Reviewed by Konstantinos Balaskas, MD, FEBO, MRCOphth

Ophthalmology, with its heavy reliance on imaging, is an innovator in the field of artificial intelligence (AI) in medicine.

Although the opportunities for patients and health care professionals are great, hurdles to fully integrating AI remain, including economic, ethical, and data-privacy issues.

Deep learningAccording to Konstantinos Balaskas, MD, FEBO, MRCOphth, a retinal expert at Moorfields Eye Hospital, London, United Kingdom, and director of the Moorfields Ophthalmic Reading Centre and AI Analytics Hub, AI is a broad term.

Related: Cutting-edge neuro-ophthalmology: Combining artificial intelligence, eye tracking

The type of AI that has generated a lot of excitement in recent years is called deep learning, he said. This is a process by which software programs learn to perform certain tasks by processing large quantities of data.

Deep learning is what has made ophthalmology a pioneer in the field of implementing AI in medicine, because we are increasingly reliant on imaging tests to monitor our patients.

Particularly in my subspecialty of interest, medical retina, imaging tests such as optical coherence tomography (OCT) are performed very frequently and have provided the material to train, test, and then apply AI decision support systems, Balaskas noted.

In retina particularly, some of the most common causes of visual loss in the Western worldsuch as age-related macular degeneration (AMD) and diabetic retinopathyrequire early detection, prompt initiation of treatment, and regular monitoring to preserve vision.

Balaskas said this is where AI decision support systems can help improve access to care and ensure optimal clinical outcomes for patients.

Balaskas cited the AI decision support system developed in collaboration between Moorfields Eye Hospital, where he is based, and Google DeepMind.

Related: Blockchain technology aims to drive big data to 'train' AI

It is able to read OCT scans, interpret them, provide a diagnosis, and make management recommendations, he said. The other area where AI shows promise is in the development of personalized treatment plans for patients by being able to predict their response to treatment and their visual outcomes over a period of time.

Support toolsWhen considering common conditions that threaten vision, such as AMD and diabetic retinopathy, Balaskas says AI decision support toolsonce validated and once they have gained regulatory approval as medical devicescan help improve access to care.

They can, for example, assist health practitioners in the community in diagnosing diseases early, he explained. In the United Kingdom, where OCT scans are widely available in high street optician practices, an AI tool would be particularly useful to assist them to interpret scans correctly and identify disease at an early stage.

Similarly, in diabetic retinopathy, where patients require regular screening and monitoring, AI tools can significantly increase efficiency of screening programs.

Balaskas pointed out that such applications already exist and can be of particular use in diabetic retinopathy screening programs such as in underresourced health care settings.

Other indications for the application of AI monitoring, like AMD, are in advanced stages of development but have not yet been implemented in real life, he added.

Balaskas said there are challenges with integrating AI into retina diagnostics and treatments.

Related: Integrating AI to manage diabetic retinopathy in a primary care setting

He noted that he has a personal academic interest in implementation science, which looks at the gap between developing a medical device such as an AI decision support tool and deploying it in clinical practice.1

The potential barriers that we need to overcome for the tool to be deployed in a meaningful way to improve outcomes for our patients go beyond testing and validation, he said. These include economic evaluations: how would such an automated decision support model affect the finances of a health care system, so that it could provide good value for money or achieve cost savings?

Human factorsThe next consideration is human factors, particularly how these models of care that rely on AI are perceived and accepted by patients and practitioners.

What is the level of trust in these technologies? What level of information and education of patients and the public is required to build confidence in their use? Then there are considerations regarding training and technical infrastructure to support these tools.

Balaskas notes that ethical and data-privacy issues, as well as medicolegal considerations, are also important. Who is responsible for decisions made by an AI algorithm rather than a human? How do these tools affect the way health care professionals diagnose and treat disease?

Related: Deep learning algorithm proven accurate for AMD classification

There is a phenomenon called automation bias, where practitioners are sometimes more likely to defer to the recommendation of the AI tooleven perhaps against their better judgement, he said.

InterpretabilityBalaskas notes the issue of interpretabilitythat in many instances these AI tools are opaque in their functioning.

We do not fully understand how a specific recommendation is reached, whether that is a diagnosis or a management recommendation, and that lack of transparency can exacerbate the medical, legal, and ethical issues that were mentioned earlier, he pointed out. In summary, we have found that there are several hurdles to overcome before AI tools can be deployed in real life in a way that is safe and will improve clinical outcomes.

Moreover, Balaskas said that life could change for ophthalmologists in the future, and he has a optimistic vision of AI in medical practice.

Our field is becoming increasingly complex and we need to process data from various sources when we are assessing our patients: data from the many imaging modalities, genetic data and the various types of omics, such as proteomics and the emerging field of oculomics, where features on the eye examination can be indicative of problems with systemic health, he said.

Related: Telemedicine ushers in new chapter in eye care

Balaskas also noted that data from home vision monitoring devices will become increasingly available.

However, Balaskas said that making sense of all this data in order to develop a personalized treatment plan for each patient can be daunting.

AI could become a very useful aid and, as described in the Topol Review on AI commissioned by Health Education England, provide the gift of time to patients and practitioners, giving them the chance to discuss and decide together what the optimal treatment plan is, informed by the processing of high-dimensional complex data sources, he concluded.

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Konstantinos Balaskas, MD, FEBO, MRCOphthe:k.balaskas@nhs.netBalaskas has an academic interest in new ways of delivering care in ophthalmology, including telemedicine, virtual clinics, remote monitoring, and AI decision support. He has no financial disclosures.

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Reference1. Campbell JP, Mathenge C, Cherwek H, et al; American Academy of Ophthalmology Task Force on Artificial Intelligence. Artificial intelligence to reduce ocular health disparities: moving from concept to implementation. Transl Vis Sci Technol. 2021;10(3):19. doi:10.1167/tvst.10.3.19

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Ophthalmology: A pioneer in the field of artificial intelligence - Ophthalmology Times

The EU no longer aims to bridge the innovation gap in Europe, but to promote innovation cohesion, the EU commissioner for research and innovation told the European Commissions annual research policy conference.

That will require member states to acknowledge the shared goals of EU R&D policy and the effort needed to create the European Research Area (ERA) single market for research.

These objectives require a united front that leaves no countries or regions behind, said Mariya Gabriel. Its time to change our narrative, she told the Commissions research & innovation days conference on Wednesday. We need to work for a European innovation ecosystem where all our talents have access to quality information, to funding, and they can build networks.

Change is needed as Europe is enters a fourth wave of innovation, which must be underpinned by a coherent and operational strategy for fostering the growth of deep tech start-ups. We can be a real global leader in this field, so I think that we need to seize this momentum, she said.

The EU should shift towards a new innovation strategy, said Gabriel. I think that we should seize the momentum to transform Europe into a global powerhouse in the new wave of innovation.

To support this, the Commission is working on a new system of governance for ERA and a new pact for research and innovation that will chivvy member states to increase national investment in R&D and support the careers of researchers.

Stakeholders are not impressed, saying plans to revamp ERA and reduce the research and innovation divide in Europe need binding national R&D spending targets.

Kurt Deketelaere, secretary general of the League of European Research Universities said the plans will have little impact if member states dont sign up to binding targets. For over 20 years, EU countries have been encouraged to raise R&D expenditure to 3% of the GDP, but very few have done so.

We really have to take action, said Deketelaere. Action means commitments, and commitments very often mean legally binding stuff.

I think it's really the time that we oblige member states to put their cards on the table, and to make sure that, at the end of the day, things are happening, Deketelaere said.

Norbert Ltke-Entrup, chair of Business Europes working group on research and innovation, said simply wishing for a 3% target would not make it happen. We've tried it before. It didn't work, said Ltke-Entrup. I'm not really sure that I now see a different situation or a strong reason why it should be different this time.

Car manufacturers are increasing R&D investments as demand for electric vehicles grows. Germany and other countries with strong automotive industries are closer to the 3% target, but others need to follow suit. We have other new technologies, artificial intelligence, 5G networks, industry 4.0, so there is no shortage of investment opportunities, said Ltke-Entrup.

Research fueling recovery

To mitigate the effects of the coronavirus pandemic, the EU is pulling together a 672.5 billion recovery fund. Member states can spend their share according to national investment plans that must be agreed with the Commission. Commission officials estimate research and innovation projects represent between 4 and 13% of the grants requested by member states in their recovery plans.

Gabriel said 35 billion from the recovery fund will be invested in research and innovation. Separately, 5 billion from the recovery fund was added to the Horizon Europe budget.

Our analysis shows there will be important investments in innovation, she said. Gabriel hopes R&D investments of any kind will help narrow the innovation performance gap between EU member states.

Earlier this week, the Commission released the 2021 Innovation Scoreboard,, showing several countries in southern and eastern Europe have improved their R&D performance, slightly narrowing the gap with richer member states in western and northern Europe. However, excellence in research and innovation remains concentrated in northern and western Europe.

Marc Lematre, the Commissions director general for regional and urban policy, said the data are positive but the innovation gap, is still very present in Europe - and still wide. Less-developed regions in Europe represent a quarter of the EUs population, but only 5% of R&D expenditure in Europe, Lematre noted.

It is clear that because of this innovation divide, Europe is not firing on all its cylinders, said Lematre. That puts Europe at a competitive disadvantage against South Korea, Japan and the US. If we tackle the innovation divide we will be better equipped to close this gap, he said.

Portuguese MEP Maria da Graa Carvalho said the EU should make sure that member states use all funds available, including the recovery fund and cohesion policy funds. One of the conditions to narrow the gap is that we have more investment in research and innovation, she said. We have to make sure that the member states invest more.

Continue reading here:
Don't mind the gap: 'Innovation cohesion' is new route to bridge east-west divide - Science Business

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Why do so many of us find it hard to truly relax? It may be because relaxation actually requires a little effort.

Its more than just kicking back on the couch or taking a break to scroll on your phone. Relaxation is a state of physical, mental, and emotional calm. It can take some practice to reach, especially when life feels too busy to take a moment for yourself.

However, research has shown that practicing relaxation skills may boost your health and well-being. Relaxation techniques may help soothe anxiety and promote sounder sleep, among other benefits, according to experts.

Moreover, taking relaxation breaks can help you manage day-to-day stress and simply feel good both important aspects of self-care.

Weve partnered with Sunday Scaries to bring you a few tips on how to relax.

Its helpful to have a toolkit of techniques to relax your mind and body.

You might make one or more of these popular relaxation techniques a daily ritual, or use them to regain some calm and composure during a particularly stressful time.

Deep breathing is associated with a slower heart rate and reduced blood pressure, according to experts.

You know youre breathing deeply when your abdomen but not your chest balloons out when you inhale. This is why deep breathing is sometimes called belly breathing.

To practice, sit in a comfortable chair and try breathing deeply 10 times. Keep one hand on your belly to feel it expand with each inhale.

Everyone has a happy place a location that makes them feel good. Maybe its a favorite beach, a lakefront bench, or a sun-dappled forest trail.

When you feel stress mounting, try closing your eyes and imagining a mental image of this place. Take a few moments to mentally scan these pleasant surroundings and recall the calm sensation of being there.

The more you practice this, the more easily youll be able to mentally transport yourself to your happy place.

Many people use this technique to calm and center themselves during intense moments.

You can use progressive muscle relaxation at the same time as a deep breathing or guided imagery exercise. The technique is also called Jacobsons relaxation.

Starting with your feet, gently clench your muscles for 5 to 10 seconds, then release quickly, noting the feeling of tension melting away. Do the same with your other muscles, moving upward through your body until you reach your scalp.

Learn more relaxation techniques you can use.

Stress may lead us to eat foods higher in sugar and fat. This is one reason why so many of us reach for cookies and chips when were feeling overwhelmed.

Yet, while these comfort foods may momentarily take the edge off, they arent likely to make us feel happier or more relaxed in the long run.

On the other hand, some foods may enhance your sense of well-being. Several essential nutrients that are easy to find in foods at your local supermarket may help you feel good, according to studies.

Read more about foods for relaxation.

Sunday Scaries offers a range of edible CBD products, including broad spectrum CBD gummies that contain vitamins D3 and B12. Their website says the gummy bears are formulated to relieve stress and support a relaxed, focused & on-track vibe.

It may sound strange, but moving your body may actually help you relax.

Physical exercise releases endorphins, the feel-good hormones, and helps promote sleep, according to the Anxiety & Depression Association of America.

Even a single 30-minute session of moderate-to-vigorous exercise, like brisk walking, may quell anxious feelings.

The Centers for Disease Control and Prevention (CDC) recommends getting 150 minutes of physical activity per week for optimal health.

Some forms of exercise have the added benefit of incorporating aspects of mindfulness. This is the practice of paying close attention to the present moment without judgment, as well as to your own breathing patterns.

These exercises include:

To make the most of your relaxation practice, give yourself full permission to take these moments to focus on yourself.

Its understandable to think that items on your to-do list take priority over acts of self-care.

However, remember that worries or sleep troubles that intrude on your ability to think clearly and act confidently can get in the way of your daily functioning.

Managing these with relaxation techniques will support your well-being at work and at home.

Read more tips about relaxation and why its important.

The ability to deeply relax doesnt come easily for many people. However, with regular practice, relaxation techniques can become second nature.

Combine them with self-care and healthy lifestyle habits, and youve got a recipe for relaxation that will help you better manage stressful situations and boost your overall well-being.

More:
Finding Relaxation: Your 5-Minute Read - Healthline

In last week's blog post, I wrote a line that's been stuck in my mind: "Shame, the ever-present companion of medical culture, once again getting in the way of an honest conversation."

Shame wasn't the main topic of that piece, but I think my subconscious was telling me I needed to write more on it. I thought of Dr Rana Awdish's powerful memoir, In Shock. In it, she writes, "Medicine is not oriented to recognize trauma in its own...We were trained to leave the thin veneer covering our colleagues' emotions undisturbed. We have utterly no idea what to do with shame. We have built no confessionals."

For many (if not most) physicians, the mistakes we make, even minor ones, stay with us for the rest of our careers. As Dr Awdish writes, "That shame is unique in its wholeness, an impenetrable black orb that deflects light."

For some of us who write, the blank page (or screen) is our confessional. This month marks 20 years since completing my internship. There are so many memories from that intense year when I made the transition from student to doctor. But like many of us (I suspect), one of the memories that predominates is of a mistake I made. Not only the mistake but the shame that came with it. So here is my confession, one I've never shared before.

* * *

It's a typical call night on the internal medicine service. I've admitted a woman in her sixties with ESLD and ascites. She's frail, looks 10 years older than her age, and her thin arms and legs jut out in skeletal contrast to her protuberant belly. We're admitting her for a "tap," a paracentesis. Unfortunately, it's late, probably around 11 PM, before my resident and I have enough time between admissions to do the procedure.

I gather the supplies and bring everything to the bedside. Back then we did them without ultrasound, by anatomic landmarks only. I prep everything in the room and go to grab my senior resident. He's at the nurses' station on a computer. "You go ahead," he says, without turning around. "I'll be out here if you need me."

I stand still for a minute. I've done a few by this point. I've graduated past the "see one, do one, teach one" to having done one, and then several, although I haven't yet taught it to anyone. But my resident is busy and showing his trust in me. I can do this. Okay.

I go back into the room. My patient signed the consent already. She's had this done before many times, and she doesn't appear anxious, only tired. I prep the site, numb it up, insert the needle, and am rewarded with the straw-colored fluid I expect to see.

A flash of pride fills me. In hindsight, I should have known better. I hook the catheter up to the needle and connect it to the vacutainer bottle, and we make small talk as the bottles fill. When it looks like we've got all we're going to, I remove the needle and press a gauze over the site.

She cries out in pain. "What are you doing?"

I explain that the needle's out and I'm holding pressure on the site before I bandage it.

She continues to cry out in distress. "It hurts! It hurts!"

I don't know what's happening. She had no pain during the procedure. There's no external bleeding. A bad thought occurs to me the pain could mean internal bleeding. I grab more gauze and press down harder, but she pushes my hands away. The strength in her frail arms surprises me. I call for the nurse to get stat vitals and my resident.

Later, I will piece together that I must have gone through a blood vessel on insertion. While the needle was in, it tamponaded the vessel. But once I removed it, the hole in the vessel was free to bleed.

A stat ultrasound confirms a hematoma.

I'm devastated at the pain I've caused her. Thankfully, she remains hemodynamically stable. But a few hours later, I have to present the event on morning rounds. The attending responds with silence.

At the patient's door, the attending turns to me and finally speaks. "Stay out here."

My head goes hot, my heart pounds. I have to suppress a fierce desire to run away and hide somewhere. I drift over to a workstation and pretend to chart while imagining all the nurses' eyes on me.

Afterward, nobody tells me what was discussed in the patient's room, and from the furtive looks cast in my direction, I'm too afraid to ask.

My resident tells me at some point later that day that the patient doesn't want me to be a part of her care anymore. I don't know what to say, so in my post-call haze, I just nod.

She's able to discharge to home a few days later, but I have no part in her discharge.

I don't remember the rest of that rotation. I know that eventually the month ended, and I moved on to the next service. I put it behind me and buried the shame in my work.

And I never spoke of it to anyone.

I never was allowed to debrief about it. I never was given feedback on it. I was given the message that I had screwed up and I was no longer worthy of caring for the patient.

Expert shame researcher Bren Brown writes, "Shame works like the zoom lens on a camera. When we are feeling shame, the camera is zoomed in tight and all we see is our flawed selves, alone and struggling."

What it would have meant to me if the attending, or the resident, had instead had an honest conversation. Maybe shared a time they made a mistake too. Looking back now, I imagine the resident might have been concerned that he would be found out for not being in the room with me to supervise. Although even if he were, the hematoma might still have happened. Of course, I never told the attending that the resident wasn't there. The hidden curriculum had been well ingrained in me.

I know now that it's unlikely that the attending had practiced in a mistake-free vacuum. But perhaps talking about mistakes had never been modeled for him either. To talk about it might have meant confronting his own shame.

What it would have meant to me as a trainee if I could have stayed with the team on rounds that day. If the attending had explained to the patient that the superficial blood vessels in the abdominal wall become dilated in end-stage liver disease. The hematoma could have happened with anyone wielding the needle. I could have apologized and continued to be a part of her team instead of being ostracized. Because if my team had shunned me, had there been any chance of my patient not doing the same?

As Brown writes, "Shame keeps worthiness away by convincing us that owning our stories will lead to people thinking less of us. Shame is all about fear. We're afraid that people won't like us if they know the truth about who we are."

That shame has lived inside of me for 20 years. Today, I release it here by owning my own story. I hope others will join me. Let's model a better culture for our incoming interns.

Do you have a story of shame in medical training? Share it in the comments below.

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About Dr Jennifer Lycette

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Shame in Medical Training, and Owning Our Stories - Medscape

Today I'm interviewing Ray Peloso, CEO of Katabat,a software company that helps clients collect more dollars and reduce charge-offs by helping them deploy collection strategies, omnichannel strategies and synchronize and orchestrate offers across the entire collection spectrum.Ray truly embodies the theme of this series because he is indeed a different thinker. Watch our interview (or read it below) about deep thinking, collaboration, and how to minimize distractions to make your team as productive as possible.

Stephanie Eidelman:

Hi, I'm Stephanie Eidelman, CEO of The iA Institute and insideARM. I'm here today with Ray Peloso, who is the CEO of Katabat. Ray was recently here with me, but now he's back for a different kind of conversation. This one is under the banner of our Innovation Council Think Differently series. And let me tell you, Ray is a different thinker. So this will be very interesting.

Ray Peloso:

Great. Well, as always, Stephanie, it's a delight to spend time with you. So hopefully we can have a bit of a controversial conversation today.

Stephanie Eidelman:

We'll do our best. So we agreed to talk about two topics that we'll weave together. The first one is, What book or of any genre really has expanded your thinking the most and how and why? The other is, Do your best ideas come from collaboration with others or deep thinking on your own, and how does this process work in your organization? I'll leave it to you to get started on your thoughts.

Ray Peloso:

Great. I think the setup is important here, which is we are a software company and for years we've had a distributed workforce. We've been able to recruit and hire people offshore as well as onshore. We've had headquarters in Delaware, but we've always over the years supplemented with hiring talented people wherever they live. All of which becomes really interesting in the post COVID world of do you bring, people back into the office, or do you allow people to live where they want to live? So it unpacks a whole bunch of interesting questions. To tie that together, as a backdrop with the book I read, it's a book called Deep Work and the author's name is Cal Newport. For any of your listeners, I'd be delighted to talk a lot about it. We read it as a management team probably two years ago and we've had controversial, but I think really productive, discussions and even practices around some of the key lessons that came out of that book. When I saw your list of topics, I thought it'd be fun to talk about.

Stephanie Eidelman:

I love that. What are some of those key lessons?

Ray Peloso:

I'm going to start with one quote and then we'll make the rest of this conversation. In the introduction, what he writes is, "In the age of network tools, knowledge workers increasingly replaced deep work with shallow work, constantly sending and receiving emails and texts like human network routers with frequent breaks for quick hits of distraction." I remember reading that thinking, wow, that sounds like how I spend a lot of my days. And I'm pretty sure it's how a lot of my team spends a lot of their days. There are a bunch of fundamental ideas here, but a core idea is that in a knowledge economy, none of us manufacture anything. I don't manufacture cars or widgets. Your brain and your individual contributions ultimately are what create value and differentiate you.

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Ray Peloso:

So how you think about how you manage your knowledge and tap into your talents is critical. This will weave into collaboration and I'll let you leave me with a couple of questions, but to throw out a little controversy, there has been a lot of research in the last decade or so around workplace design looking at whether collaborative open table structure is productive, not productive, more effective, less effective, etc. That's too long a topic to go through, but there is a body of thinking that Deep Work presents that says if there is a wild amount of distractions, it actually erodes the ability of the individual in a knowledge economy to be productive. I'll stop there so you can guide me from here.

Stephanie Eidelman:

I would say a number of things. First of all, I think you're right. And I have been both in those big open offices in the mid-1990s, I worked for an internet startup and we had balls and we had stuffed animals and people throwing things and yelling and having fun. And meanwhile, you had to have business development conversations on the phone in the midst of it. And it was just all part of it. And as a business owner, I have created that open space as well. And I think you're right. I have learned that you need that place to do deep work. Now in our company, what happens is you walk into a space that's open that has people there, but it's silent. Everybody has headphones on and they're doing their work. And sometimes, you know, we have collaboration, but that's why, because of this challenge you raised.

Ray Peloso:

So let me give you two thoughts and then we can unpack. First is it goes well beyond ambient noise. There's absolutely distraction of somebody walking by or talking. The book really drills into all of those IMs all day, all of those emails that happen all day...the sort of "environment of distraction." And they tell anecdotes that are always helpful in book writing. Carl Jung and great inventors by and large went off and spent time alone to allow their minds to focus on the big problems.

New Speaker:

The second point I would make is that they sort of articulate the chemical costs of your brain constantly getting distracted. In a nutshell, every time your brain is distracted, it takes a few seconds to refocus. When you do the math of how many times an hour, a day, a week, you're distracted and then how long it takes you to refocus. So the book really goes through the costs of collaboration. Because if somebody just swings by your cubicle with hey, I've got a great idea, it actually has distracted you.

Stephanie Eidelman:

Yes. It rings true for me. I'm one of these people who does get distracted by the task. I like to keep things moving. I know that if somebody asks me a question and for me, it typically happens on email, but it might be an IM as well, I want to answer it. I want to keep them moving. I'm very conscious of not stopping their progress. So whether it's me reminding them to answer their own question or me answering for them.

However I see that I advance my company most when I do that deep thinking work, those are the times that I have really pushed a ball forward. What I wonder though is that the noise people have, you mention the constant IM chatter, for instance, which definitely happens in my world. I know that my team is often chatting with each other. But you can't dictate though that they can't do that. It won't stop the mind from wanting to do that.

Ray Peloso:

Right. Gosh. So the first thing I'll tell you is that doing what we talked about is really hard. So I don't want at all to suggest that we're perfect because we struggle every day with how to take these ideas and put them into practice. I empathize with your comment which is that very often I think my best contribution to the company is keeping things moving. But I've actually learned that my personal discipline to stop trying to move things along and to actually think through what I want to move along and why can actually be quite more impactful. This leads to the classic point of one or two things done really well is probably a lot more valuable than 35 things done simultaneously and rapidly. And so we continue to try to think through those lessons.

I'll pull in one other concept to give the listeners some practical applications. There's this infamous thing called the Bezos memo.

Ray Peloso:

So Amazon (you can go Google this) around, forcing people not to use PowerPoint decks, but to actually write out their arguments in long-form memos. Part of the practice we're adopting is to take a few hours each day or one hour each day, and articulate your thoughts and organize your thoughts in written form in the form of deep work. And we have found better ideas, more well thought out, more persuasive. So there's something that Jeff Bezos and Amazon really tapped into. So we're not making up new ideas. We're sort of stealing good ideas that we're reading about elsewhere. But it ties into deep work, which is you can't write a thoughtful coherent argument if you're constantly distracted.

Stephanie Eidelman:

I think that's very true. Here's another thought that's related. Something I've noticed in our company is that when we have a management meeting and we've got five people there and somebody brings up a topic, I noticed that discussion is not necessarily as productive with five people as it is with two people. Although you think five people, five minds, you get more input, but people I think are reluctant to step on each other or say something that somebody else might think is stupid or inappropriate or whatever the barrier is. It's interesting that getting that unit down to two people -- and I see it over and over again -- and maybe even one person in certain circumstances, is even the better unit. It's probably for the same reason.

Ray Peloso:

Yeah. Two thoughts. Number one is... I think it might be Bezos or maybe Elon Musk...somebody has this pizza pie rule, which is any meeting that requires more than one pizza pie is probably too large a meeting, which is just kind of a small team rule which we find to be useful. And we use the Bezos memo. So I'll work with my chief product officer or my engineer and we'll actually have small group discussions with these -- my second point, which is having a straw man. So again, this topic sort of bumps into collaboration. And how do you collaborate? How do you make collaboration effective? There is absolutely a great role for collaboration in the workplace, but "Hey, here's an open topic, let's just go around the room for an hour and a half" is less productive in my opinion than somebody going off doing a first draft. Here's what I think we should go do and why. And then using that strawman in an iterative way, over a period of time to collaborate. That's what we try to do.

Stephanie Eidelman:

A hundred percent. That rings so true from our work in the Innovation Council. We can't possibly bring an open-ended topic to the group. There's got to be a straw man that people are asked to respond to or at a minimum, small groups are assigned specific questions to answer.

Ray Peloso:

Right. So there's a point in the book because I think this whole thing started around this book where they talk about the perfect physical architecture of the workplace. And it's a theoretical point, but it's like hub and spoke, which is Stephanie has her office because it's really important for her to have quiet deep work time, but she can leave her office and go into the common area to get a sounding board, to get a reaction, to pull someone in and say, Hey, critique my thinking, critique my work. Again, it's an academic book, but it reinforces the point that there is absolutely a critical role for collaboration. People shouldn't be working in isolation, but designing collaboration is what's important.

Stephanie Eidelman:

It'll be interesting to see how that comes about in this world where many people are working remotely; how do you design that common area? It's of course, when you say, "Okay, on Thursday we're all going to get together, or once a quarter"...Creativity and collaboration don't happen on a schedule like that. But if you did have a physical space where everybody had an office, and then you had this cool collaborative area, would people be in that collaborative area at the same time?

Ray Peloso:

Going through the logistics of it is hard. That's why these guys are college professors writing books.

Stephanie Eidelman:

And that's where the IM actually comes into play. To some degree, maybe there's a combination of calendar management and that kind of disruption or mechanism for disruption. Because if I want to ask something of someone on my team, I try to look at the calendar first and make sure that they're not on a call or in a meeting. Of course, they may be doing deep thinking at that time, in which case we'd have to have the discipline to mark that on our calendar too. Maybe there's a clue in there as to when people are interruptible and when they're not.

Ray Peloso:

It's logistics, but how each of us manages our calendar and how each of us manages our calendar with our coworkers is a huge part of all this because there's randomness and chaos throughout the day unless tribal rules are established. And we struggle with that. We want our colleagues to carve off time. One of the things we're doing very tactically, by the way, is we're creating office hours. We're basically saying the product managers are available every day from 8:30 to 9:00 to answer questions. And in exchange, we're going to ask you to leave them alone from 9 to 12 so they can work on their work. So we're trying a lot of things to figure out a way within an ecosystem of lots of moving parts and people and activity to reinforce this idea.

Stephanie Eidelman:

Have any of the things that you've tried stuck?

Ray Peloso:

Yeah. So one of the points I was going to make as we wrap all this up is that deep work is really hard. You know, you're left with your private thoughts, you're left with your own ingenuity. And it is hard to turn off all of those stimuli that now we've all become so used to and actually train the brain. So I feel like there's a lot of days where I sort of fail. I want to focus on a topic and my brain gets tired. So it's really, really interesting for anybody interested in trying it. It's actually easier to read the book. It's a lot harder than you realize to practice.

Stephanie Eidelman:

That's an excellent point to end on and give people some food for thought. We will continue because it's always wonderful to hear your thoughts.

Ray Peloso:

If any listener wants to chat about it, have them call me directly. I think it's a great topic and we really are trying all of these things to be a great company.

iA Innovation Councilis a collaborative working group of product, tech, strategy, and operations thought leaders at the forefront of analytics, communications, payments, and compliance technology. Group members meet in person (and lately, virtually) several times each year to engage in substantive dialogue and whiteboard sessions with the creative thinkers behind the latest innovations for the industry, the regulators who audit and establish guardrails for new technology, and educators, entrepreneurs and innovators from outside the industry who inspire different thinking.

2021 members include:

2nd Order Solutions

AllianceOne Receivables Management

Alorica

Arvest Bank

Attunely

BBVA

BC Services

Beyond Investments

Capital Collection Management

Cedar Financial

Citizens Bank

Collection Bureau of America

Crown Asset Management

CSS Impact

Dial Connection

ERC

Exeter Finance

Firstsource Advantage

Healthcare Revenue Recovery Group

Hunter Warfield

Imagined.Cloud

InDebted

Katabat

Livevox

MRS BPO

NCB Management Services

Neustar

Numeracle

Ontario Systems

Phillips & Cohen

PRA Group

Professional Finance Company

Radius Global Solutions

Resurgent

Revenue Group

RevSpring

Spring Oaks Capital

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Thinking Differently: The Most Important Thing You Need to do to Advance Your Company - insideARM.com