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How long can we deny and
         delay?
A generation!
• Go down in the boiler room where it is
  dark, noisy, dirty, and greasy
• Go up into the sails and feel the wind in
  your face and the see the beauty of the
  sea

• Remember You are called a sailor
• What is a sailor without sails?
World changes

       • Are we like sailors in
         the ship?
       • When confronted with
         change we say
         “doctors don’t do this”
       • World has changed
       • Still trying to act like it
         has not
       • Try to do things the
         same way
Paradigm shift
• Problem is in the mind
The First Teaching of a JEDI...
 The Problem is in our Minds
• Going Digital is a whole new way of doing
                     things




 “No! No Different. Only Different in your mind”
Different in Your Mind
       Behavior as Doctors
• To extinguish old behavior-uncomfortable
• To establish a new behavior-unsettling
• We like to be competent-This is a very
  different environment
Describe this Wheelbarrow
Look at your brain when seeing
        something new

               • DENIAL

               • DELAY

               • DISPATCH
Not real – only in your mind
Point is
1. We start
2. We go negative
3. We stay negative
   and keep going on
4. Why?
THE DOWNWARD SPIRAL
Brain has Two Parts
Reptilian Brain with
 Human Cortex on top
Cave Man Finding Something New:
             LIMBIC
1. I must
   attack it
2. I must run
   from it

  Emotion
Later Developed system?
      NEOCORTEX!

                   Think Ahead

             Positive about the new

                 Open- minded

               Suppress emotion
It is really important for the
forebrain to know the Power of
        Negative Thought
                     ...Limbic

• Neutral Environment
• Four positives to equal one negative
• Be positive, positive, positive, positive
  and positive
Five Pennies
FEARS GENERATED
• Loss of money
• I can not do this and I will look stupid
• I may not survive
• It is too hard
• Let me wait, Let me run away, It will never
  work
• Delay Dispatch Deny
• It is just too big
Good Potential Concern
• What is Good about this idea today?
  Positive aspects first
• What Potential does this idea have for
  tomorrow?
• How can we address Concerns in ways
  that promote success?
• Talking Stick
• Candy
We Must Start With Our Minds

• Every decision has emotion
• Neutral environment
• Good potential concern
Paradigm shift
• Requires Creativity

  – Blocked by judgments and work
Creativity means Destruction
• Clay Christensen
Beat competitors with asymmetry of
                           motivation
                                                                                      % of tons
Steel Quality



                                                                                          55%
                                                     Sheet steel

                                                                                          22%
                                                                                      l
                                                                   Structural Stee
                                                 l
                                             stee                                         8%
                                          ed                                     ds
                                        uc                             rs & ro
                                     rod                Angle iron; ba
                               ill -p                                                     4%
                           inim                                             Rebar
                        ofm
                  ality
                Qu


                      1975           1980             1985           1990
Characteristics
        • Low quality
        • Serve market that does
          not need added features
          or is not served
        • Not a threat to traditional
          market
        • Companies leaving
          market are praised until
          the big drop
Another Example

                                                            Major Established
                                                          Electronics Markets:
                                                      Tabletop radios, floor-standing
                                                          televisions, computers,
Performance




                                                        telecomm.equipment, etc.




                                                 Portable TVs

                                 Pocket radios
                                                                  Path taken by
                  Hearing Aids                                      established
                                                                  vacuum tube
                                                                 manufacturers

                                                                      Time

              Disruptive technology: transistors vs. vacuum tubes
Examples in Medicine
• Cardiac Surgery
• Angioplasty
• Stenting
Disruptions Amongst Healthcare
                          Professionals
                                                  re   s
                                            n nai
                                       io
 Complex                          u est
                                  Q
                           ph one ks
                      T ele e ban
                            n
                       Ph o                                  Performance
                                                             that the
                                                             marketplace
Complexity
                                                             needs or
of diagnosis
                                                             utilizes
     and
 treatment


                                      re
                              Se lf-ca

  Simple
                                                           Time

               Patient Computer Dialogue
Patient Computer Dialogue is
           Disruptive
   Role of Thalidomide Trust

• New evolving products on faster track
  – Beneficiaries of Thalidomide Trust will accept
    early development
• Serve market that is not served
• Not a threat to traditional market
Other Models
Online Banking
• 40% of the banks in the U.S. offer internet banking
  facilities worth mentioning
• The UK's first home online banking services[2] was set
  up by Bank of Scotland for customers of the Nottingham
  Building Society (NBS) in 1983
Online Banking
• Be that as it may, it is estimated that a total of 55
  million families in America will be active users of
  online banking by the year 2010.
•
• The number of online banking customers has
  been increasing at an exponential rate.




                                 http://ezinearticles.com/?History-of-Online-Banking&id=270075
Drivers
1. Reduce Cost
2. Competitive Advantage
3. Protect Strategic Position
Banking
• For example, while the cost of transaction
  for money transfer was 40p for checking
  and 10p for ATM, while it was only 1p for
  Internet
• First ATM 40 years ago
Online banking
It is generally recognized that perceived risk
     plays a negative role in decision to adopt a
     new technology including Internet service


Regarding Internet banking, perceived risk
  involves two concepts: security and trust.


Complexity is “the degree to which an
  innovation is perceived as difficult to understand
   and use” Ease of use”
Where is Patient Computer interaction in other industries and where in
                              Medicine
                  Where would you place yourself?
Characteristics
• earlier adopters have
  – greater empathy
  – less dogmatism
  – less fatalism
  – greater rationality
  – great intelligence
  – more favorable attitude toward change.
Speed of innovation
• the degree to which an
  innovation is perceived as being consistent with
  the existing values, past experiences and
  the needs of potential of potential adopters


• negative attitudes cause resistance to
  change and lack of management
  commitment
Reminders
Speed of Innovations
 Larger organizations do better than small
generally (implementation of online banking)
So What is Next?

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Change change mgt_and_next

  • 1. How long can we deny and delay?
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  • 3. A generation! • Go down in the boiler room where it is dark, noisy, dirty, and greasy • Go up into the sails and feel the wind in your face and the see the beauty of the sea • Remember You are called a sailor • What is a sailor without sails?
  • 4. World changes • Are we like sailors in the ship? • When confronted with change we say “doctors don’t do this” • World has changed • Still trying to act like it has not • Try to do things the same way
  • 5. Paradigm shift • Problem is in the mind
  • 6. The First Teaching of a JEDI... The Problem is in our Minds • Going Digital is a whole new way of doing things “No! No Different. Only Different in your mind”
  • 7. Different in Your Mind Behavior as Doctors • To extinguish old behavior-uncomfortable • To establish a new behavior-unsettling • We like to be competent-This is a very different environment
  • 9. Look at your brain when seeing something new • DENIAL • DELAY • DISPATCH
  • 10. Not real – only in your mind
  • 11. Point is 1. We start 2. We go negative 3. We stay negative and keep going on 4. Why?
  • 13. Brain has Two Parts Reptilian Brain with Human Cortex on top
  • 14. Cave Man Finding Something New: LIMBIC 1. I must attack it 2. I must run from it Emotion
  • 15. Later Developed system? NEOCORTEX! Think Ahead Positive about the new Open- minded Suppress emotion
  • 16. It is really important for the forebrain to know the Power of Negative Thought ...Limbic • Neutral Environment • Four positives to equal one negative • Be positive, positive, positive, positive and positive
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  • 19. FEARS GENERATED • Loss of money • I can not do this and I will look stupid • I may not survive • It is too hard • Let me wait, Let me run away, It will never work • Delay Dispatch Deny • It is just too big
  • 20. Good Potential Concern • What is Good about this idea today? Positive aspects first • What Potential does this idea have for tomorrow? • How can we address Concerns in ways that promote success? • Talking Stick • Candy
  • 21. We Must Start With Our Minds • Every decision has emotion • Neutral environment • Good potential concern
  • 22. Paradigm shift • Requires Creativity – Blocked by judgments and work
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  • 27. Beat competitors with asymmetry of motivation % of tons Steel Quality 55% Sheet steel 22% l Structural Stee l stee 8% ed ds uc rs & ro rod Angle iron; ba ill -p 4% inim Rebar ofm ality Qu 1975 1980 1985 1990
  • 28. Characteristics • Low quality • Serve market that does not need added features or is not served • Not a threat to traditional market • Companies leaving market are praised until the big drop
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  • 30. Another Example Major Established Electronics Markets: Tabletop radios, floor-standing televisions, computers, Performance telecomm.equipment, etc. Portable TVs Pocket radios Path taken by Hearing Aids established vacuum tube manufacturers Time Disruptive technology: transistors vs. vacuum tubes
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  • 34. Examples in Medicine • Cardiac Surgery • Angioplasty • Stenting
  • 35. Disruptions Amongst Healthcare Professionals re s n nai io Complex u est Q ph one ks T ele e ban n Ph o Performance that the marketplace Complexity needs or of diagnosis utilizes and treatment re Se lf-ca Simple Time Patient Computer Dialogue
  • 36. Patient Computer Dialogue is Disruptive Role of Thalidomide Trust • New evolving products on faster track – Beneficiaries of Thalidomide Trust will accept early development • Serve market that is not served • Not a threat to traditional market
  • 38. Online Banking • 40% of the banks in the U.S. offer internet banking facilities worth mentioning • The UK's first home online banking services[2] was set up by Bank of Scotland for customers of the Nottingham Building Society (NBS) in 1983
  • 39. Online Banking • Be that as it may, it is estimated that a total of 55 million families in America will be active users of online banking by the year 2010. • • The number of online banking customers has been increasing at an exponential rate. http://ezinearticles.com/?History-of-Online-Banking&id=270075
  • 40. Drivers 1. Reduce Cost 2. Competitive Advantage 3. Protect Strategic Position
  • 41. Banking • For example, while the cost of transaction for money transfer was 40p for checking and 10p for ATM, while it was only 1p for Internet • First ATM 40 years ago
  • 42. Online banking It is generally recognized that perceived risk plays a negative role in decision to adopt a new technology including Internet service Regarding Internet banking, perceived risk involves two concepts: security and trust. Complexity is “the degree to which an innovation is perceived as difficult to understand and use” Ease of use”
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  • 45. Where is Patient Computer interaction in other industries and where in Medicine Where would you place yourself?
  • 46. Characteristics • earlier adopters have – greater empathy – less dogmatism – less fatalism – greater rationality – great intelligence – more favorable attitude toward change.
  • 47. Speed of innovation • the degree to which an innovation is perceived as being consistent with the existing values, past experiences and the needs of potential of potential adopters • negative attitudes cause resistance to change and lack of management commitment
  • 49. Speed of Innovations Larger organizations do better than small generally (implementation of online banking)
  • 50. So What is Next?