Sensing Auditory Evoked Potentials

Protecting Against Tinnitus With Big Data

Thomas Rouse - Senior Consultant, Medical & Healthcare

By: Thomas Rouse
Senior Consultant, Medical & Healthcare

30th August 2017

We are being continuously monitored in our daily lives; from search engines tracking browsing habits, shops analysing purchases via loyalty cards or online accounts, and social media targeting adverts based upon our friends, conversations, and activities. While we may accept this as the cost of entry to the modern world, few would deny that it is evocative of a dystopian, Big Brotheresque hierarchy, where the monitoring is unlikely to be for our benefit. Health monitoring may be a nobler goal, however even a seemingly altruistic project, DeepMind’s collaboration with the Royal Free London NHS Foundation Trust to reduce preventable deaths from acute kidney incidents, has fallen foul of the public perception and the Information Commissioner’s Office.

There is a lot of excitement about data-driven health innovation, especially where the data can be collected automatically, and potentially uploaded or aggregated. This could allow for improved outcomes, more accurate diagnoses, early warning of conditions, advanced recovery monitoring, fewer hospital visits, and ultimately revolutionise the understanding and treatment of many diseases and conditions.

We have developed a wonderful technology which is able to automatically provide detailed characterisation of a user’s auditory system by detecting electrical signals from the cochlea and auditory brainstem. No more user interaction is required other than putting on a set of headphones, and no clinical supervision is necessary. It can detect permanent or temporary changes, and, with regular use at home or work, provide early warning of the onset of hearing loss and tinnitus.

The applications are driven by who wants to use the data, and why. The technology was originally developed to allow employers more cost effectively and conveniently meet their health surveillance duty, under the ‘The Control of Noise at Work Regulations. Workers with high levels of noise exposure need to have regular audiometric tests. It may be disruptive or impractical to send staff to a testing centre. There are also requirements after the tests have taken place. The purpose of the regulations is to protect workers, and if an issue is detected, action should be taken to prevent further damage.

The employer must also keep health records of the outcome of the surveillance; however, these cannot contain any confidential medical records. With our technology, these tasks can be automated without any need to leave the workplace. Beyond compliance, there is also a potential upside for the employer if testing can be made before and after each shift. In a case of litigation relating to hearing loss, it is likely that it could be shown whether the damage occurred inside or outside of work hours.

Individuals may be concerned about their own or their loved one’s hearing. Building the technology into consumer headphones was also one of the original motivations. For example, a smartphone app would be able to take regular snapshots of a user’s hearing and alert them or a parent if there is any change, long before symptoms become apparent.

Medical trials of drugs which may have a side effect of tinnitus would be able to use the technology to objectively monitor and record the state of the auditory system instead of having to rely on the subject’s subjective assessment.

Perhaps most interestingly of all, the data could allow the technology itself to improve. This double-edged information sword needs to be handled carefully. It is essential that no-one feels their data has been abused, so this needs to be balanced with the potentially significant benefits. The signal we record was previously only obtainable by an expert practitioner in a clinic, so comparative studies over time are limited. Long term data from a large number of subjects is likely to improve system performance and the wider understanding. It may shed light upon insidious conditions, such as hidden hearing loss and tinnitus, and provide a vital additional tool for audiologists as part of an integrated healthcare system.

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We are being continuously monitored in our daily lives; from search engines tracking browsing habits, shops analysing purchases via loyalty cards or online accounts, and social media targeting adverts based upon our friends, conversations, and activities. While we may accept this as the cost of entry to the modern world, few would deny that it is evocative of a dystopian, Big Brotheresque hierarchy, where the monitoring is unlikely to be for our benefit. Health monitoring may be a nobler goal, however even a seemingly altruistic project, DeepMind’s collaboration with the Royal Free London NHS Foundation Trust to reduce preventable deaths from acute kidney incidents, has fallen foul of the public perception and the Information Commissioner’s Office.

There is a lot of excitement about data-driven health innovation, especially where the data can be collected automatically, and potentially uploaded or aggregated. This could allow for improved outcomes, more accurate diagnoses, early warning of conditions, advanced recovery monitoring, fewer hospital visits, and ultimately revolutionise the understanding and treatment of many diseases and conditions.

We have developed a wonderful technology which is able to automatically provide detailed characterisation of a user’s auditory system by detecting electrical signals from the cochlea and auditory brainstem. No more user interaction is required other than putting on a set of headphones, and no clinical supervision is necessary. It can detect permanent or temporary changes, and, with regular use at home or work, provide early warning of the onset of hearing loss and tinnitus.

The applications are driven by who wants to use the data, and why. The technology was originally developed to allow employers more cost effectively and conveniently meet their health surveillance duty, under the ‘The Control of Noise at Work Regulations. Workers with high levels of noise exposure need to have regular audiometric tests. It may be disruptive or impractical to send staff to a testing centre. There are also requirements after the tests have taken place. The purpose of the regulations is to protect workers, and if an issue is detected, action should be taken to prevent further damage.

The employer must also keep health records of the outcome of the surveillance; however, these cannot contain any confidential medical records. With our technology, these tasks can be automated without any need to leave the workplace. Beyond compliance, there is also a potential upside for the employer if testing can be made before and after each shift. In a case of litigation relating to hearing loss, it is likely that it could be shown whether the damage occurred inside or outside of work hours.

Individuals may be concerned about their own or their loved one’s hearing. Building the technology into consumer headphones was also one of the original motivations. For example, a smartphone app would be able to take regular snapshots of a user’s hearing and alert them or a parent if there is any change, long before symptoms become apparent.

Medical trials of drugs which may have a side effect of tinnitus would be able to use the technology to objectively monitor and record the state of the auditory system instead of having to rely on the subject’s subjective assessment.

Perhaps most interestingly of all, the data could allow the technology itself to improve. This double-edged information sword needs to be handled carefully. It is essential that no-one feels their data has been abused, so this needs to be balanced with the potentially significant benefits. The signal we record was previously only obtainable by an expert practitioner in a clinic, so comparative studies over time are limited. Long term data from a large number of subjects is likely to improve system performance and the wider understanding. It may shed light upon insidious conditions, such as hidden hearing loss and tinnitus, and provide a vital additional tool for audiologists as part of an integrated healthcare system.

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What start-ups can learn from street food vendors

What start-ups can learn from street food vendors

By: Collette Johnson
Director of Medical & Healthcare

14th June 2017

Last year I visited Vietnam and it was a truly captivating country with diverse culture, a great sense of community and phenomenal food. The food and street vendors particularly fascinated me. It was some of the most flavoursome food I have ever experienced, but beyond this, what really struck me was how each vendor ran their business. This made me think of agile start-ups and the difference between those who are successful and those who are less so.

A Vietnamese street food vendor has a basic business model; which is to do one, maybe even two things well and be widely known for these foods alone.  This is one of the golden rules for a successful product business.

Many businesses fall into the trap of thinking ‘more is better’ and within a couple of years of building their platform, they are marketing several other different products with a somewhat mixed message. The customer then loses sight of what the organisation is driving forward and the relevance it has to them.

A company that has not made this mistake is uMotif. uMotif have developed a patient-centred data capture platform for modern research and through investing in significant clinical studies and establishing key relationships, they have now become reputed for this product in their industry. They have also now started to strategically roll out their platform to other clinical service providers on an as-needed basis.

For start-ups out there at the moment, my advice would be to do one thing well, become recognised for this and build your business from there – driving your business in a scattergun approach will lead to a confused message and slow uptake of your product.

When the street food vendors prepared their food for sale, each person carried out a specific role, which they did with efficiency and to perfection. For instance, one would prepare the food, another would be cooking the food and the third person would serve and take the money. Every day these people would take their places and perform their specialist roles in the business – never once deviating from their responsibilities or taking on other roles.

In a similar fashion, some of the most successful start-ups I’ve seen employ specialists to drive the business forward, such as employing a Chief Commercial Officer to drive forward a business’s commercial prospects and actions.

Many start-ups that struggle tend to only have one person that covers multiple specialist roles. Once significant investment and growth are occurring, employ a specialist as they will be worth every penny spent. Without one, your business can feel the strain of becoming too general and not reach its maximum potential.

The most striking thing to me about the street vendors was that every person in the business knew their customer well and, in return, their customer loyalty was outstanding. From what I had seen, I’d say on average 80% of the street vendor’s sales were from repeat business. This funnel of regular customers led to vendors producing their orders before they even reached the front of the queue. It was some of the best relationship management I have seen in a long time and is a really good example of truly understanding your customers’ requirements.

As a start-up, opportunities can come in from all directions and this can sometimes confuse and dilute who the end target customer actually is. It can also distract from the business at hand and disengage those who support the business the most. Focussing on your key customers first will make your business successful in the long-term.

To end on a piece of advice once given to me when I was in Silicon Valley, “Imagine the business is a lion. In order to get a good meal, you need to chase the gazelles and not the mice. The mice will keep you going but they will not keep you full”. It’s the same in business. You need to chase those gazelles, they may take more time and strategic management but they will sustain you as a business for longer.

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Last year I visited Vietnam and it was a truly captivating country with diverse culture, a great sense of community and phenomenal food. The food and street vendors particularly fascinated me. It was some of the most flavoursome food I have ever experienced, but beyond this, what really struck me was how each vendor ran their business. This made me think of agile start-ups and the difference between those who are successful and those who are less so.

A Vietnamese street food vendor has a basic business model; which is to do one, maybe even two things well and be widely known for these foods alone.  This is one of the golden rules for a successful product business.

Many businesses fall into the trap of thinking ‘more is better’ and within a couple of years of building their platform, they are marketing several other different products with a somewhat mixed message. The customer then loses sight of what the organisation is driving forward and the relevance it has to them.

A company that has not made this mistake is uMotif. uMotif have developed a patient-centred data capture platform for modern research and through investing in significant clinical studies and establishing key relationships, they have now become reputed for this product in their industry. They have also now started to strategically roll out their platform to other clinical service providers on an as-needed basis.

For start-ups out there at the moment, my advice would be to do one thing well, become recognised for this and build your business from there – driving your business in a scattergun approach will lead to a confused message and slow uptake of your product.

When the street food vendors prepared their food for sale, each person carried out a specific role, which they did with efficiency and to perfection. For instance, one would prepare the food, another would be cooking the food and the third person would serve and take the money. Every day these people would take their places and perform their specialist roles in the business – never once deviating from their responsibilities or taking on other roles.

In a similar fashion, some of the most successful start-ups I’ve seen employ specialists to drive the business forward, such as employing a Chief Commercial Officer to drive forward a business’s commercial prospects and actions.

Many start-ups that struggle tend to only have one person that covers multiple specialist roles. Once significant investment and growth are occurring, employ a specialist as they will be worth every penny spent. Without one, your business can feel the strain of becoming too general and not reach its maximum potential.

The most striking thing to me about the street vendors was that every person in the business knew their customer well and, in return, their customer loyalty was outstanding. From what I had seen, I’d say on average 80% of the street vendor’s sales were from repeat business. This funnel of regular customers led to vendors producing their orders before they even reached the front of the queue. It was some of the best relationship management I have seen in a long time and is a really good example of truly understanding your customers’ requirements.

As a start-up, opportunities can come in from all directions and this can sometimes confuse and dilute who the end target customer actually is. It can also distract from the business at hand and disengage those who support the business the most. Focussing on your key customers first will make your business successful in the long-term.

To end on a piece of advice once given to me when I was in Silicon Valley, “Imagine the business is a lion. In order to get a good meal, you need to chase the gazelles and not the mice. The mice will keep you going but they will not keep you full”. It’s the same in business. You need to chase those gazelles, they may take more time and strategic management but they will sustain you as a business for longer.

Save

Save

Save

Save

Save

What does your body have to say about you?

What does your body have to say about you?

Thomas Rouse - Senior Consultant, Medical & Healthcare

By: Thomas Rouse
Senior Consultant, Medical & Healthcare

12th April 2017

Many moons ago, while writing up my thesis, I had been burning the candle at both ends. Unsurprisingly, I was starting to feel tired and run down. A wise friend encouraged me to heed some sage advice; “When your body speaks, listen!”.

Somehow, that little mantra lodged in my mind, and I could no longer disregard all the hints and messages I was receiving from myself but had previously managed to ignore.

The image of organs communicating their status to our conscious mind, like a conversation or shouted warning has stuck with me. Anthropomorphizing my own subsystems helped me to see them in a different way. It made the internal advice friendly, convincing me to work with my body not against it. As time has passed, that image has developed into a full blown intrigue.

There are many methods of expression within us, with seemingly no end to the fascinating tales biologist friends have provided of the incredible processes that take place. These interactions make us who we are, and reveal how we function. In just the area I specialise in, electrical signals, there is a vast amount of information passing around. It is tempting to say mind-boggling, but that would be incorrect, as we (hopefully) cope without being in a permanently boggled state! Our brain is a very effective filter, alerting us only when there is something of interest.

This is because it’s not just at the limits of our endurance that information appears. It would be nice if there was a simple alarm which only triggered when we have exceeded our specifications, are outside normal parameters, or have a failure. The signals need interpretation, and this is not a trivial matter.

What does your body have to say about you?Take for example the electrocardiogram (ECG), we can examine it on a number of levels. Our heart rate can be extracted by looking at the time between the largest spikes in the signal. This can be evaluated as an absolute value, checking it is inside acceptable limits. The safe range can vary depending on factors such as age, or what we are doing at the time. From this, we can then study how the heart rate changes with time. Is the spacing even, and how quickly does it recover after exercise? This is useful information on its own, but is just the tip of the iceberg. The ECG is composed of several features which correspond to different processes in the cardiac cycle. The height and spacing of the different bumps and troughs can provide a vital insight into how the heart is functioning. A skilled interpreter can analyse them to help diagnose a range of conditions. There are enough differences between us, however, that even with a healthy heart, this signal can be used as a biometric identifier.

We already have wearable devices which can show signals such as the ECG outside a hospital environment. The ECG is relatively loud, yet is easily masked by noises generated when moving, or electrical interference such as our 50/60Hz mains supply. Other signals of interest can be a million times quieter, making their reliable extraction something of a black art. Even with a perfect waveform, in most circumstances, diagnosis or monitoring of a condition is difficult or impossible to automate without some expert human intervention. If a specialist is involved, our brain has probably already determined that something is wrong.

What does your body have to say about you?The ability to listen and understand the subtle inflections in our internal communications, by benevolently eavesdropping at the point of care or in our daily lives could provide huge benefits from early detection of conditions, or allowing people to leave hospital sooner.

At each stage in a physiological process a signal may be generated. For example, after the initial stimulation, impulses could be detected travelling though the nervous system, when they reach the brainstem, or as they pass towards the higher levels of brain function. Like a game of Chinese whispers, each new wave may be an altered interpretation of the original. We can use this to create more data, by understanding and giving meaning to the interaction between the points in the chain, or simplify it by spying on the neural pathway which extracts what we want.

All these challenges; determining what is being said, getting the raw data, and working out what it means are at a fascinating stage where they are beginning to become possible outside specialist clinical environments. Our body has started the conversation, how are we going to respond?

Save

Many moons ago, while writing up my thesis, I had been burning the candle at both ends. Unsurprisingly, I was starting to feel tired and run down. A wise friend encouraged me to heed some sage advice; “When your body speaks, listen!”.

Somehow, that little mantra lodged in my mind, and I could no longer disregard all the hints and messages I was receiving from myself but had previously managed to ignore.

The image of organs communicating their status to our conscious mind, like a conversation or shouted warning has stuck with me. Anthropomorphizing my own subsystems helped me to see them in a different way. It made the internal advice friendly, convincing me to work with my body not against it. As time has passed, that image has developed into a full blown intrigue.

There are many methods of expression within us, with seemingly no end to the fascinating tales biologist friends have provided of the incredible processes that take place. These interactions make us who we are, and reveal how we function. In just the area I specialise in, electrical signals, there is a vast amount of information passing around. It is tempting to say mind-boggling, but that would be incorrect, as we (hopefully) cope without being in a permanently boggled state! Our brain is a very effective filter, alerting us only when there is something of interest.

This is because it’s not just at the limits of our endurance that information appears. It would be nice if there was a simple alarm which only triggered when we have exceeded our specifications, are outside normal parameters, or have a failure. The signals need interpretation, and this is not a trivial matter.

What does your body have to say about you?Take for example the electrocardiogram (ECG), we can examine it on a number of levels. Our heart rate can be extracted by looking at the time between the largest spikes in the signal. This can be evaluated as an absolute value, checking it is inside acceptable limits. The safe range can vary depending on factors such as age, or what we are doing at the time. From this, we can then study how the heart rate changes with time. Is the spacing even, and how quickly does it recover after exercise? This is useful information on its own, but is just the tip of the iceberg. The ECG is composed of several features which correspond to different processes in the cardiac cycle. The height and spacing of the different bumps and troughs can provide a vital insight into how the heart is functioning. A skilled interpreter can analyse them to help diagnose a range of conditions. There are enough differences between us, however, that even with a healthy heart, this signal can be used as a biometric identifier.

We already have wearable devices which can show signals such as the ECG outside a hospital environment. The ECG is relatively loud, yet is easily masked by noises generated when moving, or electrical interference such as our 50/60Hz mains supply. Other signals of interest can be a million times quieter, making their reliable extraction something of a black art. Even with a perfect waveform, in most circumstances, diagnosis or monitoring of a condition is difficult or impossible to automate without some expert human intervention. If a specialist is involved, our brain has probably already determined that something is wrong.

What does your body have to say about you?The ability to listen and understand the subtle inflections in our internal communications, by benevolently eavesdropping at the point of care or in our daily lives could provide huge benefits from early detection of conditions, or allowing people to leave hospital sooner.

At each stage in a physiological process a signal may be generated. For example, after the initial stimulation, impulses could be detected travelling though the nervous system, when they reach the brainstem, or as they pass towards the higher levels of brain function. Like a game of Chinese whispers, each new wave may be an altered interpretation of the original. We can use this to create more data, by understanding and giving meaning to the interaction between the points in the chain, or simplify it by spying on the neural pathway which extracts what we want.

All these challenges; determining what is being said, getting the raw data, and working out what it means are at a fascinating stage where they are beginning to become possible outside specialist clinical environments. Our body has started the conversation, how are we going to respond?

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Defragmenting Your Mind

Defragmenting Your Mind

Nicholas Hill - Chief Executive Officer

By: Nicholas Hill
Chief Executive Officer

22nd March 2017

What do you do with company email when you are on leave?

Here’s a quick survey.

Do you?

a) completely leave it behind
b) take a peek now and then
c) follow it daily but tend not to respond
d) treat it just as if you were on a business trip, engaging with it fully whenever your smartphone connectivity provides access

I’m firmly in the ‘a’ camp – I don’t look at email when on leave and I encourage our staff not to. And I fear that this view seems to be increasingly in the minority.

One of the big issues for people in business, especially in a management role, is getting enough of a break from the problems of the here and now to stand back, observe how things are working (or not) from a high level and get things into perspective. And if you don’t do that, you can’t plan for a better future and improve the business.

defragingmindUnfortunately, this time won’t make itself available, you have to create it. And the solid break of a week or two’s leave is one ideal opportunity. You have the potential to disconnect from the flood of daily small issues and unload completely. I picture the mind as a heavily fragmented disk, which over time has become full of concerns large and small, some unresolved, some part resolved, with new concerns piling in all the time and having to be cut into the already overloaded space. The effort of managing all these increases and your capacity for strategic thought dwindles. If you leave the office behind while on leave, the mind can defragment itself, sort the wheat from the chaff, tidy up, and discard the trash. This will not only generate some open space for clear thinking, it will also leave you with a better sense of what is important and what isn’t once you get back in the office.

If you are looking at your email while on leave, the regular drip, drip of reminders about all those issues acts to retain the whole lot in your head and the defragmentation process can never get started. Sadly, this will be the case even if you only spend a very short time doing it each day, so just having a peek now and then isn’t an effective compromise. You’ve just got to turn it off and leave it behind.

full-inboxSo what is driving people to take the email with them when on holiday? Well, a couple of obvious concerns, for me, is that some crisis is going to occur that demands my input, and there will be a huge pile of email that will have collected in my inbox when I get back.

Let’s look at the first issue. Aren’t particular individuals critical to the operation of the business? Let me consider my own situation. If I am required to intervene daily in business operations then I would say that I am failing in my job. A business should be like a carefully crafted machine that once running does not require constant intervention or correction from its designer. And likewise at any level within the business, it should be possible for any individual to walk away from the job for a period of time without a crisis unfolding. And if it isn’t possible, something in the business is broken. Fixing this concern isn’t just down to the individual’s state of mind, it should be enabled by appropriate business processes, management and training.

And what about the overwhelming feeling you get when coming back into the office and facing an inbox with many hundreds of unread emails? That is a pretty grim prospect. If you are in the ‘b’, ‘c’ or ‘d’ group in the above survey, you may have been spending a certain amount of time during your holiday looking at your email precisely to avoid this huge inbox. Consider instead, spending that cumulative time in one block when you get back, perhaps during the evening before you start work. You will then fix the problem and give your brain the break it needs.

If you see another employee’s ‘Out of Office’ message when they are on leave, be considerate about whether they really need to be cc’d on those emails you might be sending while they are away. And if you have influence over corporate IT policy, encourage a general minimisation of the amount of email traffic around the office. You don’t need to go as far as Daimler, where the ‘Out of Office’ message states that the employee is on vacation and cannot read your email, that the email is being deleted, with an alternative contact if the issue is really important, and recommending that the email is resent after the employee is in the office. But you could consider it.

In our highly competitive business environment, we all need to strive hard and be committed to the organisation’s success but, next time you go on leave, make sure company email is not on your packing list.

Save

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What do you do with company email when you are on leave?

Here’s a quick survey.

Do you?

a) completely leave it behind
b) take a peek now and then
c) follow it daily but tend not to respond
d) treat it just as if you were on a business trip, and engage with it fully whenever your smartphone connectivity provides access?

I’m firmly in the ‘a’ camp – I don’t look at email when on leave and I encourage our staff not to. And I fear that this view seems to be increasingly in the minority.

One of the big issues for people in business, especially in a management role, is getting enough of a break from the problems of the here and now to stand back, observe how things are working (or not) from a high level and get things into perspective. And if you don’t do that, you can’t plan for a better future and improve the business.

defragingmindUnfortunately, this time won’t make itself available, you have to create it. And the solid break of a week or two’s leave is one ideal opportunity. You have the potential to disconnect from the flood of daily small issues and unload completely. I picture the mind as a heavily fragmented disk, which over time has become full of concerns large and small, some unresolved, some part resolved, with new concerns piling in all the time and having to be cut into the already overloaded space. The effort of managing all these increases and your capacity for strategic thought dwindles. If you leave the office behind while on leave, the mind can defragment itself, sort the wheat from the chaff, tidy up, and discard the trash. This will not only generate some open space for clear thinking, it will also leave you with a better sense of what is important and what isn’t once you get back in the office.

If you are looking at your email while on leave, the regular drip, drip of reminders about all those issues acts to retain the whole lot in your head and the defragmentation process can never get started. Sadly, this will be the case even if you only spend a very short time doing it each day, so just having a peek now and then isn’t an effective compromise. You’ve just got to turn it off and leave it behind.

full-inboxSo what is driving people to take the email with them when on holiday? Well, a couple of obvious concerns, for me, is that some crisis is going to occur that demands my input, and there will be a huge pile of email that will have collected in my inbox when I get back.

Let’s look at the first issue. Aren’t particular individuals critical to the operation of the business? Let me consider my own situation. If I am required to intervene daily in business operations then I would say that I am failing in my job. A business should be like a carefully crafted machine that once running does not require constant intervention or correction from its designer. And likewise, at any level within the business, it should be possible for any individual to walk away from the job for a period of time without a crisis unfolding. And if it isn’t possible, something in the business is broken. Fixing this concern isn’t just down to the individual’s state of mind, it should be enabled by appropriate business processes, management and training.

And what about the overwhelming feeling you get when coming back into the office and facing an inbox with many hundreds of unread emails? That is a pretty grim prospect. If you are in the ‘b’, ‘c’ or ‘d’ group in the above survey, you may have been spending a certain amount of time during your holiday looking at your email precisely to avoid this huge inbox. Consider instead, spending that cumulative time in one block when you get back, perhaps during the evening before you start work. You will then fix the problem and give your brain the break it needs.

If you see another employee’s ‘Out of Office’ message when they are on leave, be considerate and consider whether they really need to be cc’d on those emails you might be sending while they are away. And if you have influence over corporate IT policy, encourage a general minimisation of the amount of email traffic around the office. You don’t need to go as far as Daimler, where the ‘Out of Office’ message states that the employee is on vacation and cannot read your email, that the email is being deleted, with an alternative contact if the issue is really important, and recommending that the email is resent after the employee is in the office. But you could consider it.

In our highly competitive business environment we all need to strive hard and be committed to the organisation’s success but, next time you go on leave, make sure company email is not on your packing list.

Save

Save

Save

Save