RWL #162 - Bell Curve, Negotiations, Mother-Daughter podcast
Greetings from the University of New Hampshire! I’m writing to you on Saturday again because yesterday was a crazy day. I did a couple of 90 minute research interviews, then had to work on some other projects and just didn’t get around to the newsletter. I was doing well for a while, composing pieces of it as I found links through the course of the week, but then I slid back into my old habits of pulling everything together day-of. In case you're wondering about my process, I gather links as I come across them in my daily browsing and keep them in a notebook in my Evernote app. If you don’t use Evernote, I would encourage you to check it out. Anyway, typically when I sit down to compose the newsletter, I open up Evernote and browse through my little trove of links looking for something useful.
Waiting till today also let me pull my latest Health Leader Forge interview into this week’s RWL, instead of next week’s. I’m really excited about this interview. The interview is with Eileen Keefe, the CNO at Parkland Medical Center, an HCA hospital here in southern New Hampshire. Eileen is great, but what makes this interview unique is I hand the mic over to my student Sara Elmendorf, who happens to be Eileen’s daughter. Isn’t that cool? Picture above is Eileen and Sara after the interview.
Have a great week and do amazing things!
Read
What: The New Yorker, The Bell Curve by Atul Gawande
https://www.newyorker.com/magazine/2004/12/06/the-bell-curve
Why: This is a long form read, so settle in for a bit. Eileen Keefe recommended it in her interview (see Listen below). It presents some serious questions without any meaningful answers. The premise is there is a bell curve of skill that applies to every human activity, and that includes medicine. So most doctors/nurses/hospitals/etc. are average. Some are amazing. And by definition, some are below average. If you have never worked in a hospital, I’ll let you know a secret: the nurses all know who the good doctors are. When I had access to that insider information, I used to take advantage of it. Now that I’m on the outside, I just face the opaque wall of obfuscation like everyone else. That said, licenses probably eliminate the worst of the worst. But what do you call a doctor who just barely passes her/his boards? Doctor. Hopefully not my doctor, but who knows? (The nurses know, but if you are an outsider, they aren’t going to tell you.)
A bunch of organizations are trying to provide grades to physicians and hospitals, so that those of us on the outside have some insight as to who is actually good at what they do. I’ve listened to conversations about these grading systems and they are regarded with a great deal of skepticism (especially by those who do poorly). Gawande says in the article:
Yet we all feel uneasy about being judged by such grades. They never seem to measure the right things. They don’t take into account circumstances beyond our control. They are misused; they are unfair. Still, the simple facts remain: there is a bell curve in all human activities, and the differences you measure usually matter.
I hear the same thing in education all the time: student evaluations are worthless and measure all the wrong things. I’m skeptical of the robustness of the claim that they capture nothing meaningful - I think a lot of bad teachers hide behind it - but they shouldn’t be the only thing used to evaluate teachers. And we shouldn’t only use grades to measure our healthcare. The problem is healthcare is so complex, there is a principal-agent problem - patients have a hard time evaluating quality of care. A student can tell if a professor is a terrible teacher. A student might have a hard time discerning a great teacher from an average teacher, especially if the average teacher is charming. A charming doctor can get away with being truly terrible, though.
I like Gawande’s conclusion:
Someone’s got to be average. If the bell curve is a fact, then so is the reality that most doctors are going to be average. There is no shame in being one of them, right?
Except, of course, there is. Somehow, what troubles people isn’t so much being average as settling for it.
That’s a good life lesson. We should always be pushing ourselves to be better. It isn’t acceptable to accept average.
Watch
What: TED, Adam Galinsky, How to Speak up for Yourself
https://www.ted.com/talks/adam_galinsky_how_to_speak_up_for_yourself
Why: I stink at negotiations. I hate shopping for a new car or anything that involves bargaining. Thankfully, I’ve only had to negotiate for a salary once in my adult life (in the Army, you get what you get - that’s how the Army works). But we negotiate in small ways all the time - with our spouses, kids, coworkers, customers, etc. Galinsky has some interesting insights on how to improve how we approach this process.
Listen
What: Health Leader Forge, Eileen Keefe, Chief Nursing Officer, Parkland Medical Center
https://healthleaderforge.blogspot.com/2020/02/eileen-keefe-chief-nursing-officer.html
Why: As I mentioned above, this interview is special because it is conducted by my student Sara, who is Eileen’s daughter. Eileen is a dedicated nurse leader who came to up through nursing education and quality. Sara and Eileen have a great conversation about Eileen’s career and conclude with a discussion of leadership. There are some great “I didn’t know that about you” moments in the podcast. Enjoy!
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line at mark.bonica@unh.edu , or you can tweet to me at @mbonica .
Also, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://tinyletter.com/markbonica
See you next Friday!
Mark
Mark J. Bonica, Ph.D., MBA, MS
Assistant Professor
Department of Health Management and Policy
University of New Hampshire
(603) 862-0598
mark.bonica@unh.edu
Health Leader Forge Podcast: http://healthleaderforge.org
"I know of no more encouraging fact than the unquestionable ability of man to elevate his life by a conscious endeavor." - Henry David Thoreau