All posts by blackfriar
New Yorker: I hate my hat magazine
Dave Chase – How healthcare’s disruption will play out…
PDF Report: Volume_to_Value_Revolution
Healthcare’s Trillion-Dollar Disruption
As a healthtech startup, you can’t help but get excited when Bob Kocher (Venrock) or Esther Dyson speak about the opportunities in healthcare given their impressive track records. Both spoke during this past week’s StartUpHealth Summit.
One of Bob’s main points was that the opportunity in healthcare is so big that most startups are thinking too small and his firm is putting their money where his mouth is (e.g. Castlight). Esther has proven time and again to be very prescient — just go back and watch her old interviews on Charlie Rose over the years to see how accurately she predicts the future. She interrupted attending the JP Morgan presentations to visit with the StartUp Health Summit. Paraphrasing, she said companies like those in StartUp Health are the future. Rather than trying to steal share from the companies presenting at JP Morgan, startups should focus on creating the new market space, and the market will move to them…not the other way around.
Transformers vs. Preservatives
While the opportunities are massive, what’s the biggest obstacle to healthcare transformers? It’s the “preservatives” — the incumbent healthcare players. That is, the preservatives are trying to protect the status quo, rather than focusing on how to sincerely address the Triple Aim (improve outcomes, reduce cost, improve patient experience). In every healthcare organization I’ve talked with, whether they are a provider, pharma, or health plan, there are transformers internally who know what to do but are stymied by preservatives.
The same is true politically. There are those who call themselves “progressive” or “conservative.” Unfortunately, it seems that 80 percent of politicos are actually preservatives just doing the bidding of lobbyists trying to protect the status quo. The preservatives are costing thousands of lives and hundreds of billions of unnecessary wasted dollars. The real leaders in healthcare will see through them and get them out of the way of progress.
One of the transformative organizations pushing for change is Oliver Wyman. Oliver Wyman is a leading consultancy that has setup a Health Innovation Center that recently published a paper entitled The Volume-to-Value Revolution (PDF) with the input of an advisory board (PDF) of CEOs ranging from large public companies to emerging companies (disclosure: I’m on the Health Innovation Center Advisory Board). In that paper, authors Tom Main and Adrian Slywotzky make the case that new patient-centered population health models will cause more than $1 trillion of value to rotate from the old models to the new and create more than a dozen new $10 billion high-growth markets (see also Patients Are More Than A Vessel For Billing Codes). Each of these markets creates large opportunities for healthtech startups. Naturally, legacy vendors are optimized for the old models (see Why It’s Good News HealthIT is So Bad) while startups optimize for the new models.
Most industries compete on value. U.S. healthcare does not. But that is about to change.
Healthcare innovators are already redefining healthcare value, putting patients first and inventing with little regard for current constraints. They have ignited a powerful, self-funding upward spiral by focusing first on healthcare’s big opportunities, transforming the value equation, generating large savings, and fueling smart reinvestment in the next wave of innovation. [Introduction, “The Volume-to-Value Revolution”]
In addition, the necessity for change and the accompanying opportunities are causing many healthcare incumbents to establish venture arms. See Strategic Healthcare Investors’ Investment Thesis for more.
Industry Boundaries Rapidly Crumbling
Everyone is getting into each other’s and new businesses. Industry incumbents would be well advised to learn from the mistakes of incumbents in other disrupted sectors. As I observed earlier, providers are making newspaper industry mistakes.
The changes the industry faces will be neither smooth nor linear. A period of intense turbulence will produce more losers and winners than any industry transformation in recent memory. Cross-industry competition (healthcare versus retail versus technology versus others) will erase traditional boundaries and generate exciting new value propositions for patients, payers, and physicians.
For example, just this past week, Walgreen‘s has made it clear they’ll compete with healthcare providers and insurance companies. Competition, as newspapers learned, doesn’t come from obvious places.
Consumerization Of Healthcare
The consumer empowerment taken for granted from everything from buying cars to planning travel is finally arriving in healthcare nearly 15 years later than most industries.
Consumers, long passive, will have a new role. Employer incentives, retail access, and new technology options will encourage them to engage, demand information, and push for value. Baby boomers reaching the age of peak healthcare need will kindle the fire and Millennials focused on nutrition and fitness will keep it burning. The industry’s metamorphosis from a supply-driven market to a more dynamic one driven by demand will happen more quickly and erratically than we expect. Inevitably, mental models will lag behind market reality, and conventional organizations will fight a rearguard battle, hampered by collapsing margins and eroding market share. [Introduction, “The Volume-to-Value Revolution”]
Walmart recently validated the domestic medical tourism I wrote about awhile back. Their Centers of Excellence program encourages their insured employees to go to the top facilities in the country for free (including travel expenses). The employees have to pay if they choose to go with organizations that haven’t demonstrated a willingness to have a fixed price while producing some of the best outcomes in the world. Love them or hate them, Walmart has a huge ripple effect. Overnight, every facility in America that does cardiac, spinal, or transplant procedures is now competing with Mayo, Cleveland Clinic and other top providers. Sticking to old models and tools endangers the traditional healthcare player.
By 2014, as many as 85 million consumers with $600 billion in purchasing power may be shopping for their own healthcare on public and private exchanges. Many will be making their own decisions about coverage for the first time. Consumers will shop not just for insurance, but also for their preferred population-health manager and standalone services, such as basic procedures and retail clinics. [pg. 18, “The Volume-to-Value Revolution”]
New Models Jeopardize Hospitals
Many are predicting half of hospitals will close by 2020. In Denmark, nearly 70 percent of hospitals closed as they made the shift from a reactive, sick-care model to proactive care model. More clinicians than ever will be needed. They’ll simply have a mainframe-to-smartphone like shift as outlined inhealthcare’s age of agility. Unfortunately, the average hospital is one of the most dangerous places with over 100,000 hospital-acquired infections causing death every year. Hospitals are almost always the most expensive place to deliver care so smart health systems are developing new models with a fresh start — what I call the Xboxification of Healthcare.
One of the reasons providers are choosing cloud-based systems over on-premise software is the resource-intensive deployments required with legacy systems. We’ve seen a small clinic get their cloud-based system fully setup and ready to use in 30 minutes without any onsite people. In contrast, in that same amount of time, one might be able to order the server that gets shipped to that clinic. They will then require onsite installers, trainers, etc. and have a dramatically higher cost base to run that system.
For entirely rational reasons, those older systems were optimized for internal workflows and maximizing billing since that is what has been rewarded historically. To think that those traditional systems will then work perfectly well in the ascending “No Outcome, No Income” era borders on delusional. The reality is hitting right away. A recent article in a HIMSS publication quoted a leading thinker in healthIT, Shahid Shah, outlining 9 major gaps in existing EHRs. He listed “sophisticated patient relationship management (PRM)” as the first major gap. It’s my opinion that as integral as EHRs have been to fee-for-service, PRM will be to fee-for-value. The old model relegated patient portal functionality to be little more than a marketing checkbox. In the new model, PRM functionality becomes a linchpin. In other words, patient portals have been like pre-Google web search (low value afterthoughts on web portals). As Google demonstrated, with the right circumstances, there was huge value ignored by the established players. Likewise, if PRM is viewed as an afterthought, that will increase the risk to providers during this transformative period. Being flat-footed in a time of great change is extremely risky.
The New York Times reported this past week that the public hospitals are already changing the way they compensate their doctors. The first performance measure they listed was how well patients say their doctors communicate with them. These doctors are used to easy communication in the rest of their life with email, text, Facebook, etc. Suddenly, the hospital IT departments are going to start hearing from doctors asking why they can’t have tools that are as easy to communicate with their patients in the other areas of their life. It’s a rare occurrence to hear a doctor say how user-friendly and patient-focused their EHR is. Of course, it’s about more than just technology. The technology simply enables new models. Despite many doctors’ fears, often the changes are for the better as was mentioned by Dr. Bob Margolis, founder and CEO of HealthCare Partners, and one of the physician leaders who has demonstrated extraordinary outcomes:
You get to the tipping point, where the physicians go, ‘Wow, life is a whole lot better.’ You know, I only have to see 20 patients a day and I go home at night and I feel like I really helped them’—as opposed to, ‘I saw 45 patients, worked until 10 o’clock because I had to then do all my paperwork, I’m tired and I can barely pay the bills because Medicare and the commercial insurers are cutting back on my reimbursement.’
Oliver Wyman’s report projects that patient-centered care and the shift to value will eliminate $500 billion in low-value-add activities. One has to be in major denial as a healthcare leader to think that we aren’t entering a deflationary era in healthcare. Just watch Bill Gates’ TED Talk on state budgets if you have any doubts. This is exactly the reason the state of New York has moved aggressively to change care and payment models. While doing that, they recognized new models require new technology and didn’t expect they’d get it from legacy providers. This is why the New York Digital Health Accelerator was established. The good news for proactive health systems is that one can thrive in a deflationary period if they shed old assumptions.
A leader at Virginia Mason in Seattle shared how Starbuck’s pushback on costs caused them to look at their entire care proces:
“90 percent of what the hospital was doing was of no value.” As it turns out, the best way to treat most back pain is with physical therapy. That insight led to new processes, including same-day visits (as opposed to 31-day waits), reduced use of imaging tests and prescription drugs, and the addition of psychological support. Within three months, 94 percent of Starbucks employees with back-pain complaints were back at work within a day.
Even today, many EMR vendors will justify the price tags that reach into the hundreds of millions of dollars on the basis of increased billings. That game is nearly over and those hospitals will be saddled with systems optimized for the old models. This past week there were articles in the New York Times and Washington Post stating that EHRs have “failed”. I’d dispute that. EHRs have done exactly as they were designed — maximize billings. That’s how they are pitched so it should be no surprise that costs haven’t been lowered.
It has been said that “when the rate of change outside exceeds the rate of change inside, the end is in sight.”
Three Waves Of Disruption
Below, I have excerpted and paraphrased some more of Oliver Wyman’s insights from the Volume-to-Value paper illustrating how each of the three anticipated waves of disruption will shift hundreds of billions of revenue from one set of players to another:
Wave 1: Patient-Centered Care (2010-2016). “If we simply mainstreamed today’s best-in-class models of patient-centered, population-health management, the U.S. health system would eliminate nearly $350 billion of low-value-add activity and shift another $600 billion from provider-centered care models to patient-centered care models.” […] ”Five percent of Americans account for 45 percent of healthcare spending—$1.2 trillion. These 15 million unhealthy Americans at the top of the healthcare pyramid are at the heart of the near-term healthcare affordability crisis and the unfortunate victims of our fragmented, illness- focused healthcare system.” [pages 5 and 7, “The Volume-to-Value Revolution”]
Wave 2: Consumer Engagement (2014-2020). In Wave 2, another $150 billion in low-value-add activities is squeezed out, while $400 billion of additional value will rotate to the new retail value chain.
Wave 3: The Science Of Prevention (2018-2025). Wave 2 will help Wave 1’s great population managers become even more effective and will devastate provider-centric players who have lagged the market. Wave 3 will make the most highly evolved and adaptive population health managers more powerful and will significantly constrict the Wave 1 players who don’t continue to accelerate innovation.
Big Opportunities Require Big Brains
I once heard someone say, “There’s a lot of big brains working on small problems.” They were commenting on the brainpower working on the 8,000th social media app versus where they should be applying their brains. That is, there are three areas that demand as many big brains as possible — healthcare, education, and energy. As a skier, I often say that healthtech startups are the double black diamond in whiteout conditions of startups: super challenging and exhilarating but not for the faint of heart.
I believe the trick is to understand the idiosyncrasies of healthcare without being shackled by them. If you want to make a difference, there’s no better place than healthcare. Healthcare needs all the engineering talent possible that is often wasted on low-impact areas of the tech industry.
Follow @chasedave on Twitter or request the Care Beyond the Clinic newsletter for ongoing updates on healthcare innovation and disruption.
The Age: Doctor obsession has led to health blowout
- Peter Brooks says we will have an excess of doctors
- He suggests there are $20B in “low value” medical procedures
Healthcare: ‘Doctor obsession’ to lead to cost blowout
- Jonathan Swan — January 2, 2014
Decisions made by Tony Abbott when he was health minister will soon cause a blowout in healthcare costs dwarfing the money saved by introducing a $6 fee for GP visits, a health workforce expert says.
As health minister in the Howard government, Mr Abbott oversaw a massive expansion of new medical schools and student intakes, leading to an oversupply of graduating doctors, said Peter Brooks, former director of the Australian Health Workforce Institute and now a professorial fellow at the University of Melbourne.
Australia is expected to have 2811 superfluous doctors by 2025, based on projections in a March 2012 report by the government body Health Workforce Australia. The figure assumes a modest 5 per cent increase in productivity in the healthcare system.
Health lobby groups often said Australia would be short 2700 doctors by 2025, but the figure was misleading because it assumed no productivity gains would be made, Professor Brooks said.
The boom in medical graduates would ”lead to a blowout in costs” with doctors already giving patients too many unnecessary procedures so they could earn a good living in Australia’s fee-for-service system, Professor Brooks said.
At least $20 billion of ”low value” medical procedures were already being done every year in Australia, he said. If Mr Abbott wanted a ”sustainable” healthcare system, he should address these multibillion dollar structural healthcare problems rather than “fiddling around” with fees for GP visits, Professor Brooks said.
The Medicare controversy kicked off at the weekend with reports of a submission to the government’s commission of audit from Mr Abbott’s former health adviser, Terry Barnes. Mr Barnes said the government would save $750 million over four years by forcing patients who are bulk-billed to pay $6 to visit their GP for each of the first 12 visits a year.
A spokeswoman for Mr Abbott said on Wednesday the Coalition ”won’t be commenting on speculation around what the commission of audit may or may not recommend”. ”Labor spent a lot of money on creating huge health bureaucracies,” she said.
”The Coalition government is committed to directing more of that money back to delivering and improving frontline services for patients.”
The debate over the $6 GP fee – which experts say will harm the poorest and sickest Australians – was obscuring a more important debate over healthcare costs, Professor Brooks said.
Australian governments had become ”doctor obsessed”, ignoring evidence that many of the tasks performed by doctors could be given to other health professionals such as pharmacists, nurse practitioners and physician assistants.
Health Workforce Australia reports that in 2003, 1889 students began medical degrees. By 2012 there were 3686 students starting medicine. Even with international students excluded, the medical education peak body, Medical Deans Australia, said medical graduates more than doubled between 1996 and 2012.
Miso soup
From: http://www.taste.com.au/recipes/23977/miso+soup
Rating: 5 stars
Ingredients
- 4 cups (1 litre) dashi stock
- 20g dried seaweed (see note)
- 1/4 cup (75g) red miso paste
- 150g silken tofu, cut into 2cm cubes
- 3 green onions, trimmed, thinly sliced
Method
- Step 1Place the dashi in a large saucepan over medium heat. Bring to the boil. reduce heat to low. Add the seaweed and cook for 1 minute or until seaweed softens. Add the tofu and cook for a further 1 minute or until heated through.
- Step 2Place the miso paste in a small bowl. Add a little of the dashi, stirring until miso dissolves. Add the miso mixture to the saucepan and gently stir to combine. Bring to a simmer. remove from heat.
- Step 3Ladle miso evenly among serving bowls. Sprinkle with green onions and serve immediately.
Nutrition per serve
| Energy 408kJ |
Fat saturated 1.00g |
| Fat Total 4.00g |
Carbohydrate sugars 5.00g |
| Carbohydrate Total 7.00g |
Dietary Fibre g |
| Protein 8.00g |
Cholesterol mg |
| Sodium 1217.33mg |
Nocebo Effect
McKinsey: building blocks of strategy
Source PDF: Mastering_the_building_blocks_of_strategy
Left unchecked, market forces continually conspire to deplete profits. Powerful business strategies can counteract those tendencies, but good strategy is difficult to formulate.1 Indeed, the latest McKinsey research (see “The strategic yardstick you can’t afford to ignore.”) finds that a very small number of companies create most economic profit.2 The research also shows that a significant number of good companies outperform even in so-called bad industries, where the average economic profit is less than the market average.
How do they do it? In other words, where do powerful strategies come from? Sometimes it’s luck, or good timing, or a stroke of inspiration. In our experience, it’s also possible to load the dice in favor of developing good strategies by focusing on the core building blocks that often get overlooked. One is the need to gain agreement—before creating strategy—on the essential decisions and the criteria for making them. Another is to ensure that the company is prepared and willing to act on a strategy once it is adopted. Too much of what passes for strategy development, we find, consists of hurried efforts that skip one or more of the essentials. The resulting strategies are often flawed from the start.
It’s also easy, though, to go too far in the other direction and make the creation of strategy a rigid, box-checking exercise. Appealing as a formula-driven approach might be, it ignores the truth that strategy creation is a journey—and an inherently messy one at that. Proprietary insights are hard to come by. Shaping keen insights into good strategies requires deep interpersonal engagement and debate from senior executives, as well as the ability to deal with ambiguity in charged and often stressful circumstances. When would-be strategists overlook these dynamics, they cover the essentials in name only. Consequently, they miss opportunities and threats, or create great paper strategies that remain unfinished in practice.
In this article, we’ll outline a middle path—an end-to-end way of thinking that views the creation of strategy as a journey, not a project. This method, developed through our work with some 900 global companies over the past five years, can help senior executives approach strategy in a rigorous and complete way. We’ll also describe some principles that strategists should keep in mind as they use the method to ensure that their strategic-planning processes embody the spirit of debate and engagement, which, in turn, yields inspiration. By better understanding both the method and how to get the most out of it, companies can boost the odds that the strategies they create will beat the market.
There’s something about TED
- excellent talk by a Visual Arts Professor about the light, deceptive folly of TED
- despite the entirely valid criticisms, I think TED still fills a void in the public discourse
- placebo technoradicalism
- middlebrow megachurch infotainment
We need to talk about TED
Science, philosophy and technology run on the model of American Idol – as embodied by TED talks – is a recipe for civilisational disaster
In our culture, talking about the future is sometimes a polite way of saying things about the present that would otherwise be rude or risky.
But have you ever wondered why so little of the future promised in TED talks actually happens? So much potential and enthusiasm, and so little actual change. Are the ideas wrong? Or is the idea about what ideas can do all by themselves wrong?
I write about entanglements of technology and culture, how technologies enable the making of certain worlds, and at the same time how culture structures how those technologies will evolve, this way or that. It’s where philosophy and design intersect.
So the conceptualization of possibilities is something that I take very seriously. That’s why I, and many people, think it’s way past time to take a step back and ask some serious questions about the intellectual viability of things like TED.
So my TED talk is not about my work or my new book – the usual spiel – but about TED itself, what it is and why it doesn’t work.
The first reason is over-simplification.
To be clear, I think that having smart people who do very smart things explain what they doing in a way that everyone can understand is a good thing. But TED goes way beyond that.
Let me tell you a story. I was at a presentation that a friend, an astrophysicist, gave to a potential donor. I thought the presentation was lucid and compelling (and I’m a professor of visual arts here at UC San Diego so at the end of the day, I know really nothing about astrophysics). After the talk the sponsor said to him, “you know what, I’m gonna pass because I just don’t feel inspired …you should be more like Malcolm Gladwell.”
At this point I kind of lost it. Can you imagine?
Think about it: an actual scientist who produces actual knowledge should be more like a journalist who recycles fake insights! This is beyond popularisation. This is taking something with value and substance and coring it out so that it can be swallowed without chewing. This is not the solution to our most frightening problems – rather this is one of our most frightening problems.
So I ask the question: does TED epitomize a situation where if a scientist’s work (or an artist’s or philosopher’s or activist’s or whoever) is told that their work is not worthy of support, because the public doesn’t feel good listening to them?
I submit that astrophysics run on the model of American Idol is a recipe for civilizational disaster.
What is TED?
So what is TED exactly?
Perhaps it’s the proposition that if we talk about world-changing ideas enough, then the world will change. But this is not true, and that’s the second problem.
TED of course stands for Technology, Entertainment, Design, and I’ll talk a bit about all three. I Think TED actually stands for: middlebrow megachurch infotainment.
The key rhetorical device for TED talks is a combination of epiphany and personal testimony (an “epiphimony” if you like ) through which the speaker shares a personal journey of insight and realisation, its triumphs and tribulations.
What is it that the TED audience hopes to get from this? A vicarious insight, a fleeting moment of wonder, an inkling that maybe it’s all going to work out after all? A spiritual buzz?
I’m sorry but this fails to meet the challenges that we are supposedly here to confront. These are complicated and difficult and are not given to tidy just-so solutions. They don’t care about anyone’s experience of optimism. Given the stakes, making our best and brightest waste their time – and the audience’s time – dancing like infomercial hosts is too high a price. It is cynical.
Also, it just doesn’t work.
Recently there was a bit of a dust up when TEDGlobal sent out a note toTEDx organisers asking them not to not book speakers whose work spans the paranormal, the conspiratorial, new age “quantum neuroenergy”, etc: what is called woo. Instead of these placebos, TEDx should instead curate talks that are imaginative but grounded in reality. In fairness, they took some heat, so their gesture should be acknowledged. A lot of people take TED very seriously, and might lend credence to specious ideas if stamped with TED credentials. “No” to placebo science and medicine.
But … the corollaries of placebo science and placebo medicine areplacebo politics and placebo innovation. On this point, TED has a long way to go.
Perhaps the pinnacle of placebo politics and innovation was featured at TEDx San Diego in 2011. You’re familiar I assume with Kony2012, the social media campaign to stop war crimes in central Africa? So what happened here? Evangelical surfer bro goes to help kids in Africa. He makes a campy video explaining genocide to the cast of Glee. The world finds his public epiphany to be shallow to the point of self-delusion. The complex geopolitics of central Africa are left undisturbed. Kony’s still there. The end.
You see, when inspiration becomes manipulation, inspiration becomes obfuscation. If you are not cynical you should be sceptical. You should be as sceptical of placebo politics as you are placebo medicine.
T and Technology
T – E – D. I’ll go through them each quickly.
So first technology …
We hear that not only is change accelerating but that the pace of change is accelerating as well. While this is true of computational carrying-capacity at a planetary level, at the same time – and in fact the two are connected – we are also in a moment of cultural de-acceleration.
We invest our energy in futuristic information technologies, including our cars, but drive them home to kitsch architecture copied from the 18th century. The future on offer is one in which everything changes, so long as everything stays the same. We’ll have Google Glass, but still also business casual.
This timidity is our path to the future? No, this is incredibly conservative, and there is no reason to think that more gigaflops will inoculate us.
Because, if a problem is in fact endemic to a system, then the exponential effects of Moore’s law also serve to amplify what’s broken. It is more computation along the wrong curve, and I doubt this is necessarily a triumph of reason.
Part of my work explores deep technocultural shifts, from post-humanism to the post-anthropocene, but TED’s version has too much faith in technology, and not nearly enough commitment to technology. It isplacebo technoradicalism, toying with risk so as to reaffirm the comfortable.
So our machines get smarter and we get stupider. But it doesn’t have to be like that. Both can be much more intelligent. Another futurism is possible.
E and economics
A better ‘E’ in TED would stand for economics, and the need for, yes imagining and designing, different systems of valuation, exchange, accounting of transaction externalities, financing of coordinated planning, etc. Because states plus markets, states versus markets, these are insufficient models, and our conversation is stuck in Cold War gear.
Worse is when economics is debated like metaphysics, as if the reality of a system is merely a bad example of the ideal.
Communism in theory is an egalitarian utopia.
Actually existing communism meant ecological devastation, government spying, crappy cars and gulags.
Capitalism in theory is rocket ships, nanomedicine, and Bono saving Africa.
Actually existing capitalism means Walmart jobs, McMansions, people living in the sewers under Las Vegas, Ryan Seacrest … plus – ecological devastation, government spying, crappy public transportation and for-profit prisons.
Our options for change range from basically what we have plus a little more Hayek, to what we have plus a little more Keynes. Why?
The most recent centuries have seen extraordinary accomplishments in improving quality of life. The paradox is that the system we have now –whatever you want to call it – is in the short term what makes the amazing new technologies possible, but in the long run it is also what suppresses their full flowering. Another economic architecture is prerequisite.
D and design
Instead of our designers prototyping the same “change agent for good” projects over and over again, and then wondering why they don’t get implemented at scale, perhaps we should resolve that design is not some magic answer. Design matters a lot, but for very different reasons. It’s easy to get enthusiastic about design because, like talking about the future, it is more polite than referring to white elephants in the room.
Such as…
Phones, drones and genomes, that’s what we do here in San Diego and La Jolla. In addition to the other insanely great things these technologies do, they are the basis of NSA spying, flying robots killing people, and the wholesale privatisation of biological life itself. That’s also what we do.
The potential for these technologies are both wonderful and horrifying at the same time, and to make them serve good futures, design as “innovation” just isn’t a strong enough idea by itself. We need to talk more about design as “immunisation,” actively preventing certain potential “innovations” that we do not want from happening.
And so…
As for one simple take away … I don’t have one simple take away, one magic idea. That’s kind of the point. I will say that if and when the key problems facing our species were to be solved, then perhaps many of us in this room would be out of work (and perhaps in jail).
But it’s not as though there is a shortage of topics for serious discussion. We need a deeper conversation about the difference between digital cosmopolitanism and cloud feudalism (and toward that, a queer history of computer science and Alan Turing’s birthday as holiday!)
I would like new maps of the world, ones not based on settler colonialism, legacy genomes and bronze age myths, but instead on something more … scalable.
TED today is not that.
Problems are not “puzzles” to be solved. That metaphor assumes that all the necessary pieces are already on the table, they just need to be rearranged and reprogrammed. It’s not true.
“Innovation” defined as moving the pieces around and adding more processing power is not some Big Idea that will disrupt a broken status quo: that precisely is the broken status quo.
One TED speaker said recently, “If you remove this boundary … the only boundary left is our imagination”. Wrong.
If we really want transformation, we have to slog through the hard stuff (history, economics, philosophy, art, ambiguities, contradictions). Bracketing it off to the side to focus just on technology, or just on innovation, actually prevents transformation.
Instead of dumbing-down the future, we need to raise the level of general understanding to the level of complexity of the systems in which we are embedded and which are embedded in us. This is not about “personal stories of inspiration”, it’s about the difficult and uncertain work of demystification and reconceptualisation: the hard stuff that really changes how we think. More Copernicus, less Tony Robbins.
At a societal level, the bottom line is if we invest in things that make us feel good but which don’t work, and don’t invest in things that don’t make us feel good but which may solve problems, then our fate is that it will just get harder to feel good about not solving problems.
In this case the placebo is worse than ineffective, it’s harmful. It’s divertsyour interest, enthusiasm and outrage until it’s absorbed into this black hole of affectation.
Keep calm and carry on “innovating” … is that the real message of TED? To me that’s not inspirational, it’s cynical.
In the US the rightwing has certain media channels that allow it to bracket reality … other constituencies have TED.
• This article first appeared on Benjamin Bratton’s website and is republished with permission. It is the text of a talk given at TEDx San Diego
Minimally invasive management
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December 27, 2013
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To Manage Well, Get Out of the Way
Management, like payroll and sales, is becoming another function to facilitate the work of the technically and creatively skilled people who do the heavy lifting. We need managers, not because people need a boss, but because people need someone to resolve the issues that are stopping them from doing their work.
Managers aren’t ball carriers. They’re running interference for the ball carriers. In the world of minimally invasive management, managers have three primary jobs:
- they need to hire
- they need to develop and serve their people, and
- they need to fire.
But most of the time, managers need to get out of the way and let people do their work.