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Care Doesn't Scale

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Re: Care Doesn't Scale

#341

Post by downut »

MisterBastahrd wrote: post #251
moolcool wrote: post #144

Earlier quoted context omitted.

To complete the thought, the baker example is explicitly in opposition to OP's point. In the economy we exist in, a 3am artisan baker does so explicitly out of a care for craft and community.

The 3am baker currently exists because the people who benefit the most from the exploitation of labor have the extra money to buy artisan products. My great grandfather had a bakery. He and my great grandmother would bake their product and my grandfather and his brothers would deliver the product to local businesses and homes. And then corporate breadmakers came in and made it impossible to compete from a price stand…

I see another comment like this one, so here I will respond to both. I've known quite a lot of rich people, all vastly richer than ourselves. As for us, we are so rich we don't think we can financially justify spending more on cars than my 23 yo pickup and my wife's 8 yo Prius. Our house in an astoundingly banal suburb is worth ~$300K. We can't afford to retire to a cool US city. I find it hilarious that SWEs posting on HN think paying $8 for a loaf of great bread means you are "rich".

As for those rich people, they generally have atrocious taste. They will drop big bucks on high priced wine, or more generally, restaurants. They stay at resorts on vacation and fly business class. We do go to Paris, and stay in a cheap AirBnB out in the 19th, and we fly steerage. We make most of our meals in the AirBnB, and... wait for it... eat food out of artisan vendors. I don't think we've ever spent more than $150 for a restaurant meal in the EU and most of the time it is less than $50. Those rich people we know would never ever spend the time to go to a great bakery. Why would they? That would take time mingling with the plebes, and who cares? Bread is bread. Impossible to play the status game on that.

The problem with the economics of artisan products is that the number of people, income immaterial, who would go out of their way to spend more on an apex product is, economically speaking, a set of measure zero. Low bid rules our world. This is the reason that at scale corporate chains produce the shit that they do, because that shit industrial product is lower cost and nearly everyone prefers that.

We don't, but we don't matter.

Fuck the rich. But they're not the problem here.

edit: improve accuracy

Re: Care Doesn't Scale

#342

Post by RicDan »

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?

I live in Switzerland and my girlfriend has been working as a doctor (surgery), and it has mostly to do with the politics that come with hierarchy. As in nearly all companies, hierarchy allows politics and favourism to enter the playing field which will attract people that do not act in the primary interest a service should have: ergo, patients.

For example you have leading doctors who prefer not to look at patients, even tho they belong to them (from a specialization point of view), as they are "cumbersome" cases. That often leads to them "ignoring" it for some time until someone else takes over, or completely delegating it to non-fit persons.

It's a huge pain for me to heard this every day, because it literally sucks out any desire to work as a doctor from my girlfriend. At the same time, it's infuriating: we pay a lot each year, and with every year more, for services like this. If I was to ever win lottery, I'd use that money to make my own hospital without all of this crap.

Re: Care Doesn't Scale

#343

Post by KetoManx64 »

rightbyte wrote: post #244
jimbokun wrote: post #194

Earlier quoted context omitted.

> Children notoriously prefer prepackaged industrially processed food over whole foods prepared with care and love. In most cases, this is probably due to the care givers training their children to prefer that kind of food because they don't make many home cooked meals. I don't even know if it's true, though. When I was a kid, the best food in the world were the home made meals my grandmother made, especially on the…

Dunno. My wife was reeeeally tryhard with our first child feeding him only home made food from the age of 1 to 2. He though industrial food was awesome as soon as he was exposed to it. (Obviously bad sample size) I think it is something about the perfect homogeneous product they like. Or how the taste even out between different ingredients on the shelf.

Something to keep in mind is that industrial food usually has a lot of sugar and other additivies added to make it taste as good as possible. . Companies literally spend billions of dollars figuring this stuff out, of course the home made meal can't compete.

Re: Care Doesn't Scale

#344

Post by Bostonian »

Regarding caring for children, for much of the 20th century it was common for women to have half a dozen children or more. The children got less attention from their parents than a single child would, and younger children got some care from the older ones. Most turned out OK.

Re: Care Doesn't Scale

#345

Post by endoblast »

mmooss wrote: post #272
endoblast wrote: post #109

>We’re pretty limited when it comes to care. In any given moment, you can only really care deeply and individually for one person. Absolutely. Society tends to assume that people are interchangeable units and that 'care' is a commodity which can be dispensed evenly as if from an industrial nozzle in a food factory. So we have 'care homes', 'daycare', 'care packages'. We are enjoined to be more 'caring'. But the reali…

> >We’re pretty limited when it comes to care. In any given moment, you can only really care deeply and individually for one person. The evidence very strongly points the other way, IMHO: Almost all people care deeply and individually about many others, starting with their families - spouse and children are a clear and I think irrefutable example of deep caring and love for multiple people. And for most, also sibling…

I'm not claiming that we can only love one person, it's just that the nature of love is unique to each dyadic relationship; they're not commensurable.

Yes, I may show empathy and respect to strangers, patients or clients, trying hard to deal with them fairly and conscientiously. Well said.

But this only operates in the short term.

It doesn't mean I can love them all, or at all, or love them equally, or anything like that. That would be meaningless. We don't know what love is exactly, but it does seem to include a sustained form of attention. It provides a space in which the other person can grow.

Such attention is always specific, by its nature; it latches onto a subject, something recognised yet new in the other. It can't be served out like soup. Yet increasingly businesses, bureaucracies and government pretend that it can!

Re: Care Doesn't Scale

#346

Post by vanderZwan »

myworkinisgood wrote: post #337
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…

Training is the high-cost missing from the equation of "low-cost" High quality training doesn't scale.

Doesn't scale compared to what, though? Because if the comparison point is the more typical modern care-work organization where tasks are divided into a fine-grained categories of "high skill" and "low skill" work, outsourcing the "low skill" tasks to the low-trained workers as an attempt to save costs, then Buurtzorg shows that that approach is not a net savings.

Because Buurtzorg has been shown to have lower costs and higher job satisfaction than its competitors, and the reasons are quite obvious too: the hierarchical outsourcing solution adds extra communiciation costs, administration costs, and similar organizational overhead. On top of that patients are in a situation where they see many different unfamiliar care workers briefly, meaning they do not get to form a bond of trust with any one of them. That is a pretty heavy costs that I don't even know how to categorize.

Re: Care Doesn't Scale

#347

Post by bunderbunder »

ToucanLoucan wrote: post #257
bunderbunder wrote: post #249

Earlier quoted context omitted.

This is also where I really dislike a lot of this more recent push toward automating communication. One person deciding what needs to be said, to whom, and when, can have a LOT of leverage in the productivity department, by reducing the time that tens or even hundreds or thousands of other people lose to coping with the fire hose. Microsoft Copilot has been yet another downgrade in this department. Since it got adopt…

At my company we are aggressively rolling out policies to forbid the use of AI. I'm one of the bigger folks behind it. I just see no benefits. I have no desire to debug AI generated code, I have no desire to read pages and pages of AI generated fluff, I have no desire to look at AI generated images. Either put the work in or don't.

I will say I have warmed to GitHub Copilot's chat feature. It's a great way to look up information and get answers to straightforward questions. It feels similarly productive to how well just Googling for information was back in the 2010s, before Google went full content farm.

Re: Care Doesn't Scale

#348

Post by vanderZwan »

consp wrote: post #269
Aeolun wrote: post #260

Earlier quoted context omitted.

To be fair, Buurtzorg doesn’t scale either, as they’re perpetually short staffed.

The other companies are also shortstaffed, all healthcare is at the moment, and the bureaucracy layers just keeps humming along ... Buurtzorg is however cheaper, and since you cannot scale the actual care that counts.

Yes, and the actual nurses also have more job satisfaction and their patients are happier too, so the quality also improves. The main explanation given for that is that compared to solutions that require a lot of time spent on administrative work, these nurses get to focus on the actual care work, and have more personal time with the patients, meaning a bond of trust can be established. Which is also an important aspect in the scaling trade-off I'd say.

Re: Care Doesn't Scale

#349

Post by bumby »

RicDan wrote: post #342
bumby wrote: post #157

Earlier quoted context omitted.

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?

I live in Switzerland and my girlfriend has been working as a doctor (surgery), and it has mostly to do with the politics that come with hierarchy. As in nearly all companies, hierarchy allows politics and favourism to enter the playing field which will attract people that do not act in the primary interest a service should have: ergo, patients. For example you have leading doctors who prefer not to look at patients,…

From your perspective, what are some potential avenues to better align the incentives of doctors to see those "cumbersome" patients?

Re: Care Doesn't Scale

#350

Post by MisterBastahrd »

downut wrote: post #341
MisterBastahrd wrote: post #251

Earlier quoted context omitted.

The 3am baker currently exists because the people who benefit the most from the exploitation of labor have the extra money to buy artisan products. My great grandfather had a bakery. He and my great grandmother would bake their product and my grandfather and his brothers would deliver the product to local businesses and homes. And then corporate breadmakers came in and made it impossible to compete from a price stand…

I see another comment like this one, so here I will respond to both. I've known quite a lot of rich people, all vastly richer than ourselves. As for us, we are so rich we don't think we can financially justify spending more on cars than my 23 yo pickup and my wife's 8 yo Prius. Our house in an astoundingly banal suburb is worth ~$300K. We can't afford to retire to a cool US city. I find it hilarious that SWEs posting…

Ever stop to think that the fancy restaurants they're going to are using these artisan bakers? The vast majority of high-end restaurants are not baking their own bread or doing their own pastries. They're outsourcing them because of the sheer amount of space you need to do that sort of specialized work.
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