Sorry for the rambling, but this was actually inspired by the story of two hospitals in Slate Star Codex:
All of this reminds me of a video I saw this afternoon on the second day of The Hospital Orientation. Please excuse me if I change it around just a little to turn it from a quality improvement case study to a morality tale.
There were two hospitals, Hospital A and Hospital B. Both, like all hospitals, were fighting a constant battle against medical errors – surgeons removing the wrong leg, doctors giving the wrong dose of medication, sleepy interns reading x-rays backwards, that kind of thing. These are deadly – they kill up to a hundred thousand people a year – and terrifyingly common.
Hospital A took a very right-wing approach to the issue. They got all their doctors together and told them that any doctor who made a minor medical error would get written up and any doctor who made a major medical error would be fired. Rah personal responsibility!
Unfortunately, when they evaluated the results of their policy they found they had exactly as many medical errors as before, except now people were trying to cover them up and they weren’t being discovered until way too late.
Hospital B took a very progressive approach. They too got all their doctors together, but this time the hospital administrators announced: “You are not to blame for any medical errors. If medical errors occur, it means we, the administrators, have failed you by not creating a sufficiently good system. Please tell us if you commit any medical errors, and you won’t be punished, but we will scrutinize what we’re doing to see if we can make improvements.”
Then they made sweeping changes to what you might call the “society” of the hospital. They decreased doctor workload so physicians weren’t as harried. They shortened shifts to make sure everyone got at least eight hours of sleep a night. They switched from paper charts (where doctors write orders in notoriously hard-to-read handwriting) to electronic charts (where everything is typed up). They required everyone to draw up and use checklists. They even put propaganda posters over every sink reading “DID YOU WASH YOUR HANDS LONG ENOUGH??!” with a picture of a big eye on them. You can’t get more Orwellian than that.
And yet, mirabile dictu, this was the hospital that saw their medical error rates plummet.
The administrators of this second hospital didn’t ignore human nature. Instead, they exploited their knowledge of human nature to the fullest. They know it’s in human nature to do a bad job when you’re working on no sleep. They know it’s human nature to try to cut corners, but that people will run through checklists honestly and effectively. They even know that studies show that pictures of eyes make people behave more prosocially because they feel like they’re being watched.
You don’t have to tell me all the reasons this doesn’t directly apply to an entire country. I can think of most of them. But my point is that if I’m progressive – a label I am not entirely comfortable with but which people keep trying to pin on me – this is my progressivism. The idea of using knowledge of human nature to create a structure with a few clever little lever taps that encourage people to perform in effective and prosocial ways. It’s a lot less ambitious than “LET’S TOTALLY REMAKE EVERY ASPECT OF SOCIETY AS A UTOPIA”, but it’s a lot more practical.
Sunshine regiment is always going to beat the other kind of armies and the best way to make someone mad is to be really really happy.
Sorry for the rambling, but this was actually inspired by the story of two hospitals in Slate Star Codex:
Sunshine regiment is always going to beat the other kind of armies and the best way to make someone mad is to be really really happy.