Sunday, December 27, 2009

The Logic of What Might Be

We have a healthcare (insurance) reform bill passed in theory and probably soon to be passed in actuality.

The next question is: what does this mean? What does it mean, politically, functionally, to you, to me, to many others that don't have the wherewithal, desire, or ability (as a result of no connectivity or not having connectivity, if you know what I mean).

Well, if I summed it up quickly, it would go like this:

What does it mean politically?
It means that we have a president and a congress that has been in the position and created the positioning to push something through in about a year that has only been done a handful of times in the short history of the U.S. democracy.

It means that there will be attacks that happen any time any individual or group overcomes aggressive political opposition to accomplish something that the opposition vowed publicly and privately to completely derail.

It means that implicitly, something that has never been done is being done by a figure that has done something that has never been done.

It means that explicitly what we will hear is that when a figure that has done something that has never been done twice, the ultimate outcome is that there will be grave consequences because what has been done can't be that good. "There is no proof."

What does it mean functionally?
Functionally, it means that things are going to shift, some slowly, some within the next year. It means that some of us will pay a little more, some of us will pay a little less. It means that some of those folks with no connectivity or less than functional connectivity will have more opportunity to connect with things they need to feel and be connected.

It also functionally means that until we get accustomed to the shifts, that we may feel a little uncomfortable. It means that not everything that certain people wanted will be on the table immediately and in some cases not at all. There is no way this could have been all things to all people.

The inevitable consequence is that some companies and individuals that are already making a large sums of money from healthcare, will more than likely continue making large sums despite the varying stances on this dynamic. In fact, I am not sure if that would have changed more than a couple percentages in any direction because in reality, functionally, those making large sums anticipate how they can make money despite political outcomes. If we look at it logically, it is smart business. If a company does not anticipate what could be, they are subject to whatever is when it surfaces without any ability to turn the rudder when the ship requires a change of course.

So, that brings me to the title of this post. . ."The Logic of Might Be". This statement comes from Roger Martin talking about "abductive logic" in his book The Design of Business. Thinking abductively or proving what might be, asserts that past-based logic is not the only logic that drives our predictions of success. This way of looking at problems doesn't guarantee success. Nothing guarantees "success" where outcomes are concerned.

However, what it does is creates a space that allows for exploring possibility. In fact, to me it allows us to validate not just a single possibility but multiple dynamics simultaneously.

I can honestly say that I am quite disturbed that in this country that we have become so polarized that there is absolutely nothing that we can rally around as a idea that is good for us all. In fact, it seems that whenever such an idea comes about, we, the media, political parties, whomever, seeks a contrary position and drives that resistance so quickly and aggressively, that most people take a side. They seemingly do so because dichotomous options occur to them as the only options possible. This is the Logic of What Was or What Has Been.

In this healthcare insurance reform question or any other critical issue facing us in this current reality: Can we explore "The Logic of What Might Be"? or Will we stay limited by inevitability trapped within the cycle of what has been?

Make it a great day!

Thursday, December 17, 2009

Predictive Modeling of the Masses

My observation of the healthcare insurance reform debate and the war debate and the Tiger Woods debate and the economy debate and the obesity debate and the. . .is that there a lot of debates. There is little action towards an idea, centrally agreed upon that will move the U.S. and perhaps the world forward.

So, I came to the conclusion that all of us have become coffee table, computer desk, bar, stationary bike, recliner, barber shop statisticians as we are all engaged in Predictive Modeling. Let me briefly explain.

Predictive modeling is the process by which a model is created or chosen to try to best predict the probability of an outcome. (Geisser, Seymour (1993). Predictive Inference: An Introduction) In many cases the model is chosen on the basis of detection theory to try to guess the probability of a signal given a set amount of input data (Wikipedia).

The difference with us armchair statisticians in regard to predictive models for healthcare reform is that our models (for the most part) are not based on "detection theory" as described above. If so, that would mean that there was some level of understanding about how we discern potential outcomes. In most of the situations that we currently face including health insurance reform, the dynamics are completely without discernment.

In fact, most predictive modeling going on currently is based on one or a combination of: Self Interest, Fear, Preferred Media Outlet, and in the case of healthcare reform one's general depth (or lack thereof) of knowledge about healthcare.

Now, my biggest concern about the entire dynamic that we are facing is that given the circumstances (maybe given any circumstance at any time), speculation about what will happen in the future that is so highly unpredictable is a formula for failure and perhaps a formula for mass paranoia. It is not worth it.

What is the alternative? Well, I will stick to what I am most familiar with and what is the subject matter of this blog. . .Moving healthcare forward, in my opinion, will be much less dependent on reform of the system than it is on a paradigm shift in our organizations and individual consumers. The fundamental premise of healthcare is not cost, it's people, quality, and care in that order. I recognize that we have to make money to stay in business, those that know me will tell you I am far from naive in that regard.

However, the "money first" strategy has gotten us where we are in healthcare. The heuristic that emphasizes care is grossly compromised by financial considerations. In a model where people come first, efficiency is created through effective communication. Doing things well early in the process and setting the stage for effective self-care will inevitably save money.

Let's try this as a premise--1) focus on people/patients; 2) with this focus learn what effective communication is for each patient--make developing cultural competence central to effective communication; 3) resolve that effective communication for a year and the investment into it (not a highly expensive one) will impact quality/core measures more than anything else a healthcare organization can do.

Now, this premise is not going to quell the voracious appetites for the predictive tweeters and bloggers, ranting on about how the world is coming to a halt due to the actions of a single leader in one year. Nor will it make those demanding a public option without knowing enough about the pros and cons to do anything more than make an emotional plea.

What the premise above or any other premise you suggest can do is move us towards something we commonly agree on with the intent to use this heuristic to prove something or disprove something rather than speculate ourselves stagnant.


Make it a great day!