RHetoric

The message is simple: you would ask your waiter a few questions about the menu; so why wouldn’t you ask your doctor a few questions about your care?

I was talking health reform with my primary care physician last week, and she made an interesting comment:  “One of my biggest frustrations with healthcare is that most of my patients just expect me to tell them what to do.”

Whoa - this was not a criticism of Medicare, or Obama, or insurers, or anyone else in the supply chain - it was directed at the patients themselves!

As patients, we tend to think of our primary care physicians as the managers of our care.  But in truth, they are simply contributors.  Our insurance companies, specialists, and even friends and family are all contributors.  This can be frustrating and even vexing, but it is a golden opportunity for health reformers, and for IT.

If IT can make medical information more accessible, portable, and personalized, perhaps we patients can be empowered to ask informed questions and contribute to decision-making about our care.  We have a long way to go.  But some of the emerging tools within Google Health and HealthVault are encouraging.

Even if a patient never maintains a personal health record, asking a few questions at the doctor’s office could vastly improve the quality of one’s care.

I am not one to be brashly competitive, but when I hear from executives that are being under-served and overcharged by large PR agencies, I can’t help but tighten the laces on my racing shoes. The truth is that for most businesses, a smaller agency can produce twice the results at half the price.

Long gone are the days when a start-up company needed the Edelman or Ogilvy name to appear on its road show deck to impress investors that it is working with “the best” (and at 30k per month, plus hourly fees over and above a cap, plus a 10% mark-up on all expenses). Likewise, many established, mid-sized companies that dabbled with the biggies have also pulled back, finding true partnerships with smaller agencies.

Yet many mismatches remain in the marketplace. In my opinion, no company or division needs a global public relations firm on its team unless it is substantially more than a $1 billion-a-year business. Even then, a large agency is not the only option.

Think about the culture of a large agency, which is run like a large company. It is full of very smart, seasoned people who have ascended into management, leaving junior account reps to deliver the daily value to the clients. This is where mediocre writing, naive pitches to reporters, and jaw-dropping client maltreatment come into play.

In a large agency, as in a large company, these shortcomings are overcome by the volume of good work that is done by others. The result? Average. However, the waste and average results of this model are not so welcome in smaller organizations, where every dollar spent on talent must be optimized for maximum effect.

To make matters worse, a lost $10k retainer is a rounding error in a large agency, where the largest clients are the bread, the butter, and the dessert. Waggener Edstrom, which employs roughly 500 people, is one of Microsoft’s PR agencies and grew its revenues to $100 million because of that. I have never met anyone at that company who doesn’t work on the Microsoft account, with the exception of one senior vice president in Lake Oswego who doesn’t work on any accounts (although my sample population is skewed toward the Seattle area).

This example is not meant to degrade WaggEd in any way, instead, it’s meant to point out that they are well-suited for a multi-billion dollar company like Microsoft. Not so for the vast majority of companies seeking PR expertise.

A smaller firm can get a lot done without that overhead. Every person is wholly invested in their clients’ success, because their livelihoods are directly tied to retaining every client. Small firms tend not to hire mediocre talent, and can’t afford to mitigate it if they did. Small firms know what it means to be lean and mean, and that quickly translates into an account service ethos.

Finally, the economy is tightening. Now is not the time to waste precious marketing or PR resources. I suspect that much of the griping I’m hearing from corporate execs engaged with large agencies is backlogged discontent, surfacing now in anticipation of belt-tightening. Maybe the economic uncertainty will cause another healthy shakeout in the industry, much like the one that occurred in the wake of the dot-com bust.

I generally prefer to take a national or global view of current events, but my third year in the 98104 zip code has opened my eyes to some extraordinary developments in Seattle with global implications.

First, consider how much of the last 200 years of global growth was firmly rooted in the east coast cities of the U.S. Ever since Colonial times, these cities benefited from being the geographic hubs of trade, finance, and politics, reaching across the Atlantic to Europe, and across the continent to the Pacific.

Now look at where the action will be in the next 200 years. China, India, and much of the Pacific Rim is undergoing an unprecedented regeneration, spilling over any known bounds of investment, infrastructure build-out, education, population, and every other measure of expansion.

What is the relevance to Seattle? John Markoff of The New York Times, referring to the Emerald City, recently noted: “Many communities dream of becoming the next Silicon Valley. This one is actually doing it.” He noted the ‘Baby Bills’ (Microsoft spin-offs), the ‘Baby Jeffs’ (Amazon spin-offs), and even the ‘Baby Sergeys’ (Google has established a substantial and labor-hungry presence here). He noted the power of the University of Washington — where the average GPA for undergrad admissions has risen to somewhere around 3.7 — and the billions of dollars in venture capital that is invested here annually.

Beyond technology, there are building cranes in every vista, whether in downtown Seattle, South Lake Union, or Bellevue. Recession? It doesn’t feel like it.

Finally, the largest state-wide technology association in the world is right here in Washington State, the Washington Technology Industry Association. It represents 1,000 companies and 80,000 technology sector employees. This group recently opened an office in China… they know where opportunities lie for the region’s technology employers. Attend a networking event and witness for yourself how many people have migrated from India or China and are part of the fabric of Seattle’s economy.

It is far too early to make predictions about the future global balance of economic power, and which cities stand to be the great geographic hubs of 21st-century commerce or innovation. But I would argue that there will be a colossal nexus between technology innovation and global economic development. Seattle is certainly hitting all the right notes as it auditions for the global stage.