Wednesday, February 24, 2010
Howard voiced the concerns of many Americans who feel their legal system is out of control. The cost of torts there is 2% of the GDP. But the most pernicious cost is the way it impacts people's behaviour and inhibits their ability to deliver their best.
He started with some anecdotes from a teacher who said that threat of litigation had crippled her ability to deliver high-quality education, because she had to sacrifice the best interests of the whole class in deference to the few disruptive ones she could no longer discipline.
He argued that the legal system must be changed so that matters are judged based on their benefits to society rather than to individuals. Supposedly Canada's system is more attuned to this point of view, yet we can see some of the same tendencies creeping in here. Certainly the opening stories about the educational system resonate with some I've heard about the Canadian system.
But enough of a summary. Go and listen to his wonderful talk.
Tuesday, February 23, 2010
Johns Hopkins did some pioneering work on developing a check list to reduce the infection rate in central lines. This check list consisted of merely five steps - all no-brainers:
- wash your hands with soap
- clean the patient's skin with chlorhexdine antiseptic
- put sterile drapes over the entire patient
- wear a mask, hat, sterile gown and gloves
- put sterile dressing over the insertion site once the line is in.
Meanwhile, research was going on at University of Toronto and and Toronto General and at Kaiser in California on checklists for surgery. These experiments delivered equally stunning results. Gawande started to experiment with checklists. He used them in his own operating rooms, feeling out what worked and didn't work.
Then Gawande was approached by WHO to improve the safety of surgery around the world. After all, at least one million a year die in operations, just slightly more than from malaria. Gawande decided that the greatest contribution could be made by designing a surgery checklist. For a pilot, he chose hospitals as disparate as hospitals in high income countries in Toronto, Seattle, Aukland and London, and intensely busy hospitals in low and middle income countries, in Manila, Amman, New Delhi, and a rural hospital in Tanzania. These hospitals started introducing a two-minute, 19-step checklist. Comparisons of outcomes in the three months before and after introducing the checklist were astonishing. Major complications had dropped 36% and deaths 47%. Many highly sophisticated innovations in the OR have cost lots of money (an example might be robotic surgery) without a good return on that investment in terms of improved outcomes for large numbers of patients. Yet this simple, virtually free innovation seemed to make a huge difference.
Several lessons from this book will stick with me.
- The first step on the checklist is to require the surgical team to introduce themselves at the beginning of an operation. Typically, the group in an OR will not usually know each other very well, or at all. Gawande says the simple introduction goes a long way toward turning that collection of people into a team. Who'd have thought you could be undergoing an operation, something dangerous and unexpected could happen, and the team operating on you would have to communicate in this emergency without even knowing each other's names? This is part of a sea change in medicine from the accent on the individual hero doctor to the team.
- Put the checklist it in the hands of the circulating nurse and giving her or him the authority to stop the process if a step is skipped. Another aspect of making it a team sport.
- Keep the checklist as short as possible. If it's too long, practitioners will view it as a distraction from taking care of the patient, and will ignore it. As is so often the case with strategy, deciding what not to do or include is your most important decision.
- After these results, it seems almost criminal for a hospital not to adopt checklists. However, the constraint on adoption of innovation is the reluctance of people to change behaviour. Doctors are no different. As a public champion of checklist adoption, Gawande even admits to his own resistance initially to using the checklist he'd helped develop.
- If you want to succeed at innovation, start with a single, focused innovation. Once you have proof of concept you can expand beyond that initial niche. In the OR, for instance, there is scope for specialized checklists for all sorts of specialized operations, rather than just the general one to cover all surgery, Then, just like in aviation, you could develop a series of checklists which spring into action to guide actions in emergencies.
- It's a real innovation to look beyond your own industry for ideas that are transferable and transformative. Gawande talked to many people outside healthcare - in industries as diverse as construction and investing. His most important insights came from aviation, the pioneers in the use of checklists. Boeing spends huge amount of resources building checklists for the pilots who will fly their planes. He argues that Captain Sully, the 'Hero of the Hudson', was not being modest when he said it was the team that ensured the plane landed safely on the river. He was being dead right. And in the cockpit, the checklist for what to do upon losing engines after a bird hit was a key contributor to the pilot's ability to land the plane.
Saturday, February 20, 2010
This focus on visual detail has been crucial in her career of working with animals. She has seen, where others haven't, what spooks an animal. To most people, a person walking and a person sitting on a horse are conflated to the same thing. But not to an animal. And not to an autistic with a focus on the detail rather than the big picture. Such insights have been the key to Grandin's successes in humane livestock handling.
It was interesting to see Grandin talk quite soon after seeing her interviewed in the movie The Horse Boy. To my chagrin, I'd missed the movie at Toronto Hot Docs, where it was known as Over The Hills And Far Away. The movie chronicles the story of an autistic boy Rowan Isaacson, for whom being with animals was about the only thing that could soothe him. His family takes him on a pony trek in Mongolia to visit shamans, after which he reaches a new level of behavioural calmness.
Grandin's also the subject of an autobiographical movie, named simply Temple Grandin, that aired recently on HBO. Must keep an eye out for that one. It got great reviews.
Sivers is also responsible for another of my favourite short talks on TED.com, in which he talks about seeing the flip side. Americans name locations by street names, whereas Japanese name locations by the blocks. This can lead to puzzlement and it's an interesting way of explaining how cross-cultural communication can be derailed.
In my innovation courses, I hammer the necessity of questioning assumptions to have any hope of creative innovation. The hardest assumption to challenge is the one you don't know you're making. Sivers' talk does a great job of pointing out one assumption most of us have never questioned.
Friday, February 19, 2010
We heard of this theme of open information from Tim Berners-Lee last year at TED when he talked to us about a new age for the Web, when numerical data would be linked the way text has been. When you have the raw data, you can freely manipulate it and integrate different data sets to elucidate relationships.
Berners-Lee discussed an example of just how quickly this can happen - just two days after the UK Department of Transport published data on the locations of bicycle accidents in Britain, The Times had published an interactive zoomable map showing the locations.
The US and the UK have already started to publish such data, in the interests of open government, and many have hopes for improved political accountability through these efforts.
Thursday, February 18, 2010
Bill Gates' incisive talk on energy was one of my favourites this year. His acute analysis went step by step through his thinking with startling clarity. (In fact, if you want a template for a perfectly formed presentation, you could do worse than use this model.)
The Gates Foundation is working on vaccines and seeds. But climate is more important to the very poor than anything else. And the price of energy is critical to them too. In order to arrest climate change,we need to do more than just reduce carbon - we have to Innovate to Zero, from the current 26B tons of carbon/year (of which the US is responsible for 20B tons).
Carbon math is inescapable
Next, Gates identified five candidates for that miracle:
- carbon capture and storage
- solar photovoltaic
- solar thermal.
The potential of nuclear
Gates pointed to nuclear as a strong contender in this race. The current technology in nuclear power plants dates back to the 1950s and uses rare enriched uranium. Furthermore, the process is quite inefficient and produces a lot of waste, without a sound plan for its disposal.
Gates disclosed that he is backing an initiative out of Intellectual Ventures, run by his friend and former CTO of Microsoft, Nathan Myrvold. Terrapower's uses U25 (i.e. spent uranium that is now considered nuclear waster) as fuel, rather than U28. It has the potential to use all that nuclear waste we now worry about so much. Even better, the process takes place in a sealed reactor in the ground, which you fill once every 60 years, eliminating the risks of accidents associated with refuelling. This approach has the potential to meet the deadline, through 20 years in development and 20 years for wide deployment. (Gosh, as much as I admired Gates' analysis, I wouldn't go so far as to put him in charge of a deadline!!)
The Gates talk is one of the first to go up on TED.com here. It's well worth watching.
Other TED talks on nuclear
Nuclear wove its way through a couple of other TED talks. Stewart Brand, an early environmentalist and creator of the Whole Earth Catalog has come to the conclusion that nuclear is the only answer. The risks of nuclear are less than the risks of climate change. And TerraPower's approach reduces those risks further. He outlines his reasoning in his new book Whole Earth Discipline: An Ecopragmatist Manifesto. He participated in a debate about nuclear power against Mark Jacobson, a Stanford civil and environmental engineer, whose most persuasive argument against nuclear power was that it couldn't come online fast enough to make a difference, mostly because of regulatory delays. That's the 20 years Gates allows for deployment after development has proven the concept.
And of course one couldn't help but link the Countdown to Zero movie (described in an earlier post) with Innovation to Zero. Using nuclear power creates a market for the uranium in all those weapons that should be dismantled).
Monday, February 15, 2010
We experience events that result in happiness as they occur. That happiness is felt by our 'experiencing self'. Later, we remember these events, and our 'remembering self' feels happiness. The happiness of our remembering self might be either greater or lesser than that of our experiencing self. He uses the simple example of enjoying a lovely musical recording, which ends with an ugly screech at the end. The experiencing self would have had several minutes of happiness with a few seconds of displeasure at the end. However, the entire memory of the event will be coloured by those last few seconds. The remembering self is a powerful filter for our experiences.
Kahneman described research on people undergoing colonoscopies, who give feedback about their varying discomfort level in real time. This measures the response of their experiencing self. Later they were queried about the procedure, essentially querying the remembering self. Their memory of the discomfort depended almost entirely on how they felt at the end. So extending the treatment artificially so that it ends with low pain, determines the patients’ assessment of their overall pain, no matter their total experience.
During a two-week vacation, you’ll experience twice as much happiness as during a one-week vacation, but you don’t remember twice as much happiness. In fact, there is only a .5 correlation between the happiness of the experiencing and remembering self. So our happiness (which is about memories) is not equal to well-being (which has to do with experiences).
This has an impact on anyone trying to determine policies which will increase well-being: do you try to maximize well-being (the experience) or the remembered happiness (which is how, say, the voters will judge you). In US research, people’s ‘happiness’ rises as incomes rise to $60,000, and then plateaus, even thought you could argue that well-being continues to rise. The lack of money can make you unhappy, but beyond a relatively modest point, more doesn’t make you happier.
Judging by the number of later speakers who referred to the difference between the experiencing and remembering self, this was an insight that resonated with a lot of people.
Sunday, February 14, 2010
The film Countdown to Zero describes these risks in chilling detail. There are 23,000 operational nuclear weapons still in existence. It is easy to make the actual bomb; it's the acquisition of highly enriched uranium that's tricky. Although you could make the HE uranium, the best tactic would be simply to head to Russia, where there are vast amounts of completely insecure nuclear material, and venal people who are willing to sell it. One Russian interviewed in the movie explained nonchalantly that he stole enriched uranium for quite modest goals - a fridge, stove and better car. He didn't have a political agenda. However,when it was pointed out that in the hands of a terrorist, many people could have been killed by this uranium, he was disturbingly unrepentant because after all it would only be Americans who would be dead.
Countdown to Zero is produced by Lawrence Bender for Jeff Skoll's company Participant Media and it was a treat for us to see only the second screening (after its unveiling at Sundance). Jeff Ivers, Executive VP of Participant, whom I met at Friday's Final Gala, explained to me how big a deal it was for them to get the film in front of this audience and how thrilled they were that hundreds of people turned up for the last-minute addition to the program. The documentaries are pretty well all losers (with the exception of Inconvenient Truth). As he says about The Cove, the movie that won Best Film at Toronto Hot Docs Festival, once people find out dolphins are going to be killed, it's hard to draw a crowd!
Saturday, February 13, 2010
We talked a bit about how unusual it must have been for her to pitch these successful series (I'd noticed that she was both female and black), and she thought that she'd benefited from naivety. Not knowing how hard it should be to pitch a TV series took all the pressure off. Interesting how that was also equally true for me in the technology industry in my early career. We shared a great bond across age, industry and background.
Then, on arriving back at the hotel, there was a sound system set up in the lobby and a crowd of people sitting/standing around. There was a jam session with most of the musicians from the conference, joined by a flamenco guitarist who was apparently playing in the hotel.
The session was hosted by the totally charming and completely endearing Jake Shimabukuro, who has astonished with his virtuoso ukelele playing. During his TED presentation, he'd showed off his range by playing flamenco music, Ave Maria and Bohemenian Rhapsody. I walked in as he was playing While My Guitar Gently Weeps.
He was joined by the string quartet Ethel, who has been playing musical interludes all conference with Thomas Dolby.
Then there was the incomparable Robert Gupta. At Juliard at 14, graduated from Yale at 20 and now the youngest violinist in the Los Angeles Philharmonic, he is one of the TED Fellows, who essentially win a 'scholarship' to attend TED. He delivered an amazing talk at TED University, describing his relationship as violin teacher to Nathaniel Ayers, the violinist befriended by the LA Times journalist and subject of the movie The Soloist. It was a powerfully delivered and emotionally charged talk. He has since played a couple of interludes of exquisite classical music that could make you cry. Another TED Fellow sitting beside me tonight says he is as delightful a person as he is musician.
Then, in pop two of the dancers from the dance troupe LXD (The Legion of Extraordinary Dancers) with mindblowing modern dancing. This was dancing street style and totally blow-away.
As Jake was trying to close the session down, resisting an enormous chorus of bravos and whistles and calls for 'one more', in waltzes Natalie Merchant who had magnificently closed out this afternoon's session. She delivered a lyrical and luscious version of that old World War II standard "Every time we say goodbye". That still didn't satisfy the crowd, and Jake delivered one final wonderful number, before we scattered to our rooms.
I always get to listen to musicians I'm not familiar with at TED, and see dancers I wouldn't have seen. This year was a particularly rich selection. Thomas Dolby is amazing in putting together an incredible selection of artists. But to hear them up close in a jam session in the lobby is a thrill I won't soon forget.
Thursday, February 11, 2010
Part of the TED culture is that you can turn to anyone beside you and strike up a conversation. Whether you're riding down in the elevator with Al Gore, or walking across the street with Peter Gabriel, or bumping into Peter Diamandes (to mention just a few from this year), you can expect to get a polite and interested response from them. It took me a couple of years of TED to understand this openness and lack of hubris and get up the nerve to start these conversations.
However, this year, there have been several occasions where I couldn't make this contact. Why? The curse of the mobile Internet: people immersed in email on their smart phones. Somehow, people were never this obsessed when it was just voice conversations or perhaps it seemed ruder to talk than to covertly check their email and apps.
The situation may be even worse tomorrow. Today there was a brief talk demonstrating the fabulous applications on the new Nexus phone from Google. At the end Chris Anderson asked how many people didn't have a Nexus phone. When approximately everyone put their hands up, he retorted "You're wrong. Google is giving every one of you a phone". So there'll be an onslaught tomorrow of people who are just dying to play with their new phones. I certainly want to play as much as possible while I'm here, because we get a free month of service in US with the phone, and I'd like to learn and play with it while free.
And so to bed, gearing up for a big day again tomorrow, starting with a 7:30 breakfast, then TED University, three conference sessions running until 6:45 followed by the TED Grand Party. I even have several of those planned 'conversations' (new to TED this year) I want to get to in the breaks, and I'm trying to catch the organizer of TEDx to talk about a potential TEDx conference in Toronto.
And soon I'll get to actually telling you about the marvellous talks!!
My rating system for TED talks runs: Good, Great, Partial Standing Ovation, Full Standing Ovation, and Thunderous Standing O. Admittedly, this is based on entire audience reaction rather than my personal opinion, but I seldom disagree. Today was a day with 7 Partial Standing Os, 1 Full Standing O, and 3 Thunderous Standing Os. And this is a crowd with high expectations. A stirring day, to say the least. And I managed to fit in a visit to Paradise Alley, where they have the wondrous Vosges chocolate and the masseuses!
It's interesting how this year has been just that much more jam-packed that I can't envisage doing the blogging during the actual conference. At least, that's my story - it has nothing to do with age!
Wednesday, February 10, 2010
Tuesday, February 9, 2010
Today, there were a variety of tours, the first semester of TED University, a chance to explore the site (I really liked the expanded bookstore), and start to get acquainted at a cocktail party in our hotel and the opening night party over at the Conference Centre.
I went to Venice on a tour of Digital Domain, co-founded by James Cameron, and best known as winners of many special effects Oscars, including most famously Titanic. Ed Ulbrich, who gave a great presentation on the making of Benjamin Button at last year's TED (and later accepted an Oscar), was our host for a visit to DD premises in Venice.
Ulbrich gave us a glimpse of the future as they see it. 3D is on the rise. There'll be increasing digitization in movies. In fact, he said tours these days were much more boring, because there were no models to show any more, since virtually everything was created digitally now. This reminded me of the tour guide at SONY last year, who showed us a room full of story boards and said these were actually the last story boards SONY would be doing.
Studies are now envisioning the entire gamut of possibilities upfront - i.e. seeing beyond the movie to games, browsers, ringtones, etc. These used to be add-ons, but now they're thought of in an integrated way right up front. This shift in moviemaking is also seen in the emergence of directors who used to make commercials into the film world. More of the specialized work is being outsourced - for instance Digital Domain has turned their sound and action stage into offices, since they usually outsource that kind of thing to other specialist players, and often outside the country. They do a lot of their work in India and Canada these days.
Ulbrich told the story of how the writers' strike caused a paradigm shift for them. The new TRON movie was conceived of during the strike, and was pitched from short 'prototype' of the look of the movie, rather than from the screenplay as it would have been done in the past. We learned one tidbit about the movie, but we were required to sign a non-disclosure agreement, so I won't tell you about that!
On returning from the tour, I headed off for the first 'semester' of TED University. Fourteen speakers covered a lot of different territory, and over time I hope to tell you about several of them in depth.
- Michael Martin told us about the life lessons he learned from living through a tornado.
- Catherine Mohr, one of the hits on the Main Stage last year with her description of robotic surgery, told of her efforts to build a green house over the last year. She pointed out how hard it really is to determine how you're doing, as you balance the embedded energy in all your material against the ongoing energy operating costs. She calculates that the amount of energy spent to build the house will be paid back in 5 year, based on the energy efficiency. To be fair, she pointed out that if you compare that with upgrading the existing house that was demolished, it would take 22 years to pay back the embedded energy of the new build.
- Felix Kramer extolled the virtues of running barefoot, or with minimalist foot covering, as opposed to running shoes. This causes strengthening of your arches, reduces injuries, and restored the joy of running for him.
- Daniel Kraft, from the faculty of the Institute for Stem Cell Biology and Regenerative Medicine at Stanford gave us a whirlwind tour of the future. He described meeting someone online who shared his haplotype, a symbol of how much we're going to know about our genetic make-up in the future, as the price of decoding our whole genome heads for $100. There'll be social networks to connect you with people with the same haplotype. He described a lab on a chip, pills with embedded technology to communicate, microbots in our body doing operations, nanomedicine, geomedicine, systems biology and 3D organ printing. I was pretty blown away a couple of years ago to hear about manufacturing based on 3D printing that builds up layers using technology similar to a printer. But building up arteries that way? That was mind-blowing.
- Kevin Stone, an orthopaedic surgeon, continued to dazzle by describing his work to move from bionic joint replacement to biologic. He's already operated on 4000 patients to regrow meniscus to repair knees. However, there's a dearth of donors, and he believes the only way to help a lot of people is through use of animal tissue. He's developed techniques for stripping these animal tissues in ways that make them usable in humans. For instance, he's already used pig ligament in 10 patients, one of whom is apparently a Canadian Masters Downhill skier. He says we're moving beyond hardware and software to bioware.
- David Bolinksy showed some amazing photographs of melanocytes (which create melanin) and urged everyone to get checked by their dermatologists often.
- Frederick Balagaade, a TED Fellow from Ghana is now working at Lawrence Livermore to develop microfluidic chips that can provide diagnostics for 100 patients for 100 different conditions in 4 hours. The size of an iPhone, such diagnostic breakthrough could revolutionize diagnosis in third world countries.
- Jonathan Klein, co-founder of Getty Images, showed up some amazing photographs that changed the world.
- Jessica Green, another TED Fellow who is a Professor of Ecology and Evolution at University of Oregon, pointed out that we spend 90% of our lives indoors, subject to mechanical ventilation. She posits this is not good for us and is beginning research on the subject.
- Jonathan Drori, one of my favourite TED U professors last year with his talk on the Kew seed vault, was back to delight us with a discussion (along with truly stunning photos) of pollen. Pollen takes many fascinating forms, and the collection and proportions of pollens on, say, someone's clothing can provide a distinct pollen signature as to where the pollen was picked up. Apart from being used on some episode of CSI to track a murderer, pollen signatures have been used to track down origins of drugs, provenance of antiques, and has helped nail down Bosnian war criminals by proving skeletons have been dug up and moved.
- Juliana Ferreira, a TED Fellow, and biologist from Sao Paolo, talked about what you do with the thousands of birds that are seized in the illegal animal trade in Brazil. The dilemma is whether they are safe to release back into the wild.
- Phil Zimbardo, who talked on the Main Stage about Evil a couple of years ago, was back to talk about his Heroic Imagination Project. He had made the point that, in the right circumstances, anybody can be evil, and illustrated it with depressing examples. He feels that anybody can be a hero, given the right circumstances. Those who haven't been a hero yet, are just Heroes in Training. And he intends to start distributing material to help people become true Heroes. It's a very interesting concept.
- Cindy Gallop expanded on Zimbardo's notion, by talking about her new web site called ifwerantheworld.com, which intends to stimulate and record microactions that make the world a better place.
Met Katie Ford in the registration line-up. Formerly head of Ford Modeling Agency, largest modeling agency in the world, she is now involved in trying to stop human trafficking. She works with Free the Slaves, whose leader Kevin Bales is a speaker here. Katie uses the experience and knowledge from arranging logistics for models from all over the world, to help in her new endeavour. I hope I get to see more of her at the conference.
Then I bumped into Melanie Kittrell waiting for the light to change and ended up eating brunch and talking. She is Executive Director at Merck running a group that enables and supports innovation throughout the commercial side of Merck. She was fascinating, and talked about all the issues that I teach about in my MBA courses. I'll definitely be trying to seduce her into a guest lecture at Queen's, which is coming up soon.
I'm off now to a tour of Digital Domain. Last year, there was a talk about their work on Benjamin Button which was astonishing. People who took their tour last year raved about it. I managed to get on the tour this year and am really looking forward to it.