“Doing QI” is Not The Same as Improving Quality (2/2)

There is a fine line between “quality improvement” and innovation. Some may argue that quality improvement is a fix – making something better, more successful, or less error-prone.  Innovation, they might, involves creating something truly new, something that had never existed.

But if one insists on that definition, then some of the world’s most respected “innovators” were not innovators at all.  Steve Jobs did not create the first portable MP3 music player, only the arguably best.  Alexander Fleming did not invent the first antibiotic, only the most effective and famous.  Issac Newton was not the first to describe gravity, only its most mathematically characterized incarnation.

Innovators is a misnomer, coming from the Latin word novus (i.e. new), convincing us that one must strive to create something novel (i.e. novus) to innovate.  Innovators do not create something new; they are fixers of broken systems.  They are masters in the their traditional crafts who felt unsatisfied with the status quo’s offering, be it in technology, medicine, or physics.  They are quality improvement experts.  They did not need Level-5, 5S’s, 5Y’s, 6-Sigma, 12-Step QAPI, DMAIC, FADE, DOWNTIME, Kaizen, balanced scorecard, Deming cycle, ad infinitum.

“Doing QI” Is Not the Same as Improving Quality (1/2)

I was once told that when someone boasts to love James Joyce’s Ulysses, to ask that person how the book ends.

Like to the lover of Ulysses, the next time you hear someone in love with “Toyota” please ask him/her to describe the Toyota Production System. The short version would do.

When we see others succeed, we ask, “How do you do it?”  They may reply, “Here’s how,” followed by a set of well-intended advice in shortcuts and tips.  We then create a spiffy mnemonic and hold it as the bible for replicating the others’ success.

When quality improvement becomes an increasingly rigid set of criteria, alphabet bundle, and kanzi, it becomes easier to think of it as an end in itself.  Let us “do quality improvement.”  Let us find a project to applying these incredible principles (and they are incredible, but they are not hammers).  Let us refer to it as “QI” because that’s a thing now.

But sometimes quality is just about mending the gap when you see one.  Sometimes being methodical helps, but being passionate – not just mending a gap, but your gap – is probably all the requisite there is.  “Doing the QI,” then, may sometimes become an unintended obstacle.

Making a Deal with Your Future Self

Last July when I started my job, I was told that success will involve completing a set of 30-35 online physics modules over one year.  Each module takes only 1 hour, and I have a whole year to do it.  35 hours over one year, or six minutes a day. Continue reading

The Nature of Information Has Changed, and so Should Our Approach

If you are at least 25 years old, you would remember the days when everyone is trying to expedite the speed of information transfer.  Messages began with the courier services, first by horse, then by car.  Then they went digital.  The internet began with dial-up, when 56kbps was deemed state of the art, then broadband.  Then we decided that having to sit in front of a computer to transmit data is too slow.

Back then, when you get a wrong piece of information, it was usually because of timeliness.  Timely data was the business of newspapers, radios, and later television.

At some point, the speed of data transmission became near-instantaneous.

We had thought that faster information means better, but it may come at a cost.  Rapid information is raw, and sometimes inaccurate.  This is a common occurrence, but like car crashes relative to plane crashes, what made Twitter newsworthy is the few times when it nailed the right information seconds after an event, not the hundreds of thousands of times when it misfires.

Like breathing air, bad information has become so commonplace in Twitter and blogs that inaccuracy is invisible to us – we easily process the concept and underlying logic behind why rapid information is sometimes inaccurate, we just don’t think about it often.

And yes, I am aware of the hypocritical nature of using a blog post to divulge this argument.  As it turns out, the burden of verification is on you; I’m just exercising my first amendment rights. 🙂

Memorable events

We’d like to think of ourselves as the sum of our prior experiences, learning and growing over time. As it turns out, we do not accurately remember our experiences. What we identify as our own “experiences” are not experiences at all but memories. What end up as memories tend to be the outliers of those experiences.

In the words of Nassim Nicholas Taleb, these are black swan events.  But black swan events do not just apply to large organizations or countries; they also occur in our everyday lives.  Our experiences compete for space in our limited memories, and we remember the black swans.  Since the events we forget do not simply reside in memory as gaping black holes – like the retinal blindspot, the brain simply does not perceive the forgotten events, it may then be suggested that black swan experiences shape who we are.

Thus, it follows that to live a fulfilling life, one should optimize on the quality and number of memory-worthy experiences.  It means to take frequent vacations, see new places, but it also means to attempt a wide array of extra-curricular activities, learn a few things about areas outside of our expertise.  It means surprising our lived ones with something special spontaneously so they too can share some of these memories with us.

[Quote] “Science has eliminated…

“Science has eliminated distance,” Melquíades proclaimed.  “In a short time, man will be able to see what is happening in any place in the world without leaving his own house.”

 

– Gabriel García Márquez, One Hundred Years of Solitude (1967).

If not for distractions, for the people

When I’m alone, it’s very easy to slack off – watch YouTube videos, read a novel, Twitter, Facebook. Working in the presence of another person or people is an entirely different story.

I had thought that working in a coffee shop helped me focus because it had less distractions, but as technology advanced, my sources of distraction also mobilized and followed me through smartphones, tablets, and always-on connectivity.

If not for decreased distractions, perhaps I go to these places for the people. There is something special about being in the presence of someone else. That someone can be a significant other, a good friend, or even a stranger. It’s as if we have some accountability to the other human beings in the same room regardless, even to the stranger minding his/her own business at a different table, to maintain that self narrative of “I’m supposed to be productive.  Let’s get to work.”

The Irony of Consolidating Innovation

Innovation competition is a common mechanism for developing novel products or or otherwise encouraging creative people to do what they do best – create.  Entire organizations are formed around innovation (IDEO being a high-profile example).

The logic that high rewards attract high performers is reasonable.  And consolidating resources to fund two critically acclaimed novel inventions arguably makes more sense than dividing up the limited funds among 20+ ideas with variable viability.

But these assumptions only work if one makes the assumption that the inception of an idea is a planned process with an “innovative index” directly proportional to effort.  Only then can one make the conclusion that bigger rewards draws better ideas – it does so because people try harder.

But what if creativity is not an effort-dependent activity?  What if innovation, like chemical reactions in equilibrium, only appears predictable on the macroscopic level but is in fact sporadic and dependent on some lucky combination of kinetic creative energy colliding against one another?

It then comes as no surprise that many NIH-funded projects are sustaining innovations, those creating incremental improvements to existing technology.  2% improvement in blood pressure control.  Statistically significant but clinically undetectable improvements in cholesterol control.   Seven Tesla MRIs.  Sustaining innovations, by definition, build on a solid precedence and have higher probability of showing positive results, albeit by a smaller magnitudes.

Disruptive innovations are the smartphones, the PCR machine, the first AML chemotherapy.  They wield the ability to change entire industries; they are also rare.  They are one-in-a-million chemical reactions that require collision at a precise angle with the right kinetic energy.  One might even say that at the start, the inception of a disruptive innovations is sporadic, a lucky accident.

If earth-shaking novel ideas occur by chemical reaction, then it may be clear what we as a society must do to foster them.  The chemist does not give her molecules incentives and rewards for making a carbon-carbon bond.  Instead, the chemist selects the ideal solvent to make the reaction possible, offers a catalyst to lower the activation energy, and gently heats the primordial soup of innovation.

Then she waits, for above all, innovation takes time.  Innovation can’t be made to happen; it can only be allowed to happen.

The hardest thing I’m learning

The hardest thing a novice radiology learns is where to see the critical finding leading to the right diagnosis.

The second hardest thing a novice radiologist learns is how to ignore the noise.

The Quest for Working Happily Ever After

Heart rate mildly elevated, the sweat glands open, eyes fixated on the task at hand.   Time feels slow – or even frozen – but also at once flies by between each glance of the watch.  It’s an experience termed flow, which has been famously described by Mihalyi Csikszentmihalyi in a book by its namesake.

Flow has many components, but the most easily understood set include challenge and feedback – engaging in a task just sufficiently difficult to the level of ability and knowing immediately whether you did the right thing.

Like Fight Club, the experience was in everyone’s face; Csikszentmihalyi just made it visible.  The experience was on everyone’s tongue, and he just gave it a name.  In fact, it’s an experience so addictive (yes, flow experience and cocaine both use the dopamine pathway) that we sometimes spend the entire first half of our lives seeking that experience which we call a career. Continue reading