Are you fighting the status quo?

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Five years ago, I had the unfortunate opportunity to witness a septuagenarian crossing a hospital parking lot in front of me go into freefall.

I'd replay the next minute again and again as I tried to make sense of it.

Not the fall itself — the blanket of Florida humidity and sun, his age, the unevenness of the pavement, it was a highly plausible, even probable event. And not the harm, though I won't forget the feeling after I rushed to help him and saw the gravity of his unconscious condition.

But here we were, here he was, lying in front of an emergency room. How awful, but okay, it is a convenient place for this?! He needed help, fast. Easy! I thought. I sprinted back inside to tell the people that deal with this exact sort of thing for a living.

Moments after entering, my head spun. Where am I supposed to go? The admissions desk? Sit down in this chair over here? Bolt down the triage hall and expect to be treated like Dr Carter with a new admission?

My inner monologue was loud and direct: C'mon c'mon, what the hell people! Grab that gurney and let's go!

But on the outside, the world was plodding through a milkshake: "Huh? Hmm ..." Nurses weren't scrambling to help. I was just some strange guy off the street that apparently wanted something ... stat?

I eventually rallied enough consciousness to trigger action and ran back outside to check on the man. At last, through an unnecessary miracle, a stretcher appeared with a couple of nurses who ... honestly, look like they're taking their sweet damn time?!

I trust he got the help he needed. It wasn't my business to know. But my mind badly wanted understand why, for a moment, I felt trapped in one of those alternate universes you see in a movie where your mom no longer recognizes you and it's because you never existed.

Context Creates Meaning

That morning two spheres touched: the ER and the sudden emergency outside. Naively, this was a perfect setup. Emergency Room, meet emergency. All I had to do was put them together!

But how does an ER work? If you don't live in America, let me tell you: you drive up, sit down, and unless you, yes you, the one standing there, are about to die (or are making a sufficiently large mess through an active bleed), you provide a bunch of information (first and foremost insurance-related) and take a seat. "You'll be seen before you die" is the implied promise (you choose to believe).

A healthy sprinter barging through the double doors flagging for help like he runs the place: this is just not how the ER works.

Where should this man be to get help? It began when someone called 911; then the paramedics arrived, placed him on a stretcher, and rolled him into the back of an ambulance. Those medics began taking his vitals, notifying the ER of their impending arrival. When they arrive, the man's gurney smoothly exits the back of the ambulance. Which all occurs in an aptly-named ambulance entrance bay. This takes him directly into the triage area where doctors know that whatever the paramedic says has life-support authority, and they respond.

My attempt, though well-intentioned, violated all of these expectations. The patient wasn't wrapped in those layers and layers of context from scene to ambulance to ER. I was attempting to inject him into a new workflow I was inventing on the fly. I was treating the ER machine like some kind of war tent, where anyone can yell out: "We got another one!" and everyone makes room.

Contrast Creates Value

This contrast between what I expected and what I experienced made it very clear to me where the value was that day, and where it wasn't. It made it clear that the world had arranged itself a certain way — not optimizing for the value of that individual, but for the steady import of the 99.999% of individuals whose emergencies take place in the, well, "right" places.

I have zero illusions that my frantic, erratic behavior that morning did anything more than temporarily disturb the homeostasis. Like a depressed memory foam pillow returning to shape, the hospital worked the case, sighed their own sigh of relief, and forgot.

You're Not Welcome

Whatever you're building is like this. You, your creation, your product, your service: if it's new, it's a new addition to a very large, complex, mostly invisible web of workflows and expectations set in motion and continuing in motion that, frankly, would rather not have to deal with you. Why must you be this way?!

But you're this way because you sense opportunity. That patient, that exception, those deserve better!

Yes, of course they do. But if you want that to exist on anything more than an ad hoc basis (and sometimes even then), you're going to have to fight very hard. Not because of conspiracy (although sometimes that), but because the system as it is today works "good enough" from the inside looking out: "it's not perfect but we have these workarounds." That's true whether you're looking out of the eyes of a single consumer (B2C) or out the windows of an enterprise (B2B).

Your challenge is to bring the outside in. As the saying goes, at first they'll ignore you, but if you persist — if you force them to reckon with this new thing that isn't going away and is causing more problems by us ignoring it than if we figure out how to accept it, you'll win.

The problem you're obsessing over? That's not their problem. But you? Yes, you can become their problem.