Data Must be Understood to Intelligently Use Evidence Based Thinking

All metrics are wrong, but some are useful

Metrics might tell you something about the world in a quantified way, but for the how and why we need models and theories … metrics are generated must be open and transparent to make gaming of the system more difficult, and to expose the biases that are inherent in humanly created data

True, understanding the proxy nature of data (and how well or questionably the proxy fits) is important.

Data can't lie but we often make it easy for others to mislead us when we don't understand (or question) what the data really means (what operational definitions were used in the collection, etc.).

Related: Operational Definitions and Data Collection - Actionable Metrics

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.

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..

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

The Management Culture Impacts How People Respond to Statements

> I still don’t really understand how “breach of protocol” could somehow be
> interpreted as “the nurse did it intentionally

Interpretation depends on logic and psychology. Fear and blame based cultures predispose people to think blame and take things as blame. Even when the words don't say that people take it that way.

This is one of the many reasons why the management system is so important. Even the exact same statement is taken very differently by people. In a good management system the statement 'breach of protocol" can be seen most employees as fine - an indication of yet again seeing a systemic issue and raising it to be dealt with. In a blame based management system it is taken as threatening and maybe even disrespectful.

Response to: Talking about Breaches of Ebola Protocol is NOT “Blaming Nurses”

Related: Creating a Culture that Values Continual Improvement - Building a Great Software Development Team

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:

Change - Why are We So Slow

Response to: One thought before sleep… why is management changing so slowly?

Psychology. Why it is we hold to beliefs and habits without evidence is a hard question that probably takes several books worth of material to answer :-/

But it is true that change is most often very slow. It isn't only management. It is our psychology that then manifests itself everywhere, even the least likely of all places - science.

A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.

Max Planck

Ironically in management we often also seek the new new thing. So while great ideas take a long time to become common practice we stop looking at them fairly quickly because we decide they are old outdated ideas. Not a very effective strategy :-(

Related: Change is Necessary, But it has to be the Right Change - Change is Often Not Improvement - When the ideas have reached the level of habits you have changed.

Should You Consider a Career in Manufacturing?

My response to this question on LinkedIn

Your Career Advice for Generation Y Adam Zak the Lean Executive Recruiter. Expert helping CEOs & their senior HR leaders recruit the best Lean executives in America.

Imagine your closest friend asks: "My son wants to consider a career in manufacturing. Should I encourage him?" How would you respond? And why?

I don't think generation [whatever you chose] makes any difference.

I do think there is some wisdom in looking forward to see the career prospects if you head down a certain path. The guesses about the future are far from perfect but also far from useless if you have some sense in thinking about the future. The prospects for manufacturing seem perfectly fine to consider such a career in my opinion.

Really for nearly any career I suggest keeping a focus on constantly increasing your skill and ability. And I would rather focus on building up skills that are adaptable to a changing workplace as my prediction is things will continue to change a great deal. Becoming an expert in lean manufacturing is great because that will be valuable in the likely changes in the workplace. Working with technology is likely to continue to grow and grow so building you abilities in that area is great. Growing your ability to work with other people is transferable to any workplace.

Related: Signs You Have a Great Job … or Not - Joy in Work in the Quality Improvement Field - The Benefits of Blogging