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Don discussed why the ACA will persist despite attempts to repeal.

https://www.nytimes.com/2017/04/01/opinion/sunday/obamacare-can-survive-trump.html?_r=0

Bob Sutton of Stanford University is first rate thinker and author. One of my favorite books by Bob is Hard Facts, Half Truths and Total Nonsense. Well worth a read. Recently, Bob and his co-author have turned their talents to scaling up change. The new book is called, Scaling Up Excellence - Getting to More Without Settling for Less. In the very first part of the book, Bob details Six Mantras of Scale Up:

1. Spread a mindset, not just a footprint. Running up the numbers and putting your logo on as many people and places as possible isn’t enough.
2. Engage all the senses. Bolster the mindset you want to spread with supportive sights, sounds, smells, and other subtle cues that people may barely notice, if at all.
3. Link short-term realities to long-term dreams. Hound yourself and others with questions about what it takes to link the never-ending now to the sweet dreams you hope to realize later.
4. Accelerate accountability. Build in the feeling that “I own the place and the place owns me.”
5. Fear the clusterfug. The terrible trio of illusion, impatience, and incompetence are ever-present risks. Healthy doses of worry and self-doubt are antidotes to these three hallmarks of scaling clusterfugs.
6. Scaling requires both addition and subtraction. The problem of more is also a problem of less.

I found #5 to be very descriptive of some famous failures in business. Sutton and Rao go into more detail on the “trio” of illusion, impatience, and incompetence: 

• Illusion: Decision makers believe that what they are scaling up is far better and easier to spread than the facts warrant.

• Impatience: Decision makers believe that what they are scaling is so good and easy to spread that they rush to roll it out before it is ready, they are ready, and the organization is ready.

• Incompetence: Decision makers lack the requisite knowledge and skill about what they are spreading and how to spread it,

   

  If you have not read Sutton before, I think you will find the read informative and entertaining. A great combination.

   

  Reference: Sutton, Robert I.; Rao, Huggy (2014-02-04). Scaling Up Excellence: Getting to More Without Settling for Less (p. 25). Crown Publishing Group. Kindle Edition.

Recently the members of API were discussing the difference we have observed between the design of services and the design of products. For products the product itself is visible and tangible to the customer but not the manufacturing system that made the product. We purchase and use a smart phone but have little or no knowledge of where and how it was made. Services are different. The service itself and the system to deliver the service are often tightly linked and observable by the customer, especially in professional services such as health care. One goes to a doctor's office to get treatment. The treatment is the service that is needed.  The visit to the doctor's office is the means by which the service is delivered. 

This link between service and delivery system can slow down innovation and improvement by distracting from the underlying need of the customer. The customer may have a need for medical treatment but the doctor's office is only one way of  delivering the treatment. One method to over come this obstacle is to use a 5x (1, 5, 25, 125, 625, ...) scale up approach when designing or  redesigning services. Develop ideas for a service and establish one or more prototypes. Test the prototype with 1 then 5 then 25 potential customers. The aim is to learn how well the service satisfies the need of the customers. If the 25  customers are chosen wisely, a lot can be learned for design and redesign of the service without undue constraint from the delivery system. As the scale is increased by 5x jumps, 125, 625 ... the issues associated with the delivery system come in to play. This approach allows the customer need to drive the design of the service as opposed to the constraints of the delivery system driving the service design. The delivery system design is then in support of the service which is aimed at the need of the customer.