OT: More Sunday Joy...

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OT: More Sunday Joy...

<http://hotair.com/archives/2017/07/09/va-office-butt-fired-actually-firing-people/
        
                                        ...Jim Thompson
--  
| James E.Thompson                                 |    mens     |
| Analog Innovations                               |     et      |
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Re: OT: More Sunday Joy...
On Sunday, July 9, 2017 at 12:37:37 PM UTC-4, Jim Thompson wrote:
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That's not going to fix anything. Their system is broken.
  

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Re: OT: More Sunday Joy...
snipped-for-privacy@gmail.com wrote on 7/9/2017 1:00 PM:
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Maybe we should repeal the VA and then give some thought to replacing it.  
But by all means let's start with shutting it down.

--  

Rick C

Re: OT: More Sunday Joy...

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Sure. Shut down the VA and pay private hospitals to take care of our
veterans.  Great idea!  Fire *all* of the bureaucrats!

Re: OT: More Sunday Joy...
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It sure gets hard to figure out who is being sarcastic about what.

--  
This email has not been checked by half-arsed antivirus software  

Re: OT: More Sunday Joy...

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Hint:  I'm not.

Re: OT: More Sunday Joy...
On Saturday, July 22, 2017 at 4:58:40 PM UTC+2, snipped-for-privacy@notreal.com wrote:
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Sarcasm is way above krw's pay grade. His ideas are ridiculous, but he's unaware of that.

--  
Bill Sloman, Sydney

Re: OT: More Sunday Joy...
On 7/22/2017 12:28 AM, Jasen Betts wrote:
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  LOL! :-)
                         Mikek

Re: OT: More Sunday Joy...
On 7/9/2017 9:37 AM, Jim Thompson wrote:
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Might be great for "feel good" but probably doesn't matter much, in practical
terms (to folks getting served by the VA).

As with anything, its the attitude of the folks actually providing the
service, doing the work, that makes something "adequate", great or
a "complete waste of time".

If you put those folks in a framework of others and policies (which
often drive their careers, compensation, etc.) then the framework
eventually distorts the service/product that they deliver.

Many (many-many) years ago, I was discussing the patent process with
an examiner (non-professional setting at a party).  He spelled out
in very specific terms how a new application would be handled.  And,
outright acknowledged that much of it was busywork that just added
to the applicant's cost (lawyer time) and reduced the efficiency
from the USPTO's perspective.
     "But, that's just plain STUPID!"
     "Ah, yes -- we ALL know it!  But, to do things the right/efficient
     way isn't the way the reward system has been set up!"

Like the medical profession; there's little incentive to find a cure
on the first visit (then there won't be a SECOND visit!).

How can you create a framework to provide services and evaluate the
quality of your providers (who should be REWARDED; who FIRED) without
influencing HOW those services are actually provided (with consequences
that might seldom be foreseen)?

Should I pay you for every Q in your design?  Won't that result in
your artificially (perhaps not maliciously) adding Q's that aren't
otherwise needed?  Or, perhaps, pay you for every Q *elided*?  Might
that compromise performance/reliability?

The *real* solution is to hire folks with good work ethics and
trust to their skillsets and decision making ability.  And *hope*
they aren't "corrupted" by others around them!

Re: OT: More Sunday Joy...
On 09/07/17 20:06, Don Y wrote:
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Indeed. The best way is to ensure there is no
financial incentive for a second visit.


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True. And it can be done.

Two famous examples from the 30s/40s: HP and the HP Way,
and Eliot Ness "picking apples" before they got mixed up
with bad apples in the barrel.

Re: OT: More Sunday Joy...
On 7/9/2017 12:27 PM, Tom Gardner wrote:
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"Well, we can treat the SYMPTOMS of that annoying ulcer forever
with a perpetual prescription of antacids, etc.  *Or*, we can
cure it with a two week course of antibiotics..."

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But you can't extrapolate from "special cases" to the general
case.

I think it would be hard to develop a set of practices for a
(large!) organization that didn't implicitly create undesired
behaviors.

I recall working at a place that offered very substantial annual
bonuses (on the order of your base salary).  It encouraged people
to *horde* ideas (lest one of your workmates end up with a bigger
piece of the pie) and *resist* accepting ideas (lest the "donor"
get credit for some of your "success").


Re: OT: More Sunday Joy...
On 09/07/17 21:59, Don Y wrote:
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I'm very glad that NICE has a significant influence
on my healthcare. https://www.nice.org.uk/


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Of course.

But existence proofs are, at the very least, important
- and can act as a catalyst for others to emulate.


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The only management book I've read that was worth the
paper it was written on is "Up the Organisation" by
Robert Townshend.

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yes :( Show me how people are rewarded, and I'll predict
how they'll behave.

Re: OT: More Sunday Joy...
On 7/9/2017 4:03 PM, Tom Gardner wrote:
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It's not just the rewards but also the "punishments" (disincentives, etc.).

I was tasked with writing a simulator for a piece of custom silicon one of
my colleagues was designing.  I sat down with his schematics and translated
the machine's operation into code.

Then, as part of testing my implementation, I threw some "typical" situations
at it (i.e., configured the machine to operate in some ways that one could
reasonably expect to occur IN REAL LIFE).  In several of these cases, the
machine performed *worse* than if it had been omitted from the system
design!  (it's role was to provide a capability lacking in other products)

I ran through the code, again, to assure myself that I hadn't messed up.
Then, took the  corresponding settings directly to the schematic and
verified their operation The Olde Fashioned Way.

Convinced that my observations were correct, I presented them to my colleague.
He shrugged and said "he'd make a note of it" (gee, I've just prevented you
from being embarassed when first silicon arrived and *that's* the extent of
your reaction?).  Boss was pissed -- AT ME!  Cuz, now he had advance notice
that there would be a delay as the changes were made to the design before
it went to fab.  So, he'd have to tell HIS boss that the project had slipped.

Of course, the alternative would have been to order the sample lot, run them
through /in situ/ tests and *hope* to catch these obvious cases (folks tend
to test extremes instead of nominals), THEN, fix the design and turn the
crank a second time... more time AND more money (two fabs).

*BUT*, that would kick the can down the road a few months as the samples
would take weeks to manufacture, etc.  And, the discovery after-the-fact would
somehow be more palatable than finding it *beforehand*.

What's the take-away for me?  Ignore any sort of problems I stumble on
as "not my job/responsibility"?  What about for my colleague?  Don't bother
to test your design unless you know you can do that in the original schedule
window as avoiding problems is NOT considered to justify delays?

Re: OT: More Sunday Joy...
On 7/9/2017 6:03 PM, Tom Gardner wrote:

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   50% of babies born today are paid for by Medicaid.
What does that tell you?
                               Mikek


Re: OT: More Sunday Joy...

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I would have guessed a higher percentage.

One thing that startled me more than twenty years ago... oldest
daughter having her third child in a Yuma hospital commented that she
thought she was the only legal citizen on the maternity wing :-(

(The game back then was to dash across the border just in time to
'drop' a new little US citizen.)
        
                                        ...Jim Thompson
--  
| James E.Thompson                                 |    mens     |
| Analog Innovations                               |     et      |
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Re: OT: More Sunday Joy...
On 7/24/2017 11:15 AM, Jim Thompson wrote:
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   It may well be higher now, I recall that was a 2010 number.
Obamacare put a lot more people on Medicaid, so, ya, it might be
well over 50% now.
                Mikek

Re: OT: More Sunday Joy...
AT Monday 10 July 2017 03:06, Don Y wrote:

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Pay for the desired results. All so called health systems live from  
unhealthy people.  Even the name health system oxymoron. There is no  
incentive to make keep people healthy. If they are too successful they go  
bankrupt.
This might be an urban legend, but in old China doctors were paid if they  
kept people healthy. I have no idea how to implement something like this  
today. What should the doctor do if his patient does not follow advise.
  
They same hold for the lawmakers. Usually they are lawyers themselves.  
Making law clear and easy to comprehend by normal people will make their and  
their colleagues jobs obsolete.
  
--  
Reinhardt


Re: OT: More Sunday Joy...
On 7/10/2017 1:53 AM, Reinhardt Behm wrote:
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Great!  Now, how do we define the "desired results"?  E.g., in healthcare,
do you target patient-oriented results?  Or, *population*-oriented results?

How do you quantify a particular set of results -- based on *improvement*
in condition (i.e., don't spend ANY resources on folks that you can't
see a measurable increase in "health")?  Or, in closeness to "ideal
health" (i.e., spend money on someone who is 98% healthy in an attempt to
get them to 100%)?

How do you factor in cost?  A single-amputee can probably get by with
crutches -- at a much lower total cost than fitting with a prosthetic
limb (or, a *good* prosthetic)... do you "cheap out" arguing that he
can still "get around" with the crutches vs. a prosthesis?  Or, a
power chair?  Or...

Where things fall apart is when you try to map "performance" (results) onto
actual services/products provided.  How much does "patient satisfaction"
enter into the calculus?  Number of visits?  etc.  Just write Rx's for opiates
and cut your "face time" to zero -- while keeping the addicts^H^H^H patients
happy...

Some years ago, I was aasked to look into a particular product idea.  I
scribbled some notes and a sketch for a prototype and gave it to my boss.
Months later, I received a check for the "invention" (WTF?  I'm salaried,
so why am I being *doubly* compensated -- for doing my job?).  The payment
was allegedly based on their expected initial profits from the sale of
the new device LESS any losses that other products potentially incurred
as a result of the new product's introduction.

Sounds logical.

But, the check was written for a very specific dollar amount.  So, someone
had to actually come up with hard numbers for the profits before the fact.
And, a GUESSTIMATE as to how much it was likely to impact other sales
(negatively).  Should I have been shown those calculations in order to
understand how I should tackle future such assignments?  (Or, should I
just have seen it as an unexpected windfall and not questioned the source
of the numbers?)

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Likewise for law enforcement:  make sure there are always *new* crimes
lest you run out of a need for enforcement officers...

A colleague was in charge of Quality at a firm.  His STATED attitude
was to make himself "redundant" (unnecessary) -- by improving processes
so that monitoring quality was not necessary.

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Lawmakers (politicians) never want to SOLVE problems cuz then there is
the risk that there will be no more problems to solve!  Instead, come up
with patchwork solutions that always need to be tweeked...

Re: OT: More Sunday Joy...
On Mon, 10 Jul 2017 12:41:14 -0700, Don Y

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And how do you quantify "quality of life"?  Often procedures aren't
necessary to extend life, rather to improve life.


Re: OT: More Sunday Joy...
On Monday, 10 July 2017 20:41:19 UTC+1, Don Y  wrote:

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unfortunately that's wildly unrealistic. If only

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no, the job of politicians is to work out how to scheme extra money from the problem.

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