There’s an old (and probably apocryphal) notion that if you try to put a frog in boiling water, they will immediately jump out. But if you put that same frog in a pan of cold water and slowly bring it to a boil, the frog will simply sit there and cook to death. As ugly as that metaphor is, I find it seems to describe traps we get into with automation, in which we willingly adapt to inadequacies in system design, and eventually lose track of the notion that we ever found them inadequate. Indeed, in my experience, pharmacy staffs often struggle to envision doing anything that is more than one or two steps removed from their current process, even when that process drives them crazy. I suspect that this occurs, in part, because we build up a procedural infrastructure of workarounds that we would have to undo if that inadequacy was addressed.
In their book, Idealized Design, authors Ackoff, Magidson and Addison argue that “the way to get the best outcome is to imagine what the idealized solution would be and then work backward to where you are today.” Part of the problem, however, is freeing yourself enough from “what is” to be able to envision “what should be”.
Indeed, in the above link, you can read about how Bell Labs imagined and then created the telephone system we now all enjoy. Now many reading this would go “Bell who?” But when I was growing up, my father worked for “ma Bell” when it was a monopoly that provided telephone service essentially to the entire United States. By the way, there was no cellular service, you had to go through a telephone operator to make a long distance call, and you used a rotary dial to call local telephone numbers. In fact, the telephone company owned all the telephones, and they were hard-wired into your house.
Sending data across a telephone line? Were you crazy? Who would want to do that? No Way!!!
Carrying a personal phone that went with you wherever you went? That was the stuff of science fiction.
And Bell Labs was busily making incremental enhancements on a dialing and switching technology that, at its peak, could not service what is now the current population of the United States, much less the world. Indeed, the rotary dial, which was the pinnacle of communications technology at that time, had been invented in 1898; it had been around for 50 years! So had signal multiplexing, the ability to carry multiple telephone conversations over a wire.
Read this story.
What you will see is that a few frogs realized that the water was getting hot; that the technology they were incrementally improving had reached the point where it was creating as many problems as it solved. And they forced the engineering staff at Bell Labs to look at those new problems, to envision a world with a completely different communications system, and to identify and solve the problems that needed to be solved to get there. More to the point, they realized that they had spent the last 50 years not inventing anything new, but simply improving on a technology that had reached its limits.
Think about what life would be like if this had not happened:
- You would still get your telephone and its land line connection from the phone company
- No caller ID
- No conference calling
- No voice mail
- No speaker phones
- No speed dial
- No address books
- No cell phones, much less smart phones
- No direct dialing to international locations
- No telepresence
- Very likely, a limit on the number of telephone lines that could even exist
All these things, that have become so essential to our lives, were the direct result of the incident described by Ackoff.
So how should this affect those of us who are practitioners of our professions, who care for patients, or who imagine, build, deploy, technology for healthcare? Let me suggest that this requires that we free ourselves from the way things are, at least mentally, and allow ourselves to dream about what could be. Not what we have become accustomed to, but what our practice would be like if we could free ourselves of constraints. I will leave Ackoff’s constraints in place…. Whatever we do cannot violate the laws of physics as we know them, and it must ultimately be economically viable. Other than that….dream! Start with the list of problems that need to be solved and think about what would have to be in place to solve them.
Because as long as we continue to only incrementally improve what we already have, we will eventually find ourselves in the boiling water of systems we have outgrown, with nothing that helps us escape the heat.
What do you think?
Dennis A. Tribble, Pharm.D., FASHP
Daytona Beach, FL
DATdoc@aol.com
(386) 481-8166
The opinions expressed herein are my own, and not necessarily those of my employer or of ASHP
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