BY KIM BELLARD
Final week the esteemed Jane Sarasohn-Kahn celebrated that it was the 65th anniversary of the well-known LEGO brick, linking to Jay Ong’s blog article about it (to be extra correct, it was the 65th anniversary of the patent for the LEGO brick). That led me to learn Jens Andersen’s glorious historical past of the corporate: The LEGO Story: How a Little Toy Sparked the World’s Imagination.
However I didn’t take into consideration writing about LEGO’s till I learn Ben’s Cohen’s Wall Street Journal profile of College of Oxford economist Bent Flyvbjerg, who research why tasks succeed or fail. His recommendation: “That’s the query each undertaking chief ought to ask: What’s the small factor we will assemble in massive numbers into a giant factor? What’s our Lego?”
So I needed to marvel: OK, healthcare – what’s your LEGO?
Professor Flyvbjerg focuses on “megaprojects” — massive, advanced, and costly tasks. His new ebook, co-authored with Dan Gardner, is How Big Things Get Done. To not spoil the shock (which might solely be a shock to anybody who hasn’t been a part of one), their discovering is that such tasks normally get finished poorly. Professor Flyvbjerg’s “Iron Rule of Megaprojects” is that they’re “over funds, over time, underneath advantages, again and again.”
Actually, by his calculations, 99.5% of such tasks miss the mark: solely 0.5% are delivered on funds, on time, and with the anticipated advantages. Solely 8.5% are even delivered on funds and on time; 48% are at the very least delivered on funds, however behind schedule or with anticipated advantages.
As Professor Flyvbjerg says: “You shouldn’t count on that they are going to go dangerous. You need to count on that fairly a big share will go disastrously dangerous.”
He has two key items of recommendation. First, take your time within the planning course of: “suppose gradual, act quick.” As Dr. Flyvbjerg and Mr. Gardner wrote in a Harvard Business Review article recently, “When tasks are launched with out detailed and rigorous plans, points are left unresolved that can resurface throughout supply, inflicting delays, price overruns, and breakdowns….Ultimately, a undertaking that began at a dash turns into an extended slog via quicksand.”
Second, and that is the place we get to the LEGOs, is to make the undertaking modular; as Mr. Cohen places it, “Discover the Lego that simplifies your work and makes it modular.”
Professor Flyvbjerg writes:
Modularity is a clunky phrase for the elegant thought of huge issues made out of small issues. Search for it on this planet, and also you’ll see it in every single place…software program, subways, {hardware}, accommodations, workplace buildings, faculties, factories, hospitals, rockets, satellites, automobiles and app shops: They’re all profoundly modular, constructed with a fundamental constructing block. They will scale up like loopy, getting higher, quicker, greater and cheaper as they do.
Like LEGOs. Or, in Professor Flyvbjerg’s description, “Repeat, repeat, repeat. Click on, click on, click on.” In the event you’ve ever performed with LEGOs, you’ll know what which means.
It’s value stating, as Mr. Andersen does in his ebook, that LEGO took a while to grow to be the LEGO we now know. It made all kinds of (picket) toys in its first couple a long time, didn’t bump into the interlocking brick thought till the late 1940’s (an thought it copied from an English firm), didn’t swap to plastics till the early 1950’s, and didn’t patent LEGO bricks till 1958. That was additionally the time that Godtfred Kirk Christiansen, the second technology of household management, wished to choose one product that it might develop a “LEGO system in play,” quite a lot of toys that “have been simple to play with, simple to supply, and straightforward to promote.” That was the LEGO brick, and it’s why now you can design and construct your personal city or construct a reproduction Millennium FalconTM. with them.
Healthcare has loads of megaprojects – costing $1b or extra – and lots of smaller ones, and I believe most don’t find yourself being delivered on time, on funds, or with the total set of anticipated outcomes. A few of that’s little question due to the failure to spend sufficient time planning, as Professor Flyvbjerg stresses, however I recommend that a lot of these failures come as a result of healthcare both doesn’t have its LEGO or has the unsuitable ones.
Healthcare’s LEGO ought to be the affected person.
Let’s take software program tasks. What number of of you’ve a number of digital data, a few of which can join with others, however nonetheless go away you feeling considerably schizophrenic? They weren’t designed across the affected person; they have been designed for hospitals, well being methods, and well being care professionals’ places of work. Well being plans’ eligibility, billing and claims methods have been largely designed round employers. And virtually all the things in healthcare is designed to make sure billing could possibly be finished. If healthcare software program already has a LEGO, it’s billing codes, as a result of folks working in healthcare need, above all, to receives a commission.
Or take precise healthcare building tasks, similar to hospitals, medical workplace buildings, or different amenities. Traditionally, they’ve been designed round physicians — how one can make it simpler for them to see extra sufferers (billing, once more), to encourage them to observe there as an alternative of elsewhere, and many others. That’s why medical doctors hardly ever make home calls anymore, why too many sufferers who could possibly be handled at residence find yourself within the hospital, and why sufferers find yourself spending so rattling a lot time ready.
Some may argue that within the new period of Massive Information and A.I., the brand new healthcare LEGO ought to be bits. Every thing goes to run on them; all the things goes to be linked by them. There’s a logic to that, and that method could appear tempting, but it surely’s a harmful path. We might find yourself with an much more impersonal healthcare system than we’ve in the present day.
We’re the LEGO brick. We’re the unit. And after I say “affected person,” I actually imply extra broadly: folks, whether or not they’re present sufferers, former sufferers, or future sufferers. It issues how we’re linked, to whom we’re linked, what the top purpose for us is. The healthcare system usually thinks of us as our diagnoses or our bodily methods, however except and till it appears to be like at us as the complete particular person – the LEGO brick, if you’ll – we’re neither going to be handled the best way we would like nor obtain the well being outcomes we hope for.
So in case you are engaged on a healthcare undertaking, take that further time that Professor Flyvbjerg urges to essentially take into consideration which individuals can be impacted, the place, how, when, and to whom they’re or ought to be linked. Construct these connections to create one thing inventive, sturdy but versatile, and efficient. As Dr. Flyvbjerg writes: “It’s outstanding what you are able to do with blocks of Lego.”
Kim is a former emarketing exec at a serious Blues plan, editor of the late & lamented Tincture.io, and now common THCB contributor
