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Steve Jobs’s other address

November 4, 2011

Steve Jobs is known for delivering one of the most widely viewed and quoted commencement addresses in history.  His speech, at Stanford University in 2005, struck a chord that resonated far beyond the campus.  On YouTube alone, the video of the address has garnered 12 million views and counting.

This was Mr. Jobs’s one and only commencement speech.  But, as it happens, Mr. Jobs delivered a very similar speech on August 27, 1991, about 14 years earlier, at the convocation ceremonies at Reed College, his alma mater.

Steve Jobs accepting the Howard Vollum Award at the 1991 Reed College Convocation.

To my knowledge, no video of this speech exists.  However, thanks to my friends at Reed College, I am happy to share an audio recording, along with black and white photographs taken at the event and a full transcript, reproduced here with permission.

The first speaker is most likely interim President William R. Haden, followed by Professor Richard Crandall who presents Mr. Jobs with the Howard Vollum Award and reads the acccompanying citation.  Professor Crandall, currently the director of Reed’s Center for Advanced Computation, is a legendary Physics professor and close friend of Mr. Jobs.

In this recording, Steve Jobs’s speech begins at 8:27.  Clicking the link will launch your audio player.

Audio Recording: Steve Jobs at the Reed College Convocation 1991

Steve Jobs with Professor Crandall.

Although it was delivered 14 years earlier than the Stanford commencement, Jobs’s Reed speech has interesting parallels.  In both, Jobs tells three stories.  “Let me tell you a story…” is a classic opening line when you want to engage an audience.  At Stanford, Jobs talked about 1) his two years at Reed College (one semester paid and three semesters gratis), 2) getting kicked out of Apple and 3) being diagnosed with cancer.  In the end, he quotes the Whole Earth Catalog, “Stay hungry, stay foolish.”

At Reed, all three stories focus, not surprisingly, on his two years at Reed.  He mentions the value, later in life, he drew from Reed’s liberal arts curriculum.  He also describes, in colorful detail, a lesson in situational ethics and appreciates the selfless generosity of Jack Dudman, then the Dean of Students.  But the strongest thread woven through the speech is the hunger he experienced during his college years.  Obviously, in 1991, he had not yet been diagnosed with cancer and the sting of exile from Apple was still fresh, making it a topic Jobs would not have been comfortable highlighting, at least not until he was given his chance at redemption.

Steve with a mortar board.

His Reed address was delivered during the “wilderness years,” the time after Jobs was forced out of Apple but before he turned around his fortunes at NeXT or Pixar.  It wasn’t a complete disaster: at Pixar, he had made a distribution deal with Disney earlier in the year but that partnership would not bear fruit for several contentious years.  At NeXT, the future was significantly less certain.

At home, however, things were looking up.  He married Laurene Powell a few months earlier, on March 18, 1991.  And, about a month after the Reed Convocation, on September 30, 1991, she gave birth to their son, whom they named Reed Paul Jobs.  Not, we’re told, in honor of the college but because the name sounded good.

So, here it is.  The transcript of Steve Jobs’s 1991 Convocation address at Reed College, which, at least for now, you will not find anywhere else:

Thank you very much for this.  It means a lot to me.  I am a peculiar Reed alumni as many of you know.  I never graduated from Reed, although that doesn’t make me that unusual I suppose.

But, maybe more unusual, I ran out of money after one semester here at Reed so I dropped out but then I dropped in for another year and a half, so I was actually here by choice, which was somewhat more unusual.

And, I had some experiences here, that I’m sure many of you will have as freshmen and throughout your years here, that have stayed with me my whole life.  I was thinking of some of them to recount to you.

Remember that I’m much older than you now, in that, I’ve always thought that people’s spark of self-consciousness turns on at about fifteen or sixteen.  And so, if we normalize age to fifteen or sixteen then most of you are two or three or four years old here as freshmen.  I’m about twenty.  So, that maybe puts in perspective what it’s like to return to Reed after so many years.  But a few things stick in my mind that I wanted to pass on maybe would be of some value.

The first was, that as you will be shortly, I was forced to go to humanities lectures.  Seemed like every day.  I studied Shakespeare with Professor Spitowsky.  And at the time, I thought these were meaningless and even somewhat cruel endeavors to be put through.  I can assure you that as the patina of time takes its toll, I thank God that I had these experiences here.  It has helped me in everything I’ve ever done; although, I wouldn’t have ever guessed it at the time.

The second experience that I remember from Reed is being hungry: all the time.  The cafeteria here taught me quickly to be a vegetarian.  And I didn’t have so much money so I would gather up Coke bottles and take them up to the store to find out how to eat. 

I discovered the cheapest way to eat was Roman meal.  Have you ever heard of this?  The cereal.  It was invented by a Harvard professor who studied…who was a history professor.  He one day wondered what the Roman legions took with them to eat as they conquered and pillaged these villages.  He found out through his research that it was Roman meal and you can buy it at the local store and it’s the cheapest way to live.  So, I lived for many months on Roman meal.

But, also, several of us, after not eating for a few days would hitchhike across town to the Hare Krishna temple on Sundays, where they would feed all comers.  And we, through practice, discovered just the right moment to arrive after their particular religious practices and right before the food.  And not having eaten for a few days, we would eat a lot, and on several occasions stay over because we were not able to move.  And the following morning, they would wake us up at four o’clock in the morning because it was their time to go gather flowers for their temple to honor Krishna.  So, they would take us with them, pre-dawn, out into the neighborhood where they would proceed to steal flowers from their neighbors.  And the neighbors that lived close to the Hare Krishna temple soon were wise to their pillage and would get up early in the morning and guard their flower beds and so they would have to go in an ever-wider circumference around their temple.

And, in spending a little time with these people, I noticed some of their other behaviors.  They used to sell incense to the local department stores and then go steal it back so that the department stores would buy more and they would have a thriving business.  And their ethics told them that this was fine.  That anything in the service of Krishna was fine.  In interacting with them, I think I learned more about situational ethics than I ever did on campus.

And the last experience I wanted to recount for you was there is a man, I think he’s here today, named Jack Dudman, who used to be the Dean of the school, who was one of the heroes of my life while I was here because Jack Dudman looked the other way when I was staying on campus without paying.  He looked the other way when I was taking classes without being a formal student and paying the tuition.  And, oftentimes, when I was at the end of my rope, Jack would go for a walk with me and I would discover a twenty dollar bill in my tattered coat pocket after that walk with no mention of it from Jack before, during, or after.  And, I learned more about generosity from Jack Dudman and the people here at this school than I learned anywhere else in my life.  So, I wanted to thank this community because the things I learned here have stayed with me.  And character is built not in good times but in bad times.  Not in a time of plenty but in a time of adversity.  And this school seems to manage to nurture that spirit of adversity.  And I think does build some character.  So, I thank you for teaching me how to be hungry and how to keep that with me my whole life.  Thank you very much.

Special thanks to my alma mater, Reed College, for permission to republish these photos and audio recording.  Photographs by Fred Wilson.  Thanks also to Chris Lydgate and Gay Walker of the Reed College Office of Public Affairs for allowing me a peek into the archives.

Steve Jobs

October 10, 2011

Last Wednesday, two of us at RK2 were talking about all the ways Apple products have had an impact on our lives and our work.  Unknown to us, perhaps a few minutes earlier, Steve Jobs passed away at his home in Palo Alto.

Steve Jobs was a hero of mine.  It’s not because we both attended Reed College, or because I’m a longtime Mac fan (I bought my first, a Macintosh 512e, in 1986), or because I have seen every Pixar movie ever made (an occupational hazard of fatherhood), or because I care about fonts in ways no normal person really should.

What I admired most about Steve was the way he expressed a well-rounded Liberal Arts education in everything he did.  Instead of finding technological solutions to technological problems, he curated solutions broadly, driving towards the most elegant design by probing deep into materials science, anthropology, typography, and numerous other fields of human endeavor.

There may be some who say his impact is overrated, that his 317 patents were undeserved or unremarkable, that his influence is limited to computers, that he was just a marketing whiz and not much more.  It would require a vastly longer blog post to fully debunk that idea, so let’s just look at Mr. Jobs’ impact on the world of commerce.  There are at least seven industries that have been indelibly altered by Steve Jobs:

Computer Industry

If you own and enjoy a personal computer, you have Mr. Jobs and his partner Steve Wozniak to thank for pioneering the concept of a computer, the Apple II, that regular people could use.  Graphical user interfaces, windows, menus, the mouse, USB, wifi — the list goes on — were all pioneered by Apple.  Even the World Wide Web, the thing you are using right now, was created by Tim Berners-Lee on a NeXT computer built by Steve Jobs.

Consumer Elecronics Industry

First, the iPod supplanted the Walkman.  Now, the iPhone is supplanting nearly everything else, from GPS devices to cameras to guitar tuners and is significantly disrupting the portable gaming subcategory.  Once, not long ago, if you wanted to do something new with a device, you had to buy a new device.  Now, there’s an app for that.

Movie Industry

Ignoring Mr. Jobs’ unprecedented string of 12 blockbuster feature films as CEO of Pixar, Apple is a significant player in the growing market for movie distribution served most prominently by Netflix.  No matter how you get your movies, it’s possible the film was created on Apple’s Final Cut Pro software.

Recording Industry

iPod owns the market for portable music players and iTunes is the number one music retailer.  While the recording industry was in freefall from rampant piracy, Steve Jobs proved that artists and record labels could make money selling digital music.

Publishing Industry

With the launch of iPad, Apple is now poised to take a bite out of the market for books, magazines and newspapers.

Telecommunications Industry

One word: iPhone.

Retailing Industry

While other computer manufacturers were closing their retail operations, Apple rolled out a bold retail concept that continues to enjoy average sales per square foot rivaling Tiffany’s.  If you think maybe Steve wasn’t that involved in the effort, think again: at least one of his patents was for the design of a staircase used at Apple’s retail stores.  And that iconic cube at New York’s 5th Avenue store isn’t actually owned by Apple: it is the personal property of Mr. Jobs himself.

Although Steve Jobs packed an incredible number of accomplishments into a life cut short by illness, he somehow always left us on the edge of our seats, waiting for just “one more thing.”  Had he lived an average lifespan, who knows what more he would have accomplished.  Fortunately, I suppose, ideas take time to move from concept to finished product, so it’s possible we’ll see one or two more fruits of Steve Jobs’ labors from Apple in the coming months.

In the meantime, our thoughts are with the Jobs family in their time of loss.  We will miss him.

We are two

June 27, 2011

It’s hard to believe RK2 Advisory LLC is two years old.  Seems like it was just yesterday when Aaron and I were challenging ourselves to come up with the most enigmatic, incomprehensible name possible for a professional services firm.  Let’s pick some letters!  Let’s throw in a number!  How about some random punctuation?  Wait, you can’t use punctuation in a URL (a lesson Yahoo! learned too late.)

And now, here we are, two full years later.  I probably shouldn’t get too nostalgic but, way back when RK2 opened for business, The Hurt Locker had just opened in theaters, the Black Eyed Peas were burning up the charts with “I Gotta Feeling,” and Apple had just released the iPhone 3GS.  Yes, there was life before the iPhone 4 but, to paraphrase Thomas Hobbes, “it was nasty, brutish and lacked a retina display.”

Our friends, family and clients deserve our sincere gratitude for helping us start this labor of love we call a consulting firm and supporting us every step of the way.  Thank you!

Jim Womack’s challenge to the healthcare community

June 17, 2011

Last week, with clarity and simplicity, Jim Womack exposed the principal dilemma facing healthcare providers as they seek to become lean organizations:  Value streams in healthcare flow horizontally and yet healthcare organizations are arranged in vertical silos.  So how, with patients being passed from one silo to the next, can we ever trigger the virtuous cycle of improving quality and decreasing cost that we see in so many other industries?

It’s a theoretical question with unexpectedly practical implications for healthcare delivery in this country and it’s the kind of fundamental, thought-provoking one often hears from this guru of lean production.

Jim might prefer not to be called a guru — the term has gained negative connotations in the business world — but his clarity of thought is guru-like, in the classic sense of the word.  “Go see, ask why, show respect” is Jim’s mantra, a phrase coined by Fujio Cho, the current chairman of Toyota.

Consistent with his mantra, Jim has gone to see many, many times and, speaking in a packed ballroom at the Westin Seattle, he used his opening keynote at the second annual Lean Healthcare Transformation Summit to ask why, respectfully, providers have yet to solve this basic problem.

Value streams flow horizontally.  This is true everywhere, not just in healthcare.  Yet, healthcare providers are organized into vertical silos.  These silos go by many names: units, departments, professions, cost centers.  A patient might be admitted to the healthcare system in one silo, discharged from another, and find herself passed from one to the next in-between.

Vertical organization presents grave challenges for an increasingly complex healthcare delivery system: failed handoffs that lead to high cost, medical mistakes, and suboptimal outcomes for the patient.

Within this structure, the best one can hope to achieve is point optimization when, in fact, what’s needed is optimization of the whole value stream from end to end.

Jim illustrated the problem with a simple graphic, recreated below (captions added).

The problem is vastly more difficult to solve in the real world than it is in PowerPoint.  There is no way to select vertical rectangles in a complex healthcare organization and simply “send to back.”

Of course, some healthcare providers are indeed able to optimize horizontal value streams.  A provider with a narrow sub-specialty and predictable demand can optimize the value stream from end to end.  Orthodontists seem particularly adept at this.  It may also be possible for other professional practices specializing in a single procedure: orthopedists specializing in knee replacements, urologists specializing in vasectomies, and so on.

So, is the answer for everyone in healthcare to specialize in a single procedure?  No, because not every diagnosis can be addressed with a single procedure.  Most medicine is a team effort and always will be.

In fact, achieving horizontal flow in a narrow subspecialty is not solving the problem of applying lean in healthcare at all.

Here’s why.  Lean production is often described as separate and distinct from mass production, a new way to solve an old problem.  But, in fact, mass production is a subset of lean production, a special case of lean production made possible when customers demand one product in massive quantities.

In 1909, Henry Ford famously told his management team, “Any customer can have a car painted any color that he wants so long as it is black.”  When the customer demands one product in massive quantities, mass production, one could say, is the lean solution.  But when customer demand is lumpy, fragmented, specialized, and ever-changing, as it is in healthcare and most other industries today, mass production is no longer optimal.  It is the solution to the wrong problem.

So what is the answer?  As of today, no one has stepped forward, not even Jim Womack.  However, Jim saved us some time by sharing a couple incorrect answers to the question.  For example, obliterating departments and professions is not the answer.  Healthcare value streams are not automobile assembly lines.  You cannot cross-train an anesthesiologist to perform brain surgery.  You just can’t.  According to Jim, anyone seeking to organize a hospital solely along horizontal lines will soon fall victim to “the counterattack of the verticals.”  Professions need to exist, they will always exist and they will always be vertical.

Neither is the answer to create matrix organizations.  According to Jim, “Matrices simply create conflicts of horizontal versus vertical authority.”  Matrix mayhem.

So what is the answer?  No one knows but, according to Dr. Womack, “what we need is not assertion, it is experimentation.”  Jim Womack’s challenge to the healthcare community is to experiment and, if your experiment yields the solution, Jim promises, you will be prominently featured in his next book.

Airlift Northwest hosts open house

January 25, 2011
Our friends at Airlift Northwest opened the doors on Friday to show off their new facilities.  For many years, Airlift operated out of a well-worn wood-framed and stucco-clad building alongside Boeing Field.  In November, they moved to a new home, still in the Boeing aviation complex, just a short walk north.  The new space is not luxurious by any stretch but it is undoubtedly more functional.
Airlift Northwest is, of course, the premier air medical service provider with one of the world’s largest and most geographically varied service areas, stretching from Alaska to Eastern Washington.  Founded by Dr. Michael Copass in 1982, Airlift’s mission is to provide safe, efficient air medical care to critically ill and injured infants, children and adults.  In 2010, Airlift served 3,684 patients.  In that year, 26% of flights were rotary wing 9-1-1/EMS scene responses, 23% were fixed-wing flights and 51% were rotary wing inter-hospital transfers.  Airlift doesn’t officially track “lives saved” but the numbers one could compile anecdotally would be overwhelming.
In Airlift’s old space, the ComCenter, the continuously manned (and womanned) room from which rescue flights are dispatched, overlooked a parking lot and railroad tracks.  Now, they have a much more practical view towards the tarmac where Airlift’s small fleet of fixed and rotary wing aircraft are located.
The new facilities also provide better space for emergency medical training so the flight nurses, the men and women who do some of the most dangerous and demanding work in the healthcare profession, can keep their skills sharp.  They also have more comfortable barracks for flight nurses pulling late shifts on-call.
The new training room at Airlift Northwest.

In attendance were a cross-section of Airlift’s extended family.  Trustees Johnese Spisso and Lori Mitchell, two of Airlift’s strongest supporters, were on hand to lend encouragement.  KING 5 News anchor Allen Schauffler, no stranger to helicopters, toured the facilities.  And colleagues from throughout UW Medicine came to see Airlift’s new digs first hand.  Some folks who typically interact with Airlift exclusively by phone or email were finally able to match a name to a face, so the atmosphere was one of meeting old friends for the first time.

Guests also had a rare opportunity to step inside an air rescue vehicle.  Pilots and flight nurses were on hand to describe the operation of their EC135 helicopter, Learjet 35A and their new turboprop.  Last year, Airlift missed over 160 flights because their Learjet was in use and unavailable.  The turboprop helps Airlift meet that demand and provides enhanced capability to land at shorter airstrips.

The new space still has a few minor inconveniences.  For example, the administrative offices are located in a separate area detached from operations.  But the work spaces are significantly upgraded with an open floor plan.  In fact, only two people have offices with doors that close and Executive Director, Chris Martin, is not one of them.  Overall, the new headquarters is a vast improvement that will facilitate Airlift’s provision of high level air medical service to our region for years to come.

RK2 soiree draws friends and colleagues

January 10, 2011

A good time was had by all at RK2’s annual holiday party held Friday night at the Big Picture in Belltown.  Sorry, we haven’t gotten in the habit of taking snapshots at these events, so I’ll do my best to paint a picture with words.  Sometimes, frankly, the lack of photographic evidence has been for the best.

This time, though, it was good clean fun.  Soon-to-be Academy Award winning film, The Social Network played in the theater while our honored guests created an old fashioned social network of their own, mixing and mingling amidst the comfortable surroundings.  Topics of conversation varied wildly: from the difficult process of recovering from an Angry Birds addiction, to the use of Game Theory to allocate unequally desirable rooms among families sharing a beach house,  to the curious words used to describe the North American turkey in various languages of the world.

Later in the evening, the nerds among us, myself included, retired to the theater for a screening of Family Guy: Blue Harvest, Seth McFarlane’s nearly frame-by-frame cartoon reboot of Star Wars Episode IV: A New Hope.

Special thanks to Saruon and Maj for selecting the menu and Paper Moxie for designing the invitations.  Thanks also to Janet, our awesome captain for the evening, and to her employer, Ray’s Catering, for providing tasty food, including what might be the among the most enticing hors d’ouevre ever invented: the One-Bite BLT, a hollowed out cherry tomato filled with pepper bacon, romaine, and aoli.

Thanks most especially to our guests, friends and colleagues alike, for making it an unforgettable evening.  Plans are already underway for next year!

Book Review: ThedaCare’s lessons for lean providers

October 12, 2010
On the Mend
Revolutionizing Healthcare to Save Lives and Transform the Industry
By John Toussaint, MD and Roger A. Gerard, PhD with Emily Adams
Lean Enterprise Institute, Inc.

…humans will try anything (and everything) easy that doesn’t work before they try anything hard that does work.  And that’s where we are in healthcare.  All the easy fixes have been tried and only the hard things are left.

Those were the words of James Womack, the eminently quotable founder and now former chairman of the Lean Enterprise Institute, upon the publication of On the Mend.  Healthcare organizations have been slow to adopt lean production but, with this new book by John Toussaint and Roger Gerard, the authors hope to make up for lost time.

Of course, the best time for healthcare organizations to begin their lean journey has been “now” for quite some time.  But perhaps this “now” will prove more propitious as we reflect upon the recently concluded healthcare debate and prepare for the new reality the Patient Protection and Affordable Care Act promises to inaugurate.

This book is not a how-to.  Nor is it a workbook.  And it’s not the result of a vast academic research program like The Machine that Changed the World.  However, it is a worthwhile read for anyone involved with healthcare delivery.  Part memoir, part manifesto, On the Mend leaves the reader with a realistic appreciation of the challenges and triumphs one can expect when embarking upon a lean transformation.

The more engaging examples revolve around ThedaCare’s efforts to apply lean principles to reduce the time between arrival and treatment for two life threatening conditions: heart attack and stroke.  A potential heart attack or stroke victim arriving at a typical American hospital would be astonished by the unnecessary steps that stand between them and lifesaving treatment.

In an automobile factory, time spent waiting unnecessarily is unfortunate.  In a hospital, time spent waiting can mean death.  Although ThedaCare was already an industry leader, they attacked wastes systematically, scientifically and thereby improved patient outcomes.

For those, like myself, who come from a lean manufacturing background, it takes some concentrated thought to translate lean principles to a healthcare environment.  Fortunately, Drs. Toussaint and Gerard provide some helpful translation, listing the eight wastes of lean healthcare, quoted below.

The Eight Wastes of Lean Healthcare

1. Defect: making errors, correcting errors, inspecting work already done for error.

2. Waiting: for test results to be delivered, for an appointment, for a bed, for release paperwork.

3. Motion: searching for supplies, fetching drugs from another room, looking for proper forms.

4. Transportation: taking patients through miles of corridors, from one test to the next unnecessarily, transferring patients to new rooms or units, carrying trays of tools between rooms.

5. Overproduction: excessive diagnostic testing, unnecessary treatment.

6. Overprocessing: a patient being asked the same question three times, unnecessary forms; nurses writing everything in a chart instead of noting exceptions.

7. Inventory (too much or too little): overstocked drugs expiring on the shelf, under-stocked surgical supplies delaying procedures while staff goes in search of needed items.

8. Talent: failing to listen to employee ideas for improvement, failure to train emergency technicians and doctors in new diagnostic techniques.

Some credit the recent and ongoing healthcare debate for directing focus on lean techniques for reducing healthcare cost and improving patient safety.  While the resulting legislation promises vastly improved access for the millions of Americans lacking health insurance coverage, it is yet to be seen whether the changes will align incentives in a way that pulls waste out of the system.  Once providers are more clearly rewarded for efficiency and effectiveness, the same way the marketplace rewards auto makers for productivity and product quality, the lean approach advocated by Drs. Toussaint and Gerard will be the obvious way to achieve breakthrough improvement.

RK2 Advisory LLC requires book reviewers to declare conflicts of interest.  Conflict of interest exists when the reviewer has ties that could inappropriately influence his or her judgment, whether or not judgment is in fact affected.  Examples include but are not limited to financial relationships through employment, consulting arrangements, stock ownership, and exchange of goods, services or favors, either directly or through immediate family.

Reviewer’s statement on conflict of interest: A copy of On the Mend was provided to Mr. Ostrow by the publisher free of charge.

Murray supplies stats at Turner Society shindig

October 8, 2010
UW Medicine held its annual Turner Society reception at the UW Medicine research campus in South Lake Union yesterday.  The labs and offices, built around the former Washington Natural Gas “blue flame” building, provided a sleek and modern backdrop for this year’s gathering.
The keynote presentation was delivered by Christopher Murray, MD, DPhil, director of the Institute for Health Metrics and Evaluation (IHME).  The IHME, a group for which we have expressed admiration before, is one of the many world-class organizations affiliated with the University of Washington.
Before filing into the auditorium for Dr. Murray’s talk, the donors in attendance got chatty over wine and hors d’oeuvres.  One of the fun things about these events, even more than the meatballs and roasted broccolini, is the chance to talk one-on-one with IHME-affiliated graduate students doing groundbreaking work in public health.  Students, each contributors to published academic papers, were deployed throughout the ground floor space with placards displaying the fruits of their research, ready to engage the gathered congregants in scholarly discourse.
Although the IHME’s mission is to improve the health of the world’s populations, Dr. Murray’s lecture addressed mortality here at home, in the United States, but did so from a global perspective.

Dr. Murray grapples with mortality as the clock ticks, quite literally, over his shoulder.

While the United States is number one in health spending, it is far down the list in life expectancy.  But within the United States, mortality varies wildly.

Dr. Murray's mortality map with the legend magnified.

Dr. Murray presented a fairly standard information graphic, shown above, illustrating male mortality by county, but with a twist.  Instead of expressing mortality as a rate or an age, he showed it as an equivalent nation in the world.  So, while many counties in the Pacific Northwest have mortality like Japan’s (dark blue) or Norway’s (blue), other counties, including a broad swath of the Deep South, have life expectancies closer to Vietnam’s (orange) or Iran’s (purple).

Mortality in the Pacific Northwest (top) and the Deep South (bottom).

Without question, there is room for dramatic improvement in mortality outcomes in the developing world.  But, it’s clear from Dr. Murray’s presentation that there are significant public health disparities to be addressed within the United States, as well.  And the solutions are not always obvious without methodical examination of data.
Mortality, after all, is a matter of life and death, and a topic worthy of research.  By supporting UW Medicine, members of the Turner Society are contributing to the IHME’s mission to provide the most rigorous public health information to policymakers around the world.
Update:  The IHME posted a compact and informative summary of the event, including poster presentations of IHME students and fellows, here.

Obama talks economy, dishes red meat

August 17, 2010

President Obama visited Seattle today, speaking to a packed ballroom at the Westin Seattle.  The appearance was billed as the Murray Victory Luncheon with President Barack Obama, a fundraiser for Patty Murray’s senate campaign.  Security was tight; much tighter than when Vice President Joe Biden visited several months ago.  The line to register and pass through security stretched down the escalator, out the door and around the block.  With the mercury pushing 90 degrees, it was a bad day to wear a suit.    

You’ll often hear events like these described as “$500 a plate fundraisers,” implying perhaps that they are gatherings for fat cats rich enough to regularly drop $500 for lunch.  But the attendees weren’t all millionaires.  At my table was a young real estate agent, an unemployed office worker and a small business owner, among others, united more by their support of Patty Murray than by their tax bracket.  And I can say with certainty that no one was there for the food.  Lunch today consisted of cold shrimp, rubbery chicken and garnish masquerading as salad.  I’m a carnivore but I opted for the vegetarian plate, partly for safety reasons.  The President wisely stopped for a turkey sandwich at Grand Central Bakery in Pioneer Square before making his way to the Westin.    

President Obama shaking hands at the Seattle Westin, flanked by Secret Service agents. Presidential "body man" Reggie Love can be seen behind Obama's right ear.

There were a number of light moments, like when Congressman Jay Inslee facetiously announced his intention to introduce a “three strikes” bill in the U.S. House of Representatives directed at Senator Murray’s likely Republican opponent, Dino Rossi.  Of course, he was referring to Mr. Rossi’s failed runs for governor in 2004, again in 2008, and now his current Senate candidacy.    

Following a short Murray campaign video, Governor Chris Gregoire appeared on stage without introduction, garnering whoops and cheers once people realized she was standing there.  She offered testimony of Senator Murray’s work ethic and single-minded focus on the issues important to Washington State.  Having run against Dino Rossi twice, Ms. Gregoire expressed that she identifies with Senator Murray’s current situation and offered her conviction that things will work out in the end.    

After the Governor concluded her remarks, Suzi LeVine went on stage, delivering a brief but enthusiastic pitch to donate money on behalf of Democratic candidates.  Suzi is my neighbor, an ultra-smart person, and a full-time activist for Democratic causes and early childhood development.    

Not wanting to presume the outcome of today’s primary election, Patty Murray never mentioned Dino Rossi by name.  Instead, Patty’s speech focused on the principles that drive her work in the Senate.  When the press pool and White House photographer Pete Souza appeared below the stage, it was clear the President was in the building and Patty wasted no time introducing him.    

President Obama’s policy remarks focused mainly on the economy, noting that, while the economy is in serious shape, job growth is positive now after severe job losses in the waning months of the previous administration.  He said he didn’t intend to re-litigate the past but he was determined not to repeat it.    

The President also displayed his skills as Comedian in Chief, comparing the economy to a car that has been driven into a ditch.  He described his efforts over the last 18 months, working with congress to push that car out of the ditch.  Mr. Obama then described his Republican colleagues standing on the sidelines, “drinking a Slurpee,” complaining that he’s not pushing fast enough.  The President’s Slurpee-drinking pantomime was priceless, by the way.  “Now that the car is on level ground, those guys are demanding the keys back.”  According to the President, “When you want a car to move forward, you shift into D, not R.”

Update:  The New York Times just published a fun article on President Obama’s Slurpee comment, along with more accurate quotes.  Sorry, I’m writing from memory; the professional journalists at the Times use a recorder.

Times features lean transformation at Seattle Children’s, debate ensues

July 12, 2010

Seattle Children’s Hospital and Medical Center is one of a growing number of local providers making a long-term commitment to lean and reaping the benefits, a success story highlighed Sunday in The New York Times.  Along with Virginia Mason and Group Health, Seattle Children’s draws a steady stream of visitors to Seattle to see how lean can be successfully implemented in a healthcare setting.

Of course, one of the pitfalls of being featured in a general circulation newspaper, even one as venerable as the Times, is the appearance of the inevitable “two sides to every story” subplot.  I think we’re all familiar with the rule that journalists are required to solicit counterarguments from those who might be critical.  In this case, the Times sought to balance the roundly positive results enjoyed at Children’s by interviewing Nellie Munn of the Minnesota Nurses Association.  As reported by the Times,

On June 10, Ms. Munn helped lead a one-day strike by the Minnesota Nurses Association against six local health care corporations, including her employer, partly in protest of lower staffing levels her union thinks have resulted from hospitals’ “lean” methods.

Journalists can’t be experts in every subject (although beat reporters make a reasonable effort).  So, to avoid unduly favoring one viewpoint over another, they report two sides and let the reader decide. 

Balance makes complete sense until you try to apply it to your own line of work.  For example, if you are a CFO, you can’t walk into the CEO’s office and say, “Well, according to prevailing opinion, you made a profit.  However, there is an increasingly vocal faction within the organization who believe that you, in fact, took a loss.  I’m simply reporting both sides of the story.  You’re free to decide the company’s financial stability for yourself.”

You can say I’m biased but, contrary to a vocal faction within the Minnesota Nurses Association, evidence shows lean improves patient safety.  Done right, the benefits of lean accrue not just to the patient, but also to the individuals caring for the patient and the hospital’s bottom line, generally in that order.  Of course, lean is difficult, it takes time to master, and it doesn’t always show results right away.

The two pillars of lean are continuous improvement and respect for people.  However, there are aspects of lean that can ring alarm bells among employees who do not yet have a wholistic appreciation for lean.  The first is standardized work.   In lean, first you standardize, then you improve.  Improving a non-standard process is like remodeling a house built on quicksand.  It won’t do you much good in the long run.

Unfortunately, there is a long history in America, from the early work of Fredrick Taylor to today, of managers and consultants hovering above employees with stopwatches seeking to cut costs by eliminating jobs.  You can say lean is collaborative.  You can say no employee will be laid off as a result of lean improvements.  But the weight of history sometimes prevails and the only way to prove lean is different is to see results over the course of several years.  In the meantime, critics of lean will have ample fodder.  For a sample of how this conversation can unfold, read Mark Graban’s online discussion with an anonymous supporter of the Minnesota Nurses Association.  [Full disclosure: My mom is a practicing nurse and member of a nurses union at a hospital that unsuccessfully attempted to implement lean practices.]

Mr. Graban, one of the leading voices in lean healthcare, exercised laudable restraint in his responses.  In fact, it must have felt a tiny bit awkward being party to a “lean vs. union” debate, since lean production systems operate with the full blessing and support of union leadership and membership in a wide range of workplaces, from hosptials to automobile plants.  Children’s of Minnesota, the object of the Minnesota Nurses Association’s misplaced suspicion, is a mission-driven not-for-profit organization.  While no organization is immune to bad decision-making, the argument that Children’s of Minnesota is knowingly endangering patients to make a quick buck falls flat.

The second aspect of lean that can ring alarm bells is its association with Toyota.  Indeed, lean’s greatest champion can sometimes be its greatest Achilles heel.  Isn’t lean the system invented by Toyota? critics may ask.  Why would anyone want to send an uncontrollably accelerating Prius careening down the corridors of a hospital?

Again, there’s no equally visceral counter-argument.  Lean is a mostly scientific process, driven by front-line care providers based on evidence.  One can respond with evidence but, as we see in arguments over climate change or evolution, evidence is not always the primary medium of exchange in certain debates.  Instead, we hear that caring for sick people is not the same as building automobiles.  And it’s true.  In fact, automobiles in a Toyota factory receive more attention to quality than patients in a hospital, not less.  If reducing medical mistakes means learning from a car company, then learn we should.