Counterintuitive

“I always knew I was going to be somebody. But now I wish I had been more specific.” – Lily Tomlin

In April 2014 at a conference on “Redefining Roles: Embracing the Patient as Partner,” one of the speakers, a Ph.D. and President of a division of UnitedHealthcare Corporation, began by taking a step back in time to recount the historical evolution of risk management practiced by the leading doctors of the past.

During the early settlement of the United States, the principal medical treatment consisted of “blood letting.”  In the 1700s, during the Yellow Fever epidemic, Benjamin Rush, a physician signatory of the Declaration of Independence, bled 100 to 125 people per day. Other treatments included “purging,” “sweat boxes,” “mercury ointments” and “medicinal hanging.”  The treatments sound worse than the illnesses.

Before anesthesia, medicine was a horror show, with surgery often resulting in death from shock.  Successful amputations were based on the speed and strength of the surgeon often at the expense of the fingers of surgical assistants.

It took nearly 100 years before physicians took a more scientific approach to medicine.  The practice of hand washing between surgeries was nonexistent until the 1800s.  Soon new discoveries – including the use of ether for anesthetics, immunization as a cure for a host of diseases and the use of carbolic acid in post-surgical wound treatment – transformed hospitals into a place of healing and not death.

Why did it take hundreds of years and the lives of so many patients for the best physicians of their time to not consider alternative patient care?  Because it would have been considered counterintuitive to try something different!  No one dared to challenge the status quo!

It is easy to see the mistakes made in the past, but we often miss the obvious for fear of going against social norms.  Conventional wisdom may be safe, but it clearly does not lead to innovation.  The fear of new approaches, innovative ideas and counterintuitive thinking may in fact be the limiting factor to innovation and may lead to increased risk rather than reduced risk.

New information is often ignored simply because we are not prepared to try a novel approach or don’t have the will to change what has worked in the past.  According to the speaker, “One in three people look beyond medicine to healing arts like meditation and therapy. Information alone will not change health-adverse behavior. Becoming knowledgeable is the first step. We must look at more effective ways to change and help people monitor their behavior.”

What is the lesson for risk management today?  Are today’s risk managers committing the same risk malpractice in the name of building consensus?

One of the clear lessons for today’s risk manager is that risk management without clear outcomes is simply wishful thinking.  The old axiom, “you can’t manage what you don’t measure” is true.

How many risk programs have been implemented based on some prescribed framework without any evidence that said framework has a proven methodology based on measurable outcomes?  Or has the same framework been implemented across a variety of industries and reinforced by regulators simply because everyone else has one?

History tells us that this approach is probably wrong or, worse, that it will be considered illogical in the not too distant future.  Our speaker reminds us that “It’s hard pushing in new knowledge and pushing out old knowledge.  Once we have information to doctors in real time, it’s a small step to get it to patients when they can use it — and once patients have this information, they will begin to drive the system.”

We have a natural blindside to risk and need help making decisions under uncertain conditions.  Counterintuitive solutions expose the influence of cognitive risk.  “A more radical view, which I espouse, is that of informed decision making using computer technology and involving the patient in all aspects of care, including diagnosis. I have had a number of experiences where the patient came up with a diagnosis that I missed.”

Incorporating change is the real challenge. Change is threatening and uncomfortable because it may be perceived as counterintuitive and we label that as “bad.”   These emotional responses to new ideas are simply that: emotional.  Risk management must become more scientific or risk becoming irrelevant.

We can’t and shouldn’t introduce too much change all at once, but we can question whether we have measurable outcomes for the things that we do today.