The Business Proposition: Keeping the Bird’s Eye View

Healthcare’s Miserable Business Model

Any of you familiar with The Innovator’s Prescription by Clayton Christensen? It’s a book that nails healthcare’s major problems right where it hurts (I leave the anatomical reference to your imagination)—and it starts at the top. Healthcare is an industry forged of multiple business models with more power players attached to it than mafia family heads in New York, Chicago, and Vegas collectively.

Ever sat in a meeting with a client and realized their goals are completely different than yours? Not only that, but it’s like they expect you to read their mind and magically intuit what it is they need and why they hate your solutions! It’s a communications nightmare!

There might have been a situation not too long ago where I sat in a meeting trying to understand why we were coddling a new provider so much. Why were we privileging them over our all the others who must abide by standard best practices that are modeled on protecting the institution’s best interests? Turns out that particular service has had trouble recruiting and keeping this particular type of specialist, forcing us to have to cede, enacting practices that aren’t necessarily optimal for our site users. (I am keeping this deliberately vague to protect the agitator.)

Why does it have to be that way? Lemme’ tell you why: We’re not all playing on the same field.

Nobody’s on the Same Page!

Nobody’s on the same page. Yeah, I just wrote that again ’cause I know you all relate. And I’m not just talking about seeing eye to eye and having things in common and striving for a company culture of unity. I’m talking about top-down bottom’s-up confusion built on multiple premises that we stupidly expect to play nice together.

If there’s anything that I’ve learned over and over and over again in 2017, it’s this: a siloed* department will not stand, or more importantly, will not bring about accolades, accomplishment, or awards-except on an insular individual-centric basis.

So we need to start keeping the bird’s eye view in mind, ’cause if we don’t rise above our siloes, we will continue to kick against the pricks, as it were.^ We need to listen and determine what our colleagues’ endgames are. Only this will help us craft more effective marketing plans and content strategies.

Models of Three, Leave Them Be

That classic mnemonic^^ could really be “models of three, leave them be,” as in don’t try and smush together things that don’t go together. But let me clarify that for you. As defined by Christensen in his prescription, healthcare is made up of three businesses:

1. Solution shops
2. Value-adding business processes
3. Facilitated business networks

We are perhaps most familiar with the solution shop: an entity diagnosing and providing solutions hoping to effect an improved outcome. That pretty much defines the most familiar healthcare business model we know. Providers see patients, compile data, and make a recommendation that we then pay for: fee for service.

The value adding model combines resources and people in a process to output a better product. A restaurant sources food, brings in a chef, and puts out extraordinary (we hope) food selections for us to choose from. In some cases this can be repetitive work, enabling optimization processes that can reduce overhead costs.

Hospitals and clinics bring people and resources together to provide care at lower prices than individual practices can often do. This can evolve into a fixed price system, embedded in equipment and processes.

And business networks. We are familiar with these via social networks, where we get recommendations from friends, keep in touch with peeps, and occasionally buy and sell things. This model offers a network that makes this possible. In healthcare this can be seen in professional business ties to treat chronic illnesses in a more effective manner or pass on knowledge to general practitioners (telehealth models).

The Bird’s Eye View

With three different business models, no wonder no one is on the same page!! No wonder doctors and subject matter experts can’t understand why we make the recommendations we do! They have almost completely different needs! Are they even operating under the same financial model that we are? In many healthcare organizations (or maybe I just mean mine), no!

For example, are healthcare providers individually reimbursed by health insurance separately per patient they bring in making it more effective to emphasize their personal practices? Or is there a blanket payment for sum total patients for the entire service area?

Almost every single group of providers I meet with has different needs. Some need to make money from out of pocket procedures, some need to recruit and retain providers/faculty, some are driven to separate out their own “practice” from the institution due to payment/reimbursement models that will benefit them. And yet others need to reduce hospital readmissions to maintain reimbursements or be penalized.

Lemme’ tell you, it may take awhile to get the lay of the land, but when you catch that bird’s eye view, it really starts to come into focus, albeit a little at a time.

The Proposition

(Remember There Is Always More to the Situation Than Meets the Eye)

So where does that leave us professionals? Hopefully not on the couch at 2 am watching Are You Being Served and trying to think of how to make everybody happy. Because the reality is, nobody’s happy, and nobody’s going to be happy, as long as we continue to operate in siloes. Let me adjust that sentence. The people who are happiest tend to be at the top of the heap in their silo OR the people who actively choose to take the best from their situation and squeeze lemon juice onto their salads.**

What I’m trying to say, in this delightfully amusing (I hope) yet informative post, is that if the confusion starts at the top, we need to realize that and include that in our work satisfaction calculations. What I’m proposing here colleagues, is that we recognize and validate others in their own business models.

We need to figure out what their end goals are before we can effectively diagnose and make recommendations for effective marketing, management, or content strategies. We need to keep the bird’s-eye view in mind.

*Btw, siloed is actually a verb-I just double checked. Silo can be either a noun, a verb, or an adjective referencing isolation, to isolate, or isolated.
^This is a Biblical reference, and a disgusting one. I will leave it up to you to suss out the hairy details however.
^^You know, after that mnemonic about poison ivy “leaves of three, leave them be…”; a mnemonic, might I add, that was no help when I ventured in to some stinging nettle across the pond. Did our wilderness trainers never consider that we might venture farther abroad than our own back woods? Don’t answer that.
**We are sooooooo tired of lemonade. Unless it’s pink. Then I could be persuaded. What about shocking pink? (Elsa Schiaparelli’s signature color and one I came to appreciate when working for a costume designer whose love for it was almost as great as mine has now become. There were sequined dresses.)

Got My Mind Made Up: The Barrier to Your Personal Empowerment

What’s Your Definition of Success?

I was nearly to 17th S, mentally cocooned in what felt like Deep Thought, braking and gassing those vehicular pedals as only a commuter en route to a day’s labor can, when it came to me—you have to change your mindset yo’! And when I say you, I really don’t mean you or me or even my too-early-to-rise feline. What I I’m trying to engender is more collective, more existential.

Definition of mindset

Our professional coach at work (yes, we are so spoiled) had hostaged us with homework the day before: We were tasked with identifying our personal definitions of success. Unlike the last time she brought this up, that day’s declaration sunk down to a more subliminal level. The next morning as I drove down the commuter chute, between that artery of green, I cogitated.

I feel successful when I empower others. I feel successful when I advocate on the behalf of others. But, interestingly, I do not feel the need to empower or advocate for myself.* It’s one thing to read about our cultural mindset toward women and minorities, but a completely different experience to recognize it in yourself.

What is your definition of success? My definitions apparently need an infusion of vision. Not because I wish to excuse myself from the collective, but because I need to recognize my own needs—what do I need to be fulfilled and thus successful? Does my success truly latch only on the support of others? Or is there something more at the center of that onion?

What’s Your Barrier to Empowerment?

So what’s your barrier to empowerment? What makes you shut down in a meeting or denigrate others because you can or throw things? What makes you lose control and holds you hostage?

Part of my path to enlightenment was learning about Schema Therapy. There is a brilliant book called Disarming the Narcissist by Wendy Behary.^ While you may or may not know any textbook narcissists, the book is entirely worth the read simply to better understand yourself!

Stories We Tell Ourselves

To paraphrase, a narcissist has surrendered control to a belief or notion—an attitude—they formed when their needs were not met as a child. They developed a survival tactic based on these beliefs to cope with this devastating series of circumstances and now are unable to leave this story—a schema—they set up to protect themselves.

They started out vulnerable and impressionable, and then became literally prisoners to that which they used to defend this vulnerability.

Definition of schema

But all of us have schemas. (It’s not just about the narcissists!) As human beings** we run rampant with emotions, whether overly expressed or distinctly suppressed. Our emotions and personal narratives color everything in our lives. Some of my colleagues face down a fear of irrelevance, some a difficulty with authority. Still others are chained to a need to be the best at everything.

What Schema Is Coloring Your Narrative?

What is your BE? (Or barrier to empowerment, as Patricia, our fearless coach, likes to ask.) What’s standing in the way of your success? What is the attitude with which you face life everyday?

What’s your mindset yo’?

* You could argue that quality is along the lines of Mother Teresa, but I think it hints at a deeper, possibly more twisted story. Not that I need hints of course, since I’m bloody living it.
^2008, Disarming the Narcissist: Surviving & Thriving with the Self-Absorbed by Wendy Behary
**Yes, I just invoked the clause of humanity stating that we all exist in a shared state with Things In Common.

Be Brief! And Other Paradoxes of Long Form Content

After All, Brevity Is the Very Soul of Wit*

“Be brief!” says Howard Rauch, author of Get Serious About Editorial Management.1 “Following this should be duck soup for most editors,” Rauch writes. “But that’s hardly the case.” What does Rauch mean by this? Should our sentences consist of only three words—noun, verb, direct object? Or should we seek for more, as the long form content movement progresses?

Primarily, Rauch references sentence structure and grade reading level. He writes of something called the Fog Index, a quantitative measuring resource I will have to check out. He brings up, what is for many of us, a fantastic point: how long are our sentences? What grade reading level are they written for? For whom are we writing?^

But how does this figure in to long form content?

Long Form Content

At first glance this long form business appears to be based around search engine marketing, but hark! What is the end goal of search engines? I find the answer to my question “What does a search engine do?” confusing:

What does a search engine do?

Apparently, a search engine is a web index. That’s nice and all, but how does that help me? Web indexes in search engines provide us with results to our queries on the internet. So, let’s ask Google another question: What is the point of search engines?

The result can be found with an even better question: Why do people use search engines? Dummies.com suggests the top uses for a search engine are:

1. Research,
2. Shopping, and
3. Entertainment.

While my experience certainly does not support the ordering of that list, it definitely supports the content. (My experience rarely equates with the 99%, however, I can only guess that it does make up some part of that total percentage as someone, somewhere, does relate with my experience, probably that miniscule .00000001 percentage of people—I call them friends).

If those are truly the top uses of search engines, then it behooves the search engine to try and align the quality of their web indexing to match those user goals. If search engines are focused on users, then it follows that perhaps we should be too.

Why have I followed this train of thought so thoroughly? Because I focus quite a bit of energy on thinking about applying SEO guidelines to my work. And SEO best practices should be very aligned with content best practices. While search engine results can’t tell us why users are doing something, they can certainly tell us what they are doing.

And if what they are doing is spending a lot of time and energy on long-form pages, perhaps we should spend some time focusing on quality long-form pages.

There and Back Again**

Not too long ago, I recall breaking up long form pages of content. These pages were miles long—well the web equivalent of miles—with anchor links and “back to top” under every section. If long form is The Thing, why then did we change our pages a couple years ago, breaking up information into tabbed pages?

I tend to think we followed a design trend. Or perhaps it was the explosion of SEO-gaming tactics, writing multiple short articles about nothing—fluff punctuated by keywords leading to higher search results. There were also things like microblogging and tumblr.

Design-wise, in a desktop focused industry, it was a way of making vast amounts of information more visually palatable. The web however, as all other things do, evolves. What remains constant is the centrality of search engines in our lives.

With this brief reminiscence, we now ask: long form content, what are you now?

Long Form: 2,000+ Words

A return to Search Engine Journal indicates long form is primarily 2000+ words formatted in whitepapers, e-books, and how-to guides. Short form content, like blogs, social posts, and emails (although I’ve seen some reallllllly long emails…) are apparently also useful, often referencing this long form business.

The best length guidelines for content that I’ve found focus more simply around your audience. What are their needs? What research are they conducting? What do they need to know to make a purchase? What tasks will your content help them to?

Longer form content for webpages focus on these user tasks. What does our user need and how can we deliver that information?

In my work at University of Utah Health, we discovered in our content audits that pages packed with information approximately 1,600 words more or less in length performed very well, at least as far as number of visits and time on page. Whether these met marketing and conversion goals, however, is another story!

Duck Soup^^

Our mission then is clear: we must be brief—but not too brief—focusing on our users’ needs. We must write for our readers using well-constructed but not overly wordy sentences. Our brevity must be more than a haiku but less than a dissertation, and I like to think witty.

Shall we organize a duck soup tasting?

  1. 2017, Get Serious About Editorial Management, Howard S. Rauch, pg 120.

*A sentence that was for Shakespeare, indeed very brief.
^Note: I write this primarily for myself to study and consider the vocation of content. If you are reading it, then wow! Please continue!
**A reference to Bilbo Baggins’ recounting of his journey in The Hobbit. If you don’t know who hobbits are, you have missed out.
^^An idiom meaning something easy to do or accomplish, which became widely used after its use as a title for a Marx Brothers film in 1933

WHY ARE YOU SHOUTING AT ME?

The Kosher Use of Uppercase: A Brief Case Study

Capitalization has a long and sordid history, but generally a well-known meaning: the use of a Capital Letter places Emphasis on a Word. The stylistic guidelines regarding when it’s proper to use upper case and when not to differ widely from language to language and culture to culture.

HOWEVER, there is a right time and a wrong time to use capital letters.*

The Right Time to Use Capital Letters

Proper names and personifications – Ask yourself these questions:
• Is the word a name for someone you know or a person that theoretically exists (even though you haven’t personally met them)?
• Is it a trademarked phrase or name for a company, brand, or entity?
• Does it refer to a movement that exists in one place only in history, such as the Age of Enlightenment or Postmodernism?

If not, don’t capitalize it.

Titles (before, not after names) – I know it’s tempting to associate capital letters with important people, but technically capital letters are used to emphasize something or someone specific. For example, if you are referring to the president, then it works like this:

Example (right): President and Commander in Chief Barack Obama came to visit us.

But, if you aren’t referring to a specific president, but rather the fact that Obama is a president, you use capital letters like this:

Example (right): Barack Obama, president and commander in chief, came to visit us. (I didn’t make the rules—blame the style guides.)

The beginning of sentences – Here is where I pose the thinking question: Why do you think capital letters are used to begin sentences? Bonus question: Why are sentences that fall after a colon capitalized?**

The pronoun I – Since we are referencing a specific person, ourselves, it probably makes sense that we capitalize it. One does wonder, however, what that says about us and our culture…

THE WRONG TIME TO USE CAPITAL LETTERS

Generalizations, such as specialties listed in a sentence or paragraph:

Example (wrong): The doctors at U of U Health Care specialize in Radiology, Neurosurgery, and Irritable Bowel Syndrome.

All of these specialties are general specialties (not that they aren’t still special); they don’t refer to a specific person, a trademarked company, or patent, so they should not be capitalized.

Titles after names: 

Example (wrong): Joe Jones, MD, Dean of the Department of Punctuation, requested that students express greater respect for the use of uppercase.

While the Department of Punctuation, since it refers to a specific if fictional department, can be capitalized, the word dean, since it falls after the current dean’s name, refers to the general position of dean, not the Dean Joe Jones himself.

TEXT MESSAGING OR EMAILING IN ALL CAPS WITH YOUR CHILDREN/FRIENDS/CO-WORKERS, EVEN IF YOUR KEYS GET STUCK—THEY WILL THINK YOU ARE SHOUTING AT THEM.

This is a more recent use of capitalization stemming from our ever more frequent messaging with typed symbols to express ourselves as opposed to talking on the phone or in person where our body language can express tone or attitude.

Take a quick browse back over those paragraphs above. Which are easiest to read? Which are More Difficult to Make Out or Skim (a technique we frequently use in reading and not just on the web)?

Conclusion / CONCLUSION

The use of uppercase is a practice to be respected, particularly in formal or business writing. While legalese and, occasionally, bureaucratese can get away with almost everything, we regular peeps must abide by writing style guides to be respected as professionals in whatever sphere we adhere to.

Oh, and if you have a bit of time, read this highly entertaining article about the origins and use of caps lock: I TURNED CAPS LOCK ON FOR A WEEK AND EVERYONE HATED IT via @thisisfusion. It might change the way you type.

*I invite you to enjoy the dramatization—I think it adds to this piece. At least I hope you laugh.

**A: The use of a colon generally indicates an independent clause or sentence (the colon acts as the equivalent of an equals sign); independent sentences are almost always capitalized, except after a semi-colon. (Don’t you love English with all these exceptions and rules and best practices?)

Previously published on Pulse, University of Utah Health Care; used with permission.

5 Reasons Writing for Web Is Different Than Writing for Print

Cover of Writing for the Web Guide
Cover of Writing for the Web Guide

Originally published Sept 19, 2014, on Pulse, University of Utah Health Care’s intranet. Used with permission.

Every medium requires slight adjustments in writing style, tone, punctuation, formatting, and the like. The web is no different. While the current goal of web content specialists is to create content that is device (or it could be said medium) agnostic, the overall style and tone of web writing is far more personable and relaxed than has been the case for print writing. Here are five reasons why web writing is different from writing for print:

1. It’s interactive.

When we visit any page on the web, we do so with the expectation that we can leave the page at any time via hyperlinks or search if we don’t find what we’re looking for. And there, in a nutshell, is the web: we are usually searching for something. While this can be the case with printed material, the web culture demands faster results—pretty much right now.

2. Readers scan paragraphs rather than reading them.

Most readers are either searching for specific content or browsing. As such they tend to scan paragraphs for the information that most appeals to them. Usability tests have overwhelmingly confirmed that this is how we read the web.* If that’s the case, we need to alter our writing techniques to match. We need to include subtitles, catchy first lines, and highlighted areas of importance via techniques like bold text, anchor text for a hyperlink (though this will take your reader away from your page), or bulleted lists.

3. Tone and style are more informal.

There are tons of different articles and pages, even books, on the web, but the writing tone and style that overwhelmingly define it are more informal. This is in part due to how we read articles, but it’s also a product of the intimacy of the web. Web pages have varying levels of credibility due to the democracy of the web: anyone can post almost anything, and many, many pages are personal sites and posts by individuals, which are not vetted through editors or any other sort of accrediting body. This naturally leads to a lighter, more informal style.

4. TL; DR: Shorter is sweeter (most of the time).

Too long; didn’t read. Literally. Readers are turned off by articles that take way too much time to describe something that could be done in a condensed manner. For example that last sentence could have been: “Readers are turned off by articles that aren’t succinct,” or “Readers like short articles.” The general rule of thumb is to cover the subject adequately, but not over the top. Some writing styles lend themselves to the verbose, but know your audience. As a general rule, shorter is sweeter.

5. It’s never finished!

People who spend vast amounts of time on the web innately understand this. News that is updated in real time is valued more for its timeliness than for its definitive nature. This doesn’t mean that content of a more evergreen nature (or always valuable) isn’t an essential part of any site, but rather that updates, corrections, or changes are just as important to the written piece because of the way we use the web.

* http://www.nngroup.com/articles/how-users-read-on-the-web/ Yes, this article is older, but it’s that evergreen sort of content, and from a highly, highly reputable source.