I’ve had a lot of good business writing come my way of recent. First, although I am still gradually working my way through it, is Craig W. Kirkwood’s “System Dynamics Methods: A Quick Introduction“. Second is Dharmesh Shah’s OnStartups blog. From there I read a recommendation for Professor Christensen’s “The Innovator’s Dilemma“. This begins charmingly with this paragraph:
When I began my search for an answer to the puzzle of why the best firms can fail, a friend offered some sage advice. “Those who study genetics avoid studying humans,” he noted. “Because new generations come along only every thirty years or so, it takes a long time to understand the cause and effect of any changes. Instead, they study fruit flies, because they are conceived, born, mature, and die all within a single day. If you want to understand why something happens in business, study the disk drive industry. Those companies are the closest things to fruit flies that the business world will ever see.”
So the Catholic Church is finally considering permitting contraception, but only within a married couple where one of the partners is HIV positive. In a couple of centuries the Church will hopefully get round to apologising for having contributed to the deaths of millions of people from HIV around the world with its ban on contraception, but in the meantime, I chanced upon another charming ditty from Christy Moore. It is called “Bridget’s Pill” but I cannot figure out the words to the chorus. The remaining words, however, are below:
Now Bridget O’Reilly was a fine strapping girl,
Her skin was like ivory her teeth were like pearls
All the boys chased her in vain ’till one day,
She went and got married to Barry O’Shay.
And after nine months, to their pride and joy,
Along came a baby, a fine strapping boy,
After three years they’d two boys and a girl,
And to clothe them and feed them made Bridgette’s heard whirl.
So she went to the priest, in great desperation,
Becuase of this process of constant gestation,
Say father this business is making me ill,
Would it be a sin if I went on the pill?
Well the priest heard her story, and when he had heard it,
To higher authority perlplexed he reverted,
All the bishops they we baffled, the cardinals too,
No one could tell Bridgette of what she should do.
Two years they debated the holy profundity,
Of what should be done about Bridgette’s fecundity,
But by now her family amounted to five,
She scarcely was able to keep them alive.
Well they gave due attention to points theological,
To points philosophic and physiological,
Till in desperation the Pope said O sod,
There’s only one thing to do I’ll have to ask God.
So he sends him a letter in the three penny post,
And painful not paid addressed ‘Holy Ghost’,
Sayin’ send me your answer in double quick time,
You can get me at home just ring Vat’ 69.
Oh well the answer it came and the Pope he announced it,
Oral contraception he strongly denounced it,
Unethical means to prevent procreation,
Were banned under pains of eternal damnation.
And now the church is in ferment and great trepidation,
As such thoughts they might spread to the whole congregation,
They recorded an LP to prevent the schism,
‘tween the Pope and the hierarchy called I got rythm.
Red Herring magazine begins an article on Google Maps this week with a wonderful reference to the short story “Rigor in Science” by Jorge Luis Borges. The story is so short it is worth quoting in its entirety:
“… In that Empire, the Art of Cartography reached such Perfection that the map of one Province alone took up the whole of a City, and the map of the empire, the whole of a Province. In time, those Unconscionable Maps did not satisfy, and the Colleges of Cartographers set up a Map of the Empire which had the size of the Empire itself and coincided with it point by point. Less Addicted to the Study of Cartography, Succeeding Generations understood that this Widespread Map was Useless and not without Impiety they abandoned it to the Inclemencies of the Sun and of the Winters. In the deserts of the West some mangled Ruins of the Map lasted on, inhabited by animals and Beggars; in the whole Country there are no other relics of the Disciplines of Geography.”
And there is an MP3 audio clip of Borges reading the story in Spanish.
A friend recommended this series of interviews to me and I’m enjoying slowly going through them. The first interview recommended was with the creator of the Facebook, but I found it a let-down – a kid with nothing to teach because he hasn’t had time to learn… But then again another friend accused me of being jealous. When I think of a defense I will be sure to write it, but in the meantime, my hat is off to all the great achievers in the series, including Mark Zuckerberg.
However, you would never know this from looking at them. For a start, they are interesting to look at, reminding me of the popular magazines that most people gladly pay money to read, like Bella, Men’s Health, Hello and Us Weekly. Inside are interviews with celebrities in which they discuss their life and work. The editors have cleverly steered the discussion towards health topics, and my personal favourite is Girls Aloud‘s description of their tips for staying healthy on tours. Nadine apparently stays off the alcohol and describes her “trusty OJ recipe”. An honourable mention must go to Rachel Stevens, who exhorts on the cover “Put one hand down your trousers, boys”.
I cannot overemphasise how good these magazines are.
Ellen’s team also ran a diabetes screening project, a double-decker bus that went round Slough. They diagnosed several hundred presymptomatic diabetics, at the cost of around 50 pounds per patient if I remember correctly, astonishingly good value – remember that a single GP appointment would cost at least that much per patient, plus the nurse’s time and equipment costs. Finally, my guess is that many of these patients were from demographics that would only have presented to the healthcare system much later in the disease process, with problems that would have cost a lot more to deal with.
Finally, I am grateful to Simon for the time he spent showing me the company’s Real Time Monitoring products. This has also been described by the company’s chairman, Tim Kelsey, at a Cambridge-MIT Institute workshop, and I have a copy of the presentation.
The data for this comes from forms that clinicians fill out all day in the NHS. I remember the A&E consultant I worked for spending time to make sure that we all knew that all those forms had to be completed correctly. It now became apparent that if they were not filled out properly the hospital would not receive payment for treating the patient.
I could easily see this because the software could show me (anonymised) details about each patient’s treatment and how much the institution billed for the treatment. Incorrect form = no payment. Clarke’s separation between provider and payer has finally come of age, and under a Labour government. There are many critiques of this, but the RTM products finally show the advantages.
Here are some of the questions that the software allows to be answered:
- How much did my patient cost when I referred her to the local hospital for treatment? How much is the average cost for the treatment of this condition (including subsequent complications) in the rest of the region, and the rest of England?
- How much did my patients cost me in diabetic complications last year? How much would preventative treatment for the population have cost me instead?
- How often do my hip replacements patients suffer from primary, secondary and tertiary complications? How am I doing relative to other surgeons in the region and country?
- How often do local GPs pick my hospital for referring orthopedic patients? Why has this rate dropped in the last year?
- How is this hospital doing in preventing deaths for conduction disorders and cardiac arrhythmias?
The latter question is answered in the screenshot, using CUSUMs. The cumulative summation technique (CUSUM) is a risk-adjusted outcomes measure intended to help clinical centers identify persistent, clinically relevant changes in performance over time. Of course, the data is adjusted for the local patient population.
My guess is that this sort of analysis is only possible in the UK – only there have so many patients (50 million) had so much of their medical records stored electronically, shared centrally, and the data analysed so impressively.
But the next challenge is to make sure that doctors understand how to use the software. My guess is that the clinicians have spent so much time filling out the forms that they resent the whole system. My guess is that they end up ignoring its benefits, ie Dr Foster’s software. The software probably ends up being used by local IT or statistics departments, ie individuals with low political capital in each institution, unable to conduct the right clinical analysis, and ignored when they make recommendations using the software. If that were the case then it would be a tragic waste of such a wonderful resource.