Friday, October 29, 2010

Could you build a hospital out of a used truck?

If you had to pick the one medical technology, a pill, a shot, a vaccine, a surgery, a scanner, the one medical technology that provided the longest benefit, i.e. extended human life the most - what would it be? I can remember the very early days of heart transplants and the unbelievability of it. But was the surgery more impressive then the immunosuppressant drugs that kept the patient from rejecting the donor’s heart?

A case could be made that infant incubators hold the clear record for enhancing human longevity. No other device (in utero procedures - perhaps), are responsible for an entire lifetime of health. As far back as the 1870s, hospitals around the world have been able to demonstrate statistically that the introduction of these enclosed, clean, warm environments dramatically reduce infant mortality. From 1950 to 1998, the U.S. witnessed a 75% decline in the infant mortality rates (i.e. death) as a result of incubators.

No matter what else is going on, humans continue to have babies. Perhaps that is why, after the 2004 Indian Ocean tsunami, incubators were sent from all over the world to the affected region. Understand that incubators are not cheap; while roughly the size of a small desk, or a push cart, these things can sell for $40,000, and that doesn’t begin to cover the cost of transportation, training, expendables, and such.

So you can imagine the heightened disappointment when doctors showed up a year or two after the tsunami and found that none of the incubators were being used. Most had broken and no one knew how to get them fixed. Some were usable, but the instruction manuals were in English.

Jonathan Rosen, a Boston doctor, had noticed that third world peoples often struggle with technology as a result of a diminished supply chain, but that somehow they always managed to keep their Toyota 4Runners on the road. Maybe that’s a testament to Toyota, but I rather think it has to do with common knowledge, availability of technology, and human nature. So Rosen proposed, and the organization Design that Matters developed, an incubator out of leftovers from readily available car parts. Car batteries supply the power, headlamps the heat, door chimes the alarms, air conditioner fans provide circulation and so forth. The entire incubator is constructed using readily available components and knowledge.

There are any number of lessons here that can be applied to first world corporate I.T. shops and the designs that matter to us. But first, let’s agree that building new solutions, with ever increasing complexity out of diminishing knowledge pool is not a good idea. The key takeaway from the incubator / 4Runner lesson is that the maintenance of a solution is at least as important as the initial construction.

Every time we design and build / enhance an application, a system, or component, we need to ask - what happens to the maintainability of this solution after I move on? Can the organization find among the populous the necessary skills and tools to support the solutions I am building today.

Tourturing the incubator analogy just a little more... as you consider your next design, think about how you could assemble a solution using readily available components that the pool of future support resources will understand. If you always go back to the solutions you are comfortable with, you may be putting your business at risk once your knowledge retires.


  1. I'm wondering if the version made from common parts costs any more than $400 instead of $40k.

  2. Well, if purchased from a auto dealer, it could be about the same. Back in the day, we'd just use "midnight auto."


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