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Seems ripe for disruption by a large conglomerate which lets tradespeople syndicate with them and verifies they are not A) Crooks or B) Drug addicts. It gives them a certificate of approval and then they can use that to prove to prospective clients they are decent and thus get more work, no different to how any certification regime (that's not been captured) works at the moment.
The disruption is always going to take the form of standardization of items into interoperable and easily swappable units. Custom work, that requires some degree of skill, will always be beyond the ability of large corporations to do all that well/efficiently.
The disruption in HVAC, for example, is going to be the decline of expensive and complicated central AC in favor of cheap and replaceable wall mounted mini-split units that can be installed by a clever homeowner or a cheap handyman. When part of the unit breaks, you replace it with another plug-and-play unit. Central AC requires skill in working with high amperage wiring, running ductwork, installing large and complicated and expensive equipment, and balancing the system across multiple rooms. Mini splits can run on regular 12-2 wire, each room has its own unit and its own thermostat so you don't have to balance or run duct, and each distinct element is relatively cheap and so can be replaced rather than repaired by a specialist.
The more you can turn the process into black boxes that an owner replaces in their entirety, rather than requiring skill, you can remove the need for skilled intermediaries and produce profit for larger corporations that can produce black boxes at scale.
Sure, I agree with that. I'm actually surprised by how many american homes have a central HVAC, the rest of the world already uses wall mounted mini split units everywhere (another benefit is that that you can cool down only certain portions of the house rather than running a massive power guzzler all the time). Plus you can upgrade your system incrementally rather than needing to do a building wide scale change if it turns out that you're not getting enough cooling in a certain part of the structure.
I blame the usual American largesse.
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As others have mentioned, good contractors have enough customers lined up that they don't care.
One thing I've seen done several times is companies guaranteeing a quality standard. Basically, they are eager to tell you everything about what good framing/plumbing/wiring/stuccoing should look like and will either send a second guy with a checklist or let you do it yourself or hire a third party.
Two drawbacks:
I asked for this once and they had no idea what I was talking about.
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I wonder if the right disruptive model here almost goes the other direction: not a clearinghouse for finding tradespeople, but a trusted service you can have "on retainer" effectively to subcontract the work. Ideally, you call 'em up, ask for [task], and they shop various provider options (some perhaps that they use often) with a reasonable expectation of the marketplace, and maybe even for an extra fee can manage the "will arrive sometime between 9:00 and 3:00" part where it's pretty disruptive for folks with full-time not-from-home jobs to let them in and get things done without the usual concerns. Bonus points for being able to make sure the job is done correctly the first time.
Although what I've described sounds a bit like a combination of the network of a general contractor (for larger tasks) and a rental property management company. But I've never heard a sufficiently-glowing review of the latter from a renter to want to consider asking "Hey, I own this house and live here: would you be willing to handle when something breaks?" Does anyone actually do that?
I’ve heard of gated communities, particularly for retirees, that essentially have this for homeowners, where the office will have their company / their guys who both built the homes, did the plumbing etc originally come back to maintain them without the owners needing to do more than call management and pay the bill.
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You might want to look into a home warranty company. Disclaimer- quality is generally not very high.
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Work on a house is just too sporadic for a retainer that would be worth it to a tradesperson to also be worth it to a homeowner. Property management companies have enough work... but also pretty much care only about cost to do the absolute minimum to keep the renters from leaving or suing (depending on the market).
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The good ones have no trouble filling their schedules, there's no incentive for them to join such a system.
If someone advertises you can treat it as signal that they're not good enough to book clients via word of mouth only.
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On a small scale, things like Angie's List exist. I've used them a couple times and was happy.
On a larger scale, my guess is that there is a lot of laundering of immigration status that happens which a large company might not be able to do.
But finally, honest contractors do exist. Both my brother and parents did a complete rebuild with a contractor and were not in any way screwed over. Honest ones may be hard to find, however, since they will get so much positive word of mouth they will quickly have a full slate.
Angie's List, as it once was, hasn't existed for years. It's now basically just an advertising service for contractors.
Yeah, it's called Angi. I've used it twice and both times got services at a reasonable price. If I had bad service, I could have rated the contractor which would have made it less likely for them to get future work. And it also saved me from having to call 50 places for my $200 job that no one would have wanted.
I know this is an internet forum and it's cool to be jaded. But, I don't know, this corporation provided value to me 🤷. I wish there was an Angi for health services.
Their is. Sort of - and they fucking suck.
The industry has essentially landed on patient reviews as the mechanism to do this and you can find all kinds of websites that track this, and certain forms of reimbursement may be partially contingent on patient satisfaction metrics.
The first layer of problems is the usual review issue - most people don't bother to leave a review if they had average care, a small fraction of people who receive great care leave a review, and a lot of people who are mad leave angry reviews, this creates a lack of realistic balance in the reported experience.
The other piece is that what makes for good care isn't usually legible to patients. NPs like to brag about studies where they have higher levels of patient satisfaction and it's often tied to not appropriately saying no to patients or things like unnecessary testing and treatment. People don't like being told "no" or "I don't know" doctors are better at doing that but it pretty uniformly pisses people off. The classic example is telling a patient no when they ask for antibiotics for a viral infection. This is good healthcare but obviously decreases patient satisfaction, and that's not bringing up things like angry patients seeking drugs of abuse and review bombing, or psychiatric patients who are angry because they have poor insight and received good care.
Outside of outpatient clinic medicine things get even trickier. The best hospitalist in the hospital is spending his time not in the room with you running down to pathology and radiology, calling insurance companies or social workers for dispo, teaching students, etc. The worst is sitting in his office playing Sudoko. Both only spend five minutes with you a day, you'll have no way to tell if they are good or not unless you have an avoided near miss or something like that.
I was hospitalized a little while back at my own hospital and was the victim of a pretty severe and unacceptable/easily avoidable medical error. I don't think a non-doctor would have even noticed.
Some other examples - anesthesia.....you'll wake up either way, the horribly wrong outcomes aren't generally the doctor's fault. With good gas you'll have an easier emergence, or if you know exactly what to look for on your anesthesia record you could see you were getting good care. How many people get enough surgeries or have the training to read those tea leaves?
For surgery... a lot of aspects of outcomes are patient and not surgeon dependent (like overall health status, engagement with PT), you don't know if your insides are an avoidable mess afterwards or not. The good surgeon might make your next surgery much much easier but you are unlikely to ever know. Patients will also often jump at the chance to get surgery not realizing when NO surgery is the better outcome. You might be a better doctor for saying no...and get worse reviews.
Exceedingly hard to manage this.
There have been attempts to look at more formal outcomes and this rapidly runs into pretty severe juking stats and perverse incentives.
A classic example is transplant surgeons forcibly keeping patients "alive" to get them to die outside of various thresholds (since that gets reported).
Surgeons will sometimes refuse to operate on risky cases because of the morbidity and mortality outcomes. Some of the best surgeons have the worst outcomes because they'll swing on cases that others won't. Some of the worst surgeons too - they'll swing on cases that they shouldn't.
It's a mess.
I do get asked "how do I find a good doctor then." I don't have good advice for this. In my specialty and my area? I already know who is shit and who isn't and hoard that knowledge like gold. Some related specialties? My specialty further away than I don't know them personally? Sometimes I can guess, but mostly I just have to know someone in that specialty in that region who has the wisdom to be able to determine which of their colleagues are ass.
That is not generalizable.
I agree, patient reviews are clearly a bad indicator. The ideal would be some kind of anonymous ranking of doctors by other doctors, but it’s hard to imagine a feasible system for it.
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Would you mind saying more about the error in question? If not, I totally understand but you've nevertheless piqued my curiosity.
I've bitched about this enough IRL that I will refrain due to opsec.
A good example is NPO status though. Your surgeon says don't eat or drink anything. You are thirsty and hungry. Your nurse has mercy. Surgeons are very conservative with NPO, nurses want to be nice. Patients aren't going to know when "psst have some ice chips" is a good idea and when it isn't.
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Those syndicates put 1000% markups on everything. A conglomerate which can do this will prove unable to restrain its greed.
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