Some Chicago Boyz know each other from student days at the University of Chicago. Others are Chicago boys in spirit. The blog name is also intended as a good-humored gesture of admiration for distinguished Chicago School economists and fellow travelers.
According to The Times (London), Guy’s & St Thomas Hospital has cut patient wait times via some workflow process improvements…analogized to a Formula One pit stop.
Sounds pretty impressive. I do wonder, though: are these results sustainable? Or do they require a level of intensity that people can keep up for a certain period of time but not for the long run?
Link via Dr Anton Howes, who writes interestingly about the history of technology.
Andy Kessler, a very smart and generally insightful guy, has a recent WSJ column titled ‘The is One Puzzling Job Market’ and subtitled ‘Why has productivity lagged for so long? Because huge sectors shunned technology.’
This assertion doesn’t feel right to me. In the case of the healthcare industry, for example, Kessler says “Medicine is unproductive. It’s a doctor-intensive chronic-disease-treatment business. But with prevention and diagnostics to find disease early, perhaps we’d need fewer oncologists and cardiac surgeons.” Perhaps, but it’s not as if diagnostics–mammograms, for example–have been ignored. Prevention can involve, for example, better diets and obesity reduction–these things are really more about accurate science, proper statistical analysis, and honest and effective public communication than they are about technology per se.
A major technology initiative in healthcare of the the last decade or two has been the wide use of electronic medical records. While these do have considerable potential, the current implementation reality is different. I don’t think I have ever heard or read a physician or other healthcare professionals who had anything good to say about these systems. The perceived productivity impact is negative.
It is certainly true that telemedicine has great potential for productivity improvements, and also probably for better paytient outcomes, since it makes it far easier to get an appointment than is the case with traditional practice approaches. But some of the same advantages can also come from local clinics with an emphasis on quick availability and more use of nurse practitioners and other alternatives to the need to see physicians for every visit.
As another example of an industry with poor productivity, Kessler cites education. I think we can agree on the poor productivity. But is the problem really lack of technology? How about the massive administrative overheads, the insistence on instructional methods that don’t work very well (in teaching reading, for example), and the overweening power of the teachers’ unions? Indeed, schools have been quite eager to spend money on ‘technology’. The kind of projects that Michael Schrage referred to as ‘sparkly tools’ will not do much good until these other problems are addressed.
In transportation, there are indeed technology improvements that can be made in air traffic control and, for railroads, in rail car tracking and hot-bearing detection to prevent derailments, for example. But there are also physical infrastructure issues–no matter how great your air traffic control system is, an airport’s capacity is going to be limited by the number of parallel runways, and, in some wind conditions, the availability of crosswind runways. There are also management and process issues–in freight rail, for example, is the current vogue employment of very long trains, now under the banner of ‘precision scheduled railroading’, really a good idea from the standpoints of productivity and market growth?
Kessler says: “Bell Labs invented the transistor in 1948, but its parent, AT&T, had 10 to 20 years of old vacuum-tube inventory and so delayed using transistors.” This claim makes no sense to me. I can’t imagine that any company, even AT&T would have built up a 10-20 year inventory of just about any commodity, let alone inventory of items in a field which was already known for rapid change. And early transistors weren’t cheap, and did have their limitations.
There is indeed an apparent paradox when you consider all the technological improvements of recent years–and then look at the productivity numbers. But I suspect that much of the cause for this disconnect will be found in:
Mediocre or outright bad management. There is a tremendous amount of wasted motion and effort in a lot of organizations today. There’s always some of this, of course, but my sense is that it’s been getting worse, rather than better. See for example this article about Google, written by a guy whose startup was acquired by that company.
Google has 175,000+ capable and well-compensated employees who get very little done quarter over quarter, year over year. Like mice, they are trapped in a maze of approvals, launch processes, legal reviews, performance reviews, exec reviews, documents, meetings, bug reports, triage, OKRs, H1 plans followed by H2 plans, all-hands summits, and inevitable reorgs.
Unwise mergers and acquisitions. Although company combinations can be beneficial, too often they are done under sets of assumptions that turn out to be, shall we say, optimistic. How much productivity is lost as a result of all the legal and finance work done to enable these combinations and in the organizational disruption that often follows? (And then, in some cases, to unwind them via a spinout?)
Excessive regulation, particularly ideologically-driven regulation. In Washington, DC, childcare workers will now be required to have associates’ degrees. There are many other examples of pointless education and training requirements. And the ‘industrial strategy’ programs favored by the Biden administration are very likely to direct resources into politically-favored…but not particularly productive..companies and entire industries.
Bad technology implementations. There are a lot of examples of technology implementations that seemed promising, but resulted in either complete failure or marginal…if any…productivity gains. Often, there problems are a result of failing to systematically think about the overall business process and the potential people problems involved. See the sad story of Target Canada, and Zeynep Ton’s description of retail inventory systems that carry meaningless balances because the work of the checkers, and the way in which the feedback loop from goods availability to sales numbers worked, is not properly understood.
There are certainly many technologies now available, and becoming available, that can greatly enhance productivity. But it is difficult for any technology or combination of technologies to improve productivity enough to overcome the drag of the structural problems sketched about..and many others. As Lewis Carroll said, we must run as fast as we can just to stay in place, and if we want to go anywhere, we must run twice as fast as that. Unless we do something about the sources of the persistent backward motion.
Your thoughts on productivity and technology?
I read this book this week and found a good book review in “City Journal,” titled “Three Blind Mice.” Atlas began as an academic neuroradiologist and then transitioned to a 15 year career as a health policy researcher. I did something similar when I was forced to retire at age 55 with an old back injury. I spent a year at Dartmouth learning methodology and biostatistics. I don’t know enough about Atlas’ story to know if he did something similar. Quite a few academic physicians have done similar transitions, especially as they get older.
In Atlas’ case, once he was recognized by the Media, he was immediately denigrated as “a radiologist.” He was also labelled as “not an epidemiologist.” It did not matter that none of the other three MDs on the Task Force was an epidemiologist, either. Atlas was in contact with many epidemiologists who were feeding him data and statistics.
He found the “Three Blind Mice” of Birx, Fauci and Redfield were uninterested in data or the scientific publications he kept bringing to the meetings. Eventually, he gave up going to the meetings. He found Trump receptive and he agreed with Atlas’ program of protecting the high risk population, especially nursing home residents, plus others with pre-existing conditions, one of which has turned out to be obesity. He blames Trump and his team for being afraid to sack Birx who was the one telling all the Governors to lock down their states. As he says in conclusion, “It didn’t matter. They still lost the election.” They feared a firestorm in the press if she was demoted.
Atlas was in despair as they continued to emphasize testing the asymptomatic and neglect the nursing homes where almost 50% of the deaths occurred. The psychological and economic damage from the lockdowns may last for years. Masks are useless and he quotes many studies to prove it. The one study quoted by Birx all along was based on two beauty parlor employees. That was it.
In the end, he quit after the election although Trump wanted him to stay. He continued to communicate by email. He describes the insane abuse he took from the Media and may spend a little too much time on it in the book. Some professors at Stanford (not the epidemiologists) sent out an email letter attacking him for working with Trump.
He has one section about Florida Governor DeSantis who, he writes, was already familiar with the literature and who implemented most of Atlas’ policies on his own. I remember the Media attacking DeSantis when he set up treatment facilities at a large retirement community, accusing him of treating supporters first. He was following the science they ignored in their identity politics frenzy. Florida could have been as big a disaster as New York with their huge senior population. The fact that DeSantis followed the science and not the Media prevented that outcome.
Other books are beginning to come out now but this one seems authentic by an insider. Here is the book at Amazon. I read the Kindle version. The hardcover came out a few days later.
Obamacare changed American Medicine forever. I am becoming convinced that was a major purpose. Since 1978, Medicine and doctors have become the most regulated sector of the American economy.
Five years ago, I predicted one consequence. A doctor shortage. Why ?
A few years ago, it was reported that 10,000 doctors were leaving UK every year. How has the NHS dealt with this shortage?
By importing third world doctors.
The UK’s National Health Service (NHS) will soon begin a major campaign to recruit health workers from other countries to meet growing staff shortages.
Reports suggest a strategy has been drawn up to target a number of countries around the world, including poorer nations outside Europe.
One estimate in March this year said the NHS will need 5,000 extra nurses every year – three times the figure it currently recruits annually.
But what about the countries that it will recruit from – what impact will it have on them?
Where do non-UK staff come from?
The NHS already recruits globally to meet its staffing needs.
More than 12% of the workforce reported their nationality as not British, according to a report published last year.
How are we dealing with our doctor shortage ? By adding “Practitioners” instead of doctors.
How did this begin? In 1978, a new federal program was created called “Professional Standards Review Organizations.”
It is now becoming a theme on the left that Trump was not quick enough to recognize the coming epidemic.
For that reason, I think it valuable to keep a record of the time line.
Here is the January 12, 2020 WHO report on the virus epidemic in China.
The evidence is highly suggestive that the outbreak is associated with exposures in one seafood market in Wuhan. The market was closed on 1 January 2020. At this stage, there is no infection among healthcare workers, and no clear evidence of human to human transmission. The Chinese authorities continue their work of intensive surveillance and follow up measures, as well as further epidemiological investigations.
Here is the January 30, 2020 report by WHO on the epidemic in China.
The Committee believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk. It is important to note that as the situation continues to evolve, so will the strategic goals and measures to prevent and reduce spread of the infection. The Committee agreed that the outbreak now meets the criteria for a Public Health Emergency of International Concern and proposed the following advice to be issued as Temporary Recommendations.
The Committee emphasized that the declaration of a PHEIC should be seen in the spirit of support and appreciation for China, its people, and the actions China has taken on the frontlines of this outbreak, with transparency, and, it is to be hoped, with success.
Trump stopped incoming flights from China on January 31, 2020.