Wednesday, November 11, 2009

Signal-to-noise ratio

Ever heard the term "Signal-to-noise" ratio?

It's basically an engineering term. It compares the amount of background noise, with the amount of "signal" coming through the noise.

If you've ever seen a car approaching on a foggy day, you've seen the car (signal) through the fog (noise).

Another great example of this phenomenon : The old analog car radio, where you would turn the dial to hear static, until you came upon a "signal" that sounded like normal music/speech - At which point you stopped turning the dial.

I'm writing about this phenomenon because it's starting to affect healthcare.

Ever heard the phrase, "Why don't the doctors read their mail?"

How about "I've tried posters, mails, letters, and lectures - Why is it so hard to train our doctors?"

Here's the reason we docs have a hard time reading mail : EVERYONE WANTS TO TELL A DOCTOR SOMETHING.
  1. I check my physical mailbox about once a week - Even though I try to clean it out, it's generally full every time I return.
  2. I check my email box several times a day - Again, even though I try to read it all, it's generally full with messages every time I return.
I've noticed some administrators struggling with the same difficulty : Imagine if every day you received over a hundred emails - How would you figure out "which is important"?

This is why some people in healthcare have noticed the phenomenon of "things change when someone gets upset enough" - An upset patient, administrator, physician, nurse, or pharmacist is a "signal" trying to get through the "noise".

As the noise level increases, the signals get lost, and eventually :
  • Administrators start to feel, "My clinical staff isn't listening to me."
  • Clinical staff starts to feel, "My administration isn't listening to me."
Eventually, problems that become severe enough, will generate enough signal to get through the noise.

If you want to have a less chaotic environment, it helps to consider this phenomenon - Every extra email and paper mail that goes out only worsens the noise.

And it seems with the amount of people who have something to say about healthcare (regulatory agencies, insurance companies, vendors, outside practices, etc.), the noise level in healthcare seems to just keep getting worse. So the signals have to get louder and louder to get through.

My advice : Think twice before you carbon-copy someone on an email. Do they really need it? Can you wait until later in the discussion to send them a copy?

If we all use our communications a little more sparingly, we'll help make sure that we hear the weaker signals before they become larger signals.

1 comment:

Majkul said...

I hear you loud and clear. I think it really speaks to change management. If a system considers itself to be in constant flux, it will feel the need to communicate changes and instabilities to all members very frequently. (we are changing this today, and tomorrow we will be using form X, the day after we will trial process z etc...) A well planed system, I think, knows how to meter and dose change. In this way the frequency of needing-to-distribute-information is reduced. The less communication the more valued those communications become: Change and communication of that change on a predictable and metered cycle. (also, could you put perma-links for each post? :-) )