Like millions of people across the world, I’m an enthusiastic amateur cook. I pore over cookbooks and recipes for fun, constantly scanning for opportunities to learn, experiment and build new skills. In service to these experiments, I regularly handle potentially dangerous materials (like uncooked meat) and equally dangerous technologies (like sharpened knives and open flames), which might, if mishandled, seriously harm or even kill me. Then I put the results of these experiments into my body, and into the bodies of the people I love most in the world.
I can do all of this because cooking is one of humanity’s few truly democratized forms of practice. As an amateur cook, I don’t just have permission, but encouragement to experiment, fail and innovate – all in the service of learning and improving. Cooking places me in a dialogue with my culture, my region’s food traditions and agricultural practices, the seasons, family history, current social trends and contemporary scientific understanding, as well as with a thriving global community of cooks, who happily share all kinds of tips, tricks and techniques.
To cook in this way requires no special licensing from the government, or the taking of tests or paying of dues, or swearing to uphold a certain code of conduct. (Although it does sometimes involve swearing.) If I were ever to decide to cook professionally, the state mandates primarily that I keep a sanitary kitchen, not that achieve a certain consistent level of quality or that I prepare a set of sanctioned dishes.
In all of this, I am representative of the vast majority of the world’s cooks, only the tiniest fraction of which will ever be ‘professionals’. (Indeed, purely as a matter of statistics, it’s likely that most of the world’s best cooks are amateurs.)
The results of this system are pretty wonderful. Every day, human beings consume billions of delicious meals, prepared by themselves and others using an incredibly vast array of techniques, without incident.
Yet the results are not universally benign. Each year, some people get sick, and some even die from things cooked by themselves or others – whether from a single undercooked shrimp or from the accumulated effects of too many cheeseburgers. We tolerate these outcomes as acceptable risks – understanding them to be the cost of having a wide variety of food choices, and trusting ourselves to make them.
Not every field is so democratic – and some that were once more participatory have become intensely professionalized. Such is the case in healthcare, another ancient field where, as with cooking, people employ potentially dangerous technologies and and put things in the human body, with mostly (but not universally) good outcomes.
Healthcare is, in contrast to cooking, the hard-won realm of professionals. The government and medical bodies tightly control the license to operate. One cannot be a ‘hobbyist’ doctor, as one might have in the distant past; by and large, one must participate in the professional ecosystem of healthcare delivery or not at all.
This may seem like the appropriate and natural order of things, but it was not always thus. The professional, institutional delivery of health and medicine as we experience it today took centuries to develop, taking much of its modern form only in 19th century with the advent of professional medical associations, credentialing and licensing processes, the differentiation of specialists and general practitioners, the codification of medical ethics and the standardized delivery of care in hospitals. (Many great medical journals, such as the New England Journal of Medicine and the Lancet all date from this period; the American Medical Association was founded in 1847.)
Much of this effort was spurred not only by a desire to ensure higher quality outcomes, but to suppress competition from a sea of unqualified competitors, and to normalize the interactions and expectations between doctors, specialists and patients. The highly professionalized, highly specialized and highly institutionalized model of healthcare we have to today is the product.
How well does this system innovate? It might seems strange to even ask the question, given that we’re living through a veritable Cambrian explosion of medical innovation, from personalized cancer therapies to point-of-care diagnostics.
But as wonderful as these innovations are, they represent the work of a very specific segment of the healthcare field, with an equally specific set of incentives and motivations. Innovation in today’s healthcare system is often arduous, expensive, and typically undertaken by only by a narrow set of commercial interests; not even everyone in the formal system gets to participate. Partly, this is due to the understandable (and commendable) instinct to avoid harm and quackery; partly it’s because the stakes and costs of insuring against failure are extremely high; partly it’s because new innovations arouse the natural, protective instincts of incumbent organizations and bureaucracies; and partly it’s because there’s a lot of money to be made.
In some cases – as with drug discovery and the development of very advanced technologies – the huge capital risks involved (and equally huge potential benefits to humanity) absolutely warrant this kind of outcome. But in many other circumstances, the results are less inspiring. When only a chosen few get to innovate, the results often end up just being more expensive than they have to be, not necessarily better. The problems that get addressed are often the ones that have the most significant potential for financial return, rather than the ones that solve the most acute medical needs in the most cost-effective way. Worse still, channeling innovation into a few officially sanctioned corners retards the growth and spread of innovation in the field as a whole, by discouraging a wider array of voices and perspectives.
I was thinking of all this when I watched the following video, which has been making the rounds online lately:
The video shows a small and typical example of knowledge sharing in the nursing field – how to use the strap from an oxygen mask to remove a ring from a swollen finger. It’s exactly the kind of noncommercial sharing of technique that is perfectly commonplace in cooking; yet has become less encouraged in fields like nursing, which is, paradoxically, the field closest to the actual delivery of care.
It wasn’t always like this. A scan of the back pages of The American Journal of Nursing from the 1940s and 50s shows lots of sharing of what we might today call nursing “hacks” – clever, unconventional uses for products, and DIY, jerry-rigged devices all invented to improve patient care, and make nurses’ jobs easier.
They include innovations like “a simple wire contrivance … used to hold drainage bottles on the patient’s bed” and “an apparatus for rinsing baby bottles, designed by the nursery staff, made of several copper pipes welded together … that could rinse fifteen baby bottles at one time”.
These innovations – products of a less bureaucratic, less litigious, and, one assumes, less market-oriented time in medical innovation – are answers to problems which nurses encountered (and still encounter) every day. Now, as then, nurses are loaded with this kind of tacit knowledge and insight – hard-won observations from the trenches about what is needed and useful. Every day, working outside the limelight of the “professional” innovation discussion, they are quietly fabricating solutions to many challenges on the front lines of patient care.
The challenge is to channel and amplify all of that latent creativity to best effect. That’s just what MIT researchers Jose Gomez Marquez and Anna Young, at the Little Devices Lab are attempting to do with MakerNurse – a project that brings together nurses with the right support and tools to unlock their tacit insights and give expression to their creative solutions. (The examples already documented by the project are impressive – ranging from pediatric nebulizers to reusable tracheostomy collars.)
This is work that assumes the natural inventiveness of the nurses themselves as a starting point. Helping them take their ideas further might then mean helping them understand and use the fabricating technologies needed to develop and prototype their ideas; sometimes it might mean pairing them with professionals who can help them refine their insights; sometimes it might mean helping them find a wider audience for their solutions; and sometimes it might just mean helping them find one another.
In addition to these worthy goals, the MakerNurse project is a great example of how the Maker movement will likely grow up. Once seen mostly as the provenance of techno-hobbyists and entrepreneurs, it will smuggle not just the tools, but the ethos of distributed innovation into entire fields of human endeavor.
In the process, it will enable and ennoble professionals on the front lines and amplify their creativity and effectiveness. And it should act to keep the costs of needlessly expensive innovations in check. A healthcare system that empowers MakerNurses is one that is better designed, more humane, cheaper to deliver, with happier providers and customers, and better outcomes. So too is airline industry with MakerAirlineAttendants, and an educational system with MakerTeachers.
We need a “Maker_____” project – and more cooks, and more kitchens – in every industry.