Thursday, February 27, 2003

I've heard it said that people who try to see both sides of the issue end up with no viewpoint at all. I think that happens to me.

Take the ideas of bureaucracy and innovation. Because I work for a software company that does outsourced work for some state governments, I get to see the people who make some bureaucracies work. Seeing their web of organization charts, and the listings of their various responsibilities, I'm amazed that they function at all. A fair number of the people who work at these places are the classic bureaucrats, with not much motivating them except their next scheduled coffee break and retirement -- but not all, not by any means. A goodly number are intelligent and experienced at what they do. For someone to walk into their job and try to do it, or to redo it by 'reengineering' or ' improving the process' or any of the other buzzwords, is as likely to succeed as me being able to leap into the cab of a combine harvester, grab the knobs and levers, and run it smoothly down the lane. It's possible -- but not very likely.

Yet these same intelligent and experienced people are dead set against anything that changes the way they do business. Or if not dead set against it, at least dead set against anything but the most minor changes. They want to debate everything, and their favorite word is No, followed by their favorite phrases: We Can't Do That, We'd Have To Get Approval, and "We Need To Study That." The idea of Just Do It is anathema to them.

The thing is, if I had their responsibilities, I might well be that way, too. If I had a public customer that knows nothing of what it takes to do what I do, but knows 'they could do it better'; if I had no one defending me and encouraging me; if all the risk was downside -- I might become a coffee-break scheduler and retirement watcher, too.

How in the world can this be improved? How can we get these organizations to do what they are charged with doing, but do it with verve, style, and speed? How can we get them to embrace change when they soak every day in a culture that rejects it?

Is this why governments hire business people to enforce change?

Tuesday, February 25, 2003

Some parts of anatomy and chemistry fascinate me. Others make me feel pretty dumb. A site that does a wonderful job of feeding the first, and doesn't do the second at all is: Neuroscience for Kids, at

It's worth visiting.

Monday, February 24, 2003

I spent most of today doing something that is quite boring to watch, and tedious to do. I wasn't exactly sure how to go about it, or how to tell if I was doing it well; further, I couldn't predict what a good outcome would be, except in the most general of terms. What I was doing is called Performance Tuning, and it is as much voodoo as art, and as much art as science. Steven King once said something to the effect that if you couldn't describe exactly what you were creating -- what the effect of your words would be -- then whatever else you were doing, it wasn't writing. Similarly, it's likely true that if I could not precisely describe how to do what I was doing, and what exactly the outcome should be, then whatever else I was doing, perhaps it wasn't Performance Tuning. Messing around, maybe. Nevertheless, it was great fun. Have I mentioned that I'm sort of a geek?
Some startling news in the paper today -- one good, one not so good.

The good: In the middle of the mess at Duke University regarding the transplant error, one surgeon has accepted fault for his part in the process that resulted in the girl's death. He assumed that an organ agency would have confirmed the recipient's blood type, which, in fact they did not. I am impressed by that acceptance. I don't know if he is taking the quick way out, but I would like to think that he is doing the honorable thing. It's been a while since I've seen anyone doing the honorable thing, so I don't really recognize it any more -- but I think this is what it looks like.

The not-so-good: The inventor of the Segway scooter says that he needs governmental assistance to make his scooter profitable, and he's hiring politically-connected follks to push the idea. This sort of bushwah is why its a lot easier to recognize the dishonorable in our society. At what point would he say 'no more goverment help, thanks' -- when the profits roll in? Reprehensible.

Tuesday, February 18, 2003

Every so often, during the spring or summer, I'll be driving past some people doing outside work -- gardening, road construction, telephone linemen, that sort of thing -- and issue a sigh, thinking 'Man, that looks like it'd be a heck of a lot more fun than what I do, sitting at a desk, staring into a laptop screen'. And then the snows come.... I just got my aerobic exercise, shoveling out the driveway. Always mindful of the warnings about sedentary people and sudden exertion, of course. There is a certain pleasure in seeing the blacktop clear again, knowing that we can get out, if only to where the township has inadequately plowed the main roads... but there is also a great deal of pleasure in working from the kitchen table, looking up to see a pile of snow cascading down the big evergreen in back, and stopping to take a sip of flavored water. Ah, roughing it...

Wednesday, February 12, 2003

Several years ago, I read a description of someone who said that he read almost everything. A questioner went through the categories -- Do you read biographies? Science? Novels? Technical books? Books about finance, child raising, architecture,deep sea diving, gambling, automobiles? ... -- and the answer was that he read almost everything within a limited set of categories . I'm the same way. Though I've never boasted of being the omni-reader, it's only been in the last few years that I realize that my reading tastes look like a bell curve -- and right in the middle are science fiction novels. I can't even say that I read all of them, either. I like science fiction that at least makes a nod to hard science, and certainly ones that have a plot, and characters about whom I care. And like my finicky eating tastes, I hardly ever read material from an author I haven't read before.

To that end, I was delighted to come across the Vorkosigan novels, by Lois McMaster Bujold. The very first one I read was a handoff from someone who thought that I'd enjoy it. The title was 'Cordelia's Honor'. I read it, but quickly -- it was interesting, but it didn't grab me. Some time later, I came across a hardcover novel titled Cetaganda -- that being a planet and a race of people. To my surprise, it was a continuation of the Cordelia story, many years later. I was hooked -- it had a plot, an interesting main character, and strange people with alien viewpoints. Further, it had hard science deftly mixed in, and it was written well. Well enough that when I reluctantly came to the end, I went looking for the others in the series. And now I've read all but two. One really doesn't sound like something I want to read, but the other does, so I'm looking for it. In the meantinme, I'm rereading Cordelia's Honor. For some reason, it's better, second time around.

I occasionally wonder: does it irk a professional author that they can work years to turn out a body of work that an enthusiastic reader can polish off in a month?

Tuesday, February 11, 2003

Since the furor over gun control has died down for now, I figure that this might be a safe time to admit that I’m a gun control advocate who supports the rights of gun owners. I think that people have the right to own guns, without harrassment. Where I diverge from the NRA is that I think that those guns should be registered, and their use should be controlled just like any other deadly device.

The NRA would likely say that any attempt to register the ownership or use of guns would be the first step to the end of life as we know it. I don’t think that most NRA members are idiots, though, so they probably don’t believe that. Maybe they do. Jackboots kicking open doors in the night, invading marauders, all of that. Got to admit, if I thought that scenario was likely, I’d want to be armed, too. Tactical nuclear weapons wouldn’t be out of the question. I figure, though, that most gun owners simply want to keep their guns because they like to hunt, or to target shoot, or because they want to be able to protect themselves if the need should arise. Some want to keep their guns not so much for what they are, but as a symbol of independence from governmental control. Some want to keep their guns simply because gun ownership is something they like - it’s part of their culture. Or maybe they don’t even use guns, but they like having the gun that their grandfather left to them, sitting up over the mantel. They’re not maniacs, and they’re not idiots. They simply like guns.

Guns are inherently dangerous, but not if they're used correctly. Got to admit that the NRA does a good job of promoting gun safety -- so good, it was even part of the plot of an episode of The Simpsons, once. Odds are, if you went to an NRA member’s house and asked to see their gun, they’d have to get it from a locked cabinet. And if they wanted the ammunition for it, that’d come from a second locked cabinet. No one knows what a weapon can do as well as people who use them. Ask anyone who owns and uses a gun. Especially the ones who’ve actually used their personal gun to defend themselves. They know the effectiveness of having a weapon.

Of course, so did the kids at Columbine. Remember Columbine? That's where you move from the gun culture to the effect of uncontrolled gun ownership and use. I can't honestly say that were guns to be registered, and their use controlled, as I wish, that Columbine, and all the other Columbines, would not have happened. But I don't think that registration and background checks would have been that big a price to pay for just the chance of preventing that massacre.

Unfortunately, the NRA leadership does.

Friday, February 07, 2003

One of my continuing interests is the use of information technology in hospitals. It’s a natural for me, because it lies at the intersection of two fields that I like -- medicine and IT. I’m particularly interested in technology that improves the way that medicine is practiced and delivered. One fascinating concept in this regard is the electronic medical record, or EMR. It’s also known as web-based patient data, electronic patient record, and the like. The motivating forces behind EMRs are their potential to reduce the cost of doing business, and their potential to improve the safety and effectiveness of the practice of medicine at both the individual and hospital level.

Getting EMRs operational is a difficult process. Techies don’t usually understand what doctors want from an EMR system, so it takes multiple iterations to get it right. That eats up time that most doctors don’t have. Further, doctors want different things from EMRs; they don’t like ‘one size fits all’ implementations. Finally, doctors despise anything that gets in the way of how they practice medicine; they can be the ultimate iconoclastic users. Since hospitals tend to cater to doctor’s needs, an EMR has to be exactly what the doctor ordered -- so to speak -- immediately.

An article in the current issue of CIO Magazine describes a medical center which has implemented such a system, and made it work. I was struck by how much the success factors sounded like the success factors for any project. First, the system had the complete support and financial backing of the local management team. It didn’t hurt that the management team was headed by a doctor, who spoke the users language and who understood what they wanted. Second, the system was sold first to the people who would get the most out of it right off the bat - the nurses, who often were stuck running errands for doctors, or doing documentation after the doctor left. Power users among the nurses adopted the system and promoted it with their colleagues; the nurses then sold it to the doctors, showing them by example how useful the system could be, selling it in the currency that matters most to a time-pressed doctor: efficiency.

Support, money, and functionality made the project work. It’s a valuable thing for techies to remember.

Wednesday, February 05, 2003

Sometimes, I feel like a fraud, just because I happen to know a concept or the right word, but I really don't know much more than that. For example, I was talking with a graphic artist once and I used the phrase 'negative space'. The guy was impressed, and I didn't see fit to tell him that that was about all I know about the concept. But there's a history of this kind of thought on my part. When I worked for another company, several years ago, they had a laudable effort to establish a corps of techies who would be able to speak knowledgeably on a range of subjects -- the term that the program originators used was 'deep conceptual understanding'. You wouldn't know exactly how the magic was done, but you would know what the magic did and how it might be used in any given environment. For example, there's a scene in The Hunt For Red October where one character is theorizing how the Russian submarine might be using a 'caterpillar' as a stealthy propulsion method. When the hero doesn't understand, the character says 'Magneto hydrodynamic propulsion -- you follow? Its like a jet engine for water'. That tells you virtually nothing about how it actually works, but you can take it and start to think about how you might use such a concept. Another example -- an article in the Washington Post, several months ago, spoke about traffic flow on the I495 Beltway, and how 'phantom accidents' occur that cause drivers to slow down, even though there is no reason to do so; this slowing causes a ripple effect, and what starts as a tap on the brakes becomes a full-fledged stop of a semi three miles back. The article used the concept of airflow modeling as an analogy for how this 'stop' was transmitted back through the traffic flow, and how models do calculations for 'chunks of space', determining the effect of the change to one space on the spaces around it. The machines doing this modeling used to have to work with fairly large chunks of space, so their predictive ability was good but not great; as computers got more powerful, the chunks of space that the model handled got smaller, and so the model got more precise and its predictive abilities got better. The equivilent for traffic flow is cars -- used to be that you could only model very small sections at a granular level, or big sections at a coarse level. Now, you can do both -- for air flow and for traffic models. Well, that gave me a general understanding of what might cause traffic to ebb and flow, not to mention how airflow modeling generally works. It’s not actual understanding, but its DCU, and it's fun. For a geek, anyway.

Sunday, February 02, 2003

I was thinking about malpractice insurance today. Here’s what I think:

The degree of risk associated with a specific medical procedure is based on the skill of the person doing it, the physiological situation of the person upon whom the procedure is being done, and some degree of luck on the part of the person doing the procedure and the person upon whom it is done.

Some procedues have bad results.

Some bad results are the result of error, incompetence, bad luck, unreasonable expectations on the part of either the doctor and/or the client, or some combination of the above.

Unreasonable expectations occur because the client did not understand the concept of ‘probability of success’, or because the doctor was wrong about the probability of success, or because the client didn’t understand what ‘success’ meant.

Some competent doctors make mistakes. Some mistakes affect the outcome of the procedure, and some do not.

Some doctors are incompetent to perform a specific medical procedure.

Some lawyers are greedy or unscrupulous.

Some clients believe that they are entitled to compensation for bad results. Some of them are correct.

Bad results that are primarily because the person doing the procedure screwed up should result in compensation to the client.

It's usually a judgement call whether bad results are due to error.

Hospitals and doctors will not admit error or bad luck because they beleive that to do so would place them in a weak legal position should they be sued.

Clients sue because they feel that they have no alternative, or because they believe that they are due more compensation and/or understanding as a result of a bad result than they have received prior to the point of submitting the lawsuit.

Saturday, February 01, 2003

The space shuttle just -- what, came apart, blew up? We don't know. The usual suspects -- how awful it is that we even have 'the usual suspects' -- are going to be blamed. And who knows, maybe they're right. Maybe right now someone evil is quite happy. The polished, glib talking heads, both media and governmental, are undoubtedly already gearing up the sonorous words, dipping into their stock of Phrases That They Hope Sound Like Winston Churchill. Well, here's my contribution.

The spirit of exploration and discovery is one of the few constants in our world that speaks against the spirit of hatred and acrimony (another of the constants). NASA may be an overblown federal bureaucracy that has as little in common with the spirit of exploration as the Concorde has with the Wright Flyer, but they are as close to a guardian of that noble spirit as we seem to have, these days. I hope that this tragedy -- that overused word that is precisely the correct one here -- does not cause their resolve, or the resolve of their supporters, to weaken. We need them. At times, perhaps, not as much as the ten thousand other things we need, but we need them.

Requiescat in pace, Columbia.
February first. Whatever happened to our inalienable right to months that lasted long enough to notice? The classic explanation would probably be that we're all so busy, we have so many distractions, so much to do, that day after day flies by without being remarked upon. And certainly that's true -- last night, before the weekend had even started, I was thinking about what it will feel like to be at Sunday night, facing the beginning of another week, wondering where the weekend had gone. In a perfect world -- Martha Stewart's, say, or at least the one that she sells -- weekends would last several days, and there would be multiple instances of delightful whimsy along the way, prepared by the hordes of staff and behind-the-scenes support people. You'd reach out a languid hand, and your drink would be there; you'd have a yen to ride, and the staff would already have saddled up your favorite mount. I'm sure that there are people who live in worlds, perhaps even dimensions, like that, but no one I know does. I know one wealthy person - a relative who started and aggressively promoted an engineering business; it's now international, and though odds are you've never heard of it, the people in the field know it -- and I know one almost-wealthy person - a doctor who earns a fine income, and who might be wealthy were it not for the fact that she lives in an expensive area, has to pay malpractice insurance premiums which I gather can reach a staggering level, and has two children of college age who don't plan on attending the local U -- and neither of these people lives a life of languid ease. In fact, they are both hard chargers -- interesting, intelligent, accomplished -- whose weekends likely rocket by faster than mine. There's probably a message in there somewhere. Carpe diem? I'm having difficulty with carpe mensis.