The post-Christmas, pre-New Year time tends to be a bit slower for many of us. Take some time to reflect on the past year and honestly assess your role in both the successes and challenges of your team or business. What did you do (for better or worse) that impacted the performance of the people around you.

Reflecting is a hard-won skill found in people who are really trying to prepare for their future. It’s one of the eight skills I highlighted in my first book and it’s one of the top three skills least  used in most businesses. We have plenty of reasons for not reflecting (too busy is top-most) but no real excuses. It something we need to do if we want to improve.

The past is the past — spend a few minutes thinking about what you did right and wrong in 2011 and get ready for 2012. More adventures lie ahead of you. Happy New Year.

I’ve been away from this for a while but have decided to return in a more focused manner. My intent is to issue a weekly thinking exercise to help anyone interested in improving their critical and strategic thinking skills. I hope you find these comments and exercises helpful.

Assumptions Gone Bad:  Assumptions are the foundation of personal and business strategy. Sears assumed they understood the  needs and wants of middle-class America. True for about a century; wrong for the past fifteen years or so. Martgage and financial service companies assumed that the price of a house would always go up. Right for fifty years — bad assumption starting around 2007.  Kodak assumed that film would gradually decline and that they had time to shift to a digital world. Oops.

Look at the assumptions you have been using in your personal and professional life. Are any of them “going soft” on you? Do you have a big decision coming up? Document your assumptions, vet them with people you trust, and review them every six months or so. Watch for “assumption erosion.” It’s a killer.

For the past six years I have been conducting workshops on “critical and strategic thinking” for some of the better corporations in America. And in these workshops I cover the key attributes of critical thinking. Two of them seem to be lacking in the congressional “debates” we see played out in the news.

First, an aspect of critical thinking (or just plain good thinking) is the willingness to look at a situation from multiple points of view.  Every time I hear that congress “voted along party lines” I realize that the people who are deciding things that affect my future have abdicated their responsibility to think! This is “groupthink” at its best/worst. If all we need is a tally of party votes, we should fire all of our senators and representatives (and save a TON of money) and let a clerk tally the votes.

Second, good thinkers realize that complex problems (like healthcare, like the national debt, like the wars) do not have known or even knowable solutions – they require experimentation to discover possible part-solutions that can be combined to find a reasonable total solution. As long as both parties see this as a win-lose situation they will never undertake the bold experiments that are needed to find real solutions. They are unwilling (as seen by their actions) to risk their party reputation for the good of the country. Sorry, but that seems gutless to me.

What do you think?

One of the harder aspects of critical thinking is to be willing to accept that your point of view is only one of many points of view addressing a particular situation and that they are just as real as yours . You may not like them; you may disagree; but they are real.

The challenge you face is to consider them and take them for what they are – legitimate expressions of concern. If you ignore them, you are guilty of lazy thinking.

Consider our health care system and the many points of view that need to be considered by those attempting to improve the system.

• To people with good company paid insurance, the system is just fine and they see no need for change.
• To the uninsured, the system is divided into “haves” and “have-nots” and all that they know is they are not even in the system.
• To insurance companies, the system is part of a business ecosystem and they know that they have to keep their shareholders happy with decent profits.
• To a Medicare recipient, healthcare is a promise from our government for a lifetime of work.
• To a patient with long-term illness, the system is slowly driving them into bankruptcy.
• To a healthy young adult, the system is something they may need sometime, but not right now.
• To a hospital executive, the system is overly complicated and rife with administrative duties.
• To a doctor approaching retirement, the system is the reason to give up a lifelong passion because it’s “just not worth the hassle.”
• To a conservative, the system has no need for government.
• To a liberal, the system needs government involvement.

And on, and on, and on.

Take a look at our healthcare system and consider some of the points of view.

Now, without falling back on a predisposed ideology (which is a single point of view) consider actions “we” could take to improve the overall performance of the system.

Not so easy, is it? How would you like to be an “independent” in Washington? Must be lonely.

We need people who will think about the problems with health care, not simply use ideology to drive their position.

What do you think?

The medical community refers to high blood pressure as “the silent killer.” It’s a disease without obvious symptoms and many people, unfortunately, don’t even know they have high blood pressure until a stroke or heart attack kills them.

The “high blood pressure” of strategy is the set of assumptions that the strategy is based upon. The assumptions may have been fine at one point in time but may have degraded over time and may well be wrong when the strategy is stressed.

The roll-call of strategic irrelevancy often finds degraded assumptions at the heart of the matter.

• Manufacturing companies assumed they needed lots of raw material and work-in-process inventory until the Japanese surprised us with “just-in-time” manufacturing.
• Airlines assumed a hub and spoke system was best until SouthWest Airlines got real good at point-to-point.
• Kodak assumed that film-based cameras would have about three more years of sales than they actually had.
• The entire housing and mortgage industry assumed that the price of houses would continue to rise year after year.
• Sears assumed it had a lock on middle class Americans.

Staying with the health care theme of the last few posts, what assumptions do you see your local healthcare providers making? What assumptions do you think they are making with respect to:

• Who will control your “medical home”
• Telemedicine?
• Insurance rates?
• Your attitude about safety?
• Defensive medicine?
• Medical tourism?
• Hospitalists and surgicalists?
• Electronic medical records?
• Elective surgery?
• Patient education?

All industry “truths” are built on assumptions that were true at one time or another.

How many of these truths do you think will prove invalid in the coming couple of years?

Concepts help active critical thinkers organize their thinking. Sometimes the simplest of concepts work the best.

Reflect on the reality of workers in the healthcare system. I don’t care who you think about – it could be a doctor, a nurse, a technician, or an administrator. These workers are talented and dedicated and eager to do the right thing (most of the time). However, they “live” in the smallest box of a series of nested boxes.

It would be wonderful if the boxes fit in perfect alignment. However, the reality is more like:

Leaders at all levels in the system should be searching for answers to the following questions:

• How will the economy (and its slow recovery) affect the healthcare industry?
• How will your company respond to changes in the industry?
• How will jobs have to change to respond to changes in company strategy?
• Will the leaders and the workers have the skills needed for the job changes?

Most of the workers “in the trenches” simply want to do a good job, feel satisfaction, and have security. It’s up to the leaders in the government, the industry, the hospitals, the companies, etc. to make sure the people actually doing the work know why their jobs have to change.

Think about the turmoil surrounding healthcare; think about nested boxes. This is “creative destruction” at work and the system WILL (eventually) realign itself. What “pinch points” can you forecast as we reflect on the reality of changes to the system? What

Great thinking is built on great questions. Unfortunately, it seems to me, we have started with answers before we agreed on the important questions.

One of my favorite books is Asking the Right Questions: a Guide to Critical Thinking by Browne and Keeley. Let’s see how a few of their questions help inform the discussion about health care

• What are the issues and the conclusions?
  • Let’s stick with the issues from the last post: coverage, quality, cost, and choice. We are still wrestling with the conclusions about each of these issues. Coverage seems to be the big Democratic issue and a conclusion for many is that coverage needs to be universal. Cost and choice seem to be the big issues for the Republicans and tentative conclusions are that cost will be too high and that choice is important and will be hurt by a “government” agency.
  • Bring this down a notch and look at it from the perspective of a hospital executive: universal coverage is good; high quality is demanded; cost should “reasonable;” and choice may be bad if it adds to administrative costs.
• What words or phrases are not clear?
  • Do we have common understanding of: “rationing,” “free market,” “recission,” “Obamacare,” “level playing field,” “socialism,” or, for that matter, “health.” Think back to the days of the “quality” movement – lots of discussion by what we meant by quality.
• What are the value conflicts and assumptions?
  • Is the healthcare system run as a “zero sum” game. Does one party win at the expense of the other? Unfortunately all of the public “debate” has focused on differences and not common ground.
  • What line items should be used in a healthcare system report card? Until we have a common set of items we can cherry pick “the best system” to fit our needs.
  • There are a bunch of assumptions that have to be investigated: Will quality reduce cost (like it did for manufacturing)?
• How good is the evidence?
  • There are bits and pieces of evidence floating around, but little has been used in coming to terms with the debate.  Furthermore, when numbers are presented they are not always put in proper context nor made widely available.
  • What evidence would you want to see to come to grips with the issues of coverage, quality, cost and choice?
• Are the statistics deceptive?
  • The short answer is Yes. We have to make sure we understand the basis behind the numbers.

We have a lot of very smart people who can find answers once we have posed the right questions. From your point of view, what are important questions that no one seems to answer?

The foundation to good critical thinking is coming to grips with the issue at hand. Saying that “the system is broke” is meaningless until you define system and all of its components. To rail against “Obamacare” is meaningless unless you can explain what you mean by Obamacare. So, what’s the issue?

I’ve been reading T.R. Reid’s excellent overview of healthcare, The Healing of America, wherein he compares healthcare in Germany, France, Japan, the U.K., Canada, and the United States and his framework is very instructive for considering “the issue” about healthcare. His framework is composed of four factors: coverage, quality, cost, and choice. With just these four words, you can start to better define some of the many issues.

• For the 30 to 45 million uninsured, it really is all about coverage. However, for the business owner coverage means added cost.
• For the well-to-do, or the retired person pondering Medicare Part D, it may be about choice so as to maximize benefits. However, for the insurance company with a near lock on a state, choice is the last thing they want.
• I want to know exactly how much an operation is going to cost, but my doctor has no way of knowing until after the fact!
• All of us want “the best” but someone (“not me”) has to pay for it.
• And on, and on, and on.

And here is the nasty part of trying to define “the issue.” We can be pretty sure that some blend of the four factors is going to change. We just don’t know what the blend will be.  So what is a healthcare executive to do? As I said in response to an earlier post comment, the answer is not to stand still and react after-the-fact.

Whether you are a hospital exec, an insurance exec, a doctor, an employer, a supplier or an individual the issues are explored and defined by knowing what is in your control and what is not and then determining what it will take to remain viable as the system changes. Here are some hypothetical responses to possible futures of healthcare. Consider the plight of a hospital exec if…….

• Universal coverage is enacted – How much will ER capacity and staffing go down if patients see docs earlier?
• Electronic medical records are legislated to improve quality – How many older docs will take retirement rather than make the change?
• Patients can choose from hundreds of insurance funds – How many billing clerks will have to be added unless standardized forms are used.

You get the picture. We know the system will change. We don’t exactly know what will change. It’s a human tendency to wait – but that may be too late.

OK, I’m not foolish enough to think that healthcare executives are reading this blog. So let’s make it personal. MY issue with healthcare is simple – since my wife and I are on an individual policy and can be dropped or priced-out if either of us dare to get too sick, our actions are to exercise and eat healthy and hope Medicare is there in a couple of years. It’s my responsibility to stay out of the system, because I know I can’t afford to get sick. Depressing, but true.

See if you can define YOUR issue with healthcare. They say that all politics are local, and nothing gets more “local” than health. Consider Reid’s factors of coverage, quality, cost and choice.