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Care Doesn't Scale

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Re: Care Doesn't Scale

#231

Post by bunderbunder »

bumby wrote: post #221
bunderbunder wrote: post #204

Earlier quoted context omitted.

Paperwork. I swear, it's paperwork. My mom is a (retired) preschool teacher. By the end of her career, she was working for a school affiliated with a large chain, and maybe 1/3 of her time was spent on filling out all the paperwork required by management. That was time she absolutely was not spending with the kids. My dad is a (retired) doctor. Similar story there. His hospital ultimately ended up associated with a r…

> The same thing happens at my own job, software. The bigger a company I'm at, the more of my job consists of filling out paperwork about the work I'm doing, rather than doing the actual work. There's some irony here considering software has been promising for decades to help businesses scale information sharing.

Oh, it has. The scale at which we share information has never been greater.

Concrete example:

15, 20 years ago when we tracked user stories, the status of the sprint, etc., with sticky notes on a wall. We didn't have to record a lot of information on them because they only needed to track status at a high level. Details were communicated through conversations. That did mean that a lot of that information was tribal knowledge, but that was actually fine, because it was of ephemeral value, anyway. Once the work was done, we'd throw the sticky notes in the trash can and forget the tribal knowledge. Reporting out happened at a much higher level. We'd report status of projects in broad strokes by saying what big-picture features were done and what ones were in progress. We'd fill operations in on the changes by telling them how the behavior of the system was changing, and then let them ask questions.

Nowadays, we put it all in Jira. Jira tickets are extremely detailed. Jira tickets live forever. Jira tickets have workflow rules and templates and policies that must be complied with. Jira rules make you think about how to express what you're doing in this cookie cutter template, even when the template doesn't fit what you're actually doing. Jira boards generate reports and dashboards that tell outside stakeholders what's happening in terms of tickets and force them to ask for help understanding what it means, almost like you're giving them a list of parameters for Bézier curves when what they really wanted was a picture. Jira tickets have cross-referencing features, which creates a need to do all the manual data entry to cross-reference things. Jira tickets can be referenced from commits and pull requests, which means that understanding what changed now means clicking through all these piles of forever-information and reading all that extra documentation just to understand what "resolves ISSUE-25374" means when a simple "Fix divide-by-zero when shopping cart is empty" in the commit log would have done nicely. etc.

We communicate so much more these days. Because we can, because we have all this communication technology to facilitate all that extra communication. What we forgot is that, while computers can process information at an ever faster pace, the information processing hardware inside our skulls has remained largely unchanged.

Re: Care Doesn't Scale

#232

Post by Kevguy »

bumby wrote: post #218
drivingmenuts wrote: post #212

Earlier quoted context omitted.

Most healthcare organizations in the US are profit-oriented, sometimes to the detriment of the patients. That is why we have large, unwieldy organizations surrounding the very few people that actually do hands-on healthcare. There’s also the issue of liability – it can be pretty litigious in the US, and companies are frequently wanting to limit their liability, which means having the paperwork to back up their decisi…

> Most healthcare organizations in the US are profit-oriented According to the American Hospital Association, less that 20% are for-profit [1]. I'm sure all are extremely budget-conscious, but that's not the same as being profit-driven. It seems to me that the US optimizes for quality to the detriment of cost and, more recently, access. [1] https://www.aha.org/statistics/fast-facts-us-hospitals

But also be aware that non-profit does not mean non-profit-oriented. Just that any profit goes to executives [1] instead of toward community/charity services [2].

[1] https://paddockpost.com/2021/06/10/executive-compensation-at... [2] https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01542

Re: Care Doesn't Scale

#233

Post by baoluofu »

kome wrote: post #20

I have what I think it's a very good article on the economy of care - making exactly this point and others, but it's in the dungeon of peer review for more than one year. And the reviewers do not even answer my emails.

I would be keen to read it if you're happy to share?

Re: Care Doesn't Scale

#234

Post by moolcool »

taylorius wrote: post #226
moolcool wrote: post #215

Earlier quoted context omitted.

> No-one said anything about automating any human connection Maybe I was inferring the wrong thing, and if so I apologize, but the context of this comment was invoking LLMs and humanoid robots in a discussion about how "care doesn't scale". Like of course automation and technology should do things to make the lives of the elderly easier, but I would not classify any action done by a machine as "care". My dishwasher i…

Perhaps it is a question of the different meanings the word care can take. Care in its normal everyday usage is indeed a natural human emotion, however this was not the subject of my post. "Carers", are people who perform functions for people unable to do them themselves. Whether they "care" or not for their charges is not directly relevant (though often they are relatives, and certainly do care for, and love the peo…

> For what its worth, I doubt we disagree too much, I think it was a misunderstanding

I think so as well-- I'm glad you replied.

We certainly agree on the problem of bad care homes. We've all seen and heard the horror stories, and it's really unacceptable what's going on at a lot of these places. The question is, would unscrupulous care homes buy a robot and re-task workers with providing more social care to residents, or would they simply lay off the workers?

For a pretty large chunk of the population, care workers are the only source of regular human interactions. As such, I would make the argument that the necessity for these tasks to be completed by a human is, in many cases, a feature, not a bug.

Re: Care Doesn't Scale

#235

Post by intended »

hardlianotion wrote: post #111
intended wrote: post #100

Earlier quoted context omitted.

This comes across as a comment on the headline and not the article. The article had a very specific circumstance it built upon - how much human time time it takes to help kids. This doesn’t scale, in the context of the article. Your statement would translate into a point on economics and organization, than individual care. This still obscures the fact that many critical functions don’t scale. I would add that these t…

The comment comes from reading the article, then wondering how can societies make things scale? We make things scale by delegating our concerns to people who know and care more about specific outcomes, and helping them to make the differences that are required. Scale comes from people learning that things around them matter and that they are responsible for making them good.

Ok.

In that case i'll ask for a clarificaiton on the link. From the article it seemed quite a clear cut case about activity types that dont scale.

Outsourcing the responsibility doesn't mean it scale, which seems contradicted by what you are saying. People learning that things matter and that they are responsible, doesn't change this does it?

Re: Care Doesn't Scale

#236

Post by vanderZwan »

cassepipe wrote: post #154
vanderZwan wrote: post #142

If we're going to talk about how to "scale care" and how not to, then Buurtzorg has to be mentioned[0][1]. It's a Dutch home-care company that was started by nurses who basically got frustrated that managers got in the way of them doing their job. It operates by having a flat organization working with small teams of highly trained nurses, and trusting them to make the right decisions. The result is a low-cost provide…

Thanks for elaborating further what we mean by "scaling". Couldn't it be said that when organization acquire ranks, it is to solve coordination problems that arise with scale but that in this case, there isn't much that is solved by more organization ?

That sounds about right. If you watched the video then you also will notice that the further up the management chain we go, the more abstract the goals become compared to the most concrete ones that the nurses are dealing with. One could say that if most care work starts and ends with those concrete individualized issues, the cost of handling (or worse, prioritizing) abstract goals is far greater than the benefits that they add.

Compare that to the pandemic response example I gave: that is the kind of challenge where there are concrete problems at individual, city-wide, national and international scale to tackle, and they're all interconnected too. So plenty of those coordination problems you mentioned.

Re: Care Doesn't Scale

#237

Post by moolcool »

tripper_27 wrote: post #165
Tade0 wrote: post #46

> But I wonder if part of that smaller focus comes from a deep realization that care doesn’t scale. My experience (and I believe it to be common) is that I'm really, really, really out of spare energy to care about anyone or anything else. Mind you, I'm in my best shape in years and I've explored my limits to find out they're actually way further than I originally thought, but still.

hey, I hear you. Modern America is full of voices demanding you give them care/attention. Every. Single. Thing. It is overwhelming. See following comments on the need for slack/margin in capacity. Well, we also need it in emotional demands. Yet every commercially-moderated interaction in our society seems to be optimizing for making us care more about it, because that increases their revenue.

I really resent how our collective attention has been so commoditized. Advertising lies at the core of so many of our problems, and I'm not sure how we can come back.

Re: Care Doesn't Scale

#238

Post by vanderZwan »

bumby wrote: post #157
vanderZwan wrote: post #142

If we're going to talk about how to "scale care" and how not to, then Buurtzorg has to be mentioned[0][1]. It's a Dutch home-care company that was started by nurses who basically got frustrated that managers got in the way of them doing their job. It operates by having a flat organization working with small teams of highly trained nurses, and trusting them to make the right decisions. The result is a low-cost provide…

Your reply seems focused on size, but this line caught my attention: > trusting them to make the right decisions. I'm wondering if trust isn't the real issue. For example, wouldn't a large high-trust organization be able to provide good care? Or is there something intrinsic to scale (e.g. diffusion of responsibility) that makes "high-trust" and "large organization" incompatible?

Well, Buurtzorg is a large organization, it's just that it does not have a large hierarchy. I suspect you're really asking "high-trust" and "large hierarchy". In that case there's plenty of causes to point at. I'll just give a few of the top of my head

First, note any organization that breaks into different departments (hierarchical or not), at least partially does so to let each department "abstract" away the other ones - if you don't have to worry about issues outside of your responsibility, you can focus more on yours. That is actually a form of trust.

In the case of a hierarchy however, that means that each layer abstracts away the layers above and below, and since going up multiple levels in the hierarchy happens indirectly, the further away, the more abstract things become. So that often needs some kind of structure to regain the trust that is lost by dealing with abstract departments - leading to bureaucracy.

On top of that, usually more power resides higher up the hierarchy. That means that without explicit structures to compensate for this, people lower in the hierarchy lack individual leverage to protect themselves against bad decisions made higher up, that may not even be malicious or intentional but just a consequence of the aforementioned abstraction.

Of course, most structures that are created to fix this typically are also abstract procedures, meaning they barely help with our instinctual "I cannot attach a face to this" type of distrust. Bureaucracy can create leverage, but rarely creates trust. Which also explains that quite often, talking to someone in person can make such a difference in being allowed to "go ahead" or not. Because it can provide a more "natural" sense of trust that bureaucracy is supposed to provide but barely does.

Re: Care Doesn't Scale

#239

Post by zeroCalories »

bccdee wrote: post #187
Uvix wrote: post #52

Earlier quoted context omitted.

You mean the elders who failed to take care of themselves, assuming someone else would do it for them.

That's how getting old works, yes. You lose the ability to take care of yourself and begin to depend on others. Do you really think infirmity is something that can be avoided with the right grindset?

He means that they messed up by investing in their children and providing them a good life instead of putting everything in an index fund. They didn't realize the rug pull they were about to eat.

Re: Care Doesn't Scale

#240

Post by bumby »

Kevguy wrote: post #232
bumby wrote: post #218

Earlier quoted context omitted.

> Most healthcare organizations in the US are profit-oriented According to the American Hospital Association, less that 20% are for-profit [1]. I'm sure all are extremely budget-conscious, but that's not the same as being profit-driven. It seems to me that the US optimizes for quality to the detriment of cost and, more recently, access. [1] https://www.aha.org/statistics/fast-facts-us-hospitals

But also be aware that non-profit does not mean non-profit-oriented. Just that any profit goes to executives [1] instead of toward community/charity services [2]. [1] https://paddockpost.com/2021/06/10/executive-compensation-at... [2] https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01542

I think there’s an error in conflating “not for profit” with “charity”. You could provide all care at cost and have zero charity care. That d doesn’t imply all “profit” goes to executives, but rather to keep reimbursed or charged costs lower.
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