A Slight Case of Overbombing

The "Little Disturbance" Ahead

The Sisters of Mercy were pure genius right from the jump. Like NWA’s “Straight Outta Compton,” their sound was so identifiable, so simple and evocative, that it formed its own strand in the DNA of music.

An auspicious turning point for a band that started as a joke was the album Vision Thing, their third studio album. “A very, very, very, dry joke,” Andrew Eldritch, the band’s founding member, clarified to an interviewer around that time. His idea back then was to embrace the most ridiculous aspects of strung-out rock showmanship and marry them to music so exasperatingly bleak that it formed a meta-commentary on making art in an inhospitable world.

The sense of humor came through their sulking covers of unlikely songs — say, ABBA’s “Gimme! Gimme! Gimme! (A Man After Midnight)”— and their occasional insistence on style over substance. Here was a band who crafted their own logo and merch before ever recording a song. (“I thought T-shirts were the key to this,” Eldritch reflected in 2019, “and I have not been proven wrong.”)

HIMSS 2025 is a happening happening this week (I’m honored and humbled not to be attending. Abundance breeds boredom, and I don’t need to hear another “30,000 health IT visionaries” pitch me on AI’s potential to save humanity from itself).

As HIMSS President and CEO Hal Wolf took the stage yesterday, he applauded the audience –- comprising a substantial portion of HIMSS' 120,000-plus members worldwide –- for tackling the hard problems in a fast-evolving healthcare space beset by big challenges.

"If you don't like change, you're in the wrong ecosystem," said Wolf, using one of my favorite vogue-vague words in the sort of off-hand way that most are now doing, as sort of happy-to-glad edit in the PowerPoints and keynotes, “ecosystem” becoming a substitute metaphor, a neat phrase behind which hides the blow-up-your brain complexity ‘out there’ in the ether somewhere.

Here’s how Mike Milliard, Executive Editor of Healthcare IT News, covered Wolf’s narrative of the obvious:

He rattled off a partial list of the many headwinds faced by health systems in the U.S. and abroad: changing funding environments, workforce shortages, geographic displacement, the need for care at home, just to name a few.

Add to that an aging population and a new era of "unsettled policies in Washington."

The stakes are high. But so is the will to manage this tsunami of change."Every citizen in the world and every single person who works in our delivery systems are fundamentally counting on each and every one of you," said Wolf.

But while HIMSS is a healthcare technology conference, with a sprawling exhibit floor showing off all manner of envelope-pushing innovation – "I defy anyone to try and find a booth that does not mention AI," Wolf joked – these problems will not be solved with tech alone.

Wolf recalled an equation he first learned more than two decades ago: NT + OO = COO. "New technology, plus old organization, equals costly old organization."

Which, I think, only underscores the point I was making in Houston, We Need a New Narrative: When everyone has access to the same amazing technologies, and everyone deploys the same amazing technologies the same amazing way, you get a sea of sameness at an amazing scale.

Technology breeds competitive convergence, not strategic differentiation.

The shape and texture of transformational visions come from discovering new language — different strategy stories — to frame and sell (and implement) roadmaps that work horizontally across enterprise, market, industry, state and even national boundaries. This is what an ecosystem-centered market strategy is really all about: building ‘lateral strength’ as a form of big market innovation.

Appetite for Destruction

President Trump last night celebrated the whirlwind of changes his “flood the zone” strategy has brought to the world. Writes the Wall Street Journal this morning (Trump’s ‘Swift and Unrelenting Action’ Tests Americans’ Appetite for Upheaval): “His success from this point on will depend largely on whether Americans believe the unease caused by his speedy actions — an unsettled stock market, a trade war with allies and uncertainty over the extent of federal job and spending cuts—will lead to the American renewal he promised.

In making his case, Trump suggested that a return to “the golden age of America,” while under way, would take time to complete. He acknowledged that prices remain high, singling out the cost of eggs, and twice in his speech said his tariffs could cause short-term pain.

“There’ll be a little disturbance, but we’re OK with that,” he said.

On February 25th the House of Representatives passed a budget blueprint charging the committee which oversees Medicaid with finding savings worth at least $880 billion over ten years. Republicans are searching for ways to pay for $4.5 trillion in tax cuts, which are set to expire at the end of this year.

“The way the math would work is that those cuts would largely need to come out of Medicaid,” said Robin Rudowitz, director of the program on Medicaid and the uninsured at the Kaiser Family Foundation. “Medicare is off the table, and there just aren’t any other sources of funding to look at.”

Because the federal government pays for 50 percent of healthcare, Wolf said, healthcare organizations should expect to see diminished cash flow as the Trump administration and Congress work their way through funding cuts. He advised healthcare organizations to plan for contingencies based on the severity of the cuts from D.C.

And of course, spend more on technology.

Health systems that have the financial resources should invest in digital health technologies to find cost-saving partners soon, he said.

“If you're going to have some money to invest this year in digital health, you want to find those tools as soon as possible ... so you can go ahead and really jump in,” he told reporters during a press briefing Tuesday morning.

Which is all small bore.

Technology is a commodity input, like electricity. The thing in short supply are novel objectives, not the means to reach them.

The “digital health” market (what exactly is “digital” anyway?) is flooded with health apps. Over 90,000 offers were introduced to patients and healthcare providers alike in 2020 alone, at an average rate of 250 a day. Globally, the field attracted over $100bn of investment in the three years to 2022, according to CB Insights.

"We get a lot of solutions looking for problems. We get very few people who want to understand our problems and our challenges, and then bring a solution to us," John Couris, CEO of Tampa General Hospital, said.

Couris spoke with Yahoo Finance at the ViVE digital health event in Nashville last week (Hospitals 'not going to manage hundreds of partnerships' in digital health, CEO says). He explained that hospitals are thinking more intentionally about where their digital investments will go after years of watching the industry grow. That has led to hundreds, if not thousands, of independent programs being used and administered by the health systems.

"So I'm not going to manage hundreds of partnerships or even thousands of partnerships anymore," he said. "We're not going to do that. What we are going to do is find those partners who really want to understand our problems, who want to help us solve those problems, and then have a very deep relationship."

Fortune favors the aggregators.

Roadmaps to the next hundred billion in growth from the largest and most lucrative market on Earth don’t start with “data interoperability” to enable big tech visions. They start with ‘market interoperability’ to invent better economic systems (“ecosystems”).

Ecosystem-centered market strategy is a platform shift in health innovation. It’s a unique way to deal with competitive pressure, and stock market pressure. The ambition isn’t producing another technical product to make the “horseless carriage” run more efficiently; it’s inventing ‘the automobile’ as an economic concept around which new markets are born.

Listening to the Music of Trump

The world is adrift. It is between orders.

That comfortable mental furniture used as the centerpiece of business management — principles of branding, positioning, message and even “strategy” itself — are coming apart at the seams, unable to accommodate the seismic instability happening the world over. Existential crises abound and confound.

Just ask Walgreen’s. By this time tomorrow, a 127-year-old brand will probably cease to exist. Or ask NATO, another brand teetering on the edge of collapse.

Strategic problems don’t have technical solutions.

And while everyone is now struggling with the Steady-Breaking Set of Big Waves of Disruption from The Donald (say what you will, he’s not boring), navigating his flood of his “holy shit moments” is going to take a whole new orientation. I think the better message for leaders trying to decipher how to listen to Trump is this:

The equivalent of ‘Johnny Rotten’ is now the most powerful person in the world.

The ‘adaptive challenge’ Wolf was aiming for in his comment about change, which he borrowed from Eric Shinseki, former Chief of Staff of the Army, who was also the first Asian American to achieve the rank of four-star general, is this:

“If you don’t like change, you’re going to like irrelevance even less.”

It’s a vision thing, not a technical thing.

/ jgs

John G. Singer is Executive Director of Blue Spoon, the global leader in positioning strategy at a system level. Blue Spoon specializes in constructing new industry ecosystems.