What Gets Measured Gets Done...But....

....What gets pressured gets spun.

Targets. Targets. Targets.  A curious thing.  They include not only a prediction of the future, but also a prediction of influence on that future, and specific measurement of all that too.   Seeking that special sweet spot between being both challenging and achievable at the same time.

Of course in some cases it might well be visionary and aspirational, as in the old Eastern proverb ..."Aim for the top of the tree and you'll never leave the ground.  Aim for the moon and you might at least get to the top of the tree".  But more often than not it's about performance, and about success or failure.  Binary rather than multidimensional.

So big headlines around falsification of the measurement of cancer treatment waiting times to meet government targets.  The Care Quality Commission (CQC), the independent regulator of heath and social care in England found that measurements in one hospital, nearly a third of the patient records examined (22 of 66) had been altered to hide "extensive" delays for treatment.

What is measured and targeted sure does get attention and focus.  But once the that pressure tips the balance from being a priority, to being the pure judgement of success or failure, then unhelpful creativity and system redesign sets in.

That might just be managing the system.   There's the example from transport logistics moving electronically tagged parcels.  The sorting centre will bring the parcels inside only once they are ready to process them. Simply bringing them over the thresholds starts the electronic clock.   So best they wait outside until we can start the clock when it suits us.. That may well minimise the amount of time in the sorting centre, but overlooks the bigger picture of overall faster delivery.

It's also possible to entirely design out measurement of failure.  There were maximum waiting times from booking to appointment to see your local GP.  The solution.....take away the advanced booking system so you can only book on the day for the day.  No luck today, then it all starts again tomorrow.

What's disappointing is that the target it set at the minimum acceptable level.  So take the original four hour target for waiting times for Accident and Emergency departments.   So the margins can be managed, for example ambulances can be left queuing before patients are accepted which starts the hospital acceptance clock, and patients can also be transferred to "assessment units" which stops the clock.

That was strongly reinforced, hearing super presentation at the recent Royal Statistical Society Annual Conference (Sept 2014) from the joint academic and medic research team at the University of Sheffield. There's a fantastically clear spike where patients were admitted in the moments before they exceed the 4 hour waiting time.  The target has gone now but by all accounts the 4 hours is still a strong corporate driver.

What's even more staggering is some of the background measurement activities.  Different hospitals measure these things in different ways.  In fact it's possible to stay two nights and still not be classed as an admission.

So rather than the one dimensional focus on four hours, what about a four dimensional focus.....on the number of people waiting for 1hr, 2hrs, 3hs and then 4hr.   The elapsed time is being measured anyway so there's no additional measurement overhead.  That's a much more refined perspective.

Post four hours might well be failure, but how about some success focus too, at the 1hr and 2hr end of the spectrum.  Sure there might then be micro management at the hour margins, but at least it's a fuller and more multidimensional picture. Two A&E departments with identical performance at the 4hr threshold, might well look different when it's unpacked into the hour performance slots.  Even mean waiting times might give a more insightful view.

Some Psychological Context for Evidence

Evidence based decisions.  A mantra that gets used widely.  But there is of course a balance in decisions between evidence and judgement.  Decisions are easy, good decisions are more difficult, as they rely on getting that balance right between evidence and judgement.  But it does not stop there.

The reality of the world is that the evidence is set in the context of individual and social behaviours, which it can be easy to overlook.  The psychologists and sociologists have articulated and categorised plentiful behaviours that influence us both personally and collectively.  That adds another layer of challenge to power of evidence.

Here's just a few of those psychological contexts...

Cognitive Dissonance.  This is all about self perpetuating perspectives.  Where something is counter to a prevailing view (cognitive consistency), there are tendencies to find ways to assimilate those contradictions.  (Leon Festinger 1919-1989).  So the remedial action can typically include decreasing the perceived importance of the dissonance.  Dissonance can also be designed out....only taking information or news from specific sources for example.

Groupthink.  Really just cognitive dissonance for groups.  Coined in 1971, this describes the mutual reinforcement of group behaviour, often demonstrated as a general collective over confidence.   

False Memory.   Memories may not always be real.  They can be a distorted recollection or entirely imaginary.  So where memory is incomplete, the gaps can be filled with other information from other circumstances.  Entire false memory can be quite easily induced in experiments, often through mis-information.

Invisible Gorilla.  This about missing something obvious by being so focussed on something else.  In an experiment, a person in a gorilla suit (or dressed as a ghost or on a unicylce) walks through as baseball game and goes unnoticed by half of the spectators who have been briefed to count the number of passes.   More interestingly perhaps, even expecting the unexpected doesn't help you see it.

Halo Effect. Where one positive trait or outcome can lead to the assumption that other traits or outcomes are positive.    It works the other way around too as the "Horns Effect".  Its a long standing cognitive short cut for dealing lots of complex or missing data.

Muller-Lyer Illusion.  This is about the influence of visual context, especially important with the ever increasing infograhics and visualisations.  This is where the same two lines will seem to be of different lengths depending on their immediate visual context (typcially inward or outward facing arrows at each end).  The lines with the inward facing arrows will seem shorter, due to visual conditioning around perspective. 

Barnham Effect.  Named after the US Showman P.T. Barnum (1810-91), this describes statements which on the surface appear detailed or specific, but in fact will be vague or ambiguous, and even self contradictory and hence widely applicable as it covers all angles....Barnam described it as "having a little something for everyone".

Sources: Freudian Slips. Joel Levy. 2013

Serial Thinking

There's an emerging mainstream "thinking about thinking"  Given that "Learning about Learning" has become more common place and even expected - the explicit focus on Study Skills for example - so the same interest is applying to thinking.    In short there's increasing recognition about how our brains can work better if we're more concious about it.  Welcome to one such example....Serial Thinking.

So move over multi-tasking and welcome to serial tasking.  So if multi-tasking is parallel working, then serial tasking is linear working.  Of course multi-taking is really just lots of micro serial tasking with lots of switching.

There seems to be some increasingly recognition that the busyness of constantly switching from one area of thinking to another has more explicit downsides.   So natural multi linguists who start counting in one language then switch to another will stumble on the switch.  Its the overhead of switching tasks.  The more the switching the more the overhead, and hence becoming less productive, and often when we need to be more productive.  I'm not sure we should be surprised at this.  It would appear that the word "priority" only took a plural addition "priorities" in the 1970's.

So it's about having the mental capacity, space and energy to both focus on the specific and to have the capacity to think more broadly too, and without carrying in the baggage of previous tasks or the anticipation of the next one. "It's not just about time but about bandwidth...when we are most busy we think we are becoming better users of time when we are really becoming worse managers of our bandwidth" (Sendhil Mullainathan, Prof of Economics at Harvard).  As ever it's a matter of balance in these things.

That can translate beyond the personal to the more corporate and cultural.   Easy to be busy on the wrong things or in the wrong way (wrong busy), rather than making the space to make sure that it's doing the right things in the right way (right and less busy).

Sources: Wired October 2013

Rush to Wrong

In the world of strategy, planning, analysis and performance, there's a real balance to be struck between planning and action.   Sometimes this can be simple enough, especially in short term and reactive situations.

My favourite example here is generating parliamentary answers to parliamentary questions - with the red flag clipped to the wallet "Ministerial - Immediate at all stages".  But as scale increases, and where there is more choice, then that balance needs to be more sensitively managed.

There are two ends of that action-planning spectrum.....

Rush to Wrong.  Without sufficient planning then action can be wasted, even contradictory or counter-productive.  In a desire to do something and get busy, that might end up being "wrong busy".  That may take us further from our objective and makes things more difficult or longer to subsequently achieve.  If we're looking for the buried treasure, it's digging in the wrong place (ineffective) or with the wrong tools (inefficient)

Paralysis by Analysis.  With to much planning there is a risk of over-analysis.  Elapsed time can take a real toll.   There's the now immortal quote...."Move fast and break things. Unless you are breaking stuff, you are not moving fast enough" (Mark Zuckerberg).  That would rather assume that it's right things that are being broken.

So the challenge is to get the balance between those two extremes just right for the context.