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Care Doesn't Scale

stevenscrawls.com

301–310 of 382 posts

Re: Care Doesn't Scale

#301
I think one of the most important purposes of technology, if not the most important one, is turning the things that don't scale into those that do.

Fundamentally, technology increases how much change a single person can achieve in the world.

The steam engine made production and transportation scalable. The printing press, radio, television and the internet did that to information sharing and knowledge preservation. The telegraph, telephone and internet did that to person-to-person communication. Writing and the computer did that to knowledge work. The record player, the radio and the internet did that to music listening. If you start noticing this pattern, you eventually notice it everywhere.

To predict where technology goes next, I think it's important to look at what can't be scaled just yet. Customer interaction, childcare, healthcare and physical product delivery are obvious examples, though there are probably many more.

It's not like we don't know how to do these things. We have machines (human brains) that clearly know how to do them, we just don't yet understand how to make similar machines ourselves, just like we didn't understand how to make machines that would be better muscles or better horses. This is not like e.g. faster-than-light transportation, where we don't even know whether it can be done at all.

I think it's worth thinking about how a wourld where those things could be scaled would look like. Individual instruction for each child, exactly fitting their needs and abilities, is an obvious consequence, so is much better care for those who can't currently afford a (good) specialist doctor.

Re: Care Doesn't Scale

#302
post #157

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?

Two reasons I can think of.

Legally an organisation is usually exposed in relation to its scale, even if the misconduct was limited to one employee trusted to carry out work independently, the penalty will likely be related to the total size of the company.

The second is if you're scale is large enough that you are considering a significant portion of the employees with some skill in a region, you have a harder time selecting for anything other than "holds a qualification" during hiring. This leads to all sorts of policy to prevent someone with qualifications but less integrity causing issues.

Re: Care Doesn't Scale

#303
post #93

Earlier quoted context omitted.

Try giving everyone housing without centralized production of things like nails, screws, siding electrical wire... Decentralizization is fine sometimes, but a single huge nail factory is going to beat thousands backyard forges in (average/95th percentile) quality and especially in prices.

This isn't true though. Neither in theory nor in practice. A broad set of individual product quality has consistently declined throughout the industrial era - not least, infamously, one of your own examples: nails. Many products have increased in quality due to factors unrelated to centralised production: new scientific research, intensive r&d, internal standardisation efforts - but centralised production tends inste…

Planned obsolescence is not a consequence of centralization, it is a strategy of capitalism.

Re: Care Doesn't Scale

#304

Earlier quoted context omitted.

There's also a different kind of coordination problem. The incentives of an organization - or at least of a corporation - are to make money and to continue to exist and to enrich and empower the people who control it. But employees' incentives are usually pretty different. Nurses usually get into nursing because they, at least to some extent, want to help people. Engineers get into engineering because they, at least…

This is the most insightful comment about organizational dysfunction and misaligned incentives. What you have described is astute and 100% accurate. Please make a blog post or something and share it around.

Possibly relevant:

"Institutions try to preserve the problem to which they are the solution", https://news.ycombinator.com/item?id=39491863

Re: Care Doesn't Scale

#305

Earlier quoted context omitted.

There's also a different kind of coordination problem. The incentives of an organization - or at least of a corporation - are to make money and to continue to exist and to enrich and empower the people who control it. But employees' incentives are usually pretty different. Nurses usually get into nursing because they, at least to some extent, want to help people. Engineers get into engineering because they, at least…

> Your engineers want to do that This is not true, I can confidently say, most of the time. Engineers generally want to build software they think is a good trade off between fulfilling the spec and not being too hard to build. This does not generally translate to good software. It’s not a detriment of character or anything like that. They’re just lazy like most people are

You need to work with better engineers.

Classically people got into software engineering because they liked writing code and they needed a way to pay the bills. Plenty of retired software engineers still code because it is part of who they are.

Re: Care Doesn't Scale

#306

Earlier quoted context omitted.

There's also a different kind of coordination problem. The incentives of an organization - or at least of a corporation - are to make money and to continue to exist and to enrich and empower the people who control it. But employees' incentives are usually pretty different. Nurses usually get into nursing because they, at least to some extent, want to help people. Engineers get into engineering because they, at least…

Then there's also the "rat-race" aspect. If you're focused on teaching, building or caring instead of test scores, conversions and profits, you're going to lose customers and opportunities. Parents choose schools with better test scores, not schools with better teaching. Customers use products with better conversions; this is literally what the word "conversions" means. If you focus on making your employees happy ins…

> Parents choose schools with better test scores, not schools with better teaching.

Only because other signals don't exist.

Parents know test scores don't correlate perfectly with learning, but what other metric do they have to judge by?

There are some schools with a stellar reputation for learning, and they get to charge an obscene premium. Amongst private schools, the ones with the best word of mouth reputation get to charge a lot more!

Re: Care Doesn't Scale

#307
post #131

> There was some pain in that realization. So many of my utopian dreams—what if we could live in a society where everyone can get the food, the housing, the healthcare, the opportunities for growth that they deserve—come from a place of wishing that we could live in a world where people are cared for. I'd like to offer some comfort to the author on this score. Food, housing, healthcare broadly... while these are all…

> The food system is different from homecooked meals This is a good point, and everything I've heard from parents says that it's parents, not children, who identify home-cooked meals with care. Children notoriously prefer prepackaged industrially processed food over whole foods prepared with care and love. In order to feel cared for, all children need is to trust that the person caring for them will make sure they ge…

> Children notoriously prefer prepackaged industrially processed food over whole foods prepared with care and love.

Nearly all people do, food scientists are really damn good at their job.

It isn't even that the stuff tastes better, it just triggers more of the pleasure centers in the brain and causes people to want more.

No one eats an entire bag of doritos because they taste better than a good steak.

Re: Care Doesn't Scale

#308

Earlier quoted context omitted.

> Children notoriously prefer prepackaged industrially processed food over whole foods prepared with care and love. Let me fix that for you: Children notoriously prefer heavily marketed food in attractive packaging which is designed/optimized for addictiveness and immediate gratification.

Eh, if you dumped a container of sugar into a home cooked meal they'd like it more than packaged food.

There is a famous saying: A professional chef is just some one who is willing to use more butter than a home cook.

Re: Care Doesn't Scale

#309

Earlier quoted context omitted.

> Your engineers want to do that This is not true, I can confidently say, most of the time. Engineers generally want to build software they think is a good trade off between fulfilling the spec and not being too hard to build. This does not generally translate to good software. It’s not a detriment of character or anything like that. They’re just lazy like most people are

You need to work with better engineers. Classically people got into software engineering because they liked writing code and they needed a way to pay the bills. Plenty of retired software engineers still code because it is part of who they are.

> better engineers.

a no-true-scotsman fallacy.

A company should be able to build working software even without good engineers. Just like how TCP can deliver ordered packets over unreliable connections - you change the processes and systems to do it. Of course, you give up some things - such as speed and agility in that case.

For most people, a job is a job. It's not something they want to dedicate their life to - that's for artists and craftsman, and not many people are of that ilk in the modern day.

Re: Care Doesn't Scale

#310

Earlier quoted context omitted.

> Your engineers want to do that This is not true, I can confidently say, most of the time. Engineers generally want to build software they think is a good trade off between fulfilling the spec and not being too hard to build. This does not generally translate to good software. It’s not a detriment of character or anything like that. They’re just lazy like most people are

You need to work with better engineers. Classically people got into software engineering because they liked writing code and they needed a way to pay the bills. Plenty of retired software engineers still code because it is part of who they are.

Most software engineers especially now are definitively not plucky kids who just love computers. They are in it entirely for the money. It's a completely different kind of person, the motivation comes from a completely different place.
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