…in Bhutan, a lot of the clinicians were just operating outside of their skillset or level of training but were a bit unaware of that fact. So dosing of chemotherapy is pretty complex, you need to use body surface area to dose a lot of chemo and then you make a lot of modification to the dosing, depending on say the patient’s lab results, the blood tests and their vitals. And what I found was that there were a lot of errors being made in the dosing of chemotherapy because the baseline level of arithmetic was sort of a bit too low to safely dose chemotherapy in this kind of setting.
So it was remarkably common for me to see order of magnitude errors in calculation and a lot of just very simple errors with division or multiplication or failing to carry figures, even though this was being double checked with the calculator. And as well as having poor arithmetic skills, the clinicians lacked the experience or knowledge to know when they’d made a calculation error because the result was outside of the normal range.
So I think in my experience in Australia, if you do the calculation and you come up with something that is 10 times the normal dose, you’ll sort of recognize that and check your calculations, so that will give you some idea that you’ve made an error and you need to go back and check. But that level of clinical knowledge just wasn’t there so these errors weren’t being caught.
And so I figured out that pharmacists were spending 30% of their time on these kind of ad hoc drug requests which meant that that was time that they weren’t spending with their patients. And on top of that, I was also significantly increasing mortality for a lot of patients there, there were a lot of urgent requirements, cases where every minute that you delay causes worse outcomes for those patients.
So I, again, pulled a lot of data from the pharmacy dispensing system to try and figure out which drugs were most commonly out of stock. The hospital was using a really simple par based system for stocking all of their drug cabinets around the hospital where they would just have a minimum allowable quantity and a maximum allowable quantity for every single drug and you’d go around and if it’s below the minimum, you top it up to the maximum. That didn’t changed based on the day or the time of day or even the time of year, even though we know that there are lots of variations in that. …
I calculated I saved the hospital $8m. It was a combination of two things, so both the cost of drugs that were not expired and then also the cost of fines that the hospital was paying basically to the state government for times when they had failed to meet some of their benchmark criteria. So if they say didn’t see a patient within four hours of them being admitted to the emergency department, the hospital would get fined.
I think that a good ops person doesn’t just allow you to scale linearly but also can help figure out bottlenecks and solve problems such that the organization is able to do qualitatively different work rather than just increase the total quantity of work that’s done by researchers.
For example, I feel like so many times people have come to me and said, “Oh, I don’t know, why don’t we do this thing or why don’t we solve this problem?” And I’ve been able, because I have so much context on the organization and how it runs and all of the things that go into any of the projects, I can suggest ways of solving that problem that other people wouldn’t have come up with that actually make it possible to do a project that wouldn’t have been possible if we’d only thought about the other way.
I think ops is sort of sold as this thing that can be super motivating because you can free up time for all of these other people and then enable more direct work that you care about to get done. But I think that the job itself is actually really exciting and interesting and it gives you a great opportunity to learn and to skill up. So ops has a lot of great feedback loops and a lot of variety as well. So you’re constantly learning new skills, doing different types of tasks and getting to improve how well you do all of those things.
And then you get feedback, you know when your plan worked and you know how effectively you were able to solve that problem and then you can do it better next time. And you also get a lot of autonomy. A lot of the work is really self-directed. So this means a lot of the time you’re working on concrete tasks, so you get a sense of progress, you have a lot of autonomy and freedom to choose what you wanna do and the day to day work contains so many different things that you kind of never get bored. But I think the job itself is really satisfying, not just because you know how much impact you’re having but also because the work itself is really fun and challenging.
One thing that I think is really great about working in ops is that it’s a cause neutral skill set in some sense. I think with the experience and skills that I have now, I could go work in AI, I could work in bio risk, I could work for an organization in global health and there are so many different things that I could do. So I think that ops gives you really a good flexibility and it’s really a great avenue to go down if you’re someone who’s pretty uncertain about how your views might change in the future or think that as you learn more, as EA grows and changes that you might not want to specialize too soon and develop this really highly specialized skill set that only makes sense in some worlds.
I think another thing that people often do prioritize is kind of cool stories. I think when you go into a job interview, if you can tell a story about how you went into an organization and changed things and really improved that organization, that’s gonna get you so much further than saying you just went in and kind of did the job that you were expected to do really well. And I know that now, any startup would be really excited about hiring ops people who’ve worked at EA organizations because they’ve had that breadth and depth of experience in so many different areas and they’ve constantly had to just solve problems on the fly and pick up new skills.
Another thing that I think is a common misconception about working in ops is that you need to be super organized and detail oriented. And I know, I’m certainly not like that. And I think there’s sort of this perception that you need to have a really good GTD system and track all of the different tasks and write everything down and never forget anything. But I think ops actually requires a much deeper problem solving skill set and what you actually need is a lot of creativity and initiative and working memory.
And to succeed at ops, just being kind of generally smart and well motivated will probably get you further than only just being super organized. So I think, I talk to a lot of people who are interested in working in ops and they’ll say to me, “Oh, but I’m not very organized or I’m a bit forgetful,” and they think that that rules them out and so I kind of want people to know that that’s not the only thing that matters. And you can be really effective by just taking initiative and by coming up with creative solutions to problems.