Healthcare: Revolt…or Mutate?

As we wind down the first year of the second decade of the twenty first century, Revolution abruptly emerges as a global topic of attention. Clearly, Occupy Wall Street is the social object du jour.

It may be time, however, to think about what Revolution accomplishes. Specifically, what work does it do…and what work does it not do?

If you examine the cannon of Revolution over the last few thousand years, Revolution dominates as a pattern in all civilizations, cultures, religions, sciences, etc.

The work of those revolutions – in retrospect – accomplished the often difficult task of raising awareness. But they rarely – if ever – accomplished the actual lift-work required to manifest the Dream of the Revolution.

No, that work has always been left to another mechanism: the Mutation.

The mutation is what governs the river of biological evolution via natural selection. Evolution is not Revolution: it is Mutation. If Evolution were Revolution, the chromosomal links would break, and species would die off.

It’s those tiny mutations that make just enough of a course-shift, which make giant leaps in function and speciation.

This is the case with Technology and Ideology and Culture – although with a difference: these things do not evolve so much in a Darwinian fashion, but in a more Lamarckian algorithm – the idea for a gun can leap into the idea for a cannon, without having to go through millions of mutations.

Cultural genes – memes – can make leaps, unlike genes. In that sense, the work of cultural and technological and ideological Revolution can take place – but only as the results of accumulated mutations. Leaping ideas (Revolutionary idea) need connected pieces on the ground to accomplish work.

And so it is with Healthcare.

In Healthcare, it’s almost always the case that a slight mutation of an idea leads to radical insights which lead to what we end up calling “revolutionary”.

When the Hungarian physician Ignaz Semmelweis realized that a simple idea – that of hand washing in between deliveries – he generated a slight mutation in conventional medical practice. And although his peers shunned him and continued in their obstinent disregard for hand-washing, his idea became Revolutionary.

That is, Ignaz didn’t do something Revolutionary at the moment of his experiments. He initiated a tiny mutation. And that tiny mutation generated a leap in thinking which changed Healthcare – but even there, his idea isn’t followed sufficiently: to this day, there are doctors and nurses who don’t practice proper hand-washing technique!…

…Which just goes to illustrate how true Revolution almost never happens….just the (hopefully proliferative) expression of “good” mutations.

So what’s my point?

It’s this: When seeking to change an enormous project like Healthcare, you can focus on fomenting Revolution – or seek out the tiny mutations that can spread through vectors already in existence.

This may be a difficult thing to accept for those trying to Occupy Healthcare. Healthcare isn’t a country, nor street, nor any single entity. It is, in fact, the results of millions of mutations.

If you want to Occupy Healthcare, you can’t.

…But: you can take on a few tiny ships on the big ocean so-to-speak.

Everything has an opportunity cost. Might the opportunity cost of trying to create a “Healthcare Revolution” be foregoing the benefit of focusing on making one tiny mutation which could deliver better care – one way or another – much quicker?

A true Revolt doesn’t take place by revolting.

A true Revolt occurs over the course of tiny mutations.

Tiny. Mutate.

Thus the word: Mutiny.

Phil Baumann




Transcript of #OccupyHealthcare Twitter Chat

A chat around the hashtag #OccupyHealthcare took place on Sunday, November 6, 2011.

As of now, this is not a formally scheduled chat – but based on its remarkability, I hope we’ll see this become a regular feature for Sunday nights. It’s good to see more Twitter chats on healthcare that are more than just chats on social media. Perhaps Healthcare social media is finally starting to mature out of the initial shiny new object syndrome into what it should be: advancing Health care.

Anyhoo, a few weeks ago my friend Ben Miller (@miller7) started a blog in an effort to capture the spriti of OccupyWallStreet. I don’t know if the sprit necessarily ports in to Healthcare, but as a rallying point for discussion it makes sense.

The chat was moderated by @RichmondDoc and had the input of Ben’s OccupyHealthcare team.

So here’s a transcript of the chat – the tweets were moving rather fast and resulted in over 70 pages of content. The tweets were moving fast, so the good stuff starts on page 2.

This kind of discussion will certainly evolve into a political one.

That may be a challenge given the emotional charges carried in Healthcare, especially the financial reform part of it.

But that’s OK – it’s opposing energies move the world forward.

The biggest challenge? Putting this energy to work.

It’s one thing to talk on Twitter about how bad healthcare is, or how we need change. Actually doing something?

Ah, there’s a problem.

Still, it’s good to see this start up.

Phil Baumann



The Healthcare Polymath

Last century was the century of the professional. It was also the century of the cog. The human being who played a well-defined, mechanical role in a big machine.

20th Century hospitals – which were actually 19th Century factories tarted up with submissive nurses, white linens and sterile rules – don’t meet the needs of today’s patients.

The operations management view of the world which emerged out of the Industrial Age, which in turn emerged out of the printed book, saw things in lines – “the lines of the page”. Thus the people who worked in factories and hospitals were expected to work within the lines.

But it’s becoming clearer now, more than ever, that people don’t bring forth their best within boxes. In fact the mechanical environment kills creativity. Machines are machines, people are people.

The Web is now assaulting the factory. The Web isn’t linear. The Web is not just lines of text, but sounds and sights and video. People can network and connect and collaborate in ways not possible last century – the fractal, not the factory, is the engine of today’s economics.

Enter: Informational Osmosis and the Healthcare Polymath.

Nurses can now hear the stories of other nurses living half-way across the globe working in totally different fields of nursing.

Same with physicians.

What’s more, physicians and nurses can now trade their varied stories – can now create small or large communities to push the envelop. No need for permission, nor need to work within the lines – if they see a revolution to be created, they can make it happen.

A physician no longer has to be a physician. A nurse no longer has to be a nurse.

Each can be a writer, a web designer, an online community leader, a technological innovator…an artist who can tweet her latest work to anybody in the world. And each can suffuse their work to create remarkable experiences for the people they serve.

This informational osmosis means that what used to be the professional can now mature into something more organic and powerful: the Polymath.

The polymath didn’t do so well last century. The dominant economic structure was the factory. That condition benefited the cog. Now the factory is collapsing. And the cog is unemployed and unemployable.

It’s not easy being a polymath – but it doesn’t require anybody to be a genius. No, it just means having an unquenchable thirst for knowledge and art and accomplishment and caring.

The polymath keeps us from Single Vision and Newton’s Sleep.

What will the future of medicine look like? Will we still have the rigid lines among the nurse and physician and information systems engineer?

The future of Healthcare rests upon the polymaths – the courageous status-quo busters, the dreamers waving pointed flags toward the horizon, the human alarm clocks of a sleeping world.

The polymaths run the playgrounds of ideas that make our lives anew.

Healthcare’s days of the sterile factory are numbered.

Time and space were once thought to be linear – fixed and rigid elements of our universe.

Fortunately, we had a young polymath destroy that false assumption which retarded physics for millennia. We now know that time and space are bendable.

Same thing with Healthcare.

Imagine where we’d be today if Newton bothered to treat time as a variable instead of a constant. How many variables in medicine are we treating as constants?

We need the polymaths to destroy the old factories and to create the new playgrounds.



The Ugly Pearl of Healthcare

The world is your oyster.

A grain of sand. A biological process. Time.

A pearl.

The story of the pearl and the oyster is one of the most powerful mythologies.

…But what if we twist the metaphor a bit? What if the process that takes a tiny germinal and then grows around it something terrible?

In thinking about today’s Healthcare – all the Kafka moments, the waits, the language, the disconnects, the rules that self-defeat – it’s obvious that we need to understand what happened.

The problem is: we can’t really. We don’t have time to do a deep analysis. But metaphors can help us gain perspective.

So, I offer the Ugly Pearl.

A pearl, like health care, is supposed to be fascinating – in a cool way, ya know? Well an ugly pearl…well, that’s just heartbreaking.

So here we go…

There were grains of sand around which modern healthcare formed:

  • Military context – “Doctor’s Orders
  • Paternal social structures
  • The factory, assembly-line mentality of the Industrial Age
  • The objectification of the patient

These were some of the grains of sand around which grew an important part of civilization.

Over time – more than a century – these grains of sand have accumulated, infiltrated and calcified around healthcare.

And all this ugly pearling has produced lock-in: once a traditional idea sinks in, it’s hard to remove it.

For example: there was a time, not very long ago, when doctors and nurses determined your pain level. Think of that! It sounds dumb and it is dumb – and yet, there it was: a locked-in dumb idea which took wrenching to remove.


Hospitals still run on the factory-model.

There are physicians who still don’t listen to their patients – truly listen.

Nurses are still often abused – and abuse each other – in a manner that recalls the woman-hating cultures of the past. (It may be more subtle today, but it’s there – and it affects the males in the profession too.)

Patients often still feel like objects – or soldiers on a battlefield waging for the portability of and access to their healthcare data.

What’s more, physicians and nurses and other providers are now in the ever-tightening grip of this ugly pearl.

Today’s Healthcare is not PERRLA, and the industry is largely entrenched in lock-in.

But the world is changing.

Hospitals don’t get to decide if Social Media goes away.

Physicians don’t get to decide what patients do online.

When the world changes, smart people don’t look down at their feet.

When the world changes, smart people ask how it’s changing. They work to understand the world around them.

They entertain the possibility that all their decades of what they know aren’t what they should know.

Their pupils are open, equal, round and react to light and accommodation.

Healthcare – according to the stereotype – is made up of smart people.

If that’s the case, I have no doubt that we’ll witness the formation of a what a pearl should be: an achievement of life.

If it’s not the case, we’ll be ensnared in an ugly pearl for a very long time.

The world is your oyster. So is your health.

@PhilBaumann@HealthIsSocialPearls of Wisdom


Healthcare Problems To Discuss in 2011

We’re now more than 10% into the 21st Century. Here’s where we are in Healthcare today:

  • Most hospitals still use paper to record your most important information
  • Many of the best minds in Healthcare are nowhere to be found online – we have great ones, but we need more, more, more!
  • Doctors and nurses are getting in trouble for using iPhones in the care of their patients
  • Social Media Literacy in Healthcare – to a large extent – isn’t even at the pre-school level
  • Many providers don’t offer patients simple electronic tools and media to keep in touch
  • Facility-acquired infection rates are practically genocidal. Gen. O. Ci. Dal. Genocidal.
  • Mental Health is still called “Mental Health”, in spite of scientific evidence suggesting that the brain, not some mysterious fog, is responsible for our consciousnesses
  • Physicians are losing respect and reimbursements are declining
  • Nurses are overworked, are treated as expense items and burning out
  • Clinical collaboration is not as technologically swift as it can be
  • We treat many of our ‘elderly” like crap (sorry for the language, but it’s true)
  • Consumers continue to get bombarded by confusing and contradicting messages about health
  • Healthcare disparities continue to widen –  and still: even the rich will get screwed (again, sorry for the language, but it’s true)
  • The Life Sciences industry still doesn’t quite see itself as a provider of Healthcare solutions – today’s technology has the potential to break-down the schism between Healthcare and Pharma
  • Hospitals are still largely run on models based on the 19th Century factory
  • Domestic violence, including violence against children, still isn’t getting the attention it deserves
  • We have yet to fully understand how the ever-creeping infiltration of rapidly evolving technologies affect our health
  • The health-related data we radiate gets lost because we aren’t exploiting the technologies which could help to do that
  • The United States of America has no backup generators for Healthcare in the case of economic collapse or natural calamity

The list goes on.

Step back and re-look at the list.

Does this anger you?

Does it make ANY sense to you that this is where we are with Healthcare?

What happened? Never mind. It’s in the past.


So: what can we do now?

Not much at the top level – it’s daunting and politically frustrating. Disagree? Then go knock yourself out. 😉

We can, however, do small manageable things. Work at the local level. Persuade a hospital to change its visitation policy for the better. Take a nurse out to dinner. Eat less refined sugar.

Technology is another, especially as cost decreases as power increases:

  • Mobile
  • Social Media
  • Augmented Reality
  • Gaming
  • Clinical Collaboration Media
  • Advanced Diagnostics
  • Biomedical Advances
  • Personalized Medicine
  • Near Field Communication
  • Personal Health Records

Again, the list goes on. Things like Accountable Care Organizations (ACOs). Simple solutions too, like mindfulness training. We’ll riff on all that too.

Technology certainly is a big part of the solutions to our problems in Healthcare.

It’s not everything. We still need to address culture, education, recruitment…politics. Ah politics.

But we can spur conversation, spark imagination, start communities, lead others and ignite new projects.

We’ll discuss them here on Health Is Social’s blog, our Twitter Pleasure Dome, in our Newsletter, on RNchat, on MDchat, at conferences, in workshops, in interviews of smart people who care about what matters.

That’s what these media are for: to make differences that matter.

Anyhoo –

Health Is Social.

Always was, always will be.

Let’s work together – here and everywhere else we work – to make Care healthy once again.


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