Thursday, March 29, 2007

Videos - The Medium is the New Health Care Message

Taking an Honest Visual Look at Health Care

The medium is the message... There is a basic principle that distinguishes a hot medium like radio from a cool one like the telephone, or a hot medium like the movie from a cool one like TV….Hot media are low in participation, and cool media are high in participation or completion by the audience.

Marshall Herbert McLuhan, 1911-1990, Understanding Media, 1964

Mindset #11 – “Don’t forget the ecology of technology.” The changes that result from the technologically driven onslaught of the visual can have profound impacts on the environment in which you operate and the environment of the marketplace that you address. Ask yourself what in those environments will be enhanced, what will be diminished, and what will be replaced because of the changes.

John Naisbitt, Mind Set! Collins, 2007

I have a dear friend, Brian Klepper, PhD, founder the Center of Practical Health Reform and now executive producer of NCI Talk (, an educational and consulting company specializing in managing health care costs. Brian also has a personal blog ,, which I invite you to read.

The Message

Brian’s focused message is that the two major flaws leading to soaring health costs are fee-for-service and lack of transparency. He believes only the business community and major health care sectors have the heft and leverage to correct these flaws. They can do it , he believes, through use of information technology management systems that compare costs, outcomes, performance. and reward the most efficient providers and suppliers.

His message is two fold to his audiences – use your clout to enforce efficiency measures and to achieve quality management. The audiences include those attending the World Health Care Congress, cancer meetings, American College of Surgeons conclaves, the National Association of Health Underwriters, and gatherings of those who represent health care supply chain vendors. I applaud Brian’s message because it relies on employers and business sides of health care to correct the health system’s flaws rather than the government.

On the hospital side, Brian’s message to hospital executives is honest and sobering. It is this.

A) Hospital revenues come mainly from two sources: government programs (Medicare and Medicaid), and managed care organizations serving as intermediaries and surrogates for employers.
B) Hospital costs spring mainly from two sources: labor costs, supply chain costs.
C) Hospitals are losing ground financially. In an aging population with growing numbers of uninsured and an employer market that is either dropping coverage or dumping costs on employees, patient mix is shifting to the government side of the equation, which pays the least, and away from private sources of payment, which pay more.. .
D) Hospitals can’t do anything about the inevitable demographics, and it can’t do much about the shift of consumers away from the hospital to less costly environments. Nor can the hospital do much about rising hospital labor costs, for it needs skilled professionals to remain competitive. But hospitals can do something about its supply chain costs, its most rapidly rising expense and a market in which vendors often have margins exceeding 50%.

NCI Talk Videos

Effectively managing costs is where NCI talk, which might be more aptly called NCI voice views, comes in. Brian regularly tours the country to do video interviews with leading medical visionaries and innovators. Recently, he visited Washington State and Oregon to videotape interviews with multiple health care leaders, both physicians and non-physicians.

Among physician leaders, he interviewed were.

• Gary Kaplan, MD, CEO of Virginia Mason, an integrated health organization in Seattle that has adopted and modified the Toyota lean production model for its own purposes;
• John Kitzhaber, M.D. two time governor of Oregon, who is deep into devising a universal means-tested plan for Oregon that regulates public but not private coverage;
• David Lynch MD, of Bellingham, Washington, who heads up a group of 50 doctors with eight or nine medical offices covering a population of 170,000 and “doing all the right things” to offer safe, effective, and best practice care.

What’s Different about NCI Approach

To me what’s different and innovative about the NCI approach is its talk show approach. This approach consists of integrated videos featuring three expert guests talking on a single topic; a seasoned talk show moderator; a mini-documentary based on one of Brian’s visits and directed towards the audience of interest; and a closing video by Brian summing up the implications of what has been said

Under the rubric of “Taking an honest look at healthcare,” these videos are presented to health care conference audiences on subjects like comprehensive cancer care, proactive pay for performance programs, quality management, greater efficiencies, and rationalizing supply chain costs.

The Medium is the Message

NCI with Brian as its executive video producer is on the right track. To use John Naisbitt’s words, “a visual culture is taking over the world.” In a culture dominated by video games, TV, Internet images, cell phone and Blackberry pictures, and YouTube, this visual approach has profound and broad implications beyond health care. Naisbitt lists eight manifestations of a visually dominated world.

1. The slow death of the newspaper culture
2. Advertising – back to a “picture is worth thousands of words”
3. Upscale design of common goods.
4. Architecture as visual art
5. Fashion, architecture, and art
6. Music, video, and film
7. The changing role of photography
8. the democratization of the American art museum

In health care, visual forms of communication – animation and voice-guided online interactive programs featuring illustrations and simple language- may soon replace or at least supplement powerpoint presentations. Everyday Americans listen to 25 million powerpoint talks, and many, including myself, are growing weary of bullet points. Subconsciously, whether we’re aware of it or not, many of us now may be wearing bullet-point protective vests. Many will welcome straight talk, clear pictures, and moving images to tell the story


Robert K. Blechman said...

Hi Richard,

If I understand your post, the impact of the various newer media on messages results in more visual and less textual content. Fewer bullet points, more images. I'm not sure I follow how you believe this affects hospitals or the budgets thereof, but maybe I can suggest some possible influences.

Prominant Media Ecology writers such as Walter J. Ong, Marshall McLuhan and Neil Postman long wrote about issues related to our transition from a literate to an oral culture. Ong distinguised primary orality, that which existed before the adoption of writing, from secondary orality, where prior literate influences remain. This transition has implications, not only visavis text vs. images, but also logical vs. "gestalt" thinking, social organization, notions of intellectual property, and so on.

If we examine the institution of the hospital as a medium, we can apply McLuhan's tetrad to suggest where we are and where we may be going. McLuhan believed that any new technology has four major effects on a culture. Based on that technology's inherent biases, it will enhance something, obsolesce something else, retrieve something that had been lost and, when pushed to extremes, reverse into its opposite.

So here is a possible tetrad for hospitals:


Enhance healthcare efficiency by concentrating health care providers and resources in one location.

Obsolesce personal care skills. Medical students must take special courses in "bedside manner" and other "cultural competencies" in order to compensate for their intense technical training. In earlier times, the family doctor would have developed these interpersonal skills along with his/her medical skills.

Retrieve The "witch doctor." Complex diagnostic technologies, procedures and treatments make medicine seem like magic. Encourages "secondary orality" thinking and the view of the doctor as savior.

and Reverse into ineffective healthcare institutions due to fiscal starvation, bureacratic inefficiencies, insurance and lawsuit pressures and medical professional "diagnostic blinders" due to specialization and the pursuit of profit.

This is just one possible way to view the medium of the hospital.


Richard L. Reece, MD said...

I thank Dr.Blechman for his deep analysis. People understand verbal images more than written words. I don't regard this as "dumbing down" but as an innovation promoting better human understanding of how the health system works.

Richard L. Reece, MD

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