I Reiterate …

Reminders: (1) I did some rereading on my 6-hour train trip from Boston to D.C. I re-read The Wisdom of Crowds. I've Blogged it 3 or 4 times already, most recently in my MVP2004 screed. Anybody out there listening ... or reading? Consequences for every project we undertake are enormous. Author Jim Surowiecki at one point quotes Wharton prof J Scott Armstrong, on predictions of outcomes: "I could find no studies that showed an important advantage for expertise. Expertise and accuracy are unrelated." "Experts" included docs, psychotherapists, stockpickers, market researchers and their-our ilk. Do I have your attention?

(2) I also reread Atul Gawande's "The Bell Curve," the amazing 12.06.04 New Yorker article on variations in medical outcomes that I blogged before. Not only does Dr Gawande argue for outcome measurement and results transparency, but he observes that "best practices" are far from an adequate explanation for the frequently hundredfold differences he found in results even among "top" programs. Consider: "We are used to thinking that a doctor's ability depends mainly on science and skill. The lesson from Minneapolis [Fairfield-University Hospital cystic-fibrosis center] are that these may be the easiest parts of care. Even doctors with great knowledge and technical skill can have mediocre results; more nebulous factors like aggressiveness and consistency and ingenuity can matter enormously." I carry around my already dog-eared copy of Gawande's article as a Totem; it keeps me focused on my Healthcare Results passion, and my more general concerns about what makes for excellent professional practice.