<![CDATA[BERN MEDICAL - Blog]]>Wed, 22 May 2013 11:36:46 -0800Weebly<![CDATA[review of fc Barcelona's 12-13 season]]>Wed, 08 May 2013 00:30:33 GMThttp://www.bernmedical.com/1/post/2013/05/review-of-fc-barcelonas-12-13-season.html I am a soccer fan and I wanted to run some data analysis of the 2012-13 season for FC Barcelona (often called simply Barca). They have the world's best player in Leo Messi and for the last few years have won more trophies than any other team in Europe. This year only one trophy, the Spanish Liga. 

They had enormous success under their previous coach, Pep Guardiola who left the team after last season. He was replaced by Tito Vilanova, Pep's assistant. Tito has continued the same philosophy, but this season under such high standards is a bit of a disappointment. The Barca team started so well in the beginning of the season but seemed to lose their way and with 4 trophies available, they will only win one. 

So, I pulled together some data and I had a theory that I could visualize the data and demonstrate that Tito's absence during the middle of the season correlated (and presumedly caused) the dip in form to Barca. See, Tito took a leave of absence during the season for treatment for his cancer.

In the charts below, I took all the games Barca has played so far this season in La Liga, La Supercopa, La Copa del Rey, and the Champions League. For each win I gave them 3 points, 1 point for a tie, and 0 points for a loss. Only La Liga actually counts points this way throughout the season, but the goal here was to see how many points did the team accumulate throughout the season and where did the team drop points by not winning. My data set had score, location, opponent, and date.

Blue is the accumulated points and red are the accumulated dropped points. I added reference lines for when Tito was away from the team.

Problem: data doesn't match my theory of tito's absence

So after pulling together the above graphs, there is no compelling correlation to Tito's absence and dropping points. I explored the data a little to slice in different ways. I believe that as a general rule most variances can be attributed to one or two causes. So I tried to find the causes. Perhaps my data did not have the fields that demonstrated the clear cause of why Barca is not experiencing a great season.

Then I created the graph below. The bar size is the net margin of victory or loss over the season. Barca plays each team at least two times in every competition. One home and one away. (at the time of writing this there are still 4 games remaining in La Liga)

The color is % of the points won based on points available. Reds are less than 50% of the available points, greys are 50% of available points, and blues are more than 50% of available points.

This chart describes perfectly what happened to Barca's season. Real Madrid and Bayern Munich. Barcelona played Real Madrid 6 times, won once, tied twice and lost thrice. Barcelona played Bayern Munich and lost twice.

Barcelona lost the Supercopa to Real Madrid, with a net margin of 0 and point collection of 50%. They also lost once and tied once with Madrid in the Copa del Rey with a net margin of  -2 and a point collection of 17%.  In La Liga although the goals for and against were different, Barcelona had the same results, net margin of -2 and a point collection rate of 17%. The result is average net margin of -.75 and point collection of 28%.

The result with Bayern Munich is well known; two losses by a net margin of -7. This ends up a point collection of 0% and average net margin of -3.5.

Barcelona did not win the Champions League because they played Bayern Munich. They lost the Supercopa and the Copa del Rey because they faced Real Madrid. They won La Liga because they beat all other teams. Simple.
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<![CDATA[Why the Lean Start-Up Changes Everything]]>Thu, 18 Apr 2013 17:32:42 GMThttp://www.bernmedical.com/1/post/2013/04/why-the-lean-start-up-changes-everything.html
Steve Blank is a consulting associate professor at Stanford University and a lecturer and National Science Foundation principal investigator at the University of California at Berkeley and Columbia University. He has participated in eight high-tech start-ups as either a cofounder or an early employee.
WHY THE LEAN START-UP CHANGES EVERYTHING
Launching a new enterprise—whether it’s a tech start-up, a small business, or an initiative within a large corporation—has always been a hit-or-miss proposition. According to the decades-old formula, you write a business plan, pitch it to investors, assemble a team, introduce a product, and start selling as hard as you can. And somewhere in this sequence of events, you’ll probably suffer a fatal setback. The odds are not with you: As new research by Harvard Business School’s Shikhar Ghosh shows, 75% of all start-ups fail.

But recently an important countervailing force has emerged, one that can make the process of starting a company less risky. It’s a methodology called the “lean start-up,” and it favors experimentation over elaborate planning, customer feedback over intuition, and iterative design over traditional “big design up front” development. Although the methodology is just a few years old, its concepts—such as “minimum viable product” and “pivoting”—have quickly taken root in the start-up world, and business schools have already begun adapting their curricula to teach them.

The lean start-up movement hasn’t gone totally mainstream, however, and we have yet to feel its full impact. In many ways it is roughly where the big data movement was five years ago—consisting mainly of a buzzword that’s not yet widely understood, whose implications companies are just beginning to grasp. But as its practices spread, they’re turning the conventional wisdom about entrepreneurship on its head. New ventures of all kinds are attempting to improve their chances of success by following its principles of failing fast and continually learning. And despite the methodology’s name, in the long term some of its biggest payoffs may be gained by the largecompanies that embrace it.

In this article I’ll offer a brief overview of lean start-up techniques and how they’ve evolved. Most important, I’ll explain how, in combination with other business trends, they could ignite a new entrepreneurial economy.

The Fallacy of the Perfect Business PlanAccording to conventional wisdom, the first thing every founder must do is create a business plan—a static document that describes the size of an opportunity, the problem to be solved, and the solution that the new venture will provide. Typically it includes a five-year forecast for income, profits, and cash flow. A business plan is essentially a research exercise written in isolation at a desk before an entrepreneur has even begun to build a product. The assumption is that it’s possible to figure out most of the unknowns of a business in advance, before you raise money and actually execute the idea.

Once an entrepreneur with a convincing business plan obtains money from investors, he or she begins developing the product in a similarly insular fashion. Developers invest thousands of man-hours to get it ready for launch, with little if any customer input. Only after building and launching the product does the venture get substantial feedback from customers—when the sales force attempts to sell it. And too often, after months or even years of development, entrepreneurs learn the hard way that customers do not need or want most of the product’s features.

After decades of watching thousands of start-ups follow this standard regimen, we’ve now learned at least three things:

1. Business plans rarely survive first contact with customers. As the boxer Mike Tyson once said about his opponents’ prefight strategies: “Everybody has a plan until they get punched in the mouth.”2. No one besides venture capitalists and the late Soviet Union requires five-year plans to forecast complete unknowns. These plans are generally fiction, and dreaming them up is almost always a waste of time.

3. Start-ups are not smaller versions of large companies. They do not unfold in accordance with master plans. The ones that ultimately succeed go quickly from failure to failure, all the while adapting, iterating on, and improving their initial ideas as they continually learn from customers.

One of the critical differences is that while existing companies execute a business model, start-upslook for one. This distinction is at the heart of the lean start-up approach. It shapes the lean definition of a start-up: a temporary organization designed to search for a repeatable and scalable business model.

The lean method has three key principles:

First, rather than engaging in months of planning and research, entrepreneurs accept that all they have on day one is a series of untested hypotheses—basically, good guesses. So instead of writing an intricate business plan, founders summarize their hypotheses in a framework called a business model canvas. Essentially, this is a diagram of how a company creates value for itself and its customers. (See the exhibit “Sketch Out Your Hypotheses.”)

Sketch Out Your Hypotheses


Second, lean start-ups use a “get out of the building” approach called customer development to test their hypotheses. They go out and ask potential users, purchasers, and partners for feedback on all elements of the business model, including product features, pricing, distribution channels, and affordable customer acquisition strategies. The emphasis is on nimbleness and speed: New ventures rapidly assemble minimum viable products and immediately elicit customer feedback. Then, using customers’ input to revise their assumptions, they start the cycle over again, testing redesigned offerings and making further small adjustments (iterations) or more substantive ones (pivots) to ideas that aren’t working. (See the exhibit “Listen to Customers.”)

Listen to Customers


Third, lean start-ups practice something called agile development, which originated in the software industry. Agile development works hand-in-hand with customer development. Unlike typical yearlong product development cycles that presuppose knowledge of customers’ problems and product needs, agile development eliminates wasted time and resources by developing the product iteratively and incrementally. It’s the process by which start-ups create the minimum viable products they test. (See the exhibit “Quick, Responsive Development.”)

Quick, Responsive Development


When Jorge Heraud and Lee Redden started Blue River Technology, they were students in my class at Stanford. They had a vision of building robotic lawn mowers for commercial spaces. After talking to over 100 customers in 10 weeks, they learned their initial customer target—golf courses—didn’t value their solution. But then they began to talk to farmers and found a huge demand for an automated way to kill weeds without chemicals. Filling it became their new product focus, and within 10 weeks Blue River had built and tested a prototype. Nine months later the start-up had obtained more than $3 million in venture funding. The team expected to have a commercial product ready just nine months after that.

Stealth Mode’s Declining PopularityLean methods are changing the language start-ups use to describe their work. During the dot-com boom, start-ups often operated in “stealth mode” (to avoid alerting potential competitors to a market opportunity), exposing prototypes to customers only during highly orchestrated “beta” tests. The lean start-up methodology makes those concepts obsolete because it holds that in most industries customer feedback matters more than secrecy and that constant feedback yields better results than cadenced unveilings.

Those two fundamental precepts crystallized for me during my career as an entrepreneur. (I’ve been involved with eight high-tech start-ups, as either a founder or an early employee.) When I shifted into teaching, a decade ago, I came up with the formula for customer development described earlier. By 2003 I was outlining this process in a course at the Haas School of Business at the University of California at Berkeley.

In 2004, I invested in a start-up founded by Eric Ries and Will Harvey and, as a condition of my investment, insisted that they take my course. Eric quickly recognized that waterfall development, the tech industry’s traditional, linear product development approach, should be replaced by iterative agile techniques. He also saw similarities between this emerging set of start-up disciplines and the Toyota Production System, which had become known as “lean manufacturing.” Eric dubbed the combination of customer development and agile practices the “lean start-up.”

The tools were popularized by a series of successful books. In 2003, I wrote The Four Steps to the Epiphany, articulating for the first time that start-ups were not smaller versions of large companies and laying out the customer development process in detail. In 2010, Alexander Osterwalder and Yves Pigneur gave entrepreneurs the standard framework for business model canvases in Business Model Generation. In 2011 Eric published an overview in The Lean Startup. And in 2012 Bob Dorf and I summarized what we’d learned about lean techniques in a step-by-step handbook called The Startup Owner’s Manual.

The lean start-up method is now being taught at more than 25 universities and through a popular online course at Udacity.com. In addition, in almost every city around world, you’ll find organizations like Startup Weekend introducing the lean method to hundreds of prospective entrepreneurs at a time. At such gatherings a roomful of start-up teams can cycle through half a dozen potential product ideas in a matter of hours. Although it sounds incredible to people who haven’t been to one, at these events some businesses are formed on a Friday evening and are generating actual revenue by Sunday afternoon.

Creating an Entrepreneurial, Innovation-Based EconomyWhile some adherents claim that the lean process can make individual start-ups more successful, I believe that claim is too grandiose. Success is predicated on too many factors for one methodology to guarantee that any single start-up will be a winner. But on the basis of what I’ve seen at hundreds of start-ups, at programs that teach lean principles, and at established companies that practice them, I can make a more important claim: Using lean methods across a portfolio of start-ups will result in fewer failures than using traditional methods.

What Lean Start-Ups Do Differently


A lower start-up failure rate could have profound economic consequences. Today the forces of disruption, globalization, and regulation are buffeting the economies of every country. Established industries are rapidly shedding jobs, many of which will never return. Employment growth in the 21st century will have to come from new ventures, so we all have a vested interest in fostering an environment that helps them succeed, grow, and hire more workers. The creation of an innovation economy that’s driven by the rapid expansion of start-ups has never been more imperative.

In the past, growth in the number of start-ups was constrained by five factors in addition to the failure rate:
1. The high cost of getting the first customer and the even higher cost of getting the product wrong.

2. Long technology development cycles.

3. The limited number of people with an appetite for the risks inherent in founding or working at a start-up.

4. The structure of the venture capital industry, in which a small number of firms each needed to invest big sums in a handful of start-ups to have a chance at significant returns.

5. The concentration of real expertise in how to build start-ups, which in the United States was mostly found in pockets on the East and West coasts. (This is less an issue in Europe and other parts of the world, but even overseas there are geographic entrepreneurial hot spots.)

The lean approach reduces the first two constraints by helping new ventures launch products that customers actually want, far more quickly and cheaply than traditional methods, and the third by making start-ups less risky. And it has emerged at a time when other business and technology trends are likewise breaking down the barriers to start-up formation. The combination of all these forces is altering the entrepreneurial landscape.

Today open source software, like GitHub, and cloud services, such as Amazon Web Services, have slashed the cost of software development from millions of dollars to thousands. Hardware start-ups no longer have to build their own factories, since offshore manufacturers are so easily accessible. Indeed, it’s become quite common to see young tech companies that practice the lean start-up methodology offer software products that are simply “bits” delivered over the web or hardware that’s built in China within weeks of being formed. Consider Roominate, a start-up designed to inspire girls’ confidence and interest in science, technology, engineering, and math. Once its founders had finished testing and iterating on the design of their wired dollhouse kit, they sent the specs off to a contract manufacturer in China. Three weeks later the first products arrived.



Another important trend is the decentralization of access to financing. Venture capital used to be a tight club of formal firms clustered near Silicon Valley, Boston, and New York. In today’s entrepreneurial ecosystem, new super angel funds, smaller than the traditional hundred-million-dollar-sized VC fund, can make early-stage investments. Worldwide, hundreds of accelerators, like Y Combinator and TechStars, have begun to formalize seed investments. And crowdsourcing sites like Kickstarter provide another, more democratic method of financing start-ups.

The instantaneous availability of information is also a boon to today’s new ventures. Before the internet, new company founders got advice only as often as they could have coffee with experienced investors or entrepreneurs. Today the biggest challenge is sorting through the overwhelming amount of start-up advice they get. The lean concepts provide a framework that helps you differentiate the good from the bad.

Lean start-up techniques were initially designed to create fast-growing tech ventures. But I believe the concepts are equally valid for creating the Main Street small businesses that make up the bulk of the economy. If the entire universe of small business embraced them, I strongly suspect it would increase growth and efficiency, and have a direct and immediate impact on GDP and employment.

There are signs that this may in fact happen. In 2011 the U.S. National Science Foundation began using lean methods to commercialize basic science research in a program called the Innovation Corps. Eleven universities now teach the methods to hundreds of teams of senior research scientists across the United States.

MBA programs are adopting these techniques, too. For years they taught students to apply large-company approaches—such as accounting methods for tracking revenue and cash flow, and organizational theories about managing—to start-ups. Yet start-ups face completely different issues. Now business schools are realizing that new ventures need their own management tools.

As business schools embrace the distinction between management execution and searching for a business model, they’re abandoning the business plan as the template for entrepreneurial education. And the business plan competitions that have been a celebrated part of the MBA experience for over a decade are being replaced by business model competitions. (Harvard Business School became the latest to make this switch, in 2012.) Stanford, Harvard, Berkeley, and Columbia are leading the charge and embracing the lean start-up curriculum. My Lean LaunchPad course for educators is now training over 250 college and university instructors a year.

A New Strategy for the 21st-Century CorporationIt’s already becoming clear that lean start-up practices are not just for young tech ventures.

Corporations have spent the past 20 years increasing their efficiency by driving down costs. But simply focusing on improving existing business models is not enough anymore. Almost every large company understands that it also needs to deal with ever-increasing external threats by continually innovating. To ensure their survival and growth, corporations need to keep inventing new business models. This challenge requires entirely new organizational structures and skills.

Over the years managerial experts such as Clayton Christensen, Rita McGrath, Vijay Govindarajan, Henry Chesbrough, Ian MacMillan, Alexander Osterwalder, and Eric von Hippel have advanced the thinking on how large companies can improve their innovation processes. During the past three years, however, we have seen large companies, including General Electric, Qualcomm, and Intuit, begin to implement the lean start-up methodology.

GE’s Energy Storage division, for instance, is using the approach to transform the way it innovates. In 2010 Prescott Logan, the general manager of the division, recognized that a new battery developed by the unit had the potential to disrupt the industry. Instead of preparing to build a factory, scale up production, and launch the new offering (ultimately named Durathon) as a traditional product extension, Logan applied lean techniques. He started searching for a business model and engaging in customer discovery. He and his team met face-to-face with dozens of global prospects to explore potential new markets and applications. These weren’t sales calls: The team members left their PowerPoint slides behind and listened to customers’ issues and frustrations with the battery status quo. They dug deep to learn how customers bought industrial batteries, how often they used them, and the operating conditions. With this feedback, they made a major shift in their customer focus. They eliminated one of their initial target segments, data centers, and discovered a new one—utilities. In addition, they narrowed the broad customer segment of “telecom” to cell phone providers in developing countries with unreliable electric grids. Eventually GE invested $100 million to build a world-class battery manufacturing facility in Schenectady, New York, which it opened in 2012. According to press reports, demand for the new batteries is so high that GE is already running a backlog of orders.

The first hundred years of management education focused on building strategies and tools that formalized execution and efficiency for existing businesses. Now, we have the first set of tools for searching for new business models as we launch start-up ventures. It also happens to have arrived just in time to help existing companies deal with the forces of continual disruption. In the 21st century those forces will make people in every kind of organization—start-ups, small businesses, corporations, and government—feel the pressure of rapid change. The lean start-up approach will help them meet it head-on, innovate rapidly, and transform business as we know it.
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<![CDATA[lean analytics cycle]]>Tue, 16 Apr 2013 22:10:51 GMThttp://www.bernmedical.com/1/post/2013/04/lean-analytics-cycle.html
Great visualization produced by Avinash Kaushik -
http://www.kaushik.net/avinash/lean-analytics-cycle-metrics-hypothesis-experiment-act
The Lean Analytics Cycle is a simple, four-step process that shows you how to improve a part of your business.

First, you figure out what you want to improve; then you create an experiment; then you run the experiment; then you measure the results and decide what to do.

The cycle combines concepts from the world of Lean Startup — which is all about continuous, iterative improvement — with analytics fundamentals. It helps you to amplify what’s proven to work, throw away what isn’t, and tweak the goal-posts when data indicates that they may be in the wrong place.


  1. Figure out what to improve
  2. Form a hypothesis
  3. Create the experiment
  4. Measure performance and decide what to do

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<![CDATA[simplicity is the ultimate sophistication]]>Tue, 16 Apr 2013 21:12:22 GMThttp://www.bernmedical.com/1/post/2013/04/simplicity-is-the-ultimate-sophistication.html
This graph shows the relative role of independent factors in a system of 30 identifiable factors. Over 80% of the variations can be attributed to the first 2 factors. In a system with “fat tails” it will be even more concentrated with 99.999% coming from one single factor.

If you are right on Factor 1 (and possibly 2) the rest is irrelevant. The problem is that others will drag you into factors 3 through 99. All this does is distracts from the core issue. Others will want to cover all sides of an issue, because those issues do impact the variance. But it only drives you to the irrelevant and drowns your Factor 1 argument. If you do things right, you should have only one argument.

So, what is your Factor 1? It isn’t always intuitive. As Leonardo da Vinci is attributed to have said, “Simplicity is the ultimate sophistication” It can take a lot of effort to separate out these factors, to understand clearly the variances and to make the complex simple. The promise of analytics should be to help you identify your Factor 1.

Once you know what it is, don’t allow anecdotal evidences, politics, incompetence, and the difficulty of solving Factor 1 prevent you from taking it on.

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<![CDATA[The Final Speech of the Great Dictator by Charlie Chaplin]]>Tue, 16 Apr 2013 17:10:36 GMThttp://www.bernmedical.com/1/post/2013/04/the-final-speech-of-the-great-dictator-by-charlie-chaplin.html
Below is the text of The Final Speech of the Great Dictator, delivered by the character, the Jewish Barber, in Chaplin’s 1940 film, The Great Dictator. The Jewish Barber was played by Sir Charles Chaplin.
I’m sorry, but I don’t want to be an emperor. That’s not my business. I don’t want to rule or conquer anyone. I should like to help everyone if possible- Jew, Gentile, black men, white…

We all want to help one another. Human beings are like that. We want to live by each others’ happiness, not by each other’s misery. We don’t want to hate and despise one another. In this world there is room for everyone. And the good earth is rich and can provide for everyone. The way of life can be free and beautiful, but we have lost the way.

Greed has poisoned men’s souls; has barricaded the world with hate; has goose-stepped us into misery and bloodshed. We have developed speed, but we have shut ourselves in. Machinery that gives abundance has left us in want. Our knowledge has made us cynical; our cleverness, hard and unkind.

We think too much and feel too little. More than machinery ,we need humanity. More than cleverness, we need kindness and gentleness. Without these qualities, life will be violent and all will be lost. The aeroplane and the radio have brought us closer together. The very nature of these inventions cries out for the goodness in man; cries out for universal brotherhood; for the unity of us all.

Even now my voice is reaching millions throughout the world, millions of despairing men, women, and little children, victims of a system that makes men torture and imprison innocent people.

To those who can hear me, I say “Do not despair.”

The misery that is now upon us is but the passing of greed, the bitterness of men who fear the way of human progress. The hate of men will pass, and dictators die, and the power they took from the people will return to the people. And so long as men die, liberty will never perish.

Soldiers! Don’t give yourselves to brutes, men who despise you and enslave you; who regiment your lives, tell you what to do, what to think and what to feel! Who drill you, diet you, treat you like cattle, use you as cannon fodder!

Don’t give yourselves to these unnatural men—machine men with machine minds and machine hearts! You are not machines! You are not cattle! You are men! You have a loveof humanity in your hearts! You don’t hate!

Only the unloved hate; the unloved and the unnatural.

Soldiers! Don’t fight for slavery! Fight for liberty!

In the seventeenth chapter of St. Luke, it’s written “the kingdom of God is within man”, not one man nor a group of men, but in all men! In you! You, the people, have the power, the power to create machines, the power to create happiness! You, the people, have the power to make this life free and beautiful, to make this life a wonderful adventure. Then in the name of democracy, let us use that power.

Let us all unite.

Let us fight for a new world, a decent world that will give men a chance to work, that will give youth a future and old age a security. By the promise of these things, brutes have risen to power. But they lie! They do not fulfill their promise. They never will!

Dictators free themselves but they enslave the people!

Now let us fight to fulfill that promise! Let us fight to free the world! To do away with national barriers! To do away with greed, with hate and intolerance!

Let us fight for a world of reason, a world where science and progress will lead to all men’s happiness.

Soldiers, in the name of democracy, let us all unite!

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<![CDATA[AHRA Spring Conference]]>Mon, 08 Apr 2013 22:17:45 GMThttp://www.bernmedical.com/1/post/2013/04/ahra-spring-conference.html
Thursday April 11, 2013 I will be presenting  5 Tips for Creating Compelling Dashboards

Here is an overview:
Do you spend more time creating a report than analyzing the data? Does your organization use the same reports they did 5 years ago? Creating dashboards is an important part of being able to quickly understand data. The last few years have seen several advances in the visual display of quantitative information. We understand now more about how our brain and eyes can understand information. There are several new tools in the recent years that make reporting faster and less error prone. We will cover common dashboard pitfalls and explore new techniques. At the end you can take some practical advice with you on how to refresh and improve your reporting.

You will learn to:

  • Communicate what you are trying to say.
  • Measure against clear goals.
  • Keep reports simple.
  • Tell a clear visual story.

(To see the entire powerpoint presentation clicl "Read More")
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<![CDATA[Understanding Validation: A Way to Communicate Acceptance]]>Fri, 22 Mar 2013 17:31:22 GMThttp://www.bernmedical.com/1/post/2013/03/understanding-validation-a-way-to-communicate-acceptance.htmlA little out of the normal scope of what I blog about. But I wanted to share this article and also save it for later. Understanding Validation: A Way to Communicate Acceptance
One of the four options we have in any problem situation is acceptance. Validation is one way that we communicate acceptance of ourselves and others. Validation doesn't mean agreeing or approving. When your best friend or a family member makes a decision that you really don't think is wise, validation is a way of supporting them and strengthening the relationship while maintaining a different opinion. Validation is a way of communicating that the relationship is important and solid even when you disagree on issues.

Validation is the recognition and acceptance of another person's thoughts,feelings, sensations, and behaviors as understandable. Self-validation is the recognition and acceptance of your own thoughts, feelings, sensations and behaviors as understandable. 

Learning how to use validation effectively takes practice. Knowing the six levels of validation as identified by Marsha Linehan, Ph.D. will be helpful.

The first Level is Being Present. There are so many ways to be present. Holding someone's hand when they are having a painful medical treatment, listening with your whole mind and doing nothing but listening to a child describe their day in first grade, and going to a friend's house at midnight to sit with her while she cries because a supposed friend told lies about her are all examples of being present.

Multi-tasking while you listen to your teenager's story about his soccer game is not being present. Being present means giving all your attention to the person you are validating.

Being present for yourself means acknowledging your internal experience and sitting with it rather than "running away" from it, avoiding it, or pushing it away. Sitting with intense emotion is not easy. Even happiness or excitement can feel uncomfortable at times.

Often one of the reasons other people are uncomfortable with intense emotion is that they don't know what to say. Just being present, paying complete attention to the person in a nonjudgmental way, is often the answer. For yourself, being mindful of your own emotion is the first step to accepting your emotion.

The second level of validation is Accurate Reflection. Accurate reflection means you summarize what you have heard from someone else or summarize your own feelings. This type of validation can be done by others in an awkward, sing-songy, artificial way that is truly irritating or by yourself in a criticizing way. When done in an authentic manner, with the intent of truly understanding the experience and not judging it, accurate reflection is validating.

Sometimes this type of validation helps someone sort through their thoughts and separate thoughts from emotions. "So basically I'm feeling pretty angry and hurt," would be a self-reflection. "Sounds like you're disappointed in yourself because you didn't call him back," could be accurate reflection by someone else.

Level Three is Mindreading. Mindreading is guessing what another person might be feeling or thinking. People vary in their ability to know their own feelings. For example, some confuse anxiety and excitement and some confuse excitement and happiness. Some may not be clear about what they are feeling because they weren't allowed to experience their feelings or learned to be afraid of their feelings.

People may mask their feelings because they have learned that others don't react well to their sensitivity. This masking can lead to not acknowledging their feelings even to themselves, which makes the emotions more difficult to manage. Being able to accurately label feelings is an important step to being able to regulate them.

When someone is describing a situation, notice their emotional state. Then either name the emotions you hear or guess at what the person might be feeling.

"I'm guessing you must have felt pretty hurt by her comment" is Level Three validation. Remember that you may guess wrong and the person could correct you. It's her emotion and she is the only one who knows how she feels. Accepting her correction is validating.

Level Four is Understanding the Person's Behavior in Terms of their History and Biology. Your experiences and biology influence your emotional reactions. If your best friend was bitten by a dog a few years ago, she is not likely to enjoy playing with your German Shepherd. Validation at this level would be saying, "Given what happened to you, I completely understand your not wanting to be around my dog."

Self-validation would be understanding your own reactions in the context of your past experiences. 

Level Five is normalizing or recognizing emotional reactions that anyone would have. Understanding that your emotions are normal is helpful for everyone. For the emotionally sensitive person, knowing that anyone would be upset in a specific situation is validating. For example, "Of course you're anxious. Speaking before an audience the first time is scary for anyone."

Level Six is Radical Genuineness. Radical genuiness is when you understand the emotion someone is feeling on a very deep level. Maybe you have had a similar experience. Radical genuineness is sharing that experience as equals.

Understanding the levels may be easy. Putting them into practice is often more difficult. Practice is the key to making validation a natural part of the way you communicate.

Consider this example.Your best friend is upset because her husband cut up her credit card. She says he's treating her like a child and is so controlling she doesn't have room to breathe.When you ask her what his reason was, she says that she overspent or the fourth time, running the balance over the limit by buying expensive shoes and they were unable to pay the bill. How do you validate her? Remember to use the highest possible level. Think of your answer before you read further!

Probably Level 2 is the highest level you could use. You could say, "I understand, you are upset because your husband cut up your credit cards without your agreement--that made you feel like he was acting like your parent." You reflect her thoughts and emotions back to her, showing that you accept those feelings as her internal experience. 

You probably couldn't use Level 6 or radical genuineness as it's unlikely you could understand and authentically agree with her response as reasonable. Level 5, normalizing, would not work because most people would agree his response was reasonable and not be upset in that situation. There is nothing to make her response more understandable in terms of her history, so Level 4 is not possible. Level 3 is also not applicable because she's told her feelings clearly--nothing to guess.

Let's try another example. Jesse tells you she quit her job. She quit because her boss loudly criticized her in front of other people. She's asked him twice before to not embarrass her but he loses his temper easily. She felt afraid of him because he reminded her of a verbally abusive uncle and she couldn't continue to work for him. What level of validation do you use? 

Level 6 or Level 5 might work in this situation. If you have been in a similar situation or you really understand how she felt, you can validate her by saying, "I completely understand. I would have done the same thing." That would be Level 6. Level 5 would be, "I think most people would have felt the same way you did."

Though she has a history of being verbally abused, you don't use Level 4 because Level 5 fits. Always use the highest level possible. Level 4 would be to say, "Given your history of being verbally abused, I understand why you would quit." That's actually invalidating because anyone, whether they had a history of being verbally abused or not, would be upset if their boss humiliated them.

Joanna calls you and talks about her diet. She complains that she has eaten chocolate cake and other sweets and wants to eat more, but she doesn't want to gain weight. What level of validation can you use?

Level 3 would be a good choice. Joanna didn't mention any feelings though she is eating for emotional reasons. You could say, "Has something happened? My guess is you're upset about something." Then she might tell you that the cat she's had for six months died yesterday. At that point you could use a Level 5 or 6, depending on how you feel about losing a pet.

When Shawna was a teenager, she almost drowned in a large pond. She was a poor swimmer and swam out further than she realized. When she stopped swimming, her feet couldn't touch bottom and she swallowed water. She panicked and a friend swam to save her. Since that time she's been afraid of water. A neighbor invited her to a pool party. A guy who was flirting with her pushed her into the pool and she panicked, even though she was only in waist high water. She tells you that she's ashamed of her reaction and she hates being crazy.

Level 4 validation would work in this situation. "Given your history of almost drowning, of course you panicked when you were pushed into water. Anyone with a history of drowning would probably react the same way."

Emotional Invalidation

Emotional invalidation is when a person's thoughts and feelings are rejected, ignored, or judged. Invalidation is emotionally upsetting for anyone, but particularly hurtful for someone who is emotionally sensitive.

Invalidation disrupts relationships and creates emotional distance. When people invalidate themselves, they create alienation from the self and make building their identity very challenging.

Self-invalidation and invalidation by others make recovery from depression and anxiety particularly difficult. Some believe that invalidation is a major contributor to emotional disorders.

Most people would deny that they invalidate the internal experience of others. Very few would purposefully invalidate someone else. But well-intentioned people may be uncomfortable with intense emotions or believe that they are helping when they are actually invalidating.

In terms of self-invalidation, many people would agree they invalidate themselves, but would argue that they deserve it. They might say they don't deserve validation. They are uncomfortable with their own humanness. The truth is that validation is not self-acceptance, it is only an acknowledgement that an internal experience occurred. 

Verbal Invalidation 

There are many different reasons and ways that people who care about you invalidate you. Here are just a few.

Misinterpreting What It Means to Be Close: Sometimes people think that knowing just how someone else feels without having to ask means they are emotionally close to that person. It's like saying they know you as well as you know you, so they don't ask, they assume, and may even tell you how you think and feel.

Misunderstanding What it Means to Validate: Sometimes people invalidate because they believe if they validate they are agreeing. A person can state, "You think it's wrong that you're angry with your friend," and not agree with you. Validation is not agreeing. But because they want to reassure you they invalidate by saying, "You shouldn't think that way."

Wanting to Fix Your Feelings: "Come on, don't be sad. Want some ice cream?" People who love you don't want you to hurt so sometimes they invalidate your thoughts and feelings in their efforts to get you to feel happier.

Not Wanting to Hurt Your Feelings: Sometimes people lie to you in order to not hurt your feelings. Maybe they tell you that you look great in a dress that in truth is not the best style for you. Maybe they agree that your point of view in an argument when in fact they do not think you are being reasonable.

Wanting the Best for You: People who love you want the best for you. So they may do work for you that you could do yourself. Or they encourage you to make friends with someone who is influential when you don't really enjoy the person, telling you that that person is a great friend when it's not true. "You should be friends with her. She'll be a good friend to you."

There are also many different ways of invalidating. I've listed a few below.

Blaming: "You always have to be the crybaby, always upset about something and ruin every holiday." "Why didn't you put gas in the car before you got home? You never think and always make everything harder." Blaming is always invalidating. (Blaming is different from taking responsibility.)

Hoovering: Hoovering is when you attempt to vacuum up any feelings you are uncomfortable with or not give truthful answers because you don't want to upset or to be vulnerable. Saying "It's not such a big deal" when it is important to you is hoovering. Saying someone did a great job when they didn't or that your friends loved them when they didn't is hoovering. Not acknowledging how difficult something might be for you to do is hoovering. Saying "No problem, of course I can do that," when you are overwhelmed, is hoovering.

Judging: "You are so overreacting," and "That is a ridiculous thought," are examples of invalidation by judging. Ridicule is a particularly damaging: "Here we go again, cry over nothing, let those big tears flow because the grass is growing."

Denying: "You are not angry, I know how you act when you're angry," and "You have eaten so much, I know you aren't hungry," invalidate the other person by saying they don't feel what they are saying they feel.

Minimizing: "Don't worry, it's nothing, and you're just going to keep yourself awake tonight over nothing" is usually said with the best of intentions. Still the message is to not feel what you are feeling.

Nonverbal Invalidation

Nonverbal invalidation is powerful and includes rolling of the eyes and drumming of fingers in an impatient way. If someone checks their watch while you are talking with them, that is invalidating. Showing up at an important event but only paying attention to email or playing a game on the phone while there is invalidating, whether that is the message the person meant to send or not.

Nonverbal self-invalidation is working too much, shopping too much or otherwise not paying attention to your own feelings, thoughts, needs and wants.

 Replacing Invalidation with Validation

The best way to stop invalidating others or yourself is by practicing validation.Validation is never about lying. Or agreeing. It's about accepting someone else's internal experience as valid and understandable. That's very powerful. 

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<![CDATA[top 10 worst graphs]]>Thu, 21 Mar 2013 13:54:54 GMThttp://www.bernmedical.com/1/post/2013/03/top-10-worst-graphs.htmlGreat analysis on horrible visualizations. See entire analysis. here: Top 10 Worst Graphs
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<![CDATA[what do you want to know?]]>Thu, 21 Mar 2013 13:44:59 GMThttp://www.bernmedical.com/1/post/2013/03/what-do-you-want-to-know.htmlPicture
Are you asking the right questions? Are you exploring your data? 

Recently we explored the difference between radiology turnaround time from a couple of metrics. We were not content with just TAT average for the practice. 

Questions we asked: How does the TAT differ from an average over last 3 months? What is the trend by hours of the workday? Is there any difference in TAT by day of the week? What is the TAT for referring physicians? 

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<![CDATA[Understanding the job makes improvements easier]]>Sat, 09 Mar 2013 13:56:46 GMThttp://www.bernmedical.com/1/post/2013/03/understanding-the-job-makes-improvements-easier.htmlGreat, quick video from Clayton Christensen on understanding the job your customer wants to accomplish.
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