Humans versus Computers in Decision Making

I was listening to the "Mike & Mike" on ESPN radio this morning on my morning commute to work.  They were debating whether the method that the NCAA selects the final four teams for the college football play-offs is better than the old way (Bowl Championship Series, or BCS as it is more commonly known) or even if there was a better alternative.  As I understand it, the BCS used a rather complex computer algorithm that was based on the average of the AP and ESPN/USA Today coaches poll (i.e., a very subjective, human poll), "strength of schedule" (calculated by the win/loss record of opponents and cumulative wins/losses of a team's opponents' opponents), and margin of victory.  There was a lot of controversy about the BCS, but I think for the most part that it worked fairly well during the time it was in place (1998 through 2013).


Mike Greenberg and Mike Golic both had positive and negative things to say about the current system, which relies heavily upon subjective decision making by college football experts.  Interestingly enough, they seemed to prefer the BCS method of selecting the top four teams in college football (as opposed to their selection by a panel of experts), who would then play each other in the same play-off system that is currently in place to determine the NCAA National Champion. In other words, they both seemed to think that computer algorithms are preferable to humans! 


There is actually a lot of research that has been performed in this area.  Dr. Paul Meehl, a Professor of Psychology actually published a series of studies that explored this topic in a variety of settings, including the clinical setting!  His 1954 book, Clinical and Statistical Prediction: A Theoretical Analysis and a Review of the Evidence suggested that formalized statistical algorithms and decision rules actually performed better in a variety of settings compared to informal, subjective, "gut instinct" types of decision making.'


I am not saying that "gut instinct" is never right.  On the contrary, there are some good studies that suggest that "gut instinct" can be useful (see the study by Beth Crandall for a really good example - we have used this method to improve situation awarenessin our hospital).  However, the evidence to suggest that use of objective decision rules and algorithms can be a powerful tool is very compelling.  

The next MLB MVP from the greatest team in America uses "stretch goals"

I am a proud but long-suffering Chicago Cubs baseball fan.  The special relationship between Cubs fans and the "Lovable Losers" of the "Friendly Confines" of Wrigley Field is well documented.  After all, we haven't won the World Series since 1908!  In other words, there is no one alive today who has ever witnessed the Chicago Cubs winning the World Series major league baseball championship.  There is hope - the Cubs this year have led their Division for the entire baseball season, and many baseball pundits are predicting that this may be the year that they finally return to the World Series (they actually haven't even made it to the World Series since 1945) and (fingers crossed) maybe even win it all!  The Cubs started the year on a tear and looked unbeatable.  Just before the mid-season All-Star break, they looked anything but like a team of destiny.  Since the All-Star break, however, they have been back to their winning ways. 

The team this year is loaded with talent - perhaps none more so than third baseman Kris Bryant.  Number 17 could be the first player in major league baseball history to win the Most Valuable Player (MVP) award after winning the college player of the year, minor league player of the year, and rookie of the year.  Bryant leads the Cubs in all three of the so-called Triple Crown categories (batting average, home runs, and runs batted in) and ranks 16th in batting average, 1st in home runs, and 3rd in runs batted in in the National League MVP standings as of today (August 27, 2016). Last night, Bryant hit his 34th home run of the year in the 8th inning to bring the Cubs within 1 run of the Los Angeles Dodgers and his 35th home run of the year to give the Cubs the lead in the 10th inning.  The Cubs held on to eventually win the game.

In post-game interviews, a reporter from ESPN asked Bryan whether he was already surpassing the goals that he had set for himself before the start of the season or whether his goals were even higher than what he was already achieving!  Bryant reported, "I'm not going to say.  I look at them every day.  I think that if you write them down, you're more likely to achieve them."  The ESPN reporter kept on the theme of goal-setting and asked Bryant if he set goals that were attainable or if his goals were, "in essence, unachievable, raising the bar so high that he has to keep reaching for them."  Bryant responded, "You have to put them that way" (referring to the latter and not the former), "It's what keeps me going and determined."  In other words, Kris Bryant uses so-called "stretch goals" (also referred to as "aspirational goals" or as the management guru and author of "Good to Great" Jim Collins calls them, "Big Hairy Audacious Goals" or "BHAGs").

The question is, are "stretch goals" the right way to go or not?  Management experts, particularly in the area of goal-setting, disagree somewhat on this point.  On the one side are the experts who argue that setting unachievable, aspirational, stretch goals can paradoxically lead to less intrinsic motivation and ultimately to failure.  On the other side, some experts argue that setting stretch goals leads to a greater degree of intrinsic motivation and success (even if the "aspirational goal" is not achieved, performance will be so close to the goal that the individual and/or organization ultimately benefits). 

I keep promising to review the literature on this topic in greater detail in future posts.  I guess in my own mind, I am not completely sure which is the right approach to take (I even recently wrote an editorial  on this subject) in the journal, Pediatric Critical Care Medicine.  For now, I will simply say that arguably one of the best players on my beloved Chicago Cubs uses "stretch goals", and at least so far, they appear to be working out very well for him!  Perhaps there is something to "stretch goals" after all. 



 

"The Incline" was not my goal, which is why I didn't finish it!

I was visiting family in Colorado Springs, CO a few weeks ago, when someone asked if I wanted to go with him to climb "the Incline."  The Manitou Incline is a hiking "trail" located in the small town of Manitou, Colorado (very near Colorado Springs).  The "Incline", as it is popularly known, has become somewhat of a fitness challenge for locals in the area.  The "trail" is really a LONG set of "steps" that were built on an old narrow gauge funicular (incline) railway.  The average grade of the Incline is 45% (24 degrees), though in some places the grade is as steep as 68% (34 degrees).  The "trail" gains over 2,000 feet of vertical elevation over the course of approximately 1 mile.  If the steps don't get you, the altitude will definitely do so, as Manitou itself is at an elevation of over 6,300 feet!  Former major league baseball player Barry Bonds recently hiked the "Incline" and posted on Facebook, "I got to be out my mind, that's crazy," half out of breath.


There are several tips to conquering the Incline - one of which is to beware of the false summit (just when you think you are nearing the end, you pass over the false summit to learn that you are really only half way to the end!).  About 2/3 of the way up, there is a "Bailout" or "Wimpout" point in which you can hike the rest of the way up the Barr Trail (a series of switchbacks help you deal with the vertical climb and steepness of the ascent).


So, back to my attempt at the "Incline."  I arrived in Colorado Springs on a Saturday morning, and a member of our family asked if I wanted to join a small group that was going to hike the "Incline" on the following morning.  I said that I would "give it a try."  I can tell you that I am in fairly good shape - I completed my first marathon this past October.  While I am no longer in "marathon shape", I still run at least 3 miles almost every day.  Within about 100 yards of climbing the Incline, I was out of breath.  By the time we reached the "Bailout" point, my legs were burning and I was gasping for air.  I decided to "bail out" and finish the climb up the Barr Trail.  We did reach the top - two of the younger members of our group actually finished climbing up the Incline - successfully, but I did not conquer the Incline.  When we reached the top, I was met by an 80 year-old man who apparently hikes up the Incline (or so he said) every day!  Yikes! 


Now that I have had time to recover, I actually wished that I would have pushed myself a little harder (okay, a lot harder!) and finished the Incline.  I also started thinking about goals and what factors impact whether we achieve our goals or not.  I believe that the main reason that I was unable to complete the Incline was due to the fact that it was never my goal to do so.  It was someone else's goal to finish the Incline - I was just there for the ride, so to speak.  Had I truly been focused on hiking up the side of that mountain, I believe that I would have been able to finish.  Had I set a goal of hiking up the Incline, and if I had started climbing that day with that goal in mind, I do believe that I would have been successful.  It seems to me that one of the main factors in whether or not we achieve our goals is whether or not those goals are our own personal ones to achieve.  Did we set the goal?  Did we plan ahead in order to position ourselves to achieve that goal?  In my mind, I had done none of these things beforehand when I decided to "give it a try."  I was never committed to achieving that goal because it was someone else's goal and not my own.


How many times do we see organizations fail at achieving their goals because of a lack of ownership?  As I look back on some of the goals that we have set for ourselves, whether in the Intensive Care Unit or in the hospital, I find that the goals that we achieved were indeed the ones in which everyone, from the front-line employees all the way to the executive leadership, have bought into and owned.  Call it engagement, call it accountability - call it whatever you want, but one of the most important factors in goals is to have everyone firmly in support and ready to work hard to achieve them. 


So, the next time I am in Colorado Springs, my goal is to complete the entire Incline, from start to finish!  That is my goal.  I will own that goal, and I will hold myself accountable to that goal.  With that in mind, I am going to go climb some steps!

Data, Dashboards, and Decisions!

I am currently reading a book called "How to Measure Anything: Finding the Value of Intangibles in Business" by Douglas W. Hubbard (see www.howtomeasureanything.com).  The premise of the book (at least what I have read so far) is that just about anything can be measured (one of the chapters is even titled "Yes, I Mean Anything").  During my reading last night, I came across a section on the use of dashboards.  The section starts with the sentence, "The difficulty in connecting measurements to decisions seems to start at the highest levels."  Dashboards can be extremely useful and effective ("Executive Dashboards: What they are and why every business needs one") - however, dashboards, as they are frequently used, often represent a wasted resource.  A dashboard is exactly what it sounds like it would be - it is a visual representation of data that allows managers to easily get a "snapshot" view of organizational performance.  There are a number of similar tools that are used in business - for example, there are a number of publications on a specific type of dashboard called a "balance scorecard", popularized by Robert S. Kaplan and David P. Norton at the Harvard Business School.  Regardless of the name used, these tools are all different iterations of the same concept - a management information or decision support system that is used by managers and leaders to execute the organization's goals and objectives.  In order to be useful, a dashboard needs to be simple, succinct (in terms of minimizing distractions and keeping the number of key performance indicators (KPIs) to a minimum), and easily understood.  Data is often graphically displayed, frequently in the form of a dial or gauge that you would see on an automobile dashboard.  There are a number of types of key performance indicators that can be shown, including process measures, outcome measures, and balancing measures as well as leading measures (used for prediction) and lagging measures (used to evaluate success or failure post hoc).  One of the most important issues to consider when constructing a dashboard is what performance indicators or metrics to include - Hubbard is very clear in this regard.  If a particular metric or performance indicator is not being utilized to make decisions, then there is likely not a need to spend the time, energy, and resources to (1) collect that data (which can often be labor-intensive) and (2) include that measure on the dashboard.  I think that health care organizations frequently fall into the trap of overcollecting data that is not used to make important and meaningful decisions.  In this era of "Big Data", there is a tendency to collect and analyze data that is never really used.  The most effective dashboards are the ones that are used to analyze the organization's performance and MAKE DECISIONS! 

To be a Stoic in today's world... part 1

One of my favorite articles was published several years ago in a local newspaper when I was stationed at the United States Naval Hospital, Guam.  The piece was written by a Navy chaplain named Barry J. Baughman and was entitled "Attitude."  There is no Internet link to the article, and copyright rules prevent me from reproducing the article here, so I will summarize.  The premise of the article was that there are a lot of things in life that you can't control, but the one thing that everyone can control is their attitude.  Baughman quoted Dr. Charles Swindoll, who stated that "I am convinced that life is 10 percent what happens to me and 90 percent how I react to it."  In other words, if everyone worried less about things that they could not control and instead focused their energies on maintaining a positive attitude, the world would be a much better (and happier) place!  Baughman goes on to talk about Reinhold Niebuhr's famous Serenity Prayer: "God, grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference."  Baughman ended his article with a quote from Abraham Lincoln, who said, "People are about as happy as they've made up their minds to be."


While Baughman did not specifically mention it, his lessons for life are consistent with the teachings of the Stoic school of philosophy, an ancient Greek and Roman philosophy that was founded by Zeno of Citium in the 3rd century BC and later popularized by the philosophers, Seneca, Epictetus Epictetus, as well as the Roman Emperor, Marcus Aurelius. The Stoic philosophy is perhaps summarized best by Epictetus, who said "What, then, is to be done?  To make the best of what is in our power, and take the rest as it naturally happens."  In other words, Stoics believe that the best way to respond to life's challenges is to "roll with the punches" and control the one thing that is under your control - your attitude (How to be a Stoic).  Admiral James Stockdale(more to come on him in a later post) has written extensively on Stoic philosophy (Stockdale on Stoicism).


The English poet, William Ernest Henley wrote a poem called "Invictus" (recited by the actor, Morgan Freeman here) which I believe encapsulates many of the fundamental tenets of the Stoic philosophy.  Henley suffered from tuberculosis that invaded his bone, requiring amputation of his left leg below the knee at the age of 12 years (incidentally, one of Henley's close friends was the author Robert Louis Stevenson, who wrote Treasure Island - the character of Long John Silver was inspired in part by Henley).  Nelson Mandela is said to have recited the poem to his fellow prisoners while he was a incarcerated at Robben Island prison (depicted in the movie, Invictus, starring Morgan Freeman and Matt Damon, about the 1995 Rugby World Cup, Nelson Mandela, and the rugby player Francois Pienaar):


Out of the night that covers me,
Black as the pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.


In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.


Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find me, unafraid.


It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul.


It all comes down to attitude, just as Baughman said in his article.  Again, quoting Charles Swindoll, "We have a choice every day regarding the attitude we will embrace for that day...We cannot change our past...we cannot change the fact that people will act in a certain way... The only thing we can do is play on the one string we have, and that is our attitude." Perhaps this is the secret to a happy and fulfilling life...

Senator Robert F. Kennedy's speech announcing the assassination of Dr. Martin Luther King, Jr.

Thomas Paine once said, "These are the times that try men's souls."  While Paine said these words more than 200 years ago, I can't help but think that these same words apply to our current times as well.  The events that have occurred in our country over the course of the past several months instill a lot of different emotions - and deservedly so.  We do live in some difficult times.  I often wonder how anyone can look at all the things that are happening in our country today with any sense of hope or comfort.  As I have so often done in the past, I find myself looking back in our history in order to find words of comfort or advice from some of our nation's greatest men and women who have experienced similarly difficult and challenging times in their day-to-day lives.  I was lucky to find a speech that Senator Robert F. Kennedy gave in Indianapolis, Indiana on April 4, 1968.  The context and tone of his speech seems to be particularly relevant to our experiences of the last several weeks. 


Senator Kennedy was in the middle of a difficult campaign to secure the 1968 Democratic Presidential nomination, and he had learned of Dr. King's assassination shortly before boarding a plane to Indianapolis from campaign stops earlier in the day at the University of Notre Dame (South Bend, IN) and Ball State University (Muncie, IN).  Kennedy went ahead with the campaign stop (against the advice of his closest advisors, who believed that the announcement of King's death would incite riots), but rather than sticking with his original script, he made a decision to proceed with talking to the crowd, speaking directly to Dr. King's legacy and acknowledging that many in the crowd would be angry (Senator Kennedy announces the death of Dr. Martin Luther King, Jr.):

Ladies and Gentlemen,

  

I'm only going to talk to you just for a minute or so this evening, because I have some -- some very sad news for all of you -- Could you lower those signs, please? -- I have some very sad news for all of you, and, I think, sad news for all of our fellow citizens, and people who love peace all over the world; and that is that Martin Luther King was shot and was killed tonight in Memphis, Tennessee.

Martin Luther King dedicated his life to love and to justice between fellow human beings. He died in the cause of that effort. In this difficult day, in this difficult time for the United States, it's perhaps well to ask what kind of a nation we are and what direction we want to move in. For those of you who are black -- considering the evidence evidently is that there were white people who were responsible -- you can be filled with bitterness, and with hatred, and a desire for revenge.

We can move in that direction as a country, in greater polarization -- black people amongst blacks, and white amongst whites, filled with hatred toward one another. Or we can make an effort, as Martin Luther King did, to understand, and to comprehend, and replace that violence, that stain of bloodshed that has spread across our land, with an effort to understand, compassion, and love.

For those of you who are black and are tempted to fill with -- be filled with hatred and mistrust of the injustice of such an act, against all white people, I would only say that I can also feel in my own heart the same kind of feeling. I had a member of my family killed, but he was killed by a white man.

But we have to make an effort in the United States. We have to make an effort to understand, to get beyond, or go beyond these rather difficult times.

My favorite poem, my -- my favorite poet was Aeschylus. And he once wrote:

Even in our sleep, pain which cannot forget
falls drop by drop upon the heart,
until, in our own despair,
against our will,
comes wisdom
through the awful grace of God.

What we need in the United States is not division; what we need in the United States is not hatred; what we need in the United States is not violence and lawlessness, but is love, and wisdom, and compassion toward one another, and a feeling of justice toward those who still suffer within our country, whether they be white or whether they be black.

So I ask you tonight to return home, to say a prayer for the family of Martin Luther King -- yeah, it's true -- but more importantly to say a prayer for our own country, which all of us love -- a prayer for understanding and that compassion of which I spoke.

We can do well in this country. We will have difficult times. We've had difficult times in the past, but we -- and we will have difficult times in the future. It is not the end of violence; it is not the end of lawlessness; and it's not the end of disorder.

But the vast majority of white people and the vast majority of black people in this country want to live together, want to improve the quality of our life, and want justice for all human beings that abide in our land.

And let's dedicate ourselves to what the Greeks wrote so many years ago: to tame the savageness of man and make gentle the life of this world. Let us dedicate ourselves to that, and say a prayer for our country and for our people.

Thank you very much.

While there were riots at several large cities across the country that night in response to Dr. King's assassination, there were no riots in the city of Indianapolis that night or the nights to follow, partly (and maybe largely) due to Kennedy's speech. 


I found comfort and inspiration in Senator Kennedy's words, and I hope you do as well.  There are so many parallels to what we are experiencing today.