Unaccountable and rEvolution: Two Must-Reads

Two books that would seem to have little in common are Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Healthcare, by Marty Makery and rEvolution: Turn Crisis into Clarity and Ignite Growth, by Tim Leman, CEO of Gibson, northern Indiana's largest insurance brokerage. Dr. Makery has never set foot inside an insurance brokerage while Mr. Leman has never set foot inside an OR. (He may or may not have been wheeled in at one point or another but I don't know. If I did know, HIPAA rules are quite clear: if I told ya, I'd have to kill ya.) And yet these books have share a common thread.

Coincidentally, and why I am writing today about both books, Unaccountable is back in the news because Fox made a very watchable drama out of it, called The Resident. And rEvolution is in the news -- my news, at least, because I have been blown away by what I have seen of Gibson's competence and professionalism.

The Resident

First, a brief word on The Resident. It is a highly watchable medical drama that got a notch-less-than-great reviews only because, unlike in every other medical drama, reviewers didn't appreciate that the characters are based on real people. There really was a surgeon at Dr. Makery's hospital known as "Dr. Death" because of his high failure rate, and yet patients loved him because of his bedside manner. And admittedly the show goes over the top:

• While hospitals upcode all the time, vendors of these coding tools don't distribute brochures titled The Art of Upcoding.
• Revenue-maximization consultants don't watch patients get MRIs.
• Hospital CEOs don't have conference calls like baseball's winter meetings where they propose swapping patients with each other.
• No federal ICE agent has ever dragged an undocumented immigrant out of an intensive care unit. (Not that I want to put ideas in their head.)

While both the book and the show are worthwhile, if you only have time for one or the other, read the book. These are real doctors and hospitals mistreating real patients and covering it up.

What makes both books so good is how the authors learn from failure. I myself am no stranger to failure. In every job I've ever had, I was either fired or laid off, or I would have been fired or laid off if I'd stuck around six more months, or I should have been fired or laid off but no one realized it. Yet, as engineers say, you learn more from one bridge that falls down from 100 that stay up, and as a result my three subsequent ventures, The Disease Management Purchasing Consortium, Matrix Medical Network and now Quizzify have been successful.

Gibson and rEvolution

This posting was actually about Tim's Gibson book, but it's hard not to "bury the lead" when the competition is a prime-time drama and my own self-indulgence. Tim's book, like Marty's, focuses on the mistakes Tim made along the way. Like Marty's, he doesn't downplay his own role in these mistakes, and Like Marty's he learns from them. We know he learns from them because the company is owned by an Employee Stock Ownership Plan (ESOP) so its valuation is objectively re-set every year...and every year for the last 8, the valuation has risen, sometimes substantially.

Having been to visit them, I can see it. I host healthcare trivia contests at many places (see the upcoming list of events if you want to play...and possibly win an all-expense-paid trip to Martha's Vineyard with a private beach and lakefront), and I don't think I've ever seen the degree of health literacy across an entire organization that I saw at Gibson. Health literacy would appear to correlate with competence, as Quizzify's interactions with Gibson are among our smoothest. Companies who have retained Gibson are fortunate indeed.

The ESOP structure also means each employee has a stake in the success of all the other employees, to create a team culture. In Tim's book he talks about the silos that typically develop over time in an organization, and how difficult it was to break them down. An ESOP is a helpful-but-not-sufficient way of doing that. Since this is a book review, I'll add that rEvolution provides some painful lessons learned in how to change a corporate culture, which -- especially in one of the country's oldest brokerage firms -- i shockingly difficult. And yet...

The introspection in these two books is rare in this genre. Try reading/watching the dueling accounts of McDonalds. If you just read Ray Kroc's account, Beneath the Arches, Ray Kroc is a hard-working, ethical genius while the McDonald brothers are self-indulgent, obstinate obstacles to the success of their own enterprise. Whereas The Founder portrays the McDonalds as great American heroes dedicated to integrity and quality, and Ray Kroc is a slimeball dedicated to, and eventually successful at, driving them out of their own business and eventually out of business overall.

Having seen them in action, I can say with certainty that there is no chance of Gibson following the fate of the McDonald brothers. If it did, as in most such cases, blame would be widely shared -- but Tim would be the first to volunteer to take responsibility for it.