Category Archives: Leadership

Managing people

Thoughts On Medical Decision Making

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Original article by Jerome Groopman

We all fall victim to habitual behaviors, and more so when we are unable to focus sufficient attention on tasks at hand, believing (consciously or unconsciously) that we can accomplish some process or task without conscious thought, instead thinking about ‘more pressing’ matters.

What is more difficult to detect are those biases not based on habit, but instead on other factors. Groopman’s article on medical decision making explored this issue in the light of decisions made every day by physicians in practices and hospitals across the world.

Several types of errors were explored, including Representativeness error (thinking that is overly influenced by what is typically true), Availability error (the tendency to judge likelihood of an event by how easy relevant examples come to mind), confirmation bias error (cognitive cherry picking – confirming what you expect to find by selectively accepting or ignoring information) and affective error (making decisions based on what you wish to be true).

The stories he shared demonstrate how a very skilled and educated doctor can make incredibly dangerous mistakes, due in some cases to the fast-paced world of medicine but in other in reaction to common human urges such as the desire to be merciful and spare a patient embarrassment or further fatiguing tests.

At my workplace we are tasked with making medical industry communication more secure and much more efficient – resulting in better patient care and increased physician and clinician satisfaction. After reading this article and having learned a great deal about how complex the communication needs of a hospital or practice have become, I have to wonder how many mistakes are made due to the very real problems of workflow dissolution and workplace communication breakdowns. How many errors of the classes described by Groopman could be avoided or reduced in severity through more frequent and higher quality peer-to-peer interactions in the medical industry?

GapMinder Data Analysis

In my HCI cognitive science class we’ve been studying visualization and how a given interface can enhance our mental processing power, bringing more of our wits to bear on a challenge. Here’s a look at comparing a few layers of data as reported by two very different nations.

Denmark vs. USA – Charitable giving related to income & life expectancy

I chose to compare the nations of Denmark and the United States, examining their respective records of charitable giving and comparing that to each nations’ income per person and their life expectancy. The data available ran from 1960 to 2008, and so it’s worth noting that the period studied spanned several wars with worldwide impact, numerous financial recessions and a gradual but accelerating trend of climate change.

The United States
The United States in 1960 was quite a charitable one, donating 0.54% of the gross national income (GNI) while only reporting $18,175 in income per person. We had a change of heart it would seem, as the % of GNI given to charity fell steadily for 37 years before finally ending at 0.18% of GNI in 2008.

During this period, while our incomes rose by $24k and our life expectancy by 8 years we gave 0.54% less to charities.

Denmark
Denmark in 1960 was a hard place, donating only 0.09% of their GNI while reporting only $11,569 in income per person. They seem to have buckled down and gotten industrious, as the % of GNI given to charity rose for 21 years to 1.03%, with a high of 1.06% before finally ending at 0.82% of GNI in 2008.

During this period, their incomes rose by $20k and their life expectancy by 6 years. In the end Danes increased their charitable giving by a staggering 0.97% over the period.

Reflections
An interesting measure to add to this comparison would be an index of reported happiness & contentment – does charity or income have a greater effect on happiness?

I would also have enjoyed seeing an overlay of world events across political, economic and climate scopes, relating those factors into the changes in life expectancy, income and charitable giving.

The animation was quite helpful, and illustrated the rate of change between compared parameters over the lengthy collection of data ranging over 48 years, clearly calling out the rapid rise of Denmark’s charity while the USA gave away less and less each year.

It’s purely correlative, but it appears that given the much larger percentage they gave to charity (from their noticeably lower income) the Danish were not overly burdened and lived to nearly the same age. Many factors could have been at play, but I’m given to lean towards the old adage that money CAN bring happiness as long as you spend it on others.

Reorgs: Rocky or Righteous (Designing the Experience of Company Transition)

As designers, we grapple every day with challenging projects. This of course is part of what keeps us coming back. Some challenges, although not directly related to project work, can still be looked at through a UX lens. In this case, I’m talking about a phenomenon you’re likely familiar with: company reorganization.

If you’ve been through a reorg (that’s ‘Reorganization’ in water cooler parlance)you’ve probably experienced your share of the whispers, closed-door meetings and mixed messages that seem to be par for the course when an organization goes through major changes in size, scope, staffing, or management.

I’ve been through a number of these shuffled decks myself, across several companies, and for a variety of reasons. It’s fair to claim that each one is different, but there’s enough overlap to identify patterns and form some baseline recommendations.

If you’re in a role with decision-making authority, then you’re ideally positioned to ensure that the reorg will be designed as an intentional experience with its actual user base in mind.

However, if you’re like the majority of us who aren’t in a position to make decisions about the reorg, you’re probably still reasonably close to the folks who are. Why not take the initiative and lay out some scenarios and recommendations for how the reorg can be designed for optimal reception and impact on your organization?

The users

Whether it’s planned or not, the scope of the reorg will have an audience far larger than the group of people seemingly affected on paper. The experience of these groups throughout the reorg should be purposefully designed by whomever is running the change management show.

Let’s take a look at who your users are.

  • The folks who are officially part of the reorg. Their status is changing in some way, be it their actual role, reporting structure, and the like.
  • Coworkers/teams who have direct or dotted-line dependencies with anyone or any team directly involved in the change.
  • Coworkers/teams whose only connection is physical or cultural proximity or who ultimately report to the same upper management.
  • Third party vendors who communicate with or provide services to reorg-affected parties.

Here’s what you need to realize: These groups will be getting bits and pieces of news about the reorg whether or not you craft that message explicitly.

With that in mind, you should ensure the messaging supports the business strategy, is accurate, and speaks to each party’s specific concerns.

This is the difference between an unplanned, unpredictable experience and an intentional, designed experience. It’s a golden opportunity to show your stakeholders they are a valued part of the organization, and you’ve got your arms firmly around managing the changes. If the right preparation goes into the reorg, you can nip in the bud any misinformation and unnecessary stress, building confidence in your team’s leadership and capability as a whole.

The alternative is to risk spending what trust currency you’ve accrued to date.

The message

Now that you know who you’re talking to, what do you say? It’s idealistic to think that you’ll know all the details when you begin planning the reorganization–but you do need to initiate your communications plan as close to the start of planning as you can.

Start by crafting general messaging that indicates the why–the logic being the necessity and desired benefits of the reorg. This should be high level until more details are known. If you know enough about the how to paint a low-res picture, do it.

A little bit of information that’s transparent and honest will go a long way–but take care not to make promises you can’t keep. Things can and will change, so own up to the reality that dates and other details are very much in flux to help you avoid having to take back your words when deadlines shift down the road.

As you approach major milestones in the reorg process and as the details solidify, provide appropriate communications to your audience groups–and do so again once the changes have been rolled out. This may seem like a lot of effort, but rest assured your people are asking questions. It’s up to you to address them proactively.

If a milestone date changes–and it will–the audience who’s been paying attention will still be looking to that date unless you update your wayfinding (in the form of project timeline communications). Without this careful attention to detail, you’re sharing bad information–perhaps more damaging than no information at all.

When the rubber meets the road

Inevitably, one question that will come up repeatedly throughout a reorg is “When does all this actually happen?” In other words, when do we start following the new processes, change how we route requests, start doing this and stop doing that?

For both logistical and psychological reasons, knowing how and when transitions will take place is vital. Often the difference between a stakeholder being stressed out

(perhaps becoming a vocal opponent of the changes) versus being calm and confident is the company’s honest commitment to consciously bridging the transition with trained, capable support.

This could be as simple as a window of time during which existing persons or processes can continue to be called upon for support or as complex as an official schedule that shows specifically how and when both the responsibilities AND expectations of the audience segments will change.

Usability research

It’s not like you can do A:B testing with a reorg. You can, however, do some polling when the initial reorg information is shared, then midstream, and again after the reorg is complete.

Why do this research? As with any project, from your first person perspective, reorg elements might seem obvious–or you may have overlooked some pretty big pieces. Talking with your ‘users’ can be illuminating and also sends the message that their input is desired and valued.

While some reorgs are expressly designed to reduce overhead/staff, reorgs are not always about cutting heads. Often-times it’s a shuffle of resources (people), and if the right discussions happen you can guide that process to a win win.

Using a handy list written by a gentleman you may know of, here are some dimensions co-opted for our use. Employ these as you see fit to generate interview material and discover how well your company reorg experience has been crafted.

Learnability: How easy is it for users to accomplish basic tasks the first time they encounter the design?

We can ask our participants what they took away from the reorg communications they were sent. This includes actual group or 1:1 meetings, formal documents, emails, etc.

Find out if the materials conveyed the message so the transition was easy to understand. Did they grasp both the high-level view and the granular details? (In other words, overall strategy and the specific impact to them.)

Efficiency: Once users have learned the design, how quickly can they perform tasks?

If the folks you’re polling have been assigned specific assignments in the reorg, ask early on if they fully understand their instructions and if they could have added any insight that might have decreased task costs or durations. Midstream or late in the game you can follow up to see if those instructions turned out to be clear and accurate enough for the tasks to have been carried out efficiently.

Did task instructions have the most time-saving sequence? Were there steps left out of the tasking communications that had to be discovered and completed?

Memorability: When users return to the design after a period of not using it, how easily can they reestablish proficiency?

Remember the telephone game? Someone makes up a story and then each player passes the story on to the next by whispering. When the story makes it back to the author, the details have changed–it’s a different story.

When those involved in a reorg talk with others, they’ll pass along what they know. The simpler the story and the more they’ve understood it, the less you’ll lose in translation.

Errors: How many errors do users make, how severe are these errors, and how easily can they recover from the errors?

A successful reorg requires a lot of work and collaboration between groups. Mistakes tend to be costly and have a ripple effect, becoming harder to correct as time goes on. The critical path of these big projects is placed at risk due to missteps due in large part to (wait for it) learnability and memorability, or due to errors introduced by people who have been put off by the lack of efficiency of the reorg process and attempt to forge their own path.

Another source of error is in failing to communicate enough timely information about role changes to employees and contractors. Major change breeds anxiety, and in a job market where workers have the power and employers are constantly on the prowl for good (and hard to find) talent, it’s a mistake to risk wholesale attrition.

Avoid this error by honestly and accurately communicating dates and the likelihood of roles continuing as is or with changes. If roles are going away, be transparent about that too. Better to maintain trust and respect with clear messaging about terminations than to leave folks in doubt and unable to plan for their future.

Satisfaction: How pleasant is it to use the design?

If the reorg does NOT leave a bad taste in everyone’s mouth, and if the stated project goals have been met, you’re doing it right. Reorgs happen for a reason, typically because something’s suboptimal or simply broken. Ultimately, everyone should pull together and work towards a positive outcome resulting in better workflow, lowered cost of doing business, increased job satisfaction, and, of course, $$$.

Moving on

Regardless of your role in the company and the reorg, consider whether or not you can use your UX superpowers to make the entire process less painful, easier to understand, and more likely to succeed.


Note: Also published at Boxesandarrows.com