Category Archives: management and leadership

health market quality, healthcare, healthy habits, management and leadership, policy, politics, rapid learning health systems

Polypill Barriers

 

https://www.mja.com.au/insight/2014/16/polypill-barriers-remain

Polypill barriers remain

Nicole MacKee
Monday, 12 May, 2014
Polypill barriers remain

BARRIERS to the global availability of a polypill to prevent cardiovascular disease remain despite growing evidence of its clinical potential, according to former BMJ editor and long-term advocate of the polypill, Dr Richard Smith.

Dr Smith, who was in Melbourne last week to attend the Cardiovascular Combination Pharmacotherapy Global Summit, in conjunction with World Congress on Cardiology, said momentum was starting to gather with growing evidence of increased adherence and clinical benefit with the polypill — a fixed-dose combination of commonly used blood pressure and cholesterol-lowering medications, and aspirin.

“But in terms of actually getting it made available to lots of people, the progress is fairly slow because, although the big drug companies are the people who know how to get a drug on the market, they’re generally not interested”, Dr Smith told MJA InSight.

Dr Smith, director of the Ovations Chronic Disease Initiative, welcomed findings from the Single Pill to Avert Cardiovascular Events (SPACE) project that showed the polypill was associated with a 43% boost in patient adherence to medication at 12 months. (1) (2)

“That’s tremendously dramatic”, he said, of the research that was presented at the cardiology congress. “Generally, if you have people taking treatment for life … after a year [of starting therapy], you’ve only got about 50%̄60% of people [still] taking the treatment, so anything that can increase adherence is really important.”

The SPACE project, led by researchers from the George Institute for Global Health, analysed data from three clinical trials involving 3140 patients, including the Kanyini-GAP trial in Australia. (3)

Dr Ruth Webster, of the George Institute, said the polypill’s capacity to prevent cardiovascular events was “potentially massive”.

“In Australia, 50% of people who should be taking these combination medications don’t take them”, she said. “Globally at least 90% of people in lower income countries who would potentially benefit from these medications are not taking them.”

Dr Webster said the affordability of the polypill could ensure that its benefits were felt in low- as well as high-income nations.

“One of the key aims of the polypill has always been … to make it cheap so that patients can afford it”, said Dr Webster, adding that governments and health care organisations could use their buying power to ensure a cheap and effective pill was available globally.

Although a polypill is available in some Latin American and Asian countries, the UK, the US and Australia do not yet have one on the market.

Dr Webster said the George Institute was actively involved in efforts to have a polypill made available in Australia.

Dr Smith said that Iran was trialling providing the polypill to everyone over the age of 50 years who had at least one risk factor for cardiovascular disease. “The future is going to come not from Australia or Britain or the US, but from these kinds of countries, where … there’s much more to gain … as there are many people not being treated [at all]”, he said.

In addition to regulatory hurdles, cardiologists were also a barrier to polypill development, said Dr Smith, who recently wrote about the key barriers to polypill uptake in his BMJ blog. (4)

“[Cardiologists] think … that constantly titrating the drugs you give people, measuring their blood pressure regularly and their lipids … is a better way of doing things. But the problem is that we have this famous rule of halves — of all of the people at risk, half are not diagnosed; and of the half that are diagnosed, half are not treated; and the half that are treated, are not treated adequately”, he said. “So you end up with a very high proportion of people who are at risk who are not getting good treatment.

“The strongest argument for the polypill is how bad things are at the moment. Not just in low- and middle-income countries where, on the whole, they are terrible, but also in high-income countries because a lot of people are not getting adequate treatment.”

Dr Smith said the polypill had also faced opposition from public health experts concerned that giving people such a pill would discourage improvements in lifestyle and diet.

“But I think that’s a myth that’s been laid to rest because in three trials that have looked at lifestyle, people on the polypill don’t get fatter, they don’t smoke more, they don’t eat unhealthier diets”, he said.

1. Nature 2007; 450: 494-496
2. George Institute for Global Health: SPACE Project
3. BMC Public Health 2010; Online 5 August
4. BMJ Blogs 2014; Online 1 May

 

health market quality, healthcare, healthy habits, management and leadership, policy, politics, quotes & aphorisms, rapid learning health systems

Peter Baume on Money in Medicine

Former senator, doctor and colleague, Professor Peter Baume, used to say that:

“matters of principle usually turned out in politics to be matters of money, while matters of high principle usually turned out to be matters of lots of money.”

He could have been talking about matters of health policy.

Quoted by Steve Leeder

https://www.mja.com.au/insight/2014/16/stephen-leeder-policy-means-people

 

Stephen Leeder: Policy means people

Stephen Leeder
Monday, 12 May, 2014
Steve Leeder

SHOULD we pay more from our pockets for health care and less from the public purse?

What current institutions in health can we do without? Should prevention be a major concern of government or should it be left to the individual?

These questions should be addressed by a national government elected to oversee — among many things — the health of the nation.

Much health care in Australia is paid for from taxes. A long history explains why this is so, much of it expressing humane concern for people who are sick and assuring access to care for those who are not so well off financially.

Our politicians have choices — they can leave the health system as it is or they can try to change it by changing the underpinning policy. In seeking to make change they inevitably provoke the interest of those who stand to lose or gain as a result — doctors, nurses, patients, managers, insurers, pharmaceutical companies and many others.

So, whether they leave the system mostly in place and merely fiddle, or propose branch and root changes, politicians are engaging in policy decisions whether they recognise it or not (policy in this case being deciding how to apply resources available for health care).

These policy decisions affect people’s lives and are not trivial. For example, increasing theprivatisation of health care, as has been proposed in Queensland, carries costs for those least able to pay.

The more privatised the system, the less the needs of the poor and the marginal are met. This in turn means that society is changed and the values that it expresses — a fair go for all and concern for the weak — are hammered in the promotion of profit.

The results of a two-tiered health system are rapid access to quality care for the rich, who pay privately, and inferior care with long waiting times for the poor through a publicly funded safety net, a system well known in less developed countries.

Because it involves money, the health policy debate occurs in the context of other public policy discussions, most notably those that have to do with the Budget. Former senator, doctor and colleague, Professor Peter Baume, used to say that matters of principle usually turned out in politics to be matters of money, while matters of high principle usually turned out to be matters oflots of money. He could have been talking about matters of health policy.

As the word implies, policy has to do with the polis — the people. In a democracy the people expect their voices will be heard, alongside those of experts in health, the financial controllers and other interest groups. They also expect that changes to the system are canvassed with them before being announced and that they have a chance to have their say.

Optimally, a competitive, comprehensive statement of intent for health care would be provided by contestants for our vote at each election. This did not happen at the last federal election and we have not been canvassed about proposed changes.

Instead we have been bombarded in the past few weeks by government and the media about proposed cuts in tomorrow’s federal Budget, rumours of extinctions (eg, the Australian National Preventive Health Agency and Medicare Locals), increased costs to visit GPs and nothing much about our public hospital system.

It would be healthy if tomorrow’s Budget acknowledged the need for people-based health policy.

We should be presented with options that emanate from clear-headed policy thinking as well as a sound budget. The publication recently of the National Commission of Audit report is not reassuring. It focuses heavily on the supply side of the cost equation for health care but does not provide any insights into what can be done to achieve real efficiency through structural change. Instead, we just hear about rising charges through copayments and by forcing high-income earners out of Medicare and into private insurance schemes.

How to achieve more efficient (and generally more effective) care is left unconsidered. For example, in the Western Sydney Local Health District in the past 2 years, we have cut millions of dollars from our recurrent budget with an 8% increase in activity by attending to contracting, procurement and not using expensive part-time staffing from a budget of a mere $2.4 billion.

Let’s have less haste and hysteria, and more speed towards an efficient and humane health system, thank you.

 

Professor Stephen Leeder is the editor-in-chief of the MJA and professor of public health and community medicine at the University of Sydney. He chairs the Western Sydney Local Health District Board.

business, management and leadership

McKinsey: Characteristics of high-performing boards

Reasonable review of board activities, aspirations and impact…

PDF: High-performing_boards_Whats_on_their_agenda

http://www.mckinsey.com/insights/strategy/High-performing_boards_whats_on_their_agenda

High-performing boards: What’s on their agenda?

Directors report that they have a greater impact as they move beyond the basics.

April 2014 | byChinta Bhagat and Conor Kehoe

Five or so years after the financial crisis, the pressure on boards and directors to raise their game remains acute. A recent survey of more than 770 directors from public and private companies across industries around the world and from nonprofit organizations suggests that some are responding more energetically than others.1 The survey revealed dramatic differences in how directors allocated their time among boardroom activities and, most tellingly, in the respondents’ view of the effectiveness of their boards. More than one in four of the directors assessed their impact as moderate or lower, while others reported having a high impact across board functions. So what marks the agenda of a high-performing board?

A hierarchy of practices

Our research suggests that the distinction between higher and lower impact turns on the breadth of the issues directors tackle and on the time dedicated to them. We drilled down to detailed board practices across the functions to which directors devote much of their attention: strategy, compliance, and M&A, as well as performance, risk, and talent management. It appears that boards progress through a hierarchy of practices that’s analogous to Maslow’s hierarchy of needs.2Directors who report having a low to moderate impact said that their boards undertake “the basics” of ensuring compliance, reviewing financial reports, and assessing portfolio diversification, depending on the function. Directors reporting that their boards have a higher impact undertake these activities, as well, but add a series of other practices in every function.

In the area of strategy, for example, this means becoming more forward looking. Boards with a moderate impact incorporate trends and respond to changing conditions. More involved boards analyze what drives value, debate alternative strategies, and evaluate the allocation of resources. At the highest level, boards look inward and aspire to more “meta” practices—deliberating about their own processes, for example—to remove biases from decisions (Exhibit 1).

Exhibit 1

Boards appear to progress through a hierarchy of practices, with high-impact boards often employing more rigorous practices.

 

We observed a similar hierarchy across other board functions. In performance management, for instance, many boards start with a basic review of financial metrics. More involved boards add regular performance discussions with the CEO, and boards at still higher levels of engagement analyze leading indicators and aspire to review robust nonfinancial metrics. In the areas of risk, M&A, and talent management boards follow comparable progressions. (For more, see “Building a forward-looking board.”)

A greater time commitment

Working at a high level takes discipline—and time. Directors who believe that their activities have a greater impact report spending significantly more time on these activities, on average, than those who serve on lower-impact boards. We found that directors reporting that they had a very high impact worked for their boards about 40 days a year, while those who said that their impact was moderate or lower averaged only 19.3 Higher- and lower-impact directors spend the same amount of time on compliance-related activities: about four days a year. By contrast, higher-impact board members invest an extra eight workdays a year on strategy. They also spend about three extra workdays on each of the following: performance management, M&A, organizational health, and risk management (Exhibit 2).

Exhibit 2

Board members with very high impact invested eight extra workdays a year on strategy.

The data suggest that less engaged boards correctly identify the next step up in the hierarchy but underestimate the time it would take to meet this aspiration. When low- to moderate-impact directors are asked how much time they ideally should spend on their duties, they suggested increasing the number of days to 27, from 19. While spending more time can never assure a high impact (see sidebar, “What surveys can and can’t tell us”), even very high-impact directors would increase their commitment to 45 days, from 40.

 

Sidebar

What surveys can and can’t tell us

 

A final implication of our survey is that CEOs need not fear that a more engaged board may constrain their prerogative to set a company’s direction. Highly committed boards are not spending the extra time supplanting management’s role in developing strategic options. Rather, they are building a better understanding of their companies and industries, while helping senior teams to stress-test strategies and then reallocate resources to support them. Some CEOs find that task to be lonely and difficult when they face internal “barons” who protect their fiefs. In short, engaged boards can still be supportive of management. And the directors serving on them, our research suggests, are not only more effective but also more satisfied with their work.

About the authors

Chinta Bhagat is a principal in McKinsey’s Singapore office, and Conor Kehoe is a director in the London office.

The authors would like to acknowledge the contributions of Frithjof Lund and Eric Matson to the development of this article.

healthcare, management and leadership, policy, politics, quotes & aphorisms

LNL: Wilful Blindness

touches on medical establishment and effect of medical school hidden curriculum on medical students leading to very poor patient care.

Also references Steven Bolsin and his impact on the NHS…

Face value isn’t very valuable.

How do things affect the least powerful people in a system.

The story of Cassandra.

http://www.abc.net.au/radionational/programs/latenightlive/wilful-blindness/2926516

Wilful Blindness

Monday 25 July 2011 10:40PM
Eye of the storm: Rupert Murdoch in LondonIMAGE: EYE OF THE STORM: RUPERT MURDOCH IN LONDON (REUTERS: LUKE MACGREGOR)

Were the Murdochs ‘wilfully blind’ to the practice of phone hacking at the News of the World?

 

Guests

Margaret Heffernan
Visiting professor and entrepreneur-in-residence, University of Bath. Columnist with the Huffington Post.

Publications

Title
Wilful Blindness: Why We Ignore the Obvious At Our Peril
Author
Margaret Heffernan
Publisher
Simon and Schuster

Credits

Researcher
Stephen Crittenden

Comments (7)

Add your comment


  • Peter Houston :

    26 Jul 2011 5:51:02pm

    Good segment on ‘wilful blindness’ – it reminded me of Barbara Tuchman’s ‘cognitive dissonance’. How about a follow-up on the psychological profile/dimensions of wilful blindness and related phenomena? What makes it tick?

    Reply Alert moderator


    • Mulga Mumblebrain :

      27 Jul 2011 4:21:06pm

      ‘Willful blindness’ seems to me to be a mealy-mouthed euphemism for rank untruthfulness, a sort of ‘innocent on the grounds of insanity’ defence.

      Alert moderator


  • marsha :

    26 Jul 2011 8:42:39pm

    And you must remember that Allan Bond had Alzheimers. I wish he’d share his cure with rest of us.

    Reply Alert moderator


  • Mulga Mumblebrain :

    27 Jul 2011 4:19:29pm

    A relative who worked on the News Corpse switchboard in Surry Hills years ago well remembered Rupert’s habit of periodically ringing from New York to have that day’s edition of ‘The Fundament’ (known then as The Australian) read to him, from front to back. A real ‘hands-off’ proprietor! What we witnessed in the UK Parliament was, in my opinion, a tour de farce of deception, and an Oscar performance from Rupe as a demented old codger who didn’t know what was going on. Already parts of James’ testimony have been utterly refuted by former senior News Corpse functionaries. Rupe was more cagey, and possibly has set James up, along with Rebeckah and Hinton, as ‘patsies’.

    Reply Alert moderator


  • Simon Barlow :

    27 Jul 2011 4:43:30pm

    I thought the piece on ‘wilful blindness’ was a segue leading from the European right-wing terror story. Like Philip expressed, we all find the rising tide of xenaphobia, and anti-Muslim sentiment in Europe (and to some extend in Australia) worrying, but aren’t we kidding ourselves? The clash of cultures, so vastly different are bound to result in this reaction, and we are ‘wilfully blind’ and courting disaster if we ignore it.

    Reply Alert moderator


  • David from Leichhardt :

    28 Jul 2011 7:25:03am

    Regarding the story on “wilful blindness” I was interested in the notion that many of us refuse to listen to views that we do not agree with. You and your guest chastised us for “having our heads in the sand” about the panoply of of views surrounding an issue. I think that what is missing here is the role of “discernment”.

    I enjoy listening to LNL and consider myself much better informed for it. I will not listen to John Laws or Alan Jones. Should I be criticized for not giving them a fair go at informing me of their points of view? I think not.

    For that matter I must tell you that when Mr Abbott is being interviewed on the news I turn down the volume because I cannot bear listening to him. Does this make me “wilfully blind” to his point of view and policies? Can you be “wilfully blind” when there is, in truth, nothing there to see?

    Reply Alert moderator


  • Lyall St Kilda :

    28 Jul 2011 7:48:19pm

    Mr Adams listen back to your show where you interview the biographer Manning Clark. Perhaps the scales will fall from your eyes.

management and leadership, politics

Geraldine: Too Much Competition

 

From the author of Willful Blindness…

http://www.abc.net.au/radionational/programs/saturdayextra/too-much-competition/5436642

Too much competition

Saturday 10 May 2014 8:10AM
competitionIMAGE: PECKING ORDER (JASON ROSENBERG (FLICKR.COM))

Studies of chickens have given way to the phrase the pecking order. Each chicken knows where it stands amongst other chickens and the head chicken, the despot, gets to eat first and has the right to peck all the other chickens. The poor chicken at the bottom though is pecked constantly but gets to peck no-one and suffers highly from stress.

But even in the chicken yard, revolutions occur as younger chicks are placed with the older ones and the despot could be toppled from the highest order at any time.

Another study on chickens shows what happens when you take the top producing hens and place them in a separate area to the average producing hens. Over time, the average hens have increased their production and are healthy and functioning. The ‘super-hens’ have all but killed each other and the ones remaining are harassed.

What lessons in life do these chicken studies have for us as we live in our ever increasing competitive world?

Guests

Margaret Heffernan
Chief executive, author and playwright

Publications

Title
A bigger prize: why competition isn’t everything and how we do better
Author
Margaret Heffernan
Publisher
Simon & Schuster

Further Information

Margaret Heffernan

Credits

Presenter
Geraldine Doogue
Producer
Kate MacDonald
management and leadership

Geraldine on Wily Leadership – Dag Hammarskjold

Terrific interview on wily leadership, wrapping up problems like a spider so they become invisible etc..

http://www.abc.net.au/radionational/programs/saturdayextra/dag-hammarskjold/5439912

Dag Hammarskjöld

Saturday 10 May 2014 8:25AM
HammarskjoldIMAGE: (BY DANO (FLICKR))

Saturday Extra looks to a model of political wisdom in the life of Dag Hammarskjöld, a Swede who led the UN from 1953 to 1961.

He was a deeply spiritual man; he pioneered the use of peace keeping forces and championed a kind of diplomacy that is at odds with much contemporary practice.

He eschewed the idea of diplomacy as a game of one upmanship and believed instead in what he called the fundamentals of good negotiation – careful preparation, truthfulness, precision, patience, impassivity and modesty.

He is the only person to have been awarded the Nobel Peace Prize posthumously, also the only head of the UN to die in office, in a plane crash in central Africa.

Guests

Roger Lipsey
Author

Publications

Title
Dag Hammarskjold: A Life
Author
Roger Lipsey
Publisher
University of Michigan Press
Description
biography

Credits

Presenter
Geraldine Doogue
Producer
Kate Pearcy
business, data saving lives, entrepreneurship, management and leadership

Saturday Extra (Norman Swan): Retail Wars // Big Data Play

Robert Gottleibsen on Woolies vs Coles retail strategy, including commentary on Wollies big data play

http://www.abc.net.au/radionational/programs/saturdayextra/supermarket-wars/5397006

Retail wars

Saturday 3 May 2014 7:50AM
Creative: Generic online shopping (Thinkstock: Ablestock.com)IMAGE: CREATIVE: GENERIC ONLINE SHOPPING (THINKSTOCK: ABLESTOCK.COM)

The supermarket giants Coles and Woolworths have reported sales results that put them virtually neck and neck in the war for our trolleys and our wallets.

The battle for supremacy has been going on for five years, with Coles taking the lead since it was acquired by the Wesfarmers group in 2007.

But even with the retailers drawing closer in terms of results, there are some stark differences in business strategy that are being played out.

file note, health market quality, healthcare, management and leadership, musings, policy, politics, rapid learning health systems

PHI dysfunction starting to gel…

Email from me to Anne-marie regarding PHI and Commission of Audit ideas…

Thanks Anne-marie… last week was so busy, but at least it was a good busy, filled as it was with so many excellent events and conversations, quite often featuring you! Glad to hear that the club delivered on expectations… maybe Steve will be up for some insurrection? Or maybe not.

[the following early morning rant is off-the-record on account of my current employment and it still being a bit rough, but am happy to explore it further with you as required J]

On the modelling question, that’s more on the economic modelling side – something we’re tooling up for with Federico Girosi and Jane Hall, but haven’t quite started on. Ian McAuley and John Menadue have been presenting solid thinking about PHI for a while and would be worthwhile speaking with, particularly if you were looking to confirm your suspicions? Off the top of my head, I can’t think of anyone who could actually back-in the COA’s assumptions, as I’ve never heard anyone credible (with the potential exception of Paul Gross – though unsure how credible he is) put forward that point of view, mainly because it is ideologically driven, rather than evidence based. Indeed, the closer I get to the PHI data, the PHI businesses and the people who run them, the more certain I am that PHI can only ever be inflationary – especially when positioned as a duplication of a public insurance scheme (as per that graph from the SMH that Jim Gillespie spoke to at the event last week), as it allows clinicians to select whichever system suits their interests best, making them the customer rather than the patient.

My back-of-envelope rationale:

PHIs market themselves as honest brokers in the health system, but in reality, benefit directly from health inflation, acting as hemi-bureaucracies which take a 13% clip of disbursements that pass through them. In Australia, this dynamic is emphasised by their mutual structure, as the lack of profit motive leads to a lack of interest in containing anyone’s costs, especially when the Minister mandates premium increases based on demonstration of increased costs!!?? The smaller PHIs have no market power, so aim to please hospitals and doctors, thus making providers the customers, rather than their patients. This all has the effect of distancing patients from value the market generates, despite the fact they are the ones who fund it. I can’t think of a more diabolical arrangement than the one we’ve got. I’m disappointed that conservatives are willing to trade this downside for the illusory benefits of choice (which don’t actually exist because the basis on which we might choose are health service have nothing to do with the quality of that service). In reality, the choice argument is just a smoke screen for queue jumping, something conservatives aren’t to keen on when it came to asylum seeker policy.

As a footnote, it’s interesting to see the behaviour of the non-mutual PHIs – Medibank and NIB. They tend to be far more innovative and disruptive towards conventional health service models, mainly in an attempt to position themselves as the customers served by doctors and hospitals, while still being funded by their members. Unfortunately, their business model still ultimately relies on cost containment AND premium growth, and so also ends up also being inflationary – the main reason the US is the situation it’s in.

Wrapping the diatribe up, ideally a health market should be singularly focused on improving the health of the population that funds it. I’d estimate the current ranking of value captured by various actors looks something like this:

  1. insurers
  2. hospitals
  3. bureaucrats
  4. politicians
  5. doctors
  6. patients
  7. nurses
  8. allied health professionals

Under the previous administration, it probably looked more like this:

  1. bureaucrats
  2. politicians
  3. insurers
  4. doctors
  5. hospitals
  6. nurses
  7. patients
  8. allied health professionals

Ultimately, all forms of private health insurance make the providers the customers while the population carries the can. Interventions which position the population as customers should be the preference. Medicare was a big, necessary but not sufficient step in that direction.

I reckon some of this can inform some interesting health market design that could support a far more advanced and efficient health system. We’ve previously discussed that we’ve got 6 years to bring this to maturity, though if things keep tracking like they have been, it could be sooner.

Let me know your thoughts?

Cheers, Paul

 

From: Anne-Marie Boxall [mailto:ABoxall@ahha.asn.au]
Sent: Monday, 5 May 2014 6:08 PM
To: Paul Nicolarakis (paul.nicolarakis@outlook.com)
Subject: Modelling

No, not the fashion kind (although I am sure you would be great).

A curiosity question – are you and your people able to model something along the lines of the means-tested Medicare scheme proposed by the Commission of Audit? Not sure what data you have, or what is needed to model such a proposal, but it strikes me that the idea rests heavily on the assumption that a market for health insurance would drive down health costs (hospital and primary care and therefore premiums prices). Not quite sure what evidence underpins this assumption (other than economic theory) as Fraser era experiment suggests that it would not work. Just wondering….

Hope you made it to your many subsequent events last week. Dinner at the gentleman’s club was interesting. I think they might also have an age criteria for membership there. 70 plus only.

Regards,

Am

 

 

Dr Anne-marie Boxall
Director, The Deeble Institute for Health Policy Research
Managing Editor, Australian Health Review

Australian Healthcare & Hospitals Association
the voice of public healthcare

T: 02 6162 0780 | F: 02 6162 0779
Post: PO Box 78, Deakin West, ACT 2600
Location: Unit 8, First Floor, 2 Phipps Close, Deakin West, ACT
E:aboxall@ahha.asn.au
W: www.ahha.asn.au
Twitter: @DeebleInstitute

 

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entrepreneurship, management and leadership

rude sales people make you buy luxury goods

 

http://www.psmag.com/navigation/health-and-behavior/condescending-salespeople-make-buy-fancy-things-80452/

QUICK STUDIES

bags

Rude Salespeople Make You Buy Fancy Things

BY PAUL BISCEGLIO • April 30, 2014 • 4:53 PM

(Photo: Karkas/Shutterstock)

Being snubbed by a luxury store only increases your desire for its goods, according to a new study.

•

If you venture into high-end stores like Gucci or Burberry on shopping trips, you probably know their salespeople aren’t famous for their kindness.

“When I went to Louis Vuitton … the salesgirls were so [unfriendly]—I could not believe it,” writes a commenter on The Fashion Spot. “I was just dressed normally … and when I walked in they stopped talking and stared at me. It was like walking into a freezer, they were so cold towards me.”

“Social rejection motivates individuals to conform, obey, change their attitudes, work harder and generally try to present themselves in a favorable manner in order to gain acceptance.”

In a forthcoming study in theJournal of Consumer Research,Morgan Ward of Southern Methodist University and Darren Dahl of the Sauder School of Business use this quote to highlight an unsettling discrepancy between how we want salespeople to act and what actually gets us to buy things.

It’s no secret that salespeople at upscale shops can be a little snobbish, if not outright rude, the researchers note. Consumer complaints recently have pressured some luxury retailers to train their staffs to be more approachable; Louis Vuitton even went as far as decorating the entrance of its Beverly Hills store with a smiling cartoon apple in 2007. But if luxury retailers want to continue to rake in the dough, they actually should do the exact opposite, the study found. The ruder the salesperson the better.

In four online surveys, Ward and Dahl had participants imagine interactions with different types of salespeople under a bunch of different conditions. Variables included the imagined store’s level of luxury, the extent of the salesperson’s haughtiness, how well the salesperson represented the store’s brand, and how closely participants themselves related with the brand. The results:

  • Rejection makes people want to buy luxury goods. A salesperson’s condescending attitude has little effect on consumers’ desire to buy more affordable brands like Gap and American Eagle, though.
  • Rejection is stronger when salespeople convincingly embody brands in the way they act and dress. Sloppy salespeople aren’t as intimidating. 
  • People who really want to own a particular brand are even more influenced by rejection. Instead of switching their loyalties, customers just become more attached.
  • Rejection works best in the short term. While great at pressuring people into buying something in the moment, dismissive staff may still alienate customers in the long run.

The results fall into a long line of research that demonstrates the extent to which rejection can jar our fragile self-conceptions. “People have an innate need to belong to social groups that define and affirm their identities,” the researchers write. “Social rejection motivates individuals to conform, obey, change their attitudes, work harder and generally try to present themselves in a favorable manner in order to gain acceptance.”

The next time you’re snubbed, maybe wait a day or two before any big purchase. Or just shop online, Ward and Dahl recommend. “While many customers may purchase online for convenience, shopping online also may enable customers to avoid threatening encounters with intimidating salespeople,” they conclude.

Fellow Paul Bisceglio was previously an editorial intern at Smithsonianmagazine and a staff reporter at Manhattan Media. He is a graduate of Haverford College and completed a Fulbright scholarship at the University of Warwick in Coventry, United Kingdom. Follow him on Twitter @PaulBisceglio.