Tag: Quality

Autocracy and Quality: Why the Russian Empire Has No Clothes


In January 1937, the USSR commissioned a census. It was the first census conducted since 1926. The census was not intended for public dissemination. Instead, it was developed purely for leadership decision-making purposes. When the data was collected and reported, it showed a massive level of mortality due to the famines of 1932-3. The data, while accurate, was unacceptable. As a result, all of the statisticians involved with the project were arrested and executed. Again, the data was never intended for public consumption. The leadership themselves could not allow themselves to be exposed to data that contradicted what they wanted to hear.

The 1937 census was a powerful illustration of the most corrosive effects of autocratic management: the loss of real-world feedback in the service of effectively closed-loop management ambition.

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From time to time the podcasts suffer from less than stellar audio quality. Most of the time it’s a case of the infrastructure being unable to deliver on the capabilities of the existing technology. First a bit of history… A long time ago, in a broadcast galaxy far away, if you were a professional freelance […]

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What Your Hospital CEO Is Thinking


I’m currently in Charlotte, NC, working as a document review attorney. My current case involves hospitals and insurance companies, and my job is to look through thousands of emails in the inboxes of various executive and operational officers. There’s the confidential information that pertains to the case (which obviously I won’t be talking about), the day-to-day minutia of running any business (“So and so is training their replacement because while diligent and hard working, they are not a model of change-friendly leadership” is a masterful bit of corporate-speak), and the personal correspondence that probably shouldn’t have been sent from one’s work email (“My real estate agent is so lazy and lacking initiative he should be a government bureaucrat!”). But there’s also plenty of non-confidential information, from Wall Street Journal articles to slides of public presentations, and that information paints a picture of the medical industry today that I found fascinating, and I think Ricochet will too.

First and foremost, hospitals are well aware that health-care is too expensive, too hard to get, opaque in its pricing, and often wasteful in its execution. Further, they recognize that their options are either to improve themselves or be replaced by more consumer-friendly options. Chief among these ideas is the idea of moving away from “fee-for-service” models, where they are paid the services performed, to a “fee-for-value” model, where they are paid for improving the patient’s situation. Part of this is by reducing complications, a trend that Medicare is pushing by penalizing hospitals that have too many hospital-caused complications.