maxopedia

So last night I happened to be at a cookie party. It was pretty fun, and there were lots of good treats. One nice thing was that I got to talk to some old friends.

One of my friends that I hadn't seen in a while who always has strong opinions made a case that managed care organizations, particularly HMOs, have the potential to stifle medical innovation. The data that he used to support his theory was that areas in which there are high levels of managed care, there are less MRI machines, and even if there is an MRI machine in such a region, it will be under-utilized.

I didn't really follow this argument at the time, but now I think I understand why he feels this is irrefutable evidence. It is not the managed care organization that pays for the installation or maintenance of MRI machines directly. It is the medical institution that subsidizes these costs, and it only recoups its investment when the machine is utilized. In the meantime the maintenance bill continues to come. Thus, if the machine is under-utilized because the managed care organizations are generally unwilling to pay for costly procedures, it sets up a feedback loop. The less the machine is utilized, the more expensive individual uses become, which makes it less likely in the future that the managed care organization will approve such uses.

If you were running a for-profit hospital, would you invest in an MRI knowing that this feedback loop exists? Why develop new procedures and new technologies if no one is willing to pay for them? Are we saying that we only want cost-effective innovations, or do we want the highest level of care possible?

I have never been good in dealing with those that assume they have authority. On the flip side of the coin, I am generally not good at ordering people around. It's not that I lack orders I could give, but rather that I don't feel I have that right over others.

Only the most serious of endeavors - organized warfare - truly requires a highly demarcated chain of command. Soldiers are not supposed to question orders for a good reason; they lack information. Not only do they lack information, they frequently lack the time to analyze that information and come to their own conclusions. Thus, I advance the notion that commands and orders are particularly nasty types of efficiency measures. They empower the giver and dehumanize the receiver while at the same time standing in place of true consensus.

As I've said before, the larger a corporation gets, the more it becomes like a total institution, with policies, procedures, and eminent managerial domain standing in place of consensual and reasoned analysis. These items may have been put into play based on healthful guiding principles, but by their very codification have become breeding grounds for petty power plays and other insidious inefficiencies. The letter of the law means far less than the spirit.

Businesses have the difficult goal of erecting a supportive and comprehensive framework for their constituents while still allowing them a great deal of autonomy. However, people don't generally do well inside of boxes, unless they are of their own construction.

It's my dream to be able to build an organization on the principles of true consensus. I'm not going to hold my breath.

The title is in quotes because it is a phrase I lifted from a recent Rolling Stone album review. I don't remember the name of the album or artist, but I remember this phrase.

Isn't it perfectly natural to have some 'vague dissatisfaction'? To be obtuse,

• people = (water and meat) robots
• life is short and can easily be no fun
• your mom

I believe vague dissatisfaction makes the world go 'round. Turning it from an unknown quality to a known one can light a fire under your ass. We have to have something to drive us through our short lives, and hopefully we can enjoy them along the way.

To be obtuse again, Surely You're Joking, Mr. Feynman! is an awesome book.

I read this post a while back, and it stuck with me.

I had a moment today at work where I felt like I was in grade school again. I had a performance review. I don't have too much of a beef with performance reviews, because you need some sort of metric, but generally someone's review of you is not based on the actual work you do, but their perception of the work you do. This is why even if you really do nothing all day at work, as long as you keep telling your boss in detail about what you do -- up to a limit of course -- will make him think you're a superstar or something, as long as your peers think you're okay.

I've had performance reviews I thought were helpful. This was not one of them. I felt like I was about ten years old. It actually made me respect my reviewer less, although he is a guy that I do generally respect.

There's a famous sociology text that talks about the concept of a total institution, Asylums by Erving Goffman.

Very large corporations tend to share many of the same features as schools, prisons, and mental health facilities. Although this seems a little extreme, and I'm personally biased towards this viewpoint, I think that this is a very important concept that one needs to hold in their head. Basic psychological experiments involving placing people in positions of power generally bodes ill for their subjects. Placing people in charge of total institutions is particularly nasty.

I intend to do some research into this topic, and post my findings as relates to my corporate environment.

to be continued...