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six keys to achieving excellence in anything

Here, then, are the six keys to achieving excellence we've found are most effective for our clients:
Pursue what you love. Passion is an incredible motivator. It fuels focus, resilience, and
perseverance.
1.
Do the hardest work first. We all move instinctively toward pleasure and away from pain. Most
great performers, Ericsson and others have found, delay gratification and take on the difficult
work of practice in the mornings, before they do anything else. That's when most of us have the
2.
Six Keys to Being Excellent at Anything - Tony Schwartz - Harvard Busin... http://blogs.hbr.org/schwartz/2010/08/six-keys-to-being-excellent-at.html
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work of practice in the mornings, before they do anything else. That's when most of us have the
most energy and the fewest distractions.
Practice intensely, without interruption for short periods of no longer than 90 minutes and then
take a break. Ninety minutes appears to be the maximum amount of time that we can bring the
highest level of focus to any given activity. The evidence is equally strong that great performers
practice no more than 4 ½ hours a day.
3.
Seek expert feedback, in intermittent doses. The simpler and more precise the feedback, the
more equipped you are to make adjustments. Too much feedback, too continuously, however,
can create cognitive overload, increase anxiety, and interfere with learning.
4.
Take regular renewal breaks. Relaxing after intense effort not only provides an opportunity to
rejuvenate, but also to metabolize and embed learning. It's also during rest that the right
hemisphere becomes more dominant, which can lead to creative breakthroughs.
5.
Ritualize practice. Will and discipline are wildly overrated. As the researcher Roy Baumeister
has found, none of us have very much of it. The best way to insure you'll take on difficult tasks is
to ritualize them — build specific, inviolable times at which you do them, so that over time you do
them without having to squander energy thinking about them.

Loneliness of older foreign immigrants

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United by their loneliness, America’s elderly Indian immigrants......PATRICIA LEIGH BROWN

They gather five days a week at a mall called the Hub, sitting on concrete planters and sipping thermoses of chai. These elderly immigrants from India are members of an all-male group called The 100 Years Living Club. They talk about crime in nearby Oakland, the cheapest flights to Delhi and how to deal with recalcitrant daughters-in-law.

Together, they fend off the well of loneliness and isolation that so often accompany the move to this country late in life from distant places, some culturally light years away.

“If I don’t come here, I have sealed lips, nobody to talk to,” said Devendra Singh, a 79-year-old widower. Meeting beside the parking lot, the men were oblivious to their fellow mall rats, backpack-carrying teenagers swigging energy drinks.

In this country of twittering youth, Devendra and his friends form a gathering force: the elderly, who now make up America’s fastest-growing immigrant group. Since 1990, the number of foreign-born people over 65 has grown from 2.7 million to 4.3 million — or about 11 per cent of the country’s recently arrived immigrants. Their ranks are expected to swell to 16 million by 2050. In California, one in nearly three seniors is now foreign born, according to a 2007 census survey.

Many are aging parents of naturalized American citizens, reuniting with their families. Yet experts say the ethnic elderly are among the most isolated people in America. Seventy per cent of recent older immigrants speak little or no English. Most do not drive. Some studies suggest depression and psychological problems are widespread, the result of language barriers, a lack of social connections and values that sometimes conflict with the dominant American culture, including those of their assimilated children.

The lives of transplanted elders are largely untracked, unknown outside their ethnic or religious communities. “They never win spelling bees,” said Judith Treas, a sociology professor and demographer at the University of California, Irvine. “They do not join criminal gangs. And nobody worries about Americans losing jobs to Korean grandmothers.”

Many who have followed their grown children here have fulfilling lives, but life in this country does not always go according to plan for seniors navigating the new, at times jagged, emotional terrain, which often means living under a child’s roof.

Devendra Singh grew up in a boisterous Indian household with 14 family members. In Fremont, he moved in with his son’s family and devoted himself to his grandchildren, picking them up from school and ferrying them to soccer practice. Then his son and daughter-in-law decided “they wanted their privacy,” said Devendra, an undertone of sadness in his voice. He reluctantly concluded he should move out.

So when he leaves the Hub, dead leaves swirling around its fake cobblestones, Devendra drives to the rented room in a house he found on Craigslist. His could be a dorm room, except for the arthritis heat wraps packed neatly in plastic bins.

“In India there is a favourable bias toward the elders,” Devendra said, sitting amid Hindu religious posters and a photograph of his late wife. “Here people think about what is convenient and inconvenient for them.”

Sociologists call Devendra Singh and his cohort the “.5 generation,” distinct from the “1.5 generation” — younger transplants who became bicultural through school and work. Immigrant elders leave a familiar home, some without electricity or running water, for a multigenerational home in communities like Fremont that demographers call ‘ethnoburbs’.

A generation ago, Fremont was 76 per cent Caucasian. Today, nearly one-half of its residents are Asian, 14 per cent are Latino and it is home to one of the country’s largest groups of Afghan refugees (it was a setting for the best-selling book The Kite Runner).

Along the way, a former beauty college has become a mosque; a movie house became a Bollywood multiplex; a bank, an Afghan market, and a stucco-lined street renamed Gurdwara, after the Gurdwara Sahib Sikh Temple.

Reliant on their children, late-life immigrants are a vulnerable population. “They come anticipating a great deal of family togetherness,” Prof. Treas said. “But American society isn’t organized in a way that responds to their cultural expectations.”

Hardev Singh, 76, and his wife, Pal Keur, 67, part of Fremont’s large Sikh community, live above the office of the Fremont Frontier Motel, its lone nod to a Western motif a dilapidated wagon wheel sign.

They rented the fluorescent-lighted apartment after living for three years with their daughter, Kamaljit Purewal, her husband, his mother and two grandchildren. As the children grew, Hardev and Pal were relegated to the garage, transformed into a room. As Hardev said, “in winter it was too much cold.”( Their daughter, Purewal, said that she “tried to give them a better life,” but felt unappreciated because her parents favoured her older brother in India. “If you’re a happy family, a small house is a big house,” she said. )

Fraught family dynamics when elderly parents move in with children often leave older members without a voice in decision-making, whether about buying a house or using the shower.

Pravinchandra Patel, the 84-year-old founder of the ‘100 Years Living Club’, intervened when he heard that the son in one family was taking his parents’ monthly Supplemental Security Income check, for $658, then doling out $20 for spending money.

“I ask the son, ‘How much money do you figure you owe your parents for your education?’ “ he said.

Fremont, 40 miles south of San Francisco, is now the Bay Area’s fourth-largest city, with voters from 152 countries. Physical distances can be compounded by psychic ones: 13 per cent of the city’s immigrant seniors live in households isolated by language. Theirs is a late-life journey without a map.

For the men in the ‘100 Years Living Club’, the road leads to the Hub, where they have been meeting for 14 years, since the Target store was a Montgomery Ward. Patel, who was an herbal doctor in India, started the group after he noticed his friends were in “house prisons,” as he put it, without even the confidence to use a bus. The men keep their spirits alive by sharing homemade chaat snacks. They are the lucky ones.

http://www.indianexpress.com/news/united-by-their-loneliness-americas-elderly-indian-immigrants/510590/

Loneliness creeps up on Delhi's elders’

NEW DELHI: On the face of it they're busy and happening at 60: exercise regime, social work, satsang, paying bills, housework and the works. Yet, in a disturbing way, loneliness is increasingly creeping up on the old in Delhi, making them feel isolated. A study on the elderly conducted by NGO Agewell Foundation shows that about 80% of the surveyed Delhi residents in their 60s reported feeling isolated despite an active life. While only 11% of old who live in joint families experience loneliness, in nuclear families, more than 70% feel isolated.

Reduced interaction with family emerges as the greatest factor leading to feeling isolated. Differentiating between emotional and social isolation, the study — conducted in January this year among 10,000 citizens above age 60 in 20 states across all economic strata — found that 44% in cities such as Delhi, Mumbai, Chennai and Kolkata felt both social and emotional isolation. Social isolation stems from a dwindling friends circle, immobility and a feeling of being ignored socially, while emotional isolation results from strained interpersonal relations within family.

Himanshu Rath, founder Agewell explains that at home, younger members are "always bone-tired and too busy" to spend time with the old. "It's not that there's no concern. Even where nuclear families do all that needs to be done for the old, life is too hectic and tough for them to give time," he says.

Additionally, adds Rath, their stagnant incomes and growing costs of living especially in the last two years have led to much self-denial, also resulting in feeling alone, says Rath. "Last two years' slowdown has hit the old hardest. Interest rates have slipped. Monthly yields are reduced. The pressure's tremendous," he says.
Rath gives an example of the stress an average middle-class 65-year-old faces. "With longer life-spans, and given that today, a 65-year-old's wife will be to 6 to 12 years his junior, the retired man believes he has to secure finances for the wife for at least 20 to 30 years." With skyrocketing costs especially for medical, conveyance and food, the feeling of helplessness is strong.

There may be better medical facilities today, but they're expensive. Neighbourhood GPs are a thing of the past, points out Rath, a simple blood test will cost Rs 200 at least. "They cut down on the simple things. A third biscuit can mean Rs 1.50 more. I'm talking upper middle-classes who've had a certain lifestyle," he says. Saving for a rainy day, the old are cutting down on socializing also to avoid expenditure. Understandably, loneliness among elderly in Delhi increases with age.

Further, in cities many oldies, says 81-year-old Carol H. Barbosa, have had to financially pitch in to help children who have suffered setbacks and job losses due to recession. "They encash FDs, send money. The financial pressure has grown. It takes a toll, it's like a physical and mental breakdown," says Barbosa, who lives by herself in a South Delhi apartment complex that houses several retired people.

The report, conducted via interviews in urban and rural randomly selected districts found that at nationally, 87% of those in their 70s reported loneliness. Interestingly, rural old reported lesser levels of loneliness at 78% than urban ones (90%). At 97%, the loneliest were individual elderly who lived by themselves.

Ten Tips for Building Stronger Networks in Work and Life

Most people understand that to be successful, they need to network. But actually going out and doing it is another matter. People "are daunted by the task and believe it requires inauthentic, uncomfortable behavior and is an activity that is inconsistent with focusing on job performance," says Jeffrey Pfeffer, a Stanford professor of organizational behavior, who covers the subject of networking as part of his Paths to Power elective course. Too often, he says, people view networking "as something that 'is not them' or that they could not see themselves doing."

But in a new e-book coauthored with Ross Walker, a 2005 graduate of Stanford's MBA program, they argue that networking ability is not just important for career success — "it is also crucial for getting things accomplished and making change inside organizations in both the public and private sector."

The authors draw on Walker's experience, which was shaped by an "ability to build relationships and an efficient and effective social network," they write. Walker became one of the youngest members to serve on the Stanford Board of Trustees; found a career in his chosen field of real estate, where he has a successful real estate investment fund; has equity in Hollywood nightclubs; and has a small ownership stake in the Oakland Athletics Major League Baseball team.

While at Stanford, Walker had a reputation for being a big-tent person. He planned events and themed parties that not only were entertaining but also brought people together. These events naturally led to networks that would last beyond his time at Stanford, but Walker's ability to make connections did not stop there, says Pfeffer, who was so impressed that he wrote a case study charting Walker's networking efforts.

They teamed up to write People Are the Name of the Game: How to Be More Successful in Your Career — and Life. Here are some tips from the book.

Time Counts

Research by University of Chicago professor Ronald Burt shows that "being even one step removed from the person within the network almost completely reduces the benefits to you," the authors wrote. "Simply put, networking is not something that can, or should, be outsourced."

Find a Mutual Connection

"People are the name of the game — you must understand how to read people quickly and find what you have in common," says Walker. "With so much public information out there, this is easier to do today." You are more likely to get a response from someone if you have already found a shared interest or acquaintance in advance of introducing yourself.

Create a Robust Network

Walker was initially interested in working in the hospitality business, and through his research learned that alumnus Chip Conley had founded the boutique hotel chain Joie de Vivre Hospitality while he was still in his mid-20s. When Walker finally reached out to Conley, the 1984 Stanford GSB graduate had already heard of him. "I got hit by three different people simultaneously saying 'you have to meet Ross Walker,'" Conley recalled, according to the case study. "All of a sudden, you have him on your radar in a big way."

Be Specific

CEOs are busy people and therefore are unlikely to respond to vague requests or take on the burden of finding ways to help you. Help them to help you by making a specific request. For instance, when Walker met Conley, he submitted a brief one-page proposal to Conley in which he asked for an internship and offered to work for the summer without compensation. The reason: "Walker believed that you could not let high-profile executives think for you. … [It is] better to give them something tangible to consider, because once you've left their presence, they are not going to spend more time thinking about you."

Be Diverse

Clearly, it is important to link up to the influencers in your intended field. But do not underestimate the importance of "weak ties." It is important to create a diverse network — diverse people, diverse industries and diverse locations — even though these connections may seem remote to your present career or contemplated future. Diversity can also help when seeking funding for a startup.

Do What You Say You Will

"Do not overpromise and underdeliver, but instead, maintain credibility by doing the follow-up work to always meet your commitments," the authors write. "In financial parlance, it is easier to exceed expectations if those expectations are not completely over the top or in your face." By keeping your promises, your reputation spreads throughout your network. "The action of 'moving things from A to B' or following through as promised builds a surprisingly rare reputation that can be leveraged in a number of ways as it builds the confidence of others," write Pfeffer and Walker.

Be Genuine

The co-authors say that the more you pursue your passion, the more compelling your story will be when you share it with someone either by email or in person.

Think Long-term

When Walker sought investors for a real estate fund he was creating, his connections led him to a billionaire CEO in Silicon Valley, who asked Walker how much he wanted him to invest. Walker suggested he contribute whatever amount he was comfortable with. "Walker saw this first fund as building a track record and, in the process, cementing relationships with people who would be 'with him for a lifetime' once they had seen what he could accomplish and gotten comfortable investing together," Pfeffer noted.

Consider Your Approach

"Crafting emails can be an art sometimes," Walker notes. "I always take time to think of the subject line. I try to write something there that reflects a connection. For example, if you are a student and you are contacting an alumnus, I might write 'Current Stanford GSB Student Inquiry,' as I know that most alumni enjoy hearing from current students for a number of reasons."

Stay in Touch and Give Back

An easy way to keep in touch with those in your network is to send them emails now and then, introducing them to people who will be helpful additions to their networks. And, like Walker does, respond when others seek to add you to their circles.

Jeffrey Pfeffer is the Thomas D. Dee II Professor of Organizational Behavior at the Stanford University Graduate School of Business, where he has taught since 1979. He is the author or co-author of more than a dozen books. Ross Walker earned his MBA from Stanford GSB in 2005. He founded and is the general partner of Hawkins Way Capital, a real estate private equity fund manager in Los Angeles.

Here are a few strategies I regularly practice to stay top of mind after a call or networking event:

1. Organize your contacts, and actually do something with them.

At Influence & Co., we use Contactually, one of our clients, and HubSpot, a partner of ours. My Contactually account organizes thousands of contacts so I can deliver relevant content to each person and make sure no one slips through the cracks. The system even reminds me when I need to be more active with certain people so I remember to check in with each contact regularly.

2. Create a net, and share content that's valuable.

I used to engage in conversations with a lot of people at events and conferences, only to never hear from them again. Now, consistently publishing columns on Forbes, Inc., and LinkedIn helps me connect with contacts--whether they stumble across an article I've written or actually read it. Having frequent one-on-one conversations with everyone in your extended network is nearly impossible. Writing and publishing content allows you to reach a larger audience, offer them a valuable resource, and ultimately shape the relationships moving forward.

3. Remind people that you exist.

Typically, if you're a reputable company offering superior service, people are willing to help you out and send business your way. One key to this rule, however, is that they have to remember you exist. By contributing on LinkedIn, you'll regularly appear on their radar. You're already connected with your contacts on the platform (hopefully), and each time you publish an article, everyone in your network receives a notification. This can open many doors to communication and subconsciously reiterate your existence.

4. Add meaning, especially to important relationships.

Touching base via email or sharing articles your contacts publish might not be enough interaction to keep you top of mind. Instead, look for ways you can add meaning to the relationship.

John Ruhlin, one of the nation's gifting experts, recently sent me one of his own products to thank me. I loved the personalized knives, but what stuck out to me most was that they weren't delivered at the same time; I received a different part of the set each month. John's unique gesture consistently reminds me that he exists, and it made him more memorable.

5. Remember details outside the business relationship.

When is that contact's birthday? Did someone in your network recently update her LinkedIn profile with a promotion? During your last call, did a potential client mention he was a soon-to-be parent? Reaching out and saying congrats on the new baby or job can go a long way, so be proactive in recognizing important events and milestones.

Although these details sound simple, I've rarely come across people who do all--or even any--of these things well. By using tools to get organized and stay relevant to your contacts, opportunities, referrals, and partnerships will naturally begin to materialize.

It all goes back to the value you provide. Make nurturing your networking relationships a regular priority, and people will remember you for it.

John Hall is the CEO of Influence & Co., a company that provides a turnkey thought leadership solution for companies.

Make Enterprise Software People Actually Love

There is a big, important change happening in digital product design. For a long time, there has been a clear split between business software (often called Enterprise or B2B), and consumer software (B2C, or simply “products”). That split is increasingly irrelevant.

As a product designer, I cut my teeth on enterprise software at Trilogy in Austin; we developed configuration tools for Ford and Nissan, pricing solutions for the insurance vertical, and supply-chain and selling management software for a host of different companies. This category of software is typically characterized as “feature-rich.” In fact, these products are sold as lists of features to C-suite executives, and the conventional wisdom over many years has been that the package with the most features wins. Unfortunately, the executive who signs the check rarely has to actually use the product he just bought, and so those features that look so good in a PowerPoint actually manifest as a mess of unusable complexity for the individual contributors in the company.

The other extreme of the digital product spectrum is consumer software, where the focus is on drop-dead simple products that provide a value-proposition related to emotions rather than features. At frog design, many of the products I worked on – HP Touchsmart, Microsoft Virtual Earth – were intended for regular people. Regular people have expectations related to ease of use, simplicity, and – most importantly – emotional attachment. When we bring products into our houses, we are implicitly expecting them to behave as we would want any person who enters our home to behave – with respect for how we live.

Of course, the joke here is that people in large companies are “regular people” too. Increasingly, these people have autonomy related to the tools they use in their jobs. We’ve all heard of the “consumerization of IT“:  workers bringing their own devices, their own software, and their own expectations to the workplace and rejecting the overly complicated software provided by their employers. Consumerization, in this context, is not the dirty word of consumption; rather, it refers to power of choice and autonomy of control. As we see more and more productivity tools emerge that are simple and easy to use, we’ll continue to see more individual business units reject massive tools like SAP and PeopleSoft for tiny tools like Harvest, Basecamp, or Smartsheet.

I’m in the middle of this enterprise-to-consumer shift at Blackboard, where we’ve had extraordinary success in the education-technology space by selling features to administrators or CIOs. But, analogous to the consumerization of IT, there is also  consumerization of education going on. Students are increasingly empowered to choose alternative educational models, alternative places to learn, and alternative technology solutions to support their education. Blackboard recognizes this shift, and that’s one of the reasons they acquired the startup where I worked previously, MyEdu – a free product focused on helping college students succeed in college and get jobs. Our ethos: instead of focusing exclusively on selling software to giant companies, we need to rally around free tools that students can elect to work with; instead of “monetizing students” or “selling features,” we need to monetize products that minimize attrition, support the complexity of the academic journey, and help students find a vocation that they enjoy and in which they can grow. This is a product ethos built around emotional impact and attachment.

But saying and believing in these words, no matter how passionately, does not shift a giant company. Here are some of the ideas and practices that have helped me and my colleagues begin to make what will probably be a hard, years-long journey to recast our focus on learners, and to reposition our software as a great consumer product.

• Show an alternative. No matter how well-intentioned, a company can’t get on board with a vision without actually seeing it. The best way to socialize a trajectory change is to show it, in detail, and in a way that the organization can understand. The designers at Blackboard began creating visually persuasive demos, prototypes, and vignettes of a path forward before the path was even crystalized. For example, Blackboard used animated visuals (a few of which are pictured below) to help rally people around an alternative vision of the future without worrying about requirements or legacy product issues.

• Ground the design in emotional research. Rather than supporting an emotional shift from enterprise to consumer with market research, I’ve found it effective to illustrate the value through qualitative, ethnographic research. We spend time with students, teachers, and parents, and leverage the findings to both substantiate new design direction and to help humanize the shift. The best tools? Quotes, images, and video snippets of real people describing their job, life, and emotions.

• Relentlessly beat the drum of experience over function. If enterprise software is characterized as “more,” consumer software is characterized as “less,” with a focus on the emotional quality of engagement rather than a breadth of robust functionality. I know from my own experience that it can be tedious to constantly remind, evangelize, and describe that this is important, and why it is important – but it is also critical to success.

• Describe an incremental path towards success. The change from features to emotion – in mindset and in operation – doesn’t happen overnight, and while the alternative visualizations paint an ideal picture of the future, the reality is often more convoluted. A change like this requires re-examining and rationalizing multiple technology platforms, existing legal agreements, and entrenched perspectives. The organization needs to see an incremental path towards simple, emotionally engaging products, one that describes small steps forward towards a big vision. It’s not enough for us to say where we are going; we need to say how we intend to get there, too. This means creating a visual road map that shows a thoughtful parsing-out and bringing-down-to-earth of the vision to something achievable; it shows small wins over time.

Our own shift at Blackboard is only one of hundreds occurring in education, healthcare, banking, and in nearly every sector and part of life. Our society is realizing that technological advancement is strange, and we need to humanize it to make it familiar. This humanization comes through a shift from features to emotions, resulting in simple, well-designed products that people love to use.

mycloset

The missing link is a flexible platform that collects all the information about each and every physical asset, providing the person with the complete picture of those to assist with the choices

IT talent shortage hitting healthcare hardest

With IT staff shortages a reality for CIOs in most industries, healthcare – driven by federally mandated incentives for such IT-intensive projects as Electronic Health Records – is experiencing even more of an IT labor crunch. Is poaching experienced IT talent from other industries the answer?

Healthcare is continuing to experience a shortage of qualified health IT staff that, in the view of some observers, is growing worse. But few healthcare organizations believe that the solution is to lure IT pros away from other industries. In fact, most hospital systems and large physician groups would prefer not to hire any IT person who doesn’t have extensive health experience. 

"Healthcare organizations are looking for healthcare-experienced people," says Frank Myeroff, president of Direct Consulting Associates, a health IT staffing firm in Solon, Ohio. 

Ernie Hood, senior research director for the Advisory Board Co., a large healthcare consulting firm based in Washington, D.C., agrees. In fact, he says, healthcare organizations are generally uninterested in graduates of health IT training programs, even if they have IT experience in other industries. "It doesn't substitute for the actual field experience working in healthcare," he says. 

It’s not about the Benjamins 

The workforce shortage in healthcare does not seem to be related to the salaries of health IT professionals. According to arecent Computerworld/IDG Enterprises survey, a CIO in health/medical services earns an average of $173,941 annually. [Computerworld and CIO.com are both owned by IDG Communications.]The same position is worth $146,111 in computer-related services/consulting, $151,889 in education, $133,972 in government, $191,762 in legal/insurance/real estate, and $192,885 in manufacturing (non-computer related). Lower-level health IT staffers are also paid fairly well, compared to those in other industries. 

As you would expect, some healthcare organizations pay better than others. Myeroff attributes much of that differential to how much individual organizations know about current information technology. In addition, small, rural hospitals don't pay as much as large, metropolitan healthcare systems, notes Hood. But overall, he says, "I don't see health IT staff fleeing to other industries, so that makes me think that the compensation is somewhere in the ballpark." 

[Related: IT continues to struggle to find software developers, data analysts] 

How bad is the current health IT staff shortage? A third of healthcare managers said they had to postpone or scale back an IT project because of inadequate staffing, according to a 2014 survey by the Health Information Management and Systems Society (HIMSS) [Note: PDF download]. But this may not be because healthcare organizations couldn't find the people they needed, Hood says. 

"This could be an indication that there's greater demand [for health IT] than the budget allows for," he points out. "Is the barrier, 'I can't find people with the skills I need,' or is the barrier, 'I don't have the resources from the organization to execute what they're asking me to do?'" 

Moreover, he says, the availability of outsourcing has to be factored into the equation. While outsourcing was not the preference of most CIOs in a recent Advisory Board Co. survey, three-quarters of the healthcare executives who responded to the HIMSS survey said they had outsourced at least some IT. The top areas for outsourcing were clinical application support, project management, and system design and implementation. 

From bad to worse? 

In Myeroff's view, however, health IT shortages are substantial and growing. "Technology is moving forward, and we don't have the staff for it," he says. "Tens of thousands of jobs are going to be needed and we don't have the people for it." 

[Related: In the IT talent wars, businesses need to sweeten the pot] 

One major reason for these shortages, he says, is the government's incentive program for electronic health records (EHRs). That initiative has resulted in the majority of hospitals and physicians acquiring EHRs in the past several years. Known as the "meaningful use" program for the criteria that providers must meet to obtain the financial incentives, this program is now in the penalty phase: For the next few years, Medicare will cut its payments to organizations that do not show meaningful use of EHRs. 

Another IT-intensive government program requires all healthcare providers to move to a new diagnostic coding system in October. This shift entails internal and external software testing, not only with health plans and claims clearinghouses, but also with other trading partners. 

In addition, doctors and hospitals are grappling with the transition to an entirely new method of payment, known as "value-based reimbursement," that rewards healthcare providers for quality and efficiency. The data aggregation and analysis needed for success in this game require specialized IT staff such as data analysts, who are in short supply. 

Because of government-mandated time frames, Myeroff interprets the HIMSS survey results differently than Hood does. Whether or not a healthcare organization has the budget to hire more IT people, he notes, it must achieve certain objectives by a specific date. For example, stage 2 of the meaningful use program requires hospitals and physicians to meet its criteria this year. "To meet those stringent deadlines, you need IT staff," he says. 

Is in-house training the key? 

To close the workforce gap, many healthcare systems are developing additional IT workers internally. These staffers – typically nurses – take IT courses offered by vendors or professional associations. But most of their training occurs on the job. 

Hood says  this is not a very sophisticated approach. No healthcare organization that he knows of has a formal in-house training program. Most of the lower-level clinicians who take on roles in IT are super-users who often function in a help-desk capacity to help other users, he says. 

Myeroff says that many healthcare systems have done a good job of developing in-house IT talent. The problem he sees is that clinicians who take on IT roles don't have all of the competencies required. Health IT professionals who know healthcare but are not clinicians may supply these missing skills. "But neither one of them can do the whole job." 

A number of medical schools now offer medical informatics courses that train physicians in some areas of health IT. But while these programs produce informaticists and chief medical information officers (CMIOs), they don't help in other areas such as security and EHR operations, Hood notes. 

[Related: 10 startups that are disrupting healthcare IT] 

The skills and experience gap between IT and healthcare persists, he says, but more and more clinicians are filling it. Hood cites the growing number of CIOs who are physicians with experience working on IT projects. This can be especially important in change management, he notes, where a hospital's management needs to persuade physicians to support an IT program that may change their workflow and even their practice patterns. 

Both Hood and Myeroff emphasize that health IT pros must understand how technology can be used to improve healthcare. Older professionals who can't do that may not be able to keep up, notes Hood. To succeed in this new era, IT staff must be very receptive to what physicians and nurses want, Myeroff adds. "You need the clinician mind to tell them what they're building."

Big Ideas, Small Scale: How GE Is Using The Wisdom Of Crowds To Design Better Appliances

FirstBuild. com went live about a year ago, issuing online challenges to design new appliances and inviting members to submit their own projects for feedback. If there’s enough support for an idea, a team of inventors, tinkerers and seasoned engineers use state-of-the-art 3-D printers, laser cutters and stamping to churn out a limited production run and sell it online. If it’s a hit, it graduates to Appliance Park for larger-scale production. The company pays 1% royalties on sales. Half goes to the lead inventor, who also gets $1,000 when it ships; the rest is split, along with $2,500 cash, among all others who contributed.

Prepare to win in the digitization 2.0 world.

Digitization 2.0: mobility ecosystems. Going beyond individual telematics systems, automakers have opened up their operating system (e.g., FordOpenXC) to third-party developers to write apps. Now automobiles and mobile phones are able to interconnect without conflicts. At the same time, Google and Apple have announced their intent to be drivers of digital transformation in the automotive sector. Android Auto and Apple CarPlay are in the initial stages of pulling together the different automakers into their ecosystems with many apps for navigation, communication, and entertainment.

Architect your products for context-awareness. Your company’s product architecture may be analog today but ask yourself: What happens when products become digital and your company can observe, analyze, and correct your products while in use? Similarly, how can you facilitate product adaptation across companies that are collaborating to deliver on a customer value proposition?

Map your digital ecosystem beyond your core industry’s boundaries.Companies are now part of digital ecosystems with connections based on data and interoperability (APIs). Competing and collaborating simultaneously with the same companies will be the norm as rules evolve with different monetization models and cross-subsidization (e.g., value for data). Senior leadership should not only map their own company’s ecosystem. They should also track others, which may help them identify potential entrants that could pose a threat or opportunity.

Develop capability for context-aware insights. Digitization, sensors, and connectivity lead to the generation of large volumes of data. Understanding products and services in use require significant capabilities to capture, store, and analyze data at unprecedented scale. New technologies like Hadoop for storage, tools like R and SAS for analysis, and visualization techniques are starting points for managing in the digital age.

Digitization is the single biggest trend affecting every company. It challenges every company to think about the drivers of value creation and capture as well as modes of differentiation beyond familiar dimensions of cost and quality. Our message is simple: Think first about how your products and services become smart as you observe them in use. Then, understand the context-aware continuous refinements that could significantly enhance the value of your products and services as part of dynamic digital ecosystems. Make sure that your business is designed to move from digitization 1.0 to 2.0.

What Apple, Lending Club, and AirBnB Know About Collaborating with Customers

The idea of “co-creating” with customers has been circulating for years, but until recently few companies effectively exploited its power or understood its contribution to the bottom line. True, customers can customize their M&Ms, build their own bikes with Trek Project One, create unique doors for their home at Jen-Weld, and design their own Nike running shoes. But these co-creation models produce only one-off physical goods, and none represents a fundamental shift in how these companies create value; they’re peripheral to the core business.

Today, however, by exploiting new digital technologies, firms like Apple, Lending Club, and AirBnB have made customer co-creation of value central to their business models and in doing so now rank among the world’s most innovative and valuable firms. Our research indicates that companies that make their customers partners, and share the value created, lead the pack on revenue growth, profit margins, capital efficiency, and enterprise value. We call these companies Network Orchestrators. By leveraging customer networks and their tangible (e.g. homes and cars) and intangible (e.g. expertise and relationships) assets, firms can gain these advantages of the Network Orchestration business model.

How, then, do firms cultivate these valuable customer networks? It starts by understanding customers’ affinity with the brands.

Four levels of affinity

Through our research on network-centric businesses and our experience advising hundreds of companies we have developed a framework for understanding customer affinity.

Insight Center

• Growing Digital Business

Most leaders are already working to deepen customers’ relationships—converting uninterested consumers (transactors) into passionate brand advocates (promoters). However, what these executives don’t fully appreciate is that the customer affinity spectrum extends far beyond promotion. Through co-creation, companies can access a deep well of customer capabilities, knowledge and assets.

Although the Net Promoter Score (NPS) is a market standard, customer promotion alone can’t sustain a co-creation model. Promoters might give you their dollars and promote your brand with their Tweets or Facebook “likes”, but today’s connected customers want to give, and receive, more. Creating models based on co-creation requires identifying the subset of customers with the right kind of brand affinity.

These four types of customers represent different levels of brand affinity:

1. Transactors: These customers have no loyalty to your brand. Although they may make purchases, they are unaware of or not swayed by your brand proposition and do not desire a relationship with your company.

Example: Carol owns a small business and needs a customer relationship management (CRM) platform. Overwhelmed with choices, she signs a one-year contract with the first salesperson that returns her call, planning to reevaluate next year.

2. Supporters: These customers are aware of your company and brand, and buy from you consciously. They support your company by purchasing regularly. However, they do not promote your brand and they may switch easily to other products.

Example: Jim’s firm has used the same CRM software for ten years. The functionality barely meets his needs, but he hasn’t yet had the time to invest in finding a better solution so renews his contract, but only on a month-to-month basis.

3. Promoters: These customers frequently purchase your products or services and are very loyal. Their affinity is strong enough that they advocate for your company to their networks helping your company grow through word-of-mouth.

Example: Ann just switched to a new CRM platform and has heard from the sales team that it saves time and increases conversion. Happy about these results, Ann recommends it to all of her followers on social media.

4. Co-creators: These customers are so engaged with the brand that they share in the value creation, and receive value back. They create and offer their own assets, knowledge and relationships in exchange for a share of the value generated—including revenue and profits.

Example: Jacob loves his CRM software and has become an expert in its use. He decides to use its open source platform to create add-on apps that he believes will be useful to other users and posts it on the company’s app exchange.

A significant shift happens when customers reach co-creation status with a brand. With Transactors, Supporters, and Promoters, the company is responsible for fulfilling the customers’ needs. However, when a company co-creates with its customers (usually by providing a technology platform which facilitates interactions and transactions), company and customers create shared value.

To help you better understand where you and your customers fall on the customer affinity spectrum, take our Customer Type Assessment. While there are many ways to segment customers, this type of segmentation is particularly useful because of its implications for the business model.

Companies that co-create

Let’s look at three companies that leveraged digital capabilities to build customer co-creation into their business models. Each has moved beyond allowing customers to design their own products, to share value by acting as a platform to promote the customer networks’ talents and assets.

• Apple’s Developer Network: Apple provides the platform; companies and individuals provide the applications. They each receive a portion of the value created, whether revenue, awareness, or utility. Over its lifetime, the app store has generated more than $25 billion for developers.
• Airbnb.com: Airbnb provides the online database and some additional services; their partners provide the good sold—the properties for lease. Revenues are shared and together Airbnb and its “hosts” have built a company that was most recently valued at more than $25 billion, more than the value of Hyatt Hotels.
• Lending Club: This peer-to-peer lending platform connects would-be borrowers and lenders. All of the “products”—loans and investments—are created and provided by its members. Lending Club went public in 2014 and its enterprise value is nearly $9 billion.

Co-creation advantages

Customer co-creation is central to the Network Orchestration business model. Our research shows that companies that facilitate a network of co-creators deliver shareholder value two to four times greater than companies that don’t leverage co-creation business models. We see four main reasons for this value gap:

Greater revenue growth: As co-creating partners, customers have an incentive to help grow the business. Your success is theirs, whether the rewards are monetary or intangible. Co-creation is less a measure of “customer loyalty” than an indicator of “reciprocal loyalty,” where both parties serve each other.

Lower marginal cost: Your customer co-creators bring an entirely new set of assets to the company, at a very low or near-zero cost (see Rifkin’s The Zero Marginal Cost Society). They may be willing to share their opinions, skills, relationships, and even their real assets (cars, apartments, etc.) for the right incentives and shared value.

Improved customer insight: The increased customer intimacy that comes with co-creation deepens your understanding of your market, enabling you to serve it better. When customers co-create and have a vested interest in its success, they are more willing to share personal data and other assets with it.

Increased organizational flexibility: A network of customer co-creators increases the company’s adaptability and speed. This network is distributed and self-organizing, which makes it highly responsive to changing customer needs. When a new vacation hotspot emerges, Airbnb does not need to change its supply chain or purchase new properties; instead its co-creation network naturally expands to satisfy the demand.

Five steps to co-creation

Customers cannot be coerced into co-creating. They must be eager participants in the value equation. To drive co-creation, you must invite your customers into the value equation. We recommend a five-step process called PIVOT: Pinpoint, Identify, Visualize, Operate, and Track.

1. Pinpoint where your customers currently lie on the customer affinity spectrum and the areas where they will be most interested in co-creating. Evaluate your leadership team’s openness to co-creation as well.

2. Identify the characteristics of your key customer groups, including their level of engagement, their unmet needs, and any tangible or intangible assets that could be leveraged in a co-creative relationship.

3. Visualize a new business model where your customers co-create with your firm to help meet their own needs. Based on their characteristics, design a system that will incent them to participate, with a particular emphasis on leveraging digital technologies as the platform.

4. Operate your new co-creative digital business. Fund it, recruit the right digital talent, and insulate it from the politicking of the broader firm. Experiment and iterate rapidly.

5. Track the performance of your co-creative customers and the value they add. Add new metrics to standard financial reports, including the revenues customers generate and the costs saved through their participation.

As written, these five steps seem relatively simple, but we all know they are far more difficult in practice. The biggest hurdle to co-creation is usually shifting the leadership team’s mental model. Most leaders are so accustomed to owning the value creation process that they cannot imagine the customers as active participants, instead of passive recipients.

Think of it this way: Does the hospital ask patients to help design their own healthcare? Do professors enable college students to contribute to the curriculum? Do auto manufacturers allow drivers to co-create their next car? In general, no. But they might see a dramatic change in engagement and innovation if they did.

Giving up control, and sharing rewards, may seem terribly risky, but it is the key to the co-creative business models that generate unprecedented value with lower marginal costs, and greater profits. It’s unwise to delay this journey any longer. Your customers are waiting.