Slow. Small. Simple

Through my random readings and realizations, many themes have emerged that span the personal and the professional. This is an attempt to organize some of them. And while the examples I’ve used are largely related to healthcare, the application of these principles is equally if not more applicable for a personal quest to live a more connected life.

If you want to know, think slow

Recovered colon cancer patients overwhelmingly chose the option to give up future years of their life to avoid a colostomy if they had had one in the past. The memory of that past experience was so powerfully negative that it was able to overcome the most primal desire to live. Memory is more likely to retain extremes and is, therefore, subject to cognitive bias. As another example, the rate of depression among paraplegics was wildly overestimated by people who did not personally know any. So projection into the future, too, is subject to cognitive bias. The point being that both experiential reality and projected reality suffer from cognitive biases that keep us from knowing the true nature of reality. 



Nobel Laureate economist and psychologist Daniel Kahneman describes the self in terms that sound more like spirituality than psychology—that we have two selves—one that experiences and one that deliberates and discerns. The experiencing self is “in the moment” and subject to the biases of knee-jerk reactions, whereas the remembering self remembers and projects—and is thereby subject to the biases of the partial memory of a few memorable moments (good or bad) of a lived experience. When we make choices, being aware of which self is making these choices is important to avoid blindness to its biases. 

The choices we make for how we live as individuals and as a society depend on the decisions we make—whether we are legislators, innovators, analysts, communicators, or just seekers of knowledge. We also must seek to understand the human factors that limit our ability to comprehend reality at a deeper level than emotional reactivity or shallow observational research.

In his book Thinking, Fast and Slow, Kahneman explores these ideas from an empirical standpoint and shows how poorly equipped we are to grapple with the limitless complexity that reality presents. To know requires us to accept that we cannot for sure know, and from there begins the journey of slow thinking in a quest to know a little more, with humility as the safety blanket that keeps us aware of our biases and limitations.

Thinking small changes the world

As an industry, value-based medicine is a big idea that’s been just around the corner for the past five years. Complex laws have been drafted, argued over, and signed; infrastructure for health records put in place; compensation models drawn up; mergers and acquisitions taken place, and many white papers spewed. Yet a meaningful transition to a value-based–medicine model that shifts the paradigm from services rendered to health outcomes eludes us. 

It’s a big idea, and like most big ideas, it has yet to come to pass. Small ideas, on the other hand—such as incorporating biometrics for post-surgical follow-up, sensors in pills that record when they’re swallowed, or pacemakers that monitor and report inconsistencies in heart rhythm to a monitoring sensor to prevent heart attacks—are all small ideas with a big impact. When we look at healthcare today, manufacturers are desperate to differentiate in a marketplace full of competing molecules whose clinical data is in parity. 

Differentiation based on data and feedback mechanisms is clearly an area of customer experience innovation that depends on small but impactful ideas. Inexpensive sensors that send data about product leaks, biometrics, movement/lack of movement, and so on, have spawned a massive surge of products and solutions that adds value along the health continuum from prevention to acute post-surgical care. My favorite question to jump-start an innovation-oriented thought process is to ask: “If you had to give your product away, how else could you make money?”

Getting to simple is not that simple

"Nobody knew that healthcare could be so complicated" is now a famous quote. So, yes, in the age of exponential growth of data, information, and a networked economy, complexity is par for the course. But getting to simple is an act of subtraction—and that requires courage as much as clarity. In Lisa Bodell’s book Why Simple Wins, she describes a simplifier as having courage and a minimalist sensibility, while being results oriented, focused, personally engaged, and decisive. Simple requires a reduction of redundancy (in rules, organizational structure, tasks). 

It requires meaning (the “why”). And it requires an orientation towards seeking where real value lies, as opposed to auditing time and/or effort. She cautions against mistaking something well organized as being simple. And relatedly, against mistaking what I call “meta” work as work. Meta-work is audits, tracking, reports, presentations—things that most people spend most of their time doing. 

Associated tasks, such as checking and answering emails, internal meetings (especially long ones), and reports and presentations to “get on the same page,” are all well-intentioned meta-work that are acts of organization. The metrics of time and effort, therefore, are metrics of meta-work, not of value. I’d like to add that unless we’re vigilant, we’ll end up living metalives—going through the motions of existence, repeatedly and with diminishing return over time. Hollow routines need to be disrupted by courageous simplicity.

Simplicity is contagious because it is the natural path of evolution. Establishing simplicity as a key strategic priority for an organization, and for us as individuals living in times of utter clutter is as essential to a company’s success as it is to an individual’s attempts to scale the pyramid of self-actualization.

Innovation comes from creative thinking, and self-actualization comes from creating meaning. If we truly view the world for what it is, then it’s whatever we’ve created. In other words, the things we think matter are the only things our world is comprised of. Be it companies, governments, or individuals, let’s think and think again about what those things are that we think matter.

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