Sunday, November 16, 2014

How to Deal with Motivation Problems.

Comment on, The Great Addiction to Motivation
By saying that we lack the motivation, it gives us another excuse to procrastinate.


Have any tips for getting your motivation back? I’d love to hear them.

I think we misidentify the issue when we claim it is motivation (as you allude to). As to why we don't take action, I believe it is more about habit than motivation. As to what to do, make habits of what you care about.

Our organizations often demotivate us. We don't need pep talks and reward/carrots to get over the de-motivation. We need the practices that de-motivate us (Dilbert does a good job highlighting many of these) to cease. In this sense what is needed to motivate us is to remove those things that are de-motiving us. Leaving those in place and relying on pep talk and such gimmicks is a losing strategy.

Words about how employees should be all motivated about work while the organization beats out the intrinsic motivation people have at ever turn only drives de-motivation to higher levels. Instead, build an organization where intrinsic motivation flourishes.

For more ideas see the Curious Cat Management Improvement blog posts on motivation.

Monday, November 10, 2014

Data on Medical Errors

How Many Die From Medical Mistakes in U.S. Hospitals?
In 1999, the Institute of Medicine published the famous “To Err Is Human” report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media.

In 2010, the Office of Inspector General for Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.

Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says.

That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second.
I wish these reports would provide some detail on what these really mean. Is it 250,000 people that were completely healthy coming in for a physical and they die when they would have been healthy if the medical system didn't exist? I doubt it. Is it 2,000 completely healthy people and 248,000 people that were under intensive medical care for years keeping them alive and now we slipped up and they died? Probably not, again, but my guess is it is closer to the second.

Preventing errors is obviously important. And in health care it is very important, of course. But just because you use data doesn't mean it isn't misleading. Medical errors leading to death is just too big an operational definition to be very meaningful in my opinion. For these numbers to provide much insight I really think they need to be segmented more:

  • perfectly health person that was going to be perfectly healthy for decades but were killed by medical error.
  • person that needed life saving care of they were going to die that month and we routinely should be able to provide the very easy care to make them perfectly healthy again but they were killed.
  • etc…
  • person that was extremely sick with many problems for years and was saved with medical care over and over again. Complex care was needed and much of it was done well but in the very challenging situation there was a mistake and that mistake is the proximate cause of death.
We should be working on making everything better and eliminating medical errors that cause damage and death. But there are huge differences between a medical error conditions that caused death and to me those differences are so huge lumping them together is hardly useful.

My understanding is we do use risk based assessment to compare things like survival rates or operations at different hospitals. A figure of survival rates comparing two hospitals when one was the hospital where all the most difficult case for the Western USA were sent to a local hospital that dealt with the easy operations for that health issue would not be very useful. So they try to adjust for the severity of the problem (as I understand it). It would seem to me a similar thing would be much more useful for medical error death rates. Was the person in such a risky state that the tiniest misstep (error or whatever else) would kill them or was it someone who is perfectly health and dies immediately due to an error.

Related: Errors in Thinking - Epidemic of Diagnoses - Health Care Crisis - Great Visual Instruction Example (taking pills)

Response to comment on my comment

Right, l think the thing I am getting at is there is a big difference between making a mistake while you are in a complex situation where any of 30 bad decisions in a pressure situation could result in death (and where doing nothing results in death) versus a situation where there is no risk of death until you do an absolutely idiotic thing that turns my visit to get a physical into death.

Everything should be constantly improved and made safer with mistake-proofing thinking... And healthcare needs this more than most everything due to the dangers and consequences involved.

When there are headlines like 100,000 deaths due to medical error every year that reads to me like John was walking along the street and boom a medical-error/piano dropped on his head and killed him. But I don't believe that is true. I bet it is true that are lots of deaths due to just unforgivable errors - someone is given a drug which was indicated in numerous sensible ways would kill them due an allergy but they were given it anyway and died.

But I don't trust how much of the deaths attributed to error are really 20% error, 19% cancer, 18% diabetes, 17% cardio-vascular disease, 16% long term high level use of powerful drugs ravaging the body, 10% car accident (which also someone else might say is 5% error, 30% cancer, 25%...). The error is still bad, and the system needs to be improved to reduce the frequency and consequences of errors. But I just don't know how to take the error to death data without much more explanation.

In reading more details on the studies they comprehend this issue with the data but I haven't found where they provide more meaningful data. What I read just talks about the contributing nature of "blame" on medical error etc..

Sunday, November 02, 2014

Managing the Organization as a System with Many Stakeholders

Comments on "Deming’s thinking is alive and well…in China! That's why those looking for evidence of Profound Knowledge in the US may be looking in the wrong place." (my response is to a discussion on The W. Edwards Deming Institute LinkedIn group - I can't link to the original comment because it is a private forum)

(Jack Ma) If you want to invest in us, we believe customer number one, employee number two, shareholder number three. If they don't want to buy that, that's fine. If they regret, they can sell us. 

(Lara Logan) In the U.S., the shareholder is usually first.

(Jack Ma:) Yeah. And I think they were wrong. The shareholder, good. I respect them. But they're the third. Because you've take care of the customer, take care of the employees, shareholder will be taken care of.“

Deming couldn't have said it better. And it illustrates why he often insisted that the CEO, who invited and introduced him to his staff, actually stay and listen.
The problems are real. But there is a significant minority of companies that don't accept the Wall Street conventions. There are very few companies that don't allow CEOs to steal from the corporate treasuries - through completely unjustifiable "pay" packages (but there are some - Berkshire Hathaway, Costco and I believe Bezos, Larry Page and Sergy Brin also don't behave like kleptocrats).

But I can't include Google and a company that doesn't let those with power take the companies gold, senior executives have taken ludicrous pay including past CEO Eric Schmidt. I must say I think Schmidt has done an excellent job at Google (the lame decisions by Larry Page only make it more obvious) but even so his pay was insane.

If you look at Google and Amazon they both also refuse to bow to the idea that their job is to please wall street analysts. A fair amount of the interest business companies in the last 15 years don't place much faith in wall street "wisdom."

Google from their start with their IPO didn't accept wall street dictates. They are actually moving to become much more conventional, ever since Larry Page became CEO. The new non-voting class stock they created GOOG (GOOGL is the stock that has actual ownership voting rights) could be seen as fighting wall street convention or could just be seen as founders greedily setting up the rules so they control no matter what.

Jeff Bezos is a former Wall Street analyst and knows the games and what matters. If your business NEEDS to get cash from Wall Street - raising equity or bonds you might have to listen some. Otherwise the talking heads regurgitating wall street dictates are entirely pointless. While Amazon has very little profit, the cash flow situation is much better (Bezos doesn't need to raise capital and therefore what wall street says just doesn't matter and he is smart enough to know that unlike the majority of CEOs that do as Wall Street wishes).

But even the companies that are doing some things very well (Google, Amazon, Apple...) have a very long way to go in learning about managing organizations. But those companies have some aspects of they are doing very well.

"At Berkshire, managers can focus on running their businesses: They are not subjected to meetings at headquarters nor financing worries nor Wall Street harassment."
- Warren Buffett

Related: Google is Diluting Shareholder Equity with Massive Issuing of New Shares - Amazon Innovation