Monday, November 27, 2017

Christmas Party shenanigans – let’s fight for the right to paaarty….. and call it a HR-free zone

The Christmas Party is a small, intense pool of chaos in the corporate year, a licence to misbehave, drink too much, say things you otherwise wouldn’t. Only on the surface is it is a celebration of the company and its achievements for the year. In fact, it is the opposite, a Dionysian release from the Kafkaesque restrictions of HR and hierarchy. It is an opportunity to let rip – be in the company but not subject to its rules. The worst possible venue for the Christmas Party is on company premises. What happens at the party stays at the party
The Christmas party has little to do with Christmas. Giving out presents would be bizarre, unless they were weirdly satirical. Carols are replaced by party hits. . This is no time to reflect on moral issues but a one a year chance to be amoral, even immoral, if at midnight you’re still capable of discerning the difference. A sure sign of this is the yearly debate about whether partners should be included – usually a charade that ends in their exclusion. Everyone knows that they are the one’s that would dampen the whole affair and encourage people to leave early just as the real fun begins.
When I was the CEO of a company I had to rescue a lad who had been caught with cocaine by the staff of the venue. I hadn’t even finished my soup! He was spread-eagled against a wall by the bouncers. Solution? I did a deal with the venue manager to use the same venue for the next year’s party if they let him off. We didn’t sack him – this was a party in Brighton, the town, as Keith Waterhouse once famously said, “that looks as though it has been up all night helping the police with their enquiries”. At another there was a discussion the next day on the sauna trip (famously seedy in Brighton) after the Christmas party where nipple rings, piercings and tattoos had been compared. There were always shenanigans and so it should be.
My friend Julian Stodd tells the story of two people being sacked because they posted images of them getting drunk and throwing up at their Christmas Party. The American CEO has got wind of this (why he’d be interested is beyond me) and had taken action, bringing the full force of HR bureaucracy down upon them. This is pathetic. It’s as pathetic as searching through Facebook to find what a potential employee did when they were a teenager. HR has no business being judge and jury, unless something has caused harm to others. The Christmas Party, in particular, is a no-go zone for that sort of bullshit.
Tales of Christmas Parties Past become part of an organisation’s folklore. The planning needs clear execution but everyone knows that the aim is to organise an event that gradually descends into chaos. We have as a species always celebrated through feasts and drinking. Long may it continue in work.

It’s the perfect opportunity to put the middle finger up to company values, not that anyone pays attention to them anyway, especially those idiotic acronyms, where the words have clearly been invented to fit the letters of the word or lists of abstract nouns all starting with the same letter. For example, “ innovation, integrity and i*****… what was that third one again?” People have their own values and HR has no business telling them what their values should be. They’re personal. Most employees will have values and they’ll be leaving your organisation for another at some time, where another set of anodyne words will be put forward as ‘values’. Keep it simple you need only one rule ‘Don’t be a Dick!’.
Back to the party - organisations need this Dionysian, release valve, as it vents frustrations, allows simmering relationships to form, people to show their true selves, not playing the usual office game, conforming to the sham that is corporate behaviour. Wear a stupid hat, dress up, pull a cracker, drink too much – be a little transgressive, be a dick. HR – leave your rules in the office and do the same.

Monday, November 20, 2017

Janesville - a town that explains Trump and also why you shouldn't judge or blame people for being poor

Want to know why working America is pissed and rolling with Trump? Read this book. Told with compassion but realism, through the lives of real people in a real town.

Here's a town that implodes when the car plant closes down and 9000 people lose their jobs. GM was a mess – incompetent management, old models, a company that failed to innovate. As if that wasn’t enough Janesville is hit with Biblical levels of rain (climate change?). Journalism at its best, by a Poulitzer-winning writer, Amy Goldstein, written from the perspective of the people affected. 

For over 100 years they had produced tractors, pick-ups, trucks, artillery shells and cars. Obama came and went, the financial crisis hammered them deeper into the dirt but while the banks were bailed by the state, the state bailed on the people. On top of this a second large, local employer, Parker Pens, outsourced to Mexico but the market for upmarket pens was also dying. The ignominy of being asked to extend your wages by a few weeks to go down to Mexico to train their cheaper labour was downright evil.

Then the adjunct businesses started to fail, the suppliers, trades, shops, restaurants, nurseries – then the mortgage and rent arrears, foreclosures, house prices fall and negative equity. As middle-class jobs disappear, they push down on working class jobs and the poor get even poorer.

Family is more important than GM” this is the line that resonated most with me in the book. In this age of identity politics, most people still see a stable family and their community as their backstops. The left and right have lost focus on this. The community didn’t lie down – they fought for grants, did lots themselves to raise money, help each other – but it was not enough. Grants for retraining were badly targeted, training people for reinvention is difficult with monolithic, manufacturing workforces. Some of it was clearly hopeless, like discredited Learning Style diagnosis, overlong courses of limited relevance to the workplace or practice. Problems included the fact that many couldn’t use computers, so there was huge drop out, more debts and little in the way of workplace learning. Those that did full degrees found that what few jobs there were had been snapped up while they were in college – their wages dropped the most, by nearly half. One thing did surprise me, a curious offshoot that was anti-teacher hostility. People felt let down by a system that doesn’t really seem to work and saw teachers as having great holidays, pensions and healthcare, while they were thrown out of work. Teachers and trainers were perceived as benefitting from their misfortune. The whole separation of educational institutions from workplaces seems odd.

Jobs didn’t materialise. What jobs there were, existed in the public sector – in welfare charities and jails. A start-up provided few jobs, many commuted huge distances to distant factories. Even for those in work, there was a massive squeeze on wages, in some cases a 50% cut, sometimes more. In the end jobs came back but real wages fell. Healthcare starts to become a stretch. But it is the shame of poverty, using food banks, homeless teenagers and a real-life tragedy that unfolds that really shocks you.

The book ends with the divide between the winners and losers. This is the divide that has shattered America. Janesville is the bit of America tourists, along with East and West coast liberals, don’t see. The precariat are good people who are having bad things done to them by a system that shoves money upwards into the pockets of the rich. Looked down upon by Liberals, they are losing faith in politics, employers, the media, even education.

Wisconsin turned Republican and Trump was elected. The economist Mark Blyth attributes the Trump win to their wages squeeze and fall in expectations, even hope. People got a whole lot poorer and don’t see a great future for their kids.

A more relevant piece of work than Hillbilly Elegy, with which it is being compared. Final thought –why are journalists in the UK not doing this? Answer – they’re bubble-wrapped in their cozy London lairs, part of the problem and too lazy to get out and do their jobs… writing the same stories about why they don’t like social media, failing to see that they are the purveyors, not so much of fake new but inauthentic news, irrelevant news, news reduced to reporting on shadows within their own epistemological cave…

Saturday, November 18, 2017

Jared Lanier: Dawn of the New Everything: A Journey Through Virtual Reality

As a fan of VR I was looking forward to this book. Lanier is often touted as the inventor, father or, more realistically, the guy who name up with the phrase ‘Virtual Reality’. I’m not sure that any of this is true, and to be fair, he says as much late in the book. The most curious thing about the book is how uninteresting it is on VR – it’s core subject. Lot’s on the early failed stuff, and endless musings on early tech folk, but little that is truly enlightening about contemporary VR.
My problem is that it’s overwritten. No, let me rephrase that, it’s self indulgently overwritten. I’ve always liked his aper├žus, little insights that make you look at technology from another perspective, such as ‘Digital Maoism’ and ‘Micropayments’ but this is an over-long ramble through an often not very interesting landscape. He has for many years been a gadfly for the big tech companies but the book is written from within that same Silicon Valley bubble. Critical of how Silicon Valley has turned out he's writing for the folk that like this worls and want to feel it's earlypulse.
He finds it difficult to move out of that bubble. I’m with him on the ridiculous Kurweil utopianism but when Lanier moves out into philosophy, or areas such as AI, it’s all a bit hippy dippy. On AI there’s a rather ridiculous attempt at a sort of Platonic dialogue that starts with a category mistake VR = -AI. No – they are two entirely different things, albeit with connections. Although interesting to describe AI as a religion (some truth in this) as it has it has transhuman aspects, it’s a superficially clever comment without any accompanying depth of analysis.

I was disappointed. You Are Not A Gadget was an enlightening book, this is a bit of a shambles.

Sunday, November 12, 2017

7 ways to use AI to massively reduce costs in the NHS

I once met Tony Blair and asked him “Why are you not using technology in learning and health to free it up for everyone, anyplace, anytime?” He replied with an anecdote, “I was in a training centre for the unemployed and did an online module – which I failed. The guy next to me also failed, so I said ‘Don’t worry, it’s OK to fail, you always get another chance…. To which the unemployed man said 'I’m not worried about me failing, I’m unemployed – you’re the Prime Minister!” It was his way of fobbing me off.

Nevertheless, 25 years later, he publishes this solid document on the use of technology in policy, especially education and health. It’s full of sound ideas around raising our game through the current wave of AI technology. It forms the basis for a rethink around policy, even the way policy is formulated, through increased engagement with those who are disaffected and direct democracy. Above all, it offers concrete ideas in education, health and a new social contract with the tech giants to move the UK forward.

In healthcare, given the challenges of a rising and ageing population, the focus should be on increasing productivity in the NHS. To see all solutions in terms of increasing spend is to stumble  blindly onto a never-ending escalator of increasing costs. Increasing spend does not necessarily increase productivity, it can, in some cases, decrease productivity. The one thing that can fit the bill, without inflating the bill, is technology, AI in particular. So how can AI can increase productivity in healthcare:

1. Prevention
2. Presentation
3. Investigation
4. Diagnosis
5. Treatment
6. Care
7. Training

1. Prevention
Personal devices have taken data gathering down to the level of the individual. It wasn’t long ago that we knew far more about our car than our own bodies. Now we can measure signs, critically, across time. Lifestyle changes can have a significant effect on the big killers, heart disease, cancer and diabetes. Nudge devices, providing the individual with data on lifestyle – especially exercise and diet, is now possible. Linked to personal accounts online, personalised prevention could do exactly what Amazon and Netflix do by nudging patients towards desired outcomes. In addition targeted AI-driven advertising campaigns could also have an effect. Public health initiatives should be digital by default.

2. Presentation
Accident and Emergency can quickly turn in to a war zone, especially when General Practice becomes difficult to access. This pushes up costs. The trick is to lower demand and costs at the front end, in General Practice. First, GPs must adopt technology such as email, texting and Skype for selected
patients. There is a double dividend here, as this increases productivity at work, as millions need not take time off work to travel to a clinic, sit in a waiting room and get back home or to work. This is a particular problem for the disabled, mentally ill and those that live far from a surgery. Remote consultation also means less need for expensive real estate – especially in cities. Several components of presentation are now possible online; talking to the patient, visual examination, even high definition images from mobile for dermatological investigation. As personal medical kits become available, more data can be gathered on symptoms and signs. Trials show patients love it and successful services are already being offered in the private sector.

Beyond the simple GP visit, lies a much bigger prize. I worked with Alan Langlands, the CEO of the NHS, the man who implemented NHS Direct. He was adamant that a massive expansion of NHS Direct was needed but commented that they were too risk averse to make that expansion possible. He was right and now that these risks have fallen, and the automation of diagnostic techniques has risen, the time is right for such an expansion. Chatbots, driven by precise, discovery techniques, can start to do what even Doctors can’t, do preliminary diagnosis at any time 24/7, efficiently and in some areas, more accurately, than most Doctors. Progress is being made here, AI already has successes under its belt and progress will accelerate.

3. Investigation
Technology is what speeds up the bulk of investigative techniques; blood tests, urine tests, tissue pathology, reading of scans and other standars tests, have all benefited from technology. In pathology, looking at tissues under a microscope is how most cancer diagnosis takes place. Observer variability will always be a problem but image analysis algorithms are already doing a good job here. Digitising slides, and scans also means the death of distance. Faster and more accurate investigation is now possible. Digital pathology and radiology, using data and machine learning, is the future. If you need convincing further look at this famous test for radiologists.

4. Diagnosis
AI already outperforms Doctors in some areas, matches them in others and it is clear that progress will be rapid in others. Esteva et al. in Nature (2017) describes an AI system trained on a data set of 129,450 clinical images of 2,032 different diseases compared its diagnostic performance to 21 board-certified dermatologists. The AI system classified skin cancer at a level of competence comparable to the dermatologists. This does not means that Doctors will disappear but it does mean they, and other health professionals, will have less workload and be able to focus more on the emotional needs of their patients. Lots of symptoms are relatively undifferentiated, some conditions rare and probability-based reasoning is often beyond that of the brain of the clinician. AI technology, and machine learning, offers a way forward from this natural, rate-limiting step. We must accept that this is the way forward.

5. Treatment
Robot pharmacies already select and package prescriptions. They are safer and more accurate than humans. Wearable technology can provide treatment for many conditions, as can technology provided for the patient at home. Repeat prescriptions and on-going treatment could certainly be better managed by GPs and pharmacists online, further reducing workload and pressure on patients time. Above all patient data could be used for more effective treatment and a vast reduction in waste through over-prescribing.
Treatment in hospitals through automated robots, such as TUG, are already delivering medication, food and test samples, reducing the humdrum tasks that health professionals have to do, day in, day out. Really a self-driving car, it negotiates hospital corridors, even lifts, using lasers and internally built AI maps. The online management of treatement regimes would increase complaince to those regimes and save costs.

6. Care
Health and social care are intertwined. Much attention has been given to robots in social care but it is  AI-driven personalized care plans and decision support for care workers along with more self-care that holds most promise and is already being trialed. AI will help the elderly stay at home longer by providing detailed support. AI also gives support to carers. It may also, through VR and AR, provide some interesting applications in autism, ADHD, PTSD, phobias, frailty and dementia.

7. Medical education
Huge sums are spent on largely inefficient medical training. There are immense amounts of duplication in the design and delivery of courses. AI created content can create high quality, high-retention content in minutes not months (WildFire). Adaptive, personalized learning gets us out of the trap of batched, one size fits all courses. On-demand courses can be delivered and online assessments, now possible with AI-driven digital identification, keystroke tests and automated marking make assessment easier. Healthcare must get out of the ‘hire a room with round tables, a flipchart and PowerPoint (often awful)’ approach to training. The one body that is trying here is HEE with their E-learing For Health initiative. Online learning can truly reduce costs, increase knowledge and skills at a much lower cost.

It is now clear that AI can alleviate clinical workload, speed up doctor-patient interaction, speed up investigation, improve diagnosis and provide cheaper treatment options, as well as lower the cost of medical training. We have a single, public institution, the NHS, where, with some political foresight, a policy around the accelerated research and application of AI in healthcare could help alleviate the growing burden of healthcare. Europe has 7% of the world’s population, 25% of its wealth and 50% of its welfare spending, so simply spending more on labour is not the solution. We need to give more support to healthcare professionals to make them more effective by taking away the mundane sides of their jobs through AI, automation and data analysis.