Incendies

A friend recommended that I go to this movie.  She had gone, not because Incendies was nominated for an Academy Award, but because she would go to see anything of Denis Villeneuve's.  I've now joined the Villeneuve fan club.

Incendies was a complex film with an intricate plot, spanning two generations, two countries (Canada and Lebanon), and two time periods.  It starts with twins who are charged in their mother's will to trace their father and brother.  The quest takes first Jeanne, and then her twin Simon, to Lebanon on a sleuthing mission.  Interwoven with this quest is that of their mother, who lived through the cruel civil war in Lebanon in the eighties.  After being captured during the war, she is brutalized in a Lebanese prison.  Yet she is remembered as 'the woman who sings', a testament to her courage and fortitude. 

Incendies is a powerful film, documenting inhumanity in the name of war and religion.  Incendies is a film of people's ability to rise above their conditions and live a life of meaning, and, ultimately, conciliation.  Two views - take your pick.

Put this on your must-see list.

Russka

Edward Rutherford's novel Russka is a great read.  960 pages.  1800 years of history.  A sweeping history of Russia through the tales of several families - peasants to the nobility.  It's a rollicking good story, or rather a series of stories, with each section set in a different time period, linked because they cover multiple generations of the same families.

I would say my knowledge of Russian history is limited to the major facts.  The five families in this book are set against the major events of Russia's history.  And the main feeling I gained was of how backward Russia has been.  It's always been behind the rest of Europe, and it's never had the incredible cultures and accomplishments of other Asian countries.  Serfdom was still in vogue long after the rest of Europe was developing healthy middle classes.  The serf had a miserable life; although not technically a slave, he was not allowed to move to a new farm or work for a new master.

The maintenance of such stiff autocracy by the tsar into the 20th Century meant that at the time of the revolution, there was no history at all in Russia of anything other than completely autocratic rule.  I knew that of course, but this book really got me thinking aobut it and put Russia's current situation in perspective.  They don't have good governance now, but in fact they never did.

Suite Francaise

Suite Francaise is a book about the early days of World War II, as the Germans are advancing on Paris.  It was written contemporaneously with the events, before the author was sent to Auschwitz, where she died.  The book follows an assortment of characters as they flee Paris before the Nazis.  The majority are a pretty unappetizing bunch, with a highly warped sense of values.  Their characters are revealed through their behaviour:  what they decide to take with them when they flee, and who they decide to take with them.  Will it be the mistress or the faithful servants who get to go?  Will it be valued possessions or food?  And what would I take if faced with the same tortured choices?

I thoroughly enjoyed the book, but it had an unfinished quality to me.  Afterwards, when I read that the author was a victim of the Holocaust before fulling polishing off the book, I understood why I felt that way.  Nevertheless, I would definitely recommend this book.

Driving Disruption in Healthcare

After a rather long hiatus (for a long variety of boring reasons), I'm going to try to catch up with quite a few new posts.

To be in an industry that is being disrupted can be anything from disquieting to distressing to downright terrifying.  Most people in such an industry will respond disruption with denial.  So how do you get them past denial?  Creep up on them with a story from a different industry, so they can understand the concepts and hope they recognize the application to their own industry. 

There’s a story Christensen tells of how this happened at Intel.  Christensen described how the conventional integrated steel industry was disrupted by mini-mills making inferior steel cheaply.  The mini-mills captured the rebar market, bits of steel which are embedded within concrete, a market that needed only low quality and exhibited great price sensitivity.  Since the integrated mills considered this the least interesting segment of the market –  `nuisance´ customers who were the smallest market segment with the lowest profit margin – big steel almost welcomed loss of their rebar customers to the new mini-mills.  Moreover, they disdained these new mini-mills who could only produce steel good enough for the lowly rebar market, and assumed they could never produce steel good enough for any part of the market except rebar. 

But the mini-mills moved quickly up the technological improvement curve and peeled off one segment after another of the steel market, each one bigger and with a better profit margin than the last.  Eventually, the conventional steel mills were left defending their best customers, the car makers.  The car market represented the biggest part of the market, and the most lucrative by far, with the best profit margins.  So conventional steel looked seemed to be doing very well, as their profit margins had steadily increased with the departure of the lower-margin customers.   Until, that is, the mini-mills figured out how to make automotive steel, and conventional steel was wiped out. 

The conventional steel companies had known about the mini-mills for years; they simply didn’t consider them a threat, because of their `crummy' products.  They were complicit in mini-mills taking over the steel market, because they were happy to yield small markets, with low margins and cranky customers in order to focus on bigger markets, with higher profit margins and customers who valued their quality. 

When he heard Christensen tell this story, Andy Groves, Intel’s brilliant CEO, exclaimed, “That’s what’s happening to Intel.  We’re losing the low end of the chip market, and we’ve been complacent about it because they’re the lowest margin segment of the market.  But those low-end chip makers will keep peeling off low-end segments of the market, until they attack our core business”.  Groves acted decisively and built a new low-end chip business for Intel.

And Christensen’s message to the OHA was that the hospital industry was about to be disrupted – in fact had to be disrupted if we are ever to get healthcare costs under control.   And one way they will be disrupted is by simpler hospitals, those without the incredible sophistication of high end acute-care teaching hospitals.

To bring home his point, Christensen describe a company that made axles.  Their oldest plant was about to be closed down because they had the highest per-unit cost, due to high overhead costs.  The manager sought Christensen’s analytical help.  As she and Christensen compared this plant to all the rest, they realized that this was the only plant that offered to build any sort of axle.  The plant layout looked like this:

 When orders came in, they followed different paths through the plant.  This put a high burden of overhead costs on the plant.  Other plants had essentially laid out the different departments in a straight line, and only accepted certain orders, that fit their pre-arranged pattern.  Christensen likened the axle factory to today’s general hospital, whose main costs are due to their very general nature; patients take totally individual paths through the hospital.

Christensen compared this to the Shouldice Hospital in Toronto, which has done the equivalent of those newer axle factories.  They deliver only one treatment, hernia repair, basically in an assembly line.  Thirty patients operated on daily, a full briefing for everybody the night before, walk away from the operating table after their local anaesthetic, and home after a good night's sleep.  When you compare the cost of hernia repair at Shouldice versus a typical acute-care teaching hospital, it's hugely cheaper at Shouldice.  The direct costs are slightly less, but the overhead costs are massively less.  This also follows the pattern of medical services drifting to the simplest - and cheapest - locale possible, as described in the previous post.