Physicians

Regression to the Mean

You may have heard about the Sports Illustrated Effect, the notion that people who appear on the cover of the magazine are likely to experience bad luck, failure, or a career spiral.

Over the 30 years of my own professional life, I’ve watched many colleagues become famous, receive significant publicity, then fail to live up to the impossible expectations implied by their fame. They regress to the mean. Nature seems to favor symmetry. Things that rise slowly tend to decline slowly. Things that rise rapidly tend to drop rapidly.

Fame is usually a consequence (good or bad) of invention, innovation and accomplishment. Fame itself is generally not what motivates a person to accomplish their feats. An Olympic athlete is usually inspired because of a highly competitive spirit. An inventor is usually inspired because he/she believes there is a better way. Fame that is the consequence of a feat can affect future behavior. It can become an intoxicant and motivate someone to strive for accomplishments that keep the fame coming.

I’ve thought about my own brushes with fame.

When I was 18 and started at Stanford, I realized that my scholarships would only cover the first year of tuition. I visited the Stanford Law library, read the US tax code and wrote software for the Kaypro, Osborne 1, and CP/M computers that calculated taxes. The software shipping from my dorm room generated enough income to start a small company. When the PC was introduced, we were the first to provide such software to small businesses seeking to compute their tax obligations. By the time I was 19, I moved into the home of Frederick Terman, former Provost of Stanford, and the professor who first encouraged William Hewlett and David Packard to build audio oscillators and form a new company called HP. The story of a 19 year old running a software company and living in the basement of founder of HP was newsworthy at the time. I did interviews with Dan Rather, Larry King, and NHK TV Japan.

The company grew during my medical and graduate school years, but as technology evolved it did not innovate to take advantage of new platforms, graphical user interfaces, or emerging networks. I sold the company when I began my residency. It eventually closed.

By the time it closed, I was learning to build clinical systems and worked during residency to develop a hospital-wide knowledge base for policies/ procedures/protocols, an on-line medical record, a quality control system, and several systems for medical education. I achieved local fame when the County of Los Angeles voted me the County Employee of the Month, the first time it was given to a physician.

I left residency and began practice at Beth Israel Hospital while doing post doctoral work at MIT, writing a thesis about using the web to securely exchange medical records. In 1997, using the web was considered risky, unreliable, and insecure, but the recent merger of Beth Israel and Deaconess needed a quick win, so “CareWeb” was born. I became CIO.

In 1999, Dr. Tom Delbanco and others had the idea that patients should be able to access their own records electronically. My team created Patientsite. We were credited with inventing one of the first personal health records.

And the list goes on – the 2002 network outage, early regional healthcare information exchange, harmonizing standards, creating a private cloud for health care records, and achieving hospital certification in the meaningful use process.

The interesting conclusion of all of this is that in every case, the fame was temporary, and very soon followed by regression to the mean – a stellar performance or innovation became typical/average/mundane.

It’s nearly impossible to remain at the front of the race forever -eventually someone stronger, faster, or more nimble will displace you.

In my case, I stopped thinking about my own reputation and fame about 1998, recognizing that every episode of fame is followed by a decline into anonymity – the Sports Illustrated effect. What’s lasting are great organizations and teams that are constantly reinventing themselves – changing the race they are running.

Steve Jobs said “we’re as good as our last product” and he’s right.

If you focus on creating great organizations, which consistently achieve discrete episodes of fame but continuously innovate so that those episodes of rise and fall actually look like a continuous series of peaks, then you can beat regression to the mean.

The organizations in which I work will last for generations. Their reputations transcend anything I will ever do personally. My role is to champion, support, and publicize a few key innovations every year that will keep the organizations highly visible. That visibility will attract smart people and retain the best employees who want to work for a place on a rising trajectory. If I can transform the rise of fame and regression to the mean into a trend that feels like one organizational strength after another, I’ll declare victory.

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What is the SI Regression Level? | Race AdvisorBobbyGThe Regular Cycle « Lebs295's BlogDavid H. Recent comment authors
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[…] want to predict the performance for and then you would add this figure to the SI Regression Level.This shows the level of regression for todays race and can be a strong indicator of the level of per…a similar distance (the same as the RA Graphs). This is NOT necessary to know to use the figures but […]

BobbyG
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Regression to the mean, in addition to the “S.I. effect,”, also known as The Oscar Curse.

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[…] Regression to the Mean (thehealthcareblog.com) […]

David H.
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I agree that it may be impossible for the “famous” to live up to standards imposed upon them by others (or themselves). But I think also they may see this success as something that they can never improve upon, and thus feel a little depressed (and get “mean”) because they think their life has hit a climax and it’s only downhill from there. I’ve seen this one too many times. Mostly it’s a problem of people believing their own “press.” I also have to say, you have a 30 year career already? You, John, look way too young to have… Read more »