Tony Blair’s Memoir — Fascinating, Quirky and Often Funny

This book surprised me — the  reviews I read ranged from mediocre to hostile, but I found  Tony Blair in excellent explanatory form, describing his thinking of New Labour, his efforts to get the party to adopt the ideas, and his fights along the way. That this wasn’t simply a PR exercise is demonstrated by the election of a new party leader, Ed Miliband, who promptly announced the end of New Labour.

 

In chapters on New Labour, Princess Diana, Northern Ireland, government, Kosovo, Iraq and his battle with Gordon Brown, Blair provides his historical account, along with some excellent personality profiles, and then draws some conclusions about the change in English society, why government is slower than the private sector to adapt to change, what makes negotiations work or fail, and the changing role of national leaders in an era of frequent global conferences which leave them far less time to manage politics and parties at home. He is also good on what it takes to be a leader who will go for winning elections rather than persisting in the apparent purity of opposition. 

 

“It’s extraordinary how anyone who opposes the government is principled while anyone who is loyal is just a sycophant…”

Out of office for years, Labour needed to show that it could “cross the class and employment divide, that it could unite the nation. I was the modernizer, in personality, in language, in time, feel and temperament.”  Some of his colleagues understood that if they wanted to retake power they had to break from a union past; others argued and resisted and some came along; others never did.

 

One example of his task — rewriting the party constitution to remove the demands for nationalization  and state control, Clause IV, drafted in 1917. No one paid attention to the clause, but no one wanted to make the effort to remove it either. Blair insisted on change, leading some in the party to suggest he enjoyed making enemies within. But his argument is persuasive — years after the Soviet Union and China had moved to market systems and away from nationalization and collective farms, British Labour still had nationalization and collectivism in its goals.

 

He proposed instead a statement of purpose that stressed the goals of individuals:

 

“The Labour Party is a democratic socialist party. It believes that by the strength of our common endeavor, we achieve more than we achieve alone so as to create for each of us the means to realise our true potential and for all of us a community in which power, wealth and opportunity are in the hands of the many, not the few, where the rights we enjoy reflect the duties we owe, and where we live together, freely, in a spirit of solidarity , tolerance and respect.”

 

Okay, it might be the English equivalent of American Mom and Apple Pie but it does appear to renounce feudalism while celebrating achievement rather than equal poverty for all. As people become more educated they don’t necessarily want the state making decisions for them, he said.  During its years in the wilderness, Labour had become more of a cult than a party, and the Lib Dems even more so — Blair must be watching with great interest their role in government rather than in perpetual opposition.

 

Blair had a battle, which is apt to continue, to persuade people inside and outside the party that the government and state agencies can become a vested interest. Reforms to health care were battled by physicians who said they would harm health, when the only real threat was to the doctors’ well-being. It is a theme familiar to readers of The Washington Monthly where Charles Peters points out that when budgets are threatened governments invariably explain they will have to lay off firemen and close fire stations. State governments around the US are finding they can’t afford the pension plans which elected officials and unions agreed upon as a way to raise compensation without paying for it.

 

Part of the problem was that Labour had confused means and ends.  It had lost touch with its basic purpose. In Blair’s eyes, political power should be about the individual…a powerful state, unions, social action and, collective bargaining were means to an end — to help the individual gain opportunity. Government failed to recognize that its success had changed the society. By the 1960s, the first generation had been liberated and didn’t want more state help but instead wanted freedom to earn money and spend it. The private sector moved fast with the change, state sector got stuck.

 

Governments, whether of the right or left, are not naturally inclined to reform the bureaucracy.

“…whereas the market compels change, there is no similar compulsion in the public sector. Left to its own devices, it grows. Governments can change it, but governments use the public sector, depend on it and are part of it…Whatever the enormous impact of the Thatcher reforms had been on the private sector in the 1980s, we had inherited a public sector largely unreformed; and we weren’t instinctively included to reform it.”

 

Blair is amusing in describing how at the time he was pushing for action against antisocial behavior his son, Euan, was arrested in the middle of London for underage drinking and being drunk in a public place.  Police assigned to Number 10 located him and brought home through a back door.

 

“Around 2:30 a.m., Euan insisted on coming into my bed. Alternately he would go into a mournful tirade of apology and then throw up. I loved him and felt sorry for him, but had a police cell been available I would have been all for moving him there.” Later that morning he had to address the Black Churches conference in Brighton, where all assembled prayed for him, Euan, his family, etc.

 

“I did, at one moment, want to point that, OK, he was drunk…but all this seemed a little excessive….But I didn’t and it wouldn’t have mattered a jot if I had. To them, the boy was lost and now was found, and that was all that mattered.”

 

Heading back to London, his party stopped at a pub…”much to the amusement  of the locals. They were all thoroughly supportive of Euan and I heard in turn each customer’s tale of a similarly misspent youth. At moments like that, the British are very decent folk.” 

 

A few of my English friends really despise Blair for being all fluff and no substance, but this memoir provides  ample evidence to the contrary. Blair really cared about how the government worked. A few minor reforms wouldn’t do; he insisted structural change was required in crime, education, health, welfare and immigration, to start. At the suggestion of Michael Barber, the government established a Delivery Unit to measure the delivery of services, rather than, as governments so often do, discuss the goals. He is frustrated by a newspaper industry that was almost completely uninterested in government and mostly focused on scandals. I have to agree. It may be a function of shortened attention spans and a drive for profits over substance colliding with the increased complexity of modern governments.

 

Think what you will about him, with Blair Labour won three elections, and as he says the Tories never won a by-election from Labour during his time in office. 

Governing is a learning process, writes Blair, as he dissects where he could have done better, lessons learned, mistakes that couldn’t be corrected. His book is a useful and highly readable analysis for anyone interested in government.

 

Although not all my friends agree. At a wedding dinner recently a friend sitting to my left said Blair and New Labour had wrecked the fabric of England. On my right, a financial technology consultant who is now working with the Tories on policy, described the book as extremely self-aggrandizing and vomit-inducing.

 

But I enjoyed it and never got sick once.

 
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Wisconsin’s Aurora Uses Teradata To Improve Patient Outcomes

Like other industries, health care initially used technology to automate time-consuming processes such as billing, registration and scheduling. 

“What organizations discovered is that, as an indirect result of operational systems, they had collected huge amounts of data on the business and how it performs” said Phil Loftus, chief information officer at the health care group. “We are shifting our focus from putting in operational systems to figuring out how to tap this wealth of data to make better business decisions and develop data driven improvements to the business.” 

 

 

The health care group is completing Smart Chart which Loftus described as probably one of the last giant $200 million operational systems that Aurora will deploy across the enterprise.  

About 10 years ago Aurora began building a data warehouse based on an Oracle database. 

“We started taking key pieces of data from our operational systems and putting it into a data warehouse,” said Loftus. “The original reason was to get nationally recognized measures of our clinical performance by scoring them against national standards and benchmarking the results through a third, which would tell us how we were performing and where we stood nationally.” 

That drove some major changes across Aurora. Once a hospital starts measuring the performance of its departments on a national scale, and sharing the results, physicians began to pay attention. 

“You don’t want to be in the fourth quartile; you want to be in the first, especially for physicians who tend to be competitive. This allowed them to see that  they could improve their performance by adopting clinical best practice.”   

Collecting and using its clinical data helped Aurora establish a national reputation for quality. The Center for Medicare and Medicaid Services (CMS) did a six-year demonstration project with  a number of major healthcare providers providing additional reimbursement, for high quality outcomes. At the end of the project, Aurora was named the best system in the U.S. and its Green Bay hospital was recognized as one of the top performers. Aurora works with the Premier Alliance, which benchmarks clinical quality data from hundreds of hospitals  allowing them to see their performance nationally. 

“Using these results, we have been able to build up hospital clinical quality performance in most major departments into the top quartile,” said Loftus. 

The route to higher quality has certainly been data intensive. Four years ago Aurora had a terabyte of data in its data warehouse; now is has over seven terabytes. 

“The amount of data has gone up by almost an order of magnitude. We are collecting 10 times as much data as we were 10 years ago,” he added. Aurora is using the data to look at effects of length of stay, complications and readmissions. 

“Not only is there an order of magnitude more data, but we want to ask more complex questions of the data. Using conventional technology, the cost would be prohibitive. We needed a different type of computer which was specially designed to process very large data sets quickly and cost effectively.  Aster (now part of Teradata) is one of the vendors that came up with computers which were specifically designed to analyze very large datasets and do it much more cost-effectively than regular computers.”  

The system from Aster uses massively parallel processing (MPP) — taking multiple inexpensive microprocessors and dividing the computing across them for fast results which Loftus estimated at 20 to 30 times the computing power of a traditional data warehouse. Aster was acquired by Teradata last spring. 

“Teradata positions us to accommodate the fact that our data will continue to grow and our questions become more and more complicated. We can look at our data and see if we are getting the optimal outcome for each of the diseases we treat.” 

As access to large data set analysis becomes possible, the nature of the analytics has changed from looking at individual patients to looking at populations of patients with problems such as congestive heart failure or diabetes, for instance.

“This allows us to increase clinical outcomes across a whole population of patients while lowering the overall cost – the holy grail of healthcare. We can look at the treatment of whole populations of diabetic patients, making sure that they meet hemoglobin Ha1c and cholesterol LDL targets that help control the progression of the disease and reduce the incidence of major complications such as retinopathy and impaired circulation.  Using these kind of approaches with our 1.2 million Aurora patient population has enabled us to achieve savings of 42 percent versus the Segal [a national health care cost survey] trend over the past 10 years. 

Health care providers are facing a revolution in the way they get paid — from payment for office visits, services, tests and hospitalizations to payment to meet the healthcare needs of a defined patient population at a fixed cost. 

“The move is from volume to value,” is how Loftus described it. An employer is going to pay a provider to look after a patient population at a fixed cost. About 42,000 Aurora employees are in a version of that model now.

“If we can find better, more effective and lower cost ways of looking after that population, we will have the opportunity to keep some of the savings.” 

Whatever the outcome of the current Supreme Court case, or the next Presidential election, the need to provide improved patient outcomes at lower overall cost will persist.  

One of the major goals in hospitals is to reduce the average length of stay for patients.  Aurora’s system wide length of stay is 3.8 days, compared to an expected average of 4.6 days, for a similar patient population. 

“We are also working to minimize the number of 30-day re-admissions,” he said. Pending federal reimbursement guidelines will require a hospital to take care of re-admissions within 30 days, for certain specific conditions, with no additional reimbursement. 

The Aurora computer system provides a detailed clinical history for patients. It is accessible to caregivers across the system to ensure that diagnoses and treatments are based on the best available patient information.  The system also includes 550 order sets based on clinical best practice that can be used as a starting point by physicians and modified to accommodate specific patient needs. This also gives patients the benefit from Aurora’s system-wide expertise at every facility. 

“One of the major changes that we are likely to see in healthcare in coming years is the growing ability to successfully treat patients in their own home,” added Loftus. The way the U.S. health care system evolved over the last 20 or 30 years, the system was built to funnel the patient into hospitals, because they were the higher margin part of the system. Now the shift is toward treating patients in less expensive and much more convenient settings such as clinics and the individual’s home. This is an area where monitoring and medicine delivery technology are already playing a growing role. 

Aurora has around 2,300 patients who are being treated at home by laptop-equipped nurses. They use their wireless data cards to tap into the patient records, giving them the same access to patient information as they would have in an Aurora hospital or clinic. For patients with chronic conditions, like congestive heart failure and diabetes, regular monitoring can be done at home and reported by nurses or remote monitors. Lofuts expects , the use of mobile technology, such as tablets and smart phones will grow rapidly. 

Aurora is preparing for outcome-based payments from the government, state and commercial payers, using a model known as accountable care organizations. Aurora is in talks with a number of employers to provide healthcare coverage for their employees at a fixed price. Already about 42,000 Aurora employees are in a similar outcomes-based model.

Even if the Supreme Court overturns the Obama administrations health care program, care providers will have to o move to similar models.  

Inevitably, said Loftus, that places healthcare providers in the risk business.

“In the past providers were reimbursed on the basis of payment for service didn’t take on financial risk.. In the future they will increasingly take on risk in the delivery of agreed upon outcomes for defined patient populations.  Risk is the element that you are now adding that wasn’t there in the past.” 

And as risk managers in finance know, managing risk requires lots of data plus sophisticated analytics.

 

 

 

 

 

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My Content Has Shifted

I am doing most of my technology and finance writing at Forbes.com, so look for my work there at http://blogs.forbes.com/tomgroenfeldt.

However, now that I have straightened out the administrative difficulties that had delayed the transfer of this site, I will be posting some previous information here and doing some shorter updates than I do on Forbes.

Big issues on Forbes have been big data, Hadoop and technology in both finance and health care. Comments welcome.

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