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Just recently, I’ve had quite a lot of experience caring for elderly parents. It’s caused me to reflect a lot on the challenge of joined up approaches to problem solving in organisations.

Imagine the scenario. From the family’s perspective, a sick relative is a whole person. They don’t turn into a bag of disconnected bits, just because one part isn’t functioning well. When you care for a whole person, it’s natural to consider how basic needs like eating, drinking, personal safety interact with their medical conditions. Yet, the structure of the support systems actively discourages that sort of joined up thinking. The divisions in the system lead to fragmented judgements that put the patient at risk. Each specialism focuses on a different aspect of the patient needs. Doctors and nurses respond to immediate medical problems, social workers support social care needs, occupational therapists provide mobility aids and equipment for easier living, assisted technology experts provide alarms and fancy gadgetry. Then there are the physiotherapists, podiatrists, pharmacists, and paramedics, moving and handling specialists, mobile oxygen suppliers, meals on wheels and individual carers who are under pressure to care for a whole range of complex conditions that beset the elderly, with only limited knowledge. Lots of care available, but all of them have different aims and objectives, different targets to meet, and different policies to comply with. Most of them seem to have only a superficial connection with one other, and little agreement about what is possible. If you compound that problem by allowing your relative to fall ill away from their home community, then you are in deep trouble! No-one knows who to speak to and procedures prohibit the delivery of service in other locations. So joining up the various procedures and rules between different councils and spending areas becomes nigh on impossible. For example, the rules say care can’t be provided until the nurses and social services have assessed the needs in the patient’s home, but the patient is unsafe to go home until care is in place!

Of course, each of them has the interests of the patient at heart. Yet they system as a whole has more holes that a piece of Swiss cheese!

When the holes line up catastrophes can happen

What has this to do with knowledge work you might ask. Everything, I would argue. Similar scenarios arise in a business context too. If I replace the word patient with client or customer, the words health with well-being or satisfaction, and health services with value chain, we have the same complex problems involving hand over from one area of expertise to another.

It’s not much of a stretch to think of the customer as a whole person and the international business as the organisation dedicated to their well being. The same problems of joining up interests and intent relative to incentives and procedures apply to commercial activity as well as public sector service. Knowledge work is simply people, processes and technology working together to deliver end results. Processes and technology only work well if people apply them appropriately and in concert with one another to solve the real problem, rather than satisfy the narrow targets or singular objectives in their own little niche. The key is in the judgement of the individuals and how effectively people work together and communicate across a complex system that has to adapt to changes in context.

A visualisation of Crossan Lane and Whites 1999 perspective on organisational learning

Holes exist due to poor communication. More holes arise because contradictory targets and conflicting policies constrain flexibility and responsiveness. Further holes occur where processes are incompatible. Human error is unavoidable however tightly one specifies procedures. Perhaps tighter specifications even encourage mistakes, because they detract from the fact that people may care about a meaningful outcome Any of these problems happening in isolation may not be life threatening, but as Professor James Reason argues, when the holes are aligned the consequences for the patient or the customer can be significant, even life threatening. Risk is compounded and catastrophes happen. This is the basis of his analysis of Professor Reason’s many major catastrophes like the Columbia Space disaster, Chernobyl and other major disasters. Recent bank failures may also be in the same league.

The biggest problem seems to be the lack of incentive to focus on the big picture outcome that matters. Professor Reason’s recent book places more emphasis on the Human Contribution, the behaviour of heroes who are able to adapt to context because they are mindful of the consequences of their actions not only for their singular targets and objectives, but also for the more interconnected results of collective action. Processes and procedures can be useful guides, technology can solve many problems but ultimately it is human care and judgement that makes use of knowledge in a way that is truly beneficial for the end user. Surely that sense of being connected to the larger implications of one’s actions and the care for the consequences is what we have to get back into organisational life for knowledge to really work effectively and for organisations in their role as knowledge integrators, to create real value?

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