Meatball surgery and disaster recovery

I love the description of “meatball surgery” in M*A*S*H (the original book, not the saccharine sit-com that came two degrees of separation later). To quote Hawkeye Pierce:

We are not concerned with the ultimate reconstruction of the patient. We are concerned only with getting the kid out of here alive enough for someone else to reconstruct him. Up to a point we are concerned with fingers, hands, arms and legs, but sometimes we deliberately sacrifice a leg in order to save a life, if the other wounds are more important. In fact, now and then we may lose a leg because, if we spent an extra hour trying to save it, another guy in the pre-op ward could die from being operated on too late. Our general attitude around here is that we want to play par surgery. Par is a live patient.

This seems to be a general principle: Processes that have evolved as useful heuristics to satisfice in normal times based on the precautionary principle—the cost of a small delay is small relative to the cost of a mistake whose effect will last for a long time—may need to be replaced by discretion when situations are critical and the costs of delay are become large.

The meatball principle can be applied to administrative processes following a natural disaster like an earthquake. For example, careful consent processes and restrictions on the types of housing development that can occur might make sense in normal times: Once built, an inappropriate dwelling by some value judgement will stand for a long time; it might be worth erring on the side of caution in terms of what types of buildings are approved and in taking time to make a consent decision. After a natural disaster, however, the costs of delay can be huge. There are multiple equilibria in which a city could come back stronger than before or permanently move to a more depressed state, based on self-fulfilling prophesies of investor optimism or pessimism. In that environment, delays in providing sufficient housing to make the city affordable for rebuild workers and others, and delays in providing certainty about what land is subject to compulsory purchase, are not appropriate application of the precautionary principle; they are potentially decisions akin to letting the next patient die while trying to save the first patient’s leg.

Similarly, in normal times, there is some sense to universities having very careful procedures for approving new courses and programmes, even if that means 12 month delays in getting the new programmes started. But a university on the cusp of either a virtuous cycle of increased student enrolments and investment in new programmes and facilities or a vicious cycle of reduced numbers and further retrenchment needs to think in terms of meatball surgery rather than the precautionary principle.

I hope the city and university leaders in Christchurch have read M*A*S*H. We really need a meatball rebuild.