Thursday, January 31, 2008

Health Care and Health Care Financing Reform

Bringing Peace to Iraq is Easy…

No - I’m not out of my mind even though the title of this article might suggest otherwise. I just haven’t finished my statement. The War in Iraq was won in less than 30 days with combat fatalities under 100. Unfortunately attempting to establish the peace has been much more costly in terms of dollars, days, and lives and we are still a long way from “Mission Accomplished.” Now I’ll finish my statement - Bringing peace to Iraq is easy COMPARED TO REFORMING OUR SYSTEMS OF HEALTH CARE (HC) AND HEALTH CARE FINANCING (HCF).

Iraq presents a challenge because it’s “not one world.” It’s actually a conglomeration of Arabs, Kurds, Persians - Muslims and Christians - Sunnis and Shi’a - peasants, politicians, insurgents, Imams, war lords, victims, and survivors. It is world where for most Maslow’s hierarchy of needs has only the Survival rung. Security is merely a dream and Self Actualization a fantasy. Unbelievable as it may seem each of these factions thinks they are right / good and everyone else is wrong!

The only wisdom I’ve heard come out of the chaos of this war and the search for peace came from a U. S. General who said, “this will end when the people of Iraq love their children more than they hate their neighbors.” How wise! This “place of chaos” is driven by fear, anger, hatred, ideology, self-serving leaders, fanatics, and history. These are the challenges. Freedom and safety for the people are the ideal.

In America today our HC system includes consumers that use care (patients) and the premium and taxpayers that pay for the care we use. We have providers (doctors, hospitals, home care organizations, nurses, allied health professionals, etc.) that deliver the care we use or the facilities in which the care is delivered. Add to this the insurance companies, HMOs, TPAs, and others that administer the funding of care, lobbyist that are “bodyguards” for each special interest and the insurgents that attempt to destroy the competing self interests, legislators, regulators, the pharmaceutical industry and others and you have a “place of chaos.”

Much like the factions in Iraq - each of the aforementioned stakeholders or “special interests” think they are the answer to the problem and everyone else is part of the problem. In reality and in the stereotype I can show great good done by each group or great harm / abuse contributed by the dark side of these same folks / interests.

Here’s the reality - the Sunnis - Shi’as and Kurds will not come to peace until the individual members of each group create a demand for a new “special interest” - that of the common good. Our HC and HCF systems will not be reformed or “at peace” until each of us as consumers - patients and premium / taxpayers demand a system of quality care, accessible to all at an affordable cost.

I believe the major stakeholders need to sit at a peace table and find a solution. To do this they must abandon their existing special interest in favor of the common good. We have no choice because in this pending war - the Marines can’t save us.

Copyright (January 2008)- Michael G. Manes
All rights reserved

Wednesday, January 30, 2008

Agency Perpetuation - From Preaching to Meddlin'

It was about July of 2000. I was leading a CE class for agents at the PIA annual convention. The topic was a Tomorrow Readiness Audit. My intent was to have each agency principal “test” him or herself on their willingness and ability to move their organizations forward in the world of the future – that ever elusive Tomorrow.

The demise of the Independent Agency system much like the end of Community Banks has been predicted for my entire work life and I’m guessing these were “hot topics” long before I entered the business. Independent agencies today are doing well and I expect them to continue to do well. Community banks are also rebounding from some of the hard times of the late 1980s. New Agencies and Community banks are starting up faster than old organizations can buy them out.

The mistake made by the futurists of doom that have been making these predictions is that they focus on the wrong word in each name. These gurus believe that these are agencies and banks – not realizing that the important name is INDEPENDENT and COMMUNITY.

The relationship with an insurance carrier that creates the principal / agent contract has long since deteriorated and all but expired. The traditional bank that these same “know it alls” consider is gone. The reality is that the individual entrepreneurs that are INDEPENDENT and COMMUNITY exist because they understand this world is about relationships and effective and profitable delivery that exceeds the expectations of customers.

The competitors that were supposed to put them out of business have failed to do so because these dinosaurs of tomorrow focus on the product and its efficiency – a transaction. They forget that in business today and for individuals with resources it is still important that someone know your name and understands your needs and is committed to help you get what you want. People count more than process.

All of the above being said – it is still the responsibility of the surviving agency owner or the bank president of tomorrow to extract every bit of inefficiency, waste, fraud, and redundancy out of their organization and take these savings to add value to the customer relationship and to reduce the cost of products / services provided and to increase the efficiency of delivery for the client – the happiness quotient.

Your success in the past – does not guarantee you success in the future. The audit addressed issues of technology, speed, leadership, marketing, product offerings, etc. I even discussed issues of perpetuation – the organization, its leadership, its client relationships and its profit. The hope was to assure another generation of success.

I asked the hard question of the owners in the room, “Would your demise increase or decrease your agency value? The old man in the front said “Boy, you done gone from preaching to meddling.” I knew I had hit a nerve and the nail on the head.

Copyright - Michael G. Manes / Square One Consulting (June 2007)
All rights reserved

Wednesday, January 23, 2008

The Opportunity in Darkness

Whacha Doin?

Boudreaux and his best friend Comeaux go to the Friday night dance at the American Legion Hall. When they get there, they park in the back lot and enter from the rear door.

During the night they dance, drink, and party hearty. In the vernacular of the Cajun culture there is “laissez les bons temps rouler”(let the good times roll). Around two in the morning the band quits playing, the dancing ends and the party breaks up.

Comeaux goes to the car but Boudreaux is not there. He goes back into the Hall – no Boudreaux. He checks the bathroom – no Boudreaux. As he gets near the bandstand he looks out of the front window to see Boudreaux on all fours scratching in the grass under the street light.
As Comeaux approaches Boudreaux he sees that he is drunk. “Whacha doin?” Comeaux asks. Boudreaux responds “Mais, I’m looking for my keys – I lost dem.” Comeaux is amazed and explains to his friend – “Boudreaux we parked in the back, we came in the back, stayed inside all night, what are you doing looking for your keys in the front of the building? Your keys can’t be out front.”

Boudreaux slurs back – “Mais you right but the light is better here!”

This silly story speaks volumes about human nature and the organizations that people create. For Boudreaux the light brought comfort to his search for the keys he needed to continue his night and to get on with his life. He knew the keys weren’t there yet the “comfort zone” created by the light for him at that time was better than reality and the result (ideal) he needed.
Before you dismiss this story as ridiculous and Boudreaux as a “dumb Cajun” ask a few tough questions about yourself and your organization.

Are you and your organization scratching around in the "light" of your "comfort zone" instead of venturing into the darkness that is the opportunity in tomorrow?

Copyright (1998) - Michael G. Manes / Square One Consulting
All rights reserved.



I WILL BE ON VACATION UNTIL NEXT WEEK.

Mike Manes

Tuesday, January 22, 2008

Change Management versus Change Architecture

Lessons in Literature

literature \ n … 3 a : writings in prose or verse, esp: writings having excellence of form or expression and expressing ideas of permanent or universal interest…

classic n 1: a literary work of ancient Greece or Rome 2 a : work of enduring excellence: also: its author b : an authoritative source 3 : a typical or perfect example 4 : a traditional event…

epic n 1 : a long narrative poem in elevated style recounting the deeds of a legendary or historical hero (the Iliad and the Odyssey are classics) 2 : a work of art ( as a novel or drama) that resembles or suggests an epic…

“The Great Books” have earned that title. Because of their style, substance, and probably most of all their impact, these works of art have stood the test of time. They have survived for centuries, educated generations, touched our hearts, and reinforced our souls. They often define the “civil” in our civilization.

Over the long holiday weekend, in the pursuit of wisdom and relaxation I reread one of these classics. As so often happens I discovered through this exercise an application of the message that had been overlooked in earlier readings. In my youth this story was thrust upon me. I did not seek it out. I did listen, read, and enjoy but I did not fully discern the real meaning. At that time my search was for entertainment more than wisdom. I did not know what I did not know.

Today, decades later, I discovered one of the great lessons in this epic and its importance in my personal life and in my business. My “brain tissue” dominated my first reading. I didn’t realize how my enjoyment and understanding would be enhanced through the “scar tissue” that I have developed since my original experience with this work of art.

I won’t retell this story since most of you are very familiar with it and I don’t want to ruin the experience for those that have yet to spend time “buried” in this classic. I will merely reinforce what the students of literature already know. The story commences with “once upon a time” and ends simply with the hero “living happily ever after”.

It is about a family – triumph and tragedy, success and failure, life and death. The siblings are the key characters. The circumstances of their birth and early childhood give no insight into whether the outcome is the result of “nature or nurture”. It is not about a “good” and “bad” person but rather the “good” and “bad” results or consequences that naturally accompany our decisions.

This is not a lesson on good and evil yet both are present. The most positive aspect is that in the end good does prevail. The story does not contain sex. It is heavily influenced by violence. Although the lack of sexual experience does not diminish the narrative nor reduce the lesson, I’m sure that if this classic is ever made into a movie sex will be added. It is a natural story in a pastoral setting.

What fascinated me was the appropriate message for tomorrow in this story from yesterday. As a businessperson the message of this story may include the “cleaver” that will separate tomorrow’s winners from the losers.

Simply stated the ultimate hero in this adventure proves to be a great decision-maker, long-term visionary and willing to trade short-term pain for long term gain. The losers made decisions but were more influenced by the short term “sirens” of comfort, convenience, and immediate gratification. To them the status quo was most important.

From a business prospective this story foreshadows what ultimately proved to be Sam Walton’s genius. Once when an interviewer asked Sam Walton the secret of his success, he simply stated, “good decisions”. When asked how he makes “good decisions”, he responded, “experience”. When pressed to explain the source of this experience, he smiled and said, “bad decisions”. Fortunately for Sam his bad decisions were not fatal (sadly, I must report that two of the characters [and ultimately the villain] in this story were not so lucky).

Not to appear too “nerdy” I must now confess that once I discovered the business and strategic applications of this story I enthusiastically read it a second time. The theme I discovered earlier became more focused. Two of the characters who were unsuccessful in the long term and paid the ultimate price chose to manage change – they dealt with the problems and opportunities in their environment as these were presented. They usually solved problems and capitalized on the opportunities that appeared. They were reactive.
The hero chose to architect change. This individual chose to take charge of the environment. He built backwards from the future. He was proactive.

This epic personifies CHANGE as both SLAVE and MASTER.

What follows are my notes as I studied in depth the lessons of Change Management and Change Architecture that are this classic.


Change Management – The Definitions

Carpe Diem – Seize today!

"The 90's will separate the winners and the losers. Those who embrace
change will be the winners, those who resist it will be the losers."
Jack Welch - CEO - General Electric

Today’s opportunities in tomorrow’s world.

Transitioning the organization from today into tomorrow.


Change Management – The System

A Vision

Commitment to the Vision

A Plan

Implement – Monitor – Adjust


Change Management – The Process

Define Current Reality

Establish Future Ideal

Create Strategies and Action Steps to Bridge these Points

Determine Contingency Plans – LET’S ROLL!


Change Architecture – The Definitions

Carpe MaƱana – Seize tomorrow!

Tomorrow’s opportunities today!

“The best way to predict the future is to create it.” – Peter Drucker

Transforming in advance the organization for tomorrow.


Change Architecture – The System

Visit the Future (Travel light – bring no baggage.)

Identify and Prioritize Opportunities

Define Models Necessary for each Opportunity

Design Processes to Build and Operate the Models


Change Architecture – The Process

Determine the Foundation for the Model (Values, Mission, and Direction)

Establish the Infrastructure (Budget, Organization Structure, Standards, etc.)

Disassemble the Current Organization to Assemble the New.

Monitor, Implement, Adjust – LET’S FLY!

If these “notes” intrigue you I suggest that you search your library for this classic - read, think, learn, and ACT. The version I studied was authored by Paul Galdone, the publisher was Clarion Books (© 1970), the Title – The Three Little Pigs!

Remember the Change Manager’s strategy was to “outrun the wolf”. The Change Architect’s strategy was to “create a secure future.”

Good luck in your quest for knowledge. For the future – ARCHITECT CHANGE!

Copyright (January 2002) - Michael G. Manes / Square One Consulting

The Concept of Concrete

Yesterday's post on this blog segmented the learning process into the categories of brain tissue and scar tissue. Today The Concept of Concrete is introduced. Since most of education, most of our dialogue, and all of the status quo is dependent upon the concrete and all of our "learning" and the change that we need to compete and survive in the future is dependent upon concept - we discover the "conflict" that is change. As Maxine, the cartoon character, once said, "Change is good as long as I don't have to do anything different."


Over time - this blog will focus more on scar tissue than brain tissue and more on concept than on concrete. For this reason it will bring value to the marketplace - not necessarily comfort to any readers. Enjoy!



The Concept of Concrete

Legend has it that about 200 BC, Julius Caesar Boudreaux – sales manager for General Chariots, Incorporated –arrived late for the annual sales meeting. This was not unusual since J.C. was always late. He was a great salesman but he was a flake who was never on time.

What was significant about this date is the enthusiasm with which Mr. Boudreaux entered the room. He was covered with mud and smiling ear to ear. He had an urn in each hand and was talking a mile a minute. “Sorry I’m late; my chariot got stuck in the mud. The good news is that this gave me time to think and have I got a great new idea.”

He held up the two urns and asked, “Does anyone know what this is?” Cassius Comeaux whispered to Brutus Belanger, “I hope this isn’t that what’s a Grecian urn joke.” Without further invitation, Julius took the liberty to explain.

“In one urn I have a gray powdery substance called cement. It’s actually a mixture of limestone and clay that has been heated to a very high temperature to form glass cinders called clinkers. These were then ground down to form this substance I’ve called cement.”

He continued, “In this second urn, I have water and in that water is a sun dial. This is symbolic of water over time. You see, I have discovered that if we mix this cement with water over time, it will form something I will call concrete.”

The audience yawned but J.C. continued with enthusiasm, “this mixture will form a gray paste that will harden as it dries to form a stone like texture. I believe we can spread this paste over our cart paths. When this substance dries, the paths will be hard surfaced so that our chariots will never get stuck again. I suspect there will be numerous other uses for this but I just haven’t had time to think them through.”

Today, we realize that Mr. Boudreaux had presented the concept of concrete. We know what concrete is and what it can do. In Mr. Boudreaux’s time however, this was all new – it was a radical departure from traditional thought.

In a broader sense, the term concrete means that which is known, experienced or understood. It includes activities with which we are all familiar and those things that are comfortable to us. It is a safe haven. Concrete does not require explanation or thought. It is also the focus of the majority of our time.

In business, if a new concept is introduced the tendency is to dismiss it because it’s not in concrete terms. It is easy to ignore the new. We can protect the status quo and our comfort zone by not considering anything innovative and different, any concept. It is human nature to want to return to “concrete” discussions.

The reality of tomorrow’s world is change. To survive and prosper in the future, we must innovate. (Remember the definition of insanity is to continue to do what we’ve always done and expect a different result.) To innovate we must spend our time developing new concepts and then converting the best of these into concrete practices. Our growth comes in concept.

If we only talk about what we already know – the concrete, we will not experience growth. If we do not talk to or more importantly listen to those with a differing viewpoint we will not fully develop and cannot innovate.

If we, like Boudreaux’s colleagues, dismiss new ideas as “kooky” or their developers as “flakes”, we are destined to stay stuck in the mud of the status quo. We will go nowhere. In today’s fast moving world, going nowhere is tantamount to failure. It means the end.

From this point forward, it is incumbent upon each organizational leader to spend time focusing on the new – development of concepts. (S)he must encourage every member of the organization to innovate – to offer the new. Each must listen more to all of the stakeholders in their business. Most importantly, they must pay attention to those who think differently, have different experiences or are of different cultures.

Our growth and prosperity will come from our ability to develop new concepts, evaluate and prioritize them and then convert the best of these into concrete!

By the way, what’s a Grecian urn?

Monday, January 21, 2008

Brain Tissue / Scar Tissue

Fred Dent, a friend of mine often talks about Brain Tissue versus Scar Tissue. He’s wise. In his opinion, and I agree, these are the two ways that we learn.

Brain Tissue is about “schooling”, academics, textbooks, and issues of the head. It includes the basic principles, the standards, the facts, and the rules that frame and sometimes limit our lives.

Much of the time the world of Brain Tissue is spent “sitting on your butt” listening to someone tell you about life or you reading about someone else and their experiences. The teacher then grades (judges) and posts what (s)he thinks you’ve learned.

This learning opportunity is also limited and it discriminates – some never learn to read while others get a Ph.D. The value of the result can vary based upon the quality of the facility, the text, the talent, the culture, and focus of the student, and / or the instructor.

All too often this academic process is about trying to have the knowledge of another person force fit into our own skull. Utilization of our Brain Tissue is a low risk activity. Brain Tissue is life proposed. It’s a thinking thing.

Brain Tissue is good – much of what we learn in this way stays with us or can be recalled by us on an as needed basis. It’s what we try to remember.

Scar Tissue is about living, learning, trying, failing, and trying again. These are issues of the heart and soul. Much of the value of Scar Tissue is earned by “falling on your butt” and gaining wisdom from that experience and courage from the act of standing only to fall again. Lessons from scar tissue are hard to forget.

Scar Tissue is more about experiencing life and gaining the knowledge that is the result of each experience. Scar Tissue is about implementing what you learned, monitoring the results, and adjusting the process. It’s living - an action thing.

Access to Scar Tissue is available to all. There are no predetermined ages of entry, normal matriculation dates, advanced degrees, non-traditional students or an acceptable G.P.A.

Scar Tissue doesn’t need buildings, administrators, or regulations. It is a fully integrated (all the world can be included) and yet, as needed, a fully segregated (you are a classroom of one) process. Admission is free and everyone willing is able to obtain a Ph.D. from the universally recognized and respected SCHOOL OF HARD KNOCKS!

Brain Tissue provides us with who, what, when, where, and how life should work. It gives us a history and a handrail for life. It tells us what should work and what probably won’t.

Scar Tissue provides an observation deck of the past and a runway for the future. It is about risk, excitement, and opportunity. It convinces us that “that will never work” is merely someone’s opinion, “miracles (as well as s---) happen” and that Murphy’s Law is sometimes real.

Most importantly of all with Scar Tissue we learn - “who we be” - the why of life - versus just gaining ideas and instructions for “what to do.” It also reinforces the genius of “Momma (mine and yours)” when she said after each time we fell down – “Pick yourself up, dust yourself off, and start all over again!”

Failure only results if you don’t learn from an experience!

“If you create from the heart, nearly everything works; if from the head, almost nothing.”
Marc Chagall (1887 – 1985) Artist

“Wheresoever you go, go with all your heart.” –

Confucius / K’ung Ch’iu (551 - 79 BCE)
Chinese philosopher and political theorist

Copyright (2002 - Revised 2009) - Square One Consulting / Michael Manes
All rights reserved