Archivi del mese: settembre 2014

Inflazione e Moneta endogena: il PDF

Keynes blog


Per agevolare la lettura, abbiamo realizzato un PDF con la serie di articoli su inflazione e moneta endogena.

Si può scaricare cliccando qui.

Buona lettura!

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How Philosophy Makes You a Better Leader

Sprechi in sanità

Girolamo Sirchia

In sanità gli sprechi sono molto alti, fino a costituire circa 1/3 della spesa sanitaria. Le cause di spreco sono numerose. Ecco le principali.

I farmaci

L’uso di farmaci è eccessivo, specie nelle persone anziane, che rappresentano il 20% della popolazione, ma utilizzano il 70% della spesa farmaceutica. In questa popolazione, fra l’altro, l’eccessivo consumo e la combinazione di varie molecole comportano danni alla salute non indifferenti. I geriatri sono ben consapevoli di questi fatti e a loro dovrebbe essere affidata la valutazione e la terapia degli anziani, in collaborazione con il medico di famiglia. Il tentativo di correggere tutte le patologie con farmaci si è dimostrato pericoloso oltre che inefficace. Alcuni farmaci, inoltre, non hanno senso nel paziente anziano: tipica la correzione dei valori di colesterolemia con statine.

L’efficacia e l’innocuità dei farmaci devono essere valutate con studi clinici controllati per ammetterli alla fascia A del Prontuario Farmaceutico (cioè…

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Four Key Issues in Innovation Management @timkastelle @Medici_Manager @WRicciardi @leadmedit


Co-authored by Tim & Ralph

What are the key innovation issues facing the business community right now?

When we met up in person recently we had a great talk about this question.  We’ve continued the discussion over email, and these are the four innovation management issues that we believe people need to be thinking about right now.

Differentiated and integrative innovation concepts

Sustainable innovation cannot be achieved by one-size-fits-all and one-sided approaches. It requires a common understanding of what innovation is, classifying concepts in order to assure individual assessments as well as differentiated approaches for firms to strengthen their innovation capabilities and performance. Further, innovation is about balancing complementary, and often opposing, variables. Therefore, integrative frameworks may help to gain a more holistic perspective and direction of impact. Examples:

  • The Innovation Matrix is supposed to help assigning firms to one of nine types of innovative organizations. Depending on the characterization, a tailored approach can be developed in order to define where innovation should sit in the business model and how to drive growth.




  • The Three Horizons Model integrates a short, middle and long term view of innovation, often being in tension to each other. It enables generating a balanced innovation portfolio, consisting of activities with different time horizons. This model can be of great benefit when it comes to mixing incremental and radical innovation activities with regard to risk and strategic alignment.
  • As outlined previously, firms need to ensure a balance of exploiting existing businesses with exploring new opportunities, i.e. they need to become ambidextrous in order to thrive sustainably. As each direction of impact requires dedicated culture, metrics, leadership, mindset and organizational setup, this is another tension to be managed. An integrative framework (below) can be useful to determine a firm’s inclination and how to move towards a balanced innovation capability. It’s important to note – particularly for leaders: Exploration and exploitation are different, but equally important!ralphmatrixStartups, typically positioned in the upper left quadrant need to move to the right direction for increased exploitation and optimization of new businesses. Bigger, established companies, in turn, aim at strengthening their exploration capabilities by moving from the bottom right box upwards. One of the main challenges for organizations to attain ambidexterity is to simultaneously enable separation and integration of both directions. While novel opportunities flourish best when they don’t interfere with core business, they must be linked to the firm’s core in order to scale successfully after validation.

A more detailed discussion of this issue is planned for an upcoming post. On a personal level, sustainable innovation requires integrative instead of either-or thinking. In order to be able to manage ambidexterity, Roger Martin suggests to balance reliability with validity by developing a design thinking mindset.


Walking through Lausanne, talking innovation

Walking through Lucerne, talking innovation

Reinvention and business model innovation

As the life times of business models steadily decrease and more radical innovation activities are about to enter the pipelines of most firms, the business model is the new unit of design. Indeed, research has confirmed that business model innovators outperform traditional innovators over time.

One key issue here is to establish systematic approaches to business model innovation. While most companies have proven processes for product innovation in place, only few follow process models for innovating business models. Steve Blank has recently pointed out that generation of novel and reinvention of existing business models is imperative for corporations to succeed in the time to come. Some of his points are:

  • For companies to survive in the 21st century they need to continually create a new set of businesses, by inventing new business models.
  • Most of these new businesses need to be created outside of the existing business units.
  • The exact form of the new business models is not known at the beginning. It only emerges after an intense business model design and search activity based on the customer development process.

Unlike execution of existing business models, the invention and validation of new business models is based on a scientific and emergent approach: defining and testing hypotheses through rapid iterative experimentation. This is what the Lean Startup approach is about. It also implies designing and testing solutions on a minimum viable basis to gain a high iteration and learning frequency through customer feedback.

To develop the ever more important (re-) invention and search capabilities into new fields, existing companies are challenged to consider to implement the lean startup concept. Or as Eric Ries puts it: Entrepreneurship is the new corporate function.




Another key issue for existing, in particular larger companies, will to build a structure, capable of successfully combining search (= generation and validation of new business models) and execution (= scaling and improvement of existing business models).

Co-creation through open and social approaches

Facing growing complexity, organizations are finding it increasingly impossible to be successful when entirely operating on their own. To move innovation forward more effectively and efficiently, they aim at building appropriate networks and partnerships. Findings of a recent IBM study confirm outperformers to be more inclined to innovate with external partners – including customers. It suggests a clear tendency to leverage openness, connectedness and co-creation.

Combining internal and external capabilities is becoming crucial for organizations to survive and thrive. Interorganizational partnerships and distributed value networks can be formed to pursue open business models and complementary capabilities. One interesting example is the intensified partnering between startups and larger firms to achieve sustainable innovation by combining their natural strengths. There is one simple reason behind: customer value and continuous disruption don’t care about silos and boundaries.

There is also a growing awareness of the benefits to make organizations more social. According to Nilofer Merchant, becoming social is about connecting things, people and ideas. Networks of connected people with shared interests and goals create ways that can produce returns for any company that serves their needs. This refers to both the organizational and the individual level. As for organizations, it’s all about moving from isolation to communities.

Here is Nilofer again:

The social era will reward those organizations that understand they can create more value with communities than they can on their own. Communities of proximity, where participants share a geographic location (Craigslist is an example but co-working locations are another) will allow people to organize work differently. Communities of passion who share a common interest (photography, or food, or books) can inform new product lines. Communities of purpose will willingly share a common task to build something (like Wikipedia) that will carry your brand and its offer to another level. Communities of practice, where they share a common career or field of business, will extend your offer because it extends their expertise (like McAfee mavens). Communities of providence that allow people to discover connections with others (as in Facebook) and thus enable the sharing of information, products and ideas.

On the people level, connecting individual stakeholders through social business design – particularly involving customers – is on the rise. In social organizations, people are seen as most valuable asset to make a difference. As discussed here, a higher degree of connectedness in combination with making interaction workers more effective and efficient, seems to be a prerequisite for strategic advantage over industry peers. Moreover, social designs bear significant potential to help organizations in better tackling the complexity of business model innovation, adaptability and strategic reinvention.  

Building a culture of experimentation

One of the best tools to use to improve innovation capability is experimentation.  We often think that great businesses are built on great ideas.  But the fact of the matter is that great businesses are usually built by tinkering until their great idea emerges – this is the story told in Little Bets by Peter Sims.

Experimentation is an organisational skill that underlies all of the other issues that we have raised here.  While there is no one-size-fits all innovation tool, experimenting is pretty close to being a one-size-fits all innovation skill.  It is an approach that works best when it is used to test hypotheses – so that it enables structured learning.  Experiments and hypothesis testing are an essential part of business model innovation.  If we are trying to embed lean start-up principles into larger organisations, this is a capability that must be there.  Experimenting is also central to co-creation and other social approaches.

Start-ups and smaller organisations often experiment naturally.  The issue that we would like to raise is that this skill must also be nurtured in larger organisations as well.  If you’re a manager, this means building experimenting into your organisational structure and routines. If you are reporting to someone, it means figuring out how much you can get away with, and using that scope of action to support experiments.

Other people may well come up with other innovation issues that are important, but these are the ones that seem most interesting to us right now. Now we just need to start making progress on them! Therefore, we’ll try to elaborate on these issues in the time to come, in order to provide further ideas to help make innovation more successful.

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About Ralph-Christian

Experienced innovation, technology and product management professional. Looking at the intersection of organizational and personal innovation capabilities. Integrative thinker. Boundary spanner. Author of the Integrative Innovation blog. You can follow him on Twitter @ralph_ohr.

2013: The Year In Healthcare Charts @pash22 @Medici_Manager @WRicciardi

By Dan Munro ,

This is the 3rd and final installment of my year-end series for 2013.

Part 1: Healthcare’s Story Of The Year For 2013 – Pricing Transparency(here)

Part 2: Top Ten Healthcare Quotes For 2013 (here)

Like the Top Ten Healthcare Quotes, this collection of 15 charts is far from complete or comprehensive, but they are ones I found to be representative of a broader healthcare trend or story. In most cases, the charts are self explanatory, but in others they are simply gateways into larger, more compelling stories.

Given the complexities around data collection and presentation – there is often a lag between the current year and the latest available data from a major/reliable source.

As a part of what I called the “story of the year” (Healthcare Pricing Transparency – here) was this chart from Elizabeth Rosenthal’s multi-part series on “The $2.7 Trillion Medical Bill.”


Source: The $2.7 Trillion Medical Bill by Elizabeth Rosenthal (here)

While it’s too early to call it a trend, this chart for ER visits (1996 – 2010) is notable because 2010 is the first time in 14 years that the consecutive upward trend was broken. The unknown at this stage is why and if it will continue (lots of speculation and debate), but it’s an important barometer for reasons around cost and healthcare more broadly.


Source: CDC / National Center for Healthcare Statistics (PDF here)

The Milliman Medical Index is another broad indicator around annual healthcare costs for a family of 4 with PPO coverage.


Source: 2013 Milliman Medical Index (PDF here)

For Health Insurance Premiums alone (no accounting for “out-of-pocket” expenses), the Kaiser Family Foundation gave us these two related charts:



Source: Kaiser/HRET 2013 Employer Health Benefits Survey 2013 (PDF here)

According to Medscape – Orthopedics edged out Cardiology and Radiology as the specialty with the highest average annual compensation for 2012 (reported in 2013).


Source: Medscape Physician Compensation Report 2013 – (26 slides here)

Obesity and related illnesses saw coverage from every direction throughout 2013. Once again, the relatively small town of McAllen Texas (population of about 135,000 and profiled by Atul Gawande in The Cost Conundrum – 2009here) was front and center again in a story by The Washington Post that included this provocative chart on the correlation (by U.S. region) of childhood obesity and poverty (as measured by the Federal Poverty Limit):


Source: The Washington Post – Too Much of Too Little by Eli Saslow(here)

This next chart has broad healthcare implications and the dubious distinction of making an entirely different list – “The Most Important Charts in the World” (at least according to “Wall Street’s ‘Brightest” Minds).


Source: Wall Street’s Brightest Minds Reveal The Most Important Charts In The World [Chart #57 – Monthly Food Stamps by Nicholas Colas of the ConvergEx Group – here]

Another contributing factor to several healthcare related illnesses is the global consumption of sugar – and soda in particular. Once again, at least according to Credit Suisse, the U.S. is an outlier relative to all of the other industrialized countries.


Source: Credit Suisse Research Institute – Sugar: Consumption At A Crossroads (PDF here)

From their Biennial Health Insurance Survey, The Commonwealth Fund delivered this chart as a part of broader analysis that concluded: “In 2012, nearly half (46%) of U.S. adults ages 19 to 64, an estimated 84 million people, did not have insurance for the full year or had coverage that provided inadequate protection from health care costs.”


Source: The Commonwealth Fund Report – Insuring the Future (PDF here)

Reducing the number of uninsured continues to dominate the healthcare headlines more broadly and Sarah Kliff at the Washington Post used this chart to summarize the effect of the ACA on coverage by 2016.


Source: Obamacare Explained In 2 Minutes by Sarah Kliff at The Washington Post (video here)

No less than 3 of healthcare’s larger topics (Big Data, Gamification and Wearable User Interfaces) made it to the top of another chart – Gartner’s Hype Cycle for Emerging Technologies. All 3 appeared at (or near) the “Peak of Inflated Expectations.” Clearly the trend that Gartner was identifying is larger than just healthcare, but healthcare is a part of the broader picture too.


Source: Gartner Hype Cycle For Emerging Technologies 2013 (here)

Big Pharma continued to make restitution to the Department of Justice for past grievances around overly aggressive marketing of some of their drugs. Just this month, GlaxoSmithKline announced their intent to change some of those practices – which included paying doctors (in a variety of ways) to sell their branded drugs. This chart (created by ProPublica for a larger piece on the flow of dollars from big pharma to providers) doesn’t include the Johnson & Johnson settlement on behalf of their subsidiary Janssen for $2.5 billion which was finalized and announced just last month (here).


Source: Big Pharma’s Big Fines by Lena Groeger for ProPublica (here)

Pricing transparency throughout the year revealed wide variations – some of which was explained by L.E.K. Consulting in their analysis which produced this chart (for a broader discussion on the profit profiles ahead for hospitals under the Affordable Care Act). They make a compelling argument that only one of the 4 different payment types seen by hospitals is profitable and this one category of payment has to offset the negative margin of the other 3.


Source: Hospital Economics and Healthcare Reform by Tip Kim and Scott Miller for L.E.K. Consulting (PDF here)

This final chart is one I’ve used extensively in the past, but has now been updated with OECD data for 2011. The older version was using data from 2009. Not much change – but strengthens the argument that we still have a long way to go in our healthcare reformation and transformation.


Source: OECD Health Data 2013 (Access the OECD StatExtracts Databaseonline here)


Un’eredità di avorio e ambra: lettura raccomandata per capire la decadenza @WRicciardi

Edmund de Waal tratteggia le vicende di una grande famiglia ebraica europea, di una collezione preziosa di 264 netsuke (piccolissime sculture giapponesi di avorio o legno), delle imprevedibili svolte del destino.

Un libro da leggere, divorandolo, anche per capire l’attuale decadenza della società europea (e italiana) e i rischi del crescente antisemitismo.

Una frase: “Viktor ed Emmy hanno ancora tutto – tutti questi averi, tutti questi cassetti pieni di cose, queste pareti tappezzate di quadri – ma hanno perduto il senso del futuro come ventaglio di possibilità. Ecco la misura della loro decadenza”.