Guests:
Tim Gunn is, of course, promoting Project Runway. Which is available free online the day after the new episode airs, for anyone else without cable. Turns out I'm much less resentful of their crap when I watch online -- though it's early in the season still, and there's at least one godawful-yet-dramagenic designer/contestant who's already overstayed his welcome. I'm sorry, that one dress was *not* on the right side of the stripper/chic line. Also, Heidi's "My Fabulous opinion is the only one that matters" mean-girl attitude is already showing (as are her dreadful fashion choices, which also tend to be on the wrong side of the stripper/chic line). And Lifetime.com, all that raising the volume of the commercials does is make me hit mute. It's even easier when all I have to do is click the mouse, which doesn't get lost nearly as easily as a remote. But with two whole episodes done, I'm not fed up yet. So far so good.
Jon's a fan of the show, but I've got no idea what John thinks of it. Lemme know if the interview is worth watching.
Stephen's guest should be worth watching, though. Atul Gawande has been on both shows before, selling his Checklist Manifesto. It seems he's here to talk about this New Yorker article (Heavily snipped, with my emphasis):
Slow Ideas
Some innovations spread fast. How do you speed the ones that don’t?
by Atul Gawande July 29, 2013
...In our era of electronic communications, we’ve come to expect that important innovations will spread quickly. Plenty do: think of in-vitro fertilization, genomics, and communications technologies themselves. But there’s an equally long list of vital innovations that have failed to catch on. The puzzle is why.
Did the spread of anesthesia and antisepsis differ for economic reasons? Actually, the incentives for both ran in the right direction...So what were the key differences? First, one combatted a visible and immediate problem (pain); the other combatted an invisible problem (germs) whose effects wouldn’t be manifest until well after the operation. Second, although both made life better for patients, only one made life better for doctors...
This has been the pattern of many important but stalled ideas. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. The global destruction wrought by a warming climate, the health damage from our over-sugared modern diet, the economic and social disaster of our trillion dollars in unpaid student debt—these things worsen imperceptibly every day. Meanwhile, the carbolic-acid remedies to them, all requiring individual sacrifice of one kind or another, struggle to get anywhere.
The global problem of death in childbirth is a pressing example...Simple, lifesaving solutions have been known for decades. They just haven’t spread.Many solutions aren’t ones you can try at home, and that’s part of the problem. Increasingly, however, women around the world are giving birth in hospitals...
Here we are in the first part of the twenty-first century, and we’re still trying to figure out how to get ideas from the first part of the twentieth century to take root. In the hopes of spreading safer childbirth practices, several colleagues and I have teamed up with the Indian government, the World Health Organization, the Gates Foundation, and Population Services International to create something called the BetterBirth Project. We’re working in Uttar Pradesh, which is among India’s poorest states...
Lots of detail worth reading in there, but I'll just post the politically relevant parts:
We’re infatuated with the prospect of technological solutions to these problems—baby warmers, say. You can still find high-tech incubators in rural hospitals that sit mothballed because a replacement part wasn’t available, or because there was no electricity for them. In recent years, though, engineers have produced designs specifically for the developing world. Dr. Steven Ringer, a neonatologist and BetterBirth leader, was an adviser for a team that made a cheap, ingenious, award-winning incubator from old car parts that are commonly available and easily replaced in low-income environments. Yet it hasn’t taken off, either. “It’s in more museums than delivery rooms,” he laments.
As with most difficulties in global health care, lack of adequate technology is not the biggest problem...Getting hospitals and birth attendants to carry out even a few of the tasks required for safer childbirth would save hundreds of thousands of lives. But how do we do that?
To create new norms, you have to understand people’s existing norms and barriers to change. You have to understand what’s getting in their way. So what about just working with health-care workers, one by one, to do just that? With the BetterBirth Project, we wondered, in particular, what would happen if we hired a cadre of childbirth-improvement workers to visit birth attendants and hospital leaders, show them why and how to follow a checklist of essential practices, understand their difficulties and objections, and help them practice doing things differently. In essence, we’d give them mentors...
Reactions that I’ve heard both abroad and at home have been interestingly divided. The most common objection is that, even if it works, this kind of one-on-one, on-site mentoring “isn’t scalable.” But that’s one thing it surely is. If the intervention saves as many mothers and newborns as we’re hoping—about a thousand lives in the course of a year at the target hospitals—then all that need be done is to hire and develop similar cadres of childbirth-improvement workers for other places around the country and potentially the world. To many people, that doesn’t sound like much of a solution. It would require broad mobilization, substantial expense, and perhaps even the development of a new profession. But, to combat the many antisepsis-like problems in the world, that’s exactly what has worked. Think about the creation of anesthesiology: it meant doubling the number of doctors in every operation, and we went ahead and did so. To reduce illiteracy, countries, starting with our own, built schools, trained professional teachers, and made education free and compulsory for all children. To improve farming, governments have sent hundreds of thousands of agriculture extension agents to visit farmers across America and every corner of the world and teach them up-to-date methods for increasing their crop yields. Such programs have been extraordinarily effective. They have cut the global illiteracy rate from one in three adults in 1970 to one in six today, and helped give us a Green Revolution that saved more than a billion people from starvation.
In the era of the iPhone, Facebook, and Twitter, we’ve become enamored of ideas that spread as effortlessly as ether. We want frictionless, “turnkey” solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. People and institutions can feel messy and anachronistic. They introduce, as the engineers put it, uncontrolled variability.
But technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process...
Yeah, I'm quoting a lot. But it's a long article, and I'm leaving out most of the detail. The "magic" of Technology and Efficiency is a pet peeve of mine, much as I love tech.
In childbirth, we have only begun to accept that the critical practices aren’t going to spread themselves. Simple “awareness” isn’t going to solve anything. We need our sales force and our seven easy-to-remember messages. And in many places around the world the concerted, person-by-person effort of changing norms is under way.
Imagine that. In order to make actual changed in people's lives, you have to get actual people on the ground and involved. Holding back my snark here ('Imagine if we had this governing method, let's call it "government", by which we could organize these 'making people's lives better' projects...') -- bet you can imagine the rest. And someone (or I) should really put this together in a diary which people will actually read...
Anyway. Relevant links:
wikipedia
TED.com profile
@Atul_Gawande
gawande.com
WHO profile
about the Better Birth project
Harvard press release about the Better BIrth project & funding
blog from someone involved in the project
2011 Q&A about the project
New Yorker article
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