Outsourcing hernia repairs

I've got another anecdote from Atul Gawande. This one is about hernias.  Repairing hernias is one of the simplest procedures in the surgical field.  When you are learning to be a surgeon, you can start doing this during your first year. It takes about an hour and a half to repair a hernia and the recurrence rate is somewhere around ten or fifteen percent, depending on the hospital. It doesn't seem like an area that requires greater efficiencies. It's not an expensive procedure and it's generally quite successful. But there is a hospital near Toronto called the Shouldice Hospital that challenges this conventional viewpoint.

At Shouldice, repairs take somewhere between thirty and forty five minutes and the recurrence rate is approximately one percent. There is no magic knowledge or other breakthrough. They just have a single minded focus on hernia repairs. Each surgeon at Shouldice performs between six and eight hundred repairs a year. This is more than a typical surgeon performs in a lifetime.

This story resonated with me during my visits to various customers over the past couple of years. I've notice that no matter how knowledgeable the customer was, there was always something that they used a consultant for. They especially used consultants for tasks that they didn't perform regularly, like deploying new services or upgrading Exchange. At first this was a little surprising. After all, we put a lot of work into making our products simple to install and it was a little unnerving that no matter how simple it was, there was always a specialist doing it. This was especially surprising given the depth of knowledge of the customers we visited.

The hernia story helps explain it. Most businesses don't install Exchange often enough that they have acquired any particular expertise. It's far more efficient to have a specialist that services a number of customers and installs Exchange on a very regular basis. It doesn't speak to any deficiency on the part of the in-house IT staff, or even to the intelligence of the consultant. It's all about practice. Outsourcing can greatly minimize risk. A ten percent recurrence rate on a hernia repair may not sound all that bad. But surgery is unpleasant enough that I know if I needed a hernia repaired, I would much prefer the one percent rate demonstrated by Shouldice.