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  • Sad and Disturbing, but Not Surprising

    Posted by David Foster on July 15th, 2012 (All posts by )

    A couple of weeks ago, there was a growing forest fire in northwestern Nevada. Fortunately, the Washoe County sheriff’s department had aloft in the area a fire-fighting helicopter tanked up with 323 gallons of water.

    Unfortunately, it wasn’t clear whether the Federal land on which the fire was burning was under the jurisdiction of the Bureau of Land Management or under the jurisdiction of the Forest Service. If the former, then the chopper had approval to legally drop the water, if the latter, then it did not. So the team in the helicopter did nothing. More than 200 acres burned.

    There have been a lot of stories like this lately. The thicket of rules governing life in America today has become so thick, and belief in the importance of adhering to these rules even in defiance of common sense has become so strong, that the default for many people has become the belief that inaction is safer than action.

    In 1805, Lord Nelson said:

    When I am without orders and unexpected occurrences arrive I shall always act as I think the honour and glory of my King and Country demand. But in case signals can neither be seen or perfectly understood, no captain can do very wrong if he places his ship alongside that of the enemy.

    “Unexpected occurrences” occur quite frequently, whether they take the form of a forest fire in a jurisdictionally-ambiguous area, a kid in school having an asthma attack, or a transatlantic flight losing its airspeed indication capabilities. Human beings need to be ready and empowered to use their judgment and intelligence in such situations, not constrained to act like rigidly-programmed computers.

    A couple of years ago, I would have posted this story under the “Just Unbelievable” category. Sadly, that category no longer applies, because stories of rule-driven bureaucratic rigidity have become a commonplace of American life.

    In 1797, a Spanish naval official named Don Domingo Perez de Grandallana wrote about the reasons his country tended to lose naval engagements with the British. One of his points:

    An Englishman enters a naval action with the firm conviction that his duty is to hurt his enemies and help his friends and allies without looking out for directions in the midst of the fight; and while he thus clears his mind of all subsidiary distractions, he rests in confidence on the certainty that his comrades, actuated by the same principles as himself, will be bound by the sacred and priceless principle of mutual support.

    Accordingly, both he and his fellows fix their minds on acting with zeal and judgement upon the spur of the moment, and with the certainty that they will not be deserted. Experience shows, on the contrary, that a Frenchman or a Spaniard, working under a system which leans to formality and strict order being maintained in battle, has no feeling for mutual support, and goes into battle with hesitation, preoccupied with the anxiety of seeing or hearing the commander-in-chief’s signals for such and such manoeuvres…

    In my 2007 post on Don Domingo’s comments, I linked a Washington Post article on “the increasing propensity of Americans to be driven by rules and procedures, rather than doing what makes sense” and noted that “there are certainly trends in our society which, if not reversed, will make us increasingly similar to the (French / Spanish) Combined Fleet of 1805, rather than Nelson’s victorious fleet.” Over the last 4 years, I am afraid that we have traveled much further down that road.

     

    14 Responses to “Sad and Disturbing, but Not Surprising”

    1. Bill Brandt Says:

      Look at how this applies to business – many businesses are, instead of doing nothing, choosing to leave for places to not have so many restrictions on their process of getting something to market.

      And at first thought I wanted to blame this on the nature of legislative bodies themselves – they want to “legislate”.

      But I believe the biggest reason for the explosion of rules if the proliferation of bureaucracies – unaccountable to the voting constituencies.

    2. Brandoch Daha Says:

      It’s been claimed that this is one of the reasons for Israel’s success in wars against Arab nations: An Israeli military unit cut off from the chain of command happily charges off to set itself alongside the enemy. An Arab unit in the same circumstances will tend to hunker down and do nothing, because acting without orders will always be punished. My personal limited experience with in business and bureaucracy tends to support that. But I did say “limited”.

      I’d hesitate to write off the Arab military behavior as a feature of Arab culture rather than of dictatorial government culture, because Arab terrorists seem to be able to function autonomously and effectively. Wouldn’t it be nice if Hamas were as protocol-bound as the Egyptian army…?

      Anyway, this is also what happens when good, loose, aggressive, mission-focused startups turn into bureaucratic monstrosities, with HR and professional managers mothering everybody to death.

    3. Brandoch Daha Says:

      Sorry, meant “my personal limited experience with *Israelis* in business and bureaucracy”. I have none with culturally Arab institutions or organizations, just scattered regular guys I’ve known in the US.

    4. Michael Kennedy Says:

      This ability to improvise used to be an American virtue. The German army was so successful in WWII because of the noncoms and their ability to improvise. The Japanese lost all the later battles in the Pacific because of rigid rules and inability to improvise.

      It seems to be a basic feature of Obamacare to restrict any variation in delivering medical care. This is thought to be a way to control costs but may also be a way to limit innovation. The development of laparoscopic surgery in the US is one area with which I am very familiar. It was driven by private practice surgeons, not the academic side of medicine. I first heard about it at a laser medicine meeting in 1988. I enrolled in a class in Houston being taught by a university surgeon who was almost the only one offering such instruction. Then I took a class in Marietta Georgia by a GYN surgeon who was a friend of Eddie Joe Reddick. Reddick was on a trip to France with his wife. He wasn’t too interested in museums so he spent a day watching surgery. There he saw one of the early applications of laparoscopy to general surgery. A lot of the revolution came from the introduction of chip cameras, which attach to the laparoscope eye piece and transmit the picture to a TV monitor so everyone sees it.

      Reddick came back and got his friend Barry McKernan to teach him laparoscopy. I took the class from McKernan a year later. Once patients heard about the difference in postop recovery, the revolution was on. I had three patients waiting for me to learn how to do the surgery. I told them I had never done it and they needed to know that. They said, “I’ll wait.”

      McKernan had us do the surgery on pigs. Unlike a lot of the courses that came along later, McKernan had us use sterile technique and after the pig’s gallbladder was removed, the pig went back to a pig farm run by McKernan’s son. Talk about private enterprise ! Nothing was wasted, even the pig.

      The universities did not start to teach this for another two years. It was all driven by patients. I had doctors’ relatives coming from all over California and Nevada to have their gallbladder surgery done.

      Then I started to do appendectomies this way. One of the early ones was a doctor’s daughter. He sent her to the office on a Friday afternoon. Sure enough, she had early appendicitis. I got the one hospital that was allowing the lap surgery to take her. We did her appendectomy about 9 PM that Friday night. One Monday morning, the doctor’s wife who was school nurse at the private school all our kids went to in San Juan Capistrano, learned she had had her appendix out on Friday night. She called the hospital to see how she was recovering. The kid was in class !

      You can imagine how fast that word got out in the community.

      I used to videotape all the surgeries. I kept the tape for a month in case of a complication. None ever happened. Then I offered the tape to the patient. The hospital lawyers later stopped that, a stupid response. One of the kids I did a lap appy on took his tape to school and shared it !

      Obamacare, if not repealed, will ensure that nothing like laparoscopic surgery ever happens again. It was driven by patient comfort, not an important consideration for the rules makers. One of my early lap appys was on the wife of a Kaiser medical director. I called him to see if Kaiser would OK the surgery, even though their surgeons weren’t doing it. He had heard about it and was enthusiastic. Now, they would be more worried about what it cost and would squelch any interest.

      My own coronary bypass was done by a young surgeon in Tucson who looks like one of my medical students. He did a one vessel bypass through a four inch incision in my left armpit. No heart-lung machine. It’s called “beating heart surgery.” Another innovation that will be squelched by the “guidelines” that are alleged to be about quality but are all about cost. All these innovations start looking more expensive but quickly become standard and often a cheaper alternative. Lap gallbladder surgery ends the five day hospital stay. I was doing them as outpatients before I retired.

      Romney is finding out that he has better educate people about business or he will be demonized by the folks who will kill any innovation.

    5. Jonathan Says:

      Michael, that is the comment of the year.

    6. veryretired Says:

      First hang all the lawyers…

    7. Michael Kennedy Says:

      Thanks, Jonathan. I didn’t mean it to get so long. One problem with cost is the fact that a bunch of companies jumped on the lap-chole bandwagon with lots of disposable instruments. At one hospital in Laguna, we were under some pressure to hold down cost because a lot of cases came from a local HMO. That hospital had a great director running the equipment section. Roger was gay and HIV positive so he had been forced to step down from being an OR tech. They made him head of sterile supply where he was great.

      We went through catalogs and found non-disposable equipment and cheap disposable parts for those bits that needed to be one-use. By assembling a tray with the cheaper stuff, we got the cost down to the point that the hospital could still break even at the lower HMO price. All you need is the motivation and somebody like Roger to bird dog the details. Instead of $10,000 of disposables, we had a set of $16 plastic ports and a $50 set of clips. I had to buy the two $1200 clip appliers but they worked just as well as the disposables that were about the same price per unit and got thrown away.

      The academics that will be on those Obama guideline commissions have no idea of nuts and bolts like that.

    8. Ginny Says:

      Romney could use you as a speech writer – the dog that doesn’t bark (the innovations not done, the medicines not brought to market, etc.) are important & invisible.

      And while medicine should be more central and your history more significant, almost everyone on here has such points to make. Is there anyway we could?

    9. David Foster Says:

      MK, Ginny…the idea that innovation often occurs *on the firing line*, rather than being something done by a few highly credentialed “experts”, is entirely alien to a substantial part of the population, especially those who themselves have spent many years in educational institutions and then moved into “staff” positions with little contact with operations and the people involved therein.

    10. Michael Kennedy Says:

      “the idea that innovation often occurs *on the firing line*

      David, Toyota learned that 30 years ago, then ate our lunch in new cars.

    11. Locomotive Breath Says:

      Never Mind the Maneuvers; Just Go Straight at ‘Em.

      Meanwhile, in order to reduce cost, Obamacare introduces a 2.3% tax on medical devices. WTF!

    12. ErisGuy Says:

      the increasing propensity of Americans to be driven by rules and procedures, rather than doing what makes sense

      Any speculation on the relation of this trend to the development of computer science?

    13. David Foster Says:

      ErisGuy…I have wondered about this. One school of thought is that computers liberate people from the routine and allow them to be more creative and less procedure-driven; another is that the inclusion of computers in processes tends to increase the rigidity in those processes and make people more like computers themselves.

      Certainly, the large-scale clerical operations of pre-computer days (for things like check sorting and insurance-company policy billing), which involved thousands of people doing mind-numbing work, were as rigid as anything to be found today; indeed, some have commented that these clerical operations were more fully Taylorized and involved more fragmentation of work than a typical major manufacturing plant of the same era.

      A worthwhile subject for further discussion.

    14. Slumlord Says:

      I don’t think it has anything to do with computers, rather, the real evil in our society the encroaching “legalisation” of it. People don’t want to act out of fear of being punished. Our society views the obeyance of laws, no matter how stupid or innapropriate to the circumstance, more important than common sense. We have created a society where there is a real risk of being punished for doing the “right thing”.

      In the end initiative is destroyed and the “right thing’ does not get done.