Good Read: n=1 by John Koster, Gary Bisbee, and Ram Charan

Don’t let the title of this book by John Koster, M.D., Gary Bisbee, Ph.D., and Ram Charan fool you. While the book is about the shifting healthcare landscape and the need to truly personalize the care experience, it also very much is a book about leadership. More precisely, it is a book about the need for leaders to ask the right questions, for a better shot at readiness for a bright future.

In n=1, the authors posit that “questions are the best approach to uncertainty,” and note that successful leaders need to “move from asking the questions they want to ask, to the questions they need to ask.” In short, a “culture of questions” is key.

The authors provide a backdrop for this focus by recapping the forces of uncertainty facing healthcare today. From there, they note that two key elements are influencing healthcare. Digitization and disruptive scientific innovation are fueling rapid change, broad access to information, and an ever-increasing ability to analyze care from an individual perspective. Risk transference and healthcare’s “sacred trust” provide social context, and reflect the balancing act which both organizations and individuals face moving forward as everyone strives to be able to afford the healthcare of the future.

From this introduction, the authors review how leaders need to use their understanding of these market forces to outline key competencies and structures. This provides the “conceptual framework” for transformation. The book then moves from framework to function. It provides an overview of the major functional players who must align to meet the needs of n=1, including integrated health systems, physicians, and insurers. To throw more uncertainty into the mix, the authors then describe new entrants into the healthcare domain that will challenge most leaders’ assumptions about how, where, and when care can be delivered.

Throughout the book, the authors remain true to their theory that asking incisive questions is key. At the end of each chapter, insightful questions are posed to the reader, challenging him or her to think beyond the “easy” questions to queries that genuinely reflect the transformation that lies ahead. This book is a good read for its ability to synthesize a sweeping topic, and provide context for future planning. The book does not have all the answers…but it sure shows how to ask the right questions. 

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