RTCrawford's Weblog

I don't make this stuff up. I'm not that smart.

Archive for the ‘Performance Psychology’ Category

Investing and Healthcare — The Quality and Learning Link

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A couple of years ago, my colleague Jim Porto at UNC Chapel Hill asked me to teach a two-day seminar on performance psychology, and I loved it. My students, on the other hand, initially evidenced a normal distribution, with agnosticism as the mean. In other words, a small number loved it, a small number hated it, and most figured it was a necessary block to check before moving on to more productive things. As I continued to teach it and my skills presenting the materials became better, the response improved, and, because the materials were taken from research rather than the self-help section at Borders, the impact has been rewarding (and the student evaluations would make my mother proud).

Well, I no longer teach the seminar (having handed it to others who are every bit as capable), but I’ve retained interest in the topic. Over the winter holidays, I read Malcolm Gladwell’s Outliers and Geoff Colvin’s Talent is Overrated. While both are interesting (Colvin’s is better, despite Gladwell’s higher standing on the New York Times Best Seller list), I decided to apply Jacobi and invert – looking at the causes of failure.

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Clinical Pathways and The Story of O

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Newton wrote the Principia (the most influential, non-religious text in human history) in 1684.  His three laws of physics and theory of gravitation are contained within it.  Almost immediately there was controversy, when Leibnitz published his text creating calculus, and Newton off-handedly claimed he had invented calculus in order to perform his research for the Principia.  The issue is not resolved until Newton produced his working papers – with credit ultimately given to both for this monumental advance.

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Written by rcrawford

November 30, 2008 at 12:39 am

Reversion To The Mean

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The question had to do with “Reversion to the Mean” in investment settings, but, in fact, it extends to management of firms, in general. Simply put, it sought a defense of reversion to the mean as a reliable and actionable model. The answer, in my view, requires an understanding of physics, psychology, philosophy, economics, and management. Here is the original question and my response.

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Computer Simulation Lessons Learned

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In previous postings, the names Kahneman and Smith have been referenced – Daniel and Vernon, respectively. Jointly, they won the Nobel Prize in economics (2002); although, their work was conducted separately. http://nobelprize.org/nobel_prizes/economics/laureates/2002/index.html .

In the case of Kanneman, the award was “for having integrated insights from psychological research into economic science, especially concerning human judgment and decision-making under uncertainty,” and for Smith “for having established laboratory experiments as a tool in empirical economic analysis, especially in the study of alternative market mechanisms.”

Both focused on investor psychology and the use of simulations to study investor and market behavior, response to new information, reactions to uncertainty, and the speed with which markets achieve equilibrium.

I mention this because the use of simulations may strike some as fundamentally different than fully competitive markets, but the research was validated as accurately mirroring typical market responses under an assortment of scenarios.

Why mention it here? Well, I use a computer simulation with my marketing class, and, yesterday, the four competing teams gave their end-of-semester “lessons learned” presentations. As usual, the results were interesting, and I thought you might be interested in some of the more significant realizations.

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The Strategic Helix of CQI — Sherika Hill

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As time permits, I am posting final exam papers written by selected students of mine (with their consent, of course). In each case, they have addressed the question of whether the tools and techniques of continuous quality improvement work in healthcare settings. This seemingly simple question is abundantly difficult. My students, however, are brilliant, and I am frequently rewarded with “mind candy” such as that provided by Sherika Hill, who posits that the continuous improvement of Shewhart’s and Deming’s PDCA cycle is not necessitated by perfection’s impossibility but, instead, by the changing forces and influences of the informing environment.

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Newsletter – February 3, 2008

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Medicare / Medicaid Budget Proposal. After several years of consecutive budget cuts by the federal government to state Medicaid programs, a New York Times article this weekend describes the budget proposal due for submission on Monday, February 4, 2008. The opening paragraph reads:

“In his new budget, to be unveiled Monday, President Bush will call for large cuts in the growth of Medicare, far exceeding what he proposed last year, and he will again seek major savings in Medicaid, according to administration officials and budget documents.”

With the boomer generation slated to enter retirement starting in less than two years, the high and increasing cost of health care in the United States represents a growing burden on the federal budget. The majority of those costs strike Medicare, where the most significant expenses associated with senior care appear. More than 70% of health-care costs are incurred in the last five years of life, and, with average life expectancy in the United States approaching 80 years, the brunt of this financial burden falls on Medicare. Medicaid, which is part of the same government office, represents an easier target for budget cuts, given the comparative power of these two constituencies – senior citizens and the poor. It is not, therefore, surprising that the lion share of cuts have struck Medicaid in recent years, nor is it unexpected that cuts are planned for Medicare given our close proximity to 2010 and the start of the boomer retirements.

As mentioned in previous postings, today’s 47 million seniors (those over the age of 65) will nearly double by the year 2030. This is 10 years after the Centers for Medicare and Medicaid Services (CMS) project insolvency of Medicare in 2020, and 2020 is a decade after the first of the boomer generation retirements in 2010. This increasing level of fiscal hiccupping is something that I and my students my projected nearly a decade ago, and it is something that I predicted during testimony in support of cost-reduction legislation in Pennsylvania several years ago.

Bird Flu. Roughly a year ago, bird flu was everywhere in the news. Today, however, it is barely mentioned. The majority of reported cases come from Indonesian, and the World Health Organization, as reported in this New York Times article, indicates the following:

“The virus is known to have infected at least 357 people around the world in 14 countries, killing 224 of them, according to the World Health Organization. Experts say that because of poor reporting of infections and deaths, the true number could be much higher.”

Not everything in health care is “doom and gloom,” and the recognition that bird flu has not spread more widely represents a success story, to date. Keeping my fingers crossed, I cannot help but connect this story with the previous one concerning budget cuts for Medicare and Medicaid. The Medicare population is consistently the most at risk for any form of flu, while the Medicaid population often represents one of the most significant vectors for communicable disease in the United States. This is largely a consequence of poverty and the inability to afford regular health care. While many complain that America’s poor increasingly use the emergency room as their primary care physician of choice, few who make such statements recognize the singular fact that, even for this demographic group, the emergency room is not an E Ticket at Disney World or high on the poors’ list of entertainment options.

Nevertheless, just as Katrina represented a significant embarrassment to the federal government, reductions in Medicare and Medicaid spending may constitute a similar threat to the reputation of government if bird flu ever meets its potential as a global pandemic. It is only then that the proposed and recent funding cuts will receive the close scrutiny it warrants today.

Invention and Innovation. Stanford psychiatrist Albert Bandura, who initially conducted research on dysfunctional behavior, ultimately focused on the psychology that makes superlative performance possible. More recently (nearly 50 years later), Charles Manz and Henry Sims (“The New Super Leadershp”) have returned to the subject, verifying much of Bandura’s work.

Both indicate that the most common trait of superior performers is a high tolerance for recurrent failure. Of course, there are other attributes that contribute to this outcome, as well. Frustration is also helpful, since it provides motivation and causes the subconscious mind to work on a problem even after we have mentally moved to more immediate concerns.

This tolerance for recurrent failure, however, cannot be emphasized enough. It represents the daily existence of most medical science researchers, who typically work for decades toward identifying the next advance. In their case, there is no guarantee of ultimate success, and each day represents just another in a long string of what many may consider daily “failures.” There are, in fact, decades worth of failure leading to nearly every Nobel Prize, and, for every Nobel Prize winner, an abundance of similar researchers complete productive careers without ever achieving that pinnacle.

This represents a significantly different take on the subject of innovation, inspiration, and accomplishment than is the norm. Most believe that the eureka moment arrives in a flash, rather than as a consequence of long and persistent labor. This next article, however, notes the fallacy of that bias.

Double Dipping. Sometime back, researchers studied the five second rule for a cookie dropped on the linoleum floor. It appears that five seconds is not sufficient time for bacteria to attack the cookie. Double dipping – the practice of returning a partially consumed tortilla chip to the salsa –, however, appears to be a different matter. Researchers with nothing better to do have concluded that the practice does, indeed, spread bacteria, according to this CNN article. Personally, I would prefer they diligently fail at finding a cure for the common cold (which hit the Crawfords last week) than spend their days confirming what my mother and common sense suggest are right, reasonable, and true. [Not every story in the news is worth reading, but some make us more competitive at Trivial Pursuit.]

High Operations Tempo Leads To Lower Military Morale. As an old combat arms officer, I am understandably concerned about the military and the current state of its morale. Over the last year, I’ve spoken with a number of military members (something on the order of 15) and have come to the conclusion that morale is significantly lower than at any time in my memory – including those dark years during the Carter administration, when funding was scarce, and during the first term of the Clinton administration, when the nation was pursuing a “peace dividend.” The military, it appears, has come to the same conclusion, according to this CNN article.

This represents a healthcare issue because soldier suicides are up, as are self-inflicted injuries. What does not appear in that article is what I am hearing from members of the Reserves and National Guard. Until recently, most members of the Reserves and Guard entered service never expecting foreign deployment, much less employment in a war zone. Repeated deployments and separations from family, however, are taking a toll, even if national support for the military is significantly better than during Vietnam.

This should not suggest that I am opposed to our presence in Afghanistan or Iraq, however. During my time in the military, I was privy to the classified reports concerning Iraq’s former dictator, and I remain surprised that he did not have weapons of mass destruction. Nevertheless, suicides and self-inflicted injuries are up 20% over last year, and are roughly double pre-9/11 levels.

Nightly Ritual. It was a nightly ritual that extended well beyond my son’s toddler years. Over the objections of mom, I was the enabler of my sons nighttime stalling routine. In an effort to delay his bedtime, my son would attempt to engage me in conversation on any subject he believed I would find interesting. And, as he would wind down from the day, laying there in bed, with me sitting on the edge, his mind would become pliable, open, and receptive, and it was then that I would impart those lessons that I believed most important.

I told him not to take drugs, because, at his early age, his mind was still growing, and the death of a single nerve cell represented the death of all the subsequent cells that single cell would become as it divides. I described all the negatives associated with smoking, above and beyond the risk of lung cancer. I told him that during his grammar school, middle school, and high school years he would confront an abundance of opportunities to mess-up his life but few opportunities, beyond good grades, to make his future successful. Those opportunities, I explained, would arrive when he entered college; which would be less likely if he became an unplanned parent.

Chief among those opportunities to mess up, I explained, would include overvaluing the opinions of his contemporaries. As an adult, I said, he would care little for what his neighbor thought; focusing, instead, on the strength of his marriage, raising his children to be the best adults they could become, paying the mortgage, succeeding at work, and earning a graduate degree. His friends of today would be gone tomorrow and barely remembered, so peer pressure and bullying should be put into perspective. Neither, I asserted, were worthy of him as perpetrator and both could be profitably ignored as the victim.

Today, he is an honors and advanced placement student at one of the top 50 high schools in the country, and, as a junior, the volume of his “junk” mail from colleges and universities around the US far exceed that which is addressed to his parents. I mention all this because of a CNN article on the aftermath of a suicide prompted by bullying.

Sometimes, there are more important things than a good night’s sleep.



The Critical Mass of Collective Intelligence

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An earlier posting, titled “The Outlier’s Power — Why We Emerged from the Caves,” was also posted on my department’s weblog, The Effective Health Executive, where it received a response from alamanach — making note of two content errors. That comment and my response follow. For those who follow this blog because of its focus on healthcare, the connection and implications become evident in the last two paragraphs:

2 Responses to “The Outlier’s Power — Why We Emerged From the Caves”

  1. alamanach Says:
    February 2, 2008 at 12:40 am editThat was a nice post, but if I may correct your handwriting on two points: the Second Law of Thermodynamics predates Heisenberg; Heisenberg’s eponymous Principle deals with quantum uncertainty. Newton’s second law of motion is that Force = mass x change in momentum (change in momentum is usually interpreted as acceleration), not velocity. But your point is taken, and it’s a nice post.
  2. rcrawford Says:
    February 2, 2008 at 3:54 pm edit


You are, of course, correct on all accounts. The first law of the Academy is to never trust an old management professor to accurately recall the science he learned in high school and as an undergrad. I had to go back and verify the blush of embarrassment I felt when reading your response, and, indeed, the second law of thermodynamics was created by Sadi Carnot in 1824—nearly 80 years before Werner Karl Heisenberg issued from his mother’s womb in 1901.


It is worth noting, as well, that the “friend” who urged Newton to publish his findings (in what would become the Principia) was Edmond Halley, of Halley’s Comet fame. In fact, Halley largely financed the publication at a cost of between five and six shillings per copy. That conversation occurred because of Halley’s interest in astronomy, of course, but he was also interested in meteorology.


“In 1686 Halley published the second part of the results from his St. Helena expedition, being a paper and chart on trade winds and monsoons. In this he identified solar heating as the cause of atmospheric motions.” http://en.wikipedia.org/wiki/Edmond_Halley


Following publication of the Principia, Halley wrote to Newton:


“I hope you will not repent you of the pains you have taken in so laudable a piece, so much to your own and the nation’s credit, but rather, after you shall have a little diverted yourself with other studies, that you will resume those contemplations wherein you had so great success, and attempt the perfection of the lunar theory, which will be of prodigious use in navigation, as well as of profound and public speculation.” Edmond Halley, July 5th, 1687.


In other words, Halley recognized the potential utility of Newton’s work on improving nautical navigation and trade. As the producer of the Principia, Halley would have an in-depth understanding of its contents, but he wrote this to Newton shortly after its publication and release. If Halley had not made this intellectual connection, surely some other academic of that day would. This can be contrasted with the referenced discovery by Archimedes, prior to the invention of Gutenberg’s printing press.


Archimedes ability to determine the purity of gold and other precious metals made international trade more readily possible because the value of coinage (money) could be identified with greater precision. This prevented unscrupulous traders from counterfeiting the unit of exchange by diluting its contents, as those on the other end of the trade now possessed the ability to verify the quality of the currency being offered. Without the printing press, there must have been some significant lag between the discovery and its broad adoption in the marketplace – with some period of awkward transition, as those familiar with the practice were compelled to explain this new approach without ready reference to an authoritative treatise.


In this contrast between Halley’s realization and Archimedes Eureka-moment, we have tangible evidence of Gutenberg’s powerful influence on the progress of humankind. By bringing together the collective intellect of any era, a critical mass of curiosity and contribution occurs. As Newton, himself, wrote to Robert Hooke in February of 1675, “If I have seen further it is by standing upon the shoulders of Giants.”


This is why the World Wide Web (of which this blog is just a small contribution) is so powerful. It is Gutenberg on steroids, but it has Gutenberg as its origination and inspiration. Equally important, it suggests the vital role of recording and publishing our failures, because there is information contained in the attempts that fall short of the mark – warning others that an unsuccessful path represents a waste of time or warrants alteration. This practice, however, has largely fallen into disuse within medical science, as the industry competitors funding research seek to publish their successes and strategically avoid admission of failure and experience its uncomfortable consequences –namely, harming regulatory approval and undermining the company’s equity value.


I believe, however, that we confront a looming resource-constraints challenge with the boomer generation in retirement. Already bowing under the heavy weight of health-care costs and inflation, institutional payers increasingly require failure on lower-priced generics before approving prescription of patent-protected medications. As we seek to more-frugally manage the cost of care, this seems likely to depress industry spending on research and development – making publication of our successes, near misses, and abject failures all-the-more important if medical science is to continue advancing through efficient and best use of our collective intellect.