Category: Articles

Articles

How to get the biggest bang for the buck when you donate to good causes: Effective altruism

Image by truthseeker08 from Pixabay

Bang for the buck? We like to donate money to good causes. It gives us a “warm and fuzzy” feeling when we do something that helps those less fortunate than ourselves. But we rarely pause to consider whether our contribution is truly beneficial. We mean well, but there is no guarantee that the outcomes will match our expectations.

Here are some examples of unintended consequences.

  •  Too much of a good thing: When natural disasters such as earthquakes and tsunamis are widely publicized, a large amount of money and resources can pour in. But, the state of affairs at the scene of the event may not be adequate enough to put these to good use. A lot of good intentions go to waste.
  • Selfish altruism: Many of us split our donations into small amounts and give them to many different organizations. We’re called “warm glow givers.” Small sums of money can often cost more in processing charges than the amount donated.

Enter, effective altruism

In the past few years, effective altruism has come to be seen as a new way to think about giving.

“. . .a philosophical and social movement that advocates using evidence and reason to figure out how to benefit others as much as possible, and taking action on that basis.” – Wikipedia

The profile of an effective altruist

Data, not emotion: Effective altruists use a data-driven approach to do good. They prefer to donate money or give their time to causes that have the largest impact. In a sense, it follows the ethical philosophy known as utilitarianism.

How can one go about becoming an effective altruist?

  • Choose a career in which you make the most income, not with the intention of living affluently but so that you can do more good.
  • Choose a modest lifestyle in which you can donate a portion of your income to the most effective charities without putting yourself through discomfort or wearing a hair shirt. Guilt should not be a driving force in the decision.
  • Spend time researching organisations. The key question is: “Is the organisation working on important issues and are they doing it with a frugal, cost-conscious approach?”
  • Disseminate the message through various channels, including conversation, public speaking, and social media.

How do you know where your donations will be most effective?

GiveWell, is a not-for-profit organisation that has been working since 2007 to answer this question. Their data and resources are available online to anyone at http://www.givewell.org.

Emotions get in the way of charitable giving

Utilitarianism is not practical for most of us; it offers no room for emotions. However, we are largely driven by emotion when we give to good causes. Here are some of the mechanisms that work at stopping us from giving.

  • One over many: People experience a more positive effect when helping a single identified individual than when helping many. We will consistently choose family and friends over strangers and citizens of our own country over those of other nations. People’s responses to the suffering of others do not scale in a linear fashion but diminish as the number of affected individuals increases, a phenomenon that has been referred to as ‘compassion fade’ or ‘psychophysical numbing’.
  • Does it really reach the needy? In many places, corruption and local politics suck away donations. The needy don’t get them. We are concerned that donations made to such places might actually be supporting and promoting corruption.
  • Evolution rules: In the past, when the rules of evolution held sway, three fundamental motives helped solve key challenges: parochialism, status, and conformity. All of them are barriers to sharing and giving. Society has evolved to the point where these factors no longer hold good in day-to-day lives. Yet, evolution is a hard thing to shake off and can continue to create psychological barriers to effective giving.

Our moral boundaries can be examined by sound reasoning. Effective altruism tries to look closely at the results of charitable acts to make sure that money is spent in the best way possible.

 

Articles

If you want to be a leader, you need this “X factor”​: Executive Presence

Image courtesy Pixabay

The “X” factor: Executive presence distinguishes leaders from the crowd of people with mere talent or merit.

First named and described by Sylvia Ann Hewlett, EP is:

“… an amalgam of qualities that true leaders exude, a presence that telegraphs you’re in charge or deserve to be. Articulating those qualities isn’t easy, however.”

Success does not naturally follow talent and hard work. There are studies in support. You need to have extra qualities that are not easily acquired, and can even be hard to pin down. The most well known is Daniel Goleman’s description of Emotional Quotient (EQ).

3 Qualities: EP is a mix of 3 elements.

No alt text provided for this image

1. Gravitas: confidence + poise under pressure + decisiveness. This is the defining characteristic of leaders and is easily the most important.

2. Communication skill: speaking skills + deep, close listening + ability to read an audience or a situation. A powerful vocabulary needs to be a part of the territory. There is a direct correlation between vocabulary size and rank on the corporate ladder. Leaders have a much more powerful arsenal of words than those lower in the hierarchy and know how to tailor them to the audience at hand.

3. Appearance: Although not as critical as the other two, it completes the overall effect. A scruffy, distracted appearance does not go down well.

In addition, there are 3 more elements that complete the picture.

No alt text provided for this image

1. A calm demeanor: Tantrums and prima donna-like behaviour turn people off. You may be a genius and endowed with rare abilities, but you are unlikely to be a leader if you can’t keep a firm grip on your emotions.

2. Self-awareness: Leaders are aware of their own limitations. They are not afraid to ask for help when they are out of their depth. They delegate effectively.

3. Getting things done: They strive for and achieve completion in all of their tasks. They don’t leave situations hanging and unresolved.

Next time you come across someone who is “charismatic”, use this EP list to see how many of the boxes they check. Ask yourself how you can build it into your persona. Executive presence is not an inborn gift. It can be learned and implemented.

Articles

Pay it forward – be a mentor

Photo credit: Image by Sasin Tipchai from Pixabay

The Buddha constantly emphasised that the attainment of enlightenment was not the end of the spiritual journey but merely the beginning of a duty: the unremitting responsibility for providing counselling and solace to those in need of help for their prevailing predicaments (Dukkha).

In a professional context, and in a word: mentorship.

Paying it forward: Traditionally, we look at paying back as the way of acknowledging help and support given to us in times of need. There is a more effective alternative: paying it forward. In gratitude for what was received, we should consider helping others in need. The downstream benefits and multiplier effects are much greater. That’s what mentorship is all about.

“. . . a great mentor can provide a path to finding your own true answers.” Tina Turner quoting Miles Davis, the jazz legend.

Coaching differs significantly from mentoring. It is often short-term, well-structured, and designed to achieve specific, tangible outcomes. A coach is the least personal relationship option.

“Searching for a mentor is similar to searching for a spouse: you two need to share common values, concerns, experiences, communication style, and, of course, have time to invest into meaningful conversations with one another.” — [Anna Szabo, Turn Your Dreams And Wants Into Achievable SMART Goals!

An ideal mentor should be:

  • Accessible: there when needed.
  • Experienced: been there, done that.
  • Well connected: knows someone . . . who knows someone.
  • Tough but empathic: iron hand under a velvet glove.
  • Enthusiastic: yes, you can do it!
  • Charismatic: wow factor.

The scaffolding of good mentorship

  • Recognise what you desire from the relationship. It’s crucial to keep in mind that mentorship is a relationship. Instead of jumping right into business, the most effective mentorships are those in which the mentor and mentee take the time to get to know each other and grasp each other’s viewpoints.
  • Set expectations together from the start. How long do you want the mentoring to continue (but you may always extend it if you both believe it’s beneficial). Define critical objectives for your mentee to attain. Work together to build a general idea of how your meetings should go. Make certain they are focussed on a few essential problems.
  • Take a genuine interest in your mentee as a person. The cornerstone of good mentoring is empathic listening.
  • Develop a sense of trust. Trust takes years to develop, yet it can be shattered in an instant.
  • Don’t make assumptions about the mentee – inquire. Age, gender, colour, physical habitus, and appearance are seldom reliable indicators of what lurks underneath. Find out what makes the mentee tick by talking to them.
  • Share your experiences. It can provide you with a unique perspective on the challenges your mentee may be dealing with. You could have had a similar situation, so now is a wonderful opportunity to share what you went through and how you dealt with it.
  • Look for resources to help your mentee. This is where mentors can make a real difference. You’ll have insider knowledge of the area and access to resources that your mentee wouldn’t be able to obtain on their own. Link them to these resources.
  • Be aware of your limits. When your bandwidth is limited, admit your lack of expertise and recommend other sources or persons.

Anyone can be a mentor: The image of a mentor is often one of leaders, who have been sharpening their skills for years and are experts at what they do. However, that’s not quite true; you can be a mentor if you are enthusiastic and willing to share your experience with others!

Virtual mentorship

Post-COVID, remote work is now firmly entrenched as an alternative for providing professional services. Many individuals believe that physical closeness is necessary in developmental connections such as mentorship. This is wrong. However, mentorship is characterised more by the results achieved than by the medium by which it is carried out.

  • Plus: Virtual mentoring may be more egalitarian since visible status signals signifying organisational position and physical stature are reduced to a voice and a screen of equal size in video-based talks.
  • Plus: The limitations of shared space and location are also removed with virtual mentoring. Mentor/mentee schedules and locales are more flexible with online choices.
  • Minus: Because the whole spectrum of nonverbal signs and vocal subtlety may be lacking, it may take more work to create trust and rapport in the relationship. Virtual mentoring, like many other online partnerships, may suffer from email overload and screen weariness.

“I knew from my own life experience that when someone shows genuine interest in your learning and development, even if only for ten minutes in a busy day, it matters.” — Michelle Obama, Becoming

 

Articles

The secret sauce for “Getting Things Done”: slow down

The claim, “I’m busy,” is flaunted as a badge of honour. But, are you getting things done? Is your health and personal relationships suffering from your busy-ness?

There is a better approach to success and productivity: “slow work.”

“Restore your attention or bring it to a new level by dramatically slowing down whatever you’re doing.” —  Sharon Salzberg, Real Happiness: The Power of Meditation

  • Dismount the treadmill: We get stuck in the cycle of prioritising the urgent over the important. You have to step off and reverse the choices.
  • Single-tasking: Set aside time to focus on a single activity. If the job is complex, break it down into smaller, simpler chunks. It’s useful to work in 20- to 30-minute sessions with short breaks in between. If you are stuck, listen to music, take a short walk–break the rhythm.
  • Use the Pareto Principle (80-20 rule): 80% of our outcomes originate from 20% of our efforts. Invest time in understanding the activities that have the “greatest bang for the buck” and focus your energies on them. This will help you transition from a hustling attitude to a leisurely work philosophy.

Decision making has speed limits

In today’s world, much of our daily efforts involve decisions. If you are hoping to hasten your decision-making, forget it. You can’t ramp up the speed of your thoughts no matter what you do or how hard you try. Your thinking rate is fixed.

Some guidelines for good decision making

  1. Concentrate on what you really want. Ask yourself, “What do I intend to accomplish by addressing this choice?” Look at the answer from a 360 degree perspective.
  2. Don’t get caught up in little details. Leave them for later, when you are actually executing the task.
  3. To avoid decision-making under pressure, pre-commit to strategies that you have thought out ahead of time. 
  4. Seek the opinion of others. Obtain a few perspectives, preferably from those who have past knowledge of the subject.
  5. Be aware of your emotions. Don’t let anger and other negative feelings push you.
  6. Write down your ideas and options to help you clarify your thinking.

The quality of your judgments suffers when you are under pressure.

If you want to make better decisions, you need to do everything you can to reduce the pressure you’re under. You need to let your brain take all the time it needs to think through the problem at hand. You need to get out of a reactive mode, recognise when you need to pause, and spend more time looking at problems.

Make judgments while sitting down and examining the subject from several perspectives. You’ll still need to set aside time to do nothing but ponder.

The merits of slack time

Slack is the lubricant of change.

We are brainwashed by the belief that continuous activity equals efficiency. A lot of this perceived busyness is spent in the pursuit of trivial, unimportant tasks. In order to be effective, a certain amount of wiggle room is mandatory.

 

Articles

Want to be more empathic? Try listening with your eyes closed

This is how the Japanese listen to speakers. When someone addresses a group in Japan, the audience will shut their eyes and listen with their heads bowed. They are focusing on the Hara, an energy field that is centred around the navel of the abdomen. This response can be extremely disconcerting to outsiders who are invited to talk and are unaware of the practice.

There is a lesson to be learned from the Japanese about the skill of listening with empathy.

Skills can be hard or soft. Hard skills can be made explicit and overt, taught and passed down hierarchies with relative ease. Apprenticeship remains the major route for acquiring hard skills.

In earlier times, you could thrive on your hard skills alone. You could be rude, gruff and inhospitable, but the world would beat a path to your product. Not so any more.

Soft skills are vital in an age where technology is usurping and executing physical tasks. Soft skills are tacit — much harder to teach and certify. There are varying degrees of difficulty in the quest to acquire them. Indeed, there are some that can’t be taught; empathy may be one such.

Humans are social animals. Except for the occasional hermit, we need contact with our fellow humans on a regular, sustained basis. From an evolutionary standpoint, this makes perfect sense: connected groups have a better chance of survival than solo artists. Many people, even though they have strong feelings about wanting to connect with others, have problems with social connection and understanding.

Communication skills head the list of useful social soft skills. This is the age of networks where persons who are most valued and respected — influencers — are those who are deemed to be good with people at all levels, not tied down by rigid hierarchies and social strata.

  • Listening skills are very important tools for being a good communicator. Empathy — the ability to feel another person’s emotions, particularly pain — is the cornerstone of good listening.
  • Humans have an impressive array of tools for expressing and perceiving emotions. Body language and facial expressions are two traditional outward manifestations that can be read by listeners. They can often convey more messages than words.
  • Nevertheless, the spoken word is the cornerstone of communication. The voice is a particularly powerful channel for expressing emotions. In addition to the linguistic and content elements of speech, there are “paralinguistic” vocal cues that may provide effective pointers to underlying feelings which impel the words. These include volume, pitch and cadence.

Empathic accuracy is a skill with which individuals can effectively judge the emotions, thoughts, and feelings of others.

In 2017, Michael Kraus from the Yale University School of Management published a very intriguing piece of research. The study was carried out with 1772 participants. The central prediction tested in these studies was that voice-only communication enhances empathic accuracy relative to communication across senses. In other words, shutting off sight could enhance empathic accuracy.

The data showed that voice-only communication elicited higher rates of empathic accuracy relative to vision-only and multisense communication, both while engaging in interactions and perceiving emotions in recorded interactions of strangers.

  • Voice-only communication is likely to enhance empathic accuracy by increasing focused attention on the linguistic and paralinguistic vocal cues that accompany speech.

It seems as though the advice to listen with your mouth shut needs to be extended to the eyes as well!

Reference: Voice-Only Communication Enhances Empathic Accuracy. Michael W. Kraus, Yale University, School of Management, American Psychologist 2017, Vol. 72, No. 7, 644–654

Articles

A Walk Through the Brave New World of Healthcare Data Analytics

With a stethoscope around the neck, a good flashlight, thermometer and genuine empathy for patients, you were all set to go as a doctor, just a few decades ago. The need for empathy remains, but the world of healthcare delivery has changed hugely since then.

Fast forward to today. Sci-tech has given us tools of remarkable capability. There is no corner of the human body, however small or remote, that cannot be imaged, measured, probed and altered in some fashion. We are armed today with devices that can even work upon the very stuff of life and creation: DNA. The words of the science fiction writer, Arthur C Clarke, come to mind: “Any sufficiently advanced technology is indistinguishable from magic.” What modern Medicine can deliver today is undoubtedly magical.

From Pieces, Into Bits — the Digital Transformation

In keeping with all other areas of human activity, the years have seen a shift in medical technology from analogue to digital. As an example, imaging studies are almost all captured in digital form. The old x-ray film is now obsolete. This change is convenient; reporting, viewing, archiving, transferring and analysing are all made much simpler with digital systems rather than physical.

The Data Tsunami

The power comes with a price. The data that pours in from any given patient is vast. Everyone dealing with healthcare delivery — users, caregivers, administrators or third-party payers — struggles with the effort of staying afloat in this deluge. Making sense of all this information is a task that can exceed the cognitive abilities of the smartest. It’s now an uphill task to stay up-to-date even in narrow specialities.

Looking at just one speciality, oncology (2005 – 2015):

  • 140 million patient encounters,
  • Generating 0.1 – 10 GB of data per patient (14 – 1400 TB overall)
  • 80% of which is unstructured.

An average hospital generates 665 TB of data, yearly. The quantity is doubling every two years.

A Triple Whammy

Three properties characterise the data deluge.

  1. Volume — as exemplified earlier.
  2. Velocity — the rate of accrual and change is estimated at 20 – 40% per year, meaning that the size of the data store doubles every other year.
  3. Variability — Captured data is stored in silos that can be difficult to penetrate. A large part of the problem is the lack of unified data storage structures and inter-operability. On top of all this, a substantial portion of the data resides as unstructured records, often descriptive text and narratives.

Tunnel Vision versus Big Picture

As a result, it is challenging for anyone — users, caregivers, administrators or payers— to get “the Big Picture”. Like the story of the blindfolded men encountering an elephant, each one interprets the whole through the narrow lens of what is immediately perceivable by the remaining senses.

New Wine, Old Bottles

Fortunately, the very same technology that has brought about the problem also can provide solutions. Data analytics is the hottest ticket in today’s information technology scene. Data mining, machine learning, deep learning and artificial intelligence offer us the means to make sense of this mass of bits and pieces in a way that individuals — even large teams of people — cannot.

Big data analysis has been a part of managing efficient businesses for some time now. We can extend the lessons learned from business into healthcare delivery to the great advantage of all —- users, caregivers, providers and payers.

Meanwhile, Behind the Scenes

While this flood has been building up, a paradigm shift is ongoing in the way quality healthcare delivery is assessed. For decades, the model of payment in healthcare was “fee-for-service”. Whether the outcome was good or bad, a service was appraised as being worth a specific sum of money and the amount released to the provider.

In recent decades, quality assessment has shifted from a physician-centric approach to a patient-centric one. The endpoint for satisfaction is an outcome that the patient feels is worth rewarding. Life and activities of daily living have been changed for the better (or at least, not worsened) by the transaction. The two points-of-view are, quite often, tangentially opposed.

A “pay-for-performance” model is slowly replacing fee-for-service.

This new model demands a panoramic view of service provision where the individual is compared against a population-based norm. The data keeps shape-shifting and has to be evaluated in real-time from the perspective of the 3 Vs: volume, velocity and variability. Humans can’t do this with ledgers or even spreadsheets. Big data analytics is the need of the day.

Promises to Keep

The intention to harness big data can be sincere, but the tools cannot be wished into existence. There is no magic wand. Starting from a well-organised assessment of needs, healthcare analytic systems have to be carefully designed and implemented. It’s all too common to take a “kitchen sink” approach to the exercise and end up with a product that no one likes.

The Winners

Healthcare data analytics will benefit four groups.

  1. Patients will receive the best quality of care.
  2. Professionals (caregivers) can deliver the best quality of care.
  3. Providers (hospital administrators) can assure users of getting the best quality of care.
  4. Payers (third-party agencies) can be confident in getting the best value for money.

Let’s take a walk through the garden of possibilities.

Data Sources

Where does this mass of information come from? Every aspect of healthcare delivery is today, a geyser of data.

The Patient Record

The patient record is the cornerstone of high-grade medical care. It’s where the process of data analysis begins.

The history and physical exam report is the core component. This document maps the patient’s current and past health status in great detail. Personal habits, past illnesses, family and social history, medications, and treatment plans enter the archive.

Other details are appended over time. They include:

  • lab summaries,
  • treatment plans,
  • procedure notes,
  • nursing notes,
  • medication records,
  • progress notes,
  • consultation requests.

Over time, the repository can become quite sizeable and bulky. Making meaning out of the record becomes a laborious and frustrating endeavour.

The Electronic Health Record (EHR)

The traditionally paper-based record is now captured digitally as an electronic health record (EHR).

EHRs have many advantages over paper.

  • They don’t need the vast spaces that physical records demand.
  • Multiple users can view them at the same time, from different points of the hospital.
  • They can be transmitted anywhere in the world.
    • Most of all, being digital, they lend themselves to data analytics.

The push for widespread EHR usage in recent years has led to the availability of an extensive database which, after analysis, may be repurposed as information packets directed at improving patient care.

There is data in plenty and, of concern, just as many standards for defining the record structure. Any given piece of data may be stored and coded in any number of fashions, often with the same package.

Other Hospital Data Sources

Modern healthcare delivery is a comprehensive, diverse, complex system, probably more so that any other activity in everyday use. Every element of this system pours in data which needs to be factored into the care of a patient.

Some typical sources include:

  1. Laboratory Information Management Systems (LIMS): The number of tests available for clinical use run in the hundreds. Starting from collection of samples from the patient to transporting them, processing them in highly sophisticated machines, reporting results and delivering reports back to patients and care providers, there are numerous points of data collection.
  2. Diagnostic Procedures: There is an equally large number of diagnostic procedures used today. Most of them are now capable of recording the entire transaction digitally. ECG, X-rays, scans, endoscopic tests, angiograms: every one of them can be piped into the data backbone of a hospital.
  3. Monitoring Equipment: The mandate for high standards of patient safety and outcome results in the need for intensely monitoring patients during their journey in a hospital. Multi-channel monitors, alarms, respiratory support devices and many more are data points.
  4. Wearable health devices are here to stay. Immense amounts of personal information are pouring in every day. We have access to perspectives of any persons’ health in a manner never imagined before.
  5. Pharmacy Management: Beginning with simple records of prescriptions, pharmacy systems offer an opportunity to keep track of the complex interactions between drugs and quality care.
  6. Scheduling Patient Flow: A hospital sees large movements of people in and out of the system: appointments have to be made, patients tracked during their journey from area to area, beds allocated to the satisfaction of the patient and the doctor. Computer-based systems coordinate these functions today. They are no longer hand done. Once again, tons of data.
  7. Radiofrequency identification (RFID) is increasingly integrated into healthcare to provide real-time management, tagging, and tracking of patients and staff
  8. Insurance Claims/ Billing: The entire process is now done online. The life of an institution hangs on the efficiency of financial management.
  9. Human Resources and Supply Chain Management—many healthcare organisations now use enterprise-level systems to manage the complexity of care in modern hospitals.

This list merely skims the surface of all that is available. Suffice it to say that modern healthcare delivery pivots around data management.

Meet the Data Scientist

We are now at a point in time where the 3 “Vs” of data which we talked about have to be tamed and converted into useful, actionable packets. The complexity of the task has led to the evolution of a distinct brand of information analyst: the data scientist.

They are highly skilled, specially trained, much-in-demand professionals who are a single-point resource for managing, analysis and interpreting Big Data. They have the capability of using tools that are in themselves complicated bits of engineering.

The Upside

I: Patients

Medical practice is, in its entirety, directed towards the welfare of patients. Let’s see how data analytics can improve what is delivered.

A: Chronic Disease Management

Patients diagnosed with chronic non-communicable diseases (NCD) consume a substantial portion of health services. A handful of specific conditions like diabetes, high blood pressure, heart disease and respiratory disorders account for a major share.

Cost-effective management of NCDs hinges on the ability of providers to pre-empt high-impact, high-cost complications which often occur in patients with these disorders.

NCDs, usually life-long afflictions, provide a wide window of opportunity for applying health care data analytics. The number of data points that need to be weighed and acted upon in each patient can overwhelm the cognitive capacity of the most well-informed, conscientious doctor.

Using smart devices, RFID-embedded machines and the universal availability of mobile telephony, patients can be closely monitored for specific target levels such as vital signs, oxygenation, blood sugar, glycosylated hemoglobin, blood pressure and many more. Detection of abnormal levels or worrisome trends permits early, evidence-based intervention which can slow down the rate of progression of many of these disorders.

Treatment can be personalised and tailor-made to fit the demands of each patient.

In a review of 49 studies of chronic disease management (Bhardwaj et al, 2018), big data analytics was beneficial in:

  • risk prediction,
  • diagnostic accuracy,
  • patient outcome improvement,
  • hospital readmission reduction,
  • treatment guidance and
  • cost reduction.

Population Health Management using predictive analyses has shifted the focus of Public Health from the traditional wait-and-watch approach to prediction and prevention.

B: Genomic Medicine

Genomic Medicine has changed the face of medical practice. Patient genotypes can provide pointers to the most effective drugs and treatment regimes, risk of complications and long-term outcomes.

The discipline is expanding at a breakneck pace. New information pours in every day. Genomic data has to be matched to the vast amounts of values observed for individual patients: a daunting task. The field is wide open for application of data analytics.

 

II: Professionals (Care Providers)

Although the doctor continues to be at the centre of healthcare delivery, modern medical practice is a collaborative effort involving many highly trained and certified providers: nursing professionals, pharmacists, physical therapists, social; workers to name a few.

Data analytics bears great promise for enhancing the skills of care providers.

A: Pre-empting acute/ critical events

As discussed earlier, predictive algorithms can point out and highlight patients with chronic disease who are at risk for crisis situations. Interventions can be made before a patient’s condition snowballs into an acute crisis requiring emergency department visits. Data analytics can identify such high-risk individuals early. Ongoing progress can be monitored, and customised care plans put in place.

B: Learning Health Systems

The information base of healthcare delivery is expanding and changing so rapidly that conventional learning tools like textbooks are obsolete almost from the time of publication. Medical information has to be far more dynamic and real-time.

Data analytics offers tools for designing and implementing “learning health systems”. Every patient visit is an opportunity to both learn and generate new knowledge. Knowledge bases can be looked up to provide the most current evidence. Recommendations can be matched to a patient’s specific data set. New patient information can be added to a global database and analysed on the fly.

Personalised Medicine is the mantra of the day.

C: Research

Data mining tools can pick up patterns that are not easily seen by humans. As data accrues, the analytic engine can keep sniffing out many gems of information and new knowledge. Some examples:

  • Risk assessment
  • Early detection
  • Epidemic detection
  • Potential cures
  • Quality of life improvement
  • Prevention strategies

The COVID 19 pandemic has shown us numerous instances of data analytics picking out potential treatment modalities.

 

III: Providers (administrators)

Hospital administrators are under constant pressure while performing the difficult balancing act between quality and cost. Despite its undeniable benefits to other business domains, healthcare has been slow, even reluctant, to adopt practices that are of proven value in business. The post-Covid years are sure to see notable changes in healthcare delivery methods. The role of data analytics will be crucial to survival and staying afloat in what promises to be a highly competitive arena.

Here are some critical areas where data analytics can find an application.

A: Key Performance Indicators (KPI)

Every process offered in healthcare has an outcome. Both process and outcome can be objectively assessed, tracked over time frames and outcomes compared against established norms or over changes in time within a given provider’s domain. This is a KPI.

Any number of KPIs are in use. Some common examples include the length of stay (LOS), 30-day readmission rates and healthcare-associated infection (HAI) rates.

The variables (process(es), factors) underlying each outcome can be complicated. Making associations between intervention and outcome can’t be done manually. Multi-factorial analysis of massive data requires data analytic tools.

KPIs can be keyed into performance dashboards (see below). Feedback to caregivers, when done in a sensitive, non-punitive manner, can be powerful tools for quality improvement.

KPIs can be used to set up “best practices” manuals that could be highly specific for a given institution.

Even with clear goals in mind and a manageable list of KPIs, the process gets very foggy when large volumes of data are involved. Enter, data analytics.

30-day readmission rates

30-day readmission rates are an important KPI of quality of care. Hasty discharges before adequate stabilisation of patients often result in readmissions within a few weeks.

These events lower patient satisfaction. Outcomes are often adverse. Hospital costs climb steeply. Payers often impose penalties on providers for this complication.

Data analytics give valuable insights into the mechanisms that could have been responsible for this event. Corrective measures and policy changes could be implemented.

B: Patient Traffic Flow Management

There is a constant movement of patients and personnel, both into and within a hospital. For long periods, this flow has been managed by personnel who acquire skills on the job, without any formal training in operations management. Considering the intricacies of patient movement in a modern hospital, data analytics can be handy for smooth service delivery.

Waiting time is a leading cause of patient dissatisfaction. Quite often, appointment times are delayed by long periods. Patients who need elective admission often simmer in lobbies till rooms are ready for occupation. The average waiting time in an emergency room is about 4 – 6 hours.

Radiofrequency identification (RFID) is a useful option for tagging and tracking patients and staff. Patient’s can be pinpointed with accuracy. The data is valuable for shaping patient flow in the care process. Once again, data analytics offers solutions for optimising and managing hot spots related to patient movement.

C: Billing and Finance

However competent the caregivers, efficient financial management is vital for organisations to stay afloat.

Key Performance Indicators (KPI) can be handy for finance managers. A variety of metrics are available from organisations like the {Healthcare Financial Management Association (HFMA)

Data analytics can provide up-to-the-minute assessments of the financial health of a hospital.

D: Human Error

Adverse events during healthcare delivery are commonly due to human error. Failure to note abnormal values, improper medication administration or misidentification of patients are all too common.

Data analytic systems can spot these events and issue warnings.

 

IV: Payers

Third-party payers usually make healthcare payments in modern practices. Be they governmental organisations or private insurers; they are always battling costs and seeking to get the most value for money.

Data analytics are vital tools for payers.

A: Comparative Analysis

Data analytics permit payers to survey the market for costs and effectiveness of specific disorders and interventions. They can be done both within an institution and between hospitals. Device and procedure costs can be compared.

Pricing data can be mapped against quality outcomes to identify the best quality, lowest cost providers. This data can be used to leverage prices with hospitals carried by the payers.

Once again, data analytics can provide detailed, up-to-date figures.

B: Fraud Prevention

Suspected fraudulent claims can be investigated with data analytics. Comparisons can be made for similar claims at other hospitals of known quality and integrity. Hard data can support rejections.

Dashboards and Displays

It’s not enough to capture and process data. Actionable information has to be displayed to users in a fashion that is easy to grasp. Anyone who has played video games will know that current-day computer graphics is more than up to the task.

The Old Way

The typical healthcare report is a static document delivered in a one-size-fits-all model. Revisions and updates are slow and time-consuming, often out-of-date at the time of printing.

The complexity of data available demands much more dynamic output.

Dynamic Displays

Look at the NYSE

Although nowhere as demanding, the rapidly moving and changing screens that we see on the floor of the NYSE and other financial centres, gives us an idea of how data can be displayed for the benefit of users.

Interactive, multi-coloured dashboards are available, showing data in easily-grasped formats. The data is updated in real-time or at least in short, frequent intervals.

Users can view critical metrics, trends, benchmarks and such.

Bells and Whistles

Complex data, when presented as easily-understood charts and tables, allow users to make confident decisions.

The Brave New World of Healthcare Data Analytics

Everywhere we turn, we keep seeing, reading or hearing about the rapidly expanding role of big data analysis and artificial intelligence. Computer power and software complexity have reached a point where hitherto fortressed domains are being breached. Recent reports of programmes generating sophisticated pieces of journalism that are hard to distinguish from human writing have induced a sense of fear in all professions. Robotisation revolutionised manufacturing. The automation wave is advancing relentlessly into white collared jobs and the service sector.

Healthcare has stayed defiantly refractory to the changes happening around it. This state can’t last for long. Major disruptions are in sight. Healthcare data analytics hold the promise for being a dominant force in bringing about a much-needed change in the area of healthcare delivery.

Articles

In memoriam: Side Kick and the days of yore

Some time ago, I read about and started using a wiki with an intriguing name: “TiddlyWiki”. It’s a wiki and less; a wiki that went on a diet, shed large amounts of flab and emerged leaner and meaner. It’s a single html file that requires nothing special, no server, no geekspeak, works through your browser and does everything a wiki should. Jeremy Ruston (may his tribe increase), its creator, describes his brainchild as a non-linear, personal notebook. It has the austere simplicity of a Google opening page and, likewise, packs a punch. It grows on you and continues to amaze with its elegance. Explore it at TiddlyWiki.com.

This essay is not about TiddlyWiki but something that set me thinking in its wake. My first personal computer was bought after a lot of quick talking to my wife about how it would save my soul: an Apple II plus. The year was 1980. The box was all you got for a thousand plus dollars. I bought a small car the year before for about four thousand, so that should put things in perspective. No monitor; you hooked up to your TV set. No disk drive; if you wanted a 180 KB floppy drive, that would add another fifty per cent to the cost. Forget printers; a thermal-paper-based one would chalk up another 300 dollars. The software came on music cassettes that you played on your cassette player and plugged into the computer. A whopping 48 KB (K, not M, not G) of memory. I loved it.

This memoir is not about Apple II pluses either. Then came my first “PC” — loaded with 256 KB (yes, K, not M) of memory and a floppy drive that used 360 K floppies (yes, K again, not M). The machine roared along if you bought the double drive version. This way, you didn’t have to take out the floppy with the programme software and put in a data disk every time you needed to save files. The two-drive system allowed the programme and the data to cohabit the same box. If you were wealthy, you could ask for a 10 MB (yes M, not G) hard disk that had the heft of a Tom Clancy novel and crashed at least once a week. Reformatting hard disks and reinstalling operating systems and software was all in a day’s work.

This memoir is not about the travails of working in a frontier land where men were men and so on. No doubt, like the cowboys of yore who carried everything they owned and needed in their saddlebags, not their pick-up trucks and SUVs, we travelled light. 

This brings me to what this memoir is all about; software that made you gasp, made you feel like the guy on a horse seeing Marlboro country for the first time. Appropriate to the current metaphor, it was called “Side Kick”. I believe that there was a space between the words; this was in the prehistoric days before wiki words and camel case. Somehow, after installing and working with hundreds of packages, I cannot recall any that gave me the high that Side Kick did. Remember, we were in an age where windows were washed regularly, not minimized. To run a second programme, you had to shut down the one you were with and fire up the one to follow. Multitasking meant talking with the phone cradled between your head and shoulder, trying not to get choked by the cord while frying eggs. In this background, Side Kick was a stunner. The entire package was about 50 K in size (K, not M). It was memory-resident, which meant that it could perform the miracle of staying in the background while another programme was running; a “Ctrl-esc” combo would wake it up. It popped up on top of your open programme in a resizable window and did not take up the entire screen. It could do several things at once: a calendar, a word processor, and a small database, amongst other things. You could save files from it. You could copy, cut and paste — all for 50K.

Okay, “So what?” the generation X-ers are saying as they slaughter a horde of slime-eating mutants on their Play Station. Like stout Cortez on the peak of Galen, you just had to be there to get the feeling. It’s like standing in line for hours to see the first Star Wars episode in the seventies. All film-making technology that has followed does not do the same for me that my first exposure to R2D2 and the Force did. I can’t describe it, but those of you who were there would know what I am talking about. 

Well, Side Kick died, and I don’t think anyone even cared. I would mourn, now and then and like in life, the now and then became further and further apart.  And then, TiddlyWiki! In the words of my contemporary, Barry Manilow, it was time to get the feeling again. TW weighs in at about 200K, minuscule in today’s world of software bloat that considers 50 MB as slim and svelte. TW is Side Kick born again, as Zen-like in its stark simplicity and majesty, which is the real reason for this memoir.

PS: If you mourn Side Kick, you will also remember PFS:File, in my opinion, the best flat-file database manager ever. Using the current version of Access is like trying to roll a fallen elephant with a toothpick.

Articles

Making meetings matter: do it like Bezos

“It’s a truth universally acknowledged” that employees resent meetings and try their best to avoid attending them. Surveys show that as much as fifty percent of people in an organisation believe that they are a waste of time. Executives can spend up to 20 hours a week on them. They interfere with productivity; time spent could have been put to better use. But, no enterprise, big or small, runs without periodic meetings.

We Don’t Like Meetings and We Don’t Want Them Gone

Still, when asked if meetings should be abolished altogether, the same number of people reply that it would not be a good move. They feel that meetings are essential for maintaining a democratic spirit. Ideas should be aired, discussed and modified by groups of people; otherwise, the management style will be seen as autocratic.

Two factors are at work.

1. Parkinson’s Law of Triviality — Meetings have agendas. Items on an agenda vary in importance from critical to trivial. Professor Northcote Parkinson, him of the much quoted, eponymous law, also described a constant characteristic of meetings: The Law of Triviality.

There is an inverse relationship between the importance of an item and time spent on discussing it. Plans for a large investment on a major expansion will get passed over in a few minutes whereas a half hour or more will be spent on arguing about a new coffee dispenser in the lounge. It’s easier to talk about something that you are familiar with than something beyond your knowledge limits. (This law is also called “ the bike-shed effect ” based on a popular anecdote.)

2. More People, Less Effective the Meeting: There is also an inverse relationship between the number of people attending and effectiveness of a meeting.

The optimal number is 5. As the number increases, meetings become more and more unproductive. At 20, chaos reigns; from here on — 20 or a 100 — the number in the room doesn’t make a difference. It’s imperative that only those who can contribute effectively to the discussion be invited to take part. This is one element that is seldom carefully addressed.

The challenge, therefore, is to structure meetings to make them matter.

First, and For Ever, No “PowerPoints”

Jeff hates PowerPoint (or any other flavor) of presentation app. He believes that “ Powerpoint-style presentations somehow give permission to gloss over ideas, flatten out any sense of relative importance, and ignore the interconnectedness of ideas. ”

That’s an earth-shaking diktat for all of us who automatically reach out for these tools when making a presentation.

Well Structured Narrative

The man says, in a much-quoted memo that he sent out: “Well structured, narrative text is what we’re after rather than just text. If someone builds a list of bullet points in Word, that would be just as bad as Powerpoint. The reason writing a good 4 page memo is harder than “writing” a 20 page Powerpoint is because the narrative structure of a good memo forces better thought and better understanding of what’s more important than what, and how, things are related.”

The fundamental argument is not so much about the medium itself — Powerpoint or written document — as the need to think critically and clearly.

Here’s how it’s done

Step 1: Writing the Narrative

The person or group responsible for the meeting, spends a good amount of time producing a 4-6 page, tightly reasoned, carefully worded, written narrative. (More on how to do this in another post).

Step 2: All Those Needed for the Meeting Gather at an Appointed Time.

Step 3: Read the Narrative for 30 Minutes.

The document is NOT distributed ahead of time.

Everyone present now gets a copy of the document and spends 30 minutes in silent reading. They note down their observations, comments, opposition and so on, now.

Wouldn’t it be more efficient if the document were to be given in advance? No, says Bezos; “Just like high school kids, executives will bluff their way through the meeting, as if they’ve read the memo, … you’ve got to actually carve out the time for the memo to get read — and that’s what the first half hour of the meeting is for.”

Step 4: Discussion Begins Now.

The document is used as the anchor for all that follows. It’s easy to keep all members tightly focused on the task at hand with everyone being on the same level of knowledge about the agenda. The event acquires both magnitude and direction.

Meetings have been given a bad rap. Some of the reasons are valid. In order to extract maximum effectiveness, Jeff Bezos of Amazon uses an unique structure for all meetings in his organization. In summary, here’s how he does it.

  • Prepare a carefully-written, 4-6 page narrative about the topic for discussion.
  • Invite the smallest possible number of people for the meeting. Limit invitees to those who can make meaningful contributions.
  • Circulate the document at the start of the meeting and give everyone present half an a hour to carefully read and annotate the paper.
  • Tether discussion to the contents of this document.
  • Designate one person to be responsible for summing up the discussion and to provide an action-taken report.

The sole purpose of meetings is to create change, hopefully for the better. Like any tool, meetings are neither good nor bad in themselves. It’s how we use them that matters.

“The meeting of two personalities is like the contact of two chemical substances: if there is any reaction, both are transformed.” ― Carl Gustav Jung

Dr Arjun Rajagopalan

{P}rescription

All rights reserved

Articles

How to write a business narrative which will impress Bezos

“There is nothing to writing. All you do is sit down at a typewriter and bleed.” ― Ernest Hemingway

But then, we are not talking about writing like Hemingway or Nabokov or Alice Munro. You have come up with a project. You are sure it’s a winner. You work at a company like Amazon and to take it forward you have to first write about it in a 4-6 page narrative. This document will serve as the pivot for all discussions about the project, something that your colleagues and bosses can read with ease and grasp the ideas you are putting forth.

What are We Looking At?

First things first, we must be in tune with Jeff Bezos’ recommendation. “Writing a good 4-page memo is harder than “writing” a 20-page Powerpoint … the narrative structure of a good memo forces better thought and better understanding of what’s more important than what, and how, things are related.” Powerpoint presentations are banned at Amazon. Meetings, when needed, have to be structured around a pre-prepared, carefully thought out, flowing narrative.

Who, Me?

The prospect of writing a business narrative is daunting to most of us. We baulk at the act because we have never received training for it. Writing with clarity and flow is hard work. Even Hemingway viewed it with trepidation.

Yes, You

Most narratives, business or fiction, have a typical structure. Once we get familiar with this simple scaffolding, the process of writing becomes natural and effortless. Let’s look at a 4-step method of producing a business narrative that even Jeff will smile at.

Step 1: Where are We Now?

As Julie Andrews sang, “Let’s start at the very beginning.” What was it that provided the original impetus or spark for putting forward this proposal? Write about it in simple words. The starting point could be one or more of many things. Maybe it was:

  • Pain points: Write about whatever produced discomfort in your present situation: things that make you uncomfortable, wary, anxious, frightened or angry.
  • Dangers ahead: There may be lurking threats to the organisation which you feel need prompt and proper handling.
  • Opportunities: Maybe it’s about things that present a lucrative prospect and could be harnessed for the good of the company. Describe it.
  • Innovations: In a rapidly changing business world, it may be that you feel the present set up does not encourage new ideas. To survive, you sense that innovation has to be nurtured.
  • Competition: Today’s world is brutally competitive. You know that other groups are sniffing at your heels. We have to start moving faster and farther than them

The number of starting points are limitless but you will have a single, specific item. Identify it and write in detail about it.

Step2: Where are We Headed?

If you don’t know where you are going, one thing is certain: you won’t get there. Describe your goal and ambition. There are many frameworks for outlining this section. A popular one is the “SMART” mnemonic:

S = specific – be clear about what you want.

M = measurable – assess results by objective means.

A = assignable – allocate specific people for specific tasks.

R = realistic – stay within your ways and means — don’t over reach.

T = time bound – be hard nosed about deadlines.

Step3: The road map

We live in the age of Google maps. You wouldn’t stir out anywhere new without first getting a road map. Your narrative must talk of three things.

  • The various steps that need to be taken to get to the goal.
  • The time limit and deadlines for each step.
  • Obstacles that are likely to pop up en route and your plans for working around or over them. Anticipate road blocks.

Step 4: What will it Look Like when You are There?

“Are we there yet?” — the constant refrain of children on a road trip applies to your narrative as well. Don’t just go with gut feelings. Refer back to the stated goals and make sure that you have reached every one of them. Take a hard look.

  • Use objective methods of assessment.
  • List the benefits and joys of having reached your destination.
  • Pitch it against the list that started your journey.

Not Just for Business Narratives — be an Ace Speaker

Storytelling is a sure-fire way to capture attention. Anytime you need to make a presentation, convert it into a story and you will hold your audience during your talk. The framework that we just saw can be used to rephrase an idea into a narrative. With a little imagination, a boring sermon can be transformed into a tale of how the idea was born, its goals, the path to implementation and the view from the top. Like the ad says: “Just do it.”

Clever Tip

You don’t have to use the steps in the order listed. You can play around with it for dramatic effect. For instance, you could open with a vision of what the end looks like, shift to the reason for starting the journey, talk about the road and end with what your goals were. Play around with the four steps and see which order suits the spirit of the narrative

Come Back to Papa Hemingway

You don’t need a vast vocabulary or a smart turn of phrase to write well. Hemingway said this when putting down Faulkner: “Does he really think big emotions come from big words? He thinks I don’t know the ten-dollar words. I know them all right. But there are older and simpler and better words, and those are the ones I use.”

Write from the heart. Focus on:

  • Simple language.
  • Short sentences.
  • Brief paragraphs — each one containing one idea, each paragraph flowing logically into the next.
  • Anticipating objections and addressing them ahead of time.
  • Redrafting your manuscript many times. Be a ruthless critic of your writing, logic and flow. Every word must have a reason to be there.

Writing well is the best way of thinking well. Which is why anything written is given far more value than spoken words. Penned sentences linger as a legacy of a human being, sometimes well beyond the life of the person who wrote them. To disseminate great ideas, you need to write captivating stories. 

“After nourishment, shelter and companionship, stories are the thing we need most in the world.” ― Philip Pullman

Dr Arjun Rajagopalan

{P}rescription

All rights reserved

Articles

Every job application must include a covering letter

A carefully-crafted resume is the keystone of a job application. A large number of employers will also ask for a covering letter. Most, often, you will use a standard template: a few lines dashed off thoughtlessly.

Why Bother With a Covering Letter?

Giving a lot of time and attention to the covering letter might appear old-fashioned in an age when applications are submitted online. Still, a well-written document can make you stand out amongst a crowd of applicants.

The covering letter is a single-page letter of introduction — yourself, to the hiring manager. It is a carefully-crafted argument for why you are the best person for the job.

Remember, applications are scanned for specific keywords, phrases and qualifications, often by apps and bots, before being passed on for review by humans.

When Do You Send A Covering Letter? Always.

Quite often, a covering letter may not be mandatory. Don’t take this as an opportunity to slip out. Always send one.

No Templates, be Creative

Although you can recycle some portions of the letter, the bulk of the message should be one-of-a-kind, targeted at the company and the job you are applying for. Resist the temptation to automate the document.

Use this outline for writing your letter.

Begin with the usual salutation, a name preferably, or the designation of the person doing the hiring. Increasingly, there is a tendency to be informal: a “Hi” or a “Hello” rather than the “Dear …”. Judge the nature of the organisation before you decide. If it’s a young, start-up, open to fresh ideas, stay informal. If it’s a well-established company, then a more traditional style of address.

STEP 1: Start with Them, Not Yourself.

It’s customary to start by talking about yourself. Don’t. Your resume will do that. Do some research on the organisation and learn what their mission/ vision is. Point out how your ambition fits with theirs. Keep the tone enthusiastic but not over-powering. As the Taoist saying goes, pointed, not piercing.

STEP 2: Talk About the Job and How You Fit the Description

Show that you have understood the nature of the job and the specific requirements of you. Describe how your skills suit the position. How do they solve a problem or address a pain point for the company?

Many a time, tucked somewhere in the body will be a question or task assigned to you. The employer uses this as a check to see if you have scrutinised the application well. Make sure you respond and highlight your response.

STEP 3: Close With a Call-to-Action

The last paragraph should be a single-line recap of the company, the job and your fitness for the position. Give a contact number or email address, even if it’s there in the resume.

Keep It …

  • Short – not more than 2 or 3 sentence per paragraph.
  • Clear.
  • Succinct – don’t use grandiose or flowery language.
  • Neutral in tone – don’t be fawning, effusive or stiff.

And Don’t Forget to …

  • Spell check, grammar check, obsessively. Nothing negatively portrays you as much as a sloppily-written document, full of spelling mistakes and poor grammar.

There’s no question that the resume is the make-or-break factor in your application. Remember though that an outstanding covering letter could deliver the tipping force to your effort at getting a job.

Looking for work can be very disheartening. Finding your perfect job takes a lot of courage, persistence and ingenuity. Steve Jobs said:

“If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on.” ― Steve Jobs

Dr Arjun Rajagopalan

{P}rescription

https://p-rescription.com