Sunday, June 20, 2021

Doing More Of What Works

Dear friends – sharing an article from bestselling author James Clear on implementing what is already known. Enjoy!!

In 2004, nine hospitals in Michigan began implementing a new procedure in their intensive care units (I.C.U.). Almost overnight, healthcare professionals were stunned with its success.

Three months after it began, the procedure had cut the infection rate of I.C.U. patients by sixty-six percent. Within 18 months, this one method had saved 75 million dollars in healthcare expenses. Best of all, this single intervention saved the lives of more than 1,500 people in just a year and a half. The strategy was immediately published in a blockbuster paper for the New England Journal of Medicine.

This medical miracle was also simpler that you could ever imagine. It was a checklist.


The Power of Never Skipping Steps

The checklist strategy implemented at Michigan hospitals was named the Keystone ICU Project. It was led by a physician named Peter Pronovost and later popularized by writer Atul Gawande.

In Gawande's best-selling book, The Checklist Manifesto he describes how Pronovost's simple checklist could drive such dramatic results. In the following quote, Gawande explains one of the checklists that was used to reduce the risk of infection when installing a central line in a patient (a relatively common procedure).

On a sheet of plain paper, [Pronovost] plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check.

These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

This five-step checklist was the simple solution that Michigan hospitals used to save 1,500 lives. Think about that for a moment. There were no technical innovations. There were no pharmaceutical discoveries or cutting-edge procedures. The physicians just stopped skipping steps. They implemented the answers they already had on a more consistent basis.

New Solutions vs. Old Solutions

We have a tendency to undervalue answers that we have already discovered. We underutilize old solutions—even if they are best practices—because they seem like something we have already considered.

Here’s the problem: “Everybody already knows that” is very different from “Everybody already does that.” Just because a solution is known doesn’t mean it is utilized.

Even more critical, just because a solution is implemented occasionally, doesn't mean it is implemented consistently. Every physician knew the five steps on Peter Pronovost's checklist, but very few did all five steps flawlessly each time. We assume that new solutions are needed if we want to make real progress, but that isn't always the case.

Use What You Already Have

This pattern is just as present in our personal lives as it is in corporations and governments. We waste the resources and ideas at our fingertips because they don’t seem new and exciting.

There are many examples of behaviors, big and small, that have the opportunity to drive progress in our lives if we just did them with more consistency. Flossing every day. Never missing workouts. Performing fundamental business tasks each day, not just when you have time. Apologizing more often. Writing Thank You notes each week.

Of course, these answers are boring. Mastering the fundamentals isn’t sexy, but it works. No matter what task you are working on, there is a simple checklist of steps that you can follow right now—basic fundamentals that you have known about for years—that can immediately yield results if you just practice them more consistently.

Progress often hides behind boring solutions and underused insights. You don’t need more information. You don’t need a better strategy. You just need to do more of what already works.


Source –

Friday, June 4, 2021

The King and his monkey

Sharing a short story this week, enjoy!!

Once upon a time there was a king. Like all kings he was great, powerful and whimsical. He had a pet monkey. His favourite. He was with the king at all times, the king used to enjoy the antics of the monkey and keep himself entertained. Everyone knew about the special position of the monkey in the king’s heart and the monkey basked in his masters attention and the privilege of being the special one.

One day, after a scrumptious lunch, it was nap time for the king. However there was a little problem - a fly. Every time the king started snoozing, the fly would come and sit on the kings nose disturbing his siesta. The fly was very persistent, this happened many times. The king was very irritated. The monkey was even more irritated and decided to teach the fly a lesson. The next time the fly came and sat on the kings face, the monkey hit it with a sword with all his might. End of story, for the king. For us, there are some lessons from this tragic story.

Every king has a monkey. As long as it is for entertainment, it is cool.

Problems arise when the monkey and those around him start taking the monkeys seriously.

Small problems can be ignored if monkeys are not around.

Monkeys with power lead to tragedies, sooner or later.

For all the kings, identify the monkeys and keep them in check.

For all the monkeys, stick to your natural talent of keeping your masters entertained and don’t take yourself too seriously.

For the others – if you see a king and the monkey together, don’t hesitate to tell the king, if you really love him and want him to be around.

You see, even the best intentions can lead to tragic outcomes.       

Take care, stay safe and enjoy your weekend.

Personal Finance 101

If you have the means to comfortably retire today, well done, this may not be for you. For the other mortals who have some time to go before that happens, read on, there may be some tips that you may find useful.

There are 2 ways to plan for your finances

1 - Bad things happen to other people.

2 - Expect the best but prepare for the worst.

This is for those in camp 2. For those in camp 1 – my best wishes!!

Term Life Insurance is absolutely necessary –

The insurance value should cover your current/ near future loans +5 or 10 years of loss of income. For those of us who live in a metropolis and had the courage to buy a home on loan, this may mean a life cover of 5 cr or more. Good thing is you can discontinue the coverage once the loans have been paid off and one has a retirement egg. It is best not to mix investment and insurance, so plans that mix the both can generally be avoided. Add ons of critical illness and permanent disability should also be taken. Think of it as planning for the untimely in a timely way. The earlier you start the better.

Medical Insurance is absolutely necessary too –

The insurance from your employer does not qualify, sorry. While it is good to have esp if you have co-morbid parents, it may not be available when you need it the most since your company may have different thoughts in the next crisis. So take medical insurance independent of your employer. Amount is also important – 25/50 lcs or higher. While I hope none of us will need to use it, it is an absolute must have. Earlier the better. 

Have liquidity in hand –

3/6 month expenses should be readily available. One can substitute this with credit card limits as well.  Be mindful that banks can also unilaterally reduce your limits when you need them the most.

Savings and investments –

Step 1 is savings. This should be a % of your total income and not some fixed absolute amount. Higher the better. Anything below 20% of your post EMI income is insufficient. Only home loan EMI’s count – depreciating assets and EMI’s for holidays etc don’t. Consistency is critical.

Step 2 is investing that saving. Take advise from someone you can trust, educate yourself and invest what you can understand and are comfortable with. Don’t get too comfortable though – it comes in the way of growth. Equities are absolutely essential if you want to save for retirement and have 20 years or more to get there. Earlier the better here too.

Risk Management –

Don’t try to get rich quickly. It’s a trap.

If it’s too good to be true, it generally isn’t.

Always think about the motive of your counter party. If it is clear, then good. It will help you make better decisions.

Verify the background of the advisor and speak with some of their clients before taking and implementing advise.

Keep a margin of error. Larger the better.

Concentration creates wealth. Diversification protects wealth.

There are many ways to get rich. There are only few ways to lose it – greed, leverage, ignoring risks, copying others without understanding what they are doing and (generally) bad financial decisions.  

Involve your partner –

Keep your partner updated on financial matters. At least once a year, make a balance sheet to list all assets and liabilities with details of bank accounts/fund statements/policy nos. If you owe someone some money or vice versa, your partner should know. Keep your policy documents and statements of investments secured and let your partner know. Create nominees and have joint accounts.

Keep your advisors close –

Advisors are very important – for your major life, career and financial decisions. Once you find people who really care about you, keep them close. People will make mistakes and not all decisions will turn out well, that is part of life. As long as it is not life threatening and an act of commission, it is ok. They will be around to hand hold your family in your absence.      

Give back –

It may be time, your attention, your money, a good advise or just a shoulder to cry on – pay it forward.

Invest in yourself –

Some of us are uncomfortable to manage money. It is important skill to work on it and can be acquired, just like you may work on your fear of water and inability to swim or your public speaking skills. As we upgrade our lifestyles as we progress through our careers, we need to upgrade ourselves too. Also take good care of your health, it is the best investment you would possibly make. 

Your financial plan is as unique as your DNA so there are no rules that apply to all. A principles based approach works best – understand the rules and apply the same to your situation. Why start with financial advise and end with advise on life? Because better finances lead to better lives, not vice versa. Please take good care and stay safe.