"Considerably Higher Costs" Indeed

June 23, 2009 at 6:13 pm | Posted in Attention Management, communication, email, Information Work | Leave a comment

I recently posted a set of ideas for improving e-mail from the point of view of enterprise attention management.  It listed 15 ideas that would help e-mail users (which is pretty much everybody these days) to allocate their attention more efficiently to their daily tasks, whether that means more attention to some e-mails or less.

One of the items I listed on was this:

Remind sender if no reply

Avoid “dropping the ball” with e-mails by adding a simple checkbox indicating if an e-mail being sent should alert the sender if no reply is received within a given time (like 3 days). Too often post mortems indicate that a message was never replied to, the sender forgot about it (“fire and forget”), and the task was therefore left in limbo.

I cannot overstate the importance of closing the loop on communications between senders and receivers.  Especially when you combine important messages with “weak” connections (meaning they are unlikely to speak often and are unlikely to have other chances to reiterate the information and check up to see if a message was delivered).  Getting medical test results fits this pattern to a tee.  In fact, when I added this item as one of the 15 ideas, I did so knowing that it had a very personal connection to my life.  Today’s WSJ described why (6/23/09, pD4, “Make Sure You Get Test Results”).  I can’t find the exact article online, but here’s a summary from the USA Today:

No news isn’t necessarily good news for patients waiting for the results of medical tests. The first study of its kind finds doctors failed to inform patients of abnormal cancer screenings and other test results 1 out of 14 times.

The failure rate was higher at some doctors’ offices, as high as 26% at one office. Few medical practices had explicit methods for how to tell patients, leaving each doctor to come up with a system. In some offices, patients were told if they didn’t hear anything, they could assume their test results were normal.

… “If bad things happen to patients that could have been prevented, that will lead to higher costs and in some cases considerably higher costs,” Casalino said.

I can vouch for “considerably higher costs.” At the risk of being overly personal or melodramatic, the issue mentioned in the study was the primary likely contributor of the death of an immediate family member of mine last year.  When the “fire and forget” mechanism I describe involves a communication from a lab to a physician, that message can be important indeed.  In the case I mention, a message indicating a negative result and recommending more tests was sent, but the recipient claimed to have not gotten the message.  By the time the proper tests were run a few years later, the condition had progressed from highly curable (85% chance of survival past 5 years) to terminal (15% chance).

The “confirmed delivery” features of e-mail programs may be of some assistance, although in my experience recipients often do not acknowledge receipt and I’m not sure how consistent implementation is between e-mail systems.  Besides, what I’m recommending is the opposite – a “delivery wasn’t confirmed” response.  In cases like those described in the cancer screening study, “fire and forget” messaging can have very serious consequences.


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