Tag: Kim Bellard

What is Health Care’s LEGO?

Feb 8, 2023

BY KIM BELLARD

Last week the esteemed Jane Sarasohn-Kahn celebrated that it was the 65^th anniversary of the famous LEGO brick, linking to Jay Ong’s blog article about it (to be more accurate, it was the 65^th anniversary of the patent for the LEGO brick). That led me to read Jens Andersen’s excellent history of the company: The LEGO Story: How a Little Toy Sparked the World’s Imagination.

But I didn’t think about writing about LEGO’s until I read Ben’s Cohen’s Wall Street Journal profile of University of Oxford economist Bent Flyvbjerg, who studies why projects succeed or fail. His advice: “That’s the question every project leader should ask: What is the small thing we can assemble in large numbers into a big thing? What’s our Lego?”

So I had to wonder: OK, healthcare – what’s your LEGO?

Professor Flyvbjerg specializes in “megaprojects” — large, complex, and expensive projects. His new book, co-authored with Dan Gardner, is How Big Things Get Done. Not to spoil the surprise (which would only be a surprise to anyone who hasn’t been part of one), their finding is that such projects usually get done poorly. Professor Flyvbjerg’s “Iron Rule of Megaprojects” is that they are “over budget, over time, under benefits, over and over again.”

In fact, by his calculations, 99.5% of such projects miss the mark: only 0.5% are delivered on budget, on time, and with the expected benefits. Only 8.5% are even delivered on budget and on time; 48% are at least delivered on budget, but not on time or with expected benefits.

As Professor Flyvbjerg says: “You shouldn’t expect that they will go bad. You should expect that quite a large percentage will go disastrously bad.”

He has two key pieces of advice. First, take your time in the planning process: “think slow, act fast.” As Dr. Flyvbjerg and Mr. Gardner wrote in a Harvard Business Review article recently, “When projects are launched without detailed and rigorous plans, issues are left unresolved that will resurface during delivery, causing delays, cost overruns, and breakdowns….Eventually, a project that started at a sprint becomes a long slog through quicksand.”

Second, and this is where we get to the LEGOs, is to make the project modular; as Mr. Cohen puts it, “Find the Lego that simplifies your work and makes it modular.”

THCB Gang Episode 114, Thursday February 2 1pm PT 4pm ET

Feb 2, 2023

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday February 2 at 1PM PT 4PM ET are futurist Ian Morrison (@seccurve); fierce patient activist Casey Quinlan (@MightyCasey); writer Kim Bellard (@kimbbellard); and Olympic rower for 2 countries and all around dynamo Jennifer Goldsack, (@GoldsackJen).

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

MedEd in an AI Era

Jan 31, 2023

BY KIM BELLARD

I’ve been thinking a lot about medical education lately, for two unrelated reasons. The first is the kerfuffle between US News and World Report and some of the nation’s top – or, at least, best known – medical schools over the USN&WR medical school rankings. The second is an announcement by the University of Texas at Austin that it is planning to offer an online Masters program in Artificial Intelligence.

As the old mathematician joke goes, the connection is obvious, right? OK, it may need a little explaining.

USN&WR has made an industry out of its rankings, including for colleges, hospitals, business schools, and, of course, medical schools. The rankings have never been without controversy, as the organizations being ranked don’t always agree with the methodology, and some worry that their competitors may fudge the data. Last year it was law schools protesting; this year it is medical schools.

Harvard Medical School started the most recent push against the medical school rankings, based on:

…the principled belief that rankings cannot meaningfully reflect the high aspirations for educational excellence, graduate preparedness, and compassionate and equitable patient care that we strive to foster in our medical education programs…Ultimately, the suitability of any particular medical school for any given student is too complex, nuanced, and individualized to be served by a rigid ranked list, no matter the methodology.

Several other leading medical schools have now also announced their withdrawals, including Columbia, Mt. Sinai, Stanford, and the University of Pennsylvania.

THCB Gang Episode 113, Thursday January 26 1pm PT 4pm ET

Jan 26, 2023

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday January 19 at 1PM PT 4PM ET were futurist Jeff Goldsmith; THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); policy expert consultant/author Rosemarie Day (@Rosemarie_Day1);

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Ultrasound is Ultra-Cool

Jan 25, 2023

BY KIM BELLARD

AI continues to amaze – ChatGPT is now passing Wharton Business School exams, Microsoft and Google are doubling down in their AI efforts – and I’m as big a fan as anyone, but I want to talk about a technology that has been more under the radar, so to speak: ultrasound.

Yes, ultrasound. Most of us have probably had an ultrasound at some point (especially if you’ve been pregnant) and Dr. Eric Topol continues his years-long quest to replace the ancient stethoscope technology with ultrasound, but if you think ultrasound is just another nifty tool in the imaging toolbox, you’ve missed a lot.

Let’s start with the coolest use I’ve seen: ultrasound can be used for 3D printing. Inside the body.

This news on this dates back to last April, when researchers from Concordia University published their findings in Nature (I found out about it last week). Instead of the more common “Additive Manufacturing” (AM) approach to 3D printing, these researchers use Direct Sound Printing (DSP).

The paper summarizes their results: “To show unique future potentials of DSP, applications such as RDP [Remote Distance Printing] for inside body bioprinting and direct nanoparticle synthesizing and pattering by DSP for integrating localized surface plasmon resonance with microfluidics chip are experimentally demonstrated.”

Fighting the Wrong (Culture) War

Jan 20, 2023

By KIM BELLARD

News flash from the culture wars: they’re coming to take our gas stoves!

Well, actually, “they” are not, but the kind of people who got alarmed about it are a threat to our health, and to theirs.

The gas stove furor started with a Bloomberg News interview that Richard Trumka, Jr, a Consumer Product Safety Commission commissioner. “This is a hidden hazard,” he said. “Any option is on the table. Products that can’t be made safe can be banned.”

He was referring to the well known but little acknowledged fact that gas stoves emit various pollutants, especially nitrogen dioxide. Last year the AMA adopted resolutions about the risks of gas stoves, and urged migration efforts to electric stoves. Shelly Miller, a University of Colorado, Boulder, environmental engineer has said:

Cooking is the No. 1 way you’re polluting your home. It is causing respiratory and cardiovascular health problems; it can exacerbate flu and asthma and chronic obstructive pulmonary disease in children…you’re basically living in this toxic soup.

So one can see why the CPSC might be concerned. But the outcry about Mr. Trumka’s comments were immediate and vociferous. “I’ll NEVER give up my gas stove. If the maniacs in the White House come for my stove, they can pry it from my cold dead hands. COME AND TAKE IT!!” Rep. Ronny Jackson (R-TX) tweeted. The Atlantic further reported:

Governor Ron DeSantis tweeted a cartoon of two autographed—yes autographed—gas stoves. Representative Jim Jordan of Ohio declared simply, “God. Guns. Gas stoves.” Naturally, Tucker Carlson got involved. “I would counsel mass disobedience in the face of tyranny in this case,” he told a guest on his Fox News show.

Almost as immediately, Mr. Trumka clarified: “To be clear, CPSC isn’t coming for anyone’s gas stoves. Regulations apply to new products.” CPSC Chair Alexander Hoehn-Saric issued a statement making it clear that, while “emissions from gas stoves can be hazardous…I am not looking to ban gas stoves and the CPSC has no proceeding to do so.” The White House issued its own denial. Case closed, right?

Healthcare, Meet Southwest

Jan 3, 2023

BY KIM BELLARD

Customers experiencing long, often inexplicable delays, their experiences turning from hopeful to angry to afraid they’ll never get back home. Staff overworked and overwhelmed. IT systems failing at the times they’re most needed. To most people, that all probably sounds like Southwest Airline’s debacle last week, but, to me, it just sounds like every day in our healthcare system.

Southwest had a bad week. All the airlines were hit by a huge swath of bad weather the weekend before Christmas, but most airlines recovered relatively quickly. Southwest passengers were not so lucky; the airline’s delays and cancellations numbered in the thousands and stretched into days. Overnight, it seemed, Southwest went from being one of the most admired airlines – loyal customers, on-time service, happy employees, consistent profitability – to one with “its reputation in tatters.”

CEO Bob Jordan has had to do his mea culpas, and he’s not done.

Some pointed to Southwest’s reliance on point-to-point flight schedules, in contrast to other airlines’ use of hub-and-spoke models, but most seem to agree that the root problem was that its IT infrastructure was not up to task – particularly its employee scheduling system, which told its employees who needed to be where when and how to accomplish that. Casey A. Murray, president of the Southwest Airlines Pilots Association, told The New York Times: “Once one card falls, the whole house falls here at Southwest. That’s our problem. We couldn’t keep up with the cascading events.”

Our Plants Should Be Plants

Nov 15, 2022

BY KIM BELLARD

It seems like most of my healthcare Twitter buddies are enjoying themselves at HLTH2022, so I don’t suppose it much matters what I write about, because they’ll all be too busy to read it anyway. That’s too bad, because I was sparked by an article on one of my favorite topics: synthetic biology.

Elliot Hershberg, a Ph.D. geneticist who describes his mission as “to accelerate the Century of Biology,” has a great article on his Substack: Atoms are local. The key insight for me was his point that, while we’ve been recognizing the power of biology, we’ve been going about it the wrong way. Instead of the industrialization of biology, he thinks, we should be seeking the biologization of industry.

His point:

Many people default to a mindset of industrialization. But, why naively inherit a metaphor that dominated 19th century Britain? Biology is the ultimate distributed manufacturing platform. We are keen to explore and make true future biotechnologies that enable people to more directly and freely make whatever they need where-ever they are.