All the numbers from the pathology lab are good, the paperwork is complete, and…. the patient is dead.
A US doctor invented a word for this sad phenomenon in health care: “the patient is “euboxic””.
“Eu-” meaning good, as in euphoria and eulogy; “boxic” referring to all the little tick boxes neatly filled in (and no doubt a blackly humorous allusion to the coffin shortly in order.
The truth is that human diagnosis is a complex task, and it can’t be reduced to algorithms in pathology laboratories, even though they make a vital contribution to the task. Pathology testing is a place for routine expertise. Diagnosis is a task for adaptive expertise.
Adaptive expertise is essential in working with complexity. Routine expertise works in contexts where there are stable specifications for the work. Adaptive expertise is required when the problem space has moved “upstream” – it comes before the specifications could even be written. It comes when even the requirements themselves are changing.
“Hatano and Inagaki (1986) distinguish between routine-expertise and adaptive expertise. Routine expertise is mainly developed by constant and repeating requirements whereas adaptive expertise develops especially in the context of changing requirements. According to that differentiation, routine expertise is valuable in order to implement context-specific strategies whereas adaptive expertise represents meta-strategies which transfer knowledge to new situations or generate new knowledge. As a consequence, both types of experience work under different conditions but are equally important.” (1)
Sadly, despite the recognised shift to complexity in human activity systems, too much work is done by those whose only experience is within the conversation and cognition patterns of routine expertise. As a consequence, all over human enterprises, we have euboxic systems: The reports are good, the boxes are ticked, but the system is completely incapable of delivering outcomes.(2)
Facing complexity drives our thinking “upstream”, insisting that thought is given, and shown to be given, to the front end thinking processes that are essential to viable and sustainable systems, and requiring conversational capabilities for competence in those spaces.
McMorland describes adaptive expertise in the context of senior management (where we might expect to find it routinely, but often don’t).
“Levels 4 (General Managers)and 5 (VP’s, CEO’s) are responsible for Adding Value for the Future. Level 4, which is typical of senior executive level in medium to large businesses, requires the holding together of business in the present whilst at the same time building for the future…Level 4 is the most problematic level of work…as it signals a shift away from central operational concerns (maintaining business as is) to managing both continuity and change, including the devising of new means to achieve new ends and letting go of means and ends that no longer serve potential business. When managers are promoted from operational practice to strategic development they need to be made aware of the different complexities Level 4 entails and the inherent tensions of managing continuity and change. CEO’s who complain that their senior staff are not talking a sufficient “whole of business” perspective have to hold themselves responsible for tasking their executives appropriately.” (3)
With high speed change, very plastic organisation arrangements (value chains), and growing complexity, the only constant will become that we know how to navigate conversation spaces – an adaptive competence. Enterprise velocity x complexity x plasticity demand growth in knowledge worker intelligence, span and absorptive capacity. There is a deeper issue – not just tasking, but equipping. Managers’ development to this point has been focused on performance in the business as it is. They need that part of them exercised that can hold both the now and the not yet (or as Wheelwright (1982, 19) calls them, the “what just was” and the “what is just about to be”)(4).
But adaptive capability is no longer sufficient if confined to senior personnel. Bringing conversation into our explicit capability set unlocks growth in adaptive expertise. Garry Hamel is one who has seen that this kind of expertise is not the exclusive province of senior management. Of course, failure there is often acute and catastrophic, while at the levels of the organisation closer to the customer, the disease of excessive specialism is more chronic. It is simply not functional to face the challenges of constant change if your workforce can only handle the conversations of specialism – of learned routines, settled language and fixed meanings.The modern organisation is a tribute to the extensive, systemic enculturation of ineffective ways of being. In “The Future of Management”, Garry Hamel points out that the DNA of management is based on how to control farmhands to do routine work – and it has succeeded at that. The goal was to make them into semi-automatons. In the context of manual work 100 years ago, nothing was exponential – now most things are. Change has changed. Change is as fast as change itself.
Change is taking place so fast and so much that the only thing that can keep up – quite literally – is how we talk together. Because it is in our talking together that we take ideas and possibilities, threats and challenges from the world and make them our own. We fuse the already and the not yet into capability for living well.
(1) Badke Schaub, Petra Strategies of experts in engineering design: between innovation and routine behaviour Journal of Design Research (JDR) Volume 4 – Issue 2 – 2004
(2) If you think this is a bit strong, read Young, Raymond, O’Connor, Paul & Poon, Simon Governance Of Programmes And Portfolios For Strategic Success – Implications From A Study Of The State Of Victoria Thirtieth International Conference on Information Systems, Phoenix 2009 1, AND/OR Blake Dawson Scope for Improvement 2008: A Report on Scoping Practices in Australian construction and infrastructure projects Blake Dawson 2008
(3) Judith McMorland Are you big enough for your job? Is your job big enough for you? Exploring Levels of Work in organisations University of Auckland Business Review Spring 2005 75-83 Emphasis mine The levels she refers to are from a model by Elliot Jaques made popular by Gillian Stamp, advanced by Luc Hoebeke, and used throughout organisations such as the Commonwealth Bank, BHP and Rio Tinto.
(4) Wheelwright, P. (1982/1968). The burning fountain: A study in the language of symbolism. Gloucester: Peter Smith.
Changing the ways people talk to get work done.
New work? New conversation! Change Conversation.