This is one of the few times in life that I will discuss football. Or sports. In my defense, I hope to make this post boring enough that no sports fan would bother reading it. Here goes.
The only football team I care about is Ebbsfleet United, and that is only because it was founded as an innovative social experiment. The club was bought with funds from fans, it remains completely owned by fans, and the fans are supposed to vote on every decision.
Earlier this week I received this message from the club:
We know you have followed MyFootballClub and Ebbsfleet United’s progress, which is why we wanted to keep you up to date with some breaking news.
Ebbsfleet United have received an offer from a League club to purchase striker John Akinde. This request follows a number of offers, from several different clubs over the last few months. MyFootballClub members are currently voting whether to accept or reject the bid.
The offer, made on Wednesday 27 August, is in excess of £140,000. Ebbsfleet United could also receive further payments depending on performance plus a significant percentage of any sell-on should the player be transferred to another club.
Fuller details of the deal – and the reasons why Liam Daish, the CEO and the Chairman believe that this offer is in the best interests of the football club as well as the player – will be disclosed if the transfer proceeds. (This is to protect Ebbsfleet United’s future negotiating position should the deal falter.)
Liam Daish, the CEO and Chairman are seeking the opinion of the club’s owners, the MyFootballClub members. Members have until 19:00 (UK time) Friday 29 August to decide.
This is quite a dilemma for me. I don’t mean whether or not Mr. Akinde should be sold – it is possible for me to care less, but not by much – but rather by the decision not to disclose full information to the club’s owners, the fans, so as
to protect Ebbsfleet United’s future negotiating position should the deal falter
There ought to be a way to use openness as a strength. On the one hand you have Mozilla’s Firefox web browser which continues to beat Microsoft’ Internet Explorer in quality and features. My brother pointed out to me that this state of affairs is ludicrous. Microsoft could pay for an entire team of programmers to do nothing all but watch the Mozilla team’s work and then copy it. In fact, they could literally copy and paste the code into their own web browser because Mozilla has a very permissive open source license. And yet, Microsoft’s closed work continues to trail Mozilla’s open work. This is the beauty that I see in open source software.
And yet as I study for my MBA I learn about negotiation skills and the importance of restricting information. A key tactic for building co-operation rather than capitulating to competitors in a negotiation is to have gradual, sequential sharing of information. Share a little information. If you negotiator reciprocates with sharing some of his or her own information, you can share yet more of yours, and so on. If you share all of your information at the outset, however, you lose because the person you are negotiating with has all the information while you only have half, and because information is power in a negotiation.
I do not know how to use openness as a strength. There must be a way, but I do not think it has been discovered yet because openness is still a new phenomenon. Even the Mozilla example is not about beating Microsoft because openness overcomes secrecy, but because the advantages of openness in collaboration outweigh the advantages of secrecy in planning against competitors.
But there really ought to be a value for openness in planning against competitors. For example, one advantage that Israeli negotiators have against the Arab dictators is that the Israelis can always say that they personally agree to something, but that The Knesset will never approve it, or at least that the negotiators have to consult with the rest of their people back home. By contrast our “leaders” never get to say that they have to get approval from their populace. And the open societies of the West beat the closed ones of the USSR, and will go on to beat the pseudo-open one of Russia today, because lively public debate minimizes inappropriate decisions made through private negotiations.
I do not know, however, how to apply this in business. I cannot find any books about it, and the few examples like open book accounting are practiced by mavericks like Ricardo Semler. There does not seem to be a body of knowledge showing repeatable best practices that I can learn how to copy.
Spellings continue you fascinate me for a number of reasons. The most recent one is this amusing story from an article in the Economist about modernizing English spelling:
Residents in Cologne once called the police after a hairdresser put up a sign advertising Haarflege, rather than the correct Haarpflege (hair care).
In my younger years I used to argue with my English friends about the superiority of American spelling. As I lived in the USA and learned more, I saw plenty of inconsistencies fossilized in American spelling as well. Connecticut and Tuskegee spring to mind, but even centre seemed more attractive than center because it preserved the French origin of the word. I guess I got more sentimental with age.
But this excellent article from TechCrunch UK was a timely wake-up call as it discussed starting a company in the UK and aiming it as US customers.
5. Always write in US English
Dates, spelling and phrases – UK readers are generally used to reading both UK and US English. Many US readers aren’t so don’t make understanding your product harder for them. Also US English will be better for your SEO.
So, from today I hope to stop writing in British English on my websites and stick to the American spelling. This is not so much modernizing as as it is pragmatism, as I make my US hospital CIO customers more comfortable with my company’s products.
But modernization of languages is also important as I consider my experiences teaching Arabic in DC. One student was particularly reticent about telling me where she had learned her Arabic.
In the end, she confessed that she had studied in Israel. I was fascinated to contrast her experiences in learning Arabic and Hebrew. Apparently, because of the migrations of Jews from all over the world who did not speak Hebrew, Zionists tried to modernize the language to ease its study. The result, my student and friend told me, was that she learned Hebrew much more quickly than she did Arabic.
This is a shame for Arabs need friends now more than ever.
But it is also a difficult problem to solve. One of the wonderful principles introduced in Islam is that the every Muslim should be able to read and understand the Quran. Long before Luther demanded that Christians be able to read the Bible without needing help from Latin-speaking priests, Muslims all over the world were learning to read so that they could understand their religion.
But such a progressive principle requires a conservative approach to enforce it. If the Quran is sacred text that no one must change, and all Muslims must understand it, then their language must not be allowed to change lest they cease to understand the Quran.
This is a serious issue, one that continues to hamper the learning of Arabic even as it rightly preserves the continuity of the Quran.
In the meantime, the technology is maturing nicely, and over the last week I have begun making use of Semantic MediaWiki (SMW) software to document clinical knowledge. Part of the course that I teach at UCL’s medical school this September is to get medical students to populate this wiki.
It is worth reading the Semantic MediaWiki user manual to understand why the technology is so useful. Here is the list of five reasons, modified with my own explanations the clinical benefits:
- Manually generated lists. Wikipedia is full of manually edited listings such the causes of secondary hypertension. Errors are common when a list has to be updated manually. Furthermore, the number of potentially interesting lists is huge, and it is impossible to provide all of them in acceptable quality. In SMW, lists are generated automatically like this. They are always up-to-date and can easily be customised to obtain further information.
- Searching information. Much of Wikipedia’s knowledge is hopelessly buried within millions of pages of text, and can hardly be retrieved at all. For example, there is no list of diseases that present with coughing and weight loss in Wikipedia. A SMW query would be much more effective than a text search is.
- Inflationary use of categories. The need for better structuring becomes apparent by the enormous use of categories in Wikipedia. While this is generally helpful, it has also led to a number of categories that would be mere query results in SMW. For some examples consider the category deaths from leukemia lists people who have died from the disease, but the disease itself is absent from the category vascular disorders, which only includes Migraine, cluster headache and reflex neurovascular dystrophy. The contents of the categories could easily be replaced by simple queries that use just a handful of annotations, for example Category:Disease, Property:body system, Category:People, Property:death from, and Property:date of death would suffice to create thousands of similar listings on the fly, and to remove hundreds of Wikipedia categories.
- Inter-language consistency. Apart from overcoming the differences between hematologists in the USA and haemtologists in the UK, you can ask for the incidence of leukemia (or even lukaemia) in the Chinese Wikipedia without reading a single word of this language. This can be exploited to detect possible inconsistencies that can then be resolved by editors. For example, the classification is slightly different for leukemia in the English Wikipedia and leukämie in the German one.
- External reuse. Some desktop tools today make use of Wikipedia’s content, e.g. the media player Amarok displays articles about artists during playback. However, such reuse is limited to fetching some article for immediate reading. The program cannot exploit the information (e.g. to find songs of artists that have worked for the same label), but can only show the text in some other context. SMW leverages a wiki’s knowledge to be useable outside the context of its textual article. Since semantic data can be published under a free license, it could even be shipped with a software to save bandwidth and download time.
The last reason is crucial for me. The development of decision support systems is stymied by each provider trying to create their own, text-based, proprietary system. The semantic incompatibility of these systems means that creators of electronic medical records cannot integrate the work of decision support systems providers.
It remains to say that I learned about the semantic wikipedia by attending HealthCamp Md, which was organized by the very wonderful Mark Scrimshire. Aside from inspiring me to try Twitter (I am still waiting for my new smartphone to arrive in the UK) and to start HealthCamp UK, he allowed me to meet Melanie Swan and Mike Cariaso. As a bona fide futurist, Melanie had already had her DNA analysis back from 23andMe and gladly shared the data with Mike. Mike ran these through the tools he had created at SNPedia. Within a couple of hours he was able to give Melanie an explanation of what was known about her DNA sequence, using the latest information documented in the SNPedia semantic wiki.
I was shocked and awed, and wanted to create something similar for doctors to use.
One of the most interesting features of LinkedIn is the ability to ask questions. I was put off at first because most of the questions were advertorials masquerading as questions. But if you have a serious question there are some seriously helpful people waiting to answer it.
I am outsourcing the development of software based on my paper prototypes. I have done this a few times in the past for small-scale projects, but the one I am working on now is a large one so efficiency is more important.
Does any one know of template I should use for laying out my instructions to the programmers? I do not want to over-engineer this, so I do not want book references or entire methodologies to adopt. A simple template, ideally with a couple of examples, is all I need at this stage.
And I was blown away by the quality of the answers. I knew about Gliffy already because I love the company’s software, but I did not know that they were actively promoting it for this prototyping. However, I do not like the pricing structure of the company, especially as I am in bootstrap mode, and besides in the past the software was a little slower than I had wanted it to be. Given that its competition is paper, I wanted to explore the other solutions recommended.
Extremeplanner, MockupScreens , and Axure look good but I want the software to be web-based to ease collaboration. In the end what impressed me the most is Balsamiq, built by a talented developer who is focused on integrating its excellent feature set with different wikis. He started with Confluence, my least favourite wiki, but I guess he is pursuing the Enterprise customers. TWiki is next on the development time-line and I will now try to convince him to include Deki Wiki, my current favourite.
One gem I had not expected to find recommended was the wireframe guidelines by Yahoo!. The company continues to impress me with its understanding of the hacker ethos, rolling out products like BOSS, an open search engine, and Fire Eagle, an open geocoding framework. I do not know if these efforts are too little too late to help the company, but they are certainly helpful to me.
And what was the point of all these tools? It was to create prototypes for my diabetes mellitus personal health records software of course. The designs are confidential for now, but if you would like to participate, do drop me a line on mohammad at patientsknowbest dot com.
I really enjoyed the interviews with senior staff at The Advisory Board Company back in 2006. I think they decided to hire me after I said that “the early bird gets the worm, but only the second mouse gets the cheese”. Before that, I think they knew that I knew about IT and healthcare, but they worried that I was evangelical the use of IT in healthcare, and that I would not help hospital CXOs make the correct business decision.
I thought of this quote many times while reading Authoritas by Aaron Greenspan. I bought the book because I had heard that Mark Zuckerberg had stolen the Facebook from Aaron while they were both studying at Harvard. He did, and it is a juicy story, even though it only takes up the final fifth of the book. The price of the book was worth it just to understand how frivolous Mark is, and to read that he rejected Aaron’s full-featured site because it was “too useful”.
But if you are a change agent, please buy this book. It shows you why there is no money in change management.
Aaron does not seem to have any cunning or guile in him. He seems to be a really nice guy, just trying to do the right thing. I feel safe in saying this because he includes so many conversations that make him look really stupid. I have done many stupid things in my life, but like most people, I hide them from myself and from other people. Aaron just writes down, in detail, what he remembers happening.
This kind of writing is what I call the “dark matter” of research material. Most accounts of change management are by or about people who succeeded in bringing about change, and whom society has recognised and rewarded for these changes. But society fails to recognise most people who try to improve, and instead these unreasonable people are crushed and never get to write their story, much less have it read. We should be grateful that these people exist, irrational on their insistence for a better way, and irrational in their persistence against society’s irrational rejections.
The transcripts of Aaron’s arguments with Harvard’s faculty are priceless, and the discussions between Dean Jay Ellison are fascinating illustrations of The Social Life of Software‘s descriptions of how restrictive digital communication is. I should add that Aaron hates Jay, but I thought Jay was the most reasonable of the Harvard bunch, and that he was genuinely trying to be helpful, but that they spoke in different tongues. Aaron’s accounts reminded me so many times of transcripts of conversations in books by Deborah Tannen and John Gray. Except the conversations do not illustrate arbitrary differences between how women and men talk to each other, but how change agents talk and stupid people respond.
There, I said it. I think the people Aaron tried to help were stupid for what they did to him. But then again, it was stupid of Aaron to continue trying to help them. This book is not so much a description of Mark stealing from Aaron, as much as documenting how Aaron keeps on being the first mouse that has his neck snapped by the mousetrap while the other mice grab the cheese.
What is interesting to me is that Aaron admires Bill Gates, or Sir Bill, as the Queen calls him. Bill Gates was never a change agent, and is the richer for it. That is why Microsoft continued with DOS for so long, even though it was the first and largest company to develop software for the Macintosh. They fully understood the superiority of graphical user interface, but most people (“business buyers”) were too stupid to understand, so Microsoft continued to sell them what they wanted to buy. DOS. Microsoft and Bill Gates only try to make change after they have enough monopoly power and people have to obey them. And even then, even the mighty Microsoft can be stung, as the Vista debacle shows.
So what is the lesson? It would be a shame to deprive society from the benefits of change, so I hope that reading the book does not dissuade anyone from trying to make change happen. But you really should read the book to understand what can happen to you, and to at least figure out when to quit and protect yourself. Aaron, I salute your courage, and hope only that you can continue your efforts long after the world has moved on from Facebook.
For the last couple of months I have been digesting the book Good Health is Good Business as I think through its implications for Patients Know Best. I had only thought of providers and patients as markets for my software, but now payers seem a significant possibility. I had originally dismissed this because insurance companies had the wrong incentives, and besides the more progressive ones were convinced they should build their own versions.
But the book discusses the incentives for employers to manage the wellness of their employees, and my software should support wellness. But enough about me. The rest of this post is about the points that I learned the most from.
First was the point that insurance companies have no incentive to improve the health of the patient, only to quickly process the claims for illnesses. By contrast, employers should pay to maintain their employees’ wellness because paying for illness is much more expensive, and maintaining wellness is possible. Here is the full list of reasons that Dr. David Rearick gives for employers to get involved, and its analogue in the UK is the government as payer rather than provider:
- You are the payer, and you have the incentive
- You are not big enough for anyone else to care (this is less the case in the UK)
- The health of your employees is the only factor under your control
- You have a captive audience
- You can motivate your employees
- Biometric testing
- Tobacco cessation
- Stress management
- Weight management
- Cholesterol reduction
- Hypertension management
- Physical exercise programs
- Substance abuse prevention
- Back care and injury prevention
- Health assessments
- Health risk counseling
- Nutritional interventions and supplementation
- Education on Aspirin Chemoprophylaxis for heart disease
- Being sure your dependent children are adequately immunized
- Establishing a tobacco screening and prevention program
- Providing brief counseling interventions for acute medical issues
- Encouraging appropriate colorectal screening
- Hypertension screening
- Providing Influenza worksite immunizations
- Providing Pneumococcal immunizations
- Providing problem drinking screening and brief counselling
- Providing vision screening