If you want to be a great painter, perhaps you could reverse engineer what made the Mona Lisa such an important painting.
You could move to Italy. You could learn about shadows and light and technique.
The problem is that the Mona Lisa isn’t the most famous painting in the world because of all of those things. Lots of paintings have those things.
The Mona Lisa is the most famous painting in the world because it was stolen a hundred years ago, was missing for a year and was featured in the then brand-new medium of big newspapers and color printing.
In other words, right when the world was ready for an icon that stood for ‘famous painting’, there she was (or more accurately, wasn’t).
You can’t step in the same meme twice–the second time, the culture is different.
Making the next version of something is a completely different project than creating the conditions for the first version to happen.
February 23, 2025
Those three words unlock our understanding of innovation and of biological evolution.
Successful outcomes often follow unpredicted actions.
If we allow ourselves to do things that might not work, we’re far more likely to discover the things that do.
And then we can repeat them.
February 22, 2025
An expensive watch isn’t purchased to tell time. We already know what time it is.
The food at a wedding isn’t really there to keep guests from going hungry. A cookie could do that.
Our focus, energy and money are often spent on transactions that are disguised as something else. What we’re really doing is buying affiliation, status or the freedom from fear.
February 21, 2025
A great intern brings positive energy, a relentless work ethic and doesn’t cost very much. They ask a lot of questions, and the most useful questions will help you see an existing situation with fresh eyes.
Of course, you’ll expect them to make mistakes, and a professional needs to double-check all of their work. If you skip these steps, don’t blame the intern.
You’ve already guessed that your new best intern is an AI like Claude or Perplexity.
Treat an intern with respect and don’t look for experience. You might learn something useful.
February 20, 2025
The tenured philosophy professor at Princeton might not even be half as effective a teacher as the adjunct at the community college.
The head of surgery might be relatively better at meetings and politics than they are at actually helping patients.
Having a lot of social media followers doesn’t mean you’re really good at making pizza.
Choose accordingly.
February 19, 2025
We take stability for granted, until it’s no longer there.
Some art forms and enterprises benefit from an unstable environment, where systems are in flux and the changes are unpredictable.
Others are nearly impossible.
How much priority do your investors, clients and employees put on building processes that do well in chaos? Or are you betting that the conditions will be just like now, but better?
Resilience is underrated.
February 18, 2025
Some facts and assertions about healthcare (particularly in the US) and then an outline of a change agent that could improve health, perhaps dramatically.
- We spend an enormous amount of time and money on healthcare.
- The typical visit to a healthcare clinic lasts an hour and a half.
- The typical time with a doctor is sixteen minutes.
- Improving the timing and accuracy of a diagnosis has enormous leverage in changing outcomes and reducing costs.
- There is a significant amount of anxiety and dissatisfaction with the system. Patients are upset at the cost, society is paying more than ever, and chronic diseases take an ongoing toll.
- Women and non-white men are often underserved, misdiagnosed and dismissed. The same is true for humans who don’t fit standard types of symptoms and backgrounds.
- The healthcare system makes treatments, not health. It’s treatments that are measured, marketed and sold.
- The rigorously maintained status roles assigned to each player in the system can make communication more difficult. Patients hesitate to share enough information, and communication between and among the professionals in the system is intermittent and often poorly facilitated.
- Doctors and other health professionals are hard-working and care a great deal, but often face burnout because the demands of the system are obstacles on the path to what they actually signed up to do.
And so, a system that’s organized around treatments and status, that misallocates time and effort, causing stress for practitioners and patients. Historical bias in training leaves more than half of the population underserved and unseen, and, as a result, stress is high, many people don’t get the right treatment or hesitate to get any treatment at all, and costs continue to rise.
Systems change is difficult, because persistent systems are good at sticking around. They create cultural barriers that make their practices appear normal, and there are functional barriers as well.
When a change agent (often an external technology or event) arrives, the system must respond, often leading to change. All around us, we see systems changing, and often, that change agent is the smart phone. 91% of adults in the US have a smartphone, and it’s even higher among people under 65.
The ubiquity of the connected supercomputer in our pockets has overhauled the taxi industry, the hotel business, restaurants and most of all, pop culture. But it hasn’t transformed the healthcare system. Add AI to the mix, and it’s possible that change is about to happen.
Imagine an app that does the following:
- The user narrates their symptoms, over time, to a thoughtful AI that provides prompts, encouragement and reassurance.
- The app keeps a date-stamped log of what’s bothering the patient and refines the data over time by prompting with useful questions.
- The user goes to the doctor and the app offers several things:
- It gives the doctor a high-level overview of what the patient is dealing with.
- It records the conversation with the doctor for later analysis and referral.
- It offers the doctor prompts on questions to consider or studies to refer to.
- It asks for any test results or diagnostics to be shared with the patient.
- After the appointment, the app compares the doctor’s interactions with all the doctors dealing with all the patients in a similar situation. This gives the patient insight around standards, and more agency in finding a doctor who might be more effective.
- It maintains a record of healthcare encounters over time, and correlates them with patient health.
- It follows up with the patient to make sure prescriptions are filled and actually taken.
Some patients aren’t comfortable with this sort of interaction, they won’t use it. Some doctors might be skeptical, or concerned about the shift in their status, and they might not work with patients who use it. These behaviors are typical of status quo systems, and both often fade in the face of better results combined with user satisfaction.
Like any tool that shifts an industry of this scale, the business models often take care of themselves.
The biggest information shift here is the more accurate collection and correlation of symptoms and treatments. The secondary (but ultimately longer-term) shift is finding threads of common interest and comparing doctors in their responses to symptoms. (And the side effect of giving patients agency and the solace that comes from insight can’t be ignored). Because both of these data shifts will lead to better patient outcomes (usually at much lower cost, with less trauma) the healthcare professionals who signed up for precisely this outcome will also thrive.
It’s not a panacea. But shifting information flows, improving peace of mind and the quality and timing of diagnosis are problems we can work to solve.
Systems change is never without real dislocations and regret, but this one might be worth building.
February 17, 2025
The smartphone is the most expensive device most people own, and the one they use the most.
Here’s everything you can’t have, can’t afford and won’t get, right here.
Here’s everyone you want to have an argument with, one click away.
Here is every piece of bad news we can imagine, much of it imagined instead of real.
Connection is powerful and magical. It’s also enervating, subject to manipulation and addictive.
Doing what?
When we choose which job to apply for, what career to commit to, which business to start, it might be worth a moment (or a few moments) to get at the heart of what a day well spent produces. What’s it for?
Here are a few to get you started:
- Doing good
- Doing well
- Participating
- Teaching
- Leading
- Showing your skill
- Staying consistent
- Solving problems
- Finding security
- Finding status
- Filling your day
- Pleasing your boss
- Thriving
- Maximizing profit
- Surviving
- Building an asset
- Changing the culture
- Exploring the frontier
- Growing
- Hiding
- Righting wrongs
- Seeking revenge
- Solving an interesting problem
- Playing it safe
- Following a model
- Living an unexamined day
- Raising the stakes
- Sharing smiles
- Smiling
It’s hard to have all of them.
February 16, 2025
Over the last 50 years, 167 different people have been part of the Saturday Night Live ensemble cast. Some of them went on to become comedy superstars, others lasted less than a season and are fairly obscure in the cultural pantheon.
But if you were tasked with creating an all-time MVP cast, it would be a mistake to only pick the movie stars.
Like a baseball team or the local non-profit, the group works when it functions as an ensemble, not a collection of individuals striving for the spotlight.
A brilliant and generous ensemble player isn’t someone who tried to be the big star and almost didn’t make it. They’ve chosen a different path and done it with skill.
Phil, Jane and Fred showed up to do a different sort of work. Weaving the fabric of the ensemble is not a runner’s-up prize, it’s the point.
Because most organizations don’t celebrate this role, they rely on simply stumbling around until they find the linchpin who can hold things together.
Two questions to get you started:
- Did the dozen ensemble stars who made a huge difference on SNL do it with intention?
- What is your organization doing to find and train and reward this work?
February 15, 2025
