What’s knowable and actionable: lessons from medicine

Finding what matters

The U.S. Preventive Services Task Force is a group of scientists and physicians given the formidable responsibility of sorting through the wide array of tests available for major diseases and deciding which should be part of the national standard of care. These are weighty decisions, because in the world’s most expensive health system insurers are required to pay for those tests the group deems beneficial.1 Fine-tuning when to recommend diagnostic screenings is especially fraught, as getting these decisions wrong leads to unnecessary, costly, and painful medical interventions. Conversely getting them right can help catch disease earlier when treatment is more effective, giving patients greater quality of life.

This group’s decisions often hinge on what is known as clinical significance: if knowing something makes zero difference for a therapeutic approach or is as likely to cause harm as benefit, then it is not worth investing resources to get that data. For instance DNA tests can fall into this category, as the impact of certain genes is currently unknown. For those possessing some unusual variant, finding that out would engender agita but not much else. 

The task force’s recommendations are most well-known in the area of routine cancer screening, as its age cutoffs for various tests tend to become norms across the United States. But why not just test more people earlier, just to be sure? In many cases this checking costs time and scarce resources without yielding actionable insights. Slow-growing cancers that will almost certainly remain contained until the patient dies of another cause, chest pains that don’t indicate an imminent heart attack, elevated concentrations of some blood marker that don’t correlate to any specific outcome—all of these have proven that discovering something is often worse than blissful ignorance. Knowing the wrong thing can be very costly when it sends patients and their providers on unpleasant and invasive diagnostic odysseys.

The real value then, comes from identifying what information would change an action were it to be known, and determining precise ways to get it.

Making the knowable known

The principle extends far beyond medicine. Companies have unlocked significant value by finding actionable information and building robust businesses around them. Several of the unicorns prancing around Silicon Valley and changing the very nature of the economy2 are based on this concept. The information they utilize was theoretically knowable, but until they came along no one had figured out a seamless way to acquire it. For example:

• You needed transportation and someone else had an empty seat in their vehicle nearby. For the first time GPS-enabled phones allowed both to know these facts instantly. There was no real-time way for the average person to make the match until Uber and later Lyft arrived. The same principle was at work for those with spare rooms, as with Airbnb.
• Prospective property buyers and sellers needed a good way to understand the underlying economics of a market, with price histories, tax records, and transaction data. Instead of traipsing down to the county office and waiting for a disempowered clerk to dig up the file boxes, real estate aggregators assembled this information and put it all online, drastically improving the position of the average consumer.3
• Hungry office workers tethered to their desks wanted to know which restaurants could deliver them a meal, but had to laboriously find contact information and menus for each one in a given area before giving up and selecting dinner from the break room vending machine. The advent of meal delivery (and later grocery delivery sites) opened up a world of previously limited culinary options.

The public sector is also getting in on making more things known, with open data portals publishing all manner of government records, from employee salaries to school test results. Mass transit systems track and publish the status of their vehicles, allowing riders to time their trips with precision. Public insurers release health claims data, allowing interested parties to determine exactly what the longer term benefits of various interventions might be.

Big data to big action

The proliferation of data sources and the falling prices of storage have together birthed the notion of big data. An airliner can generate hundreds of gigabytes of sensor readings per engine on a single flight. Sensors in phones track every step you take and continuously plot your location for years on end, if you let them. Managers of websites can track every visitors’ click, IP address, and referral source.

But as with medicine, just knowing something isn’t useful on its own unless it leads to more helpful decisions.

The crucial element is not acquiring these various facts, but knowing what to do with them. Separating the insignificant, the irrelevant, and the distracting from the few kernels that lead to insight will be a prime responsibility of leaders, just as physicians have to separate the incidentalomas4 from the tumors that warrant closer inspection.

Organizations can stake out new and more powerful positions by growing the upper left quadrant, and they can stay there by operating in the top right. They focus their efforts by ignoring the bottom half.

Focusing on action isn’t just a macro concept. The next time you’re in a meeting, or reading an email, or listening to a presentation, consider how the information gained will change something you do next. If the answer is not at all, perhaps rethink why that exchange was needed. Writ large, such interactions add up to an organization burning energy on things that don’t influence behaviors.

Keep in mind that despite one’s best efforts some things will remain unknowable, at least given current technologies. For instance long-term weather patterns in a specific city or the track of next year’s typhoons are speculative. This leads to people who both believe that Miami will eventually be inundated by the Atlantic and real estate developers whose profitability hinges on filling up another glass-and-steel tower. Figuring out the truth will ultimately create or destroy value somewhere, but until then both sides are placing their bets.

As doctors add value by focusing on diagnostics that change treatment paths, leaders add value by discovering things that can be acted on. Value remains to be created by those who increase the overlap between what we know and what we need to act, and there is greater opportunity still for those who can extend the frontiers of what’s knowable.

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References

Further background on diagnostic significance from The Atlantic and the always-interesting Atul Gawande in the New Yorker.