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JMG3Y

Yes, I agree that "Made to Stick" has important messages for us teachers striving to improve our part of the education process, that that its not "just the facts". But then I read Cialdini's "Influence: Science and Practice" and Gilbert's "Stumbling on Happiness" and realized just how enormous that challenge really is. I still haven't recovered from those two books.

Bob Sutton

Hi: I wish I could argue with you, but you are absolutely right. The notion that even the best effects the probabilities of success, rather than in a pure "this is right" or "this is wrong" sense ends-up being a hard thing to teach. And also something that is the best decision you can make right now may end-up being wrong or incomplete later, as better data come along. We try to make this point in part by arguing that effective managers act on the best knowledge they have right now, but doubt what they know... but in practice I agree it is tough.

The stories are another interesting thing. An irony -- if you read Made to Stick by the Heaths, is that they will influence behavior more strongly than statistics (and they have the studies to prove it!), so the trick is to tell stories that are true, or as true as you can make them, given what you know now, to sell evidence-based management.

Indeed, if you read things by David Sackett, one of the pioneers of evidence-based medicine in the U.S., he is a darn good storyteller!

Thanks again for your very thoughtful comments,

Bob

JMG3Y

Bob: I meant to include the caveat that I haven't read Hard Facts as yet; it is on my list.

I'd add that teaching the EBM process to students is hard, at least for me. Students do not like dealing with the uncertainty and complexity on the professional knowledge base side as well as the patient side. They want solid facts upon which to base their actions; from their perspective just getting all the facts down is a tough enough task. Experienced practitioners are more amenable but tend not to react well to anyone questioning the integrity of their personal knowledge base.

Bob Sutton

Thanks for the comment. Note that our book, Hard Facts, Dangerous Half-Truths, and Total Nonsense, does exactly what you suggest. It uses evidence-based medicine as a point of departure for understanding management. And while the above is meant to consider logic rather that quantitative evidence, that book, and in fact, many of the ideas on this blog, proposes ideas based largely on quantitative evidence from peer-reviewed studies -- which I confess are weaker than medical studies, but better than what most companies use. At the same time, as quantitative evidence shows, points stick better when they are made with sticky stories. Thanks again for the comment.

JMG3Y

A core principle of EBM (of the medical variety, who have a prior claim on the acronym) is the assessment of strength of evidence and the use of reliable, repeatable procedures to do so. Developing such procedures and then performing these to answer specific clinical questions is a difficult task involving incredible amounts of person-hours. The Cochrane Collaboration is the primary location of this effort and most of their materials are available on-line.

The strength of medical evidence hierarchy forms a logical pyramid, with the strongest (randomized controlled blinded clinical trials) being the least plentiful tip and the weakest (anecdotal case reports) being the most plentiful broad base. Another broad but useful classification is the study form - experimental (randomized allocation of subjects) vs. observational, the weaker base of case-control, cohort and the weakest, case series.

Most of what is described above as management evidence is at best observational evidence and at worst descriptive case series, the weakest form from a logical perspective. IMO, EBM of the business management variety could learn much and perhaps avoid some pitfalls by looking over the fence at the history and current developments in the EBM of the medical variety. For example, once it becomes popular, paying attention to the actual strength of that which is labeled EBM by its individual proponents is critical.

Coert Visser

I agree with 'Don’t just look at winners, look at winners and losers.' I agree with you that the positive deviance approach as decribed here has the disadvantage of creating a benchmarking situation. An alternative would be to look at positive deviance not only within the system (organization) as a whole but to look at positive deviance within individual members of the system too. Both with top performers and underperformers you could lookt at when what they did worked well. If you can identify WITHIN the performance of an underperformer when his performance was adequate or even quite good you can then invite the individual to treat this like an 'INTERNAL BENCHMARK'. This will lead to finding 'internal solutions' which have a higher chance of working because people (1) know how to apply them, (2) have the skill to apply them, and (3) trust in the relevance and effectiveness of the solution. This is one of the basic ideas of the solution-focused approach: help people to learn from their past successes. This can be done even if, overall, they don't function too well at a specific moment. There will always be moments when things have been better (or slightly better). These are the moments from which you often can learn a lot.

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