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Memorial Hall, Sanders Theater, Harvard | by pmorgan
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Memorial Hall, Sanders Theater, Harvard

I set photos that resonate as my desktop background, to rotate through a type of personal favourites portfolio. These stately buildings and the fall colours struck me, almost a year later …


(7 Oct 2013: I know I need to either use software to pull the top of the building a bit forward to be straight, and/or invest a small fortune in a tilt-shift lens ... 9 Oct 2013: Done with DXO software)


This is from Harvard, where I was fortunate to attend the Value-based Healthcare seminar offered by Porter (of Competition fame) and Kaplan (of Activity-based Costing fame). I was skeptical and left a convert to the rigour of the Harvard methodology, however lightly imparted in the seminar ("If this were a full MBA, I'd grill you about not knowing the case well enough" said Kaplan at one point to the hapless class.) I also found both Porter and Kaplan warm and receptive as teachers.


Porter said they'd tried "all the technology" but found chalk boards were still the best. He seemed to have one or two full-time personal assistants at his disposal, bringing him copies of papers etc as well as a non-stop flow of diet/regular coke and walnuts. Kaplan, on the second morning got into a state of what I would describe as Csikszentmihalyi-like flow and was talking about the origins of his work; a bit hard to explain but there was a kind of intense concentration. Everyone was focused.


Some quotes:


“Doctors think they are like wine; they getter better with age” - Course participant

“Some academics think the same.” - Kaplan


"This is all bullshit. We don't know the outcomes. We don't know the costs." - Porter on the overall state of [American] healthcare.


"This is a little different from Toyota making cars better" - Porter on why it mattered to do the work


“Better to be approximately correct rather than absolutely wrong” - Kaplan on measurement


“With four-digit accuracy it is hard to imagine the first digit could be wrong” - Kaplan on the need to focus on order of magnitude calculations.


“To collect the data ask 'what were you doing' and 'how much time did you spend'? When we compared this approach with results from automated systems, such as in an OR that capture time automatically, there was a surprising similarity." - Kaplan on why he is now satisfied with just asking people vs a scientific Tayloresque approach of using stop watches and the like.


“When we compared surgeons time to complete a total knee replacement in Germany it took 43 minutes. In the US it also took 43 minutes. The German surgeon completed seven surgeries a day while the US surgeon completed three.” - Kaplan on externalities


“We use eminence-based decision making but we need evidence-based decision making” - course participant.

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Taken on November 29, 2012