"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.”

They categorized the interventions into the different strategies put forth by various experts and political agendas, and analyzed their total potential savings. They then reviewed four strategies: keeping the current health care system’s trajectory as is; comprehensive demand-side reform; aggressive supply-side reform; and a combination of demand-side and supply-side reform.

They had two key findings:

  • The political rhetoric about demand-side versus supply-side as a better option is ill-founded; both have roughly the same effect on total spending.

  • Even if the United States implemented all the approaches whose effectiveness has been measured, only 40% of the estimated $1 trillion of wasteful spending would be addressed, leaving a significant opportunity for innovation in all areas of health care.

Naturally, their effort took the existing system as the thing to fix. Energy and attention was focused on finding problems that fit the math, of imbuing stability into traditional economic theory and casting the arc of healthcare in a form that is amenable to mathematical and deductive methods. Missing, of course, was the human dimension.

When Information Turns to Noise

Welcome to April in America.

You’re no doubt aware this is Autism Awareness Month and Foot Health Awareness Month. April also includes Sexually Transmitted Infections Awareness Month, Oral, Head and Neck Cancer Awareness Week, Infant Immunization Week, Hemophilia Day, Women’s Eye Health and Safety Month...

I'm still catching up on all the calls to action from March’s days of awareness.

Too many organizations concentrate on raising awareness about an issue — such as the danger of eating disorders or high blood pressure in African Americans (see here for Humana’s awareness campaign, “More Healthy Days” Barbershop and Beauty Parlor Tour, launched this week to raise awareness of stroke risk and diabetes in African Americans — without knowing how to translate that awareness into action, by getting people to change their behavior or act on their beliefs.

In Stop Raising Awareness Already, Ann Christiano, who holds the Frank Karel Chair in Public Interest Communications at the University of Florida College of Journalism and Communications, and Annie Neimand, a PhD candidate in the University of Florida Department of Sociology, Criminology and Law, write on the need to adopt a more considered approach to designing public health communications that actually change behavior.

Their perspective:

For those working on a cause they care about, the first instinct is often to make sure that as many people as possible are aware of the problem. When we care about an issue or a cause, it’s natural to want others to care as much as we do. Because, we reason, surely if people knew that you’re more likely to die in an accident if you don’t wear a seat belt, they’d wear their seat belt. And if people only knew that using condoms is critical to preventing the spread of disease, then they would use one every time.

That instinct is described by communication theory as the Information Deficit Model. The term was introduced in the 1980s to describe a widely held belief about science communication—that much of the public’s skepticism about science and new technology was rooted, quite simply, in a lack of knowledge. And that if the public only knew more, they would be more likely to embrace scientific information.

That perspective persists, not just in the scientific community but also in the world of nonprofits, marketing, and public relations. Public relations texts frequently cite awareness, attitude, and action objectives. Marketing students learn that awareness precedes action. And many of the foremost public relations and advertising agencies still report results to clients in the form of impressions—the number of people who were exposed to the message.

Do any of these campaigns work?

The data, naturally, is all over the place. There’s certainly no shortage of “awareness” campaigns around the things that either cause, can or should be done to control diabetes and obesity, for example, but worldwide obesity has nearly tripled since 1975, according to WHO. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.

Bad Versus Good Redundancy

Without significance, variety is not the spice of life.

Says sociologist Orrin E. Klapp in Overload and Boredom, Essays on the Quality of Life in the Information Society:

“Bad redundancy is a lack of information which, when degraded, cheats in some way. It filters out some needed parts of a message while repeating too much that is not needed. It fails to serve continuity. It does not reinforce identity. It defeats resonance.”

Reframing: the gospel of healthcare “transformation” needs new words.

Strategy and innovation should happen at a system level, and include a new kind of communications and creativity. Solving for banality and boredom is as elemental to sustain engagement and health outcomes as all things "digital" and cloud.

Alas, though, the allure of the gadgets is hard to resist. We tend to confuse technology for innovation, and healthcare for technology. It’s costing the world (and investors) trillions.

As Jefferson Airplane’s Grace Slick sang in White Rabbit, “logic and proportion have fallen sloppy dead.”

/ jgs