Category Archives: Formazione

Che cos’è un leader: tutto dipende dalla definizione di leadership

Interessante articolo di Travis Bradberry su Inc. Author, Emotional Intelligence 2.0 


What makes someone a leader anyway?

Such a simple question, and yet it continues to vex some of the best thinkers in business. I’ve written books on leadership, and yet it’s a rare thing to actually pause to define leadership.

Let’s start with what leadership is not …

Leadership has nothing to do with seniority or one’s position in the hierarchy of a company. Too many consider a company’s leadership to refer to the senior most executives in the organization. They are just that, senior executives. Leadership doesn’t automatically happen when you reach a certain pay grade. Hopefully you find it there, but there are no guarantees.

Leadership has nothing to do with titles. Similar to the previous point, having a C-level title doesn’t automatically make you a leader. You don’t need a title to lead. You can be a leader in your workplace, your neighborhood, or your family, all without having a title.

Leadership has nothing to do with personal attributes. Say the word leader and most people think of a domineering, take-charge, charismatic individual. People often think of icons from history such as George S. Patton or Abraham Lincoln. But leadership isn’t an adjective. We don’t need to be extroverted or charismatic to practice leadership. And those with charisma don’t automatically lead.

Leadership isn’t management. This is the big one. Leadership and management are not synonymous. You have 15 people in your downline and P&L responsibility? Good for you; hopefully, you are a good manager. Good management is needed. Managers need to plan, measure, monitor, coordinate, solve, hire, fire, and so many other things. Managers spend most of their time managing things. Leaders lead people.

So, again, what makes a leader?

Let’s see how some of the most respected business thinkers of our time define leadership, and let’s consider what’s wrong with their definitions.

Peter Drucker: “The only definition of a leader is someone who has followers.”

Really? This instance of tautology is so simplistic as to be dangerous. A new Army captain is put in the command of 200 soldiers. He never leaves his room or utters a word to the men and women in his unit. Perhaps routine orders are given through a subordinate. By default, his troops have to follow orders. Is the captain really a leader? Commander, yes; leader, no. Drucker is of course a brilliant thinker, but his definition is too simple.

Warren Bennis: “Leadership is the capacity to translate vision into reality.”

Every spring you have a vision for a garden, and with lots of work carrots and tomatoes become a reality. Are you a leader? No, you’re a gardener. Bennis’s definition seems to have forgotten “others.”

Bill Gates: “As we look ahead into the next century, leaders will be those who empower others.”

This definition includes “others,” and empowerment is a good thing. But to what end? We’ve seen many empowered “others” in life, from rioting hooligans to Google workers who were so misaligned with the rest of the company they found themselves unemployed. Gates’s definition lacks goals and vision.

John Maxwell: “Leadership is influence–nothing more, nothing less.”

I like minimalism, but this reduction is too much. A robber with a gun has influence over his victim. A manager has the power to fire team members, which provides a lot of influence. But does this influence make a robber or a manager a leader? Maxwell’s definition omits the source of influence.

So what is leadership?

Definition: Leadership is a process of social influence that maximizes the efforts of others toward the achievement of a greater good.

Notice the key elements of this definition:

  • Leadership stems from social influence, not authority or power.
  • Leadership requires others, and that implies they don’t need to be “direct reports.”
  • No mention of personality traits, attributes, or even a title; there are many styles, many paths to effective leadership.
  • It includes a greater good, not influence with no intended outcome.

Leadership is a mindset in action. So don’t wait for the title. Leadership isn’t something that anyone can give you–you have to earn it and claim it for yourself.

So what do you think of my definition of leadership? Please share your thoughts in the comments section below, as I learn just as much from you as you do from me.

Special thanks to Kevin Kruse for help with this post.

Like this column? Sign up to subscribe to email alerts and you’ll never miss a post.
The opinions expressed here by columnists are their own, not those of

Il potere magico del fallimento: perché la sconfitta ci rende liberi

“Io non perdo mai. Certe volte vinco, altre volte imparo.” Questa frase di Nelson Mandela è riportata nella quarta di copertina di un aureo libretto di Charles Pépin: Il potere magico del fallimento: perché la sconfitta ci rende liberi edito da Garzanti.

La vera crescita è sempre costruita attraverso errori, sconfitte e delusioni.

Il messaggio dell’autore è profondo: per diventare quelli che siamo ed esprimere il nostro potenziale dobbiamo accettare l’esperienza del rischio e non limitarci a scegliere tra alternative note e rassicuranti.

Molto interessante è l’analisi che egli fa sulla cultura francese (molto simile a quella italiana secondo me) rispetto a quella anglosassone, in particolare, americana. Per francesi (e italiani) il fallimento è una colpa di cui vergognarsi. Per gli americani è un’esperienza e un’opportunità.

Una lettura interessante e stimolante


The Dying Art of Disagreement @WRicciardi @drsilenzi @dr_enricorosso

Pubblicato ieri sul New York Times: a must read!

The Dying Art of Disagreement

SEPTEMBER 24, 2017

Bret Stephens
Bret Stephens

This is the text of a lecture delivered at the Lowy Institute Media Award dinner in Sydney, Australia, on Saturday, Sept. 23. The award recognizes excellence in Australian foreign affairs journalism.

Let me begin with thanks to the Lowy Institute for bringing me all the way to Sydney and doing me the honor of hosting me here this evening.

I’m aware of the controversy that has gone with my selection as your speaker. I respect the wishes of the Colvin family and join in honoring Mark Colvin’s memory as a courageous foreign correspondent and an extraordinary writer and broadcaster. And I’d particularly like to thank Michael Fullilove for not rescinding the invitation.

This has become the depressing trend on American university campuses, where the roster of disinvited speakers and forced cancellations includes former Secretaries of State Henry Kissinger and Condoleezza Rice, former Harvard University President Larry Summers, actor Alec Baldwin, human-rights activist Ayaan Hirsi Ali, DNA co-discoverer James Watson, Indian Prime Minister Narendra Modi, filmmaker Michael Moore, conservative Pulitzer Prize-winning columnist George Will and liberal Pulitzer Prize-winning columnist Anna Quindlen, to name just a few.

So illustrious is the list that, on second thought, I’m beginning to regret that you didn’t disinvite me after all.

The title of my talk tonight is “The Dying Art of Disagreement.” This is a subject that is dear to me — literally dear — since disagreement is the way in which I have always earned a living. Disagreement is dear to me, too, because it is the most vital ingredient of any decent society.

To say the words, “I agree” — whether it’s agreeing to join an organization, or submit to a political authority, or subscribe to a religious faith — may be the basis of every community.

But to say, I disagree; I refuse; you’re wrong; etiam si omnes — ego non — these are the words that define our individuality, give us our freedom, enjoin our tolerance, enlarge our perspectives, seize our attention, energize our progress, make our democracies real, and give hope and courage to oppressed people everywhere. Galileo and Darwin; Mandela, Havel, and Liu Xiaobo; Rosa Parks and Natan Sharansky — such are the ranks of those who disagree.

And the problem, as I see it, is that we’re failing at the task.

This is a puzzle. At least as far as far as the United States is concerned, Americans have rarely disagreed more in recent decades.

We disagree about racial issues, bathroom policies, health care laws, and, of course, the 45th president. We express our disagreements in radio and cable TV rants in ways that are increasingly virulent; street and campus protests that are increasingly violent; and personal conversations that are increasingly embittering.

This is yet another age in which we judge one another morally depending on where we stand politically.

Nor is this just an impression of the moment. Extensive survey data show that Republicans are much more right-leaning than they were twenty years ago, Democrats much more left-leaning, and both sides much more likely to see the other as a mortal threat to the nation’s welfare.

The polarization is geographic, as more people live in states and communities where their neighbors are much likelier to share their politics.

The polarization is personal: Fully 50 percent of Republicans would not want their child to marry a Democrat, and nearly a third of Democrats return the sentiment. Interparty marriage has taken the place of interracial marriage as a family taboo.

Finally the polarization is electronic and digital, as Americans increasingly inhabit the filter bubbles of news and social media that correspond to their ideological affinities. We no longer just have our own opinions. We also have our separate “facts,” often the result of what different media outlets consider newsworthy. In the last election, fully 40 percent of Trump voters named Fox News as their chief source of news.

Thanks a bunch for that one, Australia.

It’s usually the case that the more we do something, the better we are at it. Instead, we’re like Casanovas in reverse: the more we do it, the worse we’re at it. Our disagreements may frequently hoarsen our voices, but they rarely sharpen our thinking, much less change our minds.

It behooves us to wonder why.

* * *

Thirty years ago, in 1987, a philosophy professor at the University of Chicago named Allan Bloom — at the time best known for his graceful translations of Plato’s “Republic” and Rousseau’s “Emile” — published a learned polemic about the state of higher education in the United States. It was called “The Closing of the American Mind.”

The book appeared when I was in high school, and I struggled to make my way through a text thick with references to Plato, Weber, Heidegger and Strauss. But I got the gist — and the gist was that I’d better enroll in the University of Chicago and read the great books. That is what I did.

What was it that one learned through a great books curriculum? Certainly not “conservatism” in any contemporary American sense of the term. We were not taught to become American patriots, or religious pietists, or to worship what Rudyard Kipling called “the Gods of the Market Place.” We were not instructed in the evils of Marxism, or the glories of capitalism, or even the superiority of Western civilization.

As I think about it, I’m not sure we were taught anything at all. What we did was read books that raised serious questions about the human condition, and which invited us to attempt to ask serious questions of our own. Education, in this sense, wasn’t a “teaching” with any fixed lesson. It was an exercise in interrogation.

To listen and understand; to question and disagree; to treat no proposition as sacred and no objection as impious; to be willing to entertain unpopular ideas and cultivate the habits of an open mind — this is what I was encouraged to do by my teachers at the University of Chicago.

It’s what used to be called a liberal education.

The University of Chicago showed us something else: that every great idea is really just a spectacular disagreement with some other great idea.

Socrates quarrels with Homer. Aristotle quarrels with Plato. Locke quarrels with Hobbes and Rousseau quarrels with them both. Nietzsche quarrels with everyone. Wittgenstein quarrels with himself.

These quarrels are never personal. Nor are they particularly political, at least in the ordinary sense of politics. Sometimes they take place over the distance of decades, even centuries.

Most importantly, they are never based on a misunderstanding. On the contrary, the disagreements arise from perfect comprehension; from having chewed over the ideas of your intellectual opponent so thoroughly that you can properly spit them out.

In other words, to disagree well you must first understand well. You have to read deeply, listen carefully, watch closely. You need to grant your adversary moral respect; give him the intellectual benefit of doubt; have sympathy for his motives and participate empathically with his line of reasoning. And you need to allow for the possibility that you might yet be persuaded of what he has to say.

“The Closing of the American Mind” took its place in the tradition of these quarrels. Since the 1960s it had been the vogue in American universities to treat the so-called “Dead White European Males” of the Western canon as agents of social and political oppression. Allan Bloom insisted that, to the contrary, they were the best possible instruments of spiritual liberation.

He also insisted that to sustain liberal democracy you needed liberally educated people. This, at least, should not have been controversial. For free societies to function, the idea of open-mindedness can’t simply be a catchphrase or a dogma. It needs to be a personal habit, most of all when it comes to preserving an open mind toward those with whom we disagree.

* * *

That habit was no longer being exercised much 30 years ago. And if you’ve followed the news from American campuses in recent years, things have become a lot worse.

According to a new survey from the Brookings Institution, a plurality of college students today — fully 44 percent — do not believe the First Amendment to the U.S. Constitution protects so-called “hate speech,” when of course it absolutely does. More shockingly, a narrow majority of students — 51 percent — think it is “acceptable” for a student group to shout down a speaker with whom they disagree. An astonishing 20 percent also agree that it’s acceptable to use violence to prevent a speaker from speaking.

These attitudes are being made plain nearly every week on one college campus or another.

There are speakers being shouted down by organized claques of hecklers — such was the experience of Israeli ambassador Michael Oren at the University of California, Irvine. Or speakers who require hundreds of thousands of dollars of security measures in order to appear on campus — such was the experience of conservative pundit Ben Shapiro earlier this month at Berkeley. Or speakers who are physically barred from reaching the auditorium — that’s what happened to Heather MacDonald at Claremont McKenna College in April. Or teachers who are humiliated by their students and hounded from their positions for allegedly hurting students’ feelings — that’s what happened to Erika and Nicholas Christakis of Yale.

And there is violence. Listen to a description from Middlebury College professor Allison Stanger of what happened when she invited the libertarian scholar Charles Murray to her school to give a talk in March:

The protesters succeeded in shutting down the lecture. We were forced to move to another site and broadcast our discussion via live stream, while activists who had figured out where we were banged on the windows and set off fire alarms. Afterward, as Dr. Murray and I left the building . . . a mob charged us.

Most of the hatred was focused on Dr. Murray, but when I took his right arm to shield him and to make sure we stayed together, the crowd turned on me. Someone pulled my hair, while others were shoving me. I feared for my life. Once we got into the car, protesters climbed on it, hitting the windows and rocking the vehicle whenever we stopped to avoid harming them. I am still wearing a neck brace, and spent a week in a dark room to recover from a concussion caused by the whiplash.

Middlebury is one of the most prestigious liberal-arts colleges in the United States, with an acceptance rate of just 16 percent and tuition fees of nearly $50,000 a year. How does an elite institution become a factory for junior totalitarians, so full of their own certitudes that they could indulge their taste for bullying and violence?

There’s no one answer. What’s clear is that the mis-education begins early. I was raised on the old-fashioned view that sticks and stones could break my bones but words would never hurt me. But today there’s a belief that since words can cause stress, and stress can have physiological effects, stressful words are tantamount to a form of violence. This is the age of protected feelings purchased at the cost of permanent infantilization.

The mis-education continues in grade school. As the Brookings findings indicate, younger Americans seem to have no grasp of what our First Amendment says, much less of the kind of speech it protects. This is a testimony to the collapse of civics education in the United States, creating the conditions that make young people uniquely susceptible to demagogy of the left- or right-wing varieties.

Then we get to college, where the dominant mode of politics is identity politics, and in which the primary test of an argument isn’t the quality of the thinking but the cultural, racial, or sexual standing of the person making it. As a woman of color I think X. As a gay man I think Y. As a person of privilege I apologize for Z. This is the baroque way Americans often speak these days. It is a way of replacing individual thought — with all the effort that actual thinking requires — with social identification — with all the attitude that attitudinizing requires.

In recent years, identity politics have become the moated castles from which we safeguard our feelings from hurt and our opinions from challenge. It is our “safe space.” But it is a safe space of a uniquely pernicious kind — a safe space fromthought, rather than a safe space for thought, to borrow a line I recently heard from Salman Rushdie.

Another consequence of identity politics is that it has made the distance between making an argument and causing offense terrifyingly short. Any argument that can be cast as insensitive or offensive to a given group of people isn’t treated as being merely wrong. Instead it is seen as immoral, and therefore unworthy of discussion or rebuttal.

The result is that the disagreements we need to have — and to have vigorously — are banished from the public square before they’re settled. People who might otherwise join a conversation to see where it might lead them choose instead to shrink from it, lest they say the “wrong” thing and be accused of some kind of political -ism or -phobia. For fear of causing offense, they forego the opportunity to be persuaded.

Take the arguments over same-sex marriage, which you are now debating in Australia. My own views in favor of same-sex marriage are well known, and I hope the Yes’s wins by a convincing margin.

But if I had to guess, I suspect the No’s will exceed whatever they are currently polling. That’s because the case for same-sex marriage is too often advanced not by reason, but merely by branding every opponent of it as a “bigot” — just because they are sticking to an opinion that was shared across the entire political spectrum only a few years ago. Few people like outing themselves as someone’s idea of a bigot, so they keep their opinions to themselves even when speaking to pollsters. That’s just what happened last year in the Brexit vote and the U.S. presidential election, and look where we are now.

If you want to make a winning argument for same-sex marriage, particularly against conservative opponents, make it on a conservative foundation: As a matter of individual freedom, and as an avenue toward moral responsibility and social respectability. The No’s will have a hard time arguing with that. But if you call them morons and Neanderthals, all you’ll get in return is their middle finger or their clenched fist.

One final point about identity politics: It’s a game at which two can play. In the United States, the so-called “alt-right” justifies its white-identity politics in terms that are coyly borrowed from the progressive left. One of the more dismaying features of last year’s election was the extent to which “white working class” became a catchall identity for people whose travails we were supposed to pity but whose habits or beliefs we were not supposed to criticize. The result was to give the Trump base a moral pass it did little to earn.

* * *

So here’s where we stand: Intelligent disagreement is the lifeblood of any thriving society. Yet we in the United States are raising a younger generation who have never been taught either the how or the why of disagreement, and who seem to think that free speech is a one-way right: Namely, their right to disinvite, shout down or abuse anyone they dislike, lest they run the risk of listening to that person — or even allowing someone else to listen. The results are evident in the parlous state of our universities, and the frayed edges of our democracies.

Can we do better?

This is supposed to be a lecture on the media, and I’d like to conclude this talk with a word about the role that editors and especially publishers can play in ways that might improve the state of public discussion rather than just reflect and accelerate its decline.

I began this talk by noting that Americans have rarely disagreed so vehemently about so much. On second thought, this isn’t the whole truth.

Yes, we disagree constantly. But what makes our disagreements so toxic is that we refuse to make eye contact with our opponents, or try to see things as they might, or find some middle ground.

Instead, we fight each other from the safe distance of our separate islands of ideology and identity and listen intently to echoes of ourselves. We take exaggerated and histrionic offense to whatever is said about us. We banish entire lines of thought and attempt to excommunicate all manner of people — your humble speaker included — without giving them so much as a cursory hearing.

The crucial prerequisite of intelligent disagreement — namely: shut up; listen up; pause and reconsider; and only then speak — is absent.

Perhaps the reason for this is that we have few obvious models for disagreeing well, and those we do have — such as the Intelligence Squared debates in New York and London or Fareed Zakaria’s show on CNN — cater to a sliver of elite tastes, like classical music.

Fox News and other partisan networks have demonstrated that the quickest route to huge profitability is to serve up a steady diet of high-carb, low-protein populist pap. Reasoned disagreement of the kind that could serve democracy well fails the market test. Those of us who otherwise believe in the virtues of unfettered capitalism should bear that fact in mind.

I do not believe the answer, at least in the U.S., lies in heavier investment in publicly sponsored television along the lines of the BBC. It too, suffers, from its own form of ideological conformism and journalistic groupthink, immunized from criticism due to its indifference to competition.

Nor do I believe the answer lies in a return to what in America used to be called the “Fairness Doctrine,” mandating equal time for different points of view. Free speech must ultimately be free, whether or not it’s fair.

But I do think there’s such a thing as private ownership in the public interest, and of fiduciary duties not only to shareholders but also to citizens. Journalism is not just any other business, like trucking or food services. Nations can have lousy food and exemplary government, as Great Britain demonstrated for most of the last century. They can also have great food and lousy government, as France has always demonstrated.

But no country can have good government, or a healthy public square, without high-quality journalism — journalism that can distinguish a fact from a belief and again from an opinion; that understands that the purpose of opinion isn’t to depart from facts but to use them as a bridge to a larger idea called “truth”; and that appreciates that truth is a large enough destination that, like Manhattan, it can be reached by many bridges of radically different designs. In other words, journalism that is grounded in facts while abounding in disagreements.

I believe it is still possible — and all the more necessary — for journalism to perform these functions, especially as the other institutions that were meant to do so have fallen short. But that requires proprietors and publishers who understand that their role ought not to be to push a party line, or be a slave to Google hits and Facebook ads, or provide a titillating kind of news entertainment, or help out a president or prime minister who they favor or who’s in trouble.

Their role is to clarify the terms of debate by championing aggressive and objective news reporting, and improve the quality of debate with commentary that opens minds and challenges assumptions rather than merely confirming them.


Una lettura obbligatoria: Exponential Organizations di Salim Ismail @WRicciardi @leadmedit

Una lettura estiva (forse sarebbe meglio dire uno studio estivo) di un libro affascinante: Exponential Organizations di Salim Ismail, edito da Marsilio nella collana Nodi.

Che cos’è un’organizzazione esponenziale? Essa è un’organizzazione il cui impatto (o output) risulta notevolmente superiore – almeno dieci volte – rispetto ai competitor, grazie all’utilizzo di nuove tecniche organizzative, che fanno leva sulle tecnologie in accelerazione.

Gestire organizzazioni esponenziali focalizzate sui clienti e non sui competitor esterni e sulle strutture interne tradizionali richiede una svolta epocale, paragonata a una nuova “era cambriana”. Richiede una nuova cultura e nuove e più dinamiche competenze.

Ho raccolto alcune frasi che mi hanno particolarmente colpito! Buona meditazione a tutti noi perché molti dei temi trattati riguardano anche la sanità!

  1. L’unica costante del mondo d’oggi è il cambiamento, e il ritmo del cambiamento sta aumentando.
  2. L’accelerazione (del cambiamento) è costituita dalle 6 D: digitalized, deceptive (ingannevole), disruptive (dirompente), dematerialized, demonetized, democratized.
  3. L’utilizzo di strumenti lineari e di tendenze del passato per fare previsioni su di un futuro in accelerazione è deleterio (vedi i casi di Iridium e Kodak).
  4. Gli esperti, in quasi tutti i campi, messi di fronte ad una crescita di tipo esponenziale, continuano sempre a pensare in un’ottica lineare, ignorando l’evidenza davanti ai loro occhi.
  5. Il vecchio detto secondo cui un esperto è “qualcuno che ti dice perché qualcosa non può essere fatta” è oggi più vero che mai.
  6. Nessuno degli indicatori tradizionali quali l’età, la reputazione e le vendite attuali possono garantire la sopravvivenza di un’azienda.
  7. La legge di Moore afferma che il rapporto prezzo/prestazione della potenza di calcolo raddoppia ogni diciotto mesi.
  8. “Le nostre organizzazioni sono fatte per resistere ai cambiamenti che arrivano dall’esterno” piuttosto che per accoglierli, anche quando sono utili (da John Hagel).
  9. Le strutture organizzative aziendali esistono proprio per annientare i fattori dirompenti di cambiamento.
  10. La maggior parte delle organizzazioni complesse si basa sulla cosiddetta “struttura a matrice” … Questa struttura è efficace nel garantire il controllo, ma è disastrosa in termini di individuazione delle responsabilità, di velocità e di propensione al rischio … Con il tempo, le funzioni orizzontali acquistano sempre più potere … Per le grandi organizzazioni con struttura a matrice attuare il cambiamento rapido e dirompente è qualcosa di estremamente difficile. Quelle che ci hanno provato, infatti, hanno sperimentato che il “sistema immunitario” dell’organizzazione tende a rispondere alla minaccia percepita attaccando.
  11. Le organizzazioni esponenziali hanno la capacità di adattarsi a un mondo in cui l’informazione è pervasiva e onnipresente e di convertirla in vantaggio competitivo.
  12. I tratti comuni delle organizzazioni esponenziali sono: il Massive Transformative Purpose (Mtp), cinque caratteristiche esterne denominate Scale e cinque interne denominate Ideas. Per essere un’organizzazione esponenziale, un’azienda deve avere il Mtp e almeno quattro caratteristiche.
  13. Il Mtp non è la missione: il Mtp è aspirational. Il fuoco è su ciò che si aspira a raggiungere.
  14. Scale: staff on demand; community and crowd; algoritmi, leveraged asset; engagement
  15. Ideas: interfacce; dashboard; experimentation; autonomia; tecnologie sociali.
  16. Il concetto di autonomia non implica non rendere conto a nessuno delle proprie azioni. Secondo Steve Denning, “In un network esistono ancora le gerarchie, ma esse tendono ad essere basate sulle competenze, e fanno affidamento più sull’accountability tra colleghi che su quella dovuta all’autorità, cioè sul dover rendere conto a qualcuno perché sa qualcosa e non per il semplice fatto che occupa una determinata posizione indipendentemente dalle competenze. Il ruolo del manager si trasforma, non viene abolito”
  17. Un’organizzazione esponenziale tende a essere una zero latency enterprise cioè un’azienda in cui si annulla l’intervallo tra ideazione, approvazione e realizzazione.
  18. In passato il lavoro si concentrava principalmente sull’importanza del quoziente intellettivo (QI), oggi il quoziente emotivo (QE) e quello spirituale (QS) stanno diventando indicatori sempre più rilevanti.
  19. Un secolo fa, la competizione si giocava principalmente sulla produzione, Quarant’anni fa, invece, il fattore decisivo divenne il marketing. Oggi, nell’era di internet, in cui produzione e marketing sono diventati merci e sono stati democratizzati, tutto ruota intorno a idee e ideali.
  20. Il piano strategico quinquennale è in sé uno strumento obsoleto … Esso è un suicidio per un’organizzazione esponenziale … L’unica soluzione è stabilire un Massive transformational Purpose (Mtp), costruire la struttura aziendale, adottare un piano (al massimo) annuale e osservare la crescita, con aggiustamenti progressivi e in tempo reale a seconda delle necessità.
  21. Nel mondo delle organizzazioni esponenziali, lo scopo (Mtp) è più importante della strategia e l’execution ha la precedenza sulla pianificazione.
  22. Arianna Huffington ha detto: “Preferisco lavorare con una persona meno brillante ma che sa fare gioco di squadra ed è chiara e diretta, piuttosto che con qualcuno molto brillante ma dannoso per l’organizzazione”.
  23. In un’organizzazione esponenziale, la cultura (con il Mtp e le tecnologie sociali) è il collante che garantisce la tenuta del team nonostante i salti quantici della crescita esponenziale. Secondo Chip Conley “la cultura è ciò che accade quando il capo non c’è”. E secondo Joi Ito “la cultura si mangia la strategia a colazione”.
  24. Sta diventando sempre più facile acquisire potere, ma è sempre è più difficile mantenerlo.
  25. Consiglio ai CEO delle grandi aziende di affiancare a chi occupa posizioni di leadership i venticinquenni più brillanti, per colmare il gap generazionale e tecnologico, per permettere a questi giovani di crescere più velocemente e per innescare un meccanismo di mentoring al contrario.
  26. Se siete un manager di Amazon e un dipendente viene da voi con una grande idea, la vostra risposta di default deve essere : Se volete dire di no, dovete motivare questo rifiuto con una relazione di due pagine spiegando perché non ritenete l’idea valida.
  27. Jeff Bezos (Amazon) ha detto: “ Se sei focalizzato sui competitor, devi aspettare che siano loro a fare la prima mossa, prima di agire. Concentrarsi sui clienti, invece, consente di essere dei pionieri”.
  28. Il miglior modo per definire questa macrotransizione verso organizzazioni esponenziali è considerarla un passaggio dalla scarsità all’abbondanza … Secondo Dave Blakely “queste nuove organizzazioni sono esponenziali perché prendono qualcosa di scarso e lo fanno diventare abbondante”.

Il CV efficace: lo ha inventato Leonardo Da Vinci! Copiate! @drsilenzi @redhenry88

Tempo fa, sui social, Roberta Zantedeschi che si occupa di ricerca e selezione di personale e diformazione e orientamento professionale, ha pubblicato un interessante post su come stendere un CV efficace prendendo Leonardo da Vinci come testimonial.

Eccolo: interessante!

Quel gran secchione di Leonardo Da Vinci tra le varie cose è fautore pure del CV efficace.

Quel CV cioè che non descrive ogni singola esperienza lavorativa (quello che hai fatto in passato) ma che mette in evidenza le capacità maturate (ciò che potrai fare presso chi ti assumerà).

Un CV non autoreferenziale ma concreto, pragmatico e rivolto ai bisogni e ai problemi di chi legge.

La lettera è indirizzata al Duca Ludovico Sforza detto Il Moro in occasione del trasferimento dello stesso Leonardo a Milano e pare proprio una moderna domanda di assunzione.

Eccola tradotta in Italiano corrente:

Avendo constatato che tutti quelli che affermano di essere inventori di strumenti bellici innovativi in realtà non hanno creato niente di nuovo, rivelerò a Vostra Eccellenza i miei segreti in questo campo, e li metterò in pratica quando sarà necessario. Le cose che sono in grado di fare sono elencate, anche se brevemente, qui di seguito (ma sono capace di fare molto di più, a seconda delle esigenze):

1- Sono in grado di creare ponti, robusti ma maneggevoli, sia per attaccare i nemici che per sfuggirgli; e ponti da usare in battaglia, in grado di resistere al fuoco, facili da montare e smontare; e so come bruciare quelli dei nemici.

2- In caso di assedio, so come eliminare l’acqua dei fossati e so creare macchine d’assedio adatte a questo scopo.

3- Se, sempre in caso di assedio, la fortezza fosse inattaccabile dalle normali bombarde, sono in grado di sbriciolare ogni fortificazione, anche la più resistente.

4- Ho ideato bombarde molto maneggevoli che lanciano proiettili a somiglianza di una tempesta, in modo da creare spavento e confusione nel nemico.

5- Sono in grado di ideare e creare, in modo poco rumoroso, percorsi sotterranei per raggiungere un determinato luogo, anche passando al di sotto di fossati e fiumi.

6- Costruirò carri coperti, sicuri, inattaccabili e dotati di artiglierie, che riusciranno a rompere le fila nemiche, aprendo la strada alle fanterie, che avanzeranno facilmente e senza ostacoli.

7- Se c’è bisogno costruirò bombarde, mortai e passavolanti [per lanciare sassi e ‘proiettili’] belli e funzionali, rielaborati in modo nuovo.

8- Se non basteranno le bombarde, farò catapulte, mangani, baliste [macchine per lanciare pietre e ‘fuochi’] e altre efficaci macchine da guerra, ancora in modo innovativo; costruirò, in base alla situazione, infiniti mezzi di offesa e difesa.

9- In caso di battaglia sul mare, conosco efficaci strumenti di difesa e di offesa, e so fare navi che sanno resistere a ogni tipo di attacco.

10- In tempo di pace, sono in grado di soddisfare ogni richiesta nel campo dell’architettura, nell’edilizia pubblica e privata e nel progettare opere di canalizzazione delle acque. So realizzare opere scultoree in marmo, bronzo e terracotta, e opere pittoriche di qualsiasi tipo. Potrò eseguire il monumento equestre in bronzo che in eterno celebrerà la memoria di Vostro padre [Francesco] e della nobile casata degli Sforza.

Se le cose che ho promesso di fare sembrano impossibili e irrealizzabili, sono disposto a fornirne una sperimentazione in qualunque luogo voglia Vostra Eccellenza, a cui umilmente mi raccomando.

Che cosa fa Leonardo?

Per prima cosa sintetizza le sue competenze in un elenco numerato, così facendo facilita l’organizzazione dei contenuti e la lettura da parte di chi riceve la missiva.

Inoltre, e ancora più importante, contestualizza la lettera citando soprattutto le sue competenze in ambito bellico. Lui, che era prima di tutto un artista e pure pacifista, scrive un CV promuovendo una gamma ben specifica di abilità, quelle che ritiene possano servire al Duca. Delle sue qualità di artista ne accenna solo al decimo punto, senza forzare la mano.

Da Vinci docet quindi, il CV moderno l’ha inventato lui, e non ha niente a che fare con il formato europeo.

È invece un CV lean, contestualizzato, funzionale, che punta dritto all’obiettivo facendo leva sui bisogni di chi dovrebbe ingaggiarlo. Funziona così anche oggi: chi assume lo fa perché ha un problema e sceglie la persona che ritiene possa risolverlo nel migliore dei modi.

Quando scrivete un CV chiedetevi sempre: che problemi ha il mio interlocutore? In che modo io posso contribuire a risolverli? E poi scrivete di questo! Tutto il resto che vi verrà voglia di inserire nel CV potrebbe essere inutile, pensateci bene prima di occupare spazio con parole e informazioni che non portano valore aggiunto.

E strutturate il testo perché sia immediato e fluido, gli elenchi puntati sono i vostri migliori alleati.

Ora basta! Contrastare le bufale sui vaccini @drsilenzi

Andrea Silenzi su Facebook ha pubblicato un’ottima e sintetica presa di posizione per contrastare la diffusione di bufale sui vaccini. Eccola!

“Per chi, nonostante tutto quello che avete avuto modo di leggere in questi giorni sui giornali, ancora si chiedesse quale fosse la scientificità e autorevolezza alla base della pratica clinica dell’ormai ex medico radiato dall’Ordine dei Medici e Odontoiatri della provincia di Treviso, offro un esempio paradigmatico che sintetizza in poche righe l’infondatezza dei rimedi pubblicati sul sito web personale del predetto e ripresi anche nei social. Rimedi privi di qualsiasi fondamento a cui molti ignari pazienti (adulti e bambini) si affidavano (e forse ancora si affidano) come sempre ci si fida quando un medico – non una persona qualsiasi – consiglia qualcosa a qualcuno per il bene della propria salute.

È questa la cosa che, da medico, mi da più fastidio in questo come purtroppo in molti altri casi dove sono colleghi medici a farsi latori di teorie prive di evidenze scientifiche. Teorie che offuscano l’immagine della prevenzione vaccinale creando danni inimmaginabili fino a pochi anni fa:…/italy-becomes-us-travel-risk-for-measl….

Analizziamo, come esempio, i “consigli per prevenire le malattie invernali nei bambini”:

– Evitare il latte vaccino e i suoi derivati: questo consiglio è quasi obbligatorio per i bambini soggetti a forme catarrali delle prime vie aeree o a disturbi intestinali;
– Ridurre i cereali contenenti glutine e i loro derivati;
– facilitare il sonno nei bambini ….somministrando loro per tutto l’inverno anche la melatonina (2-3 mg la sera);
– Somministrare multivitaminici, ovviamente “naturali” – ma (cit.) “aggiungendo integratori (nutraceutici) a base di vitamina C (250-300 mg al giorno), vitamina D (800-1.000 unità al giorno), vitamina A (800-1.000 unità al giorno)” per tutto l’inverno;
– Somministrare multiminerali per tutto l’inverno, ma attenzione (cit.) “non è sufficiente un prodotto che contenga solo 8-10 minerali, perché nella nostra alimentazione mancano specialmente i microelementi, cioè i minerali in tracce. Consiglio allora di acquistare un multiminerale completo, come quello costituito da acqua di oceano adeguatamente purificata” (NB : 12 fiale di acqua di mare = costo 15 euro, consigliate 3 fiale al giorno nei bambini, 6 fiale al giorno negli adulti);
– Aggiungere prodotti a base di magnesio (150-200 mg al giorno) e zinco (10 mg al giorno) specialmente nei bambini più irrequieti e/o nervosi per tutto l’inverno;
– Somministrare probiotici tutti i giorni, per tutto l’inverno;

L’ex collega, infine, conclude dicendo (cit.) “non posso non ricordare che i consigli che ho dato andrebbero integrati anche con la terapia omeopatica, che svolge sicuramente una potente azione preventiva sia specifica che aspecifica nei confronti delle patologie infettive invernali”

Vieppiù che, non bastasse questa chiosa, il consiglio finale è che per saperne di più su come non far ammalare i bambini d’inverno, basta acquistare (cit.) “la mia pubblicazione più specifica”.

Tradotto: per non far venir l’influenza ad un bambino, i medici corrotti dalle aziende farmaceutiche somministrano un vaccino (costo 7-10€, una tantum), mentre quelli trasparenti e incorruttibili consigliano di spendere circa 50€ al giorno per 6 mesi /anno (9.000€, che se per caso hai due figli 18.000€).

Perché, si sa, le aziende che producono prodotti omeopatici, melatonina e nutraceutici vari sono dei gran benefattori.

Infine, il libro dell’ex collega (quello che il predetto chiama “pubblicazione” – forse per equipararlo, confondendo, a una pubblicazione scientifica?) per puro caso (veramente per puro caso) costa esattamente quanto il vaccino antiinfluenzale (10€) … ed è anch’esso un prodotto “una tantum”.

P.s. Se cercate informazioni corrette sulla salute, informazioni “anti-bufala”, rivolgetevi sempre a siti istituzionali e mai a siti di persone auto-emarginatisi per scelta dalla comunità scientifica internazionale.

P.p.s. Esiste poi la buona comunicazione online, dove si coniuga buona comunicazione con rigore scientifico e piena trasparenza con la comunità scientifica. È il caso di MedBunker di Salvo Di Grazia o delle pagine Roberto Burioni, Medico | VaccinarSì di Ulrike Schmidleithner e VaccinarSìdella SItI – Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica| IoVaccino | Rete Informazione Vaccini – RIV | Gavi, the Vaccine Alliance.
I “buoni” sanno essere anche “web-friendly”, insomma.
Fatene tesoro.”


Basta attenzione solo alla struttura, lavoriamo sul cambiamento dei sistemi organizzativi e della cultura

Sir Muir Gray ci ha offerto un (apparentemente) semplice schema di interpretazione dei servizi sanitari: ognuno di essi è caratterizzato da una struttura (istituzionale, giuridica, economica, geografica, fisica), da sistemi organizzativi (idealmente impostati per realizzare le finalità dei servizi sanitari), dalla cultura (generale, professionale, organizzativa).


Dobbiamo riconoscere che in Italia, e in tutte le sue Regioni e Province autonome, l’unica modalità per introdurre un cambiamento dei servizi sanitari è quello di pensare a una riforma: cioè a un cambiamento della struttura (istituzionale, giuridica, economica, geografica, fisica). Nessuna attenzione, invece, viene dedicata alla necessità di cambiare i sistemi organizzativi e la cultura sottostante.

Il recente libro di Roberto Perotti (ex Commissario alla spending review) “Status quo” affronta il tema del “perché in Italia è così difficile cambiare le cose (e come cominciare a farlo)”.

Una frase, in particolare, mi ha colpito: “E’ proprio della mentalità giuridica attribuire importanza spropositata all’impianto istituzionale, compiacersi dell’eleganza formale e dell’equilibrismo di un compromesso, e immaginarsi che piccole variazioni a uno statuto possano portare benefici strutturali al paese. Se solo il mondo fosse così semplice…” (pag. 170).

Lavorare sui sistemi organizzativi e sui necessari cambiamenti culturali significherebbe “chinare la testa e lavorare” (R. Perotti, ibidem) sui problemi veri, sulla loro dimensione quantitativa e qualitativa, ipotizzare nuove soluzioni praticabili (socialmente e politicamente) e sostenibili (economicamente, professionalmente e culturalmente).

Certamente è più semplice fare una nuova legge, una nuova deliberazione, un nuovo atto aziendale pensando che un atto legislativo o amministrativo possano di per sé determinare il cambiamento.

Chissà se ce la faremo? Si dovrebbe cominciare smettendo di raccontarci bugie!


Renewing the dialogue between the medical and nursing professions @kevinmd @Medici_Manager

A recent post observed that the “highly charged scope-of-practice” fight between the medical and nursing professions has resulted in social media hate speech – too often, from physicians directed at other physicians. “Like bees to nectar, a post on the topic is sure to draw dozens of anonymous, hate-filled comments” write the authors.  They propose the following “principles for civil discourse” which I believe should apply more broadly to all social media commentary, not just on the physician versus nurses conflict:

“Anecdotes are fine, but avoid drawing generalizations from one story. (‘We had that dumb NP once. She didn’t know where the gallbladder is located. So NPs must all be dumb.’)

Identify the underlying emotion of a comment that irks you, and name it when you respond. (‘Doctor Strangelove, it sounds like you’re frustrated that NPs have fewer hours of training and are asking for the same salary as MDs. Here’s my take: ….’)

Name-calling is out. Polite, respectful comments are more likely to be taken seriously, and to stimulate a productive conversation. ( ‘SJ, I appreciate hearing your viewpoint. Here is WHY I disagree with you.’)

Own your comments. Instead of making broad generalizations, make it clear that you are offering your opinion. (Rather than saying, ‘NPs simply should not be practicing without some sort of physician supervision,’ say ‘I don’t think NPs should practice without any physician supervision.’)

Consider phrasing your comment in the form of a question. (‘I’m troubled by the thought of NPs working in a rural area with no access to collaborating physicians. Does anyone have experience with that?’)

Go for the win-win. (‘The demographics, economics and politics of health care reform suggest there’s enough pie for all of us in the primary care world. We are all undervalued and overworked. By uniting in cause and working with each other, both groups stand to gain in terms of creativity, relationships, and (dare we say) income.’)

Find the best alternative to a negotiated agreement (known as “BATNA” — taken from the classic tome, Getting to Yes). (‘NPs are here to stay, with increasing autonomy across more and more states. Let’s find a way to work together — whether you’re a doctor or NP, our end goals are the same.’)”

If such principles were broadly accepted by all of us involved in social media commentary, they would result in a much better informed, respectful and constructive discussion than name-calling and personal attacks. Civil discourse, though, by itself won’t be enough to end the uncivil war between the nursing and medical professions.  What’s needed is a way to get to the “win-win” point where the legitimate interests and concerns of both professions are recognized and addressed.

Recently, the Annals of Internal Medicine, ACP’s flagship peer reviewed journal, published a paper titled, “Principles Supporting Dynamic Clinical Care Teams: An American College of Physicians Position Paper” which I believe could become the basis of such a win-win outcome. (Full disclosure: I am the principal author of this paper, along with my co-author and colleague Ryan Crowley, which was written by us on behalf of ACP’s Health and Public Policy Committee and Board of Regents).

Our goal in developing the paper was to constructively address the legitimate concerns of both professions as a step toward renewed dialogue between them.  Nurses have legitimate concerns about being held back by restrictions on their licenses and physician supervision arrangements that limit their ability to provide care to patients, that is within nursings’ skills and competencies.  Physicians have legitimate concerns that their unique and more extensive years of medical training are being devalued by the calls to substitute independently practicing advanced practice nurses for primary care physicians.  Both professions assert that their views are based on what is best for patients.

Our paper asserts that professionalism is the answer to resolving such differences. “Professionalism” we wrote “requires that all clinicians — physicians, advanced practice registered nurses, other registered nurses, physician assistants, clinical pharmacists, and other health care professionals — consistently act in the best interests of patients, whether providing care directly or as part of a multidisciplinary team. Therefore, multidisciplinary clinical care teams must organize the respective responsibilities of the team members guided by what is in the best interests of the patients while considering each team member’s training and competencies.”

The goal, then, must be to assign, “specific clinical and coordination responsibilities for a patient’s care within a collaborative and multidisciplinary clinical care team should be based on what is in that patient’s best interest, matching the patient with the member or members of the team most qualified and available at that time to personally deliver particular aspects of care and maintain overall responsibility to ensure that the patient’s clinical needs and preferences are met. If two team members are both competent to provide high-quality services to the patient, matters of expedience, including cost and administrative efficiency, may contribute to division of that work.”   While we affirm the importance of, “patients having access to a personal physician who is trained in the care of the ‘whole person’ and has leadership responsibilities for a team of health professionals, consistent with the Joint Principles of the Patient-Centered Medical Home” we also state that, “Dynamic teams must have the flexibility to determine the roles and responsibilities expected of them based on shared goals and needs of the patient.”

“Although physicians have extensive education, skills, and training that make them uniquely qualified to exercise advanced clinical responsibilities within teams…well-functioning teams will assign responsibilities to advanced practice registered nurses, other registered nurses, physician assistants, clinical pharmacists, and other health care professionals for specific dimensions of care commensurate with their training and skills to most effectively serve the needs of the patient.”  We observe that, “especially in physician shortage areas, it may be infeasible for patients to have ‘an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care” and that, “in such cases, collaboration, consultation, and communication between the primary care clinician or clinicians who are available on site and other out-of-area team members who may have additional and distinct training and skills needed to meet the patient’s health care needs, are imperative.”

On the debate over each profession’s role in solving the primary care workforce shortage, our answer is, “a cooperative approach including physicians, advanced practice registered nurses, other registered nurses, physician assistants, clinical pharmacists, and other health care professionals in collaborative team models will be needed to address physician shortages.”

And on the most divisive issue — state regulation of nursing scope of practice — we state that, “Clinicians within a clinical care team should be permitted to practice to the full extent of their training, skills, and experience and within the limitations of their professional licenses as determined by state licensure and demonstrated competencies. All clinicians should consult with or make a referral to other clinicians in disciplines with more advanced, specific, or specialized training and skills when a patient’s clinical needs would benefit from such consultation and referral.”  We assert that,  “Licensure should ensure a level of consistency (minimum standards) in the credentialing of clinicians who provide health care services” and called on state legislatures and licensing authorities, “to conduct an evidence-based review of their licensure laws” and “consider how current or proposed changes in licensure law align with the documented training, skills, and competencies of each team member within his or her own disciplines and across disciplines and how they hinder or support the development of high-functioning teams.”

Now, I know that the paper will not please everyone in the medical and nursing professions, but we hope that it can be the starting point of a renewed dialogue between the professions.  We end the paper by noting that, “ACP offers these definitions, principles, and examples to encourage positive dialogue among all of the health care professions involved in patient care—in the hope of advancing team based care models that are organized for the benefit and best interests of patients. ACP also hopes to inform policymakers to ensure that regulatory and payment polices are aligned with, rather than creating barriers to, dynamic team-based care models. ACP encourages discussion of dynamic clinical care teams that puts patients first.”

Let’s get this dialogue started — with civility, of course.

Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog.

We are spending billions to train the wrong kind of doctors @kevinmd @Medici_Manager @WRicciardi @pash22

Earlier this year, the physicians at my academic family medicine practice met with two senior officials from our parent health care organization to be oriented to its new initiatives and projects. Their presentation documented the organization’s ongoing investments of many millions of dollars into renovating subspecialty care suites and purchasing new radiology equipment that was likely to be highly profitable, but provide dubious benefits to patients.

Two of my colleagues asked why, given the expected influx of millions of newly insured patients into primary care starting in 2014, and an estimated shortfall of more than 50,000 primary care physicians by 2025, the organization had not identified expansion of primary care training as a financial priority. Where exactly did they expect to find family physicians to staff all of the new community offices they planned to open? An awkward silence ensued, followed by some polite hemming and hawing about how this was a complicated issue, and that supporting generalist training would likely require additional funding that was perhaps beyond the organization’s limited resources.

Additional funding required? How about $9.5 billion? That’s the approximate amount that that Medicare spends each year, with no strings attached, to subsidize the cost of training physicians in U.S. residency programs. Noting that the federal government doles out these dollars without requiring any particular outcomes from the institutions that benefit from them, some have called for Medicare to hold institutions more accountable for meeting America’s physician workforce needs.

If we have a surplus of radiologists and a shortage of general surgeons, why not tie funding to training more of the latter and fewer of the former? Given the decentralized nature of the U.S. health system, though, that has been easier said than done. In particular, it is challenging to follow the money trail and determine which institutions end up producing which types of doctors.

new study in Academic Medicine by health services researchers at George Washington University and the Robert Graham Center fills this information gap. Painstakingly assembling and cross-checking data from several sources on actively practicing physicians who completed their residency training from 2006 to 2008, they were able to identify residency-sponsoring institutions that were top producers of primary care physicians, that produced lower proportions relative to all physicians, and that produced none at all.

Notably, they conclusively disproved “The Dean’s Lie“ that counts all internal medicine residents as going into primary care (when only 1 in 5 actually plan to do so), demonstrating that at some institutions fewer than 1 in 10 internists become primary care physicians. They also identified a large funding discrepancy between the top and bottom primary care producers.

The top 20 primary care producing sites graduated 1,658 primary care graduates out of a total of 4,044 graduates (41.0%) and received $292.1 million in total Medicare GME payments. The bottom 20 graduated 684 primary care graduates out of a total of 10,937 graduates (6.3%) and received $842.4 million.

In short, where physician production is concerned, you get what you pay for. In this case, Medicare pays a disproportionate amount of its nearly $10 billion per year in subsidies to institutions that produce mostly subspecialists, even in specialties where supplies are plentiful, at the expense of training sorely needed family physicians and other generalists whose presence has been shown time and again to deliver better health outcomes.

That’s the big picture. Since all politics is local, policymakers who want to know what types of physicians their teaching hospital or health system is training can use the Graham Center’s free GME Outcomes Mapper tool to find out. And if enough of them do so, maybe we can all have a serious national conversation about moving beyond guaranteed health insurance coverage to ensuring that the care (and the workforce) that coverage is paying for will actually help us to live longer or better.

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

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. 

Doctors can learn from how nurses provide care @Medici_Manager @kevinmd

In today’s health care environment, we are all driven to see more patients in less time and do more with less support.  Obviously most of this is financially motivated — the delivery of medical care had unfortunately become more of a business than an art.  As more physician groups are now owned by hospital systems, the “bean counters” and administrators are now crafting the rules of engagement.  Physicians no longer have the luxury of time for a leisurely patient visit.  No longer do we have the time to routinely ask about the grandkids and the most recent trip that our favorite patients have taken in their retirement.  Ultimately, it is the patient who suffers.

Those who are ill and those who love them often need more than pills, blood tests, IV fluids and heart monitors — they need support and genuine caring.  These patients and families need a doctor or other health care provider  to sit on the edge of the bed and unhurriedly listen to their concerns — to simply chat for a bit.  Unfortunately, this is no longer the norm.  Luckily, we have dedicated caregivers on the front lines in our hospitals who can often fill the gap: nurses.

I was moved last week as I read a wonderful article in the New York Times by Sarah Horstmann.  In the essay, Ms. Horstmann (a practicing registered nurse) describes her special connection to a few patients and their families on the orthopedic unit in which she works.  She chronicles her struggle with remaining objective and professional in her role as nurse when she becomes emotionally invested in her patients.  She paints a picture of an engaged and caring nurse who is able to put everything on the line for her patients.  Her internal struggles with “crossing the line” in her care for the patient is one that we all as health care providers have faced at one time or another.

However, she handles her feelings and her patients with absolute grace.  We can all learn a great deal from Ms. Horstmann.  We should all strive to feel and care as deeply as she does.  Our patients and the care we will provide them will certainly benefit greatly.

In medicine, it is the nurses that often lead the way for all of us.  They spend the time required to get to know the patient — their fears, their thoughts about disease, their thoughts about their own mortality.  Nurses understand family dynamics and can help in managing difficult family situations.  Nurses make sure that above all, the patient comes first — no matter what the consequences.

The very best nurses that I have worked with over the years are advocates for those who are too scared or too debilitated to advocate for themselves.  Many times early in my career, I did not pay attention or listen to the lessons that were all around me on the hospital wards.  However, as I approach mid-career I am much more attune to these very same lessons that I may have missed earlier.  There is much gained when we watch and listen to others who are caring for the same patient — maybe in a different role — but caring for our common patient nonetheless.  I now realize that nurses have “shown me the way” many times and for that I am truly grateful.

Emotional investment and developing patient connections can improve care and assist patients and families with acceptance and with eventual grieving and loss.  I believe developing bonds with patients is a wonderful expression of love for another human being and is completely acceptable in medicine — as long as we are able to remain objective when critical clinical decision making is required.

In medicine we strive to provide excellent care for all patients but every now and again there are special patients that we develop emotional bonds with.  Just as in everyday life, there are certain people that you are able to connect with in a spiritual way — whether they are co-workers, colleagues, friends or significant others.  We must stop and appreciate the way in which nurses provide care — we can learn a great deal from them and ultimately provide more “connected” care for our patients.

So, next time you are in the hospital, find a nurse.  He or she will likely be haggard from running from room to room, and it is likely that they have not stopped to eat lunch.  Thank them for caring for our patients.  Thank them for showing us all how to provide better care for our patients.  Then, stop in and say hello to your patient — sit on the edge of the bed and take time to simply just chat.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

How to Create a Culture of Self-Learning @Medici_Manager @giovanimedici

There is nothing like giving employees the drive and confidence they need to find their own way to success.
ARTICLE | THU, 01/17/2013 – 01:00

By Dan Carusi, Vice President, Global Education, Deltek

When it comes to the workforce, motivated, top performers always find a way to access the knowledge and develop the skills they need to be successful. Whether through requesting a mentor, attending continuing education classes, or joining a peer-group book club, they will go out of their way to get what and where they want. In this article, I will outline how to infuse this drive into an organization’s workforce, emphasizing the importance of corporate education by creating a culture of self-learning across the entire employee population. The key to success is a methodology we call ED3:

Envision the strategy

Design the vision

Develop the design

Deliver the product

The end goal is increased employee confidence in their knowledge and ability to successfully do their jobs.

Build Excitement and Engagement

Employees are the No. 1 resource of any organization, and the first step (after the executive team is on board) is to “employee source” and test new ideas to gather feedback. By allowing employees to have a part in the creation of the program, they will feel responsible for its success. By implementing it in one part of the organization—perhaps an on-site project team or division—and working closely with the employees, you can demonstrate initial success as it’s rolled out more broadly. Building excitement around the program can have a viral effect, and without engagement and excitement from employees, it will fail miserably.

Provide the Right Assets

Providing the right assets is at the heart of creating a culture of self-learning. The right tools delivered via the right technologies at the right place and time (and communicated properly so they are used correctly by employees) is critical to the success of the learning strategy. Today’s workforce is accustomed to digesting information in “chunks,” and this should be taken into consideration when providing learning tools. Technology allows flexibility, speed, and interaction and supports on-demand learning, all key to driving home this culture. In a self-learning program, technology should be based on the following attributes:

  • Consistent
  • Reusable
  • Transferable
  • Manageable
  • Sellable

For example, at Deltek we have a learning portal that includes “how-to-type” videos answering common questions; a forum where employees can ask questions and converge in groups to discuss them; and a place see what peers are reading this month.

Build Into Corporate Culture

In order for a self-learning program to be a success, it must be ingrained deeply into corporate culture, from the CEO down to the intern. The program needs to be strategically communicated and implemented to ensure success. With a top-down approach, success will cascade down throughout the organization. But while CEO buy-in is paramount to success, it is not the only ingredient to creating the culture. The self-learning program needs to be evangelized across the company to drive awareness and excitement, feeding and accelerating the success of it going viral. Also, it’s important that every employee understands, and is measured in relation to, his or her role. From manager to employee to the “company,” each role is important and must be clearly defined.

Create Peer-to-Peer Accountability

To instill a desire to learn across the employee population, it’s important to create peer-to-peer accountability. By creating peer groups, merchandising successes, and creating individual and team goals, employees will push themselves outside of their normal comfort zones. We think of as the “Boy Scout Approach”—scouts teaching scouts, with leaders guiding along the way. Or, in office terms, employees learning from each other with guidance from managers. This increases the transfer of knowledge and creates communities of practice, with like topics being discussed and explored by interested parties across the organization. Individual development plans that outline the goals for learning and align them with corporate goals are also important in this step.

Strategically Recognize Successes

When it comes to self-learning, we do not recommend rewarding employees financially—this is something they need to buy into from a personal and career growth perspective. If it’s truly part of the culture, employees WANT to take part—not because of reward, but because of personal gain. That said, it’s important to recognize the right behaviors and successes with some type of public acknowledgement. Since the real impact for an organization is increased retention, recruiting, and development of talent, things such as promotions, new roles and responsibilities, and positive feedback from customers should be highlighted and celebrated.

While there are many approaches to creating a successful learning and development program, there is nothing like giving employees the drive and confidence they need to find their own way to success. For the organization, a pervasive culture of self-learning drives speed, performance, and results—all of which are critical in a highly competitive landscape and ever-changing market.

The current vice president of Global Learning for Deltek, a global provider of enterprise software and information solutions for government contractors and professional services firms, Dan Carusi has more than 20 years of business experience. He is responsible for providing leadership for all aspects of Deltek University to include curriculum development, operations and delivery, global employee education, business development, and educational consulting, as well as thought leadership.


Richard Smith: Is the New England Journal of Medicine anti-science? @Richard56 @Medici_Manager @pash22

4 Jul, 13 | by BMJ Group

About once a year a furious researcher writes to me complaining that the New England Journal of Medicine won’t publish a letter that strongly criticises, even demolishes, an article the journal has published. They write to me out of frustration, not because I have any influence over the Bostonian paragon, but because I’ve dared to criticise it in print a few times.

What my correspondents can’t understand is why the journal won’t publish their letter when electronic space is infinite and free. Why can’t the journal have rapid responses like the BMJ and many other journals?

I don’t know why the New England Journal of Medicine doesn’t publish electronically all the letters it receives, but I can hypothesise. The Bostonian paragon is unashamedly elitist and committed to excellence and virtue, just like their colleagues in the city teased by Henry James in his novel The Bostonians. Presumably the editors of the journal don’t want to overload their readers with what they see as ill informed criticisms, but want to present them with the quintessence of comment, beautifully edited of course.

But surely this behaviour is anti-science.

Medical journals are either explicitly or implicitly following the theory of science proposed by Karl Popper: scientists develop a falsifiable hypothesis and then test it to destruction. They never arrive at truth, but hypotheses that have survived the destructive fire serve as our best substitute for truth.

It follows that a very important part of science is giving everybody, the hoi polio as well as the blessed, the chance to scrutinise the hypotheses, methods, data, and conclusions of studies and present their criticisms. We can be much more confident in the findings of a study that has been exposed to tens of thousands of critical eyes than we can in one that has been viewed only by the chosen few, particularly when those few are of the same mental bent as the authors of the study.

Always in this kind of discussion I’m driven back to quoting the blind poet, republican, and regicide John Milton: “Truth was never put to the worse in a free and open encounter…. It is not impossible that she [truth] may have more shapes than one…. If it comes to prohibiting, there is not ought more likely to be prohibited than truth itself, whose first appearance to our eyes bleared and dimmed with prejudice and custom is more unsightly and implausible than many errors….”

The editors of the New England Journal of Medicine must think of themselves as superior people (and they are superior to most of us, and certainly to me) capable of distinguishing truth from error, but could they be making a mistake? I urge them to follow the advice of Rudolf  Virchow, the great German doctor and intellectual, who insisted that “Everybody is free to make a fool of himself in my journal.”

Competing interest: RS admires the New England Journal of Medicine but has several times published criticisms of the journal; and he is passionately committed to open access and sees the journal as an important barrier to complete open access.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.


Medical Schools Need to Change Approach in Training Primary Care Physicians @Medici_Manager

By James Arvantes

Most medical school faculties are not well versed in the fundamental changes taking place in the nation’s health care system, which makes it difficult for them to adequately prepare medical school students and residents for practicing in the changing health care environment. That was a central theme that emerged from a primary care policy forum held here recently by the American Board of Family Medicine.
Larry Green, M.D., speaks about primary care residency programs training for the future

Larry Green, M.D., founding director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, says primary care residency programs are working to change to better meet the needs of an evolving health care system.
“If we are going to talk about innovation and change, we often have to change the faculty, because their national inclination is to teach what they have been doing their whole careers and what they were taught,” said George Thibault, M.D., president of the Josiah Macy Jr. Foundation, who spoke as part of a three-member panel. “That is different from what we want to transform the health care system into,” he added.Thibault said transformation of the health care system requires transformation of the educational process, a goal that can only be attained by having teachers in place to train students and residents about new and emerging health care payment and delivery models. “If we are going to have a reformed health care system, we need to pay attention to the workforce — not just the numbers of the workforce, but the composition of the workforce,” said Thibault.

What medical school professors teach is an accumulation of their work and educational experiences, he noted. “They can’t teach what they don’t know. We talk about new models of clinical education (moving) out of the academic center and into the community. It is integrated rather than fragmented. Those experiences were not the experiences faculty had when they were working.”Thibault also addressed interprofessional education, saying that most faculty members did not receive their training in an interprofessional setting. “They didn’t learn from other faculty and leaders in other professions.”

Moreover, most medical school faculties are unfamiliar with online learning and other technologies. “We want to and need to develop future leaders and innovators in education,” said Thibault. But, he added, changes in medical school education will succeed only if entire faculties buy into the process. “The redesign of the education system and the redesign of the delivery system are only sustainable if they become the standard way we do business,” Thibault noted.

Thibault and the two other speakers on the panel, Barbara Brandt, Ph.D., director of the National Center for Interprofessional Practice and Education, and Larry Green, M.D., professor and Epperson Zorn Chair for Innovation in Family Medicine and Primary Care at the University of Colorado, Denver, pointed out that medical education is undergoing fundamental changes in some parts of the country to better align with changes taking place in the health care system as a whole.

“There are physicians all across this country who are doing their (best) to change the training programs,” said Green, who was the founding director of the AAFP’s Robert Graham Center for Policy Studies in Family Medicine and Primary Care. In fact, he added, the three main primary care residencies — family medicine, internal medicine and pediatrics — are all engaged in efforts to redesign their residency training programs to achieve better health care.

As an example of the changes occurring within medical education, Thibault described a primary care faculty development initiative spearheaded by the American Board of Family Medicine, the American Board of Internal Medicine and the American Board of Pediatrics to develop some common goals and competencies around curriculum development.

The initiative, funded by the Josiah Macy Jr. Foundation, the Health Resources and Services Administration (HRSA) and private foundations, has identified particular skills or competencies needed for the primary care workforce of the future. These include

  • teamwork,
  • change management,
  • leadership,
  • population management and
  • clinical microsystem skills.
Brandt, meanwhile, said the push to develop competencies for interprofessional education is exemplified by the National Center for Interprofessional Practice and Education. The center is funded by HRSA and private foundations, making it a true public and private partnership. One of the main goals of the center is to transform the siloed U.S. health care system into one that engages patients, families and communities in collaborative, team-based care, said Brandt.To achieve this goal, the center will create and test new health care organizations and structures while training a workforce that operates in team-based delivery systems to improve health care quality, safety and access.

“We really do not have a lot of evidence as far as what works in training and education for this type of practice,” said Brandt. “That is going to be one of the marks of distinction of this particular national center.”

The ultimate goal, Brandt said, “is better alignment of the health care system and higher education.”


  • The ability to change the nation’s health care system will require a primary care workforce that is trained in team-based and collaborative care, said three speakers at a recent American Board of Family Medicine policy event.
  • Most medical school faculties are not trained in new and innovative health care models, making it difficult for them to properly train a primary care workforce to meet the needs of an evolving health care field.
  • The speakers cited examples of how public and private partnerships are working to train a workforce that meets the needs of the health care system and the community at large.

Medical schools signal readiness for revolution @Medici_Manager

A robust response to an AMA initiative underscores the fact that medical schools recognize the need for a necessary update of how they educate physicians.

Posted March 18, 2013.

Educator Abraham Flexner’s 1910 report evaluating American and Canadian medical schools is generally credited with transforming medical education into its current modern age. Flexner shined a light on the importance of a more rigorous education so that future physicians could be trained in — and have a sharp mind for — the rapid scientific and technological advances coming out of the Industrial Revolution.

Over the last decade, numerous studies have looked at one question: Should the Flexner model be updated so medical education can adapt to the rapid scientific and technological advances of today’s information revolution? The answer is uniformly, yes, and the call for change isn’t coming only from medical and educational observers. Recently, striking evidence has surfaced that the schools themselves are ready to make a change — one as revolutionary as anything Flexner envisioned.

That evidence is their overwhelming response to a $10 million initiative by the American Medical Association called “Accelerating Change in Medical Education.” Before a Feb. 15 deadline, 115 out of 141 U.S. medical schools sent five-page concept proposals explaining what transformative changes they would like to make in teaching future physicians. Changes might include new ways of teaching and assessing core competencies, or more of a focus on patient safety or quality improvement. The proposals reflect a changing health care delivery system transformed by technology so that the skill of finding and applying information is as important — or more so — than memorizing it. Of those proposals, 20 to 30 will be chosen to write a longer request for a proposal that is the equivalent of applying for a National Institute of Health grant. From there, eight to 10 schools will be announced at the AMA Annual Meeting in June as sharing in the $10 million to help implement their ideas.

The AMA helped bring Flexner’s report to bear, with its Continuing Medical Education division. It rated medical schools at the time and solicited the Carnegie Foundation for the Advancement of Teaching — which chose Flexner — for further efforts in improving physician education. This was at a time that many schools’ quality was poor, and there were few, if any, standards for training doctors.

The AMA again has stepped to the forefront, not only with its $10 million offer but also with other efforts to promote initiatives to improve education, publishing papers on change in medical education and organizing high-level discussions in which experts talk about what the future of medical schools should be.

But unlike 100 years ago, when substandard schools closed or fired faculty to catch up to Flexner’s standards, the relationship between medical schools and agents of change is markedly more symbiotic.

Schools already are part of the discussion about accelerating the pace of instruction to three years instead of four, as a way to train more doctors and confront the current crisis of a looming physician shortage.

They have recognized the impact that the Internet and mobile technology have had as a means for doctors to quickly and easily review treatment guidelines and look up information on diseases, pharmaceuticals and procedures. Business tracks have been added at some schools to help future physicians learn about how to manage the complex insurance and financial environment they will face. There are now programs where physicians are taught how to work not only in an individual practice setting but also as leaders and members of teams that stretch across different professions, locations and practice settings.

The AMA’s “Accelerating Change in Medical Education” program indeed will fund individual schools with particularly compelling ideas, schools that a panel of experts will choose to reflect a variety of regions and projects. But the goal is not merely to promote transformations at a few schools. By including those schools in a medical education consortium, by sharing their ideas with all medical schools, and also by sharing other worthy ideas from schools that weren’t selected, the hope is that the AMA program helps facilitate creative thinking and out-of-the-box ideas across the spectrum of medical education.

The reason the AMA emphasizes “accelerating” change is that incremental changes aren’t enough to ensure that future doctors get the training they need in a world in which rapid business, population and technological changes have made being a doctor a much more dynamic profession. These have to be systemic changes, as bold and far-reaching in our time as they were in the wake of the Flexner report.

Flexner’s triumph stemmed from an era when there were many medical schools unworthy of the name. This next revolution starts from strength, solid opportunities and a well-demonstrated willingness to embrace change.


“Accelerating change in medical education,” American Medical Association (link)