Experimenting to Improve Sleep Quality

comments on: Can a Humidifier Help You Sleep Better and Snore Less?

After doing some research I learned that humidifiers have helped folks snore less. So, after some more research, I picked up a slick little ultrasonic humidifier and gave it a try. Now, it’s been less than a week which I know isn’t enough to get too excited about statistically speaking. But one thing is becoming crystal clear…it’s most definitely helping me sleep better.

Interesting post, which includes control charts showing the impressive progress.

"I’m also still trying to figure out what caused the three special cause signals in January." One nice aspect of improvement is sometimes you can make a system improvement that even without knowing the causes of previous problems, the new improvement stops those from happening again. Maybe that won't be the case this time but maybe it will. Health related issues are so touchy that I could imagine it is something like a couple bad factors stacked on top just push things over the limit. So being a bit tired and say too low humidity and you didn't drink quite enough liquid and sleep quality is bad but just 1 or 2 of those and it might be a bit worse but not horrible.

Special cause signals will be more frequent if several factors together amplify each other (and they rarely happen together so those amplified results are rare). What happens is those rare amplified events will be special, outside of the system that generates that regular variation when they act alone but when all that variation lines up just right the result will be outside what is normal (due to the very large change in the result for that special case where the individual factors acting together (amplifying) create a very large change in the result.

Related: Gadgets to Mask Noise and Help You Sleep or Concentrate - Apply Management Improvement Principles to Your Situation - Zeo Personal Sleep Manager - Using Control Chart to Understand Free Throw Shooting Results

Patient Centered Doesn't Mean Patient Directed

One thing I find annoying is when people talk about patient "choice" as if that is the fundamental principle in health care. We often try to simplify things so much that they are untrue. Health care is complex and trying to point to pithy sayings does more harm than good I think.

Patient focus matters but there are conflicts between what is the best care and what patients want. And there are conflicts between what those paying for care want and drug companies want and hospitals want and doctors want. These require difficult choices and in order to optimize results we need very well designed systems that take these issues into account.

Sadly I think the USA generally has very bad systems in place. The rest of the world isn't that great either, but by and large is better than the USA and much cheaper. Most health care providers care about patient care and often make heroic efforts to provide it. But the systems are just lousy.

Those systems that seem the most lousy to me around extracting cash from payers - it is absolutely horrible in so many ways in the USA. Sadly this creates hugh waste in the USA that is ripe for improvement (and has been for at least 30 years). Patient care also has plenty of room for improvement, but thankfully it isn't as messed up as the whole payment system is.

One of the things people ignore is that we are not talking about GM in the 1980s being pitiful compared to Toyota. When we look at how poorly the USA health care system does it is in comparison to other rich countries it isn't a comparison to "Toyota." It is more like being pitiful compared to 1980s Fiat or something. When you are twice as expensive with no better results than Toyota that is somewhat lame. When you twice as expensive as not very well run systems with no better results that is super lame. And then add on the top of it that you bankrupt hundreds of thousands of people a year, force people to avoid health care so they don't go bankrupt...

We need to have systems that are patient focused but that doesn’t mean patients dictate treatment. And we need to see a much wider system than we normally do. We need to be focused on healthy living not just disease treatment. And given the mess that is the USA health care system we need to focus on reducing the burden of coping with the horrible USA health system bureaucracy - that system does great damage to those having to deal with it (and it is nearly all waste that shouldn't be creating such hardship).

Response to: A Story About a Hospital Putting Safety First Over Patient Satisfaction

Related: USA Health Expenditures Reached $2.8 trillion in 2012: $8,915 per person and 17.2% of GDP - Our Failed Health-care System - Overview of 5 Nations Health Care Systems

Ebola Spotlights Poor Health Care and Security Systems

response to: Ebola & Systems: Can We Do Better? Can We Learn? What Comes Next?

So how did this happen? Bad processes? Bad planning? THR had received Ebola information before Duncan arrived. But, they didn’t put the pieces together and they sent him home.

What’s your take on this situation? Can we get better at anticipating problems and improving workflows, processes, and systems in advance? Can we learn from each other to avoid having to all make the same mistakes? How can we better protect caregivers, first responders, and the public? Or are we just not very good at systems and processes… at being proactive?

There are many bad processes involved, sadly.

But the most serious to me, is we have unrealistic proposed processes for dealing with an epidemic. This is potentially catastrophic but I know of no serious efforts to find realistic strategies. I am sure there are plenty of smart people working on things in isolation. But I do not have confidence in the expectations of how well those processes will be followed.They seem very susceptible to likely failures - such as people breaking quarantine (the idea that you don't endanger society for your own whims is not held by enough people - and the government does a pitiful job of dealing with this year after year).

That the government is all of a sudden going to start following the scientifically prudent actions that, after ignoring them and participating in encouraging security theatre for years (moving towards decades now) is very questionable. You can't encourage society to ignore science for decades and then expect they will respect scientifically necessary processes when the failure to do so will be catastrophic (such as in a deadly epidemic). Maybe you will get lucky and society will, but that is a very risky gamble.

The huge amount of waste on security theater and trying to spy on everyone and classifying (gag orders, "national security letters…") their actions to hide them from public ridicule and disgust would be much better spent on things that will actually make us a safer society.

I don't think the answers are simple, but if we don't take seriously how critical it is to plan better to cope with epidemics we will be sorry. And the money in the billions is there to do so - all we have to do is stop spending money on the atrocious things the Department of Homeland "Security" is spending money on now.

There are risks that are real and large (include health care risks and terrorism risks). But with so much bad behavior by government that erodes any sensible confidence government is focused on the rights and safety of citizens creates a horrible climate for coping with real risks to society. Government that doesn't demonstrate honesty, openness, a respect for the law and the people is creating exactly the wrong climate to cope with real security risks.

The science seems pretty clear that ebola is not going to be a series epidemic in the USA. But something else may well do so and we are pitifully prepared to cope with it. We continue to increase the odds of such an event with very bad antibiotics practices and foolishly failing to take vaccines creating the perfect conditions for epidemics.

Thankfully certain aspects of our health care system make coping with disease like ebola a problem that can be dealt with effectively. But the systemic problems are huge and ill suited to a real large scale crisis. And the pitiful behavior of government over the last 10 years gives no indication they are focused on sensible security that will help citizens.

Even worse though is how poorly we (as a global society) dealt with the initial conditions in Africa as well as our continuing efforts now. We had poor processes in place. We didn't commit funds early enough. We got behind and are not doing enough now. Lots of people are taking heroic action in Africa but without good processes it isn't enough.





Additional comment I added on the original blog post in response to another comment.

What the USA's role should be in helping people outside the USA is indeed a tricky question.

Even if you take the position those in the USA don't believe other people are worth protecting (which I don't believe) just a purely selfish government with an understanding of science and epidemics understands the risks of external disease vectors.

Just like those failing to use vaccines create a risky health system that everyone suffers from when things go bad, ignoring disease until it strikes your body is a bad way to protect yourself.

Plus when rich countries like the USA show disregard for people living elsewhere that drastically increases terrorism risks. Coping with that by allowing frustration to grow feeding crazy people's use of terror and then trying to spend hundreds of billions on weapons and the like is a lousy strategy.

It isn't like this is some shocking idea. Pretty much everyone that studies this understands that link. In the Bush administration they talked a lot about it and did some things especially with Karen Hughes. But even forgetting any terrorism concerns or humanitarian feelings, allowing dangerous virus and bacteria to infect lots of people (anywhere in the globe) is hugely dangerous for rich countries health. It is just a hugely foolish (looking at it completely selfishly and even when doing that ignoring positive externalities of action and negative externalities of inaction) to stand by while dangerous epidemics grow.

I believe the first reason to act is because all people matter, not just those inside your border. But even for people that don't care about that the completely selfish reasoning means not acting is foolish. And an understanding of disease makes it obvious you need to act a long time ago. Yes after failing to act more sensibly for a decade or more we should have acted drastically a few months ago. But even that would have been too late. Though actually for Ebola from a 100% USA selfish perspective it might not be too late - because it is likely like to become a huge problem in the USA. But something similar easily could and we have failed to prepare (which in this instance means failed to make sure the larger global health system is much better able to cope).



2nd update, good video by John Green on the subject:

Twice the Cost, Significantly Worse Results - The Sad State of Health Care in the USA

Why Is the United States So Sick?

Americans die younger and experience more injury and illness than people in other rich nations, despite spending almost twice as much per person on health care. That was the startling conclusion of a major report released earlier this year by the U.S. National Research Council and the Institute of Medicine.

Not so startling if you have paid attention the last few decades. The deadly disease of excessive health care costs (with, as Deming noted, the bad results that come from poor systems that are bloated with cost, waste and poor quality) has been a huge problem for decades.

The newest part of the breakdown is how even the massive spending in the USA has not been successful in even keeping the USA at a mediocre level compared to other rich countries. It was maybe arguable the results in the USA were no worse than average 20 years ago. It is getting impossible to make that claim today. Twice the cost, significantly worse results. Eventually you would think people would get tired of excuses.

The poorer outcomes in the United States are reflected in measures as varied as infant mortality, the rate of teen pregnancy, traffic fatalities, and heart disease. Even those with health insurance, high incomes, college educations, and healthy lifestyles appear to be sicker than their counterparts in other wealthy countries.

Related: USA Spends $7,960 Compared to Around $3,800 for Other Rich Countries on Health Care with No Better Health Results - Can We Expect the Health Care System in the USA to Become Less Damaging to the Economy? - Measuring the Health of Nations (USA ranked 19 of 19 rich countries) - CEOs Want Health-Care Reform (2009) - posts on the health care system on my management blog

Apply Management Improvement Principles to Your Situation

Can’t Always Believe Somebody Saying “Toyota Would Tell You To...”

We’re not literally hanging “andon cords” or putting tape around every piece of equipment just because a factory does it. We have to be solving hospital problems and not just copying tools. I get that...
There’s going to be variation in healthcare and we have to plan for that and make sure patient care comes first. We need to have a reaction plan for how to try to get back on schedule (and part of that approach could be to have buffer times for charting during the day instead of doing all of the charting at the end of the day).

Well said. Don't surgeons use something equivalent to "tape to make visible if the right tools are ready"? It sure seems like something like that would be wise to me.

The whole idea is to take principles first (and then tools) that are helpful and apply them to your situation/system. The business type will affect decisions (likely software businesses or hospitals will be more similar to those in their industry than others due to some features of that that of business) as will your specific organization.

If you design a system to have much more cross training of people then it will allow you to take advantage of that compared to another organization that instead focused more on specialization.

The decisions you make about individual aspects of the management system will impact what options are sensible for you in any particular instance. It is helpful to challenge yourself by thinking what would others do with this type of dilema but it is helpful not in letting you copy something they do but rather to provide you a new perspective.

Related: Curious Cat Management blog posts on health care - Curious Cat management blog posts on quality tools

Are We A Few Heros or a Society

Drucker Institute tweet: "Does government tax policy “prevent and penalize” entrepreneurship? Weigh in!" On their post: Who Really Built This Blog Post?

President Obama, speaking to an audience last Friday, said the following: “Somebody helped to create this unbelievable American system that we have that allowed you to thrive. Somebody invested in roads and bridges. If you’ve got a business, you didn’t build that.” In response, Romney, highlighting the line “if you’ve got a business, you didn’t build that,” has called Obama’s words “insulting to every entrepreneur, every innovator in America.” To insinuate “that Steve Jobs didn’t build Apple, that Henry Ford didn’t build Ford Motor, that Papa John didn’t build Papa John’s Pizza,” Romney added, is “wrong.” ... What do you think: What’s the best way for the government to foster entrepreneurship?

I think far worse than any of the taxes is the extremely bad job that has been done with the health care system. Deming noted this as one of the 7 deadly diseases over 3 decades ago and it is in much worse shape today. Costing twice as much as other rich countries with no better results is bad. Since the costs are so large they are huge barriers to entrepreneurs.

Even worse for entrepreneurship though is the poorly designed system where 1 employees medical expenses can cause serious damage to small companies. And the poorly designed system that makes it difficult to get coverage for previous conditions - which greatly increase the cost (in risk) of changing jobs, starting your own new business…

The recent reforms did help some, but it is an extremely small step after 3 decades of failures and making things worse. There is so much more that needs to be done. The costs and uncertainty related to health care are likely the most critical problem for entrepreneurs. Another contender is liability costs (yet another one of the decades old deadly diseases). 

The next contender is the broken patent and copyright system (which I think of as one of the new deadly diseases - along with excessive executive pay). I would put all of these far ahead of tax system issues for entrepreneurs. The biggest thing government can do is fix the 3 deadly diseases I mentioned above. People like Jobs (and Wozniak), Henry Ford, Larry Page and Sergey Brin are extremely valuable to a society. They make great contributions. Thinking they are therefore the reason for Apple, Ford and Google's success is ludicrous. They contributed. They contributed a lot. Dump them in Mali when they were born and they would not have created those companies as adults.

Saying that society doesn't play a huge role is false (a failure to understand systems thinking). Saying governments role is the same as societies also shows a poor ability to reason. The good things that Jobs, Gates, Bezos... are related to government in some ways but are much much more related to the entirety of growing a business in the USA. Inside those companies many others helped make the organizations a success.

Certain individuals do have an amazing ability to create successful systems. Again they can't do it themselves. They need other people. Granted a few of these leaders are extremely special. 95% of CEO's are decent at their jobs (or even not that good at their jobs) but replacing them with any of hundreds of other people would make little difference. But those CEO's all think they are more like Steve Jobs - they are not.

How to Grow Manufacturing in the USA

American factories, foreign lands: How can we keep our companies here?

Lower cost of labor is only part of a more complicated story. Apple, and other manufacturers, need flexible and responsive partners that can, and are willing to, react quickly to changing demands. This more nimble and cooperative supply chain is a valuable asset–a competitive advantage for manufacturers.
...
What can we do to keep even more companies from taking their manufacturing facilities abroad?

Lots of things can be done to improve the results of manufacturing in the USA.  First though we should realize the manufacturing results for the USA are really pretty good.

China's results are exceptional but the USA has done well.  Manufacturing jobs have decreased everywhere dramatically - the USA job losses (while current data is hard to get) are possibly than global manufacturing job losses.

The biggest thing that could be done to improve the manufacturing situation in the USA is significant fixes to the health care system.  The cost of support the broken USA system is enormous.  The second is to have managers of our organizations understand current management concepts like lean manufacturing and Deming's ideas.

They would then understand the weaknesses in spreadsheet thinking that lead to seeing outsourcing to cheap countries as the solution to all problems.  They would see the benefits of producing close to consumers (which also means in the case of some that manufacturing everything in the USA moving some production offshore - for offshore customers - may well make sense).

Putting the focus on improving the processes the company uses instead of just looking for a cheaper way to do what they do increases the desirability of the USA.  Currently (this will change) the USA has people better prepared to take on a leadership role in improvements.  By valuing the brainpower of your employees the desirability of locating in the USA is increased.  This is merely due to current practices around the globe, this advantage for the USA will change (Japan and Germany are very strong in this area as is much of Europe).

Related: Manufacturing Employment Data: USA, Japan, Germany, UK... 1990-2009

Causes of the Health Care Crisis

Root Cause of Health Care Crisis? by Pascal Dennis

Costs are exploding -- and crowding out other critical expenditures like education, R & D and infrastructure. Health care outcomes are disappointing. Miracles occur within the silos, catastrophe across them.

What's the root cause of this sorry state of affairs?

I don't think there is 1 reason why the health care system is so bad in the USA. If I had to pick the most important reason it is the legal infrastructure. The system is designed (with legal constraints) to favor entrenched interests instead of customers and stakeholders.

It is true other rich countries also have massive room for improvement. But the USA stands far below all other rich countries. The costs in the USA are about double the average rich country. And the heath care outcomes are mediocre. And the economic and personal outcomes are extremely bad. Tying health insurance to an employer is an extremely bad idea - that is rare among rich countries (I am not sure if the USA is unique in this bad practice, or not).

I have many posts on the problems on USA health care and how to improve the health care system in the USA.

It is possible to try and find the common reasons for health care failures in the USA and other rich countries but the USA is really in its own class of badness.

Related: Can We Expect the Health Care System in the USA to Become Less Damaging to the Economy? - USA Spends Record $2.5 Trillion, $8,086 per person 17.6% of GDP on Health Care in 2009

Lean National Health System

Topic: Management Improvement

A presentation today, Lean Thinking For the NHS, by Dan Jones is getting press coverage in England.

NHS should embrace lean times:

The improvements came through examining the patient's whole experience, and removing the sometimes-fatal delays in getting them into the operating theatre, such as creating a faster process for radiology and removing unnecessary paperwork.

These changes also lessen staff frustrations by allowing them to spend more time helping patients. Also, by cutting length of stay and complications, costs should also start to fall, although Mr Fillingham - former director of the NHS Modernisation Agency - said it will take several years for the savings to become substantial.

This is an example of focusing on improving the system which will then result in improved measures (cost savings for example). This systems approach contrasts with cutting costs by cutting every budget by 5% across the board which often fails. Without improvements in the system reducing budgets just reduces capability.

NHS 'should copy Tesco' to boost efficiency by Elsa McLaren (Times Online - UK):

"Every one organisation, public and private, has major problems with waste and inefficiency," she said. "The NHS can learn from the latest thinking as adopted by the Royal Navy, RAF, Tesco and Toyota."

Bolton Hospitals NHS Trust has been using the method and has seen a reduction of one third in death rates for hip operation patients. The trust has also reduced paperwork in trauma units by 42 per cent, and had a 50 per cent reduction in the amount of space needed by the pathology laboratory.

Making the NHS into a lean machine by Nick Triggle, BBC News.

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