A ‘Large Language Model’ for Strategy

We have effectively killed off the independent sphere. What’s changed is the world around us is now within us — there is no “out there” that separates the observer from the observed. The deep chaos, strategic collapse and rampant commoditization unfolding worldwide reveals how ill-suited our vocabulary is to guide us through a total change in context….multiple shifting paradigms….for which the past offers no adequate compass. If the goal is displacing the status quo, competing at a different level or leapfrogging the current state, then management teams in business and government alike are going to need a whole new taxonomy for leadership.

Systems thinking is high-leverage thinking. It’s a ‘large language model’ from which to reframe strategy, a different cognitive pattern, stretching minds and imaginations with a new assemblage of words. Systems thinking creates new pools of value and power from combing markets in new ways. It opens space for bigger ideas.

Blue Spoon writing reflects fluency in systems thinking, positioning using a New Grammar of Strategy® from which to see and enact large-scale change. Outcomes happen at a system level; the locus for modern strategic visions should be the same.

05.02.23

Small and Simple, Not “Epic” and “Enormous”

The European Union’s drug policy overhaul feels under-conceptualized. Small and simple, not “epic” and “enormous”— It stayed squarely within ‘drug pricing’ as the surface area for solutions to improve healthcare in Europe. It is also policy born from the economics of fragmentation: the idea that any one piece can be isolated from its context and measured with precision.

Healthcare is a 'nested market' — its main feature is the density of structural linkages and interactions that cut across domains.

By not understanding how to create with complexity, the EU's drug reform has missed its moment to develop a modern innovation agenda, to position strategy for market interoperability, to cohere a carnival of markets and polices around the ‘production of affordable health’ as an economic objective.

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12.30.22

The Year We Stopped Riding the Magical Wave of "Digital"​

Mark 2022 as the year we stopped riding the magical wave of "digital".

Technology is never decisive, and is often strategically distracting. It can be expensive confusing new technology for a modern strategy. And it can be lethal for those still buying the simple headline that technology vision is synonymous with growth. If there's a lesson from last year, it's that our thinking will need to become better at gauging the distance between the real stakes of new economic ideas and the marketing tools and sketchy rationalizations of Big Tech. This is a great assessment by Brooke Masters, the US Financial editor at the Financial Times, yesterday in her year-end piece (Three ways Big Tech got it wrong):

"It’s time to unlearn the lessons of Big Tech.

For 20 years, the Silicon Valley giants and their peers have set the standard for corporate success with a simple set of strategies: innovate rapidly and splash out to woo customers. Speed rather than perfection, and reach rather than profits proved key to establishing dominant positions that allowed them to fend off, squash or buy potential rivals.

Entrepreneurs everywhere took note, and an assumption that scaling up and achieving profitability would be the easy part took hold far beyond the internet platforms where these ideas originated.

Investors, desperate for growth and yield amid historically low interest rates, were all too happy to prioritise the promise of growth over short-term earnings. During the pandemic, the trend became extreme, as the shares of companies with big dreams and equally large losses soared to dizzying heights.

Those days are over….

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12.19.2022

AbbVie Leaves the Herd

Renovation is required to the PhRMA storyline of value.

In any industry at any given time, there is a theoretical boundary of performance for which the operational state of the art is attained. This boundary is called the productivity frontier, which Michael Porter defined as the “sum of all existing best practices at any given time.” For the the pharmaceutical industry worldwide, strategy centered on defending “pricing” in the “drug market” has reached its productivity frontier.

As a theme for strategic communications, it has lost its ability to persuade.

It is now a losing argument because of ‘message decay’ and monotonous repetition at the extreme end of redundancy. There’s no more juice left to squeeze from the orange. It is also failing to create new power because of a strategic orientation bounded too narrowly, within the wrong economic context. And so as an industry narrative, it has a low probability of delivering influence, sparking original ideas or reshaping an operating environment.

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12.01.2022

General Catalyst Creates 'Space for Computability'​

"Ecosystems" aren't 'out there' already. They're designed and managed, with intention. System entrepreneurship is the intellectual and creative fulcrum to bring about their genesis. The process starts by abandoning the idea of ‘monovation’ — depending on a single source of innovation -- as an investment thesis.

It's a new kind of rational magic to convert ideas into revenue.

Pools of value form in the space between the words (e.g., "healthcare" + "life sciences" = n). It's the and where new power and leverage come from. Superwinners aggregate. They create a portfolio of new economic systems ("ecosystems") to reshape operating environments, write new rules of play and enact large-scale change. They are able to see and sustain a symbiotic meeting of minds questing together to spark opportunities for new markets and new feedback loops.

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08.17.2022

On ‘Strategic Fit’ to the New World Disorder

The Main Drift is painfully apparent:

The West has reached a place where an inversion of the expected order has happened. The most hackneyed word in the lexicon of Western thought needs serious re-evaluation.

Across business and government settings, infinite means (technology) are being mistaken for ends, operations are being confused for outcomes, “strategy” is something that is described afterwards, a watery residue of past actions taken in isolation from each other, then packaged and positioned in PowerPoints to sell the idea that this is what we intended all along. 

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07.06.2021

The 'Amazon Way'​ of Strategy

It’s December 1, 1976, and the Sex Pistols are being interviewed on live television.

Appearing on the British Today show at the supper hour, the Pistols' frontman John Lydon (Johnny Rotten) responded to interviewer Bill Grundy’s command, “Say something outrageous,” by calling him a “dirty fucker” and a “fucking rotter.”

The newspapers put the Sex Pistols on the front page for a week with screaming headlines like “TV Fury Over Rock Cult Filth” and “Punk? Call It Filthy Lucre”. Members of Parliament denounced them.

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06.06.2021

If the Objective in an Alzheimer's Study is "Evidence of Effectiveness,"​ Think Biogen + Spotify

Singer/songwriter Glen Campbell, best known for songs like “Rhinestone Cowboy” and “Gentle on My Mind,” went public with his Alzheimer's diagnosis in 2014 and allowed his journey to be documented in the film "I'll Be Me." The film’s director, James Keach, followed Campbell on his farewell tour that year, as he and his family navigated the wildly unpredictable nature of his progressing Alzheimer’s disease using what his family described as “love, laughter and music as their medicine of choice.”

“Continuing to engage with music helped him plateau," his wife, Kim Campbell, said at the time. "Music really kept him content. We would use it to soothe him when he got agitated." 

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01.13.2021

The Strategy That Didn’t Fix Healthcare

There is a perpetual short circuit in thinking about New Strategy for the next healthcare. “Cost” isn’t The Problem; the ‘production of health’ is.

The gap between computation and culture is not just a gulf between different systems of symbolic logic, of representation and meaning: it is also a gap between different modes of imagination. The next healthcare (+ life sciences) will emerge in the zone where human and computational assemblages can do extraordinary things.

 Which is what Amazon already knows how to do better than anyone.

Our perspective on the end of Project Haven.

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11.11.2020

A Time for 'Big Innovation'​

We are sitting astride a stark rupture in the historical timeline, a wholesale destruction of contexts. It's time for a new category of ideas to enact large-scale system change.

Healthcare's next cycle of evolution links the 'production of health' with economic development as New Strategy for "transformation," one that happens on a market-shaping roadmap. It's about assuming Total System Leadership for the 'common good' and working with a new philosophy of value. Outcomes and community impact are the organizing ideas to measure strategic success.

Though the US is the world’s largest economy as measured by GDP, writes David Rotman, editor at large of MIT Technology Review, it is doing poorly on indicators such as environmental performance and access to quality education and health care. That's data from the Social Progress Index, released late this summer by a Washington-based think tank. In the annual ranking (done before the covid pandemic), the US came in 28th, far behind other wealthy countries, including ones with slower GDP growth rates.

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02.19.2020

Strategic Fit to the Next Healthcare

During a briefing by academics at the London School of Economics as the 2008 financial crisis was reaching its climax, Queen Elizabeth II, whose personal fortune was estimated to have fallen by as much as 25 million pounds, asked the question that was on the minds of many of her subjects: "Why did nobody see it coming?"

The response by her advisors at the time was blunt:

Economics could not give useful service to explain the crisis because current economic theory has established that it cannot predict such crises. As John Kay, one of Britain’s leading economists wrote shortly afterwards, "Faced with such a response, a wise sovereign will seek counsel elsewhere.”

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05.28.2019

With New Gene Therapy, Novartis Assumes 'Total System Leadership'​

Solving insurance churn is Blue Ocean for payer and pharmaceutical markets to cohere and collaborate on health system innovation. The principal challenge isn’t technical, but conceptual: working with a new mindset and set of ideas to find mutual understanding on shared business objectives, and then reorganizing the behavior of a system of markets within a new health context.

Per new data from the Bureau of Labor Statistics, more than 2 million workers and their families lose or transfer to new commercial health plans every month in the United States. The average person has about a dozen jobs in their lifetime.

Alternative payment models -- e.g., outcomes-based reimbursement for orphan drugs and new gene therapies, such as Luxturna from Spark Therapeutics, which is priced at $425,000 per eye, and now Zolgensma from Novartis -- fall apart practically when treatment longer than a year is key to the value story.

Who “owns” the patient experience?

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05.02.2019

Who Wins the Manny for Health System Value?

MedAdNews is a trade publication covering the business of pharmaceutical marketing. It’s somewhat like Advertising Age, in that it’s focused on serving and celebrating the subsystem of marketing and communications agencies and media buyers who create the content to position and promote prescription drug brands directly to consumers and health care professionals.

It’s big business.

In 2016 alone, according to the Journal of the American Medical Association, the pharmaceutical industry as a whole invested somewhere around $30 billion on drug advertising, promotion, public relations and sales across audiences and therapeutic categories. The overwhelming majority of the content looks like this:

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04.13.2019

Overload and Boredom as Points of Innovation in Health Care

"Awareness" campaigns are a new category of waste in health care. 

Most of us accept administrative complexity, inefficient workflows, obsolete care standards and ample fraud as root cause for around $1 trillion in waste floating throughout the current system(s). 

In a Harvard Business Review piece not long ago, a group of authors spanning government, economics, entrepreneurship and strategy consulting got together “to assess what we already know we can save in our system and where policymakers, entrepreneurs, investors, and health care leaders need to focus their attention.”

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04.02.2019

"Value"​ in Healthcare is a New Market to Design

During a visit to the London School of Economics as the 2008 financial crisis was reaching its climax, Queen Elizabeth asked the question that no doubt was on the minds of many of her subjects: "Why did nobody see it coming?"

The response, at least by the University of Chicago economist Robert Lucas, was blunt: Economics could not give useful service for the 2008 crisis because economic theory has established that it cannot predict such crises. As John Kay writes, " Faced with such a response, a wise sovereign will seek counsel elsewhere.

And so might we all.

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03.08.2019

For Health & MedTech @SXSW - It's The Outcomes, Stupid

The means of creativity are endless. It's new ends that are in short supply.

The 2019 SXSW Conference & Festival is officially underway. Organizers behind the coming ten days of innovation theater are promising "a whirlwind of inspiring sessions, film screenings, meet ups, early morning tacos, showcases, exhibitions, competitions, late night tacos, and ample opportunities for networking."

Sounds cool.

There's even a SXSW bot affectionately called "Abby," who you can bond with and personalize to deliver a casual, fun and easy-to-follow experience to help navigate the event, and indulge in all the raw and boundless possibilities on display.

We're being carried away on a vessel of quasi-religious longing. There is a mythology that shrouds the system

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02.25.2019

Note to Pharma: Your Marketing is Showing

The problem that's arrived for the pharmaceutical industry is that its marketing is showing. If only it worked.

For more than a century, most Western companies have been working under a Fordist model of mass production and consumption, where industrial capitalism places the idea of 'promote-and-push product' as the center of commerce. The purpose put into the machine is managing "brand".

It's an entrenched mode of being and thinking.

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02.07.2019

Prelude to #HIMSS19 — Technology Isn’t Healthcare

It's about output, not input.

Competing on outcomes is the story behind all other stories about what it means to "transform" healthcare. It's a different kind of big for an $18 trillion global health economy that's moving to a new logic.

The transformational remit for strategic leadership is the ability to creatively explore new market space, quickly assemble a unique intellectual viewpoint, then design the new infrastructure -- the nervous system -- to own the space.

New business development is new market development.

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01.28.2019

The Problem That’s Arrived for the Pharmaceutical Industry

It has less to do with "drug."

For more than a century, pharmaceutical companies -- and the armies of vendors and advisors they buy and deploy to create capabilities and operationalize plans -- have been working under the Fordist model of mass production and consumption. It's a deeply entrenched mode of being, a view of identity and approach that prevailed for much of the twentieth century, where industrial capitalism achieved a relatively benign balance among the contending interests of business and customer.

It's the logic of the past, though, an outmoded way of thinking that's baked a kind of strategic atrophy into the system. And it will be on full display this week.

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01.03.2019

Healthcare Needs a Punk Rock Vision

It’s December 1, 1976, and the Sex Pistols are being interviewed on live television.

Appearing on the British Today show at the supper hour, the Pistols' frontman John Lydon (Johnny Rotten) responded to interviewer Bill Grundy’s command, “Say something outrageous,” by calling him a “dirty fucker” and a “fucking rotter.”

The newspapers put the Sex Pistols on the front page for a week with screaming headlines like “TV Fury Over Rock Cult Filth” and “Punk? Call It Filthy Lucre”. Members of Parliament denounced them.

“Anarchy in the U.K.” entered the charts at Number 43, but record company executives refused to handle it as EMI was fast buckling under the public pressure. The Pistols added to the outrage by refusing to apologize, and by doing long interviews in which they denounced the entrenched system of music ratings and sacred luminaries like Mick Jagger and Rod Stewart. They went on tour, traveling around the United Kingdom in a bus, arriving at gigs only to discover that they had been banned in the township. Out of twenty-one scheduled dates, the Sex Pistols played three.

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12.13.2018

Transformation Isn’t Strategy

Poor strategy is expensive.

General Electric paid more than $6 billion in fees to a galaxy of strategic advisors since the turn of the 21st century, even as its market value collapsed 80 per cent over the same period. (For more context, see GE’s Dealmaking and Outlay to M&A Advisers Called into Questionin the Financial Times).

The company said in October it would write off $23 billion from the value of its power division alone, following the disappointing performance of businesses acquired in the 2015 takeover of Alstom, a French energy company that was one of the largest acquisitions ever by GE, ultimately weighing in at about $10 billion.

Announcing the takeover in 2014, John Flannery -- one of the deal's chief architects as GE's head of business development at the time (and now the company's former CEO) -- called it "a highly strategic acquisition" in a power sector that "has excellent long-term growth prospects." 

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11.05.2018

Why Digital + Drug Discovery = Status Quo

The first transformation to make is in how you think about it.

The future of strategy and competition in the pharmaceutical industry is broader than pharmaceuticals; it also lies in servicing health. More specifically, it lies in transitioning away from an industrial-era view of 'market' bounded within the context of discovering, pricing, manufacturing and promoting the technical merits of a physical product (i.e., drug brand), to a model based on embedding "drug" within entirely new systems of health engagement.

You compete by creating a new dominant context.

It's the story at a system level that becomes the locus of innovation. The narrative transcends online, offline and the line in-between, solving multiple problem spaces, reshaping everyimportant kind of relationship among all businesses, vendors and people. Health system strategy deals in quantity of effects; not one thing, many things simultaneously and interactively.

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10.09.2018

Our Psychic Disintegration in Healthcare

U.S. National Health IT Week begins TODAY and I’m pumped at the prospect of helping “spread awareness of the value of health IT” in supporting “healthcare transformation.” My digital surfboard is primed to ride the multi-dimensional flow of eternal sunshine and technology’s transcendent promise that will emanate from the four-day event in our nation’s capital (October 8-12).

They have a blog where champions of information technology from across the industry are uniting to share their voices on how health IT is catalyzing change in U.S. healthcare. Ron Ritchey, MD, chief medical officer, eQHealth Solutions, posted his view that Health Information Technology and Business Intelligence Possess the Power to Transform an Entire Population’s Health:

“Reflecting on National Health IT Week has made me think of how far the industry has come in the effective use of health data and technology to reshape the way we deliver care to patients. The explosion of innovation and growth over the last 35 years, since I began my practice, has been miraculous to see and be a part of. In fact, I was reminiscing not so long ago — the capabilities we now have at our fingertips would have been thought to be out of a futuristic cartoon, and today, they are commonplace.”

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09.14.2018

Technology Isn't Innovation

Three non-Apple and non-Amazon events caught my divided attention this past week. In no particular order:

• We are now in the fiftieth year of the official US health care "crisis." For more than half a century, ballooning health care costs have been a source of concern, confusion, complexity and impending catastrophe to the American economy and employer operating margins when, on July 10, 1969, President Richard Nixon, proclaimed, “We face a massive crisis in this area.” Without prompt administrative and legislative action, he added at a special press briefing, “we will have a breakdown in our medical care system.” Michael L. Millenson, an adjunct associate professor of medicine at Northwestern University’s Feinberg School of Medicine, marked the milestone with an excellent piece this week in Health Affairs. Here's the link: Half A Century Of The Health Care Crisis (And Still Going Strong).

• A "summit" was held to discuss the future of pharmaceutical pricing and market access in an evolving healthcare environment. That's the event's description from the Financial Times, host of the day. Topics on the agenda included the politics of drug pricing, the rise of real-world evidence, the role of pharmacy benefit managers and what "value" means to different stakeholders. Department of Health and Human Services Secretary Alex Azar delivered the keynote, where he said he isn't banking on the pharmaceutical industry to fix the rising cost of prescription drugs in the US. 

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08.03.2018

Do "Patients" Still Matter?

Ever since The Innovator’s Dilemma was published more than twenty years ago, everyone has either been busy trying to disrupt, or scrambling to avoid being disrupted by, a pack of ravenous hyenas from Silicon Valley.

Jill Lepore, writing recently on the gospel of innovation in the New Yorker (from which the above image comes), says “the rhetoric of disruption — a language of panic, fear, asymmetry, and disorder — calls on the rhetoric of another kind of conflict, in which an upstart refuses to play by the established rules of engagement, and blows things up.”

There are disruption consultants, disruption seminars, and disruption conferences, where you can “hear from people who are not only setting the rules but also changing the tech game.” (TechCrunch is hosting “Disrupt SF” in September; you can get your pass here).

To be sure, structural change has occurred. Deep, inevitable forces have re-configured how the world thinks, interacts, creates, communicates…and in what has value.

But the “technology” part is a commodity input to this story. Tech is essentially free.

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10.26.2017

Apple, Amazon and the New Health Infrastructures

Anyone surprised that Apple considered buying a network of primary care clinics is misreading the $20 trillion shift happening in healthcare worldwide. All the money is moving to a new form of competition based on outcomes delivered through a consumer-grade experience.

The industry re-organization is happening in different ways and at different rates in different markets. But it has progressed to the point where the global trend is clear and rapidly accelerating: the center-of-gravity for health system strategy is on entirely new value propositions and enabling (if not guaranteeing) better outcomes. 

Winners will be those who can navigate this transition space with leadership and a superior understanding of outcomes-based innovation, at scale.

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03.29.2018

China Has a Vision for Health System Strategy. What This Means for the U.S.

We are essentially linear creatures.

Whether this is the native mode of humanity, or whether it is the result of acculturation, is open to question. Western society fosters and rewards linear behavior and performance from kindergarten on. Our educational system teaches and grades on it; our social programs are designed and executed on it; and it drives decisions throughout most government, nongovernment, and commercial settings.

The strategic context for business has changed radically, though, with old patterns of power fracturing along new lines.

Culture itself is passing through a new time, and the journey promises to be more transformative than the industrial revolution at the turn of the century, and the agrarian revolution sparked by the development of agriculture in the Neolithic Age.

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01.11.2017

The Magic Leap to New "Value" in Pharma

The transformation train is leaving. Powered by the promise of technology and design thinking, companies worldwide are scrambling to find a seat before disruption disrupts; across industries, somewhere around $2 trillion is going to be invested in "digital transformation" before the end of 2019 (here's the data point). Two years, $2 trillion...that's roughly the size of India's GDP. That's a very big spend.

Structural change has occurred. It is not a “happening” so much as it is a “now.” Deep, inevitable forces have re-configured how the world thinks, interacts, creates, communicates…and in what they value. 

The bleeding-edge of the next generation expectation – Amazon, Tesla, Uber, Netflix, Zappos, AirBnB, Alibaba, Google – understand how to shape the future because they understand how to harness these new forces within organizational culture and business strategy. These companies are hybrids guided by a new type of thinking – part human, part machine – embedded in an engine of constant flux. Legacy industries, including (but certainly not limited to) the global healthcare system, are struggling to adapt. 

Said better by William Gibson in 2003, “the future is already here; it’s just not evenly distributed.”  

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