If you’re reading this page, then you’re likely someone who wants to have a major impact on the healthcare industry. Perhaps you’re driven by a personal experience that touched you, a family member or close friend. Or maybe, like me, you’ve gravitated to the sector simply because it offers you an opportunity to have a positive impact on your community and the well-being of potentially millions of people. Whatever brought you here, there’s one thing that’s definitive, you’ve found yourself working in an industry that’s incredibly complex, seemingly irrational, and infamously difficult to navigate. Whether you’re working in a startup, or you’re an employee at a healthcare organization trying to drive innovation from within, it’s imperative that you fight to understand what’s going on around you. In my experience, the best path forward is to stand on the shoulders of the great minds that came before you. And for me, the best way to do that is to read. Here I will compile the list of books, some healthcare-specific, many not, that have had the biggest impact on my thinking in this space.
My perspective on healthcare started with health IT and this was one of the first books I read on the topic. Over the years, it has been (and still is) the #1 book I recommend to people getting into health IT. It provides a solid foundation to build upon. It’s a bit dated now, basing much of its teachings on the Meaningful Use (MU) program, but it covers a lot of ground and is still incredibly relevant. If you’re just getting started in health IT, then I recommend you start here.
From the Book’s Description:
Ready to take your IT skills to the healthcare industry? This concise book provides a candid assessment of the US healthcare system as it ramps up its use of electronic health records (EHRs) and other forms of IT to comply with the government’s Meaningful Use requirements. It’s a tremendous opportunity for tens of thousands of IT professionals, but it’s also a huge challenge: the program requires a complete makeover of archaic records systems, workflows, and other practices now in place.
This book points out how hospitals and doctors’ offices differ from other organizations that use IT and explains what’s necessary to bridge the gap between clinicians and IT staff.
- Get an overview of EHRs and the differences among medical settings
- Learn the variety of ways institutions deal with patients and medical staff, and how workflows vary
- Discover healthcare’s dependence on paper records, and the problems involved in migrating them to digital documents
- Understand how providers charge for care, and how they get paid
- Explore how patients can use EHRs to participate in their own care
- Examine healthcare’s most pressing problem—avoidable errors—and how EHRs can both help and exacerbate it
This is a jarring book. Be prepared to be shocked, enraged, and enlightened by the inner-workings of our healthcare system. David lost his father to that system, and his experience sent him on a mission to understand how, and why, it happened. David was the CEO of The Game Show Network and a complete healthcare “outsider”. David’s understanding of how businesses work, in particular from a financial incentive side, allowed him to get deep into the underlying factors that govern how our healthcare system works.
If you want to innovate, then you must understand where everyone is coming from and what principles drive their decision making. As Stephen Covey puts it “If you wish to be understood, seek first to understand”.
Despite the fact that I yelled out loud in disgust at several points in this book (literally), and peppered everyone I talked to with stories of its seemingly irrational anecdotes for week’s during and after listening to it (I did the audible version of this one; recommend 1.25X speed), I don’t reflect on my time with the book as negative. In fact, once the dust settled and I had some time to process the material, I came away with more sympathy for the “villains” of the story. I began to understand the complex narratives and incentives that make good people do things that seem wrong. I’ve found that much of it is about survival in an organizational and/or employment sense. Starting from a place of understanding, rather than anger and judgment, has allowed me to communicate better with the people I seek to influence. In my opinion, this may be the most important book I’ve read on healthcare so far.
From the Book’s Description:
In 2007 David Goldhill’s father died from infections acquired in a well-regarded New York hospital. The bill, for several hundred thousand dollars, was paid by Medicare. Angered, Goldhill became determined to understand how it was possible that well-trained personnel equipped with world-class technologies could be responsible for such inexcusable carelessness—and how a business that failed so miserably could still be rewarded with full payment.
Catastrophic Care is the eye-opening result. In it Goldhill explodes the myth that Medicare and insurance coverage can make care cheaper and improve our health, and shows how efforts to reform the system, including the Affordable Care Act, will do nothing to address the waste of the health care industry, which currently costs the country nearly $2.5 trillion annually and in which an estimated 200,000 Americans die each year from preventable errors. Catastrophic Care proposes a completely new approach, one that will change the way you think about one of our most pressing national problems.
Influence: The Psychology of Persuasion, Revised Edition by Robert B. Cialdini
No list of books that have influenced my career would be complete without, well, Influence by Robert Cialdini. If you want to understand how people make decisions, often without thinking, then you absolutely must read this book. Cialdini is the definitive source on the topic and has sold more than 3 million copies of this book in 33 languages. Right there, social proof… it’s one of the 6 principles of persuasion that Cialdini dissects in Influence. It’s the reason why you see “Join over 500,000 subscribers” when you’re asked to sign-up for an email list – it tends to make you think “Wow! If 500,000 people signed up it must be good!”
The other 6 principles of influence are:
- Reciprocity: People want to reciprocate when you do nice things for them. Whether it be because they don’t want to feel a sense of indebtedness, or it just makes them feel good, this one holds in everyday life.
- Commitment: People want, no need, their beliefs to be consistent with their values. This can best be seen in confirmation bias – we look for the facts that make our position sound. We tend to ignore the rest. Nowhere is this more evident than in today’s political climate. Notice how the arguments of both sides use overlapping facts, but leave out certain things to make their story work for them. They aren’t (always) doing it on purpose. We’re wired this way.
- Social Proof: I touched on this above. Want to test it out. Go out to the street during lunch today and stare up at a building. A few people will soon join you, not knowing what you’re looking at. And then lots more will join in. If everyone is curious, then I should be too!
- Authority: This one has some fascinating studies to back it. In one, subjects were willing to electrocute an actor to the point of convulsions if someone in a lab coat told them to (all fake, but the subject didn’t know it and pushed the button anyway). Another showed how people would follow an actor in a business suit across the street through traffic, but they wouldn’t follow an actor in jeans and a t-shirt.
- Liking: The more you like someone, the more you’ll be persuaded by them. This one doesn’t need much explanation. You know it’s true. And it has some cross-over with confirmation bias too. That is, you’ll see things to confirm the liking and tend to downplay things that aren’t in line with it.
- Scarcity: Act now, supplies are limited! This sale ends Monday, and after that, it’s gone! If you don’t buy this timeshare right now, you won’t be allowed to buy it tomorrow. They’re in too high of demand and we just can’t have people come back! Admit it. When someone tells you that you can’t have something, you want it more. And if you see that door closing, you’ll feel the urge to act.
Everyone should read this book. Whether you realize it or not, you’re trying to persuade people all day long. Whether trying to get your kids to go to bed, trying to get your boss to accept your idea, or trying to sell a product to millions, these tools can help you be more persuasive. And if that doesn’t sell you, then think defense. These tools can certainly be used for good, but they are regularly employed by dubious actors to take advantage of you. If you understand the tactics, then you’ll see it coming and be able to protect yourself. I just tried to close with loss aversion. Did it work?
This was a jarring read. Makary tells the story of a “code of silence” that exists among healthcare professionals. Specifically, when it comes to talking about bad doctors who harm patients. He ran into this very early in his career where he met Dr. HODAD. HODAD had great bedside manner and was very popular with patients. He was also a big revenue generator, and therefore very popular with hospital leadership too. The problem was, he was a terrible surgeon and was regularly harming patients. Everyone who worked with him knew it and that’s why they called him HODAD – Hands of Death and Destruction. I don’t know about you, but that scares the crap out of me. Online ratings won’t help you – patients love HODAD. And the best doctors lists won’t either – he’s celebrated by the health system. Makary tells us that the only way to know if your doctor is any good is to ask the people who work with them. They’re the only ones who know the truth.
The book goes on to address all reasons that enable and enforce the code of silence and gives you a deep understanding of the many challenges clinicians face every day. From burnout to impairment (he calls physician impairment a “public health crisis”), to quality measures and financial incentives that create dangerous situations for the patient, Makary paints a picture of a profession in need of help.
This one is worth reading, first and foremost, to protect your family. I now know what questions to ask before heading in for surgery. It’s also important, as I always say, to understand the world of everyone working around you in healthcare. After working in this business for a number of years, it’s all too easy to become jaded and cynical. To think that people don’t care, are selfish and gaming the system, or are flat-out irrational. But, when you dig in and get a true understanding of the pressures and incentives that are driving them, it begins to make more sense. If you can understand and sympathize with those you seek to serve, then you’ll be in a much better place to succeed.
This book is a MUST READ for anyone who is human and may need healthcare someday. It’s doubly important for all of us working in and trying to understand the incredibly nuanced and complex world of healthcare. This one will change you.
From the Book’s Description:
Dr. Marty Makary is co-developer of the life-saving checklist outlined in Atul Gawande’s bestselling The Checklist Manifesto. As a busy surgeon who has worked in many of the best hospitals in the nation, he can testify to the amazing power of modern medicine to cure. But he’s also been a witness to a medical culture that routinely leaves surgical sponges inside patients, amputates the wrong limbs, and overdoses children because of sloppy handwriting.
Over the last 10 years, neither error rates nor costs have come down, despite scientific progress and efforts to curb expenses. Why? To patients, the healthcare system is a black box. Doctors and hospitals are unaccountable, and the lack of transparency leaves both bad doctors and systemic flaws unchecked. Patients need to know more of what healthcare workers know, so they can make informed choices. Accountability in healthcare would expose dangerous doctors, reward good performance, and force positive change nationally, using the power of the free market. Unaccountable is a powerful, no-nonsense, non-partisan diagnosis for healing our hospitals and reforming our broken healthcare system.
Readers Note: I did this one on audible. The reader is a bit slow but very listenable at 1.25X speed.
An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal
This is another book that dissects the myriad problems in our healthcare system. In the same vein as Catastrophic Care (see above), Rosenthal digs deep to uncover and understand the incentives that make rational people do seemingly irrational things. This book extends on the ideas I found in my earlier reads on the topic and, most importantly, it gave me powerful tools to use as a patient.
If you’re in the business of healthcare, then I would read Catastrophic care first and then this. But do read both.
If you’re a patient, I would start here.
From the Book’s Description:
In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast?
Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw.
The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn’t just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a health care system that no longer has our well-being at heart.
I found the commentary to be a bit too one-sided in this one, but I gained a healthy new respect for the downsides of Big Data, Machine Learning, and AI. If you take everything at face value, you’ll come away from this book assuming that these tools are too dangerous to use and that the risks far outweigh the benefits. I’m definitely not in that camp. I’ve been using technology to create value since the late ’90s and I’ve seen incredible good come from my work. I don’t see new technology as having a predetermined path. If used by good people for good reasons, then they have a great chance to create value. If used by bad people for bad reasons, then they can have bad results. The problem is that there’s a lot of grey in this world, and sometimes, even with the best of intentions, good people may inadvertently cause major harm to others through their algorithms. In that respect, my two HUGE takeaways from this book, that I’ve tried to apply regularly to everything I do are these questions:
What’s your feedback loop?
The example of the self-fulfilling system that is the US News and World Report College School rankings is all you need to understand this one. If you build models and systems with no feedback loops, then you risk having them become their own feedback loop. That means that no one can ever question the system and the system is always right because its the only answer. No bueno.
Where is the value coming from?
If you implement a new model that drives value for your business, then it’s possible that value is coming directly from someone else (i.e. disruption) or, it may be changing things for others that cause them unknown hardship. The example of the Starbucks scheduling model that optimized start and end times for baristas lead to great savings for Starbucks but took away the baristas ability to have a second job, schedule reliable childcare and transportation and more. Some people may be ok with that, and I’m not judging, but I know that I’m not. So now I ask myself “Where is the value coming from?” and “Are you ok with that?”
This book is a must-read for anyone who uses data to make predictions or drive decisions. And, as I said, it’s one-sided, so go in with an open mind and I promise you it’ll be worth it.
From the Book’s Description:
A former Wall Street quant sounds an alarm on the mathematical models that pervade modern life — and threaten to rip apart our social fabric
We live in the age of the algorithm. Increasingly, the decisions that affect our lives—where we go to school, whether we get a car loan, how much we pay for health insurance—are being made not by humans, but by mathematical models. In theory, this should lead to greater fairness: Everyone is judged according to the same rules, and bias is eliminated.
But as Cathy O’Neil reveals in this urgent and necessary book, the opposite is true. The models being used today are opaque, unregulated, and uncontestable, even when they’re wrong. Most troubling, they reinforce discrimination: If a poor student can’t get a loan because a lending model deems him too risky (by virtue of his zip code), he’s then cut off from the kind of education that could pull him out of poverty, and a vicious spiral ensues. Models are propping up the lucky and punishing the downtrodden, creating a “toxic cocktail for democracy.” Welcome to the dark side of Big Data.
Tracing the arc of a person’s life, O’Neil exposes the black box models that shape our future, both as individuals and as a society. These “weapons of math destruction” score teachers and students, sort résumés, grant (or deny) loans, evaluate workers, target voters, set parole, and monitor our health.
O’Neil calls on modelers to take more responsibility for their algorithms and on policy makers to regulate their use. But in the end, it’s up to us to become more savvy about the models that govern our lives. This important book empowers us to ask the tough questions, uncover the truth, and demand change.
Demystifying Big Data and Machine Learning for Healthcare (HIMSS Book) by Prashant Natarajan
From the title, you might expect this to be a “hype” book. You know… the kind that praises buzzword technologies and tells you how they’re going to fix all of healthcare’s problems. I can assure you that it is nothing of the sort. It’s a practical look at tools (yes… they’re just tools), that when applied thoughtfully to clearly defined use cases, can help you solve important problems in healthcare TODAY.
I’ve been wrangling data since 1997, and there are some fundamental principles I’ve learned along the way. Many of them can be found in this book. In fact, when I first met Prashant (lead author) I told him that I’d wished he’d written this book 15 years earlier. It would have saved me lots of heartaches (not to mention hundreds of hours). For me, the biggest take away is the concept of Data Fidelity. That is the fitness of data for a purpose. If you can grasp this concept, and apply the practical strategies outlined in the first half of this book, then you’ll outperform your peers. Hands down.
I love this book because it starts with the fundamentals of data quality, data fidelity, Master Data Management (MDM), and other essential building blocks. Only then do they talk about how big data and machine learning can be applied to your data to create value. The horse pulls the cart in this book and it’s a must-read for anyone working with healthcare data today.
Also, Prashant was kind enough to join me on the podcast twice. Both episodes are jam-packed with insights and have been very popular with our audience. Check them out here:
Antifragile: Things That Gain from Disorder (Incerto) by Nassim Nicholas Taleb
This is not a healthcare book, but it helps you to understand why our $3.5 Trillion megalith of a health system is so hard to change. Fragility is when things are prone to damage under stress. Taleb points out that there is no antonym in the English language. The opposite of fragility is not robustness or rigidity – those terms describe things are difficult to break. The opposite of fragility is something that gets stronger when exposed to stress. Taleb calls this antifragile. An individual restaurant is fragile – its prone to the pressures of the market. If it doesn’t impress its customers and do so under a business model that allows it to succeed, then it will fail. This is why you see restaurants turnover so frequently. On the flip side, the fragility of each individual restaurant forces restauranteurs to innovate and try new things. That gives us variety and in turn, makes the restaurant business as a whole antifragile.
What does that have to do with healthcare? Well, our healthcare system is heading in the exact opposite direction. The complexity of the system and our move to value-based payment is forcing small practices to sell out and join big health systems. Payers are consolidating. Everything is getting bigger and more centralized. When lots of small practices and payers compete and innovate at the local level, they are each fragile like the restaurant, but their collective fragility makes the national health system antifragile. When a few large health systems and payers dominant entire regions, they have less reason to compete and innovate and spend more time protecting their empire. Each large system becomes less fragile than it’s smaller counterparts, but they’re sucking this antifragility from the system as a whole. The more this happens, the more fragile our entire health system, the same one that makes up 1/5 of our economy, becomes. It’s kind of like the banks that were too big to fail in the late 2000s.
There’s much more than that to this book, and it was an important read for me. I recommend it to anyone trying to understand large systems in general, but for those of you in healthcare, it will have special meaning. I promise you it will make you think. A lot.
From the Book’s Description:
Antifragile is a standalone book in Nassim Nicholas Taleb’s landmark Incerto series, an investigation of opacity, luck, uncertainty, probability, human error, risk, and decision-making in a world we don’t understand. The other books in the series are Fooled by Randomness, The Black Swan, Skin in the Game, and The Bed of Procrustes.
Nassim Nicholas Taleb, the bestselling author of The Black Swan and one of the foremost thinkers of our time, reveals how to thrive in an uncertain world.
Just as human bones get stronger when subjected to stress and tension, and rumors or riots intensify when someone tries to repress them, many things in life benefit from stress, disorder, volatility, and turmoil. What Taleb has identified and calls “antifragile” is that category of things that not only gain from chaos but need it in order to survive and flourish.
In The Black Swan, Taleb showed us that highly improbable and unpredictable events underlie almost everything about our world. In Antifragile, Taleb stands uncertainty on its head, making it desirable, even necessary, and proposes that things be built in an antifragile manner. The antifragile is beyond the resilient or robust. The resilient resists shocks and stays the same; the antifragile gets better and better.
Furthermore, the antifragile is immune to prediction errors and protected from adverse events. Why is the city-state better than the nation-state, why is debt bad for you, and why is what we call “efficient” not efficient at all? Why do government responses and social policies protect the strong and hurt the weak? Why should you write your resignation letter before even starting on the job? How did the sinking of the Titanic save lives? The book spans innovation by trial and error, life decisions, politics, urban planning, war, personal finance, economic systems, and medicine. And throughout, in addition to the street wisdom of Fat Tony of Brooklyn, the voices and recipes of ancient wisdom, from Roman, Greek, Semitic, and medieval sources, are loud and clear.
Antifragile is a blueprint for living in a Black Swan world.
Erudite, witty, and iconoclastic, Taleb’s message is revolutionary: The antifragile, and only the antifragile, will make it.
I like this book because it’s an accounting of Health IT’s history, impact, and potential from the point of view of a very pragmatic physician. Wachter has his doubts to be sure, but he expresses them in a constructive way. He’s also cognizant and supportive of Health IT when applied properly and in the right places. I struggle with anyone who sells too hard for or against anything, and when it comes to Health IT, people tend to operate at the extremes. This was a breath of fresh, practical air from a man who knows the business and maintains an open mind. If you’re in Health IT, read this so that you won’t be too full of yourself and your solution. If you’re in medicine, read this so that you’ll have a better sense of the possibilities.
From the book’s description:
While modern medicine produces miracles, it also delivers care that is too often unsafe, unreliable, unsatisfying, and impossibly expensive. For the past few decades, technology has been touted as the cure for all of healthcare’s ills.
But medicine stubbornly resisted computerization – until now. Over the past five years, thanks largely to billions of dollars in federal incentives, healthcare has finally gone digital.
Yet once clinicians started using computers to actually deliver care, it dawned on them that something was deeply wrong. Why were doctors no longer making eye contact with their patients? How could one of America’s leading hospitals give a teenager a 39-fold overdose of a common antibiotic, despite a state-of-the-art computerized prescribing system? How could a recruiting ad for physicians tout the absence of an electronic medical record as a major selling point?
Logically enough, we’ve pinned the problems on clunky software, flawed implementations, absurd regulations, and bad karma. It was all of those things, but it was also something far more complicated. And far more interesting . . .
Written with a rare combination of compelling stories and hard-hitting analysis by one of the nation’s most thoughtful physicians, The Digital Doctor examines healthcare at the dawn of its computer age. It tackles the hard questions, from how technology is changing care at the bedside to whether government intervention has been useful or destructive. And it does so with clarity, insight, humor, and compassion. Ultimately, it is a hopeful story.
“We need to recognize that computers in healthcare don’t simply replace my doctor’s scrawl with Helvetica 12,” writes the author Dr. Robert Wachter. “Instead, they transform the work, the people who do it, and their relationships with each other and with patients. . . . Sure, we should have thought of this sooner. But it’s not too late to get it right.”
This riveting book offers the prescription for getting it right, making it essential reading for everyone – patient and provider alike – who cares about our healthcare system.
NOTE: This is an active project begun on August 16, 2018. I’ll be adding more books regularly over the coming weeks, so check back for more titles soon. ~Don Lee