I am currently reading The Social Life of Information, another Harvard Business School text that critiques the IT industry. It is annoying me like IT Doesn’t Matter did, but is full of interesting historical background like The Big Switch is, so as a history junkie I am hooked. I guess the fact that I find the book annoying marks me as the techno-jingoist that they are critiquing.
The book’s main thesis, so far in my reading, is that there is a lot more social context around information and its technology than information technology enthusiasts (e.g. me) would claim. Furthermore, that social context is important and overlooked leading to problems in deployment. I will not be cruel enough to say that MIT invents the future while Harvard publishes scholarly critiques of it (oops, but Dan Bricklin’s audience agrees with me).
There are, as you might expect from the strong praise the book has received, lots of good stories and fair points. For example, there is the hilarious account of the attempt by Chiat/Day’s senior management to create the office of the future, documented by Wired News in issue 2.07, and then fittingly recanted in 7.02. The dystopian visionary CEO created office space with no offices, where hierarchy was “eliminated” as each employee had access to any desk at the beginning of the day that they wanted to take.
The reality was the employees had to rush to grab desk. Field staff would arrive in the middle of the day with no idea where the rest of their team had sat. Team members could not sit together, and turf warfare began as senior managers tried to pull rank over junior members of other teams so that they could get their own team members to sit together. These same post-hierarchical managers sent their secretaries to grab desks for them in advance. Amongst all this bullying the CEO would walk around asking people if they were sitting in the same place they had sat yesterday. If they answered yes, he would move them to another place.
And the computers, of course, were a pain to recustomize each day for each worker’s preference. No employee had any personal computer, instead they would pick up a fresh device each day. And it turns out that desks are more than just place on which to pile paper, instead the location of each pile of paper had meaning and value. You get the idea.
By contrast, I was surprised to learn how keenly socially aware Alexandar Graham Bell was with the new technology he invented, the telephone. His investors were dismayed at how useless the telephone seemed compared to the telegraph and tried to sell the patents to Western Union at rock-bottom prices. Western Union turned them down and I recently discovered (see Brunelleschis Patent in the sharing medical techniques post) that these are still the most valuable patents to date.
Instead, Bell tried to get his telephones into hotels and encouraged hotel guests to use the phones to call reception staff. He also put the phones into offices so that office staff would experience the advantages of telephones. Such social interactions must have been great for creating his market of home customers.
It is interesting to me to contrast Bell’s approach with Day’s when thinking about doctors learning and the Department of Health’s plans for modernising education. Six years ago, as I was beginning my residency, Modernising Medical Careers included bold talk of restructed teaching that fit the increasingly unstructured schedules of doctors. As junior doctors worked fewer hours with fewer overlaps with other doctors’ shifts the idea of time- and place-shifted teaching was attractive. Each doctor could watch each lecture alone.
At the time it sounded good and I was heavily in favour of it. But now, after reading this annoying book, I am annoyed to admit that I am rethinking the advantages.
As I read the rest of the book I am curious to see what else it covers. Certainly, the index does not include Google, and it has only one mention of GNU, and thus open source software, a highly social technology endeavour. And as far as I can tell, there will not be any mention of social software as the book was published in 2000, around the same time that web 2.0 began to crystalize. Social software may not fix the social problems that the book describes, but it does provide a variety of social solutions to problems that were previously intractable.
As happens to most people who visit him, I learned a lot of things from Dr. Eran Bellin when I met him last week. One story he told stayed with me because of a mild obsession I have with the social pressures around sharing information.
The story he told was the one told to him by his father, Lowell Bellin as a medical student. It was about the secrecy surrounding the invention of the obstetric forcep, a tool that would have saved many lives had other physicians known about it earlier.
I am not sure if I have the exact story he was talking about, but a little Googling around led me to the Chamberlen family. For perhaps a whole century only the Chamberlen family knew and kept the secret.
Apparently Peter the Elder was the inventor of the forceps. The brothers went to great length to keep the secret. When they arrived at the home of the woman in labor, two persons had to carry a massive box with gilded carvings into the house. The pregnant patient was blindfolded as to not to reveal the secret, all the others had to leave the room. Then the operator went to work. The people outside heard screams, bells, and other strange noises until the cry of the baby indicated another successful delivery.
Eventually, different members of the family sold the secret to other people, and then someone leaked the secret to the public.
What is interesting to me is how late the dates are: the 16th and 17th century, well after patents had become common in Europe. Dr. Bellin’s mention of the story, and its implicaitons for patient care, inspired me to scan two articles I have that cover the invention of patents in 15th century Florence (Brunelleschis Bargain and Brunelleschis Patent). The idea was to give inventors a way to make more money from sharing their inventions rather than they would from hiding them.
Fillippos Brunelleschi, the architect of Florence’s remarkable cathedral, won the world’s first patent for a technical invention in 1421. Brunelleschi was a classic man of the Renaissance: tough-minded, multi-talented, and thoroughly self-confident. He claimed he had invented a new means of conveying goods up the Arno River (he was intentionally vague on details), which he refused to develop unless the state kept others from copying his design. Florence complied, and Brunelleschi walked away with the right to exclude all new means of transport on the Arno for three years.
The reason that Dr. Bellin mentioned the forceps story is the same that he had created Clinical Looking Glass software and joined the Emerging Health Information Technology company. He wanted doctors to learn from each other what works, and then to use what they learned to help patients. For that I congratulate him.
But the story of Chamberlen family saddens me, and I would go further to say that a doctor doing this today would be acting unethically. I hope, at least, that there are enough incentives that such a doctor would also be acting foolishly.
Update: Dr. Bellin kindly corrected a couple of mistakes I made in this post. First, he heard the story about the Chamberlens not as a medical student, but from his own father, also a physician committed to the duty of physicians to share knowledge. And second, Emerging Health Information Technology was created by its current CEO, Jack Wolf, who in the words of Dr. Bellin “had the vision to realize that the only way to afford cutting edge technology in the health care sector was by creating virtual cooperative communities of hospitals sharing infrastructure costs through a trusted outside entity”.
I came across two interpretations of entrepreneurship that interested me recently. I read the first in the Harvard Business Review article Designing High-Performance Jobs:
In fact, entrepreneurship has been defined (by Howard H. Stevenson and J. Carlos Jarillo) as “the process by which individuals—either on their own or inside organizations—pursue opportunities without regard to the resources they currently control.”
The second comes from a fascinating PhD thesis Enterpreneurship and the Market Process which sees a “relationship between scientific and market processes not just that of analogy, for the growth of knowledge is the subject of both”. In the book of his thesis David Harper says:
Like scientific enterprise, entrepreneurship is described essentially as a problem-solving activity which must be conceived in terms of human ends and purposes. Like science, the market is regarded as an inter-subjective and pluralistic process for generating conjectures, exchanging and promoting ideas and attempting to refute them. Both learning processes require conventions, many of which have evolved spontaneously, to facilitate the efficient production, coordination and criticism of knowledge.
Knowledge, for entrepeneurs, is what customers want and how to get it to them. There is a scientific analogy here, with falsifiable hypotheses as entrepreneurs prefer to try the product in the market to see if customers exist who would pay for it, rather than the traditional approach I have seen by “business” people who create PowerPoint presentations to theorize over the existence of those customers.
I spent the last couple of days walking around Cambridge, my new home, as I decide what to focus my new company on. I am getting lots of ideas, but these two definitions of entrepreneurship are intriguing me.
Open source software is not just morally superior in its transparency, it is also economically more efficient because it reduces marketing and development costs.
Sun Microsystems demonstrated the drop in marketing costs through its recent layoffs of 2500 employees. Losing a job is sad, and I wish that none of those 2,500 was fired, but this is one situation in which Sun is reducing headcount from a position of strength rather than because it has lost customers.
Open source software requires fewer marketing staff because much of its marketing is done by customers. Here is an amusing story recounted by Sun’s CEO on his blog of a marketing visit he did to a large client of Sun, shortly after Sun had bought MySQL. Jonathan Schwarz asked if Sun’s customer would like to hear the latest about MySQL:
The CIO responded categorically with “we don’t run MySQL, we run [name withheld to protect the proprietary].” The CISO said, “We can’t just let developers download software off the net, you know, we’ve got regulation and security to worry about.” The CTO smiled. Everyone else appeared to be sitting on their hands. I was going to leave it at that. Thanks for the business.
Until a (diplomatically) assertive Sun sales rep piped up, “Um… no, I connected with a buddy of mine over at MySQL, and had him check – you’ve downloaded MySQL more than 1,300 times in the last twelve months.”
To test out the quality of open source software download and run it. No big demonstration, no expensive marketing visits, no sales presentations that make claims that you only get to test out after you parted with your money.
Just test for yourself if it does what it claims to do. And when it works straight away, you get to work straight away. If the work is really important to you, ask your finance department to pay the open source software vendor for a support contract.
This is a step jump in productivity of the software sales process.
Last week I went to Seattle and saw, amongst many other interesting sites, the original Starbucks coffee shop. Apparently, this is the only Starbucks that still has the original logo:
You can click on the picture to see the details. Compare this to the more discrete current logo:
Can you imagine the committee meeting in which they discussed why they were switching to this logo?
A charming example from the book Nudge: Improving Decisions About Health, Wealth, and Happiness describing the success of Amsterdam’s Schiphol Airport in reducing spillage at urinals by 80 percent.
There the authorities have etched the image of a black housefly into each urinal. It seems that men usually do not pay much attention to where they aim, which can create a bit of a mess, but if they see a target, attention and therefore accuracy are much increased.
It gets better.
According to the man who came up with the idea, it works wonders. “It improves the aim”, say Aad Kieboom. “If a man sees a fly, he aims at it.”
The title of the paper – Inefficacy of different strategies to improve guideline awareness – says it all. Here is the abstract:
In spite of numerous guidelines for evidence based diagnostic and therapy adequate knowledge of current recommendations is disappointingly low. In the Hypertension Evaluation Project (HEP I) we showed that awareness of national hypertension guidelines under German practitioners was less than 25% in the year 2000. This indicates the need for efficient strategies to relevantly improve guideline awareness.
For doctors, there is simply too much information to keep track of and the information never appears when you need it, i.e. when you are about to do something with your patient.
I think it is time to rethink the workflow. It is time to push this information out to the person who cares about it the most, i.e. the patient. It is why I am starting my new company, Patients Know Best. Watch this space.