Trafalgar, 1805, and the USA, 2022

Trafalgar Day was marked last week, and I remembered again the essay written in 1797 by a Spanish naval official, Don Domingo Perez de Grandallana, on the question:  “Why do we keep losing to the British, and what can we do about it?”

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 manoeures…

Thus they can never make up their minds to seize any favourable opportunity that may present itself. They are fettered by the strict rule to keep station which is enforced upon then in both navies, and the usual result is that in one place ten of their ships may be firing on four, while in another four of their comrades may be receiving the fire of ten of the enemy. Worst of all they are denied the confidence inspired by mutual support, which is as surely maintained by the English as it is neglected by us, who will not learn from them.

Imagine Don Grandallana’s feelings when, eight years later, he read the reports of the Spanish naval catastrophe at Trafalgar.  He had accurately diagnosed the key problems of his side, but had been unable to bring about the sweeping changes necessary to address them.

There are uncomfortable parallel in America today to the polities and mindset that Grandallana observed in his headed-for-defeat Spain.

Over at Ricochet, the physician who posts as Dr Craniotomy describes the extent to which his time is devoted to satisfying the bureaucracy and its systems.

It’s 9 p.m. on a Friday and I’m waiting for my hospital’s slow, clunky electronic health record (EHR) to load. I’m logging in from home because the administration emails became threatening.,,,The patients were already seen by me, and the notes written by either a resident or nurse practitioner.  The hospital just can’t bill until I click the “cosign” button. 

Meanwhile, there’s this JAMA article outlining how the National Academy of Medicine is going to tackle physician burnout.  The plan revolves around installing a “culture of well-being” into the healthcare workplace.  They want to develop training protocols to address discrimination, bullying, and harassment while increasing leadership roles such as Chief Wellness Officers.  This sounds like more bureaucratic busywork to complete and administrators to answer to.  I would be shocked to find out that there was a single aliquot of improved wellness from a wellness module.

I have governmentally mandated appropriate use criteria that questions every imaging order I place on a patient, forcing me to click box after box, justifying an MRI that I know is clinically indicated because I spent 12 years training in neurological surgery to know exactly when an MRI is indicated.

I have the joint commission telling me I’m not prescribing enough pain medication one day and the next day, I’m being threatened with manslaughter charges if I don’t check a slow, cumbersome, often nonfunctional online database every time I write a prescription.

As I noted in comments to the post:  The “culture of compliance” and the micromanagement of employees by bureaucracies and by rigid automated systems, as practiced in America today, bear a disturbing resemblance to the cultural practices that Don de Grandallana identified as the main cause of his country’s repeated defeats.

There is a great deal of this kind of thing in many parts of America today, and trends have been running that way for a long time.  See this Washington Post article from 2005, back when the WP was not yet totally politicized:  Over-Ruled.  Discussing hurricane response and some of the bureaucratic obstacles that appeared, the author says:  “We’ve become a society of rule-followers and permission-seekers.”

Causes of this situation are multiple; certainly one factor is the prevalence of litigation.  Another is the proliferation of top-down automated systems.  And one factor, I think is the excessive emphasis on formal education and the associated credentials.   In his post The Most Precious Resource is Agency, Simon Sarris observes that when looking at people who became highly successful in earlier times, “the individuals were all doing from a young age, as opposed to merely schooling.”

He goes on to say:

It seems that the more you ask of people, and the more you have them do, the more they are able to later do on their own. It is important to note that while we shouldn’t allow children to be bobbin boys, no one would describe Steve Job’s summer job at 13 as his exploitation. We should be thinking much harder about making sure children can make meaningful contributions to the world.

also

And I suspect the downplaying of agency in childhood not only creates fewer opportunities for great people, it must also create more marginal people. Ushering everyone into an endless default script is disastrous when underlying conditions or assumptions change. Even when they don’t, some people exit academia almost terrified to leave (to interact with the “real world”), a kind of Stockholm syndrome.

Does an assumption that people will spend 16 or 20 consecutive years in formal education…and the related assumption that this formal education will be the most important factor in their future success or lack of same…reduce the sense of individual agency? I think it probably does.

Also, this brings us to another factor that Grandallana did not mention, either because he didn’t see it as a problem or because he didn’t dare talk about it: the dominance of a hereditary aristocracy.  I think it’s pretty clear to historians now that one major reason for Spain’s naval failures was that people tended to be placed in command positions because of their titles and bloodlines, rather than their demonstrated competence.

We don’t have a formal aristocracy in the US, of course; indeed, the Constitution explicitly prohibits any such thing.  But while educational credentialism was initially sold as a form of meritocracy, and indeed did initially lead to some progress in that direction, it has devolved in too many cases to a form of aristocracy light, where obtaining the most ‘elite’ credential is largely a matter of conducting your early life in a manner of which admissions officers approve–including demonstrating the ‘right’ social attitudes–and, often, of having the right family and connections, rather than a matter of true performance-related merit.

More than 50 years ago, Peter Drucker wrote that a major advantage America had over Europe is that access to key roles in society was not controlled by a admission to a small number of ‘elite’ universities.

The Harvard Law School might like to be a Grande Ecole and to claim for its graduates a preferential position. But American society has never been willing to accept this claim…

American society today is much closer to accepting that and similar claims than it was when Drucker wrote the above in 1969, and I think this has something to do with the dysfunctionality of many of our institutions.

For discussion: How far are we down the road to the kind of environment that Grandallana described? What are the causes, and what are the potential paths for reversal?

Worthwhile Reading & Viewing

Our friend Bookworm has great photos from her trip to the Porcupine Mountains in Michigan.

Speaking of photographs,  Nikon’s Small World has an extensive collection of images captured by the light microscope.

A mosaic depicting the Trojan War has been found in Syria.

The most precious resource is agency.  Excerpt:

Seizing opportunity requires opportunity to exist at all. And I suspect the downplaying of agency in childhood not only creates fewer opportunities for great people, it must also create more marginal people. Ushering everyone into an endless default script is disastrous when underlying conditions or assumptions change. Even when they don’t, some people exit academia almost terrified to leave (to interact with the “real world”), a kind of Stockholm syndrome. How could we celebrate a higher learning that creates something so pathetic, the opposite of a readiness for life?

What is going on in the world’s art museums?

Organizational cultures and product failures. (at Twitter)

A very interesting analysis of the embedded energy associated with various products.

This natural resources investment firm suggests that the reductions in the cost of wind and solar technologies has been driven not primarily by a Moore’s-law-like learning curve, but rather by reductions in energy and capital costs.

The energy transition of the last 700 years: trends in the share of economies consumed by acquiring food and fuel.

Book Review: Rockets and People – Sputnik 65th Anniversary Rerun

Rockets and People, by Boris E Chertok

Boris Chertok’s career in the Russian aerospace industry spanned many decades, encompassing both space exploration and military missile programs. His four-volume memoir is an unusual document–partly, it reads like a high school annual or inside company history edited by someone who wants to be sure no one feels left out and that all the events and tragedies and inside jokes are appropriately recorded. Partly, it is a technological history of rocket development, and partly, it is a study in the practicalities of managing large programs in environments of technical uncertainty and extreme time pressure. Readers should include those interested in: management theory and practice, Russian/Soviet history, life under totalitarianism, the Cold War period, and missile/space technology. Because of the great length of these memoirs, those who read the whole thing will probably be those who are interested in all (or at least most) of the above subject areas. I found the series quite readable; overly-detailed in many places, but always interesting. In his review American astronaut Thomas Stafford said “The Russians are great storytellers, and many of the tales about their space program are riveting. But Boris Chertok is one of the greatest storytellers of them all.”  In this series, Chertok really does suck you into his world.

Chertok was born in Lodz, Poland, in 1912: his mother had been forced to flee Russia because of her revolutionary (Menshevik) sympathies. The family returned to Russia on the outbreak of the First World War, and some of Chertok’s earliest memories were of the streets filled with red-flag-waving demonstrators in 1917. He grew up on the Moscow River, in what was then a quasi-rural area, and had a pretty good childhood–“we, of course, played “Reds and Whites,” rather than “Cowboys and Indians””–swimming and rowing in the river and developing an early interest in radio and aviation–both an airfield and a wireless station were located nearby. He also enjoyed reading–“The Adventures of Tom Sawyer and Huckleberry Finn met with the greatest success, while Harriet Beecher Stowe’s Uncle Tom’s Cabin gave rise to aggressive moods–‘Hey–after the revolution in Europe, we’ll deal with the American slaveholders!” His cousin introduced him to science fiction, and he was especially fond of Aelita (book and silent film), featuring the eponymous Martian beauty.

Chertok remembers his school years fondly–there were field trips to study art history and architectural styles, plus a military program with firing of both rifles and machine guns–but notes “We studied neither Russian nor world history….Instead we had two years of social science, during which we studied the history of Communist ideas…Our clever social sciences teacher conducted lessons so that, along with the history of the French Revolution and the Paris Commune, we became familiar with the history of the European peoples from Ancient Rome to World War I, and while studying the Decembrist movement and 1905 Revolution in detail we were forced to investigate the history of Russia.” Chertok purused his growing interest in electronics, developing a new radio-receiver circuit which earned him a journal publication and an inventor’s certificate. There was also time for skating and dating–“In those strict, puritanical times it was considered inappropriate for a young man of fourteen or fifteen to walk arm in arm with a young woman. But while skating, you could put your arm around a girl’s waist, whirl around with her on the ice to the point of utter exhaustion, and then accompany her home without the least fear of reproach.”

Chertok wanted to attend university, but “entrance exams were not the only barrier to admission.” There was a quota system, based on social class, and  “according to the ‘social lineage’ chart, I was the son of a white collar worker and had virtually no hope of being accepted the first time around.” He applied anyhow, hoping that his journal publication and inventor’s certificate in electronics would get him in.” It didn’t–he was told, “Work about three years and come back. We’ll accept you as a worker, but not as the son of a white-collar worker.”

So Chertok took a job as electrician in a brick factory…not much fun, but he was soon able to transfer to an aircraft factory across the river. He made such a good impression that he was asked to take a Komsomol leadership position, which gave him an opportunity to learn a great deal about manufacturing. The plant environment was a combination of genuinely enlightened management–worker involvement in process improvement, financial decentralization–colliding with rigid policies and political interference. There were problems with absenteeism caused by new workers straight off the farm; these led to a government edict: anyone late to work by 20 minutes or more was to be fired, and very likely prosecuted. There was a young worker named Igor who had real inventive talent; he proposed an improved linkage for engine and propeller control systems, which worked out well. But when Igor overslept (the morning after he got married), no exception could be made. He was fired, and “we lost a man who really had a divine spark.”  Zero tolerance!

Chertok himself wound up in trouble when he was denounced to the Party for having concealed the truth about his parents–that his father was a bookkeeper in a private enterprise and his mother was a Menshevik. He was expelled from the Komsomol and demoted to a lower-level position.  Later in his career, he would also wind up in difficulties because of his Jewish heritage.

The memoir includes dozens of memorable characters, including:

*Lidiya Petrovna Kozlovskaya, a bandit queen turned factory supervisor who became Chertok’s superior after his first demotion.

*Yakov Alksnis, commander of the Red Air Force–a strong leader who foresaw the danger of a surprise attack wiping out the planes on the ground. He was not to survive the Stalin era.

*Olga Mitkevich, sent by the regime to become “Central Committee Party organizer” at the factory where Chertok was working…did not make a good first impression (“had the aura of a strict school matron–the terror of girls’ preparatory schools”)..but actually proved to be very helpful to getting work done and later became director of what was then the largest aircraft factory in Europe, which job she performed well. She apparently had too much integrity for the times, and her letters to Stalin on behalf of people unjustly accused resulted in her own arrest and execution.

*Frau Groettrup, wife of a German rocket scientist, one of the many the Russians took in custody after occupying their sector of Germany. Her demands on the victors were rather unbelievable, what’s more unbelievable is that the Russians actually yielded to most of them.

*Dmitry Ustinov, a rising star in the Soviet hierarchy–according to Chertok an excellent and visionary executive who had much to do with Soviet successes in missiles and space. (Much later, he would become Defense Minister, in which role he was a strong proponent of the Soviet invasion of Afghanistan.)

*Valeriya Golubtsova, wife of the powerful Politburo member Georgiy Malenkov, who was Stalin’s immediate successor. Chertok knew her from school–she was an engineer who became an important government executive–and the connection turned out to be very useful. Chertok respected her professional skills, liked her very much, and devotes several pages to her.

*Yuri Gagarin, first man to fly in space, and Valentina Tereshkova, the first woman.

*Overshadowing all the other characters is Sergei Korolev, now considered to be the father of the Soviet space program although anonymous during his lifetime.  Korolev spent 6 years in labor camps, having been arrested when his early rocket experiments didn’t pan out; he was released in 1944.  A good leader, in Chertok’s view, though with a bad temper and given to making threats that he never actually carried out.  His imprisonment must have left deep scars–writing about a field trip to a submarine to observe the firing of a ballistic missile, Chertok says that the celebration dinner with the sub’s officers was the only time he ever saw Korolev really happy.

Chertok’s memoir encompasses the pre-WWII development of the Soviet aircraft industry…early experiments with a rocket-powered interceptor…the evacuation of factories from the Moscow area in the face of the German invasion…a post-war mission to Germany to acquire as much German rocket technology as possible…the development of a Soviet ballistic missile capability…Sputnik…reconnaissance and communications satellites…the Cuban missile crisis…and the race to the moon.

Read more

“You may ask yourself, well, how did I get here?”

Commenter Lynn Wheeler writes at zenpundit:

“….Boyd would comment in the 80s that the approach was having significant downside on American corporations as former WW2 officers climbed the corporate ladder, creating similar massive, rigid, top-down command&control infrastructures (along with little agility to adapt to changing conditions, US auto industry being one such poster child).”

Wheeler’s comment reminded me of the following post that I had meant to blog earlier:

One occasion in particular in the late 1970s brought this home to me. McNamara had come to one of our staff meetings in the Western Africa Region of the World Bank, where I was a young manager, and he had said he would be ready to answer any questions.
 
I felt fairly secure as an up-and-coming division chief and a risk-taking kind of guy. So I decided to ask McNamara the question that was on everyone’s lips in the corridors at the time, namely, whether he perceived any tension between his hard-driving policy of pushing out an ever-increasing volume of development loans and improving the quality of the projects that were being financed by the loans. In effect, was there a tension between quantity and quality?
 
When the time came for questions, I spoke first at the meeting and posed the question.
 
His reply to me was chilling.
 
He said that people who asked that kind of question didn’t understand our obligation to do both—we had to do more loans and we had to have higher quality—there was no tension. People who didn’t see that didn’t belong in the World Bank.

Steve Denning

This too from a speech by Robert McNamara, “Security in the Contemporary World”:

The rub comes in this: We do not always grasp the meaning of the word “security” in this context. In a modernizing society, security means development.
 

Security is not military hardware, though it may include it. Security is not military force, though it may involve it. Security is not traditional military activity, though it may encompass it. Security is development. Without development, there can be no security. A developing nation that does not in fact develop simply cannot remain “secure.” It cannot remain secure for the intractable reason that its own citizenry cannot shed its human nature.
 

If security implies anything, it implies a minimal measure of order and stability. Without internal development of at least a minimal degree, order and stability are simply not possible. They are not possible because human nature cannot be frustrated beyond intrinsic limits. It reacts because it must.
[break]
Development means economic, social, and political progress. It means a reasonable standard of living, and the word “reasonable” in this context requires continual redefinition. What is “reasonable” in an earlier stage of development will become “unreasonable” in a later stage.
 

As development progresses, security progresses. And when the people of a nation have organized their own human and natural resources to provide themselves with what they need and expect out of life and have learned to compromise peacefully among competing demands in the larger national interest then their resistance to disorder and violence will be enormously increased.

Think about this in terms of the “armed nation building” of the past decade or so and in terms of successive Clinton, Bush, and Obama administration policies. Really not that much difference if you look at it in terms of securing stability through development – armed or otherwise. Not a novel observation in any way, but bears in mind repeating as the 2012 Presidential campaign continues its “running in place” trajectory….

Update:“Running in place” and “trajectory” don’t really go together, do they? Oh well. You all know what I mean….

Lean practices and starting a trauma center.

The discussion of the pharmacy reorganization got me thinking of the trauma center that we started in 1979. That was well before I learned about lean practices or the Toyota method but I think we used a number of their principles anyway.

When we started our trauma center, we did something a bit like your pharmacy project. We were a small hospital (120 beds) in a new suburban area with the ocean on one side and national parks and mountains on the other. Orange County narrows down to a triangle which ends at San Clemente where the Marine base begins. We knew the county was going to regionalize trauma. A study had come out suggesting that too many people died because “the golden hour” was lost in trying to get doctors and operating rooms organized, especially at night.

Several large hospitals planned to enter a competition to qualify as centers; one of course, was the UCI medical center. None of them was within 25 miles of our hospital. We didn’t like the idea of seeing the injured patients, some of whom would be neighbors, being taken that far and we looked to see if we could set up a trauma center for our community that would pass muster with the EMS survey team. First we had to see if the hospital and medical staff would support it. My partner and I couldn’t do it alone.

I did a study of the finances of trauma. The stereotype is a drunken insolvent who is stabbed or shot. Our community is located along I-5 where it runs from Los Angeles to San Diego. We are between mountains and the sea. I took the records of all emergency admissions, who went to surgery or who were discharged with a “surgical” diagnosis and who went to ICU. Some of those were general surgery but by using a screen we got down to the trauma cases. I found that 85% of them had some sort of insurance. This was largely because most were auto accidents. Even if people don’t carry health insurance, somebody may have medical benefits with car insurance.

We presented this to the department of surgery and they turned us down flat. The vote was something like 33 to 2. We went to the Board of Trustees. At the time, the hospital was owned by a partnership, one of the dreaded for-profit hospitals. The Board was easily convinced that this was something we needed to do if this hospital was going to grow. Southern California is cursed with many small hospitals and few big ones outside of Los Angeles. I knew a vascular surgery group, of three men, in the San Fernando Valley that went to 12 hospitals. One of the reasons I moved to Mission Viejo was to get out of Los Angeles.

Anyway, we had the hospital on board but not the doctors. The hospital decided to make the trauma center a contract service like the ER. My partner and I would run it. The hospital hired a city planner to draw up a proposal for the county. They gave me a copy when he was finished and it was the size of a Chicago telephone book. I read through it and it sounded like a proposal for a shopping center. I rewrote it. A lot of it was useful, like traffic analysis, but the vast majority didn’t answer the right questions.

Then we had to figure how we could do this and not go broke. There were two of us. We would call other specialists, like orthopedists and neurosurgeons, as needed. That’s how we got around the surgery department. There were grumbles but they faded as the orthopods began to realize that trauma cases paid well, mostly. Then we figured out who is in the hospital at night. The other trauma center candidates all promised to have a surgeon and anesthesiologist in-house 24 hours per day. We could not afford that. We promised that the surgeon and anesthesiologist would arrive within 15 minutes of being called, usually before the victim. The ER doc would be there. That was just as Emergency Medicine was becoming a specialty and our ER docs were GPs.

Read more