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Healthcare: humanity above bureaucracy | Jos de Blok | TEDxGeneva

TEDx Talks · Youtube · 2 HN comments
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Youtube Summary
In his TEDxTalk a nurse presents how he helps simplifying organizational structures in healthcare. He explains how he succeeded in encouraging trust, while integrating simplification offers a great deal more for society than bureaucratic and pyramidal organizations, making daily work more meaningful and sustainable.

Jos de Blok received the 2014 RSA Albert Medal for his work as founder of Buurtzorg, a transformational new model of patient centered community health care focused on facilitating and maintaining independence and autonomy.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx
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> stuff that David Graeber wold call BS jobs. Now... I'm not in the same camp as him entirely. I think it's rash to just write off 70% of modern, white collar work as "paperwork" that could just go away.... but I'm not entirely not in his camp too. (...) I'm not sure creative is the right word, but here's somethign going on. Ever increasing (already majority) sections of the economy are producing very ethereal things, with obscure business models...

What I don't think gets mentioned enough in these discussions is Jevon's Paradox[0], which can be summarised as:

> In economics, the Jevons paradox (/ˈdʒɛvənz/; sometimes the Jevons effect) occurs when technological progress increases the efficiency with which a resource is used (reducing the amount necessary for any one use), but the rate of consumption of that resource rises because of increasing demand.

Or more cynically: when increased efficiency creates greater demand than that increase in efficiency. I probably don't need to convince anyone here that this happens in real life all the time - we're all familiar with Wirth's Law[1], right?

So I think the same applies to automation and work. If anyone hasn't seen "Paperwork Explosion" by Jim Henson (you know, the guy who made The Muppets and the original voice of Kermit, and Ernie), this is a really good time to do so:

https://www.youtube.com/watch?v=_IZw2CoYztk

Look at what IBM promised: freedom from administrative woes! We can go back to do real productive work! Essentially exactly what we're hearing now. Now compare it to what actually happened. At the last two universities I've worked I have seen a lot of “the administration department is expanding to meet the needs of the expanding administration department” in action. At the expense of the quality of education and science, I might add.

Buurtzorg Nederland[2] got a lot of attention in recent years for breaking that trend with its simple approach to letting nurses self-organise as independent, self-managing teams (so what Agile tried to be I suppose, except for nurses). What is often overlooked is that this is basically just going back to the model that the Netherlands had up until the 1980s, but a bit enhanced with modern information/communication technology. Jos de Blok, who founded Buurtzorg, briefly that in this short TED talk[3], but my parents were both general practitioners until they retired a few years ago confirmed that this happened all throughout healthcare.

With programming, we know that complexity is something that must be actively fought or it sneaks in. We even have tons of special descriptions for how that happens: spaghetti code, big ball of mud, etc. So ask yourself: why would it be different in any other human-created system?

For me, this is part of the explanation for all the obscurity we see everywhere (that, and a vested interest of a number of parties in keeping things obfuscated). And my prediction is that the natural tendency of automation is to backfire, unless we actively fight this.

[0] https://en.wikipedia.org/wiki/Jevons_paradox

[1] https://en.wikipedia.org/wiki/Wirth%27s_law

[2] https://en.wikipedia.org/wiki/Buurtzorg_Nederland

[3] https://www.youtube.com/watch?v=SSoWtXvqsgg

(Warning: halfway through writing the thing below it accidentally morphed into a "big picture" rant, sorry about that)

This is probably one of the best examples of how the internet can amplify human kindness that I have ever seen.

Reading your message fills me with joy, and I think that goes for most of us. The same is true for your linked post. While it was sad to read you felt like that at the time, but I'm happy that you recognised that suicidal thoughts are something to worry about, and that you reached out for help, and that it all worked out in the end!

And good that you sought out therapy. The sooner we get rid of the stigma for mental illnesses, the better. We don't judge people for getting a broken bone fixed either. This probably sounds way too familiar to many of us, and it really is a clear sign it is time to seek help:

> I feel trapped. Forgotten. Not part of society. (...) I feel like, i can never "start a life", because i studied so long and no one wants a quitter

It can be so hard to explain this feeling to those who have not experienced it. Pessimism can objectively be inappropriate, yet subjectively a perfectly logical conclusion. When I felt like this, I remember that friends would list objective reasons why everything should work out fine (and there were many). It only made me feel worse: I already knew those facts, they gave no emotional comfort. All they did was make me think "if I manage to fail despite all of that, I must be even worse a person than I though".

If anyone reading this recognises any of these anxieties: it's not you. Modern society is almost guaranteed cause these thoughts in many of us. Most interactions with other humans have been abstracted away into complex systems, and some of that complexity is probably necessary for it to function. The problem is that these systems rarely acknowledge that we evolved as a social species. That our mutual dependence for survival has resulted in brains that are hardwired to seek nurturing, supportive connections, and have an excessive fear of rejection and "missing out". The systems we have set up are often a terrible mismatch with that.

Our new modes of communication have far-reaching consequences for the way we get things done[1], since (mis)communication is one of the most important factors in building trust, which is the foundation of collaboration[2]. We will need to figure out how to cope with these changes, both individually and as a society. This is why initiatives like Buurtzorg[3][4] are so successful: they are a "recalibration" (and rediscovery) of organisational structures into something that is a better fit for the way humans naturally collaborate and build trust together. It is going to be really interesting to see how initiatives like this will evolve, and the counter-responses from the people and institutes with a vested interest in maintaining the old structures.

And with all of that in the back of my head, it makes perfect sense to me that that police visit was what you needed. An anonymous stranger cares enough about your well-being to think of looking up your IP and sends it to the police, and the police then followed through on that to check in on you. And that part is important: it does not end with intangible messages on a screen, but with a physical interaction with human beings. Direct, tangible emotional proof that you are a part society, and not forgotten.

[0] https://www.additudemag.com/rejection-sensitive-dysphoria-ho...

[1] https://www.ted.com/talks/clay_shirky_how_the_internet_will_...

[2] http://ncase.me/trust/

[3] https://www.youtube.com/watch?v=SSoWtXvqsgg

[4] https://en.wikipedia.org/wiki/Buurtzorg_Nederland

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