“But people and institutions won’t willingly give up their personal data,” Jean-Michel argued.
“They will, Jean-Michel,” I responded. “Look at what’s happening with consumer sites like PatientsLikeMe—users are sharing their diabetes data and identifying themselves to the community because they believe in the power of the community to help them. Some hospitals are already using electronic medical records, and start-ups are preparing to capture data from mobile devices.”
* * *
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Next, we were off to discover. The key to our discovery is encapsulated by the Japanese phrase genchi gembutso, go and see for yourself. It’s a management principle developed by Toyota and based on the importance of going to where the action is and observing it directly. This is a fundamental aspect of meeting change early.
That’s why, not long after we launched our health discovery, I found myself walking through the lobby of a hotel in Riyadh, Saudi Arabia, the smell of sandalwood wafting through the air. I was fully covered in the required Middle East uniform: a black head scarf and a heavy black abaya that covered the fact that I was lightly dressed underneath to survive what seemed like 1,000-degree August heat. (It was 115 degrees Fahrenheit.) Out of the corner of my eye, I spied Mike Tyson, the boxer, seated on a sofa.
“What is he doing here?” I wondered. A better question might have been, “What am I doing here?” I had never been to Saudi Arabia; at the time, few from GE had been there, especially women. As I was preparing for my trip, one of my female colleagues said to me, “Why would you go to Saudi Arabia? I don’t support how they treat women there. I always have Saudi customers meet me in Dubai.”
I would come to find Saudi Arabia one of the most interesting places I’ve ever been in terms of a business setting. We had convened a lunch with a group of female doctors, investors, and professors, some of the most intelligent and forceful women I’ve ever met. Our goal was to understand how they used technology, their views on the state of health, and their aspirations for their daughters, their families, and themselves.
When we learned that Saudi Arabia’s minister of health was looking for a systematic approach to improving health care, including investing in data analytics, we thought this might be our proving ground. Once the minister was convinced that GE could help, he invited us to visit, asking us to look first at the vexing challenge of preventing women from dying from Stage 4 breast cancer. Cancer was considered a curse to many in Saudi Arabia, something to be ashamed of. Because of their customs, privacy issues, and the lack of mobility for women, cancerous breast tumors were often ignored until they became dangerous and ultimately fatal.
Jean-Michel and I had extended our teams to include two local colleagues in the Middle East, Rania Rostom and Ali Saleh, and we went to work to better understand the problem. That meant looking at the narratives behind these women’s actions. The solution wasn’t as easy as saying to them, “Get your exam.” It was about testing our image of a digital future against Saudi cultural norms, health narratives, and behaviors.
We worked with doctors, nurses, and their patients. And most of all we listened. In the course of our work, we discovered the cultural issue behind the health care failure. Screening rates were low because of the stigma and difficulty of having to go to a hospital combined with a potential diagnosis of deadly cancer.
By being in Saudi, I learned firsthand the importance of meeting face-to-face, immersing myself in someone else’s culture, and seeing the world through their eyes. The women were not what I expected. “Ask us anything,” one said, “but just don’t waste our time talking about why we can’t drive cars [a restriction that was rescinded in 2017]. We have more important things to solve.” Like staying alive longer, I realized.
Ultimately we created a mobile mammography screening van designed for maximum privacy and that went to the women in their neighborhoods. The technology uploaded test data wirelessly to personal health records and to a Saudi national database. We developed a digital media site where women could ask questions of doctors and nurses anonymously, cloaked as a digital avatar, a virtual self that gave them a new identity and, with it, a boldness to pose questions they previously would have felt ashamed to ask. This was a big breakthrough for the health ministry—so big that they asked us to create a nationwide advertising and digital media campaign on health and wellness. Only by embedding ourselves in the kingdom and observing behaviors were we able to know that Saudi women were both privacy-obsessed and digitally savvy.
Once we addressed our product design with these discoveries, we began to reinforce our digital health narrative’s scaffolding with emotionally evocative data. We found that a shocking fifteen million years of “healthy life” were lost worldwide in 2008 because of women who died early or who were incapacitated by breast cancer. In Saudi Arabia alone, some 28,000 years of healthy life were lost. The data coming increasingly from digital health records unlocked powerful insights.
How to provide access to better, more affordable health care came into focus even more while working with our professor in residence, VG Govindarajan. He helped us to see that our products were not always aligned to emerging regions. Most of our technology was too high-end for us to take advantage of global market growth—for example, health monitors that didn’t withstand being moved over rugged roads to local health centers in rural India or CT scanners that were developed for research and tier-one hospitals but proved too expensive for, and with features not needed in, rural Chinese hospitals. No wonder we weren’t growing overseas.
As in Saudi Arabia, we immersed ourselves in other developing markets, and in doing so, we discovered new digital product ideas at the edge of our vision. One case in point: GE Healthcare had a $50,000 electrocardiogram (EKG) machine that was used to diagnose patients with heart problems. But when we went to India, we realized that a huge, expensive machine that plugged into the country’s unreliable electricity grid was about the last thing the country needed. With the unique constraints of rural India in mind, GE created a $500 version of the EKG machine called the Mac I. It runs on batteries and weighs as much as a laptop. It’s simple to use and small enough to transport, which is a critical feature for those in rural areas who can’t get to a hospital.
The best thing about the Mac I—what made it “reverse” innovation—is that it created a new product from the grassroots up, the way it should be. The Mac I became such a success that it spawned an entire GE line of value-based health care products and a fast-growing business unit that target emerging markets. My favorite from this effort is the VScan, a handheld ultrasound that looks like a smartphone with a probe. Applications range from emergency care in ambulances to maternal care, putting it into the hands of midwives who can use it in areas where doctors are scarce. VScan became a symbol of GE’s accessible, mobile technology intended to shape the future. And I was able to visit midwives in Indonesia and hospital administrators in Vietnam. I sat with doctors in rural China to understand how digital X-ray would help them help patients. While in some cases, they visited patients on bike, even horseback, most doctors and health care workers had mobile phones and sophisticated means of communications. You have to see it for yourself. (China and India would prove to be the most fertile ground for market-back innovation. China is home to GE’s first innovation center, built in Sichuan province, to focus on rural health care; it is the birthplace of dozens of accessible health technologies, such as telemedicine and remote diagnostics.)
At the same time, GE was investing more in health care IT to provide workflow solutions for doctors who were expanding into electronic medical records. This would prove to be challenging for GE in the coming years, especially as start-up companies saw opportunity to make an impact financially and socially.
By May 2009, Jean-Michel and I had worked our strategy into the story we came to call Healthymagination, a $6 billion commitment to invest in technology and programs that
focused on cost, quality, and access. And in turn, we believed GE could be a force in transforming health care. Like Ecomagination, this was about profit and purpose; it was a story about our relevance in the world, told via actions and measurable impact. We were packaging GE around health outcomes, investing in new products, aiming to boost revenues, and, most significantly, sparking better health for more people.
Our employees, especially, loved this. We created a comprehensive workplace health certification for six hundred GE sites that gave employees incentives and programs to improve their health, ranging from nutrition to on-site fitness to reduced insurance costs and digital fitness trackers. We turned many of our employees into health consumers, giving them access to their data, improving their health and wallet in the form of insurance discounts, and reducing costs for GE. This expanded to a HealthyCities program—in dozens of U.S. cities—that had us partner with other companies and local health providers to build a systematic approach, giving consumers access to health-behavior change and data, and, in turn, improving health outcomes in a way that was measurable and repeatable. We created a high-powered advisory board; engaged with key NGOs on rural health care in places ranging from New Orleans to Nairobi; and contracted with Oxford Analytica, an independent research and consultancy firm, to document product usage that lowered cost and improved quality and access—we kept a set of impact metrics, just as we did with Ecomagination. Our first set of products included GE Capital financing for U.S. physicians to install electronic medical records—from GE and various providers.
Healthymagination quickly started showing returns—brand increase, a richer sales pipeline, reduced health costs. But among the more traditional managers, it seemed unnecessary. Unfortunately, one of those was Jean-Michel’s boss, the new business CEO who had been minted in GE’s love of process through a series of manufacturing assignments. A short-term-numbers guy set loose in the health care industry at a time of critical change, he didn’t want marketing involved in a strategy role—he wanted to direct it.
The customers and business models of home health and electronic patient records weren’t clear to the new boss, and that caused friction with Jean-Michel’s team. GE had joined with Intel to form a home-health joint venture, featuring tracking devices that captured vital data of the elderly and chronic health patients in home. It was an outgrowth of the digital health Imagination Breakthrough. Unfortunately, it never got the right level of championship or traction, even though it was well funded (and because of this, resented). As the effort struggled to come up to speed, the new CEO employed it as a virtual noose over the heads of Jean-Michel and me. He blamed Jean-Michel for getting GE into this new and complicated area.
I fought like crazy to keep Jean-Michel involved and regularly talked him up to Jeff, because I knew that our health care business needed a strategist and market-maker more than ever. And Jeff was a fan. For eighteen months we held back the old guard. But eventually the lack of support from his boss broke Jean-Michel, and he resigned.
“We have to expect this, Beth,” he told me when he left in 2012. “We can see things that others can’t. And it makes us a joke sometimes—for daring to imagine what will be.”
Jean-Michel’s departure was a loss for me professionally and personally. It frustrates me that established companies don’t protect and develop these people who are good at seeding innovation and nurturing the tender, early stages of its development. Not everyone can or should be scaled operators. As a team leader, you have to champion the innovators like Jean-Michel who can generate ideas, navigate ambiguity, and still take action toward a new future. As a change-maker, you need to find the champions who will do the same for you.
Champion vs. Mentor?
A mentor is someone who’s willing to give you their time, expertise, and wisdom to help you develop your career. A champion, on the other hand, is someone who talks you up to others, someone who actively promotes your good work. Champions understand the impact you wish to make, support your work, and want to see you and people like you do well. I think it’s important to have, and be, both.
Do you know what the people who champion you are saying about you? Do you take time to tell them your story? It’s important to check in with them regularly to make sure they have an up-to-date version of your accomplishments and your goals. The same is true for people you’re championing. The more able you are to champion other people’s good stories, the better leader you become.
While we lost Jean-Michel, with the launch of Healthymagination we had achieved viable proof points for GE’s push into digital technology—accessible technology made more so with digital connection and mobility, home health, and digital records. Digital was far from taking shape, but we could hear it rumbling in the distance. We had to convince the rest of GE, and the world, that it was a necessary, valuable—and unavoidable—future, even if we couldn’t clearly describe it yet.
Rolling Thunder
When I first began carving a digital future from the rock of possibilities, my team took every opportunity to “educate” Jeff and the functional leaders (like our CFO) on digital concepts. Early on, I went into one of those meetings with Steve Liguori, our executive director of global marketing. Steve was a trusted deputy—together we wrote a treatise on the “4Is” of marketing for Harvard Business Review—and even though he wasn’t a digital person per se, he just got how digital could help us work more closely with customers.
We had been trying to convince Jeff that “business model” innovation—new ways to generate revenue—was as important as technological invention. In health care, a business-model change could come about from selling ownership of an MRI machine differently—from a model where the hospital owns it outright to a new model that allows hospitals to pay by the scan and not own the MRI. Digital connectivity was becoming more of a differentiator in making these models easier, through better data capture, tracking, and ability to layer on additional services.
It was already happening in dramatic fashion with the iPhone and its app platform, which offered benefits for everyone from users to app makers to Apple.
For the meeting, we prepared a presentation. Now we take for granted the Apple application platform, but then it was still new. With great confidence, Steve began:
“Platforms are changing business. They are a means to aggregate data and then use that data to create new products,” Steve said.
Click. Next slide.
“The Apple App Store is a good example of a platform we can learn from. Apple creates a technology backbone, a tech stack, for the iPhone. They create their own applications. But they realized that they could get more apps faster if they opened up their platform.”
Click.
“What it meant for new app developers is that they could use Apple’s platform and have access to users they could never get on their own. In return, they have to give Apple 30 percent of their revenues.”
Click.
“To make sure the experience is a good one for the consumer, Apple becomes a gatekeeper, setting up guidelines. And they get to keep all of the data that flows from the app.”
Click.
Steve handed off to me, and I explained how a platform sets in motion network effects: the more people in the network, the faster the network grows and the more value it creates.
We thought our pages were blindingly clear. But the rest of the executives at the table seemed to have heard another language. As I began to launch into the second half of the presentation—“how we might do this”—Jeff couldn’t stop himself from breaking in.
“Apple is about consumers, Beth. They don’t apply to us. We make complicated infrastructure tech. Not mobile phones and apps,” he says. “I get what you are saying—I do. But I just don’t think it applies. They are apples to our oranges.”
Steve jumped up and responded, “Think of the iPhone as the small version of what
GE could do,” he said, pausing for effect. “Take the framework of an open software platform muscled up with data and analytics and imagine—imagine—what happens when you apply that to our big iron. Health care, jets, turbines—an energy platform where outside experts publish programs that improve the efficiency of our wind farms!”
Steve’s the kind of guy who barely takes a breath when he is excited. And that could make for tense meetings with Jeff, who wasn’t always as enthusiastic. This was one of those times. Steve’s passionate A Few Good Men riff was met with annoyed silence.
Looking back, I can see that we didn’t yet have the language to translate our ideas in a way that Jeff and our fellow GE leaders could understand. There was a gap between our vision of the future we had been describing—the value in Apple’s ecosystem, data, and platform—and how it applied to GE’s future.
This moment is where the evangelizing process stops for most companies. But I saw that Jeff’s response wasn’t a no. It was just a failure of language. If Jeff understood what we saw in digital and he was still dismissive, okay. But that wasn’t the case. He just didn’t see it. Yet. And we weren’t hearing Jeff well either. He was making a point that perhaps industry is different, with different competitive issues relating to data. We were stuck on our iPhone analogy.
We kept going back and going back, improving our presentation, poking, prodding, refining. Every time we dared to bring up the App Store or Apple, we’d get shut down. “Don’t talk to me about the iPhone again,” Jeff or the finance guys would moan. But we persevered.
These education sessions, demos, sparks, translators, proof points, and whispers—the tools of the change-maker’s trade—are little moments of metaphorical dialogue that taken together, over time, become the basis of a major Broadway production that acts on the collective psyche of the organization’s leaders and workforce.
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