Unlike Aaron Carroll at the Incidental Economist, I was a policy and process analyst major in younger days. But we had the same concept of the binding constraint:
the rate limiting step. See, in any chemical reaction, there’s always one part that is the slowest. If you want to speed things up, you’re going to be able to make the most difference by focusing on that step….
I had to do laundry last night. We had an adult whites and towels load, an adult colors load, a referee load, and the kids load. The process is fairly simple; put clothes in washer, wait for washer to buzz, move clothes from washer to dryer, reload washer and wait for dryer to buzz. The binding constraint in that process flow is the dryer as it takes roughly two washer cycles for a dryer cycle.
In order to maximize the amount of sleep I got, I had to optimize the binding constraint. That meant I put all of the clothes in the washer on an extra five minute spin cycle to wring out as much moisture as possible. That meant that as soon as I heard the dryer buzz, I went downstairs and changed the loads to minimize its non-use, and it meant that I hung my jeans and towels out to finish drying instead of putting them back in the dryer for another twenty minutes. The dryer was idle for maybe five minutes from start to finish. The washing machine was idle for a significant portion of the time, but the process was nearly as efficient as possible because I optimized the usage of the binding constraint.
Aaron notes that we don’t focus on the binding constraints or the rate limiting step in health care:
Bill and Melinda Gates are doing it right. From 1990 to recently, the childhood mortality rate has been cut in half. Why? Cause they pay attention to the things that matter. What kills kids worldwide? Malaria – and they’re hard at work on a vaccine. No worries about phantom illnesses or the craze of the week. Instead, they’ve got a solid focus on the things that actually matter….No fancy new medicines. No genetic tests. And it’s easy to roll your eyes and say this is common sense stuff, and it is in much of the developed world. But I think the Gates want to do the most good they can for children worldwide, period. And they can do so by improving things for those who have it the worst. That’s the rate limiting step. Further, they can do the most good in the places that need it the most by focusing on the things that are actually killing kids. In this case, it’s nutrition, hygeine, and infection control….
Rocket science is cool if the goal is to go to Europa (even if we’re warned not to) but it is not a panacea. However the United States treats high end medical science as an end all and be-all. There is plenty of research to show that talking to patients about their goals, desires, and constraints leads to better health outcomes at lower cost and resource utilization that the best pill. There is plenty of research that shows wrapping social services around individuals at high risk lowers medical utilization and net spending than telling people to come to the emergency room if they feel ill. There is plenty of research that basic checklists minimize errors. Yet we don’t do that. It is easier to get a massive capital intensive installation than revamping business practices to emphasize the human and humane.
So we spend money on the sexy and the shiny instead of the simple and effective.
The lessons for the US are clear though. What’s the number one killer of kids in the US? Accidents – by far. But the number of foundations and NIH dollars going into that is miniscule. Know what consistently makes the top five? Suicide and homicide. How much time and money do we spend on researching ways to reduce that?
We don’t want to focus on those issues because of Freedumb ™.
If we focused on suicide and homicide that would mean that we actually have to talk about guns in a rational, adult manner where costs and benefits of having an absurdly heavily armed population is a reasonable thing to talk about. Instead of how guns are non-prescription Viagra or major tribal cultural markers. It would mean talking about how are communities are designed so that it is almost impossible for children to safely walk to the vast majority of their daily places of life. It would mean talking about mental health without stigma. It would mean that we as a society are also a community with shared responsibilities.
Those are evil and deviant thoughts so we chase shiny objects instead.
schrodinger's cat
We should totally go to Europa, it is one the places in the solar system that has water.
Buddy H
Here in upstate ny, every few months I read about a toddler or baby who has been murdered by the mother’s boyfriend. The mother’s boyfriend is used as a babysitter. The boyfriends are usually stressed by fussy babies and crying two-somethings, so they end up using excessive force.
I’m always fascinated by the readers’ comments after these stories. Without fail, it’s “he should be tortured to death for his crime” or “just take him out back and shoot him” type of remarks. But no one ever steps back to see the larger picture: why are these girls (who work minimum wage jobs at weird hours) lacking in childcare options, that they have to trust their infants to the tattooed bad boy boyfriends? In other advanced countries, childcare is provided. One less thing for an overworked young mom to worry about.
Buddy H
It would mean talking about how are communities are designed so that it is almost impossible for children to safely walk to the vast majority of their daily places of life.
So true. I grew up in a small town. Sidewalks everywhere. I walked to school, to the library, to the variety corner store for my comic book addiction. A downtown with no chain businesses, all locally owned, from the hardware store to the pizza joints to the grocery store.
When I married and had children, we moved upstate and moved to a place with no sidewalks, no real downtown, and nothing but chains. I guess the school district’s high rating was a factor in our decision, I was not really aware of walkability issues; I thought we could still walk.
My kids had to be driven everywhere. I tried walking (on the shoulder of the roads) and cars sped by about an inch away from me. All I needed was one person texting or applying makeup and I would have been a flattened pedestrian. My kids couldn’t be free range, the way I’d been. And when they became teenagers, everyone had to have a car. There were no other options.
Lots of kids died in that “town” in car accidents, and being struck by cars while walking. If I had it to do over again, I never would have spent 22 years in that cul-de-sac environment.
RSR
If only Bill and Melinda were as adept at the big picture regarding public education. Unfortunately, they’re part of the chasing the shiny object team in that issue.
Buddy H
@RSR: And don’t they profit from some of their charter school reforms by providing learning software? The wingnut commenters on my local news sites, in their hatred for the public teachers’ union, are constantly advocating for computer learning for all kids. Fire the teachers, and put kids in classes of 100 children, all learning from computer programs. Where did they get that idea?
Amir Khalid
@schrodinger’s cat:
But we were were strictly warned to “Attempt no landings there.”
gene108
@RSR:
I think there’s a small subset of well intentioned Type A personalities in the school reform movement, who just cannot grasp that most folks are not Type A personalities and will be contented with a living wage, job security and some type of pension that allows them to retire, while young enough to get out and about and enjoy the retirement.
I think President Obama is in this subset.
Given what Bill and Melinda have done, I think they may fall into this subset.
raven
Shiny you say? Wait for this freakout!
boatboy_srq
Nice AC Clarke h/t there.
This is why we have the GWoT and TSA, and no improved security at any port or rail/bus transit hub nor rational foreign policy not designed to inflame over a billion humans; why we’re still arguing about SNAP instead of living wages and 40 hour weeks instead of $15/hr days; and why the Teahad would rather rail against phantom ColonioKenyan cryptoMuslim IslamoFascoSoshulism than actually enact legislation. In short it’s the new/old Why We Can’t Have Nice Things.
KG
Unfortunately, we something like this is suggested as policy, or even more broadly as “this is something we should do” the response is DEATH PANELS! THEY WANT TO KILL US ALL!
boatboy_srq
@raven: State visit in March; Israeli election in March; hence no meeting because Election and questions of international impropriety surrounding other countries’ election rules and schedules. Not to mention Totally Inappropriate Congressional Address at any time of the year. Epic Fail By Design. So naturally this will be red meat for wingnuts.
Pogonip
What is a referee load? Were you washing the whistles?
Cervantes
You don’t have to separate your laundry, unless you’re using bleach. Modern dyes are colorfast.
scav
@raven: That’ll be fun. Wonder if there’ll be attempts to smuggle him into the presence (the ‘we’ll show you who’s boss’ option to follow on the original invite) or merely media-friently wailing and stomping and beating of breasts?
burnspbesq
You live in a strange household. You mean to tell me that the binding constraint in your laundry process isn’t the elaborate game of chicken that everyone plays against everyone else to try to get out of having to fold and put away?
balconesfault
I do think you’re conflating “rate limiting step” with “cost benefit optimization” …
Violet
These days parents get reported to authorities if they let their kids walk by themselves.
Katharsis
I am guessing that this is what you meant. I really enjoy your posts, and was going to share this on FB, but that part right there confused the hell out of me. So I didn’t.
Katharsis
First!! .. comment in moderation (for me anyway).. wah wah wawawah..
Violet
@Cervantes: Red dye frequently runs, modern or not.
Frankensteinbeck
…admitting that tight parental control is not necessarily good for children, that in fact abusive assholes should not have free rein to destroy their offspring. Our society is dedicated to pretending threats come from the outside and it’s a good thing to treat children like property, so fat chance of that.
Roger Moore
@Cervantes:
I have enough off-colored whites not to believe this claim, or, at the very least, to know that there are plenty of antiquated, runny dyes still out there. Also, too, as long as you have enough laundry to justify your actual number of loads, you aren’t really hurting anything by keeping the whites and colors separated.
raven
@Violet: These colors never. . .never mind.
Roger Moore
What bothers me almost as much as absent sidewalks are grossly inadequate ones. Things that are really required for an adequate sidewalk:
1) A wide enough path for people to pass without having to step off.
2) A buffer zone between the sidewalk and street, so cars aren’t still zipping by inches from you.
3) Its own right of way uninterrupted by signposts, utility devices, foliage, etc.
4) Sidewalks on both sides of every street.
5) A crossing at every intersection, so pedestrians don’t have to go around three sides to get where they’re going.
Starchild
You guys never listen, do you?
Calouste
As soon as someone works out how to grift from social workers in the same amount as they can grift from weirdly colored pills with funny names or machines that go ‘ping’, people will actually get the treatment they need. Until then, it’s the free unregulated market, baby, profits before results. Oh, and addressing the God-complex of MDs.
Buddy H
@Roger Moore: Very true. Some of these inadequate sidewalks began cropping up on the main speedway of the cul-de-sac town we left. Too narrow for two people to walk side by side, utility poles right in the middle, and of course no buffer. Someone on the town board managed to mandate sidewalks for new construction. So a Target superstore was built, and a thin, sad little sidewalk was added, and it ends abruptly, and is useless.
Buddy H
… And in the winter, the snowplows would push all the snowpiles onto the sidewalks.
Richard Mayhew
@Cervantes: tell that to my wife
Roger Moore
@Buddy H:
I forgot to mention a few other pet peeves:
1) The surface should be weatherproof. No dirt sidewalks that turn to mud in the rain and are impossible to shovel properly in the snow, or smooth surfaces that become too slippery to be safe the moment they get slightly wet.
2) Make the damn thing as flat as the local topography allows. No trip hazards from chunks of sidewalk being lifted up by tree roots, steep sided dips where driveways cross (another reason for a reasonable setback from the road), or steep side slopes that make you walk at a funny angle.
3) How about some decent lighting at night? Lots of places lack adequate street lighting, and the minimal light is directed at the street rather than the sidewalk. This is especially bad when you have to deal with trip hazards, low hanging branches, and all the other deficiencies of bad sidewalks.
4) Keep the sidewalk parallel to the street. It’s better to wander back and forth to avoid obstacles than to leave them in the middle of the sidewalk, but best of all is to have a nice, straight path that doesn’t have either problem.
5) Parking your car so it blocks the sidewalk should be treated as seriously as parking in the middle of the road.
The big point is that sidewalks should be seen as first-class transportation infrastructure that receives the same degree of planning and maintenance that streets get.
Richard Mayhew
@Pogonip: I did an indoor tournament a few weeks ago and then an outdoor icebreaker/showcase freeze your ass off tournament more recently, so I had to put all my ref uniforms and keep myself from hypothermia gear into a wash. It’s easier for me to account for everything if I do a seperate load.
@burnspbesq: Nope — my mother beat it into my head (and the head of every other member of my large household growing up) that the cost of watching TV was folding laundry.
Anyways, I married a woman far smarter than me. When we first started living together, we did not have our own laundry, we did our laundry at the laundrymat a couple blocks away. Coincidentally, it is next to one hell of a sports bar. We lived in a city far from my childhood home, so the only way I could watch the Patriots was on a premium channel which meant going to a sports bar. So my Sunday routines quickly became bring the laundry to the laundrymat at 12:45, get it into the washers before kick-off, go to the bar, order a beer and a burger, drink my beer, switch loads at the end of the first quarter, eat my burger, fold laundry during half time, and bring it home after the game was no longer in doubt.
She said nothing about that for six months and then laundry just became my job.
chopper
@Violet:
indeed. red is the worst.
pseudonymous in nc
The Gates Foundation is also doing a lot of work to support broader adoption of mobile-phone remittance services like M-PESA in Kenya — not sexy (it’s done via SMS, not smartphones) but if you have a reliable way to manage money, you can build all sorts of things on top of it: microloans, insurance, B2B transactions.
Almost the sort of thing a rich country might try when millions of people are excluded from financial services.
Mnemosyne (iPhone)
@Cervantes:
That’s what my husband thought. He is no longer allowed to do my laundry because several of my favorite light-colored shirts came out gray.
You especially have to watch out for denim or other dark-dyed fabrics — many of them include a tag warning you to wash the article separately the first time and wash before wearing it because the dye will transfer.
ThresherK
I’ve never heard of “binding constraint”, but I’m familiar with its cousin “critical path”.
@Violet — from another thread: Thanks for the child-in-car-alarm suggestion, but there would also be times she is not driving and I don’t OCDedly remind her “Do you have your purse?” The child alarm seems almost the mirror image of what I want in a Purse Alarm.
If someone’s taking RFPs: I will bake you cookies if you invent an alarm which I can partner with our vehicles, and would sound off / flash upon the car being unlocked or the key put in the ignition, should it not detect the accessory fob (kept in the purse) within a predetermined and adjustable distance, of say 30 feet.
And should the purse be within range when the car is started, but get out of range quickly (indicating it’s been left behind), have the alarm sound off / flash then.
Hey, while I’m asking for everything, an additional fob sized nicely for the wallet (used sometimes alone without the purse) would be cool too.
Buddy H
@efgoldman: I remember seeing those sidewalk plows years and years ago. Haven’t seen one in ages.
Villago Delenda Est
Unfortunately, this has nothing to do with maximizing profit for the parasites who feed on death and disease, so the American Health Care system is not concerned with this.
Villago Delenda Est
@Frankensteinbeck: You’re some sort of spawn of Satan or something, aren’t you?
Mnemosyne (iPhone)
@ThresherK:
May I ask how old your wife is, and if this has always been a problem? If it’s fairly recent and she’s been checked out for the scarier memory problems (like early onset Alzheimer’s), there’s some recent evidence that menopause can worsen or even trigger ADHD for some women. Late diagnosis of ADHD women is pretty common (I was already in my 40s) because we grew up in an era when “girls didn’t have ADHD.” It’s worth looking into.
Elizabelle
Just happens Bill and Melinda Gates were on Charlie Rose (ugh) last night, talking about their foundation’s work.
25 minute tape; caught a little of the interview, particularly with Melinda talking about their work with women and girls in Africa, and it is worth listening.
Just One More Canuck
@Buddy H: come to Markham (burb of Toronto) – our sidewalks get plowed when there’s just a bit of ice – they also spray salt or sand
Mnemosyne (iPhone)
@Elizabelle:
I have to say, Bill Gates really married up. He says himself that he didn’t really get any of this stuff until he married Melinda and they had kids. She was really the driving force behind getting him involved in global health.
Elizabelle
@Mnemosyne (iPhone): Yeah, I really admire Melinda Gates. And Bill has his heart in the right place too WRT the Foundation.