## Friday, 30 March 2018

### Ergodicity and its application to organisational management

It is extremely interesting the link between human biology, mathematics and management.

It is often true that poor performers continue to perform poorly – for instance most hospitals with a high standardised mortality rate continue to have it for very long times, difficult to shift. In case of human body, obese people often continue to be obese. This phenomenon is true for average performers and for high performers as well.

In the human body, this phenomenon is called homeostasis.

Mathematical explanation of performance can partly be understood by the law of large numbers. According to this law, if initial seemingly random results are observed over a longer period of time, they converge to the expected average results i.e. it "guarantees" stable long-term results for the averages of some random events

Often what looks like an improvement or worsening of performance if observed over a period of time essentially reverts to the mean, which means over a period of time performance remains unchanged; this phenomenon is explained by the normal distribution of most random events.

Well, that is how nature works. We can accept that if our organisation (or our health) is a top performing one and so mostly it will stay top performing over longer period of time. What if our organisation was a poor performer; the chances are it will continue to perform poorly; that would not be acceptable for a variety of reasons, especially if our organisation is in the business of healthcare. So when an organisation wants to become better, it embraces change in the hope that change will lead to an improvement. Often this change takes the form and language of transformation, reorganisation, change and other optimism inducing terms.

Here is when the concept of ergodicity becomes useful in leadership and management.

ERGODICITY

Ergodicity is the concept which states that:

·      The time average is the same as the space average
·      A system is Ergodic when the time average is the same as the space average

As an example suppose you’re trying to figure out the most popular park in London is. One method (time average) is to follow one person over a long period of time and see which parks he visits. Alternatively you can obtain a snapshot (spacial/statistical) average by seeing how many people are in a given park at a given point in time. The degree to which the time average equals the spatial average is called ergodicity and when the time and space average are the same then it is ergodic.

Concepts of Ergodicity applied to Organisational Management

Applying this to organisational management:

1)    If you take the whole organisation average on any given day vs whole organisation average over period of time (say 3 months) – if they are the same, then organisation is erogodic

2)  If you take the average of one department on a given day and the average of the whole organisation on the that given day – if they are the same, then organisation could arguably be ergodic but may not be truly so by definition.

3)    If you take the best of one department on a given day vs the best of the whole organisation on on that given day – if they are the same, then the organisation could, arguably, be erogodic but may not be truly by definition.

The three conditions provided above can be simplified into one to arrive at a fourth condition to demonstrate that a system is ergodic (note that conditions 2 & 3 are independent of time and hence alone are not sufficient to prove that a system is ergodic):

4) If you take the whole organisation average on any given day vs the average of one department over a period of time (say 3 months) – if they are the same, then the organisation is erogodic

·      This essentially could mean that a process even if random is or could be, stable
·      This is why organisations do plenty of activity, calling it transformation, change programmes, etc but yet do not improve as it is the nature of systems to show ergodicity.
·      It is okay for good performing organisations that are high performing to be ergodic.

That is very well, but what should organisations do to enable a higher level of performance and results irrespective of whether they are high performing or poor performing organisations do to improve?

Ergodic Transformation

Here is the example from wikipedia

·      if the set is a quantity of hot oatmeal in a bowl, and if a spoon of syrup is dropped into the bowl, then iterations of the inverse of an ergodic transformation of the oatmeal will not allow the syrup to remain in a local subregion of the oatmeal, but will distribute the syrup evenly throughout. At the same time, these iterations will not compress or dilate any portion of the oatmeal: they preserve the measure that is density.

·      Ergodic transformation does a thorough job of ‘stirring’ the system without disturbing the fundamental nature of the system (due to the inverse of ergodic transformation seen in oatmeal example above)

·      This becomes a Measure Preserving Transformation – which means though there has been an addition (in the oatmeal + syrup example) the system remains ergodic (space average = time average)

Ergodic Transformation applied to organisational management

This is good for systems that are already high performing and want to become even higher performing.
For systems and organisations that are poorly performing a measure preserving transformation is of no use; hence the ergodicity of the system must be broken to see if better results can be obtained.

Ergodicity breaking

·      Spontaneous symmetry breaking: This is what wikipedia says “Is a spontaneous process It is a spontaneous process by which a system in a symmetrical state ends up in an asymmetrical state. It thus describes systems where the equations of motion or the Lagrangian obey certain symmetries, but the lowest-energy solutions do not exhibit that symmetry.”

Spontaneous Symmetry Breaking applied to organisational management

My lay application of this to organisational management is that when organisational symmetry breaks spontaneously though the overall organisation would be stable the processes and people within the organisations have changed so much that there could be significant improvement (there may be significant worsening as well, which is what the organisation has to monitor and prevent)

·      Explicit symmetry breaking (https://en.wikipedia.org/wiki/Explicit_symmetry_breaking) : This is what wikipedia states “this term is used in situations where these symmetry-breaking terms are small, so that the symmetry is approximately respected by the theory”

Explicit Symmetry Breaking applied to organisational management

·      By demanding explicit transformation we seem to end up (at least according to mathematical, physics theories) with changes that are very apparent, visible, but it does not transform the whole system. There is obviously cautiousness resulting only in very small changes, subject to resistance, these changes are planned, defined and delivered – yet the organisation does not change

Do we need to have spontaneous symmetry breaking when managing organisations?

·      Not always

·      If you have a high performing stable system you may not want this (you may want explicit symmetry breaking or measure preserving transformation so that you can get improvement without making the system unstable, improvement without the trauma of conventional transformation)

·      Yes – if you have a poor performing organisation you want spontaneous symmetry breaking so that we can have improvement with transformation – there is risk of asymmetry which may be beneficial (explicit symmetry breaking may actually be harmful by ensuring status quo while putting out an image/impression of change/improvement)

In summary

Ergodicity could be a useful principle when applied to operational management. Organisations, their systems and people have their own stability irrespective of whether they are high or low performing. To improve the performance of an organisation or to transform an organisation, it may be relevant to consider whether different approaches apply to high and low performing organisations. For high performing organisations it may be relevant to consider the concept of measure preserving transformation where there can be explicit induced changes which are absorbed as a part of good process measures which are maintained as the average increases.  For poorly performing organisations, it may be relevant to consider the concept of spontaneous symmetry breaking where beneficial asymmetry within the organisation is sought out to enable transformation; this means looking for areas within the organisation where people are attempting to or doing things differently and when they are beneficial to capture and systematise them even though the changes may not be compatible to what was externally mandated or top down defined for them; in poor performing organisations demanding explicit changes which are externally mandated or defined top down may result in status quo if lucky or could result in poorer performance making the organisation worse.

PS: Any mathematician, statistician, probability expert or physicist can educate me on this topic, especially enlighten me where I am wrong, I would be very grateful.

Acknowledgement: The above writing was advised and supported by Mr B. Patel

M Hemadri’s mini e-book 'Standardised Management Conversation' is available - click http://www.amazon.co.uk/Standardised-Management-Conversation-Hemadri-ebook/dp/B018AWBJTU

## Saturday, 24 March 2018

### BME doctors: From recruitment to embitterment

THE ELEPHANT IN THE ROOM: the Life and Times of a BME Doctor in the NHS - from Recruitment to Embitterment

Suresh Rao

These are my personal observations and experience of working for thirty five years in countries of three continents (India, Canada and UK). Till I became the President of the Indian Orthopedic Society of UK (IOS-U-K) around 2005 I had no reason to acknowledge the existence of discrimination in the NHS. I had passed all my examinations at the first attempt, I had become a consultant in the early 1990s at the same average age (about 37 years) of any UK born white male doctor in orthopaedics at that time. It was only after I had blown the whistle while actually observing the horrendous treatment meted out to my colleague orthopaedic surgeons did I actually personally experience racial discrimination in the NHS in its ugliest form.

I have now come to recognize that the traditional attitude to recruiting and retaining BME doctors and nurses into the NHS is no different from the ‘Discard After Single Use Only’ policy of the slave trade. There is little security or safety and no fairness of treatment. The system of incentives and reward for hard work and competence simply do not seem to apply to BME staff. Unlike others, the course of life of a BME professional whether doctor or nurse seems to follow several distinct stages.

1. Stage of Denial: We work hard to keep the home and family together, crediting our limited successes to the support of others. Any perceived failures are almost always attributed to bad luck, never to the possibility of discrimination.

2. Stage of Panic: Naively believing that blowing the whistle is good for the sake of our patients, we publicly voice our concerns forgetting that those responsible for the cock-ups in the establishment will not thank a BME for exposing their incompetence. Such persons will not hesitate in recruiting others even less scrupulous than themselves to intimidate and harass you for the loss of their ‘private empire’ style of working. They usually have no difficulty colluding with your colleagues who are probably already dreading the loss of their private practice to others. The establishment leviathan is now ready to turn against you for stirring up a hornet’s nest when you were least expecting this response.

3. Stage of silence: We are made to feel guilty for creating a conflict in the department where none had supposedly existed previously. We become vulnerable to subtle emotional blackmail by promising to avoid future conflicts and agreeing to behave in a more ‘civil manner’, i.e. accept that we should next time bring up any issues ‘face to face’ for a ‘negotiated’ resolution of ‘confusions and misunderstandings’ rather than going through the employer. We are later reminded of this sword of Damocles hanging on our heads and we become too frightened to think rationally, instead we too begin to behave like any victim would. We invite others to quash us underfoot like a worm by tacitly acquiescing to the rules of their game. This not only bolsters the opposition but also puts our relationship with our employer in jeopardy. We now enter a state of limbo in our career progression to the extent of even questioning our own achievements and wondering whether we had truly deserved our CEA points, if we managed to get any. We convince ourselves that this was just a favour granted to us by our generous employer but only with the benevolent support of our well-meaning colleagues. We begin to lose our self-esteem and any frame of reference we may have for our sense of self-identity, our moral character is disabled and allows us to do peculiar things we would never normally do. We are soon at risk of losing our raison d’Ãªtre.

4. Stage of Escalation: Unfortunately a number of us cannot or will not read the writing on the wall. We may injudiciously allow the situation to escalate out of control and pave the way leading to our own harassment and intimidation at the hands of the abusers in the establishment. If this does not succeed to cow us down we are then threatened with disciplinary action including the possibility of instant dismissal for supposedly ‘serious charges’ including criminal prosecutions for what are really minor infractions. The establishment will not hesitate to dispense summary retribution through Dismissal Orders under ‘MHPS’ for trumped-up charges and enforce redundancy despite any findings of  the Employment Tribunals. It is not uncommon for us to be referred to the GMC by this stage as the latter is hand in glove with the Medical Directors against the BME and feels obliged to take up investigating all such matters despite no evidence being submitted by the Establishment, a clear case of disproportionately handing out injustices to BME.

5. Stage of ‘Resolution of Conflagration’: this usually means a ‘negotiated settlement for enforced retirement’ and it is most diabolical that this sometimes comes about because the innocent BME cannot bear the humiliation of a criminal trial or a GMC hearing and will most likely be on the verge of deciding to commit suicide.

Suggestions to avoid such a fate:

This is difficult because everyone reacts to crises in completely different and unpredictable ways. Following is just commonsense, not rocket-science:

1.    Maintain good medical practice (and relations with colleagues)
2.    Know the law (including the latest version of MHPS and PIDA)
4.    Anticipate trouble (band up together, join BAPIO and MDS)
5.    Use local procedures fully (keep meticulous documentation)
6.    Involve regulatory bodies at an early stage (NCAS, GMC, CQC, CPS)
7.    Remain vigilant and focused, be discreet, stay calm and never say die

The elephant in the room is discrimination, name it, call it out, learn to effectively deal with it and work to reduce its harmful effects on yourself and others.

Prof Suresh Rao
Consultant Orthopaedic & Trauma Surgeon
North Cumbria University Hospitals NHS Trust
Hon. Professor, University of Cumbria

(The above is from the talk given by Suresh Rao at a meeting in Manchester on 26 March 2013. All the content are the personal views of Suresh Rao)

M Hemadri’s mini e-book 'Standardised Management Conversation' is available - click http://www.amazon.co.uk/Standardised-Management-Conversation-Hemadri-ebook/dp/B018AWBJTU

## Sunday, 25 February 2018

### My bias declared publicly. Could you declare yours?

For quite sometime I have been active in quality improvement, leadership, patient safety, human factors and related areas. My interest includes discrimination in general but healthcare in particular and especially doctors. This relates to discrimination in the western world particularly in the UK. We know bias plays a part in this discrimination. Government and organisations have taken efforts in dealing with discrimination, this takes the form of law, training in equality and diversity and monitoring selected data. We are told how to deal with discrimination and how to avoid discrimination.

We were never asked to assess, quantify and declare our bias.

Bias is a part of life. For better or worse our history, legacy and as humans our capacity to pattern match means that bias gets in. We could even argue that bias is a normal part of life. However when bias affects the career, livelihood, reputation and freedom of certain segments of the population, it ceases to be normal. While bias could be accepted as normal, the positive or negative effects of bias that affects segments of population repeatedly can never be accepted as normal.

How do we prevent bias from affecting others?

In my opinion unless we assess our bias by a common method and then declare it publicly we cannot begin to tackle discrimination.

Once our bias is published publicly, then we can start having methods to take that into account in our decision making by appropriate counterbalances, algorithms, adjustments etc.

I cannot ask others to publicly declare their bias unless I have done so myself.

Currently, the Harvard Implicit Association Tests are a good (but not totally proven) method to assess our bias. https://implicit.harvard.edu/implicit/takeatest.html

I have taken the test that relates to race and I am posting the results by screenshot here.

I am aware that this test relates better to the USA and refers to the black-white races. I also took this test thrice; twice the same result came up that I had a moderate automatic preference for white people and once the test showed no preference between white and black people; on the occasion that the test showed no preference, I had deliberately slowed down to take the test.

So does that make me a racist? I do not think so. Does that make me biased? May be it does, but since I have known this for sometime now, I make deliberate conscious effort to overcome my Harvard IAT data based moderate automatic preference for white people. I think very deeply on how my actions are impacting. I take extra effort to review decisions before implementing them with the awareness of my bias to ensure that my actions do not affect black and minority ethnic people adversely.

If I was an examiner, investigator, police, judge, etc I would want my decisions to be counterbalanced by a formal algorithm to prevent my bias from hurting BME people.

I am not in an unusual category as far as my bias is concerned; I am part of the largest category of persons who have taken this test. How does this affect the society?

We need to start somewhere.

I encourage you to take the test and post it publicly. I am happy to add your test result to this blog if you send it to me. Let us make a change. Let us reduce bias. Let us take the first real step by publicly acknowledging our own bias.

Here is the list of persons who have agreed to go public with their bias tests. My sincere thanks for permitting me to add their names:

Dr Kim Holt: 'slight automatic preference to black people over white people'

Dr Joe Karthikapallil (Ophthalmologist) : 'moderate automatic preference to white people over black people'.

Dr Joydeep Grover: 'no automatic preference between African Americans and European Americans'

Dr Vivek Chhabra (ED): 'no automatic preference between black people and white people'

Mr Bhavik Patel (Financial Sector) - ' slight bias towards white individuals compared to black individuals'