The Idea: A Sandbox Hospital To Test Our Systems


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The Cost of Poor Quality Justifies The Concept of The Sandbox Hospital

Did you realize that the costs of poor quality are incredibly high in most systems?  It turns out that the median amount of cost recovered from a lean or six sigma project is approximately $250,000 in healthcare.  Because the costs of poor quality are so high it is critically important to focus on quality.  Like we have discussed previously on the blog, one of the challenges in healthcare is that routine and classic healthcare accounting systems don’t make these high costs associated with poor quality very clear.  Some of the other issues exist with the fact that reimbursement is not linked directly to quality in many cases.  Here, let’s talk about a useful idea that could really help improve quality:  the sandbox hospital.


Most Quality Issues Are In Fact System Issues

Before we describe the sandbox, consider the idea that most quality issues are in fact due to system issues.  Yet again, I’ll say this concept is very different than what I was taught in the residency and fellowships I performed.  However, on reflection and review of data, this is true.  It’s actually a very common theme in the quality control literature.  Although we in healthcare tend to focus on human error, in fact, the manner in which a system is designed can make human error more or less likely.


Look:  if you saw a train coming at you and you didn’t get out of the way whose fault is that?  Well, similarly, we can see human error coming.  If we continue to see human errors in the system, and have the ability to make them less likely by building the system a certain way (FYI we can do this by the way)…well, you see where this is going.  If we can design a system that reduces human errors it’s sort of silly NOT to design a system, based on DATA, that reduces those errors.  I mean, come on!


…Not Just Human Factors.

After all, we can imagine that having a surgeon who worked 200 hours in 10 days in a hospital, with minimal support staff, in a environment that had more than thirty trauma activations an hour we would be apt to have some delayed diagnosis or quality issues, right?  We are using the extreme case to indicate how silly it is to pretend human errors sit in isolation from circumstances.


Hey, to all the “blamers” out there:  the world is complex and things are multifactorial.  This doesn’t excuse human error, yet the pragmatic way of looking at it helps us reduce it rather than beating ourselves up.  When friction abounds in a system and a human error is produced should we really attribute the issue to a human error?  Labeling things as isolated “human error” is the typical fall back position of physician or healthcare provider (doc you don’t work hard enough or you weren’t smart enough).  In fact, most surgeons and healthcare providers are incredibly dedicated, bright, and sometimes hampered by ineffective systems.  They didn’t suddenly become foolish after being some of the top students in high school and college.  So the truth is:  real process improvement takes work, and labeling things as isolated human error is kind of, well, lazy.  Or, worse yet, labeling things as isolated human error may lead us to turn over our healthcare provider staff (a bandaid solution) rather than allocating resources to improving the system.  You’ll find, if you replace the offending physician, you will have often continue to have similar human errors.  (I promise.) So, FYI, human error is only part of a bigger story.  Again…I promise.


Poka-yoke Is The Design Philosophy “Design The System To Make It Easier For People To Give The Output You Want”

Guess what?  There’s even a design philosophy we use in Lean and Six Sigma called “poka-yoke”.  It means “make it easier to do the right thing”.  If you want people to be in the trauma bay within 15 minutes, for example, make it easier to get there.  Put it close to the call room, get some prehospital notification where possible, or do something to reduce the friction in getting there.  Remember, the solutions you use don’t have to work every time.  They just need to make it more likely that the desired outcome will occur.


Ok, ok.  I’ll get off my soapbox.


Finally…The Concept Of A Sandbox Hospital

Now enter the concept of a sandbox hospital.  If you accept the idea that quality and functional systems are key to deliver excellent care especially with respect to the complex systems in place nowadays, consider how important it is to have effective systems in the hospital.  Now consider how funny it is to roll out things like new electronic medical records and similar large scale programs to a hospital without piloting them first.  Experience with roll outs and innovation literature focus us on multiple ideas to reduce the silliness of rolling out a new system to the entire organization all at once.


There are terms for innovation labs and other entities that work within organizations to build and pilot new ideas.  A skunkworks is an entity within an organization that focuses on being an innopreneur in distinction to an entrepreneur.  A skunkworks facilitates thinking differently than the company at large and can avoid being victimized by the company’s culture.


To set up an effective skunkworks, it is important that the system at large not feel threatened by the skunkworks, the staff within it, or the results from its workings.  Wouldn’t it be interesting, then, to have a “sandbox hospital”?  A sandbox hospital is a microcosm of an entire hospital used expressly to pilot roll outs of new large scale initiatives on a smaller scale and to innovate new systems.  If you’re into Six Sigma, you could even think of it as giving an easier way to perform Design of Experiments (DOE) for healthcare.


This would minimize the cost of poor quality and dropped revenue seen when large scale initiatives (like rolling out electronic medical records) occur.  Hospitals:  spend some time thinking about how to rollout big initiatives to avoid dropped revenue, quality issues, and patient care problems.  Put it in the sandbox and learn your lessons there (!)


Specifically, a sandbox hospital would be a free standing facility that could be utilized by different healthcare systems with their providers, culture, and systems.  In other words, it would be a healthcare facility in which they could experiment with how things will look as they roll out a new system.  It would be a sandbox for precisely the reason that it would be a safe area to play.


Ethical Ramifications of the Sandbox Hospital


There are some interesting questions which are ramifications of this idea.  For example, could the Sandbox Hospital treat patients?  My answer to this is yes definitely.  The Sandbox Hospital would be staffed by providers and other participants from the larger healthcare system that seeks to pilot the new initiative or dream up a new system.  The staff would be equipped with laboratory tests and all the things required to practice medicine.  In fact the only thing that would vary is the new roll out or new initiative being tried for a mode of care delivery.  We could tweek other things to simulate patient flow through the ED and beyond, although this would be more difficult owing to the ethics of potentially turning away patients to control flow rate.  But it’s ok, we could figure it out.


The medicine, technical prowess, and cognitive dimensions of practice would not change substantially.  Therefore, patients could be treated at the Sandbox Hospital and it would be disclosed to them that they would be in hospital during the roll out of a new initiative.  However, the Sandbox Hospital would be continually rolling out new initiatives.  We could tell the patients that too.  The interesting thing, again, is that it would be staffed with a portion of the various specialties or systems involved from a ‘mothership’-type healthcare system.  No matter how you feel about rolling out a new system to patients in the Sandbox Hospital, think of how much better it will be than just trying your new thing on ALL the patients who come to the larger healthcare system.


I feel the Sandbox is much better than the alternative which currently occurs.  That is, new initiatives are rolled out to health care systems as a whole.  It is challenging to roll out these initiatives while maintaining revenue and, more importantly, quality of care.  And this is fairly high stakes and high risk!  What if the new initiative, for example, grinds the ORs to a hault?  That new initiative suddenly becomes very expensive.  A sandbox hospital, and any costs associated with one, are sort of a hedge against that level of risk.  Better to spend money on a small experiment than a big failure!


Consider the ethical ramifications of the Sandbox Hospital.  In fact, it seems that the concept is actually more ethically satisfying than what we typically do in healthcare, in that it focuses on safety and could have failsafes, etc., built in with a stop-the-line patient protection measure.  Currently, when a new initiative is rolled out in the hospital, it is often up to the hard work of the residents, nurses, advanced practitioners, or other physician staff to get around the fact that the health record or physician order entry system just plain doesn’t work.  A Sandbox Hospital would help staff anticipate those opportunities and focus on expected issues to eliminate the problems with a larger roll out.


At the end of the day, a Sandbox Hospital would likely be cost effective in that it would decrease the risk of catastrophic failure of roll out for a new system to a hospital.  Sandbox Hospital could help with roll out to operating rooms, etc.


Some possible downsides of the Sandbox?  Yes, it is possible that staff from the mothership hospital running the experiment will act differently in the new venue–it’s still better than the alternative of “hey let’s try this in real life first”.  Yes, there would be some variation compared to the larger system, but a small scale model like this may help us avoid the cost of poor quality seen with larger roll-outs.


In other words, the type of errors being watched and tracked in the larger hospital system may not exist once the electronic record comes, but very real other errors do exist and a Sandbox would let us see them.  And, of course, the systems can be sold as cost saving (“hey where’d all the unit clerks go?”) and quality improving (“we don’t have to read all that handwriting anymore but hmmm now the notes say the same thing everyday…).  We feel that near-miss events and medical errors of a different type may actually be at play and again we see a justification to try a new system in the Sandbox first.


At the end of the day, the Sandbox Hospital would be a highly ethical, cost effective, small-scale “experimental” hospital. When we say “experimental”, we don’t mean the medical care delivered to patients would be anything less than excellent. When we say “experimental”, we do not mean that we would be experimenting with medical care.  When we say “experimental”, however, we mean that the Sandbox Hospital would be constantly rolling out new initiatives at the behest of the medical centre supplying it with staff and culture for a certain time.  This would allow the collection of data regarding the failure modes into which the new system deployment may enter.  The rationale for the sandbox hospital is that it is much cheaper to fail quickly and effectively on a small scale than to fail catastrophically or partially with a roll out to a major healthcare system.  The Sandbox Hospital may minimize pain of deploying new systems and would improve patient safety on the whole by obviating patient care issues that occur during major rollout.


Call For Your Comments and Thoughts

If you are reading this, you may have participated in one of these roll-outs, such as the often-cited new electronic medical record rollout, we would love to hear from you with respect to how this influenced down time, physician order entries, and near-miss type events.  For example, although we are often instructed that physician order entry decreases medical error, some of us feel that an electronic medical record actually changes the nature of the medical errors.


As physicians and healthcare providers, have you seen major problems during the roll out of new administrative plan or system? We would love to hear from you below. Experiences like yours give us the foundation on which to build the sandbox hospital in the modern day.

Literature As A Weapon





By:  The Generation Y Surgeon (@GenYSurgeon)


Every now and then I play anthropologist and try to observe people from a different angle.  I don’t have to go far to observe some very unique behaviors.  In fact, I don’t go anywhere because there is plenty to see in the hospital.  My conclusions?  The hospital is an entirely different world and the subjects of this world are strange.



Yes, I Have Opinions…And One Of Them Is About Using Literature As A Weapon

I have a lot of opinions on the behaviors of patients, nurses, students and administrators in the hospital but today I want to focus on physicians and one of my least favorite behaviors – using literature as a weapon.  For most physicians the hospital is a jungle with danger around every corner…crouching malpractice lawyers, hidden administrators.  Each week your pride is offered as a sacrifice on the shrine of the M&M.  And every day you find yourself at the mercy of whatever patient or emergency that screams the loudest.  As a result we’ve developed pathologic ways to defend our egos.  My (least) favorite is the literature-as-a-weapon maneuver.


What The Literature Should Do Versus What It Is Used For


Literature is supposed to improve patient care, develop safer treatment options and educate the masses.  You’ve seen or heard all of theses examples before, I’m sure.  “The literature says…” spouts the Dinosaur as he converts a lap appy to an open case.  The literature says a lot of things, but that case just needed a surgeon facile in laparoscopy.  “Studies show that…” you hear as another bad outcome rolls back to the OR.  Once again surgical error is somehow magically forgiven after an article (possibly from the year of my birth) gets stuffed into the chart.  As you stand at the podium in the morning you find yourself battered with outdated studies supporting anything and everything EXCEPT what you are presenting.  Worse yet you actually use literature to support an event that shouldn’t be supported at all.  PubMed is meant to help you prevent misadventures, not justify them.

Medical students using studies to look smarter on rounds, not to actually learn.  The Gunners even memorize obscure articles to make their colleagues look dumber.  Residents build landmark studies into their vocabulary to get the Dinos to back off and somehow they’re satisfied with this, even though we never read past the abstract.  Your attendings wave papers over your head and at each other as a posture to establish dominance.  People build their entire careers by doing this.  It’s like a bunch of peacocks scratching the ground and pecking each other’s eyes out….but instead of shiny green-blue feathers they have a bunch of randomized controlled trials sticking out of their assess.

Literature As A Tool To Establish Dominance


The purity of research has succumbed to the pathological behaviors of physicians working in cut-throat environments.  Somehow we’ve turned the literature into a weapon to shame others, defend our egos and establish dominance among our peers.  Somehow the more you “know” about the literature, the higher up the food chain you climb.  I use the term “know” lightly because the real truth is that very few physicians truly understand what a paper means.  You and I are both guilty of skimming through the methods, especially the stats.  Why?  Because we don’t understand stats.  If you think that you do, you’re lying to yourself.  Stats are what make the paper good, bad, or just plain retarded. Face it, if the authors made up stats over mojitos and made it sound fancy, you’d buy it.  That’s the danger of the literature, most of us don’t know what we don’t know when it comes to stats.



I Admit, I’ve Done It Too

Yes, I’m pointing fingers, yet I admit I’ve been guilty of using the literature-as-a-weapon maneuver myself.  After meeting someone who truly understood stats I realized how foolish I looked wielding a weapon I didn’t understand.  Stats are in fact a completely separate science and as a general rule doctors just don’t understand, not even the Dinosaurs writing the literature.  Do yourself a favor and spend some time with someone who knows something about stats.

I still read the current literature with the help of apps like Read by QxMD* but I now refrain from vomiting abstracts at my colleagues as a means of showing my feathers and protecting my ego.  You should stop posturing too and just appreciate the literature for what it is…a tool, not a weapon.


* Who am I kidding?  I don’t read nearly enough.  Neither do you.  QxMD however is a great resource for GenY-ers.  You check off items that you’re interested in and you get emails with abstracts that you will likely find interesting.  The app is well-designed and easy to use.  You can even link up with your local library and gain access to the full article though the app.  I have ZERO affiliation with QxMD s there’s no conflict of interest here, but if you haven’t heard of it you should check it out.

Coming Soon This Week


The response to the Generation Y Surgeon (@GenYSurgeon) has been really impressive.  This week, GenY releases part one of what we understand will be a three part series focusing on certain aspects of healthcare / surgical culture.

We hope you enjoy these often controversial blog entries as much as we do.  As usual, we focus on the ability to entertain an alternative point of view rather than if we agree with GenY on specifics.

Later in the week, we’ll describe an interesting concept that we call the “Sandbox Hospital”.  “Sandbox Hospital” is a term we use to describe an experimental, Skunkworks-like hospital that focuses on experimenting NOT with medicine or medical care but rather with the systems through which care is delivered.  Said differently, wouldn’t it be nice to trial a new medical record system with your staff and actual patients on a small scale BEFORE you go live with it across your healthcare system?  Or what if there were new policies and procedures that you wanted to evolve before releasing to the organization as a whole?  What are the ethical considerations involved?  Sandbox Hospital may be a useful way to test-pilot innovations.

Visit us throughout the week to check for these and other useful entries.

Remember, you can follow the Generation Y Surgeon with @GenYSurgeon on Twitter.  See you soon!





The Challenge: To Improve Residency





By:  The Generation Y Surgeon (@GenYSurgeon)


If you’re reading this right now, chances are you’re a surgeon, almost a surgeon (resident), or you’re a medical student who wants to be a surgeon.  We each have (or will have) a niche, but regardless of specialty there’s one thing we all share…the pain of residency.

When I matched, I had no idea what it really meant to be a surgical resident.  By that, I mean I didn’t understand what the true costs were.  I had thought long and hard about the long hours and extra years of training and the “hardcore” nature of surgery yet I failed to identify what really makes residency miserable.  What is it that turns optimistic young interns into gruff, imposing chief residents?  How does the young attending get to be as jaded and emotionless as the dinosaurs that lead our M&M’s?  Why are we so unhappy during residency and why do so many surgeons say they wouldn’t do it again?  I think about this a lot because I’d like to make residency a better experience, and because happier people make happier and more productive physicians.

Residents lose themselves somewhere in the middle of residency because they lack a sense of achievement, power, and a sense of affiliation.  We lose out motivation in the early years, succumb to the pathologic culture of surgery, and then we persist in that same miserable state because we don’t know any other way to teach or interact with each other.

Why?  I think this is explained by McClelland’s Needs Theory.   McClelland was a psychologist whose career centered around the science of workplace achievement.  In his theory, he proposed that a person’s needs are acquired over time and shaped by one’s life experiences.  Motivation and effectiveness in the workplace are influenced by three needs: achievement, affiliation and power.  I’ll go into more detail about each and how this pertains to residency below:

1.  Achievement: attainment of realistic but challenging goals, advancement in the job, feedback and progress, and a sense of accomplishment.  McClelland argued that achievement is more important than material or financial reward, and that financial reward is simply a measurement of success.

Surgeons are bad at giving feedback and even worse when it comes to giving positive feedback.  We rarely recognize, let alone validate, hard work and sacrifice among our peers.  We are quick to correct, quicker to scold and frequently guilty of downing others when our egos are threatened.  Residents, students and even attendings need little more than a pat on the butt for a job well done.  We don’t need coddling, but we do need to cut ourselves some slack and start giving each other some credit.

2.  Power: this is NOT power in the sense we want to be able to control others.  Power, here, is the ability to control our life and time.  It’s a focus on the ability for us to influence when and where we do things.

Power is often the first need to be stripped from a resident.  You lose control of your time, your autonomy and even your own bodily functions.  You are told where to be and when to be there, how to look, speak and walk.  Even your desires are dictated to you – research, fancy fellowships, high-paying jobs that you may not find fulfilling.  As a junior, your differentials/plans are frequently dismissed and for as hard as you work you are still treated as the smallest part of the team.

3.  Affiliation: motivation and need to be liked and held in popular regard, to interact positively with others who hold the same goals and gain approval.

In general, surgeons do not “play well with others”.  We often feel we work alone in our clinics and other venues.  When we do come together it’s over controversial and heated M&M’s or stressful exams.  We do have a few conferences and meetings that we seem to enjoy, yet as far as team building goes we are pretty bad at it.

In summary, we need build a training system that breeds confidence and power through achievement to keep our residents (and ourselves) motivated and productive.  We all motivate ourselves with some combination of the above described needs; it’s how we power(ed) through residency.  But what would it be like if we weren’t stripped of these needs?  What would it be like if we felt accomplished, powerful and autonomous yet part of a strong group of similar people?

I challenge you to use this knowledge in your workplace.  Start building a culture that breeds motivation and you will quickly find yourself among happier, more productive staff.  You may even find yourself a different person…

What are your thoughts on what really makes residency painful? Do you see a place for McClelland’s theory in your workplace?

Thanks for reading, I look forward to hearing your opinion.  Special thanks to SBMI for bringing me into the light.

Google Glass Review: Iterating & More Useful Soon

UPDATE:  1/21/15


Google, today, announced that the Glass program would be pulled back from developer status.  The review (beneath) was originally posted on 4/21/14–my how things have changed!  Although Google has indicated that the Glass product will be iterated and released “when ready”, we can’t say that will be anytime soon!


So, enjoy the review of Glass beneath with the very real possibility in mind that this product may be no more!



photo copy















Yes, I became a Glass explorer.  Mostly this is because I’m fascinated by the rollout of the product AND because some colleagues and I wanted to use the system as part of a new business model experiment.  Unfortunately, Glass couldn’t YET deliver on our needs.  Our team remains positive about the product (especially the way Google is iterating it and promoting adoption), but let’s talk about the positives, limitations, and features of Glass that need improvement:



(1) No video calls (!)


The day before this latest Glass release (approx 4/15/14), Google removed the ability to make video calls from the system.  How unfortunate!  First, the main reason our team purchased Glass was for the video call feature.  We needed this hands free, video option for our new business model.  Google has announced that the feature was removed owing to limited use and poor quality.  Please, Google, bring back the feature we need!


(2) Glass has a beautiful screen.


We were impressed with the resolution and clarity of the Glass screen.  You can read entire websites very easily, and the display’s brightness in different lighting conditions adjusts appropriately.  For such a seemingly small screen, it does give the illusion of a much larger screen that hovers a few feet in the distance.  Nice work, Google.


(3) Glass battery life isn’t great.


Perhaps it’s just our device–we don’t know.  However, a full charge does NOT last long at all.  For example, as I’m writing this, my Google Glass’ charge has decreased by 20% with little to no use IN THE PAST 15 MINUTES.  There is a feature that, when you remove Glass, it shuts down and saves charge.  We have that activated too.  Enough said.


(4) Glass interfaces with my home wifi router in a strange way & I’m not always sure when it’s sending data or what data it’s sending.


So sometimes Glass seems to be sending data when I’m not doing anything with it.  Sure, lots of devices do that–yet, I can’t help wondering what it’s sending.  Privacy concerns with Glass already abound and maybe that’s why I wonder what this thing is up to.


Also, my poor Airport WIFI router seems to have issues with Glass.  Don’t know why, but when Glass is on it boots everything else off the network and makes them unable to access the Internet.  Could be that I just have firmware updates, etc., to do as new devices like Glass come onto the market.


(5) Glass requires touch to operate.


Yes, much of Glass can be controlled with head movements and voice.  However, touch is often required to start or accept actions.  In light of #6 beneath, and the fact that we need a hands-free device for our business model, we’d really like to see less touch.  Maybe just us on this one.


(6) Glass voice recognition is excellent.


One really impressive feature of Glass is the voice to text fidelity.  Accuracy and speed are excellent here.


(7) Glass came with frames.


This version of Glass came with frames included.  They’re not bad, and accept a standard lens from stores like LensCrafters.  You can see the set I received in the photo above.  Overall, this is a good feature.



In the end, our team is very impressed by the intelligent manner with which Google is rolling out Glass.  The focus on an MVP-type product, and positioning with early adopters, is a nice study in how to bring something truly different to market.  The product itself is exactly what it says it is:  a developer stage device that is coming along nicely and iterating as it goes.


Some qualities of Glass need improvement (think battery life here) and others, like video calls, need to be brought back–Google hear our plea!


Glass is an interesting device with many potential uses, and we are excited to be part of its process as it goes on to fulfill its promise.


The Generation Y Surgeon Says Hello



By:  The Generation Y Surgeon (@GenYSurgeon)


Billboards, radio commercials, internet pop-ups….to patients, Surgery is cutting edge.  Closer to the truth, the scalpel is the only thing with a legit cutting edge, to my mind, in Surgery.  Here are my thoughts from the realm of the true cutting edge.


I am a surgeon.  Well, I am a chief surgical resident, which means I’m almost a surgeon.  Actually I’m just a surgeon without a surgeon’s paycheck–but my low-level of employment has its advantages.  I see Medicine from the inside, with access to the battlegrounds (the ED, floors, OR) and the round table (M&M, committees, conferences) with a license to teach and to take.  I’m still gaining knowledge and learning new skills, but I already know for certain that Medicine in general is in need of it’s own doctor.

Enter Generation Y.  My generation has been accused of being entitled, narcissistic, and detached from institutions.  Yet we embrace disruptive innovation, social entrepreneurship and creativity in the workplace.  We are the optimistic ones who still believe Medicine, and specifically Surgery, can be saved.  Some of my take on things:  as a profession, we have failed to integrate new technologies effectively, failed to address how we should most efficiently acquire knowledge in a rapidly changing field, failed to present ourselves as true professionals both interpersonally (and professionally), and failed to develop each individual to their fullest potential.  We practice by archaic social rules and endure job stresses that lead us to early burnout and early graves.

My generation, with our optimism and overconfidence, is charged with reinventing Surgery as the Dinosaurs (the patriarchal, heavy-handed, gray-haired surgeons responsible for our early surgical beatings) begin to fade into the background.  The habitat is crumbling and most have failed to adapt to the changes that have now surrounded them, be it technology, system-based changes or even their up-and-coming mentees.  Surgeons have failed to adapt in rapidly changing times, and I may not know all of Surgery but I do know this:

Truth #1: We must evolve or die.

Truth #2: The Dinosaurs are dying off.

Truth #3: It’s up to Generation Y to keep this profession alive.


In future posts I will be writing about the quirks and shortcomings of modern Medicine and Surgery in particular, as well as some potential solutions.  We have a lot to learn from our non-medical colleagues in business and technology fields, and most of all in leading change.


Stay tuned for more on how this Millennial views Surgery, dissenting opinions on yesterday’s surgical culture, and what’s to come in the very near future.  Thanks to the team at for the venue.  It’s been a pleasure to meet you all, & thanks for reading.

Coming Soon–Feature From The Generation Y Surgeon

A special thanks to all our followers on the blog! As you know, we focus on business model innovation in healthcare with tools including the business model canvas, dynamic ownership equity, and tips/tricks you can use to make your innovative business experiment that much more effective.

New ideas like gamification are featured along with proven methods of process improvement like Lean and Six Sigma. We tend to focus on tools, tips, tricks, and data.

Some of the feedback we’ve gotten from you all (thanks for all the comments by the way) includes an interest in a more personal voice for innovation and other what’s coming in Surgery and Healthcare.

After months of searching, our team has found someone to be that strong voice for innovation and provide an authentic voice for what’s coming in surgery and healthcare: the Generation Y Surgeon (@GenYSurgeon).

We’ve already seen the first few posts from our colleague, and let us share that the thoughts are direct, edgy, and sometimes even provocative. This colleague, a surgeon completing training, effectively gives voice to many of the issues we’ve seen in surgery and shares important experiences that may be common to young surgeons.

Here are several things you need to know about the GenYSurgeon, and some things we’ll need to do to keep this important voice (even when dissent or difference is challenging for us to hear) available to us as surgeons who train the next generations. I’ve presented this as an FAQ beneath and will reproduce it on an FAQ page on the blog’s main site:

(1) Who is the GenYSurgeon?

The GenYSurgeon is a resident surgeon (a surgeon in training) who is completing that training soon. This colleague is interested in providing us feedback with their view on Medicine, Healthcare, and Surgery in an anonymous format.

(2) Is the GenYSurgeon really just the editor of this site or just another person who already writes for this site?

No. The GenYSurgeon is a new voice, and is a person who has never posted on the blog before.

(3) Do you know who this person is, and, if not, how can you be sure this is really a resident / surgeon in training?

I don’t know who the GenYSurgeon is exactly and neither does anyone else at the blog. It’s a good thing because that way I couldn’t tell you even if I wanted to. Here’s how we set it up so that even I (and everyone else at the blog) won’t know the identity of the GenYSurgeon:

We approached 5 different residents and asked them to blog for this site.
We had them get together (and it was ok if they also asked their resident friends), without us present, and decide who really wanted to do this.
One of them decided to be the blogger, and emails us via a disposable email account with their entries.
Their first email to us included some info to confirm the entry originated with them.

This is a nice feature, because we can’t share who the Gen Y Surgeon is even we wanted to.

(4) Is it possible, because of how this is setup, that the GenYSurgeon is actually more than one person?

Yes, it’s possible. And we’re ok with that. After all, we were just interested in adding the voice of the future, finishing young surgeon to the blog. If it’s more than one person, yet the voice represents the unique thoughts of young, finishing surgeons that’s just fine.

(5) Why bother putting a resident’s thoughts on the blog?

First, the next generation and their views are important to our field. The way we bring them along is central to where our field goes in the future. So, even if at times it’s unpleasant for those of us who trained before the 80 hour workweek (or completed training just as it started), it is an important exercise to see what they have to say.

We believe in the idea that we must progress and that things change, so we want to hear how things look to the next generation because it is fresh eyes on our field. The GenYSurgeon, although sometimes difficult for us to hear, gives us the fresh-eyes perspective of what’s happening in our field.

The GenYSurgeon is sometimes edgy, sometimes provocative, and often direct. There’s a role for that and we’re happy to provide that viewpoint even if we don’t endorse everything GenY says.

Please help us welcome @GenYSurgeon, and, remember:

“It is the mark of an educated mind to be able to entertain a thought without accepting it.”

You’ll know the GenYSurgeon’s post by the symbol he/she chose, which made us laugh at first:









Here’s How To Get Them To Accept Your Innovation



UPDATE 1/21/15:

Well…we were wrong about some things!  First, Google recently announced that it was going back to the drawing board with Glass.  So, perhaps our assertion that Google would get us to wear something different on our faces was incorrect.  Of course, Google did get us to try Glass.  So, I guess that there was some truth in what we said!  More importantly, the apparently unsuccessful (at least things really don’t look good) Glass campaign still highlights a nice attempt at using the Rogers curve to promote early adoption.

20 Useful Tools For Your Startup Business Experiment


Our team has built virtual offices for more than 10 years, and so we’re always on the lookout for useful tools from around the web.  Here, we share with you some of the most useful tools we’ve found to build low-overhead, highly effective paths to getting done what you need done for your business:


(1) Voicerecorder hi def:  this app is available for iPhone.  Our team doesn’t know about Android or other platforms.  It is ideal for recording thoughts on the go and having them transcribed later.  It allows files to be uploaded to dropbox from within the app.  Of course you could share the dropbox folder with whomever you would like, such as a transcriptionist who could type your final document and email it to you.  Where would you find someone like that?  Read on.


(2) Dropbox:  the best application we’ve seen for sharing files between all your computers.  Works on mac and PC.  Use with ECM, sendtodropbox and efax to make a great way to get documents uploaded to all your computers at once.


(3)  this does exactly what it says.  It gives you an email address you can use with your smartphone to get documents into dropbox (and therefore all your computers) to truly go paperless.


(4)  People per hour is one of several platforms where you can find independent contractors to do many different things.  Tasks like transcribing your audio files from dropbox, maintaining a calendar, creating a logo, and many other things are available from this platform which is by far our favorite.


(5)  this is another of the most useful tools on the list.  Getfriday is a team in India that will allow you to retain a virtual personal assistant.  You can get a great assistant if you specify excellent English, etc., up front.  Your assistant will do anything that does not require physical presence, like:  place calls, maintain a calendar, online shopping (they protect your credit card with certain techniques), fill out online applications, and many other tasks.  Many of us on the team now have a virtual assistant and it is really excellent.


(6)  This will allow you to send any book to an address (eg from Amazon directly or anywhere else) and will then turn it into a PDF for you to download.  Excellent quality.


(7) Doodle:  this tool is a great way to get a group to commit to a meeting time.


(8) Boomerang:  this tool is an add-on for gmail that will show you when an email you’ve sent has been read, send a reminder email, etc.


(9) Gotomypc:  best way to have your office computer accessible from home and vice-versa.  Will usually install on your office computer despite firewalls and other network blocks.


(10) Gotomeeting:  if you work with a team that’s spread across North America, or if you want to talk with your family on a night you can’t be home, Gotomeeting works great.  It’s even better than free apps because you can record meetings you host, upload them to dropbox, and get a transcript for later.


(11) Efax:  you can setup an efax number to receive documents and email them to you as attachments.  You can also have it send to dropbox.  In other words, you can fax things from any fax machine and have it quickly on all your computers for e-signature or whatever you need.  Go to


(12) Textlater:  this is a clever iPhone app that lets you program when and where you’d like a text sent sometime in the future.


(13) Postal methods:  this allows you, from your phone or computer, to write a letter and mail it anywhere (at least in the US).  You do the typing and they do the mailing.  Google postal methods.  Obviously you can use this even if you’re out of the country.  Google postalmethods.


(14) Click2mail:  this is a great option for sending certified letters.  You can do it all from your computer.  Google click2mail.


(15) Uber:  this app allows you to get a private car (instead of calling a taxi) in most medium to large cities.


(16) Pocket Scanner:  this app creates PDFs from anything you can snap with the camera on your smartphone.  Available for iPhone.


(17) Evernote:  this service allows you to keep notes, photos, and anything else you need.  You can have it available across platforms and on your PC.  Available at the app store and online.


(18) Google Voice:  this service gives you a free phone number.  You can create a message and direct the number to any phone (or phones) you’d like.  You can change the phone number whenever you need to be less available.  The service will also transcribe the message and send it to you as an email.


(19) Badnews robot:  this is available on the iPhone app store and also on the web.  This clever app will call any number you specify and deliver a message you specify that contains bad news.  Hysterical and anonymous.


(20) Google drive:  this allows you to upload documents and files that you can share across computers.


Hope you find these 20 tools as useful as we have.  Tools like these allow us to setup low overhead business models and experiment to find ones that work.  Interested in more useful business tools from around the web?  Let us know.