|Care pathways||Algorithms||Cost and price trends||Business models|
|Diagnostic opportunities||Electronic medical records||Employer initiatives||Patient empowerment|
|Epidemiology||Surveillance (being monitored)||Medicare policy||Trust|
|Prognostic tools||Mobile health||Other federal initiatives|
|Recreational substances||Payer behavior|
|Clinical pearls||Policy musings
The Intelligence Trap: Why Smart People Make Dumb Mistakes, David Robson. 2019.
- “We have now seen three broad reasons why an intelligent person may act stupidly. They may lack elements of creative or practical intelligence that are essential for dealing with life’s challenges; they may suffer from “dysrationalia,” using biased intuitive judgments to make decisions [more broadly, mismatch between intelligence and rationality]; and they may use their intelligence to dismiss any evidence that contradicts their views thanks to motivated reasoning.”
- “Once language evolved, we needed to be eloquent, to be able to build support within the group and bring others to our way of thinking. Those arguments didn’t need to be logical to bring us those benefits; they just had to be persuasive. And that subtle difference may explain why irrationality and intelligence go hand in hand.”
“Four potential forms of the intelligence trap:
- We may lack the necessary tacit knowledge and counterfactual thinking that are essential for executing a plan and preempting the consequences of our actions.
- We may suffer from dysrationalia, motivated reasoning, and the bias blind spot, which allows us to rationalize and perpetuate our mistakes, without recognizing the flaws in our own thinking. This results in our building “logic-tight” compartments” around our beliefs without considering all the available evidence.
- We may place too much confidence in our own judgment, thanks to earned dogmatism, so that we no longer perceive our limitations and overreach our abilities.
- Thanks to our expertise, we may employ entrenched, automatic behaviors that render us oblivious to the obvious warning signs that disaster is looming, and more susceptible to bias.”
Igor Grossman, University of Waterloo psychologist, suggests six specific principles of wisdom:
- Ability to “consider the perspectives of the people involved in the conflict,” which takes into consideration your ability to seek and absorb information that contradicts your initial view
- Recognizing the ways in which the conflict might unfold
- Recognize the likelihood of change
- Search for a compromise
- Predict conflict resolution
- Intellectual humility – an awareness of the limits of our knowledge, and inherent uncertainty in our judgment; essentially, seeing inside your bias blind spot
- Benjamin Franklin’s moral algebra and self-distancing
Five stages of expertise:
- Unconscious incompetence – You don’t know what you don’t know
- Conscious incompetence – You are aware of what you need to learn
- Conscious competence – Practicing the skill requires concentration and deliberation
- Unconscious competence – Your decisions are quick and intuitive but vulnerable to bias
- Reflective competence – You know when to question your intuitions and eliminate error
Bullshit dectection kit – asking the right questions:
- Who is making the claim? What might their motives be to make me think this?
- What are the premises of the claim? And how might they be flawed?
- What are my own initial assumptions? And how might they be flawed?
- What are the alternative explanations for their claim?
- What is the evidence? And how does it compare to the alternative explanation?
- What further information do you need before you can make a judgment?
- “Simply spending a few minutes to write positive, self-affirming things about yourself and the things that you most value can make you more open to new ideas. Studies have shown that this practice really does reduce motivated reasoning by helping you realize that your whole being does not depend on being right about a particular issue, and that you can disentangle certain opinions from your identity.”
- “By enhancing our learning and pushing us to overcome failures in these ways, curiosity and the growth mind-set would already constitute two important mental characteristics, independent of general intelligence, that can change the path of our lives. [..] both curiosity and the growth mind-set can also protect us from the dangerously dogmatic, one-sided reasoning”
- University of Michigan graduate student James Stigler’s three stages of good teaching:
- Productive struggle: long periods of confusion as students wrestle with complex concepts beyond their current understanding
- Making connections: students are encouraged to use comparisons and analogies, helping them see underlying patterns between different concepts. This ensures that the confusion leads to a useful lesson – rather than simply ending in frustration.
- Deliberate practice: once the initial skills have been taught, teachers should ensure that students practice those skills in the most productive way possible. Rather than repeating near-identical problems, add variety and challenges – and yet more productive struggle.
- Carnegie Mellon University’s Anita Williams Woolley research findings include:
- One of the strongest and most consistent predictors of a team’s collective intelligence is social sensitivity. This allows teams to read between the lines of direct messages and better coordinate their actions.
- Better groups tend to allow each member to participate equally; the worst groups, in contrast, tended to be dominated by just one or two people.
- The most destructive dynamic is when team members start competing against each other.
Cornell University’s Angus Hildreth’s findings suggest:
- Underline each person’s expertise at each meeting and their reason for appearing at the group to help ensure they share relevant experience
- Allotting a fixed amount of time for each person to contribute his or her opinion at the start of the meeting
- When you come to a problem to discuss, set out a firm strategy for when and how you will make the decision to avoid the kind of impasse that may come when too many intelligent and experienced people butt heads.
- The leader should embody the kinds of qualities he or she wants to see in a team – and should be particularly keen to encourage disagreement.
- Functional stupidity, from (Lund University, Sweden) Mats Alvesson and (Cass Business School in London) Andre Spicer’s The Stupidity Paradox, are when individuals aren’t encouraged to think. This stupidity allows individuals to “go with the flow” at work. Excessive specialization and division of responsibilities can also promote functional stupidity. The most pervasive source of functional stupidity is the demand for complete corporate loyalty and an excessive focus on positivity, where the very idea of criticism may be seen as a betrayal, and admitting disappointment or anxiety is considered a weakness.
Karl Weick and Kathleen Sutcliffe have shown that high-reliability organizations all demonstrate:
- Preoccupation with failure
- Reluctance to simplify interpretations
- Sensitivity to operations
- Commitment to resilience – building the necessary knowledge and resources to bounce back after error occurs, including regular “pre-mortems” and regular discussions of near-misses.
- Deference to expertise
The Lies That Bind: Rethinking Identity, Kwame Anthony Appiah, 2018. Dr. Appiah challenges the validity of five identity constructs: religion (creed), nationality (country), race (color), class and culture.
Two of my favorite nuggets:
- “three ways in which these very disparate ways of grouping people do have [..] in common. The first is obvious: every identity comes with labels, so understanding identities requires first that you have some idea about how to apply them. [..] the second most important thing identities share: they matter to people. [..] because having an identity can give you a sense of how you fit into the social world. [..] a further crucial aspect [..] they give you reasons for doing things. [..] the third feature identities share: not only does your identity give you reasons to do things, it can give others reasons to do things to you.”
- “The central task of ethics is to ask: what is it for a human life to go well? The answer, I believe, is that living well means meeting the challenge set by three things: your capacities, the circumstances into which you were born, and the projects yourself decide are important. Making a life, my friend the philosopher and legal scholar Ronald Dworkin once wrote, is “a performance that demands skill,” and “is the most comprehensive and important challenge we face.”
The Power of Nunchi: The Korean Secret to Happiness and Success, Euny Hong, 2019.
- First, empty your mind. As Bruce Lee said: “Empty your cup, so that it may be filled.” Step back, breathe, and remember that prejudice prevents you from learning anything about other people.
- Be aware of the Nunchi Observer Effect. When you enter a room, you change a room. There’s no need for a big opening act.
- If you just arrived in the room, remember that everyone else has been there longer than you. Watch them to gain information.
- Never pass up a good opportunity to shut up. If you wait long enough, most of your questions will be answered without you having to say a word. This advice will serve you well in negotiations, where the goal is to learn as much as possible while keeping your cards close to your chest.
- Manners exist for a reason. Don’t dismiss them as superficial; they’re used to make people feel comfortable.
- Read between the lines. Pay attention to context and to what they are not saying.
- If you cause harm unintentionally, it’s sometimes as bad as if you’d caused it intentionally. Intent is just based on what’s in your own head; you need to get outside your head to make people comfortable around you. Try to create roundness, not jagged edges.
- Be nimble, be quick. The room you entered 10 minutes ago is not the same room you are in now. Survival of the fittest doesn’t mean survival of the strongest. It means survival of the most adaptable.
Would I Lie to You: The Amazing Power of Being Honest in a World That Lies, Judi Ketteler, 2020.
- First, be aware.
- Not every situation is the same. Different areas of your life have different stakes; not every decision deserves the same amount of energy.
- Be mindful of emotions. Don’t let your fear of hurting someone guide you into a potentially paternalistic lie, if they can benefit from knowing the truth.
- Intention matters. Refinement helps you see all of the options and make the best choice possible.
- Think about who you are being. Are you tempted to be dishonest because your identity – the key way you see yourself in the workplace – is threatened? How can you cultivate and embrace other identities and ways of being, to better handle identity threats?Ethics researcher and associate professor at Oregon State University Keith Leavitt suggests we fall into three buckets around identity: the personal (define yourself by what makes you distinct), the relational (define yourself through your obligations and the roles in which you serve others), and the collective (define yourself through belonging to a group).
- Say what you mean, but don’t be a jerk.
- Is it your truth to tell?
- Mine all parts of the conversation.
- Instead of looking for who to blame, map the contribution system inside your relationship – what did you contribute to the situation, and what did your partner contribute?
- Your feelings (and your partner’s feelings) are not static; they are ever-changing, and based on your thoughts and perceptions. Find the next level under the feelings you are expressing and negotiate with those deeper ideas.
- Complexify your identity inside your marriage. Opt for “and” instead of “or.”
- When you love someone, honesty is about sharing with a loving purpose.
In Difficult Conversations: How to Discuss What Matters Most, by Douglas Stone, Bruce Patton, and Sheila Heen, the authors describe the three different conversations inside every conversation that involves a disagreement or talking about a difficult matter: what actually happened, feelings and identity.
- You don’t need to pit honesty and otherworldly belief against each other.
- Otherworldly belief gives children stories bigger than themselves to help make sense of the world and understand the power of imagination.
- “Facts,” “evidence,” and “truth” don’t need to fit neatly into otherworldly belief – but be honest about which is which when your kid asks.
- Today is a new day. There is a whole category of self-honesty related to examining your role in a situation you don’t like, yet still benefit from. [..] I’m referring to those situations you complain about or express frustration at, yet do very little to change – usually because you aren’t being honest with yourself that you’re complicit in creating the situation. [..] You can ferret out these situations in two ways. One is to make a list of your deepest frustrations, most embarrassing shortcomings, or the things that most piss you off. The other is to make a list of your greatest accomplishments, most deeply held beliefs, and parts of your life that you’re most proud of. Basically, look any place you have created a powerful self-narrative that a lot rides on you continuing to believe, and then ask yourself what the consequences of not believing it would be. In fact, when you challenge yourself to honestly examine a personal narrative about your life that you have always thought was true, it can have a domino effect. And that’s the real opportunity for this work. It might break you first, though.
You’re Not Listening: What You’re Missing And Why It Matters, Kate Murphy, 2019.
- According to Carl Rogers, the psychologist who coined the term active listening, listening to opposing viewpoints is the only way to grow as an individual: “While I hate to readjust my thinking, still hate to give up old ways of perceiving and conceptualizing, yet at some deeper level I have, to a considerable degree, come to realize that these painful reorganization’s are what is known as learning.”
- After three years of collecting data, the researchers finally reached some conclusions about what made for cohesive and effective teams. What they found was that the most productive teams were the ones where members spoke in roughly the same proportion, known as “equality in distribution of conversational turn-taking.” The best teams also had higher “average social sensitivity,” which means they were good at intuiting one another’s feelings based on things like tone of voice, facial expressions, and other nonverbal cues.
In other words, Google found out that successful teams listened to one another. Members took turns, heard one another out, and paid attention to nonverbal cues to pick up on unspoken thoughts and feelings. This led to responses that were more considerate and on point. It also created an atmosphere of so-called psychological safety, where people were more likely to share information and ideas without fear of being talked over or dismissed.
- People who have conversational sensitivity not only pay attention to spoken words, they also have a knack for picking up hidden meanings and nuances in tone. They are good at recognizing power differentials and are quick to distinguish affectation from genuine affection. They remember more of what people say and tend to enjoy, or at least be interested in, the conversation. Conversational sensitivity is also thought to be a precursor to empathy, which requires you to summon emotions felt and learned in previous interactions and apply them to subsequent situations.
Not surprisingly, conversational sensitivity is related to cognitive complexity, which, as discussed earlier, means you are open to a range of experiences and can cope with contradictory views. You can’t be good at detecting intricate cues in conversation if you haven’t listened to a lot of people. It is said that intuition, often called the sixth sense, is nothing more than recognition. The more people you listen to, the more aspects of humanity you will recognize, and the better your gut instinct will be. It’s a practiced skill that depends on exposure to a wide range of opinions, attitudes, beliefs, and emotions.
- “Not listening is in that sweet spot of things that can really stir up regret over time,” [director of the Regret Lab at Miami University in Oxford, Ohio Amy] Summerville told me. “It’s essential to relationships, and we can readily recognize it’s something fully under our control.” Regret is the second-most common emotional state, after love, she said, and the two feelings are intertwined since the most intense regret comes from neglecting those we love. Relationships most often fail due to neglect, and one of the principle kinds of neglect is not being attentive. Whether viewed as an evolutionary survival tactic, basic moral virtue, or what we owe the ones we love, listening is what unifies us as human beings.
A Republic of Equals: A Manifesto for a Just Society, Jonathan Rothwell, 2019.
Poverty, By America, Matthew Desmond, 2023.
The Aristocracy of Talent: How Meritocracy Made the Modern World, Adrian Wooldridge, 2021.
- “a glance around the world suggests that meritocracy is a golden ticket to prosperity. Singapore, perhaps the world’s poster child of meritocracy, has transformed itself from an underdeveloped swamp into one of the world’s most prosperous countries, with a higher standard of living and a longer life expectancy than its old colonial master. The Scandinavian countries retain their positions at the top of international league tables of prosperity and productivity in large part because they are committed to education, good government and, beneath their communitarian veneer, competition. By contrast, countries that have resisted meritocracy have either stagnated or hit their growth limits. Greece, a byword for nepotism and ‘clientelism’ (using public sector jobs to reward Party cronies), has struggled for decades. Italy, the homeland of nepotismo, enjoyed a post-war boom like France and Germany but has been stagnating since the mid-1990s. The handful of countries that have succeeded in combining anti-meritocratic cultures with high standards of living are petro-states that are dependent on the accident of geography rather than the ingenuity of their people. They will surely revert to poverty in the coming post-oil age unless they change their habits.”
- “Meritocracy is also a valuable supplement to the market: while markets provide information about human preferences, examinations provide information about human abilities. Individuals get a sense of their strengths and weaknesses (including how they stack up against their peers). Schools get a sense of who will benefit from advanced teaching or which universities are within their reach. And governments get a sense of what intellectual resources are at their disposal. (One of the most striking results of the mass testing that followed the Second World War was that governments learned just how much talent was being wasted because so few people, particularly in the working class, had a chance of going to university.)
The Broken Ladder: How Inequality Affects the Way We Think, Live and Die, Keith Payne, 2017.
Good Inside: A Guide to Becoming the Parent You Want to Be, Becky Kennedy, 2022.
- Finding the good inside can often come from asking ourselves one simple question: “What is my most generous interpretation of what just happened?” I ask myself this often with my kids and my friends, and I’m working on asking it more in my marriage and with myself.
- This idea of multiplicity – the ability to accept multiple realities at once – is critical to healthy relationships. When there are two people in a room, there are also two sets of feelings, thoughts, needs and perspectives. Our ability to hold on to multiple truths at once – ours and someone else’s – allows two people in a relationship to feel seen and feel real, even if they are in conflict. Multiplicity is what allows two people to get along and feel close – they each know that their experience will be accepted as true and explored as important, even if those experiences are different. Building strong connections relies on the assumption that no one is right in the absolute, becuase understanding, not convincing, is what makes people feel secure in a relationship.
- The wider the range of feelings we can regulate – if we can manage the frustration, disappointment, envy and sadness – the more space we have to cultivate happiness. Regulating our emotions essentially develops a cushion around those feelings, softening them and preventing them from consuming the entire jar. Regulation first, happiness second. And this translates into parenting: the wider the range of feelings we can name and tolerate in our kids (again, this doesn’t mean behaviors), the wider the range of feelings they will be able to manage safely, affording them an increased ability to feel at home with themselves.
- Focusing too much on behavior change can cause us to lose touch with our humanity; we end up looking at ourselves and our children only for what we produce on the surface, without any regard to the elements that make us whole – our feelings, our fears, our needs, our compassion.
- Here are some questions to ask yourself after any tough moment:
- What is my most generous interpretation of my child’s behavior?
- What was going on for my child in that moment?
- What was my child feeling right before that behavior emerged?
- What urge did my child have a hard time regulating?
- What is a parallel situation in my life? And if I did something similar, what might I have been struggling with in that moment?
- What does my child feel I don’t understand about them?
- If I remember that my child is a good kid having a hard time … what are they having a hard time with?
- What deeper themes are being displayed underneath this behavior?
- Connection is the opposite of shame. [..] Shame is a warning sign of aloneness, danger and badness; connection is a sign of presence, safety and goodness. [..] Connection is when we show our kids, “It’s okay to be you right now. Even when you’re struggling, it’s okay to be you. I am here with you, as you are.”
Punished by Rewards: The Trouble with Gold Stars, Incentive Plans, A’s, Praise and Other Bribes, Alfie Kohn, 1993.
“We might say that limits and structures can be endorsed most readily when the purpose is defensible (for example, protecting the child from injuring himself), their restrictiveness is minimized (for example, preventing access to certain cabinets rather than forcing a toddler to stay in one small space), and the child has contributed to the arrangement to the fullest possible extent (for example, in helping come up with a plan for getting homework done). [..]
Do we really want to pursue an adversarial relationship with a child? If not, then it makes no sense to choose our response with an eye to preventing him from winning a contest for power, because there is no contest for power. [..]
In my view, there are two fundamentally different ways one can respond to a child who does something wrong. One is to impose a punitive consequence. Another is to see the situation as a “teachable moment,” an opportunity to educate or to solve a problem together. The response here is not “You’ve misbehaved; now here’s what I’m going to do to you” but “Something has gone wrong; what can we do about it?”
[Kohn goes on to reflect on the “three C’s:
The Self-Driven Child: the Science and Sense of Giving Your Kids More Control Over Their Lives, William Stixrud and Ned Johnson, 2018.
The Unlikely Art of Parental Pressure, Chris Thurber & Hendrie Weisinger, 2021.
- Parental warmth is a combination of accepting the child for who they are, expressing love for the child through appropriate touch, self-sacrifice, and talk, and attending to the child’s needs with compassion. (Conversely, parental coldness is a combination of rejection, reticence and ignoring.)
- Hear feelings
- Adopt an affective mindset
- Extinguish sparks
- Express empathy, but risks include:
- Empathetic statements sound too canned. (So talk how you usually talk.)
- You might guess incorrectly about how your kid is thinking or what they are feeling. (Your child will usually set you straight. Even when you miss the mark, you will have achieved your goal of expressing compassion and making an emotional connection.)
When you express genuine empathy, you make a powerful connection with your child without solving the problem that generated the feeling in the first place.
Why then, is such a potent and simple technique so rarely used?
- We delay empathy, believing that solving the problem first is the best approach;
- We skip empathy, believing that it is tantamount to agreement; or
- We provide quick and cursory empathy, immediately shifting to problem-solving mode.
- Listen silently.
- Effective praise has some or all of the Six Ss: Soon, Spontaneous, Sincere, Specific, Striving and Stand-alone.
- Four interrogation methods to avoid:
- Leading (asking a question as a setup to make your point)
- Fact-checking (asking questions to gather evidence against your child)
- Asking “Why…?” (instead of how or what)
- Asking Yes/No questions
- Dimensions of pressure
- Responsibility and reputation
- The double irony is that most courses at most secondary schools emphasize memorization, and standardized test scores say as much about a family’s means as they do about a student’s aptitude. Yet when corporate CEOs are asked what qualities they look for in a new hire, their answers are things like: curiosity, creativity, initiative, social responsibility, critical thinking, the ability to collaborate and problem-solve, and above all-a lifelong love of learning.
Build: An Unorthodox Guide to Making Things Worth Making, Tony Fadell, 2022.
- Tony suggests company breakpoints at 15-16 people, 40-50 people, 120-140 people, and 350-400 people.
- Method to the marketing:
- Marketing cannot just be figured out at the very end.
- Use marketing to prototype your product narrative.
- The product is the brand.
- Nothing exists in a vacuum.
- The best marketing is just telling the truth.
- Three kinds of CEOs
- Babysitter CEOs – stewards of the company and are focused on keeping it safe and predictable. Most public company CEOs are babysitters
- Parent CEOs – push the company to grow and evolve. They take big risks for larger rewards.
- Incompetent CEOs – usually either simply inexperienced or founders who are ill-suited to lead a company after it reaches a certain size.
Digital Minimalism: Choosing a Focused Life in a Noisy World, Cal Newport, 2019. Dr. Newport also wrote Deep Work: Rules for Focused Success in a Distracted World, 2016.
Making Space, Clutter Free: the last book on decluttering you’ll ever need, Tracy Mccubbin, 2019.
Smarter, Faster, Better: The Secrets of Being Productive in life and Business, Charles Duhigg, 2016.
- To generate motivation – make a choice that puts you in control. Figure out how this task is connected to something you care about.
- To set goals – Choose a stretch goal: an ambition that reflects your biggest aspirations. Then, break that into subgoals and develop SMART objectives.
- To stay focused – envision what will happen. Telling yourself a story about what you expect to occur makes it easier to decide where your focus should go when your plan encounters real life.
- To make better decisions
- Envision multiple futures. By pushing yourself to imagine various possibilities – some of which might be contradictory – you’re better equipped to make wise choices.
- Hone your Bayesian instincts by seeking out different experiences, perspectives, and other people’s ideas.
- To make teams more effective – Manage the how, not the who of teams. Psychological safety emerges when everyone feels like they can speak in roughly equal measure and when teammates show they are sensitive to how each other feel.
- To manage others productively
- Lean and agile management techniques tell us employees work smarter and better when they believe they have more decision-making authoirty and when they believe their colleagues are committed to their success.
- By pushing decision making to whoever is closest to a problem, managers take advantage of everyone’s expertise and unlock innovation.
- A sense of control can fuel motivation, but for that drive to produce insights and solutions, people need to know their suggestions won’t be ignored and that their mistakes won’t be held against them.
- To encourage innovation
- Creativity often emerges by combining old ideas in new ways – and “innovation brokers” are key.
- Recognize that the stress that emerges amid the creative process isn’t a sign everything is falling apart. Rather, creative desperation is often critical: anxiety can be what often pushes us to see old ideas in new ways.
- Remember that the relief accompanying a creative breakthrough can also blind us to alternatives. By forcing ourselves to critique what we’ve already done, by making ourselves look at it from different perspectives, by giving new authority to someone who didn’t have it before, we retain clear eyes.
- To absorb data better – When we encounter new information, we should force ourselves to do something with it. Every choice we make in life is an experiment – the trick is getting ourselves to see the data embedded in those decisions, and then to use it somehow so we learn from it.
The Three Laws of Performance: Rewriting the Future of Your Organization and Your Life, Steve Zaffron and Dave Logan, 2009.
- How people perform correlates to how situations occur to them (leaders have a say, and give others a say, in how situations occur)
- How a situation occurs arises in language (leaders master the conversational environment)
- Future-based language transforms how situations occur to people (leaders listen for the future of their organization)
Democracy May Not Exist, but We’ll Miss It When It’s Gone, Astra Taylor, 2019.
- “Meaningful acts of refusal have come not directly from fear, anger and hysteria, but rather from the clarity and attention that makes organizing possible.”
- “the space of appearance is my ‘ideal audience’ in that it is a place where I’m addressed, understood and challenged – thus providing a known context for what I say and what I hear in this space”
- “how thought and dialogue rely on physical time and space – means that the politics of technology are stubbornly entangled with the politics of public space and of the environment. This knot will only come loose if we start thinking not only about the effects of the attention economy, but also about the ways in which these effects play out across other fields of inequality.”
No Visible Bruises: What We Don’t Know About Domestic Violence Can Kill Us, Rachel Louise Snyder, 2019.
The Voltage Effect: How to Make Good Ideas Great and Great Ideas Scale, John A List, 2022.
Five Vital Signs that will cause voltage drops and prevent an idea from taking off:
- False positives: we thought there was an effect in early pilots, but there really wasn’t.
[Referring to the bandwagon effect] “The leader, who usually is the most passionate, strong-willed person present, tends to talk first and loudest, setting the agenda, dominating the subsequent conversation, and influencing everyone else’s opinions and decisions, either implicitly or explicitly. After all, we tend to want to align ourselves with the person who makes promotion and salary-raise decisions [..]. So when an idea or intervention is vocally championed by a trusted an influential source (who isn’t necessarily an expert and may have their own agenda), it can result in other jumping on board. In cases like these, what seems like an honest consensus is in fact a false positive [..].”
- Overestimating the intervention’s effect: when early adopters are systematically different than the general population, the intervention will perform differently when scaled
- Chef vs ingredients: does the intervention rely on easy-to-scale elements (e.g., ingredients to a recipe) or hard-to-scale elements (e.g., a chef cooking those ingredients)
- Unintended consequences of implementing the proposed intervention
Three basic categories of spillovers:
- General equilibrium effects: occur at scale and lead to unintended consequences that can have large or negative market-wide effects (“tipping point”).
- Social-side behavioral spillovers: occur when other affect your behavior, either through observation or through direct impact. Observing others causes people (consciously or unconsciously) to change their own behavior in ways that can be either positive or negative.
- Network effect spillovers: occur when the use of some product or adoption of some policy amplifies the benefits or costs for all users/adopters.
- The Cost Trap: the intervention costs are too high to implement when delivered at scale
List also outlines four techniques to increase voltage gains:
- Using behavioral-economic incentives (e.g., loss aversion)
- Exploiting easily missed opportunities on the margins
“All decision-making, at its core, involves this type of analysis: weighing what we gain against what we lose.”
- Knowing when to quit in order to win in the long-term
- Designing a high-voltage culture
“On its face, the concept of meritocracy is wonderful. People are rewarded on the basis of talent and effort, and the objective value of ideas determines which of those ideas win out. Privilege – or lack of privilege – and office politics play no role in success. In theoretical economic terms, this means that the brightest and hardest-working people will get ahead. Of course, we all know this is not how things play out in reality. Plenty of smart and hardworking people get passed over for promotions and earn little money, and plenty of not-so-smart and not-so-hardworking people climb the ladder and rake in cash. Meritocracies in workplaces don’t live up to the principles of meritocracies in a vacuum. [..]
When an organization is small, it is by its very nature tight-knit. Much like a family, one can have a heated, even combative debate without doing permanent damage to the relationships because the trust and mutual respect have already been established. Bygones are more easily bygones between people with unconditional mutual trust and respect. However, once you begin to add people whose trust and respect you haven’t earned yet (and vice-versa), you can’t really expect them to feel comfortable in such an environment. Toxicity with newcomers just doesn’t scale well.
[..] “meritocracy” has become a buzzy concept in the business world. But research reveals that an assortment of toxic norms and behaviors tend to grow out of such cultures, including biases that produce race and gender disparities in pay raises, performance scores, and other measures of career success. And in a very unfortunate irony, managers in such organizations are less prone to self-examination and accountability about these biases precisely because they are convinced their meritocracy works! Once again, trust and cooperation evaporate in such cultures, setting up problems at scale.”