Management vs Money – which is more important?

Montmartre
John Althouse Cohen, 2005

This is an age old problem for the company starting out (or indeed growing rapidly). Obviously a complete lack of top-notch people or abject poverty are both unlikely to lead to success.

But where should your focus be?

This recent piece from Startup Professionals Musing comes down pretty firmly on the people side of the argument. Even with all the caveats about being a US review of investing, the broad findings are valid here in the UK as anywhere else.

With that in mind what can you do?

Well you should get out and meet people that will either be those high quality people, or know them and can introduce you. Make yourself known to the local University incubator teams, go along to your local Open Coffee such as <shameless self-promotion>Open Coffee Bristol</ss-p>, try searching Google for <your town> entrepreneur / startup / etc.

Or go to one of the events specifically put on to help bring growing companies together with exactly the right kind of people to help the do even better.

One such event is the Angel News ‘Pitching for Management not Money’. <Disclosure; I promised Modwenna I’d help promote the event but there’s no financial return to me, and the tickets for this first event are free anyway!> The first of these events outside London (in partnership with Intramezzo and Boulevard) is taking place on Monday 28 Sept at the Smith & Williamson offices in Bristol. Sponsorship from Burges Salmon and Business Link means the tickets for both businesses and prospective executives are free.

If you’re not already registered with Angel News there are a couple of links below to sign up for this event, hope to see you there.
http://www.designcity.co.uk/invites/p4mnm_280910_comp_bris.html
http://www.designcity.co.uk/invites/p4mnm_280910_aud_bris.html

Improv concerts & what social media can learn from them

Yesterday evening I attended the live premier of a BBC Concert Orchestra & Festival of Nature commissioned concert. (Disclosure: Science City Bristol are sponsoring the Science Cafes @ Festival of Nature, but I’ve not been involved in this concert, other than attending.)

The performance was in two halves; a short sequence of clips from the BBC Natural History Unit with the orchestra playing live, short chat with Q&A and then a repeat performance. Why two performances, and what’s it got to do with social media?

Well, the orchestra wasn’t the full BBC Concert Orchestra, 5 members of the orchestra and a composer were joined by 24 young people from schools across Bristol. They met for the first time on Tues, worked for 3.5 days and gave the performance on the Friday. They hadn’t seen the film clips beforehand, and they hadn’t played as an orchestra before. They also didn’t have any written musical score at the performance; it was all played from memory and partly improvised. And it sounded fantastic, both times!

December 28, 2009 by manning999

The key came during the Q&A. When they first watched the film and asked the young people about the music to go with it, there were lots of suggestions about a cymbal crash here, some flute there, and so on. Lots of focus on the individual instruments and notes, but no ‘bigger picture’. The first thing the composer and the BBC Concert Orchestra’s Learning Team did was to re-view the films and talk about that bigger picture, the emotions they evoked or wanted to bring out, the sense of majesty (Humpback Whales) or playfulness (Giant Otters).

Once they had those broad messages and the overall framework of the pieces, then they began to experiment with chord sequences and harmonies. By all accounts it was a very egalitarian approach with ideas being voted on, and continuous refinement selecting or disposing of small parts that worked or didn’t.

In the final performance, most of the music was played from memory, but there were still flashes of inspiration by individual orchestra members, and because they’d gone through that development process and the ground rules were clearly laid out, those individual flourishes could be included without grandstanding or throwing everyone else into confusion. They were all listening intently to each other throughout the performance, as well as having great fun.

You can see the whole thing (well a recording of the concert mixed with the films) on the BBC Big Screen in Millennium Square as part of the Festival of Nature (12-13 June 2010).

Business as music

The parallels with some types of business are quite striking. They had a CEO that was clearly in control, and he empowered this team to do what they do best. They worked on a shared vision and understanding of the broad task at hand, and willingly contributed ideas to other sections if it made the overall performance better. In the actual performance they were working to agreed boundaries but within those boundaries there was freedom to do what was best at that particular instant in time.

Social media as music

Too often people talk about social media in the same way as the young people first approached the films. We could use twitter to send out little updates, and that would link to our Facebook page, and we can pull in our blog rss, and mash up with a Google map, and…

Twitter is not a Strategy

There needs to be a bigger picture. Even if all you’re doing it trying out these tools to see how they work for you or your business, you need to have some thought as the purpose. You also have to have some thought as to the socially acceptable way of doing things. The musical rules that the BBC used were a based on a heptatonic scale, rather than the pentatonic scale. Neither is right or wrong, but you can’t do both at once (at not without calling it ‘experimental’). 🙂

There’s nothing wrong with breaking a few rules, that’s almost the definition of being a stand-out excellent entrepreneur / artist / individual. But you really need to know which rules you’re breaking and to what purpose.

Of course, with social media the rules aren’t quite the same as in other forms of social interaction, and as new tools come along they can mutate. Fortunately one of the rules that has completely reversed is lurking, allowing you to observe behaviour before you dive in.

Once you have that bigger purpose, knowing what the rules of participation are, then you can choose which tools / instruments will deliver the required performance.

Plans are worthless. Planning is essential. – Winston Churchill, Dwight D. Eisenhower, & many others

And of course things won’t go according to plan, but that’s where having the clear shared sense of purpose means that people can act without having to fight through layers of bureaucracy. And they can act honestly as human beings rather than PR spin-doctors or script-reading robots.

What’s your social media strategy? Listen, plan, listen, act, repeat; or deliver a stream of ‘messages’ across all channels in a blitzkrieg approach?

Social Media Systems (3)

(Update – Swapped Sam’s live UStream with Michael’s recorded YouTube)
This is an expansion on my Brrism talk on Systems Theory and how it can be applied to social media (systems).

If you’re interested in the history of systems theory, General Systems Theory, Bertalanffy, et al, then my previous post touched on that, plus there are good wikipedia pages to read (linked to in this sentence). The first article concentrated on the overview, the next article introduces the Soft Systems approach and I’ll conclude this mini-series with this example application.

But what is it good for?

Over the 30 minutes or so after my talk at Brrism, we worked mainly on the systems description using the CATWOE acronym. As with all systems descriptions and discussions, there were several views, forcefully put.

However, by the end of the very short session we’d arrived at a pretty good consensus opinion. There’s still some work to be done refining the description and it needs to be circulated widely within the Brrism community to gather feedback.

For me the breakthrough came when we agreed that the fundamental transformation that Brrism brings about is multiple ideas / perspectives into calls for collective action. That took quite a bit of work as we didn’t think that Brrism itself was about lobbying for social change, or making B2B connections, or promoting ‘best practice’; however the Brrism community might well do a bit of that after meeting and exchanging ideas!

The next task will be to convert the CATWOE into some rich pictures; but that’s for another day.

If you’re interested in what was actually said in my talk, the video is up on Facebook (sorry, not on an embeddable site, will have to talk to Michael about that). Sam Downie (@samdownie) was streaming on UStream and the slides are on Slideshare.

Social Media Systems (2)

(Update – swapped Sam’s live UStream with Michael’s recorded YouTube)
This is an expansion on my Brrism talk on Systems Theory and how it can be applied to social media (systems).

If you’re interested in the history of systems theory, General Systems Theory, Bertalanffy, et al, then my previous post touched on that, plus there are good wikipedia pages to read (linked to in this sentence). The first article in this mini-series concentrated on the overview, this article will introduce to a particular systems approach and I’ll conclude this mini-series with an example application.

Soft Systems

Humans are particularly complex systems, free will, determinism, etc mean we need some modifications to the above general approach to describing a system that specifically includes humans. This is where Peter Checkland comes in. He was a chemical engineer who realised that many of his industrial chemical systems weren’t behaving as designed, not because the design of the engineering processes were wrong, but because of the people in the system. Unlike previous engineers, who tried to design people out of their systems, Checkland tried to understand how people influenced and interacted as part of the systems. And thus, Soft System as an analytical methodology was born.

Open University, module T552

The first thing that Checkland realised was that the very neat, formal diagrams that were generally used in systems analysis didn’t allow for the messy human element. Rich Pictures are an approach that describes the system with the human elements included.

Rich pictures have the same basic features of any systems diagram (boundary, components, inputs, outputs, transformations, environment) but with some additions.

The first addition is that of Actors, not a wandering group of minstrels, but the people within the system. You can give them names, but its usually helpful to use functional descriptions. The second addition are Clients, the people that benefit from the system. Of course the clients may in large part be the actors, but usually there is a specific group of people that are beneficiaries that aren’t part of the system.

The third addition is that of the Owner. This is often an individual but could be a group, organisation, but is whatever has the authority to abolish or fundamentally change the system. Most online social systems make substantial use of free (as in beer) software, and thus have at least two owner groups; the people that set them up and run/coordinate and the people that provide the free online resources.

The final major addition needed for a rich picture is a description of the perspective being adopted by the people drawing the rich picture itself. Checkland referred to this as Weltanschauung (World View). Is the social system about generating shareholder value, individual self-actualisation, mutual support, environmental salvation…

The role of the Environment in soft systems is more important than just “stuff that’s outside the boundary”. What’s going on in the environment can directly impact the system. A good example might be the launch of annotations for twitter; we don’t know how the new feature will impact the various social systems using twitter, but it probably will.

All of which gives rise to the slightly clumsy acronym: CATWOE (Clients, Actors, Transformations, Weltanschauung, Owner, Environment).

But what is it good for? More >>

If you’re interested in what was actually said in my talk, the video is up on Facebook (sorry, not on an embeddable site, will have to talk to Michael about that). Sam Downie (@samdownie) was streaming on UStream and the slides are on Slideshare.

Social Media Systems (1)

(Update – swapped Sam’s live UStream embed for Michael’s recorded YouTube embed)
This is an expansion on my Brrism talk on Systems Theory and how it can be applied to social media (systems).

There are a couple of benefits of using something like systems theory when designing a social media system, plus a couple of drawbacks. Perhaps most importantly, it helps with the big picture before worrying about API calls, jscript vs php, etc. The main drawback is that is won’t tell you how to make your social media system actually grow and thrive.

If you’re interested in the history of systems theory, General Systems Theory, Bertalanffy, et al, then my previous post touched on that, plus there are good wikipedia pages to read (linked to in this sentence). This article will concentrate on the overview, the next article will introduce to a particular systems approach and I’ll conclude this mini-series with an example application.

What is a System?

The word ‘system’ has become somewhat diluted and it’s meaning confused. However, systems are relatively easy to spot and describe.

Patrick Coin, Feb 1996

Firstly a system has components. A ruler is not a measurement system, it’s just a straight bit of metal or plastic with some marks on it. A feather is not a flight system, it’s very well adapted to direct airflow, perhaps with display markings, certainly helps with insulation, but it’s not a system.

All those components are contained within a boundary. Sometimes that boundary is fairly obvious, like the Yellow-Bellied Sap-Sucker. Sometimes the boundaries are more arbitrary, this website might be considered a system but there’s no physical boundary. Ultimately, the boundary is where you want it to be, but should be relevant to the system you’re looking at. But remember, the wider the system the more complex, too tight and you might not have a system at all!

There is a theoretical construct called the closed system, in reality all systems are open. This means there are inputs and outputs that cross the boundary. What this stuff is that crosses the boundary will depend on the system. You might have information, raw materials, written articles, even abstract concepts like trust. The point is that stuff crosses the boundary and you can describe it.

There is an important caveat to all this stuff crossing the boundary, there has to be a transformation between the input and output. Otherwise you’ve got a pipe! A pipe is not a system.

A communications system is a system because although part of the input (your message) is hopefully the same as the output (your message), there is a pile of associated data about the sender and receiver that is transformed in moving your message to your recipient. There are also internal transformations of the input message through encoders, compressions algorithms, decoders, etc.

Systems are also in a hierarchy of systems that form their environment. My little Sap-Sucker lives in the rainforest that is its ecosystem, that is part of a wider global system, and so on. It also has a digestive system, neural system, and so on down the scale. Systems within systems.

And lastly, but most importantly, systems display something called emergent properties. In social systems this is the law of unintended consequences. Behaviours that arise from the interaction between all the components and sub-systems, variations in inputs, changes in the environment. The point being that you can’t define them all when you analyse the system.

So far, so mechanistic. How do we apply this to social media? More >>

If you’re interested in what was actually said in my talk, the video is up on Facebook (sorry, not on an embeddable site, will have to talk to Michael about that). Sam Downie (@samdownie) was streaming on UStream and the slides are on Slideshare.

The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardised clinical cases

I have recently submitted a thesis for a masters of philosphy, entitled: The Design and Validation of assessment tools for use with Junior Doctors in Applying Clinical Pharmacology.  Part of this work has been written up and will be published in the next edition (June 2010) of the peer reviewed academic journal British Journal of Clinical Pharmacology.

Entitled: The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardised clinical cases. This paper builds on the fact that safe prescribing is a core competency in undergraduate medical education. That a large proportion of undergraduate medical students and recently graduated doctors in the UK are not confident in their ability to effectively and safely prescribe and that errors are common in all healthcare settings and prescribing errors are the most common type.

This study produced twelve valid and statistically reliable assessments of Clinical Pharmacology and Therapeutics (CPT) knowledge and prescribing skills in areas that pose a high risk to patient safety. The findings show that a large proportion of Foundation Year 1 (FY1) doctors fail to demonstrate the level of CPT knowledge and prescribing ability judged by a subject matter expert (SME) panel to be required at this stage of their careers. My co-authors (Prof Nicky Britten & Dr David Bristow) suggest strategies and areas where teaching can be focused to improve the safety and effectiveness of FY1 doctors’ prescribing.

If this is an area of interest then below is the abstract related to the article and a link to the journal.

*************************************

Aims

Recent studies suggest a worryingly high proportion of final year medical students and new doctors feel unprepared for effective and safe prescribing.  Little research has been undertaken on UK junior doctors to see if these perceptions translate into unsafe prescribing practice.  We aimed to measure the performance of foundation year 1 (FY1) doctors in applying clinical pharmacology and therapeutics (CPT) knowledge and prescribing skills using standardised clinical cases.

Methods

A subject matter expert (SME) panel constructed a blueprint and from this twelve assessments focussing on areas posing high risk to patient safety and deemed as essential for FY1 doctors to know. Assessments comprised six Extended Matching Questions (EMQ) and six Written Unobserved Structured Clinical Examinations (WUSCE) covering seven CPT domains.  Two of each assessment types were administered over three time points to 128 FY1 doctors.

Results

The twelve assessments were valid and statistically reliable. Across seven CPT areas tested 51-75% of FY1 doctors failed EMQs and 27-70% failed WUSCEs. The WUSCEs showed three performance trends; 30% of FY1 doctors consistently performing poorly, 50% performing around the passing score, and 20% performing consistently well.  Categorical rating of the WUSCEs revealed 5% (8/161) of scripts contained errors deemed as potentially lethal.

Conclusions

This study shows that a large proportion of FY1 doctors fail to demonstrate the level of CPT knowledge and prescribing ability required at this stage of their careers. We identify areas of performance weakness that pose high risk to patient safety and suggest ways to improve FY1 doctors’ prescribing.

Blast from the Past

Unfortunately I can’t be at this months Brrism (sorry Micheal @kobb). However, one of the topics will be around ancient scrolls of wisdom (or anything over 5 years in Internet time).

Which got me thinking about what I was up to 10 years ago.

At the time I was a junior PhD researcher at the University of Plymouth. Bizarrely my old homepage is still live, though mercifully I’d updated it in 1999 with fewer flashing GIF’s and roll-over image maps, though the obligatory animated email gif is still there (the email isn’t live however).

A large part of my research (1997-2000) was looking at systems theory as it applied to ‘human activity systems’, so I’m going to cheat (slightly) and reference some work that wasn’t directly about Social Media (or even web-based technologies). Though I was based in the School of Computing, my background is in engineering and the research group was mostly engineers, economists and psychologists. We were interested in how systems theory could be applied to particular social groups (mostly engineering companies in this case) and in particular the processes that those social groups used to achieve certain aims (generally converting some specification into a manufactured product). However, I believe there is good reason to think that much of that research can be applied to social media application in other business endeavours.

Squared Circle Mosaic: Fibonacci Spiral with Hue Twist - Uploaded on January 27, 2005 by krazydad / jbum

Prof Peter Checkland (Lancaster University) is a Chemist that worked in industry on complex engineering problems and eventually moved to the most complex systems of all, those involving humans (unfortunately his seminal work is a book, 1981, not an online article).

Systems are generally recognised by some fundamental principles;

  • Boundaries – there’s a bunch of stuff that’s “inside” the system, and a bunch of stuff that’s “outside” the system (there will usually be an argument over where to draw the boundary but that almost defines the fact that you’ve got a system)
  • Inputs and outputs – stuff crosses the boundary, this can be physical or non-physical [you can have a ‘closed’ system but they’re generally rather boring and hypothetical]
  • There’s some transformation, i.e. difference, between the inputs and outputs
  • There are components within the system; a single component is not a system
  • Systems are nested; within large systems are smaller systems

and most importantly

  • Emergent Properties – you can’t describe the performance of the system just by analysing the component parts

Checkland is important because he was one of the first people to try and describe the messy company and organisational situations he was working within from a systems perspective (building on much of Bertalanffy‘s work between 1934 & 1969) . He identified boundaries and within those boundaries the sub-groups that actually made the company work. He identified information and flows of power within the organisation, and across those boundaries. He was able to sketch out the ‘actual’ human activity system, rather than the business or computer information system. It was the systems characteristic of emergent properties that led to them not performing as planned, and gave rise to the law of unintended consequences (previously identified in social sciences by Robert Merton (1936) but not explained).

But what does this mean for the social media strategist?

Well it means that, despite our shiny shiny toys, there is quite a bit of good research and clear thinking about how people work in groups and in particular how we can design such systems. No matter how carefully we design them, there will be emergent properties; but that doesn’t mean we shouldn’t design them in the first place.

There will always be boundaries, some stuff will be “inside”, some stuff will be “outside”. You don’t want everything to be “inside“; even planet earth isn’t a closed system.

Stuff needs to cross your system boundary, and it needs to be transformed en-route to becoming an output. I put my details into Facebook (as do 350m others) and a whole bunch of RSS feeds, and I get a ‘useful’ homepage about my ‘friends’. I can put photos, comments, stories, whatever in, and people can further transform them with additional comments, links to other people, etc. True, you can’t automagically get that data out of Facebook, but you can log in and read what’s there. And reading what’s there is one form of taking information out of the Facebook system, as are social networks, etc.

Of course there are lots of component software chunks and sub-systems within Facebook. Each casual game on Facebook is its own system, nested within Facebook. Each fan community is a nested system. Each discussion board is, potentially, a sub-system, nested within a fan page, nested within Facebook, nested within the Internet, etc. Depending on where you draw the boundary, everyone that’s on Facebook is also part of the system…

And of course there’s a ton of emergent behaviour that wasn’t predicted (or predicable).

So what can we do about/with it?

The first thing to note is that, from my experience, most people aren’t very good at meta-cognitive thinking about systems theory. That is, they are used to living within systems (social, organisational, leisure) but they don’t actually spend a lot of time thinking about those systems, and even less thinking about how they are thinking about them.

This means that people will usually try to apply existing social behaviours and norms to on line systems, and if that doesn’t work they get frustrated/angry/disillusioned/etc. You either build your on-line social media system exactly like ‘real’ world (but then why would anyone be interested in your system?) or educate people  into the operating of the new system. That’s why all games have tutorial / training built in.

In order to develop a training programme you need to understand, and be able to communicate, the designed purpose and functioning of your system. One way to do this is draw a picture of it, not a UML diagram or a wireframe, but a human activity system diagram. You don’t need to use any ‘standardised’ modelling nomenclature, so long as you and your team understand it and it covers the basics above.

Michael, Rick Chapman, and I spent some time recently thinking about modelling social media systems. We tried to cover the basics, without employing a formal systems modelling methodology. Its not perfect but I think it’s a good start.

You should know where the boundaries are, what the expected information flows are going to be, the transformations and components that will do the transforming, and what the wider emergent property will be. That will all change once the system begins to operate but at least you’ll have a blueprint and can either take action to bring the system back into the original concept or decide to take things in a different direction.

We did quite a lot of this within my old research group, and its surprising how good a consensus you can arrive at for generic systems diagrams.

This early draft is far from ‘perfect’ but I think there is something of value if you’re building, or thinking about social media, to have a model similar to this in your toolbox to refer to.

Conclusion & Caveat

In conclusion, some thinking time about the network you’re trying to build is valuable. The tools you employ should come afterwards; twitter is not a social media strategy. There are lots of good, well established frameworks to think about social networks, systems of activity, etc. You don’t need to follow slavishly the minutia of their particular quirks and peculiarities but you should understand why they are there and why you are ignoring them.

The caveat: feedback loops are a feature of systems. The huge difference that digital technologies have brought is the near frictionless feedback loop. There is almost no transactional cost to publishing a comment and for that comment to then be republished to +350m people (it happens both automatically via services like posterous and twitter-bots, and through the retweet/comment feature in all social media services), and re-re-published endlessly. That is something that we haven’t modelled effectively yet. The good social media marketeers amongst us know how to achieve this, even if they don’t fully understand the why.

Fresh coffee & Opportunities

Uploaded on October 23, 2006 by Hamed Saber
Well it’s been quiet externally for jbsh the last couple of months but there’s been plenty going on. This post is a cross-post from Open Coffee Bristol where we welcomed in the New Year this morning.

Well 2010 kicked off in the UK with snow, ice, sub-zero temperatures and general chaos as public services ground to a halt.

But not Open Coffee and the entrepreneurs of Bristol.

Fortified by the best coffee that the Boston Tea Party on Park Street has to offer we gathered on their first floor to catch up after the break and discuss the future. By the end Steve Cayzer (HP Labs, LinkedIn), Rupert Russell (Carmen Data, LinkedIn), Helen Davies (For Effect, website), Sam Machin (Orange, personal website), Nigel Legg (Katugas Social Media, website) and Andy (who surname I’ve unforgivable forgotten, sorry).

Conversation covered the various tax implications of company car ownership, developing new brand images for the new year (and the difficulty finding a good printers these days), online marketing for small tourism companies and the challenge of getting good geo-location data, and that was just at my end of the tables!

The general opinion was that while the weather and economic climate might be a bit inclement (or just down right awful) there was business to be done and opportunities to be exploited. Business cards were swapped and a couple of new collaborations initiated.

So the New Year is off to a great start and looks to get better.

Look forward to seeing you at the next Open Coffee Bristol on Tues, 26 Jan from 8.30am in The Boston Teaparty on Park St.

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Brrism – Social Media in Bristol

Always a good evening, the next Brrism looks to be a real barnstormer (6.30pm on Wednesday 20 Jan in the Pervasive Media Studio, Bristol).

There promises to be some great presentations on social media tools (Colin Rainsforth, twitter) and the fine line between time management & time wasting (Lee Cottier, twitter) but I’m guessing the hot topic will be the Digital Economy Bill.

Paul Smith (Labour Prospective Parliamentary Candidate for Bristol West) is leading the discussion. The bill is about to enter the Committee Stage in the House of Lords, so there’s no guarantee that it’ll be law before the election, but this is a critically important bill for the UK and Bristol’s digital economy so come along and can make a positive contribution.

Events

Clinical Assessment Tools need to be user friendly

Doctor-Patient contact time is vitally important for diagnosis and treatment.  To aid doctors thousands of ‘tools’ have been developed for use in various fields of medical practice.  But as new technology (including physical assessment and validated questionnaires) is introduced assessment tools become redundent and others are introduced. However technological advances tend to be expensive and time consuming to train medical staff to use.  It is also the case that they often require additional physical space, time to administer and a level of health of the patient.

CigarettesThe aim of Dr Rupert Jones and collegues (including me) was to derive a multi-component assessment index for use with patients with COPD to gain a measure of severity. The index was intended to include items that are clinically important, applicable to all grades of disease severity and all healthcare settings, and simple and clear to use.

Traditionally, the forced expiratory volume in one second (FEV1) has been the main measure of COPD severity for clinicians and still has a prominent place in international guidelines. While patients are mainly concerned with symptoms, exacerbations and functional capacity, airflow obstruction is important to clinicians in order to measure the lung damage and determine treatment. A composite measure could account for various dimensions of the disease, and take into account both the patient’s and the physician’s perspectives.

One highly regarded composite measure is the BODE index which was originally designed to predict mortality in COPD. However, the BODE index involves a Six Minute Walking Test (6MWT) which limits its use in routine clinical settings as it takes time, supervision, and space. Another validated prognostic index, the COPD Prognostic Index is also cumbersome to use in routine clinical settings as it includes seven items, one of which is a health status questionnaire.

Therefore we have derived and validated a composite index of severity in chronic obstructive pulmonary disease, which has recently been accepted for publication by the American Journal of Respiratory and Critical Care Medicine.  We hope the index will be widley adopted by the medical profession.

If you are unsure of its relevance or usfulness to your practice, below is the abstract associated with the journal article.

************

Rationale: COPD is increasingly recognized as a multi-component disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD.

Objective: To derive and validate a multi-component assessment tool of COPD severity which is applicable to all patients and healthcare settings.

Methods/ Measurements: The index was derived using data from 375 COPD patients in primary care. Regression analysis led to a model explaining 48% of the variance in health status as measured by the Clinical COPD questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S) and exacerbation frequency (E). The DOSE index was validated in cross-sectional and longitudinal samples in different healthcare settings in Holland, Japan, and the United Kingdom.

Main results: The DOSE index correlated with health status in all datasets. A high DOSE index score (> = 4) was associated with a greater risk of hospital admission (odds ratio 8.3 (4.1 – 17) or respiratory failure 7.8 (3.4 – 18.3). The index predicted exacerbations in the subsequent year (p ≤ 0.014).

Conclusions: The DOSE index is a simple valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as healthcare consumption and predicts future events.