If that sounds like standards spin, consider your car, which implements thousands of standards, covering virtually every one of its parts, from the tires to the radio. And yet competition is relentless to upgrade the basic product ("car") by adding new features, and improving old ones, despite the fact that profit margins on most cars are quite slim.

The reality is that the great majority of standards help create meaningful choices, rather than limit them. True, some standards can restrict choice, and sometimes even in an arbitrary fashion, due to practical or economic reasons. But then again, you've probably never been heartbroken over your inability to buy a 42 watt light bulb (the standard wattages, of course, are 40, 60, 75, and so on).

No, the problem isn’t standards imposed by consensus agreement among those that implement them, but de facto standards imposed by single product or service providers that accumulated the market power to mandate them. When the customer has no choice but to buy, then the vendor or service provider has little incentive to offer the customer any more than the bare minimum it takes to cause a potential customer to part with her cash. Or, as Henry Ford once famously observed when the only reliable, affordable car you could by was his Model T, "You can have any color you want, as long as it’s black." Not long after, when competition increased, every manufacturer – including Ford – offered multiple color choices.

In most cases, de facto standards – like the Model T – eventually lose out. Either competitors meet or beat the price, or the patents expire, or a better technology or idea enters the marketplace. De facto standards that do achieve relative immortality tend to be arbitrary (e.g., the 24 hour day, and weights and measures) or utilitarian, with no commercial advantage to be gained by superseding them with anything different (like the dimensions of light sockets). But even in such cases, the standard must be doing a pretty good job, or even it will eventually be replaced, notwithstanding the huge inertia that may lie behind it.

As a result, it takes highly unusual circumstances for a really, really crummy standard to come into being and persist. But it does happen, and I expect you already know what the absolute worst, most inexcusable, most unconscionable most despicable example of design negligence is.

Can’t think what it is? I speak, of course, of that most detested excuse for a garment, the hospital "jammy."

Anyone that has ever had a physical exam, or spent time in a hospital, has become intimately acquainted with this miserable scrap of fabric, which for reasons unknown is identical and uniform in every examination room, clinic and hospital in the United States. In short, a standard, or more accurately, a standard implementation of a standard. And both the standard itself, as well as its implementation, are examples of what can only be regarded as standards and implementation malpractice, respectively.

Or, perhaps, as examples of pernicious standards degradation. Perhaps, once upon a time, jammies walked the earth (or lay on shelves; whatever) that actually did a competent job. If so, both the standard as well as the implementation certainly deteriorated over time. Through lack of competition and innovation, the jammy eventually degenerated into the sartorial equivalent of the appendix, offering little obvious benefit, but significant potential for unhappiness. 

How could this occur? The answer can be instructive, as it demonstrates why consensus based standards work, and why proprietary, de facto ones usually don’t.

Let’s find out by performing a simple exercise, and develop an appropriate standard that we’ll call People Friendly Jammy 1.0 (PFJ 1.0).

As we all know, a consensus standard should be created through the input, and meet the needs, of all relevant stakeholders (i.e., those that will benefit from, or be affected by, the final standard). So of course we’ll start by stating the requirements the standard should meet from the perspective of the two principle stakeholder groups that will need to interact with implementations of PFJ 1.0: the service provider, and the customer.

• Service provider requirements:  "One size fits all;" inexpensive; easily cleaned; able to render the subject (you) readily accessible for visual and instrumental examination, probing and other indignities.
• Customer requirements:  Easy to understand and put on; warm; capable of covering total body surface area when portion of same is not needed for examination, probing, etc.; capable of preserving human dignity, as compared to rendering the subject ridiculous; capable of providing comfort under stressful conditions; capable of reducing feelings of vulnerability and isolation in an alien environment.

Now let’s do a sanity check: do we see any mutually exclusive requirements above? No? I don’t, either. So we’re good to go!

With this much accomplished, we should now be able to come up with the specific design elements of PFJ 1.0. Just for fun, though, we’ll see how the existing market implementation of the jammy  with we are all too familiar measures up to the standard we create (the existing jammy, of course, conformns to a different standard, which we might reasonably assume to be titled Jammy Piece of Crap 1.0 (JPC 1.0)). To make the effort appropriately scientific, we’ll also evaluate how each element of the existing implementation to both the PFJ 1 and the JPC 1.0 rates against the requirements of both the service provider, on the one hand, and the customer, on the other.  Scoring will be on a scale of 1 – 10 (with 10 being highest). Finally, we’ll underline and place in italics those elements of each standard that can actually be found in current market examples of hospital jammies. Those that have evidently not made their way into the de facto market standard will be found in plain text.

I think we’re all ready, except to give our little thought experiment an appropriate title, which will be: 

 How shall we analyze the results of our exercise? The most important finding is that the standard implementation of the jammy that is in use today scores abysmally in every single design element that is important for the user, even though in most cases there is neither a corresponding benefit, nor an avoided disadvantage, to the service provider to explain this result. 

From this, we can observe the following:

1.   In order for a standard to meet the needs of all, it must first be aware of what those needs may be. This can best be accomplished by allowing all stakeholders to have input into the creation of the standard. 

2. A standard can be flexible, as long as there is competition. Note that the standard above does not require that the customer gets the shaft, although it does permit it. If a patient knew that one hospital had a jammy that met her needs, she would at least express displeasure when she was handed the traditional offensive model by a competing service provider.

3. In the absence of choice, there is no incentive to honor the needs of the customer at all. Medical facilities and service providers do compete fiercely at other levels, and do innovate and compete on price at those levels, in order to steer customers their way. But once the mouse is in the trap, the urge to please plummets. 

4. Lock in (by insurance provider, or through the physician that makes the referral or recommends the facility) is powerful.

5. There is no correlation overall, and indeed rarely even as to any individual element, between a high score for the service provider and a low score for the customer. What is most evident is negligence and disregard for the customer, rather than sacrificing a desired benefit for a customer in order to satisfy a particular need of the service provider. 

What this exercise demonstrates most dramatically is not that the control of a de facto standard will not automatically cause a vendor or service provider to consciously take advantage of its customers, but that it may encourage it to become totally indifferent to its customers opinions and needs. Either way, the vendor-customer relationship has become totally one-sided, with the customer receiving only what the vendor or service provider chooses to offer. The vendor or service provider can take advantage of the power relationship that it enjoys at any time, even to the point of abusing or humilating its customer.

Right now, regular readers might be asking themselves if there is not in fact another product in the marketplace that I might be thinking of that represents an even more egregious and invidious example of how a vendor can exploit a de facto standard to the detriment of its customers. 

Well, you’re right. I bet you can guess what that product is, too.  But just in case, I’ll tell you.

So here it is: Have you ever had to wear one of those blue paper, disposable jammies, with the squared off shoulders, that make you look like a Jack of Hearts in a pixie uniform wearing an apron? 

No?   Well, don’t get me started….

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