Book Review: Good to Great and the Social Sectors

I'm having a hard time figuring out Jim Collins.  I thought his book "Good to Great" was all right.  It had good points, but was overdone and full of awkward parables.
Now he's published a 35 page addition to his book called "Good to Great and the Social Sectors"

He says he was going to add it as a chapter in his next edition of "Good to Great" but he didn't want to force people to buy an entire new book, so he published it as a tiny little paperback by itself.

It costs $12!  (34 cents per page)

I can buy his original book: new, online, for $6.  I can buy it from the publisher for $18.
I feel like this was another money grab - not a "help the people" move.
Things like this make me really dislike him.

Then my coworkers tell me that he is one of the best speakers they've ever heard.  When others come and give their canned stump speeches, Jim Collins instead learns about his audience ahead of time and completely tailors his words to the people listening.  He sounds engaging, smart, funny, and very helpful.  He has done tons of research, and written six best-selling books.

When I reviewed "Good to Great" (here) my brother called me and laughed at me.  He said "you gave it a bad review because you didn't like his writing style.  His ideas have changed entire business models and helped innumerable companies.  You've never run a business in your life and yet your reading a reviewing one of the great business books."

My brother is right - which is why I thought I'd be better at reviewing THIS BOOK about greatness in social sectors.  This correlates with my line of work.  I work in both the State and VA health care systems.  I spend my evenings and weekends volunteering with the Boy Scouts and with my church. 

So - now that you've read this long diatribe about what led up to this review, here it is:

This book is good with a few moments of genius.  It gives about 4 examples of how business models don't work in the social sector.  Collins points out that the key isn't the business model, it's the greatness model.

The best insight he had was about the nature of leadership in the social sector:

"There are two types of leadership skill: executive and legislative." - p. 11
"Legislative leadership relies more upon persuasion, political currency, and shared interests to create the conditions for the right decisions to happen." - p. 11
"True leadership only exists if people follow when they have the freedom not to." - p. 13

I work daily with people who I don't employ. I may even be their "leader" at times but they are not paid, or they are underpaid. I could tell them all to do what I want,  but they could choose to ignore me and go on with their lives. I have no executive power. The only real power I have is legislative. I can help create the right environment where everyone will come to and agree with the best decision.

This is where Jim Collins nailed the difference in the social sector.  We work with volunteers.  We work within a system we don't control.  We often can't fire anyone.  We can't choose "who is on the bus."  We have influence, and that is all.

So when he says: "Those that failed to become great - placed greater emphasis on using incentives to 'motivate' otherwise unmotivated or undisciplined people. The great companies, in contrast, focused on getting an hanging on to the right people in the first place" - He is speaking the truth, but it's difficult to apply.

His words were much more applicable when he said: "It might take decades to change the entire system, and you might be dead or retired by the time those changes come. In the meantime, what are you going to do now?"

I work in health care and most everyone believes the system is broken.  While I do plan on working to fix the system, I'm also not going to sit back and just complain about it until it's fixed.  I'm going to figure out a way to make my little portion BETTER.  I can influence those around me.  I can change my little section of the health care world, and make it better for patients, providers, everyone.

The last line of the book is common knowledge - but it's great nonetheless:
"Greatness is not a matter of circumstance. Greatness, it turns out, is largely a matter of conscious choice and discipline."

Health Insurance Makes Sense! (yeah right)

        A friend called me this week after his wife had a baby, their fifth.  They’ve been through this before, they know the drill.  My friend now works in a small family business with a total of five employees.  They all have “catastrophe insurance,” but they pay for everything else out of pocket. 

        SO – their baby was born, everyone is fine and healthy.  Mom says she’s ready to go home.  Mom and Dad know they are paying for the entire delivery with cash, so they ask how much they’d save if they left today instead of tomorrow?

        They’d save nothing, the cost is the EXACT same.  The nurses are very kind and tell the mom that she should relax and stay through the next day.  The nurses are being very honest.  They don’t get paid any more if she stays an extra day.  They are really are just thinking about what’s easiest on the mom.  So stay the extra day – the cost is the same.

        My friend calls me asking: “How is that possible?  How can another night in the hospital for both mom and baby not change the cost at all?”  He asks me who he should talk to get an itemized bill so he can see how much cheaper it would be if his wife decided to leave that day instead of the next day.

        An Itemized bill?  It exists but it doesn’t matter.  Don’t get me wrong - The hospital knows how much it costs for every piece of equipment.  They know how much it costs to keep the lights on, the hourly wages of the nurse and CNA.  They know how much they pay the resident, the OB/GYN, and the Pediatrician.  They know the cost of each meal, each medicine, each cup of soda, each popsicle.  The administrators know the exact costs, because they pay for all these things every day.

         But the cost to them does not determine the customer price.  The two are hardy even linked.  Medicaid has determined how much they will reimbursed the hospital for a normal delivery.  They pay “x” amount for mom and baby to be treated the day of delivery and one day after.

        That’s how the hospital determines the price of a delivery – by how much government insurance pays.  They won’t charge you per item, they won’t charge you per day.  If it’s a normal healthy birth, they’ll charge you the flat fee…no matter what.

        WHAT?  How does that make sense?  I know plenty of businesses use flat rates, but that is determined by costs.  If a customer is willing to incur less costs, shouldn’t the business offer to charge them less?

How did all this start?  I don’t really know.  I do know that our view off health insurance is completely wrong.

        Most of us have health insurance but we never, EVER, use it.  We use pre-paid health care.  We pay our monthly fee to Blue Cross and then when go to the doctor we pay our co-pay (maybe $20.)  We pick up a prescription and pay another co-pay ($20), and we go home.  We take the pills, we get better, and the whole system worked.  Woo-Hoo!

        How much did the doctor’s visit cost?  Usually neither the doctor nor the patient have any idea.  This is the way it should be.  This way the doctor can treat the patient without thinking about costs, and just give them the best possible treatment…right???

        This system is moronic.  People pay, and they pay, and they pay – their insurance company.  As long as their visit to the doctor is cheap and their prescription is “covered” they don’t care that they’re paying 10 times more to the insurance company than the whole visit and prescription would have cost.

We don’t use health insurance, we use Pre-Paid Health care.

        Imagine if patients paid full price for all their regular visits - just like with your car. You pay for all the maintenance: oil changes, brakes, tires, belts, spark plugs, etc... The car insurance is used when you're in an unexpected accident and your car is totaled.

        Health care should be the same way. If you take care of your body you'll pay a little for maintenance (Regular check-ups, occasional labs, and a prescription here and there.)  You’ll pay $60-$120 per visit and your prescriptions will vary.   You’ll need health insurance when out of the blue you have kidney failure, a heart attack, or an emergency C-Section.

        Health Insurance is for the unexpected - kind of like your Fire Insurance on your house.  You pay out of pocket for the monthly expenses, the new paint, the patch in the wall, the hole in the carpet, the replaced door, etc…  Everyone in the neighborhood pays a little to fire insurance.  Then when one house has a terrible accident and is consumed in a fire – that house is rebuilt with all the money pooled in fire insurance.  Most people will never use their fire insurance, but they pay it just in case.

        Health Insurance should be the same way.  It should never be involved with routine things.  Health insurance should never cover kids with ear infections, or even healthy births.  It should apply to kids with Diabetes, cranial bone fusions, etc.  It should apply to EMERGENCIES.

        So – why can’t my friend’s wife decide to save some money by leaving the hospital a day early?  Because everyone else has pre-paid the set amount for their deliveries.  Everyone else has pre-paid health care and the hospital prefers to stick with one price - set by the insurance companies.

It’s moronic, it’s annoying, but good luck changing it.