billpapa.org Reading (b)log

In this article, Spear proposes the adoption of JIT-like methods in health care. He states that although medical staff are educated and competent, accidents are frequent because of “ambiguities” in the work system. The problem stems partly from the system’s complexity, which creates many opportunities for ambiguity, in terms of both how an individual’s work should be performed and how the individuals should be coordinated into the integrated whole.

How the health care workers react to ambiguities when they encounter them…they tend to work around problems, meeting patient’s immediate needs but not resolving the ambiguities themselves. People “confront the same problem, every day, for years”.

Spear notes that successful companies are able to reflect on the challenges they face and actually produce new knowledge in the process.

The solution proposed:

1. work is designed as a series of ongoing experiments that immediately reveal problems: Spear suggests extremely detailed procedures (you only know something good enough when you are able to articulate it in detail – echoes of Plato)
2. problems are addressed immediately through rapid experimentation: It tries to enforce reflection on practice
3. Solutions are disseminated adaptively through collaborative experiments
4. People at all levels of the organization are taught to become experimentalists

The workarounds typically employed by workers are not systemic in nature: e.g. they ignore their actions’ global vs local consequences, so latent failures remain hidden. But if a facilitator -e.g a staff member to continually monitor and improve practice through small-scale interventions- is used, they can become part of the company’s knowledge. Small experiments work, because they are applied in a small scale: no company-wide organized effort is needed for their deployment (they avoid the effects of Brooks law).

Remove ambiguity by using labels, cards etc., as coordinating artifacts

Spear mentions that when other hospitals tried to adopt the improvements made by the South Side hospital, they didn’t witness improvement because they were different. This is a problem with many “best-practices” approaches: you need to follow the process, not its results (this is one of the issues tackled in the ERP paper).

Spear suggests that great portion of time is spent nursing the system instead of the patients, and that this can be reduced with the techniques he proposes. There is a contradiction in this, since the methods proposed by Spear increase the system relevant workload (write cards, move boxes etc.).

Suggests a move from a normative (prescriptive) toward a descriptive approach (p.90), but ignores that this can lead to a local optimum: sometimes it’s good enough, sometimes not.

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