Michigan Urology Surgical Improvement Collaborative, or “MUSIC”
Recently, I was asked to give a presentation to the West Michigan Urology Association on the Michigan Urology Surgical Improvement Collaborative, also known as “MUSIC.” Approximately 90% of urologists in the state of Michigan actively participate in MUSIC, and submit their outcomes data to a central registry. Data from the registry is then analyzed at regular physician meetings to find opportunities where patient care can be improved. The program is sponsored by Blue Cross Blue Shield of Michigan.
“We want Michigan to be the best place in the world for patients to receive prostate cancer care.”
– Dr. David Miller, Director, MUSIC
One of the biggest challenges for well-intentioned groups is to create a process in which they can make decisions that have the best possible outcome. German philosopher Friedrich Nietzche, noted:
“Madness is the exception in individuals, but the rule in groups.”
The question then becomes, what is the best process for groups, like MUSIC, to use and obtain the desired outcome? Much has been written over the years in the leadership literature on this topic. As a urologist and amateur beekeeper, I recently learned some interesting facts about the processes used by bees to make critical group decisions.
It’s spring in Michigan, and this time of year, it is not uncommon to see groups of thousands of bees gathering together and forming swarms. Once a swarm has formed, it sends out hundreds of scout bees to search for a new home. The scout bees are searching for potential new nesting sites with very specific attributes.
Ideally, the bees’ new home will be in a tree, preferably facing south, with a small entrance. In addition, scout bees search for a location with easy access to water, flowering plants, and sufficient room for the colony to raise its young.
Scout bees are sent out to evaluate hundreds of possible locations. They return back to the swarm where they communicate their findings.
Evolution of Decision-Making
When bees choose to swarm, they are exposed and vulnerable. Finding the best possible nesting site is critical to their collective survival.
Nature is the Great Sculpture. It has hammered and chiseled on honeybees for millions of years so that they can optimally survive within their environment. So, after countless milennium, how does the swarm decide, from a multitude of options, what will be their future home? Do the bees await an edict from the Queen, form a consensus, decide by quorum, cast and count votes, or make a decision by some other mechanism?
Achieving a Quorum
Several elegant studies have recently reported the decision-making method honeybees use to choose a new home. Bees can communicate the location of floral sources and potential nesting sites with one another using a waggle dance. After a scout bee investigates a potential new nesting site, it will return to the swarm and communicate its location with the waggle dance. A scout bee also has the ability to communicate with the swarm its enthusiasm for the site in the number of times she performs the dance.
Scout bees that are excited about a site dance repetitively, whereas scouts that have found average or unfavorable sites, dance less repetitively. As the ideal site gains more and more visitors, more and more bees return to the swarm dancing in favor of that particular site. Over time, the dances in favor of the ideal site increase exponentially within the body of the swarm.
Studies have shown that when a single site has attracted more than fifteen bees at any given time, the bees within the swarm sense a quorum and begin preparations to move to the new site.
In making use of the quorum, bees investigate a wide variety of solutions to a given problem and encourage open competition of each option. The swarm makes optimal use of the independence, experience, and knowledge of each of its members. Individual opinions are aggregated in such a way that the breadth of knowledge within the group is leveraged, and a decision can be made in a timely manner.
MUSIC – A Swarm of Urologists
Working together over millions of years, bees have adopted the quorum-sensing, decision-making model to find answers to problems with numerous possible solutions.
Humans, over the centuries, have developed a variety of different methods groups can use to make decisions. Depending upon the situation and the participants, some of these methods work better than others.
As urologists, working together in Michigan, it’s important that we understand and consider the decision-making processes most likely to help us obtain the answers we are searching for on behalf of our patients.
The quote by Friedrich Nietzsche and research on bee behavior came from a very interesting article in American Scientist titled, “Group Decision Making in Honey Bee Swarms” by Kirk Visscher, Thomas Seeley, and Kevin Passino.