Chat with Ed Hammond

For the past few weeks I've been working to get informational interviews arranged with various professional contacts. This is all part of my job search efforts that are inspired by being within sight of the end of my program at the Duke Fuqua School of Business.

Yesterday I had the pleasure of chatting with Ed Hammond, Director of the Duke Center for Health Informatics. Where to begin! I know Ed casually through a mutual interest in ballroom dancing. We get lessons at the same studio and see each other occasionally. Also, I've participated in NCHICA meetings with him and have listened to him present several times at class events at Fuqua. Ed's a well known and regarded pioneer in electronic medical records. I really admire his efforts to remain professionally and physical active beyond the point in his career when most would be retired. This is very much a goal we share.

Ed was enthusiastic, full of information and encouragement about the MMCi program I'm in at Duke. He had several helpful suggestions and insights relative to my job search. What a wonderful person.

Influences in community culture

The class reading this week on Organizational Challenges speaks to team vs. individual play and seeks to suggest constructive ways to positively change the culture within the genomic research community. In my semi-spiral career, I've witnessed many different cultural styles and have come to believe that culture is strongly influenced by what is scarce and how we compete for these resources. As a grad student studying nuclear physics and later when working closely with computational science I was exposed to the highly collegial culture of nuclear and particle physics. The scarce resource in that community is lab time. Labs are much more expensive than what can be obtained by an individual researcher. Collaborative teams are required to do anything in particle physics research. When I began doing network research, I found a very different culture. Projects small team oriented, and the scare resource is funding. The culture is captured by a favorite quote, "when the settlers are under attack, they circle the wagons and shoot out at the attackers. Network researchers circle the wagons and shoot in at each other." Early in my career at Bell Labs, funding was abundant, but recognition and credit was scarce. The culture was one where a favorite tactic was to prove how smart you were by pointing out, in the most public way, the fatal flaw in a presenter's thinking.

Lesson for patient safety taken from the aviation industry

The assigned reading for our Management class for this coming weekend includes The Checklist Manifesto, by Atul Gawande, a general surgeon. In essence the book is a narrative on the power of checklists as tool to avoid errors and deal with emergencies. Two central threads in the book involve 1) how the aviation industry has integrated this method into their safety training and culture with great success, and 2) the author’s experience in a WHO sponsored project to apply these lessons the surgical practice. The net is that after some trial and error, a clinical trial showed substantial reductions in major complications (36%) and deaths (47%) with use of the WHO checklist. The results were published in 2009 (A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population Alex B. Haynes, M.D. et al, Jan 29, 2009 New England Journal of Medicine). In the concluding chapters, the author discusses how little notice has been given to outcomes that otherwise would have generated headlines and had significant and widespread impact. By coincidence, last weeks lecture in Data, Information, and Knowledge Representation was on patient safety. Dr. Ferranti’s lecture gave the background issues and described efforts at Duke that are based on Informatic methods, use of CPOE and monitoring using both self reporting and keyword matching in HL7 messages transiting the Duke EMR ecosystem. The observed reductions at Duke were similar in level (30-45%) in several studies that he cited. One of the case study discussion questions (which we did not end up discussing) was application of methods from aviation to patient safety in hospitals. I wonder about the extent to which surgical checklists have been considered and tried at Duke.

Hash Browns and Potato Farming

Its curious sometimes what long lost memories will pop into my consciousness at odd times. While slicing potatoes to make hash browns for lunch today, a childhood experience came to mind. My maternal grandfather was a farmer in central Florida who primarily grew potatoes and cabbage. The potatoes from that area were prized by chip manufacturers and I seem to recall my mother saying that granddad grew potato chips on his farm.

During a Christmas break visit, at perhaps age 6 or 7, when we went down for a visit, granddad was preparing to put in next season’s crop. 50 pound burlap bags of seed potatoes were stacked up to the rafters of the open shed that served as a barn. We kids found great entertainment by rearranging the bags at the top of the pile to make ever more elaborate “forts”. While doing this, we looked on as farm laborers (mostly African American women as I recall) sliced each potato into quarters taking care to assure that each piece had at least one eye from which to grow another plant. Nearby a piece of farm equipment made to quarter the spuds sat idle. I inquired about this and was essentially told that the machine was faster than humans, but didn’t do a very good job, making too many quarters without eyes.

Back in the kitchen I made some notes about these memories on the back of some junk mail while the hash browns sizzled in the pan.

New Term

We just started the third term at Fuqua this weekend. I’m finding the classes for this term to be quite interesting at this point. Finance is more math than expected (lots of applications of geometric series algebra). There was a light bulb moment in the management class. The lecture (and case study reading) were about issues in group decisions. The plusses and minuses of this method were discussed. One of the minuses was groupthink, which has a much more specific meaning in decision theory. The lightbulb went off when our instructor listed the symptoms of group think. Of the 5 indicators, 4 were in effect at siXis. Taken with the fact that we choose such a bad time to launch the company relative to the economy, it can be argued that we programmed to fail.

The other thought that went through my head was some of the political process implications of the bias effect that Dr. Fisher spoke to in class. He demonstrated that when there is a systemic bias in the group members, that poor decision are the result. I found myself thinking about a belief that humans do a poor job of assessing risk, that we overweight it. To the extent that this is true (which I believe is the case), then a democratic decision making process is going to always overreact to risk. I think about this relative to fears of nuclear power and other important social issues that face the US.

That Used to be Us

I’ve been reading That Used to be Us, by Friedman and Mandelbaum via the Kindle app on my iPOD. The discussion that they provide has been quite engaging, although the delivery or pace with which they make their cases has been a bit ponderous for my taste. They talk about the 4 major challenges that the US currently faces, impact of globalization on the economy, impact of the IT revolution, the energy crisis and global warming, and finally the debt crisis we face. They also spend significant time discussing the 5 actions that the US has to take to deal with these issues. As I recall them, fixing our education system so that it is globally competitive, scaling back entitlements and raising taxes to deal with our debt problems, the need to invest in repairing our infrastructure such as roads and bridges, the need to develop and use no carbon forms of energy along with the global need for greater energy efficiency, and some others I forget. They discuss the need for shared sacrifice that we features of WWII, the cold war and other times in our history. They talk about our dysfunctional political system and how we got here in an insightful way (high campaign cost, perpetual fund raising which empowers special interests, and the polarization of the parties so that the middle is not engaged with wither. They talk about the war on math (fiscal fantasies embraced by each party respectively) and the war on physics (global climate change deniers).

Through out this reading I’ve been thinking about game theory (a subject discussed in our strategy class at Duke) and how the Nash equilibrium of this situation could be changed. From a game theory perspective we are in a Nash equilibrium, negative campaigning works well, overly simplified solutions are red meat to each party’s base (confirmation bias of the core supporters), compromise is not possible (the trend of wave elections for the past couple of election cycles gives each party the hope of controlling the congress and white house enabling them to push through their agendas through the legislative process. I haven’t come up with anything that works in my minds eye.

At this point I’m nearing the end of the book and they are making the case for a third party candidate. A major point is their historical analysis that although no third party candidate has gotten elected, in each case the executive winning the election has co-opted and implemented much of the third party agenda, in order to remove their threat in the next election cycle. Their argument is that the candidate needs to speak truth to the American people about the problems we face and the approaches that he/she advocates to address them. The candidate needs to confront the cliché answers of the established party core supporters and win over the middle, currently not part of the polarized current structure. They argue that the candidate will likely not win, but will positively influence the situation none-the-less. I tend to think that a third party win would be less effective than a third party loss based on their historic analysis. I’m not fully convinced, but this is a plausible way of moving to another Nash equilibrium within our political system that would allow us as a nation to focus our energies constructively on those problems we have been kicking down the road.

Staying Competitive in a Global Economy

Currently I’m reading That Used to Be Us: How America Fell Behind in the World It Invented and How We Can Come Back by Thomas L. Friedman and Michael Mandelbaum. I’m about 1/3 through the book. They have an engaging thesis which centers on 4 major challenges of the post cold war world that we live in today. These are 1) the long term fiscal crisis, 2) remaining competitive in a global economy, 3) the information technology revolution, and 4) the energy crisis one. The current chapter is about the role of education, its importance in being competitive in a global economy. They note how the education system is letting us down by not being competitive relative to other countries, and that the economy needs more highly educated workers than it did 20 years ago.

Coincidently while going to HT before dinner, NPR was broadcasting an interview with Gary Hart. The discussion was about his landslide (10%) victory over Mondale in the New Hampshire primary. As an aside Hart mentioned that as a senator he put a lot of effort into trying to address two looming crisises for the US, globalization and the information technology revolution. He noted that he was not able to get the attention of his colleagues on these issues. Well, that caught my attention. First that he had the insights to have seen the issues so far back, second that our political system is still unable to engage the major real issues of our time.