An Old Salt's View of the Medtech Industry - April 11, 2012

From the 2012 U of MN Design of Medical Devices Conference:
"Origins of the Medical Device Industry and Its Future"

Norm Dann, Adjunct Assistant Professor, Innovation Fellows Program, Medical Device Center, University of Minnesota; Recipient of the 2012 Design of Medical Devices Conference Award.

Keynote Bio:

Norman Dann, board member for several medical device companies. Adjunct Asst. Professor Innovation Fellowship, Medical Device Center, University of Minnesota. Formerly: general partner, co-founder Pathfiner Venture Capital Funds. VP Sales and Marketing, Sr. VP Development Medtronic Inc. Founder The Dann Company a sales and service organization representing medical device and laboratory instrument manufacturers. Project manager Designers for Industry. BSIE Pennsylvania State University.

Abstract:



Norm will spend time telling his story of observations made of the birth and evolution of the modern Medical Device industry. The current status and some thoughts about changes needed to improve growth and maintain the US in a leadership role.

Keynote:


The medtech industry has slowed down, and may perhaps actually be in a slump.  After many years of incredible success, you in audience are probably wondering “how do we get this mother going again?”


Norm's story starts when he was young, growing up on the east coast.  His father, an immigrant from Lithuania near Vilnius, with less than HS education, was the handyman for a medical research lab and he developed all of the experimental equipment for the lab.  It was in the day before there was an industry to supply it, so Universities had to develop their own experimental apparatus.  Norm recalls Saturdays and some evenings with his father at the lab, running the lathe, making experimental equipment. 

Medical researchers, before the time of the FDA, could take innovations right from dog lab to the OR.  Heart therapies were what started medtech, when physicians saw they could immeasurably improve human life with procedures like repairing septal defects in infants and pacemakers for post-op and other indications.


After insurance came on the scene, and those making the buying decisions didn't have to pay out of their pockets, the industry wasn't accountable for cost.  If a manufacturer had a profitability problem, they simply raised the price.  A good type of problem to have.


The world has changed - we can no longer ignore cost.  "I don't care if you're Democrat, Republican, or Hindu, spending 17% of our GDP on healthcare isn't sustainable."


Norm's advice for the future:


1. Develop products for the GLOBAL marketplace, with value that can be appreciated and consumed on a global scale, or we will end up like the U.S. auto industry. (i.e. develop the next Honda Accord / Toyota Camry, not a $35k defib where you’ll only get 10% of the market b/c of economic considerations).



2. Separate PRODUCT from SERVICE - companies have historically been able to introduce products that are hard to use because their own field people (salespeople, technical service reps, field engineers) ran them; the customers didn't need to learn how.  The sales & service cost was built into the product price.  To compete with lower prices, companies need to make easy-to-use products (if Apple can make an iPad for a 3 year old, why can't we make medtech simple?), and charge more if the customer wants service included.



3. Accept the fact that the FDA can’t regulate the entire design & development process and provide 100% safety.  (Karin says - enough said.  The public and industry needs to take responsibility - and the FDA has to let them.)

Thank you Norm for your wisdom and insight.  It was a great message for the engineers and entrepreneurs of today's generation.

Atul Gawande - Better and The Checklist Manifesto

After hearing Dr. Gawande speak at the Jan. 26th 2012 Care Innovations Summit, I was interested in reading his books.  Since then, I read "The Checklist Manifesto" and just finished "better - A Surgeon's Notes on Performance."  Dr. Gawande delivers the healthcare story so entertaingly and with so many stories and much historical perspective and insight, I will never do him justice, but I would encourage you to pick up some of his books as well.  I believe he is one of the most thoughtful, visionary, brilliant, humorous, and humble storyteller writers in the healthcare space, and I know you would enjoy his writing.

Just to recap the contents of "better" - Dr. Gawande presents "Diligence" in Part I, with chapters on Washing Hands to prevent horrendous hospital-acquired infections, The Mop Up for vaccinating children in India against Polio to ERADICATE the disease, and Casualties of War, where he reviews the military's continuous improvement process that has saved so many lives that before would never have been saved.

In Part II, "Doing Right" is about doctors going "Naked" with data to expose where their care center is compared to others with outcomes; he points to the Cystic Fibrosis example, where Fairview Children's in MN achieved the best outcomes through a combination of excellent, dedicated, personable, persevering physicians and leading-edge techniques. The subject of Malpractice is addressed in "What Doctors Owe," pointing to the very difficult issue that physicians aren't perfect (just like baseball players - but a 5% error rate in baseball doesn't impact lives) but the malpractice system doesn't fix what's wrong with the system.  He discusses physician compensation in "Piecework," with an analysis of how reimbursement methodologies came to be, and doctor's roles in capital punishment in "The Doctors of the Death Chamber."  The final chapter in Part II is called "On Fighting," where Dr. Gawande asserts that the best doctors are those that will always fight but also recognize when the fight is not about the patient, but about their own egos.

Part III, "Ingenuity," addresses "The Score," or how to rate physician performance in areas such as obgyn, where midwives have been found to demonstrate better outcomes.  "The Bell Curve" and "For Performance" present the fact that performance is always on a bell curve, and what does that mean for medicine; while also taking us to poor India to understand that performance really should be looked at through the reality of what doctors are able to do without any of the western world resources, technologies and supplies; doctors there delivery miracles daily.

Dr. Gawande ends with 5 suggestions for becoming a Positive Deviant in this world that are good for us all:

1. Ask an unscripted question.  (helps you learn about and appreciate the people around you.)
2. Don't complain.  Nothing is more of a downer than doctors (and other people) complaining.
3. Count something.  Makes you learn something about something you are interested in.  His example: surgical sponges.
4. Write something.  Add some small observation about your world.  (That's what I'm doing here.)
5. Change.  Make yourself an early adopter.

Have a great day - and pick up one of Dr. Gawande's publications!