Nassim N. Taleb has written two of the most influential books of our time, "Fooled by Randomness" and "Black Swan". Here is a short bio: Nassim Nicholas Taleb is a Lebanese-born essayist, scholar and former practitioner of mathematical finance. He is best known as the author of the 2007 book (completed 2010) The Black Swan.  Taleb has had three distinct careers, built around what he calls “epistemic limitations and constraints”: probability, uncertainty and the fragility of human knowledge, which he packaged as the theory of Black Swan Events. First, he is a bestselling author with 2.7 million copies sold in 31 languages.  Second, he is a university professor in Risk Engineering (Distinguished Professor), a scholar, an epistemologist and a philosopher of science. Finally, he is a former senior Wall Street trader, risk expert, and practitioner of mathematical finance. (bio via

Mr. Taleb is currently writing a book about Anti-Fragility. Below is chapter 4 from the manuscript. I highly recommend reading below and his published books. His books help explain on a macro scale what is happening in the world economy and leads to greater understanding in micro events in life.

While I am sure I don't understand all of his thoughts in his previous books, I do understand enough to see how these theories impact Bern. In radiology we can work on eliminating steps, improve workflow and create a revenue cycle that is almost perfect. Where there should be no issues. We may develop software interfaces to transfer information. This is an improvement on what we had before. But, this causes us to be blind when errors occur. We expect the process to be perfect and it isn't. When a disruption occurs in the process it may not be recognized. There are so many things in the process that can go wrong. It probably doesn't fall on the billing department or 3rd party billing company because no one else would have caught it.

Think of it this way. In a living room there are so many ways to organize all the items. The couch, the carpet, the rug, the walls, the coffee table, the lamps, the pictures, the books, the clock, the pillows etc.... As we come into the room we bring more things. A plate, a cup, all the clothes we are wearing, bag and its contents etc... there are only a few ways in which the room can remain clean and ordered. But almost an unlimited number of options for them to be unordered.

What Bern is looking for in radiology is anything that is unordered and we get to look for 12-18 months. The fact that errors exist is more a reflection of the complex environment and not on the competency of the people or systems involved. Again, the fact that improvements can be continuos, reflects the complexity and not the competency. There will always be errors and there will always be ways to improve.


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