Archivi del mese: gennaio 2014

Hub and Spoke

Girolamo Sirchia

Oggi è di gran moda parlare di rete ospedaliera secondo il modello Hub and Spoke (Hub = mozzo centrale della ruota; Spoke = raggio della ruota). Hub: Ospedali di riferimento multispecialistici ad alta intensità di cura; Spoke: Ospedali locali più periferici a media-bassa intensità di cura, per i casi di media gravità, che trasferiscono i casi più complessi all’Ospedale di Riferimento.

Edwards commenta che:

⑴   Tutti coloro che sostengono il modello Hub and Spoke vogliono lavorare nell’Hub e non nello Spoke. Chi lavora nello Spoke è molto meno entusiasta del modello

⑵   Ci sono varie interpretazioni dello Spoke.

Evans risponde che vi sono vari modi di disegnare il modello perché one size doesn’t fit all; se nell’area c’è un solo o tanti Ospedali le cose sono diverse.

(Hawkes N. Hospitals without walls. BMJ 2013;347:f5479).

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Medical societies’ role in improving leadership in medicine @kevinmd @leadmedit @muirgray @Medici_Manager

The greatest good you can do for another is not just to share your riches but to reveal to him his own.
– Benjamin Disraeli

In 2009, when I was president-designate of the American College of Chest Physicians, a prominent physician, educator and outstanding mentor, who had recently died was honored by her colleagues. One of her junior colleagues, who had never met her but took over her patients, spoke of the profound influence she indirectly had on his life. She was his mentor in absentia, someone he looked up to as his guiding star, someone he sought to emulate.

This example serves to highlight the power of mentorship. Mentorship is inspiring and guiding others to reach their full potential.

The ACCP and other professional medical societies bring together professionals at different stages of their careers, for example medical students to senior and renowned experts in his or her specialty. They have the potential to foster powerful mentorship and leadership programs benefiting members in all career stages.

As ACCP president, the more I interacted with ACCP members, the more I realized that a track for leadership development and mentorship was a pressing need. Medical students wanted to hear of the opportunities that the specialty offered. Fellows and young colleagues wanted to get involved with the organization but did not know where to begin and how to get their “foot in the door.” Members wanted to seek advice from senior colleagues to guide them in their research or for their academic advancement. Some wanted a certificate of participation in leadership courses offered by the organization. Finally, many members, both domestic and international, wanted to know how to climb the leadership ladder within the organization.

The ACCP board of regents enthusiastically supported a leadership and mentorship initiative. A task force was developed to spearhead this effort. The task force comprised the cross-section of ACCP membership who would be involved either as a mentor or a mentee.

Over the past 2 years, the task force has had several accomplishments. Some of those major accomplishments include:

  • An annual orientation course for all new leaders of the ACCP.
  • A leadership development course for members held throughout the year.
  • The creation of the ACCP e-Community, a closed group where members can interact and learn from one another, similar to Doximity.
  • A leadership development course for future leaders. We work with program directors to identify and grow these leaders.
  • Live mentorship programs incorporated into our annual meeting.

Our organization has come a long way — and, we have a long way to go. We have identified a need to improve and enhance our leadership development, and we feel that enhancing leadership will lead to well-rounded members who will not only excel as physicians but also as leaders both at the ACCP and in their own careers.

How have your own institutions, societies, or organizations worked to expand mentorship and leadership initiatives?

Suhail Raoof is immediate past president, American College of Chest Physicians.

Science alone can’t make tough decisions for us @kevinmd @Medici_Manager @pash22


On April 14, The United States Preventive Services Task Force concluded that women with an elevated risk of breast cancer – who have never been diagnosed with breast cancer but whose family history and other medical factors increase their odds of developing the disease–should consider taking one of two pills that cut that risk in half. The Task Force is an independent panel of medical experts who review the medical literature to estimate the pros and cons of preventive interventions. This is the same Task Force that in recent years raised questions about the benefits of mammograms in 40 to 50-year-old women, and PSA tests for men of all ages, tests that screen respectively for breast and prostate cancer. Despite the popularity of both of these tests, the Task Force concluded that their harms often outweigh their benefits.

The irony now is that with this report on breast cancer prevention pills, the Task Force has switched from rejecting something patients believed in to endorsing something most patients will reject.

The seemingly strange way the Task Force ping-pong’s between popular and unpopular recommendations is inevitable, because these kinds of recommendations must necessarily go beyond the medical facts – it is impossible to decide what preventive measures people need without making value judgments.

To understand the way facts and value judgments get mixed together in these kinds recommendations, let’s take a closer look at these breast cancer prevention pills.

For many years now, doctors have been prescribing tamoxifen as secondary prevention to women who have already undergone treatment for breast cancer, in an attempt to thwart any breast cancer cells remaining in their body. In women whose breast cancer cells express “estrogen receptors”, tamoxifen reduces the chance that this cancer will recur, by attaching itself to those receptors, in effect crowding outestrogen. In breast cancer cells, any estrogen landing on these receptors will spur that cell to divide and multiply. But when tamoxifen lands on these receptor sites, it does not stimulate cell growth.

Raloxifene is a close cousin of tamoxifen, which has primarily been used to treat women with osteoporosis. Like tamoxifen, it competes with estrogen for the attention of estrogen receptors. Also like tamoxifen, it slows down breast cancer by preventing estrogen from stimulating cell growth. As it turns out, both raloxifene and tamoxifen also have the strange property that when they collide with bone cells, they don’t fight against estrogen, but seem to mimic estrogen, and thereby improve bone health. (Because these drugs and sometimes act like estrogen and other times act like anti-estrogen, they are called selective estrogen blockers.)

Two very similar drugs, then. Both slow down breast cancer cells while stimulating bone cells. Each drug has been shown to cut the risk of a first breast cancer in half for women with a high risk of experiencing this disease. In what is known as the P1 trial, for example, women who faced an average five year risk of breast cancer of 6% saw that risk drop to 3%, if they took tamoxifen.

Sounds like a good deal, yes? Take a pill for five years, and cut your risk of breast cancer in half. But keep in mind, most women do not face a 6% chance of breast cancer in the next five years. Women with this kind of risk are generally retirement age or beyond, and usually have a bad combination of family history, early onset of menses, and late age of first pregnancy. It is these women the Task Force believes should talk with their doctors about whether to take these medications. And how did the Task Force reach this conclusion? By determining that for some women, at least, the benefits of these pills outweigh their harms. Before looking at this harm benefit ratio more closely, let’s put this Task Force conclusion into context.

The Task Force essentially produces three kinds recommendations, which I have taken the liberty to name.

  1. NADA: When it concludes that the harms of an intervention outweigh the benefits, the Task Force recommends that doctors and patients avoid the intervention. Think: ultrasound screening for pancreatic cancer.
  2. OUGHTA: When the Task Force concludes that the benefits outweigh the harms, it pushes to make the intervention standard of care. For example: routine screening for colon cancer in people 50 years or older.
  3. UP TO THE INDIVIDUAL: When the Task Force concludes that the benefits of an intervention potential outweigh the harms, depending on the patient’s individual preferences, it leaves the decision up to individual patients and their doctors to weigh. This is the recommendation the Task Force made both for mammography in 40 to 50-year-olds, and for tamoxifen and raloxifene to prevent breast cancer.

When making NADA or OUGHTA recommendations, the Task Force essentially makes its own value judgment. It looks at the risks and benefits of an intervention, and concludes that no sensible person could decide differently from the Task Force. In this third type of recommendation, however, the Task Force concludes that reasonable people could make different choices, based on how they weigh the risks and benefits of the interventions.

In the case of tamoxifen and raloxifene to prevent a first breast cancer, I expect the vast majority of women will conclude that the risks of the pills outweigh the benefits.  In the past two years, I have collaborated with a team of researchers at the University of Michigan (led by Angie Fagerlin, a decision psychologist in their medical school), to help women decide whether to take either of these pills. We developed an Internet-based decision aid, a tool designed to help patients weigh the pros and cons of their medical alternatives. (I write about the history of decision aids in my book, Critical Decisions.) Our decision aid provided women with individualized estimates of their odds of developing breast cancer in the next five years. We only directed women to the decision aid whose risk was high enough to have qualified for the P1 trial.

In the decision aid, we described the benefits of both drugs – the reduced risk of breast cancer and the strengthening of their bones. We also laid out the risks – a very small chance of endometrial cancer, a slightly larger chance of heart attack or stroke, a modest risk of cataracts, and finally a very strong likelihood of experiencing menopausal symptoms such as irregular menstrual bleeding and hot flashes. We actually provided them with precise numerical estimates of these side effects, with pictures illustrating the risks to make them easier to comprehend.

Women pondered the pros and cons and concluded, almost unanimously, that the side effects of these drugs outweighed the benefits.

The decision whether to take tamoxifen and raloxifene is no doubt a personal one, and the right choice will vary depending on how a given person weighs the respective risks and benefits of these medicines. For a woman with an extremely high risk of breast cancer over the next five years – say 10% or more – cutting that risk in half might very well be worth the hot flashes and the chance of experiencing blood clots. But very, very few women faced a five year risk is highest.

Consider, instead, a woman with a 3% chance of developing breast cancer over the next five years. That risk is much higher than average – most women face a five year risk of less than 1% – but is it high enough to justify taking one of these pills? For such a woman, tamoxifen and raloxifene only reduce that risk by 1.5%. Over five years. Five years with possible hot flashes. For a cancer women have not experienced yet. These modest benefits simply do not loom large enough to interest most women in these pills.

You might wonder at this point whether our decision aid biased women against these medications. As a physician trained in behavioral economics, I’m constantly on the lookout for decision biases. In the case of our study, however, we designed our decision aid in a manner that allowed us to test for well-known behavioral economic biases. For instance, research has shown  that when people face a choice between three options and two of the options are similar, they often opt for the more different alternative even if the other options are better. In other words, a person might believe that A > B, and A’ > B, but still choose B over A and A’, because they cannot decide between A and A’.

Aware of this problem, we created several different versions of our decision aid. In one version, we presented women with a choice between tamoxifen, raloxifene or no pill. Three choices in other words, two of which – the two medications – are quite similar to each other. In another version of the decision aid, we simply presented women with the choice between pill or no pill. We thought this simpler choice would increase women’s interest in these pills, by minimizing the difficulty of choosing between the two of them. But instead, this reframing of the decision did not increased women’s interest in either of these preventive medicines.

We also designed our decision aid to take account of another well-known decision bias, what are known as recency effects. When people learn about the risks of a medication and then learn about its benefits, that order of information leads them to look favorably upon the medication, because the information they remember best, the last information they receive, is about the pill’s benefits. By contrast, people who receive the same information about this medicine, but in the opposite order, like the pill less, because the last thing they learn about are the pill’s risks, and this information sticks in their minds. To make sure this recency effect was not influencing women’s decisions, we varied the order of information across women. We discovered that this did nothing to change their willingness to take either of these medications, mainly because whichever order women received information in, they did not like the idea of taking either pill.

If these pills are so unpopular among well-informed women, why would the Task Force come out in favor of them? It comes down to judgment. The Task Force concluded that a reasonable person could look at these risks and benefits and decide that the hot flashes and blood clots are acceptable prices to pay to reduce the chance of breast cancer. The majority of women don’t have to agree with this view for the Task Force’s recommendation to be correct. Even if only a small percentage of women decide these pills are worth taking, at least they have the freedom to make that choice. And at least they know that medical experts have concluded that such a decision is a reasonable one to make.

The same goes for whether to start mammograms before the age of 50 in women at normal risk of breast cancer. The Task Force never said that women shouldn’t start mammograms at this earlier age. They just said that it was a tough judgment call, and that some women, perhaps the majority even, might conclude that the harms of early screening – the anxiety caused by false negative tests, the pain caused by unnecessary biopsies – aren’t worth the modest benefits of screening at this age.

If the Task Force is going to leave all these tough decisions up to individual patients and their doctors, why should we care about their recommendations? For starters, you will have a hard time finding a more thorough and levelheaded evaluation of the pros and cons of these kinds of interventions. These people are very good at what they do. In addition, anyone reading through Task Force reports will be forced to recognize that science alone can’t make tough decisions for us. Ultimately, science can only provide us with the facts. The rest of us eventually need to make tough judgment calls. In effect, the Task Force is doing us a huge favor, by showing us which judgments are close calls, and which ones are no-brainers.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

Doctor integration leads to higher costs @Medici_Manager @leadmedit @wricciardi @pash22

Integrating physicians into hospitals has been theorized to be a cost-saving measure. A new poll of physician executives indicates that such integration may actually increase healthcare costs.

The American College of Physician Executives (ACPE) polled its 11,000 members, asking them what happens to healthcare costs when a physician group or practice is purchased by their hospital or health system.

[See also: Managing clinical, financial integration is key to hospital success]

Of the 468 members who answered the question, 149, or nearly 32 percent, said that healthcare costs go up. Only 22 respondents (4.7 percent) said costs go down. Sixteen percent (75 respondents) said costs remain mostly the same. About 35 percent (163) said the question wasn’t applicable to their institution.

The poll results should be taken as an indication of a possible trend but not as rock solid evidence that physician integration results in higher healthcare costs, cautioned Peter Angood, MD, ACPE’s CEO.

“I think part of the issue that we need to try and tease out further is so are the costs directly related to the physicians ordering more tests and generating more care, or is it that the fact is in order to cover the investment of the physician purchase – the infrastructure that is needed to support them and the other personnel – are those costs getting transferred into the other expenses in terms of charges in the costs of healthcare care,” he said.

Angood believes it is the latter issue spurring the higher healthcare costs, and that those higher costs are likely a temporary situation. As the upfront investment costs depreciate, the higher healthcare costs should drop, he said.

[See also: Doctor medical groups a hot commodity]

Costs should also drop, he said, if the theory of providing integrated care results in improved quality, safety and efficiencies. 

Cosa significa Governance per @Treccani? @leadmedit @Medici_Manager @WRicciardi


Governance, tutti insieme aziendalmente

Nell’accezione di ‘insieme dei princìpi, dei modi, delle procedure per la gestione e il governo di società, enti, istituzioni, o fenomeni complessi, dalle rilevanti ricadute sociali’, il sostantivo aziendalistico-imprenditoriale governance, dritto dritto nell’italiano e nelle altre lingue europee del cosiddetto mondo economicamente più sviluppato, si impone, trasvolando l’Oceano Atlantico, a partire dagli inizi degli anni Novanta del Novecento (il GDU, diretto da Tullio De Mauro, certifica il 1988 come data della prima attestazione nell’italiano scritto).
L’anglicismo, che propriamente vuol dire ‘modo di dirigere, conduzione’, inizialmente ha battuto e ribattuto sulle pagine della stampa italiana le piste del mondo dell’impresa, soprattutto perché abbinato all’aggettivo (anglosassone pure lui) corporate‘aziendale’, nella locuzione corporate governance (in italiano dal 1994), che vale, «nel linguaggio aziendale, il metodo e la struttura organizzativa con la quale si distribuisce il comando tra i dirigenti di un’impresa» (
L’orizzonte s’è allargato
Insomma, prima di togliersi, almeno un poco, di dosso le stimmate aziendalistiche, governance ci ha messo qualche anno, almeno a giudicare dai referti archivistici del quotidiano «La Repubblica»: a partire dalla prima attestazione nelle pagine del quotidiano, che è del 1994, nei tre anni successivi devono allinearsi l’una dopo l’altra 26 attestazioni sì, certo, di governance, ma soltanto come secondo elemento della locuzione corporate governance (usata metà delle volte al maschile, metà al femminile: e ancor oggi una sentenza definitiva sul genere non c’è), prima che, finalmente, compaia una governance“scorporata”, libera del marchio a fuoco delle regole e procedure organizzative relative alla distribuzione del comando e alle buone pratiche dirigenziali in azienda che l’aggettivo corporate porta con sé: nel 1997, alfine, si scrive degli «organi della governance economica internazionale» (vedi il primo esempio). E sia, sempre nell’ambito dell’economia restiamo, ma perlomeno l’orizzonte s’è allargato, la governance s’è significativamente traslata altrove: dal grattacielo coi vetri a specchio siamo passati ai consessi degli organismi che tengono (o credono di tenere) il pallino dell’economia internazionale nelle loro mani.
In questa accezione allargata di ‘governo, direzione’, governance finisce ormai da tempo, nel nuovo millennio, col riferirsi a fenomeni di più ampio e generale momento (sempre inquadrabili, in prima istanza, da un angolo visuale economico), fenomeni-cornice, si potrebbe dire, come certifica questo attacco di articolo del 2011, tratto dal «Corriere della sera»: «Il governo Sarkozy aveva dato grande rilievo alla definizione di un set di regole per la governance globale di Internet» (vedi l’ultimo esempio).
Le locuzioni in corporate
Va detto, comunque, che la configurazione dell’azienda (verrebbe da dire: dell’azienda-sistema e dell’azienda-struttura), come entità centrale nelle logiche e nei flussi di contrattazione (interni ed esterni) del denaro e del potere è caratteristica del pensiero economicistico contemporaneo e ha evidenti ricadute sul lessico, che, come si sa, tende a farsi carta assorbente delle ideologie dominanti. Basti un esempio: l’aggettivo cruciale di cui sopra, corporate ‘aziendale’, entra in composizione, negli ultimi trent’anni, in un numero crescente di locuzioni nominali anglosassoni, che poi si impongono nel linguaggio economico e aziendale delle principali lingue di cultura tradizionali, italiano compreso. Ecco allora, nella nostra lingua, arrivare una serie di locuzioni sostantivali, femminili e maschili, come corporate finance ‘complesso di princìpi, metodi e procedure per la gestione finanziaria di un’impresa’ (dal 1986); corporate bond ‘obbligazione emessa da una società privata’ (dal 1987);corporate identity ‘area della comunicazione d’impresa che stabilisce l’identità e la mission dell’azienda’; corporate communication ‘comunicazione d’impresa’ (1998); corporate image ‘reputazione di cui gode un’impresa presso i consumatori’ (1987), corporate strategy ‘strategia mirata alla creazione di valore d’impresa’ (1994). Oltre, ovviamente, al(la)corporate governance di cui già si è detto.
La gubernantia di Boezio
Il bello delle lingue, specialmente se omogenee o reciprocamente permeabili per via di radici in parte comuni e a causa della fittezza di scambi economici, sociali, culturali (per non dire di rapporti politici diretti, fatti di dominio e sottomissione, nel passato) intrecciati tra le comunità parlanti, è che spesso fanno circolare tra di loro parole che appaiono, si impongono in una forma e significato, poi scompaiono da una parte, permangono in altre, ma forse un po’ modificate nell’aspetto o nel senso, poi – come si dice colloquialmente – “ricicciano” dopo decenni, o magari secoli, da un altro punto dell’ecumene e rientrano nel vocabolario in forme in parte nuove e, ancora, in accezioni specifiche diverse rispetto all’origine. È il caso di governance, che – non senza una inusitata sapienza etimologica – il programma di correzione automatico del computer sul quale è stato scritto questo articolo cambia subito in governante. Già, perché l’etimo, evidentemente ha gli stessi lontani natali: governante dagovernare, da governogovernance (inglese) già nell’antichità dal francese gouvernance, a sua volta dal latino medievalegubernantia di Boezio (a sua volta dal verbo, del latino classico, gubernare, da cui il nostro governare). Di questa storia di trasmigrazioni e mutazioni, fortune e sfortune di parole apparentate nella vecchia Europa, scrive Tullio De Mauro nel lemmagovernance del suo godibile Dizionarietto di parole del futuro (Laterza, Roma-Bari 2006, p. 40). L’antico francesegouvernance «ebbe vita modesta e si usava per precisare meglio ciò che parole come governogovern o go(u)vernmentdicevano già benissimo: governo non solo come istituzione politica, ma come modi di regolare la vita sociale, economica ecc. di un’impresa, istituzione ecc.». Succede poi che verso il 1985 la parola inglese “riciccia”, rilanciata virtuosamente dalle istituzioni economiche internazionali. Il successo del “cavallo di ritorno” è immediato. In particolare, scrive ancora De Mauro, «[i]n tedesco e italiano l’anglismo pare senza alternative e piace anche a imprenditori nella locuzione corporate governance, governo d’impresa».
Il lemma
governance ‹ġa’vnëns› sostantivo ingl. (propr. «modo di governo, conduzione, direzione»), usato in italiano al femminile – A partire dal linguaggio aziendale, in cui indica maniera, stile o sistema di conduzione e di direzione di un’impresa (in particolare nella locuzione sostantivale corporate governance, propr. «governo, direzione dell’impresa»), il significato del sostantivo si è rapidamente allargato all’accezione di insieme dei princìpi, dei modi, delle procedure per la gestione e il governo di società, enti, istituzioni, o fenomeni complessi, dalle rilevanti ricadute sociali.
Elaborato dalla redazione di “Lingua italiana” del Portale Treccani
Esempi d’uso
Che se questo Paese ha recuperato negli ultimi anni qualcosa nella considerazione mondiale della sua essenza statale, questo è dovuto all’azione giudiziaria contro la corruzione pubblica e contro la criminalità di stampo mafioso. Gli organi della governance economica internazionale hanno infatti assunto questi due disvalori (corruzioni, crimine organizzato) come parametri universali di un giudizio che pesa su tutto il resto.
Andrea Mazzarella, «La Repubblica», 26 luglio 1997
Il quarto argomento è quello della governance della mondializzazione.
«Il Foglio», 24 agosto 2000 (citato in G. Adamo – V. Della Valle, Neologismi quotidiani. Un dizionario a cavallo del millennio, Leo Olschki ed., Firenze 2003, s.v. governance).
La più parte di essi ritiene che le risposte ai guasti della globalizzazione debbano essere apprestate dai singoli stati nazionali attraverso risposte politiche interne, e non da strumenti di governance sovranazionale.
«Il Manifesto», 28 agosto 2001 (citato in GDLI. Supplemento 2009, diretto da Edoardo Sanguineti, s.v. governance).
Il Ministro dell’Economia sulla costruzione della carta – «All’Ue non serve l’egemonia di un solo pensiero politico» – I pericoli vengono da una antidemocratica e tecnocratica «governance» – Con il «metodo comunitario» i Parlamenti e i governi delegano il potere d’intervento.
Titolazione da «La Stampa», 28 febbraio 2002
Il governo Sarkozy aveva dato grande rilievo alla definizione di un set di regole per la governance globale di Internet, presentato come un tema di rilievo dell’agenda del G8 di Parigi. Dire che la montagna ha partorito un topolino suona perfino ottimistico: le velleità francesi sono naufragate di fronte all’opposizione unanime delle altre potenze.
Carlo Formenti, «Corriere della sera», 1° giugno 2011
Silverio Novelli

Becoming More Innovative in 2014 @Medici_Manager @WRicciardi @muirgray @helenbevan @pash22

By Bill Fischer ,

Organizations don’t innovate, people do. Organizations that are admired for being especially innovative don’t hire genetically different people than are available to the rest of us, they just make different managerial choices that allow their people to be more innovative. Leadership does this (or, doesn’t), and, as a result, innovative people deserve innovative leaders!

So, what can you do in the coming year to become a more innovative performer, or leader? Over the past two years (2012 and 2013), I’ve suggested a small set of innovation resolutions that would help anyone become more innovative, and which did not require investments, the mastery of new skills, nor require “permission” from above. This year, in anticipation of trying to become more personally innovative in 2014, and in the spirit of inclusiveness(which was among my 2013 resolutions), I have invited a number of friends who I admire for their insights into innovation to share their resolutions. What follows is, I think, a thoughtful, relatively global and certainly ambitious set of advice, all of which has one overall objective: to make us all more innovative in 2014! In each instance, I have also included their twitter address so that they can be followed throughout the year.

Abhijit Bhaduri: Chief Learning Officer of Wipro WIT +0.73%,  author of  Don’t Hire The Best & the MBA series: “My innovation resolution for 2014: Think of everything that annoys me as an opportunity to innovate. In addition, I will hold weekly conversations with millennials to understand how they dream. We have enough twenty somethings in Wipro!” @AbhijitBhaduri  Last year, Abhijit posted a set of fascinating resolutions for 2013 for The Times of India, that are well worth considering as well!

Alex Osterwalder: lead-author of BusinessModel Generation, Co-Founder  “In 2014, my team and I at aim to reach 1 million senior business leaders around the world. We intend to convert 100’000 of them into avid practitioners of the business (growth) tools of the 21st century – away from the arbitrary and unproductive traditional board room conversations that dominate strategy & innovation today.” @AlexOsterwalder

Sergio Monsalve: Silicon Valley VC — Partner, Norwest Venture Partners  (&, full-disclosure,  my son-in-law)  “I will do one thing a week that takes me out of my routine and comfort zone. I will ask more questions and be a better listener. I will leverage our Monday partner meetings as an opportunity to share best practices. I will put down my phone and clear my mind more often.I will spend more time asking my kids questions and learning from them … They will “love” that.” @VCSerge

Tim Kastelle:  Teacher of innovationmanagement at the University of Queensland Business School: “Schedule time for thinking & creating. It’s too easy to get caught up on things that keep me busy, & that detracts from the value I create.” @timkastelle

Greg Satell: @Forbes contributor, publisher of blog, formerly holding strategy and innovation roles in Publicis Groupe:  “To listen better and give new ideas more thought before I reject them” @digitaltonto

Steve Denning: @Forbes contributor, author of  The Leader’s Guide to Radical Management: Reinventing the Workplace, formerly Program Director, Knowledge Management at the World Bank: “My 2014 resolution: catalyze, reinforce and accelerate the coalition of thought leaders who embrace the ongoing economic phase change that is based on continuous innovation” @stevedenning

Bart DoorneweertValue Chain Developer at LEI-Wageningen UR, and founder of Value Chain Generation
“Reconciliation of doubt with self-esteem: Doubt is not necessarily a bad thing, particularly if it’s justified under a given circumstance. When dealing with the ambiguity of innovation and its hard hitting lessons, doubt can eat up your self-confidence. You start asking yourself questions like: “Am I doing the right thing?” “Probably there are 100′s of people out there who know far better how to decide than me”. “Why must I always put myself in these situations?!”.

Yet, always be aware that the situation you’re dealing with is inherently uncertain, and these questions can’t be answered directly. So, instead of asking these questions to yourself, ask the people around you for bearings. Involve them in the conversation. Don’t let your sense of self-esteem prevent you from reaching out due to some kind of misplaced fear that you will look bad. Rather, muster pride in throwing these questions out there.

Generally I find that this is the way to get confidence back on its feet and to create those valuable next steps. Doubt is only the strongest soft signal that something really interesting is about to emerge.” @BDoorn

Shaun Coffeyexperienced company director and Chief Executive of a variety of Australian & New Zealand private and public organizations:  “Challenge to process: Just because it worked once, doesn’t mean it will work again.  Every situation, every opportunity is different.  People are different, and people change. A spectacularly successful  intervention may not work in a new situation. It may not even work in the same situation again because the people will have changed as a result of the experience. Look for new ways to keep achievement high, stay aware of how people are responding. Look for signs that something isn’t working, and try something else. Don’t get stuck in your ways as that will block ideas. Your way may not be the better way.” @ShaunCoffey

Estelle Métayer: founder and Principal of Competia, former McKinsey consultant and educator, painter, pilot and trend-spotter: “Play More. Learn from kids. Build stuff. Learn a trade. Micro-travel ( travel within 2 miles of your home).” @Competia

Ralph-Christian Ohr: Senior Consultant on Innovation Management with emphasis on energy, utilities and integrative innovation: “My personal innovation resolution: take an integrative approach to managing innovation.Most discussions about exploration vs. exploitation, radical vs. incremental innovation, experimentation vs. processes, intuition vs. analysis, emergence vs. structure, push vs. pull, open vs. closed, long vs. short term etc. are misleading. Sustainable innovation entails inherent tensions to be managed appropriately, depending on a company’s particular innovation context. We therefore need to apply integrative and systemic thinking, rather than one-sided approaches, to foster successful innovation management in the new year ahead.” @ralph_ohr

Josie Gibson: corporate networks executive,  co-founder ofwheretofromhere?, and founder of Pourquoi: “May 2014 see policy/business leaders embrace the potential of 3D printing and other emerging innovations to reinvent manufacturing.” @Pourquoi

What we have here is, in a sense, a microcosm of the conversations that are defining contemporary innovation: the ambitious visions [bigger dreaming] of both Alex Osterwalder,who is unwilling to rest “until senior executives and entrepreneurs operate like surgeons!”, and the macro-societal sensitivities of Josie Gibson for the tough times that Australia has been going through, plus an abiding faith that innovation can prove the difference between today and tomorrow. Steve Denning’s and Ralph-Christian Ohr’s  recognition that traditional strategic thinking is no longer reliable to take us to where we need to go, and that we need to change our patterns of how we learn and think about the world around us, and then the immanently practical and personal suggestions as to how to do this by:  Estelle Métayer, Sergio Monsalve, Tim Kastelle, Shaun Coffey, Bart Doorneweert, Greg Satell and Abhijit Bhaduri. The fact that so many of these seers, from so many different walks of life, all recognize a need to learn differently, and from different people, is vivid testimony to the need for greater inclusiveness in our idea-networks. The fact that all of  them recognize that the principal agent for accomplishing this is the manager him/herself, places the responsibility squarely in each of our laps.

We are all heading into 2014 together. Some will do it better than others, but almost always it is those who are dreaming big about what they wish to achieve, and also paying attention to the processes by which they can raise the odds of actually realizing their desired achievement, that will emerge successful. The collection of innovation resolutions presented here addresses both bigger dreams and practicalities — dreams and details — that, when combined,  can lead to improved innovation performance in the year to come.


Bill Fischer is the co-author of  Reinventing Giants (with Umberto Lago & Fang Liu) (Jossey-Bass, 2013), as well as The Idea Hunter (with Andy Boynton & Bill Bole)  (Jossey-Bass, 2011) andVirtuoso Teams (with Andy Boynton, FT/Prentice Hall, 2005)).  Bill can be followed on Twitter at @bill_fischer

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