More Berwick!

I just can't get enough of him. I know it's incredibly nerdy to get all gushy over a guy who specializes in health care systems analysis and improvement. But think for a second - here's a guy buried to the hip in jargon and numbers of his field, and he's still able to bring to it the perspective of the everyman (not to mention communicate with the everyman). Plus, he's doing some great thinking about technology.

In "Taming the Technology Beast" (JAMA - subscription req), he starts by riffing on a paper showing that RFID tags in hospitals can mess up the pump on your IV. Not cool. So ban them from the premises? Maybe not quite. He's arguing that we should "tame" technology rather than shun it. Okay sure. How does that work? Well here Berwick gets into the tall grass a little with acronyms like FMEA and SHEL (That's software, hardware, environment, and liveware ie people if you were interested). But I think his most important point boils down to this: In complex systems like health care (or ecology) you can't predict the subtle chain of reactions that may lead to dire but remote consequences, even with the best analysis. What you can do is keep tuning up the system and correcting problems as they materialize. "Design in isolation is risky" he says.

What emerges sounds an awful lot like Aldo Leopold's intelligent tinkering. You introduce a little at a time. Watch it closely - adjust - and keep watching and adjusting. Interesting to consider how this can apply for, say, agriculture. Is there an intelligent way to integrate genetically engineered crops into ecosystems? What about our big haphazard experiments with microbiology known as confined animal feeding operations? In these, we are essentially designing new microbes - in isolation from cities. And in the cities, we are designing a new kind of microbial gut ecosystem in people. When those two ecosystems bleed into each other the results tend to neither intelligent - nor incremental.

One other comment from Berwick:

Nuclear power, military operations and weaponry, aviation, rail transport, space programs, and many more high-hazard endeavors have for decades enlisted the attention of scientists of safety, and most of those fields have a far better track record of taming the technology beast than health care yet does.

My question is why? Why is health care allowed to get away with using technology willy nilly regardless of harms when Boeing is not?