Caring for the Carers: Investing in healthcare workforce wellbeing

Learned a lot lending an editorial hand here:

PwC Strategy& Middle East, May 2025

by Irfan Merali, Dr. Christelle Abou Nader, and Andrew AlHamouch

The health of the GCC’s population depends on the wellbeing of its healthcare workforce. It is a key lever for improving the quality of care provided by the region’s 800,000 healthcare professionals, and for reducing the cost of care. Our analysis indicates that improving healthcare workforce wellbeing in the GCC countries potentially could generate US$ 2.5 billion in annual savings.

Healthcare is a rewarding and demanding profession. Long hours, high intensity work environments, and physically demanding tasks contribute to elevated incidences of chronic fatigue, musculoskeletal injuries, and other health problems. Nearly half of healthcare workers globally suffer from burnout. Almost as many experience musculoskeletal issues each year. We find comparable rates in the GCC’s healthcare systems.

These conditions harm healthcare workers and patients. Mental and physical wellbeing challenges drive up absenteeism, turnover, and job dissatisfaction, all of which increase medical errors, lower patient satisfaction, and diminish compassionate care. Research into the effects of burnout among doctors, for example, shows that it is associated with a fourfold decrease in job satisfaction. Doctors experiencing burnout are 2.2 times more likely to have made a recent medical error. Thus, current conditions foster a vicious cycle with systemic and financial repercussions.

As these conditions worsen, healthcare systems become increasingly stretched, with workforce shortages intensifying these pressures. The wellbeing of the GCC’s healthcare workforce is a large-scale issue with system-wide implications that should be investment priorities. Evidence-based research proves that investing in healthcare worker wellbeing yields tangible benefits, including a 17% reduction in absenteeism, an 11% decrease in turnover, and productivity gains of up to 25%. Read the rest here.

Rethinking Industry’s Role in a National Emergency

Learned a lot lending an editorial hand here:

MIT Sloan Management Review, May 27, 2021

by ManMohan S. Sodhi and Christopher S. Tang

Image courtesy of Michael Austin/theispot.com

Photographs of doctors and nurses wearing garbage bags to protect themselves from infection are among the most indelible images of the COVID-19 pandemic. They also testify to the limitations of the U.S. Strategic National Stockpile (SNS). By the end of March 2020, as the first surge of COVID-19 exceeded 20,000 new cases detected per day, it was woefully clear that the United States’ emergency stockpile of essential medical supplies could not meet the demand for personal protective equipment (PPE), ventilators, and other materials urgently needed to battle the pandemic and save lives.

Since then, there has been plenty of finger-pointing regarding the inability of the SNS to live up to its mandate. But none of that acknowledges the reality that, because of the scale and rarity of pandemic-level public health crises, no national reserve can reliably provide the materials needed from inventory alone.

In the decade before COVID-19, flu-related hospitalizations in the U.S. averaged 440,000 annually, but in 2020 alone, COVID-19-associated hospitalizations reached 4.1 million. This is a huge spike in need that is nearly 10 times the flu hospitalization annual mean. Moreover, public health emergencies of COVID-19’s magnitude are highly unusual in the U.S. or anywhere else, normally occurring decades apart, which makes the demand spike massive but rare.

After all, the demand challenge for the SNS is to be able to handle the following:

• More severe flus occurring every two to three years, with demand for medical products and equipment being, say, twice the average annual flu hospitalization mean.
• Epidemics and minor pandemics that may occur, say, once every five to 10 years, with demand being as much as three to four times the mean, although the spike may be regional rather than nationwide.
• Severe pandemics occurring once every 20 to 40 years, with demand as high as 10 times the annual mean occurring nationwide.

No manufacturer launching a product could handle such a distribution of demand by simply having a huge pile of just-in-case inventory, and neither can the SNS. Instead, it needs a strategically balanced approach to meeting future calls for help, keeping in mind that the outcome is counted in human lives. Read the rest here.

Supporting employees working from home

strategy+business, January 29, 2021

by Theodore Kinni


Photograph by Kathrin Ziegler

In mid-December, a light appeared at the end of a long, dark tunnel when the U.S. Food and Drug Administration issued emergency authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines. A month later, that light wavered as the death toll in the U.S. reached 400,000 — having reached 300,000 just five weeks earlier — and the outgoing director of the Centers for Disease Control and Prevention warned that the worst of the pandemic was yet to come. As Yogi Berra once said, “It ain’t over till it’s over.”

Even as millions of people are getting vaccinated, many employees won’t be returning to the workplace for months to come. Instead, they will continue to work from home with all the distractions, stresses, and fears that they have experienced over the past year. This is not an insignificant problem: 25 percent of respondents to a PwC Workforce Pulse Survey conducted between January 11 and 13, 2021, said their physical and mental well-being deteriorated during the pandemic; more than 20 percent said their ability to disconnect, their work–life balance, and their workloads worsened. These results could be magnified in the weeks and months ahead by spikes in COVID case rates and deaths and continuing economic uncertainties, especially with regards to job security.

This makes one of the WFH (working from home) challenges that leaders face even more acute: How do you assess employee wellness when your only point of contact is a phone call or a computer screen? For answers, I talked to two experts... read the rest here.

All the healthcare you can afford

strategy+business, July 31, 2019

by Theodore Kinni


Illustration by adventtr

In 2014, a syllabus and sample lecture for a course entitled Introductory Korean Drama (pdf) surfaced at Princeton University. Written by the eminent healthcare economist Uwe Reinhardt, it began, “After the near‐collapse of the world’s financial system has shown that we economists really do not know how the world works, I am much too embarrassed to teach economics anymore, which I have done for many years. I will teach Modern Korean Drama instead.” It appears that some economics professors aren’t nearly as dismal as their science.

Reinhardt never taught the class, which he said began as an impromptu lecture at a dinner with a group of Korean and Taiwanese health insurance professionals. But his tongue-in-cheek analysis of Korean TV dramas offers a glimpse of his ability to get to the nub of a matter. So does Priced Out, Reinhardt’s final book, published earlier this year, two years after his death in 2017.

In the book, Reinhardt gets to the crux of the ongoing debate over the American healthcare system — in which solutions abound but relief is nowhere in sight — with just one question: “As a matter of national policy, and to the extent that a nation’s health system can make it possible, should the child of a poor American family have the same chance of avoiding preventable illness or of being cured from a given illness as does the child of a rich American family?”

This is the ethical issue hidden behind all the talk of free markets and government control, the political rhetoric about socialism and states’ rights, and the calculations of how much the people of the United States can or can’t afford to pay for healthcare. Clearly, it’s an uncomfortable one. When Reinhardt first posed the question more than 20 years ago, he was dismissed as a “socialist propagandist” for his temerity.

“And so,” he laments, “permanently reluctant ever to debate openly the distributive social ethic that should guide our healthcare system, with many Americans thoroughly confused on the issue, we shall muddle through health reform, as we always have in the past, and as we always shall for decades to come.” 

But muddle through we must, because of two long-term trends: the seemingly inexorable growth in healthcare spending and the increasing inequality in the distribution of income and wealth. These trends, Reinhardt argues, “already are pricing more and more American families in the lower part of the nation’s income distribution out of health insurance and healthcare as families in the upper half of the distribution know it.” In other words: No, currently, the child of a poor American family does not have the same healthcare prospects as the child of a rich American family. Read the rest here.

Physician, Disrupt Thyself

strategy+business, September 19, 2018

by Theodore Kinni

If I were a senior executive in healthcare, it would scare the hell out of me to learn that Amazon founder Jeff Bezos, Warren Buffett of Berkshire Hathaway fame, and JPMorgan Chase CEO Jamie Dimon formed an independent company “free from profit-making incentives and constraints” to provide “simplified, high-quality and transparent healthcare at a reasonable cost” to a million or so of their U.S. employees. The fact that the CEOs chose surgeon and author Atul Gawande — an outspoken critic of the healthcare industry’s practices — to lead it wouldn’t settle my nerves. The news might even be jarring enough to induce me to read Vijay Govindarajan and Ravi Ramamurti’s Reverse Innovation in Health Care. Although that might prove cold comfort indeed.

“The real reason the health-care debate hasn’t gotten anywhere is that would-be reformers are debating about the wrong things,” declare Govindarajan, Coxe Distinguished Professor of Management at Dartmouth College’s Tuck School of Business, and Ramamurti, University Distinguished Professor of International Business and Strategy at Northeastern University. “It’s not about who pays for what. Skyrocketing health insurance premiums are just a symptom of the underlying problem. The problem with American health care is that it costs too much, the quality is uneven, and too many people can’t get the care they need.”

The professors thus blame providers for the fact that the U.S. healthcare system is by far the most expensive in the world while its supposed beneficiaries rank 37th globally in average life expectancy. Healthcare delivery is the problem, they argue.

As we quibble about everything healthcare-related in the U.S., I could quibble with Govindarajan and Ramamurti about whether providers or payors or patients or the fee-for-service, free-market healthcare system itself is to blame for this mess. Clearly, the costs of the U.S. healthcare system have been rising far above the rate of inflation. And given the fact that my very healthy family’s health insurance is its biggest annual outlay, I, for one, would welcome relief from any quarter. 

Reverse Innovation in Health Care argues that the quarter that the relief is going to come from is…India, which ranks 104th in life expectancy. On the surface, this seems so outlandish that the authors had to include an appendix of questions and answers titled “India? Really?” After they spend an entire book making their case, they had to make it again! ...read the rest here

Are American Workers Dying for their Paychecks?

strategy+business, April 12, 2018

by Theodore Kinni

Jeffrey Pfeffer, the Thomas D. Dee II Professor of Organizational Behavior at the Stanford Graduate School of Business (GSB), hasn’t been particularly sanguine about business management for a couple of decades now — perhaps he never was. From his Machiavellian take on power to his skepticism about leadership education, his recent books have punctured conventional wisdom and challenged executives to do better. In his brutal new book, Dying for a Paycheck, Pfeffer steps up the attack.

The book’s thesis is straightforward and blunt: American workplaces and management practices are destroying individual and organizational health. To prove it, Pfeffer partnered with GSB colleagues Joel Goh, a doctoral student (now a professor at the National University of Singapore), and Stefanos Zenios, a professor of operations, information, and technology, and surveyed a broad range of employee health and wellness research.

They identified 10 workplace exposures within the control of employers that significantly affect human health and longevity. And we’re not talking about the industrial accidents that plagued the American workforce a century ago. Rather, the exposures in the 21st century include: being laid off; not having health insurance; irregular work shifts; working more than 40 hours weekly; confronting job insecurity; facing work–life conflicts; having low control over one’s job and job environment; facing high job demands; having low levels of social support at work; and working in unfair situations. Read the rest here.

One Doctor’s Take on How to Fix the Sick Healthcare System

strategy+business, June 12, 2017

by Theodore Kinni

A decade after presidential candidate Barack Obama first declared comprehensive healthcare reform a central tenet of his platform — and seven decades after President Harry S. Truman proposed a national healthcare plan — the issue still stands at the center of political debate. In 2017, a Republican-dominated Congress and a new Republican president are grappling with their own comprehensive plan.

But even if the Affordable Care Act is repealed and replaced, Dr. Robert Pearl believes U.S. consumers and companies are unlikely to get any relief from rising costs. That’s what Pearl argues in his no-holds-barred book, Mistreated. This line of argument is dismaying and more than a little surprising, especially considering that Pearl isn’t an academic, or an activist, or a pundit with a shallow outsider’s knowledge of the industry. For nearly 20 years, until this month, he was the CEO of the Permanente Medical Group, which is a subsidiary of California-based managed-care giant Kaiser Permanente as well as the largest provider network in the nation in its own right, with more than 9,000 physicians and 34,000 staff members. In other words, he’s one of the people who manage a significant chunk of our increasingly unaffordable medical care.

“As we look toward the future, the economics of healthcare are shaping up to be a classic example of the unstoppable force meeting the immovable object,” Pearl writes. “The rising percentage of total dollars spent on healthcare (unstoppable force) and the limited ability of government, businesses, and individuals to pay for it (immovable object) are on a collision course. Something has to give.”

In Mistreated, Pearl argues that it doesn’t really matter who pays for healthcare, which has been the primary focus of the decade-long reform debate. Read the rest here

An Antidote for Health Care Reform Failure

Insights by Stanford Business, May 16, 2017

by Theodore Kinni

Want real health care reform? Focus on fixing health care delivery, says one Stanford lecturer. | Reuters/Nicky Loh

Health care reform has been the bane of U.S. presidential politics for over a century. Teddy Roosevelt included universal coverage in his run for president in 1912 and lost. Since then, almost every U.S. president has been stymied by health care reform in one way or another.

It’s no different this time around. This past March, President Trump and the Republican-led Congress couldn’t muster the votes for their own American Health Care Act, and discussions to reprise it have fallen flat.

Robert Pearl, a doctor and the CEO of the $11 billion Permanente Medical Group and a strategy lecturer at Stanford Graduate School of Business, says that might not be much of a loss. In Pearl’s opinion, neither President Obama’s Affordable Care Act nor President Trump’s AHCA adequately addresses the essential conundrum of American health care — the fact that the U.S. as a whole spends 50% more on health care that any other nation, yet ranks 70th globally in health and wellness.

Pearl, whose new book, Mistreated: Why We Think We’re Getting Good Health Care — and Why We’re Usually Wrong, hits shelves this month, shares his vision of a better health system...read the rest here

Jo Ann Jenkins’s Required Reading

strategy+business, June 22, 2016

by Theodore Kinni

It shouldn’t come as much of a surprise that Jo Ann Jenkins is an enthusiastic reader: Until 2010, she was the chief operating officer of the Library of Congress. With a staff of 4,000, a budget of more than US$1 billion, and 838 miles of bookshelves, it is the largest library in the world.

Jenkins left that position for another massive organization, AARP. Formerly known as the American Association of Retired Persons, AARP is one of the world’s largest nonprofits, with nearly 38 million members. Initially, Jenkins served as president of AARP Foundation, where she led that organization’s development and social impact initiatives, including Drive to End Hunger, and increased the foundation’s donor base by 90 percent in two years. In 2014, she was named the first permanent female CEO of AARP.

Jenkins put AARP’s large and influential platform to good use from the get-go. In her first statement as CEO, she declared her intention to redefine outdated stereotypes about health, wealth, and self-fulfillment image in old age.

Jenkins has detailed her ideas in a new book, Disrupt Aging: A Bold Path to Living Your Best Life at Every Age (PublicAffairs, 2016). Disrupt Aging reminds us that almost one-third of the U.S. workforce is now composed of people age 65 and older, and offers a host of ideas for capitalizing on the life and work experience they bring to the job. After reading it, I asked Jenkins to share a few books that have influenced her career and thinking. Read the rest here

The d'oh of healthcare reform

In which I publicly complain about healthcare reform on s+b's blog for the first and last time:

The Long Road to U.S. Healthcare Reform

The HealthCare.gov team keeps sending me emails. The March 31 application deadline for coverage in 2014 is fast approaching and they’re concerned: “Millions of Americans are already benefiting from the quality, affordable health coverage available to them through the Marketplace. We want to make sure you join them.”

I appreciate that. Really. I can’t remember a time in the past 20 years when our health insurer has expressed any interest in whether my wife and I had quality, affordable coverage. Instead, it sent us annual rate increases—usually 15 to 20 percent—accompanied by a generally incomprehensible policy. Every three to four years, as the cost of our policy made the draconian risks of self-insuring start to look good, my wife renegotiated it—that is, she reduced our coverage until it reached a level that we could afford.

Of course, I was gung ho about healthcare reform. For years, I happily anticipated the competitively priced insurance that would be available on the government-run exchanges. In good humor, I waited out the silly death-panel debates and the heroic debugging of HealthCare.gov. And then, finally, I gleefully registered and followed the simple instructions to get my quote. The payoff? Higher deductibles and less comprehensive coverage at a cost approximately US$100 per month more than our existing policy. D’oh!

This is a long-winded explanation for why I wasn’t particularly thrilled to receive an advance copy of the long-titled Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System (Public Affairs, 2014), by Ezekiel J. Emmanuel. The author was a beacon of sanity throughout the battle over reform. He is the chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and served as a special advisor for health policy to the director of the White House Office of Management and Budget for a couple years.

In his new book, Emanuel does what he does best—clearly and logically explains the U.S. healthcare system. In doing so, he reprises many of the promises that he and other reform advocates have made before in the guise of six “megatrends.”

• The Affordable Care Act (ACA) will force a radical restructuring of the insurance industry as providers and payors integrate, and markets become more competitive.
• The chronically and mentally ill will get better care.
• The demand for highly expensive acute care will fall.
• Employer-sponsored health insurance will disappear.
• Healthcare cost inflation will subside.
• Changes in medical education will eliminate the shortage of health professionals.

Theoretically, this prescription is just what the doctor ordered. The only problem is that Emanuel’s megatrends are predications about the future, and as he says, “Making predictions is highly risky.” The reality, which Reinventing American Health Care does not shirk, is that the ACA will not deliver the above benefits until sometime between 2020 and 2025 —and there are many ways in which it can go off the rails between now and then.

 

So, it turns out that quality, affordable healthcare is still quite a ways away for me and my wife. In the meantime, our insurer says that our policy is going to get cancelled next year because it supposedly doesn’t conform to the standards mandated by the ACA, and our choices on HealthCare.gov are significantly more expensive than the $1200 per month we’re paying now. Good thing we dodged the socialized medicine bullet.

s+b's Best Business Books 2012

The annual Best Business Books special section is now online at strategy+business. We've got a great team of expert essayists, who chose and reviewed a terrific stack of books...in my not-so-humble opinion. Here's my intro to the section and the best of the best lineup. Read the rest here...

New and improved! This promise gets slapped on business books as often as on household cleansers. Many books are new each year, but those with genuine insight and value are very rare indeed.

We take the time to find them. In strategy+business’s Best Business Books 2012, our team of distinguished experts — some veterans of this annual special section, namely James O’Toole, Sally Helgesen, Phil Rosenzweig, and “Z” Holly, and some newcomers, Alice Schroeder, J. Philip Lathrop, and Shaun Holliday — review 21 tomes published between the autumn of 2011 and the autumn of 2012 that fulfill their promise.

Be sure to take a close look at our Top Shelf selections — our reviewers’ picks as the best of this year’s best business books. They include a new appraisal of Dwight David Eisenhower that will prompt you to consider your own effectiveness as a leader, a realistic plan for improving healthcare that eschews political rhetoric for practical solutions, an exploration of cloud computing that gets beyond the surface technological story to look more deeply at how it will change business practices, and four more books that merit your time and attention.

Here's the Top Shelf selections (lifted off the s+b website). Congrats to the authors! 

	Biography Eisenhower in War and Peace by Jean Edward Smith (Random House, 2012)
	Strategy The New Emerging Market Multinationals: Four Strategies forDisrupting Markets and Building Brands by Amitava Chattopadhyay and Rajeev Batra, with Aysegul Ozsomer (McGraw-Hill, 2012)
	Marketing Grow: How Ideals Power Growth and Profit at the World’s Greatest Companies by Jim Stengel (Crown Business, 2011)
	Innovation Cloud Surfing: A New Way to Think about Risk, Innovation, Scale, and Success by Thomas M. Koulopoulos (Bibliomotion, 2012)
	Healthcare Healthcare Beyond Reform: Doing It Right for Half the Cost by Joe Flower (Productivity Press, 2012)
	Organizational Culture Productive Workplaces: Dignity, Meaning, and Community in the 21st Century: 25th Anniversary Edition by Marvin R. Weisbord (Jossey-Bass, 2012)
	Capitalism The Righteous Mind: Why Good People Are Divided by Politics and Religion by Jonathan Haidt (Pantheon, 2012)

            

SPC and healthcare

I think Atul Gawande, surgeon, New Yorker staff writer, MacArthur Award winner, etc., etc., is the best healthcare writer around for two reasons. First, his writing epitomizes the best New Yorker nonfiction, which I’ve been reading ever since cutting my teeth on John McPhee’s inquires into everything from Bill Bradley’s basketball chops to birch-bark canoes. Second, and more important, Gawande, unlike many writers who approach healthcare as proverbial blind men, sees the whole elephant. He looks at the woes of U.S. healthcare from a Deming-like systemic perspective that would behoove anyone concerned with healthcare reform anywhere in the world. Remember W. Edwards Deming?

Gawande’s most recent foray into the healthcare wilds, “The Hot Spotters" takes us to Camden, New Jersey, where a family physician named Jeffrey Brenner got the city’s three main hospitals to give him access to their medical billing records and analyzed the data on a desktop computer. He discovered that “just one percent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of [the city’s entire healthcare] costs.”

Brenner then set up a program to provide these “super-utilizers” of healthcare with greater attention and more education. The results: Over the long term, the hospital visits of the first 36 patients in the program were reduced by 40 percent per month and their average total monthly hospital bill dropped by 56 percent from $1.2 million to just over $500,000. Gawande points out that the net savings are lower (because of the extra attention these patients need from primary care physicians, among other things), “but they remain, almost certainly, revolutionary.” Clearly, if they could be extrapolated over Camden’s 1,000 one percenters, they could put a real dent in the city’s overall healthcare costs.

Gawande says Brenner’s program is “a strange new approach to health care: to look for the most expensive patients in the system and then direct resources and brainpower toward helping them.” This “new” approach is, of course, classic statistical process control – analyze your process outcomes, pick out the biggest variations from the mean, and address them. It’s SOP for manufacturers. If it was for healthcare systems, too, lots of low-hanging fruit would surely be revealed. But healthcare systems aren’t like manufacturing plants and their supply chains.

The major players in healthcare – doctors, hospitals, and insurers – are drowning in data, but they aren’t sharing it. The fact that Brenner got three hospitals to hand him their medical records is nothing short of amazing. And if providers and payors did start pooling and analyzing their patient data, who’s going to address the outliers that are revealed? Brenner had to scare up grants to run his program because, as Gawande writes, “that’s not how the health-insurance system is built.” That alone seems like a pretty good argument for rebuilding it.