Thursday, August 28, 2014



Selective Accountability is Wasteful and Undermines Community
Virginia Postrel, writing for the Bloomberg View, provided a very interesting description of the gap between what the best available data demonstrates about the importance of patient-centered hospital architectural design and the ways we actually build hospitals. 


The existence of a gap is not what I find most surprising.  What is most interesting is her description of why decision makers fail to build hospitals with these data-driven design features known to increase patient recovery time and reduce patient use of pain medications.  


“The problem is not a lack of knowledge…. There are specialized architects and interior designers who have spent decades studying how to improve health-care environments. There are articles in peer-reviewed journals — even an “Evidence-Based Design Journal Club” to discuss new articles — and annual conferences.

In other words, there’s plenty of information on how to make hospital-design better.

The real problem is a lack of incentives and feedback. New hospitals that hire fancy architects tend to lavish money on public areas — the places donors see — and treat hidden departments, such as the imaging suites, as purely functional. Even when money isn’t an issue, they make choices that please administrators but ignore research.

The old-fashioned insistence on highly polished floors, a hazard to older patients with fading eyesight, is a pet peeve of health-care design experts. Evidence suggests that patients react better to landscapes than abstractions, and that “chaotic abstract art” and “close-up animals” looking directly at the viewer should probably be avoided. Yet the $1-billion Ronald Reagan UCLA Medical Center, which opened in 2008, features a cafeteria mural whose violently jagged abstractions are made all the more threatening by other shapes resembling lions staring out.”

Because elite decision makers are excessively focused on impressing other elite decision makers (donors and other administrators in particular), even when these decisions undermine the mission of the institution, are contrary to the best data, and waste money. 

If hospitals are anything like universities—large organizations run by elites insulated from what happens on the ground to actually advance the mission—then these elite decision makers likely joke among themselves about the need to insist upon greater accountability from their front-line workers whom they assume act to undermine the mission, contrary to the best data, and waste money.

Sunday, July 27, 2014


Save Money and Support Democracy?
A recent edition of the Akron Beacon Journal ran an editorial from Cass Sunstein, Professor of Law at Harvard, that is well worth thinking about, personally and as educators with students who waste their scarce resources in ways that the analysis here might help prevent.   
You can read the entire commentary at this link, and I hope this selection encourages you to do just that.

At CVS, a 100-tablet package of store-brand aspirin costs you $1.99. Bayer aspirin is three times that much. Nonetheless, millions of people end up buying Bayer. When it comes to headache remedies, salt, sugar and hundreds of other important products, many people choose national brands even when a cheaper store brand is at hand. Why?”

A very good question.

“For the first time, we have solid answers, thanks to a study by Dutch economist Bart Bronnenberg of Tilburg University and three colleagues from the University of Chicago. They found a simple correlation: The more informed you are, the more likely you are to choose store brands. Pharmacists, for example, are especially likely to buy store brands of headache medicines. Chefs are far less inclined to select national brands of salt and sugar than are nonchefs who are otherwise demographically identical. In other words, national brands are succeeding largely because of consumer ignorance.”

If living in a modern democratic society requires us all to rely on others expertise (we do not need to be a chemist to pick up our prescription or become an obstetrician to have a child or auto mechanic to drive a car, etc) than there are lessons we can learn from this study.  The experts are overwhelmingly buying the cheaper, generic, store brands (in their areas of expertise) and saving billions of dollars.

“It’s interesting that health-care professionals show no special interest in buying store-brand salts, sugars or baking sodas; for those products, their choices look a lot like most other consumers’. And while chefs do show a preference for store-brand headache remedies, it’s not nearly as great as that of health-care professionals. For the most part, people’s knowledge is domain-specific.”

The least informed, and those least willing to regularly and routinely rely on the expertise of others (and insist on structures, like a robust regulatory regime, that make this even more rational) are the most likely to waste their own money and support a system of branded information that misinforms (everyone, but even more so those same consumers) by design.

Friday, July 25, 2014


As the political spectrum shifts, suddenly the middle is on the left
The generally conservative Politico ran this very thoughtful commentary recently. 

Click on the link for full text, and here is just a taste to get you interested.

"Bailouts for bankers. When the economic bets made by the wealthiest Americans soured in 2008, the taxpayers picked up the tab….[read more at the link]

Democracy for sale. The wealthy, abetted by the most out-of-touch Supreme Court in many decades, also have been permitted to purchase an outsized voice in American politics….[read more at link]

Gun massacres. I am just sickened by our tendency to accept disturbingly more frequent gun massacres as the price of being an American….


This has all made me shift my thinking, not so much about partisan politics but in feeling a sense of disquiet about both major political parties—and about our entire system….

Where might this all lead? I am no better at predicting the future than anyone else. I think there are many others like me who are just as puzzled….

…At the very least, I hope we will cease to be a nation at ease with torture and inequality, a country that once again steers by its ideals."


Thomas E. Ricks is author of five books about the U.S. military, including Fiasco and The Generals.

Thursday, July 17, 2014

Summertime
Cecilia & Colton, seafood, salt and sand.  Hanging with Mom & Dad in the big room.  Red Sox games, card games, paddleball, body surfing, wiffleball, frisbee, and smores. Bonfires and wild turkeys and thunderstorms.


This year included visits to the Saltmarsh.

Dinner for 22 at Jim's.

Whole belly clams at The Old Mill Diner.

Ice cream at Brickley's.

Chowder at the Cove.

Noodles at Luk Thai.

Oysters at Matunucks.

Mom & Dad, Lori & Julie, Ray & Amanda, C&C, Tom & Sarah, Carolyn & Greg, Linda & Paula & Trevor, cousins...

There is something about the shock of diving into the cold surf that cleanses the soul, just for a wonderfully perfect moment

the first sip of a frosty belgian white

washing down that first bite of deep fried clams

amid the hubbub

about great fries, creamy chowdha, pass the wine

sitting next to Jules

Dad on the other side of her

sun setting bathing their faces in warm light

G is off hunting for crabs

Mom and Tom are laughing about nothing in particular

...first BBQ and bonfire at the round house!




Sunday, June 29, 2014

Open hearts, Open minds
It is easy (and powerful people make it easier) to fall into a the heartless and mind-numbing trap where we only interact with people like ourselves, nodding appreciatively at our own ideas being repeated back to us with great passion.


If this cartoon made you feel like we need to interact more with people unlike ourselves, good.  If the cartoon made you pause, maybe the one below will do the job for you and cause others to pause and rethink.


Monday, June 23, 2014

Conservative Columnist Robert Samuelson On the CEO Aristocracy
In 1980 CEO compensation was 30 times what a typical worker earned.  Today it is 300 times.  While stock prices have gone up during the same period, according to this conservative economic journalist "little of the gains reflect better management."  This is a short article worth reading.  He concludes with this...

"Americans dislike aristocracy.  Unless companies can find a more restrained pay system, they risk an anti-capitalist backlash.  That is the ultimate danger."

I agree that this risk exists, but I wonder if there is not plenty of danger already in play for the millions of American working families whose real wages have stagnated since 1979, while increased worker productivity has generated explosive profits for the 1/3 of the 1 percent who are CEOs.