Christmas Wish List

The 13+ years I have spent in Healthcare have sensitized me to some things. I might have preferred to remain ignorant of many of them. In the spirit of Christmas, which is handy at this time of year, I'd like to nominate a list of gifts that would bless all residents and citizens of the U.S.A., regardless of theology or philosophy. Each item in the list relates to health care.

1. I wish that the role of technology could be clearly understood. There are a vast number of well-funded voices who want us to think that technology is health care or that health care is technology. In reality, technology is best thought of as a tool--an inert and often expensive piece of equipment, which, in the right hands, can produce wonderful results.
2. "The Patient" or "our patients" is not the same as "my patient" or "Josie Jones, patient". It may not be possible to apply technology designed for delivering care to a generic patient to Ms Jones. That doesn't mean that the technology is bad. It only means that the technology must allow for deviation in procedure. I wish that the role of abstraction is system design could be clearly understood.
3. I wish that all of the factions in the healthcare struggles were clear about their goals--with themselves and with each other. Only by being self-aware, open and open-minded can the parties negotiate a solution advantageous to all. Doctors, nurses, administrators, vendors, government and patients are currently at odds. The friction is not only between factions but within factions. Who will speak for physicians? The A.M.A.? Mayo Clinic? Who? Who speaks for government, for vendors, for patients, for nurses, for administrators? Each of these groups functions like a mob--surging to and fro as a strong voice emerges and then is drowned out. Each group must organize itself before "healthcare" can be organized.
4. Though I recognize that individuals and groups may be driven by ego to appear more knowledgeable than the next, I most devoutly wish that each of us might recognize that the person across the table might actually have some knowledge that we don't. I wish that we would listen first and assert only when necessary. I wish that we could see ourselves as occupying the same driverless bus.

There are many more things I might wish for this year but I don't want to seem greedy. May you each be showered with blessing upon blessing as one of God's beloved and may we fully appreciate each blessing as it comes.

Principles of Data Governance

Malcolm Chisolm, in a recent column in Information Management (A Principles-Based Approach to Data Governance) raises an excellent point. In 2006, when I attended my first Data Governance Conference, there was much discussion around a definition of DG. Implicit in this discussion was the need for something that was concise, yet comprehensive, and on top of that, engaging. The idea was that this definition could be used:

• As part of a sales pitch (like a slogan)
  
• To create synergy within the emerging discipline
  
• To provide focus for any ongoing methodology efforts

Some present may have had additional motivations, but I think these were the ones on most people’s minds.

The definition that emerged was acknowledged to be a work in progress. By the 2008 Conference, one of the tutorials quoted three definitions:

1. Data Governance refers to the organizational bodies, rules, decision rights and accountabilities of people and information systems as they perform information-related processes.


2. Data Governance is the practice of organizing and implementing policies, procedures and standards for the effective use of an organization’s structured/unstructured information assets.


3. Data Governance: The execution and enforcement of authority over the management of data assets and the performance of data functions.

These were troublesome to me then, probably for the very reason that Malcolm mentions. All seem to acknowledge a context based on an organization’s information assets, but their focus seems to be quite different. The feeling I have is that they are advocating a judicial, legislative and executive approach to governance.

In the U.S., a Constitution lays out these three perspectives and establishes the mechanics (framework, architecture) within which governance will be administered. Within the Constitution and before any of the mechanical parts are discussed, in fact, within the preamble, first principles are asserted. The writers tell us that what follows will be a system of governance for the purpose of

• Forming a more perfect union


• Establishing justice


• Insuring domestic tranquility


• Providing for the common defense


• Promoting the general welfare


• Securing the blessings of liberty to ourselves and our posterity

While this model would probably work on its own in establishing [data] governance, there are just a couple of nuances that will have to be accommodated because our system will not be working in a representative democracy but in a corporation.

Within the context of our system, leaders are appointed and serve at the pleasure of stockholders rather than the public. The principle of one-man-one-vote does not apply. One person may control sufficient votes to dictate to the Board of Directors. Within the day to day operations, the ability to dictate policy, direct activities and appoint deputies is granted at multiple levels, though always subject to the pleasure of the higher levels.

Having now established a context, it’s time to agree on some first principles for data governance. The candidates are:

• The entire corporation must agree to be subject to the system.
  While those placed higher may still, at their pleasure, appoint and dismiss deputies, they must agree that [data] governance operations will be a factor in those actions.


• It must be understood that within the corporation, domestic tranquility, the common defense and the general welfare are all dependent upon the information assets owned and managed by the corporation.
  When the system is followed, all processes will flow smoothly, problems are addressed at the process level, personal antipathies are secondary to process execution and process anomalies such as unplanned rework and delays are greatly reduced in number or even eliminated completely.


• Consistency is everyone’s goal.
  In a work context, surprises are almost always seen as negatives. Our goal must be to improve the consistency of our processes and their outputs such that surprises become exceedingly rare (six sigma has been suggested as a goal) and predictability becomes commonplace.

These principles should be the touchstone(s) of our efforts. Everything we do should be evaluated on the degree to which these principles are addressed.

I will suggest that these may also be the principles of the corporate Quality Assurance effort and remind everyone that they are also the basis of Deming’s 14 points as well as other quality improvement methods. No improvement is possible without first establishing a stable (consistent) process.

I leave you with one final principle: Data governance will not be implemented as a stand-alone initiative. If we cannot see data governance as part of a larger, comprehensive system of governance, we will not be able to address any of the three principles suggested above.

Survival, Error & Technology

I'm going to pass on some wisdom here. It's not very often that we encounter wisdom today, especially where technology is concerned, and it's often the case that we don't recognize or acknowledge wisdom until we're looking back over the wreckage and trying to figure out what we should have done. I'm probably also setting myself up by labeling this as wisdom but I am so weary of seeing the same ads with different acronyms and talking to the same people with different names.

You will never find your way out of the current mess you're in or about to be in by searching for and hiring someone with recent experience on a specific product. To put it another way, a specific product, no matter how much buzz it enjoys, is never the answer.

I will be among the first to acknowledge that the use of absolute language (never, always...) and even the use of unqualified superlatives (best, worst, fastest...) is a habit to be avoided, nevertheless, decades of experience have proven that the absolute statements in the preceding paragraph represent wisdom and that failure to heed this wisdom will produce cost overruns, timeline disasters, confusion, stress, employee turnover and a host of other undesirable outcomes.

In large part, the success of the human race has been due to our ability to recognize exceptions without necessarily understanding the rule. My own take on this is that, with today's reliance on technology, we may have reached the point where the process of natural selection that has honed this skill over countless generations has now produced a liability. "Something's different," is enough to put us on guard and may be enough to launch a complex defensive reaction to preserve the safety of the individual or group.

First of all, while it is still good to recognize exceptions, it is now absolutely essential (that's an absolute absolute) that we develop the ability to recognize the underlying rule. A study of human error (Human Error, Set Phasers on Stun...) shows that leaping to conclusions about the rule is what produces the error condition. In fact, if we can't describe the rule in terms of the logic of the computer (if... then... else...), we can't rely on technology at all.

You might ask, as I did, how we might acquire this ability. The time tested way is known as [survivable] experience. There are a host of cause-and-effect analysis tools and techniques that have the appearance of rigor and reliability and are an improvement over experience, especially when combined with exhaustive testing, but you will find that even these are more productive when used by people with experience in the world being analyzed.

Tools are great and another critical human enabler, but--and this can't be over-emphasized--no tool is so advanced that it runs itself. Every tool, no matter how advanced the technology requires human hands and a human mind to guide it. If you were to be presented with the greatest woodworking tool in the world or the most advanced sewing machine or fishing gear or computer, would you immediately become a master cabinetmaker or designer or fisherman or software developer? You might note that the only immediate change is one of expectation.

An experienced person with rudimentary tools is more likely to produce a quality result than the inexperienced person using the "best" tools. The fact that I used a tool just yesterday says nothing whatsoever about the level of my experience in producing the required outcome. I have made the mistake of looking for help and focusing too narrowly on what amounts to recent experience with the tools in my shop. I have learned (through experience) that I will enjoy better results if I'm learning while interviewing my prospective employee. If I'm talking with someone whose knowledge stops at the tool's user interface, then I had better be prepared to devote myself to directing the employee's work. If I have a staff composed of such employees, then I need to possess all of the requisite experience myself or else be prepared to conduct a project whose principle product is more experienced workers.

The challenge is to find the right mix of experienced people in supervisory or team lead roles and people who possess dexterity but are in need of experience. If I'm in a director or management role, I have to have experience producing a product with that scope. A technology "system" has a complexity that is beyond human comprehension. The only way to design and build it is through a process of identifying smaller and simpler pieces, building those and then assembling them into the final product. You need to look for people who have an appreciation for the amount of effort this takes and the discipline--both personal and organizational--that it takes.

Stop looking for Oracle or CRM or Rational or even "use case" or "data model" experience except as clues about the approach that the candidate might be expected to take. I understand that these things are ideal as targets for a logic rule processor, but the rule ("find resumes that include these terms") is so simple-minded as to be useless. If your only goal is to turn 1000 resumes into 100, then proceed, but if your goal is to find someone who can get you out of the predicament you're in, then you should spend more time on your rules so that the exceptions are more productive.