, we can make adjustments to kickstart our productivity. By giving ourselves realistic challenges and knowing when to say no, we can ensure that all of our work is the best we could possibly produce.
Shallow Work and the Permanent Cost of Distraction

Shallow Work and the Permanent Cost of Distraction

My last two posts have been about deep work and shallow work, with one post looking at what deep work really entails, and one post considering when you should plan your shallow work relative to your deep work. Today’s post is more directly on the costs of shallow work. Yesterday’s post discussed the importance of doing deep work when we are most focused, and an unwritten but implied aspect to shallow work is that doing shallow work when we are most focus robs us of the time and mental energy that we could use to do our most important work. But that is not the only cost of shallow work – the downsides to shallowness extend beyond the opportunity costs of doing more important work instead of the shallow busy work.

 

Cal Newport in Deep Work writes, “Spend enough time in a state of frenetic shallowness and you permanently reduce your capacity to perform deep work.”

 

Newport’s warning is very important and extends far beyond losing a few hours where we could be more productive. It extends beyond even our work schedule and the time we are in the office. The warning is this: the more time you spend distracting yourself in line at the grocery store with your phone, the more time you spend fluttering around twitter at work, and the more time you spend scrolling down Facebook before bed, the worse your brain will be when it needs to focus most. Our poor digital habits reduce our ability to focus.

 

Deep work requires that we keep our mind focused on one thing for a long period of time. It requires that we make connections by truly learning and understanding the material we are focused on. In the long run, it makes us better performers because it allows us to be more productive with our time. The future of our economy is bright for those who can excel at deep work, when others are distracted and unable to complete difficult projects in a unified and coherent manner.

 

However, if we spend our time doing lots of shallow work like answering every unimportant email as soon as a notification pops up on our computer, or if we spend lots of time distracting ourselves on social media, we won’t build the capacity to engage with deep work. We will actually diminish our ability to do deep work and teach our brain that it doesn’t need to focus for long stretches of time. Our brains get a hit of dopamine with each new social media post and each notification. Our brains can literally become overly reliant on these dopamine hits, to the point where our brains can’t focus because they can’t operate for long stretches without more cheap dopamine hits.

 

It is important that we be honest with ourselves about how we spend our time and how distracted we allow ourselves to be. Putting the phones down and blocking time for deep work is important, otherwise we will unintentionally fill our lives with shallow work, and in the process diminish our focus ability.