Elizabeth Teisberg, Scott Wallace “Capability, Comfort and Calm: Transforming Health Care” #returntohealth #sxsw 

March 11, 2017

Scott Wallace: Treatment isn’t the goal it’s care. We are trying to get health. The purpose of health care is health.

It’s a path to getting to something you want. Only as much as I need and to be as little as possible. You are not on a plane to be on the plane. You just want to get on vacation. That’s healthcare. You want to get to a place of better health.

Healthcare is scary.

Elizabeth Teisberg: Too much focus on cost reduction.

SW: Most of negotiations are about price.

Value is created between clinicians and patients.

Hospitals don’t create value.

ET: Focus on outcomes changes conversation. Taking about outcomes DURING care. Capability, Comfort and Calm. Allows clinicians to focus on why they came to healthcare in first place: to help people heal.

SW: Patients have to manage scenarios like this:


Patients that can’t figure out are called “non-compliant.”

SW: Team approach to solving problems.

ET: 90% of patients in migraine example had a huge improvement.

Better outcomes reduce costs.

How do you know what matters to patients? you have to ask them.

SW: Experience groups with people with same medical circumstances. Learned a lot that runs COUNTER to the way “healthcare” thinks about it.

ET: Measure the right things. Example is breast reconstruction. Doctors thought LOOK right versus FEEL right. A woman said “why would I want to tattoo a nipple on an Idaho potato.” Question should be look, yes, but also how it feels. And no one knew that.

SW: What to measure? Mortality sure – but other comfort and capability issues are important.

ET: Normally we ask “how were WE?” in post-care surveys. We need to ask “How are you?”

SW: Too few people want to be great.

We don’t ask questions about us, we ask questions about you. We have conversations about how these patients are experiencing care.

ET: Great healthcare should not be local. Science is not.

#NightofPossibility with @GE and @Within — space @LowLineNYC @ghettogastronyc

January 11, 2017

2017-01-10-20-53-04I’d been curious about the LowlineLab, a project to turn a huge abandoned underground trolley terminal into a garden and stumbled upon GE’s “A Night of Possibility in a post on Medium.com. It turns out that GE had rented the LowlineLab space in order to showcase 6 VR films made by Here Be Dragons in partnership with Within, a VR app company. I signed up immediately to attend, also figuring I’d see plenty of people I know there having worked with GE as a client again and again over the course of my career.

The films were interesting, STEM in focus. My favorite was the one in which I floated in space, twisting my head to see Jupiter and looking down on asteroids. There was also a piece on the fastest car, balloons into space, the experience of a hovercraft, and, GE’s own, fighting fire with fire. I also loved seeing a robot, albeit the device will eventually take away low-paid warehouse jobs and leave those workers unemployed. It’s a very, very cute robot that someone on Twitter remarked looks like a dog that knows its in trouble.

I also enjoyed Ghetto Gastro’s floating cornbread and caviar appetizer (“Hoverboard”), smoking carrots (literally) (“Fighting Fire with Fire”), lava chicken on gold (“Listening to the Universe”), and salf-flat-looking meringue with rice sorbet (“Speed Machine”). (Love the names!)

2017-01-10-19-51-42The space itself was incredible and I was lucky to get a chat with one of the Lowline caretakers. She explained to me how sunlight is piped into the space, how you have to filter out red spectrum light but then bring it back in or plants won’t flower, how the heat had gone off in the space, nearly killing the plants. (We public people can tour the place without any exhibit on weekends).

My one piece of feedback for the VR movies I’ve seen would be how can we involve the viewer more in the told story? Right now most VR pieces I see are really still flat films in 3D–meaning nothing to explore. Just watch. Why be VR if it is more just watching?

I attended the Future of Story Telling October 7-9 (2016) in NYC at 5th Avenue and 110th Street, in a building across from the farthest northeastern edge of Central Park. It was impossible nearly to get to see many of the interactive exhibits, but I finally did get to fly over Hong Kong with Birdly and fly with other “birds” in Flock. I did not see everything (badly wanted to play Ubisoft’s Star Trek) as there just was too long a wait so I’m not coming at this feedback with a lot of intelligence (in the sense of having collected intelligent info). But I did wish that the stories told in the movies could somehow merge with the experiences. Did not get a chance to watch the films that had select-able story lines, but my hunch is this is no different. Yikes–Westworld, right?

I’m looking for being able to go up and talk to characters, to be part of the story. According to Westworld there could be dark possibilities. I had just been on Twitter and saw how time after time, a quick tweet devolves into idiocy (check out the comments on this POTUS tweet, seems to me perfectly nice bunch of people busy misunderstanding each other.) Still, that sort of dynamic-feeling narrative as shown in Westworld or even Caprica (although Caprica is more AI) would be very interesting.

Overall, very interesting, but not yet totally blown away.

#onAgile2016 @estherderby ‘s keynote – my note and thoughts

October 20, 2016

My comments:

I found this talk super-useful on two levels. One, the idea of Change “Management” is a topic that re-emerges again and again in my conversations at conferences, at work with clients, and in encountering entrenched command-and-control cultures. The second is the main challenge I personally have as a sometime Change Agitator of sorts is in just that. I’m being an “agitator.” This means I can be in “coercion” mode and not just showing people useful ways to work. The user-centered approach Esther takes helps me pay closer attention to what is valuable about the past and what was actually working.

My main question would be about muscle memory. Because sometimes we think that some process or pattern is working “if only” people did it right. “If only they got the brief/requirements/assignment completely right before we started, this wouldn’t have happened.” “If only the client knew what they wanted.” I think this idea of “what we think is working” needs to be very thoroughly interrogated. I might not believe, no matter what data you put in front of me, that “it” isn’t “working.” I might believe that “if only people changed their behavior” that “it” would “work.”

The root of much suffering is that we often are coming from a stance of what we think is good for the greater good, or at least for ourselves. We believe this so powerfully that it is very hard to break out of it and “see” what we’ve done wrong.

I think Esther’s answer to this is in the framing of changes we want to make in terms of time. She described an exercise that creates a timeline by having participants look at what was going on and what trends we see for the future. A friend of mine, Rob Purdie from IBM, used this technique on our local meetup, the NYC Scrum User Group on our yearly retrospective. I had thought to do something simpler (I Like/I Wish/What If…) but am reconsidering.

Great talk, really enjoyed it.

My unedited notes:

Create great environments so people can do their best work.

Talk about Change.

How companies traditionally approach change.

Create great environments so people can do their best work.

Talk about Change.

How companies traditionally approach change.

Usual pattern:

  • Drop change on people’s heads.
  • Then “driving” change
    • Like cattle (turning people into mindless animals)
    • Or a car (as if it is a smooth road)
  • Installing change
    • As if changing a part on a piece of equipment
  • Evangelizing change
    • You get surface compliance

These actually get in the way of change. We need to create the conditions where change is most likely to emerge in a way that involves people and brings their creativity to the change.

People resist change because they feel pushed. If you stop pushing, they stop resisting.

Six Rules for Change

  1. Work form a stance of Congruence, balancing the interest of the self.

* empathizing with people that you hope to make a change for.

* need to consider your own internal state about the change

* how do you feel about the people involved in the change.

  1. Honor what is valuable about the past and what is working now

* don’t force people to admit they’ve been wrong.

* it was people’s best thinking at a certain point in time

Exercise she does poster, what was in the past, what was going on, what trends do we see for the future.

We are in a process of time.

Organizations try to freeze processes.

  1. Assess the Current Situation and the system.

Sees big training efforts, bring in coaches, but then a year later things are the same at the end.

Reason is that underlying systems don’t change.

Underlying patterns: system of approving projects, split between communications and dev people, etc.

Have to look at the environment and see what is holding the pattern in place.

People might talk about more collaboration, but they review them individually. Their raise is dependent on how they perform as an individual.

What do people currently know and what knowledge would help them move into the new situation. You have to look at what knowledge they need.

If you don’t understand WIP and how that affects the organizations to function properly.

Who benefits from status quo? Because no matter what? Someone’s happy with it.

People in traditional PM roles really felt left out of agile.

What will they lose and how can I help them through that loss.

Michelle Schwager (?) book.

  1. Activate Networks to diffuse new ideas through the system. Weave in people who are trusted and who will spread them.

* Don’t rely on formal hierarchy. Bias on positional authority can exist. When you do that, people may comply, but they don’t buy in. If you can activate a network, you’ll be far more effective in diffusing an idea without resistance.

** People don’t resist change, they resist coercion.

*** Smokers are actually useful networkers.

Communities of Practice. Issue with these is they are neither communities nor do they practice. Usually just speakers come, no sense of shared concern.

Don’t expect you’ll get the change perfect first time you try. As you try, you’ll be learning. People will come to accept and it will fit better.

  1. Design Experiments to facilitate learning and buy-in.

* Experiments don’t feel big and big changes scare people. People will learn and will get buy-in.

* Measure, Evaluate, Adjust.

(During question/answer I had computer outage).

Project Managers Bridge to Agility:


#AD16 @agilenyc @JeanAtAzureGate Jean: Conflict, Collaboration and Consciousness azuregate.net – my notes and thoughts

September 15, 2016


Jean gave an interesting presentation that made me rethink some of the presentations I’ve read by Pete Behrens about an agile culture. Kind of gives me hope that you can start where you are and don’t have to hope a company be collaborative in culture for agile to have any chance. What it is not.  Was very Interested in hearing collaboration as a conflict mode. Never thought of collaboration that way.

Also the idea that a collaborative approach might not always work and might depend on context. This directly affects influencing culture at a company, if you think of the William Schneider model (command, cultivative, competent or collaborative traits). Tempting to ask “What if a command approach works better in a circumstance?” While it is a temptation to ask, the two extremes were debate/competitive and dialogue/ collaborative. Wondering if there is a parallel for other two.

We really have to use skillful means, and find it gets back to the awareness we talked about earlier in the day.


Purpose.nGetting the things we want: a good death and good relationships.

Looking how people recover character. Coming to greater consciousness. Jack McKenna.

Conflict can also be known as problem-solving. Sometimes people think they are in conflict, but they agree and just don’t see it.

Collaboration is a conflict mode.

Thomas-Kilmann conflict model.

So sometimes being collaborative will not work.

Kilmann online trading very good.

The why we want to be in collaborative to be in greater consciousness.

Portland uses agile even in sewage system management.

Heightening conscious means awareness, knowledge of others.

Sometimes people are so much in their head they forget they have a self and that others do.

Sometimes people go to mediation NOT to learn.


Intentionally choose conflict mode.

Attitude overall is how I am.

Dialogue leaves you curious and open. Debate leaves you judging.

Debate is the court room. You talk more than listen. Reacting is going in for the kill. Interrogation. If you ask questions, it is me trying to trip you up.

(Getting your baggage out on table might dissipate it).

If someone comes at you with what they think you are about, their opinion about what you are saying, elicit more from them. Find out what they are saying.

Have team break into pairs and discuss what’s in the image, what the sculpture is about.

People don’t see their affect on people. They don’t realize how strong they are in the room. Working with them, have to bring the right approach

Not about empowering people. It’s about stopping dis-empowering them.

Agile had no need for genuflecting. Recognizes all are part of the solution.

(Statue is the torch bearers, older generation passing knowledge to older generation.)

Brought in principle of mutual causality. That we become different people together?

Pair programming is dialogue

Refactoring is releasing the entity from the void.

Why important? Software dev is a back door to how the world works. So creating it consciously helps world be a better place.