“a tendency to overhype fixes that later turn out to be complete turkeys”

An interesting passage on the contemporary dynamics of the quick fix, from “The Slow Fix: Solve Problems, Work Smarter and Live Better in a Fast World” by Carl Honore:

“The media add fuel to that fire. When anything goes wrong – in politics, business, a celebrity relationship – journalists pounce, dissecting the crisis with glee and demanding an instant remedy. When golfer Tiger Woods was outed as a serial philanderer, he vanished from the public eye for three months before finally breaking his silence to issue a mea culpa and announce he was in therapy for sex addiction. How did the media react to being made to wait that long? With fury and indignation. The worst sin for a public figure on the ropes is to fail to serve up an instant exit strategy.

“That impatience fuels a tendency to overhype fixes that later turn out to be complete turkeys. An engineer by training, Marco Petruzzi worked as a globetrotting management consultant for 15 years before abandoning the corporate world to build better schools for the poor in the United States. We will meet him again later in the book, but for now consider his attack on our culture of hot air. ‘In the past, hard-working entrepreneurs developed amazing stuff over time, and they did it, they didn’t just talk about it, they did it,’ he says. ‘We live in a world now where talk is cheap and bold ideas can create massive wealth without ever having to deliver. There are multi-billionaires out there who never did anything but capture the investment cycle and the spin cycle at the right moment, which just reinforces a culture where people don’t want to put in the time and effort to come up with real and lasting solutions to problems. Because if they play their cards right, and don’t worry about the future, they can get instant financial returns’

Anthropologizing Environmentalism – review by E Donald Elliot of “Risk and Culture”, Mary Douglas and Aaron Wildavksy, Yale Law Review, 1983

Recently I have been posting  on the cultural theory of risk developed by Mary Douglas and Aaron Wildavsky. This is a PDF of a review of Douglas and Wildavksy’s 1982 book “Risk and Culture” by E Donald Elliott adjunct professor of Law at Yale.

The review summarises Wildavksy and Douglas’ thought very well, and gets to the heart of one issue I struggle with in their writing ; their oft dismissive approach to environmental risk:

Most readers will be struck not by the abstract theory but by its application to the rise of environmentalism. This emphasis is unfortunate. The attempt to “explain” environmentalism makes a few good points, but on the whole this part of the book is crude, shortsighted, and snide. On the other hand, the sections that consider the relationship between risk and culture on a more fundamental level are sensitive and thoughtful.

I think it unfortunate that cultural theory of risk has ended up so much overshadowed by this “crude, shortsighted, and snide” discussion of environmental risk (Wildavksy, if I recall correctly, was revealed to have taken undisclosed payments from the chemical industry) It remains a powerful explanatory tool, and in clinical practice and team working one finds that different approaches to risk are rooted in cultural practices.

Elliott’s review focuses on the environmental realm, but serves as a good and sceptical discussion of the more general focus of cultural theory of risk – and an introduction to what is sometimes a less than lucidly explained theory.

“Blame Culture” in the Irish Healthcare System – another ARCH blog post

Another excellent blog post on the ARCH website, this time by Dr Marcella McGovern, on the blame culture of the Irish health system. The trigger for this article was the recent controversy on “hidden waiting lists.” This led to a rather predictable response from the current Minister for Health:

The Minister for Health, Simon Harris, responded to this programme by saying that he “intends to shine a light” on management in the Irish Health Service Executive (HSE) and that if management does not “measure up”, they will be removed from their roles.

 

Tough talk, but as Dr McGovern writes:

 it fails to acknowledge the Government’s responsibility for that problem. Governance, performance oversight and holding the HSE to account for the implementation of national health policy are key functions that the Minister for Health and his Department are responsible for performing on an ongoing basis; not in response to a crisis. The question put to Ministers for Health in a crisis therefore, should be where in your Department’s oversight of the HSE did you fail to detect this problem and what steps are you taking to correct the problem and ensure that it doesn’t happen again?

 

Of course, this is hardly new:

Paul Cullen highlighted in an analysis piece in the Irish Times (Irish Times, 11^th February 2017) that Minister Harris’ predecessor, Leo Varadkar, similarly promised that “heads will roll” over hospital overcrowding. Yet, this winter again saw overcrowded Accident & Emergency Departments resulting in planned inpatient and outpatient appointments being postponed.  The back-log of these postponed appointments are now contributing to the current crisis over long waiting lists, illustrating that unjustifiably “blaming the bureaucrats” (Dubnick, 1996) has knock on effects.

 

Dr McGovern uses the work of Dubnick on “prejudical blame culture” as a framework for her piece:

Three major conditions (for defining prejudical blame culture):
1. It makes no requirement that the blamed person or collection of persons have assumed responsibility for the condition they are blamed for; rather, it targets an ill-defined but inclusive group that everyone knows to exist (e.g. bureaucrats);

2. It doesn’t require any role for the blamed in contributing to the cause of the blameworthy or harmful condition. It is assumed that the vaguely defined ‘they’ are highly influential in shaping the world;

3. [It] eliminates the need for any degree of specificity regarding what the harmful condition entails. It could be the decline of the economy, or the loss of national prestige, or the general malaise of society. (Dubnick, 1996: 22).

Dr McGovern’s work, in the ARCH context, is on the effect on system readiness for innovation. Of course, blame culture has a much wider impact, paralysing innovations beyond the technological sphere:

From a Connected Health perspective, there is a danger that a blame culture demonstrated at the highest levels of the Irish health system will have a trickle-down effect, compromising system readiness for innovation. If the Department of Health blame the HSE for poor management and the HSE blame the Department of Health for inadequate resources, and if clinicians blame managers for excessive bureaucracy and managers blame clinicians for resisting change; organisational trust may be lost in the battles between “us” and “them” (Firth-Cozen, 2004). Within such environments, potentially transformative leaders and early adopters behave cautiously and become reluctant to take “ownership” of innovations (Heitmueller et al. 2016), which by their nature carry the risk of failure and unintended consequences (Ash et al. 2004).