How Can Large Companies Innovate? | Andreessen Horowitz

How Can Large Companies Innovate? | Andreessen Horowitz.

As the title says, this is via @a16z, the theory is that

  • The best innovations are good ideas that look like bad ideas
  • Large companies are good at eliminating bad ideas

This has some congruence with me, as I notice that I subconsciously hang out in spaces where ideas are celebrated, not eliminated (see: Innovation often happens in out of the way places) with a core group of people who I work with in a very large organization.

At some level I think big companies are ideal places to innovate, if the definition of innovation is “a good idea executed well” because smaller companies can’t execute to the scale of a big company. Everyone should of course choose the environment where they can personally thrive and change the world :) . See what you think.

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A moment of realness in Washington, DC, on the passing of Marion Barry

I came back to Anacostia sooner than I thought. Washington, DC is an incredible place because people here believe everything is possible, because it is, and at the same times, the problems to be solved are not simple. That’s why we’re here. Great to see a community help an important person rest in peace.

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Photo Friday: 2014 International Transgender Day of Remembrance, Washington, DC USA

The Transgender Day of Remembrance serves several purposes. It raises public awareness of hate crimes against transgender people, an action that current media doesn’t perform. Day of Remembrance publicly mourns and honors the lives of our brothers and sisters who might otherwise be forgotten. Through the vigil, we express love and respect for our people in the face of national indifference and hatred. Day of Remembrance reminds non-transgender people that we are their sons, daughters, parents, friends and lovers. Day of Remembrance gives our allies a chance to step forward with us and stand in vigil, memorializing those of us who’ve died by anti-transgender violence.

DC is surrounded by angels today, angels who never had a chance to say goodbye to many of us but thru their unique lives and loved shared while they were here, live in our hearts everyday.At Casa Ruby, 7 Trans women(mostly women of color) and many volunteers, honor their lives everyday by taking care of those who are still here, the young Transgenders who are homeless, the sex workers that are looking for a job, the elderly who want to be in a family setting, We all come together 6 days a week to make all of our lives a little better in a place we call HOME. – Ruby Corado (@CasaRubyDC)

Health care has an important role to play, not just in providing the necessary medicines and care so that people can achieve their life goals, also as allies, changing our society to normalize all forms of gender expression. Once upon a time, all LGBTQ people were forgotten by society. Now it is great to be present with community leaders and Metropolitan Police Department, and celebrate new opportunities for the LGBTQ community to live.

Friends & Family, It’s A Reality!! We Will Be Opening Casa Ruby Homeless LGBT Youth House. Today, I Embark on one of the biggest challenges of my life, Opening a 12 Bed Fully Equipped Home For LGBT Homeless Youth In Washington, DC. – Ruby Corado (@CasaRubyDC)

Statement from the White House on International Transgender Day of Remembrance.

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Just Read: A perfect score for Kaiser Permanente on the Human Rights Campaign Corporate Equality Index again for 2015

One-third of the Fortune 500 and over half of the CEI universe of businesses offer transgender-inclusive health care coverage, up from 0 in 2002 and nearly ten times as many businesses as five years ago;

Kaiser Permanente is one of them, of course, and every doctor should be part of a health system that is also. One day they will be.

Having 100% on the Corporate Equality Index doesn’t guarantee freedom from bias; it creates a beacon/example for other organizations and people. It’s important to remember that in the majority of States of the United States (29), you can be fired from your job simply because you are gay, lesbian, bisexual, or transgender. This is only one less state than last year. (see: A perfect score on the Human Rights Campaign Corporate Equality Index again for 2014 | Ted Eytan, MD)

This year, Kaiser Permanente is 1 of just 366 companies who earned 100%. Last year, it was one of 303. As I mentioned two years ago (see: What it means to earn a perfect score on the Human Rights Campaign Corporate Equality Index | Ted Eytan, MD):

There are a lot of other companies in this year’s index that earned a 100% score, and there were a lot that earned a 0% score.

Being 100% in terms of providing equal opportunity within the workplace and demonstrating support in the community for all is where I’d like to be, because Equality equals Health.

Thanks to the team in Kaiser Permanente’s National Diversity and Inclusion organization who do so much to promote health through their work.

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Just Read: Just 6 more seconds of listening needed to elicit the patient’s agenda

“…asking “Anything else?” repeatedly until a complete agenda has been identified appears to take 6 seconds longer than interviews in which the patient’s agenda is interrupted” Reference: Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the Patient’s Agenda: Have We Improved? Jama. 1999;281(3):283–287

Actually I read this a while ago; I realize I’ve never turned it into a slide, until now.

I’m using it to illustrate an artifact of physician culture, part of a keynote I’m preparing (Crowdsource Request: Keynote for Labor-Management Parntership all-hands – “Social innovation” | Ted Eytan, MD).

We tend to interrupt people. On average about 23 seconds into them telling us why they are here to see us. Good news is that it improved 5 seconds in between the 15 years it was studied (1984 and 1999). I can’t find a newer study, if anyone knows of one, let me know.

Interestingly, it was found that if physicians just listened for 6 seconds longer, by repeatedly asking “Anything else?” or “Tell me more?” they were able to know what the patient was concerned about. The opposite of this is not knowing up front, and the consequences of that – the door handle conversation, the “late concern,” the problem unexplored, and a less efficient encounter, and sometimes devastating health experience.

One interesting correlation is that physicians with fellowship training (training after residency) were more likely to exhibit listening behavior than those who didn’t have the training. These were all family medicine specialists so there’s no comparison of other specialties in this study.

This fits with what I have mentioned before in the world of listening, reducing conscious and unconscious bias, being there for the people we serve in and out of the exam room. The good news is it’s easy to move away from a “Yes I know what you’re asking for,” culture to a “tell me more” culture. I know because I do it all the time – “say more.” My colleague Danielle Cass (@DanielleCass) also taught me this one – “Go on..” Try replacing this response with the one you normally use and see what happens (and let me know what happens – magical!).

Listening is the hugest innovation in health in the decade of the patient.

6 seconds :)

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Innovation often happens in out of the way places

…. when using human centered design.

Arli Christian (see staff bios here), from the National Center for Transgender Equality (@TransEquality), is joining the sponsor group for Project Lantern, which will explore the transgender person life and health experience using a human centered design approach, led by the Kaiser Permanente Innovation Consultancy (@KPInnovation) – Photograph taken in Washington, DC USA

With Chris McCarthy (left), Ted Eytan (center)

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Just Read: State of Transgender Person Health, the dawn of primary care in Colorado

This is a new report published by One Colorado (@One_Colorado) that’s a non-randomized survey of 417 transgender and gender nonconforming Colorado residents. Even though it’s not randomized, that’s a pretty large sample size for this population. A few findings that caught my eye:

Survey participants reported being much more likely to have a college degree, yet were more likely to be out of work or living in a low-income household than the general population, leading to shocking income inequality for transgender Coloradans.

The Dawn of Primary Care for People who are Transgender

In the health space I noticed some metrics about the impact of having regular primary care that’s inclusive (which 61% of respondents report, contrasting to 88% of physicians who reported comfort in a previous survey):

Impact of having an inclusive provider on mental health

The data regarding mental health for this population tracks what I have seen in previous surveys in terms of high suicide rate attempt – Just Read: The exceptionally higher suicide attempt rate for trans* persons who have sought medical care | Ted Eytan, MD – although the questions in this survey and the one before it are slightly different. It isn’t known for sure what aspects of medical care may improve mental health, it’s just known that there are significant problems that are not being addressed.

The “dawn of primary care” part is the fact that access to medical care is now being measured, and is measurable, because of Colorado’s leading position in assuring medically necessary care for the LGBT community, much like Washington, DC (have to put in a plug for the #epicenter).

The Colorado Independent (@coindependent) story on this report mentions the example of a patient who know has regular (and comprehensive medical) primary care through… Kaiser Permanente Colorado (@KPColorado), where it denied at the VA (see: Thanks for publishing my photo and a bright spot in transgender person health, Colorado Independent | Ted Eytan, MD)

The second part is the fact that with regular primary care, a lot more appropriate medical care for total health will be administered, so “transgender person health care” will just be “health care.” For example, conventional wisdom is that every transgender man should have a hysterectomy, because it is unlikely that they will receive regular cervical cancer screening, because of a host of factors. This is partially based on inadequate access to care and inappropriate treatment in the health care system, and may change.

As more people are able to live, there are more people who they’ll know / Gallup – behind the times….

Gallup has been tracking this question for 30 years:

Do you have any friends or relatives or coworkers who have told you, personally that they are gay or lesbian?

As predicted, the numbers have flipped, the the majority of Americans currently “do.” (See this nice graph over at The Economist)

The Gallup (@Gallup) behind the times part is that the question excludes people who are transgender, and I’d argue, most of Gallup’s site does – the heading of this section is “same-sex relations” and the URL is “gay-lesbian rights”, where’s the rest of LGBT?

Even though we don’t have the data today (I hope we’ll start collecting it), it’s likely that we’ll see a same trend in terms of knowing someone who is transgender. This will be accelerated by access to medical care because more people will get to live in their identity, in good health, with employment, and the rest will be history….

I did a quick look and I actually can’t find a poll question anywhere that asks “Do you currently know someone who is transgender?” – if anyone out there knows of one please contact me or add a comment, thank you! And thanks One Colorado for documenting the state of health and its future improvement.

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