It Still Takes People to Solve the Really Hard Problems

This blog is inspired by the article “Slow Ideas” in The New Yorker by Atul Gawande which discusses how some innovations spread swiftly, but many important ones are much slower, mostly because they involve changing people and culture.

“Slow Ideas” starts off with a history lesson of the adoption of anesthesia versus antiseptics, both incredibly novel advancements in medicine discovered in the mid 1800’s. Anesthesia turned out to be adopted much more quickly than antiseptics simply because it had immediate, obvious benefit to a surgeon’s experience. Imagine not having to rush through a treatment on a thrashing painful patient. Antispectics, on the other hand, provided a benefit to patients that was only realized over many days, and was dependent on many factors being made antiseptic, and later, sterile.


Reenactment of first etherized operation.
[SOURCE] This image is in the public domain due to its age.

The difference between the two stories is one being immediately obvious to people, versus the other being an invisible problem, which required complexity and shared sacrifice to solve. Many problems in society are more like the latter. Gawande points out a few we know from the news:

  • Global warming
  • The mortgaging of our student’s future with debt
  • The over-sugared US food diet

He then goes on to tell the story of another global problem – preventable infant and birth-mother mortality due to a mother’s hemorrhaging, suffering of infections, babies not getting assistance breathing, and suffering of hypothermia. The preventive techniques have been known for decades, but have yet to spread into rural parts of many less industrialized countries.

As an aside, he points out how one popular type of technical solution (a popular corporate meme – designing new technologies specifically for rural developing countries) had failed to be adopted. In this case, it was an award-winning incubator created from readily available old car parts that could be cheaply built and replaced even in low-income areas. The developer, Dr. Steven Ringer, stated, “It’s in more museums than in delivery rooms.”

The solution, in many cases, isn’t new kinds of technology, but a focus on changing culture. In fact, new technologies and techniques need to be incorporated into a new culture of practice in order to have a chance of being adopted and succeeding. Changing a culture, however, is no easy task.

In the case of improving the survival rates for mothers and newborns in rural India, a combination of government action and organizational field work is making a difference:

  • An Indian government program offers mothers up to 1400 rupees for delivering in a hospital, so in many areas, a majority of births are now in facilities. (Compare the effects of this government initiative to the Finnish Baby Box tradition.)
  • A program of bringing trained, but less experienced nurses to work with and evaluate very experienced, yet-to-be-trained nurses that work in rural hospitals that builds up rapport and trust, eventually leading to changes in practice.

In the above, and other stories, the point Gawande makes is that the “really hard and complex” problems still require people-change management – a social process, but in many cases, we’ve become infatuated with all our new techno-gadgetry as a quick fix:

“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.”

I bring this article to your attention, even as I, myself, evangelize technologies related to big data, and other technological trends. The software systems built from these technologies are not solutions by themselves, but merely “platforms”. They can be designed to help real people improve their own lots, or the lots of others, but they also need to be designed to help foster needed cultural change.

Here are two examples of technology applications that exemplify how such solutions can help make cultural changes:

Finally, although not a social enterprise, one should remember the campaign technology that was deployed in the last US election as a means to foster movements for change.

As we design and develop comprehensive new solutions to solve the world’s hardest and most complex problems, we should remember that change-management of people is among the most difficult parts. This is something we have experience with in big business. Now is our chance to see how it works in the world at large.

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