A broad education and common sense – not wanted any more


The tick box training records required by UKAS and CPA (actually much more detailed and complex than tick boxes) show a belief that competence can be assured in this way.  It may be appropriate for relatively simple operations performed by relatively unqualified staff. However, such a system is unhelpful when imposed on highly qualified and experienced staff who must then spend a significant amount of their time maintaining records.   It is also of no use when these staff have the intelligence to cope with situational variations that are outside the scope of Standard Operating Procedures (SOPs).  It is a bureaucrat’s dream to record all the stages of minor technical operations in training records and to have their use prescribed in SOPs.  Such a world view is not able to cope with the variations inevitable in real life.  It attempts to replace professional education and skills with dispensable worker units.

Should you worry?  It’s a bit like a “competence-based framework.”  That’s Lord Darzi’s plan for the delivery of healthcare.

Modernising Medical Careers…Modernising Scientific Careers.  Who wouldn’t want to be modern?

Influenced by Lord Leitch’s plan for the rest of education.

Breaking everything down into “competencies” that any trained person can perform.  So that no-one of high educational and professional standards is needed.

Meanwhile…away from government change programmes…Dr James Willis, a GP, describes the complex mental planning that he went through while travelling to a night visit.  On arrival, he successfully conducted an emergency procedure he had not previously performed. He concludes his reflection thus:

The point of this little story is to show that no amount of training can prepare us for every eventuality in life and that what is needed is a broad education and a free environment in which to use our common sense — the extraordinary ability which we take for granted only because it is common to us all….

The Paradox of Progress

It is terribly important that we realize it. That we can only glimpse the whole that is ‘in there somewhere’ through the tiny window of our conscious attention and that, however much insight we think we have gained, the view that we get through that window will always remain distorted. It is only contact with real life that enables us to maintain a sense of proportion and balance by constantly reminding us of the reality which is hidden by the selectivity of our perceptions.

and goes on to say of keeping track of records:

It’s just not possible. If I did it for any length of time at all I’d have piles of flagged journals everywhere and no time to read them. Like those video taped television programmes we all have gnawing away at our consciences until someone boldly re-records something else, newer and even more un-missable, on top.
In spite of all these discouraging experiences I go on trying this or that system for organizing all the incredibly large number of things I am interested in at the time. But the lesson that has gradually dawned on me over the years is that the size and complexity of our experience is so vast that it will eventually overwhelm any system. And the better we get at organizing ourselves and arranging clever ways of coping, the bigger the eventual problem becomes. All we are doing is putting off the evil day of reckoning when we will throw up our arms, say we can’t cope and decide to do nothing at all.
This is where the specialist comes in — he (or she) is sure he has the answer. He thinks it is obvious that you must restrict the field of interest by specializing.
What a cop-out that is! Just another technical trick. If you don’t include everything in your perception of life then you are not really dealing with life at all, but an artificial model of a tiny aspect of life. A far tinier aspect, what’s more, than you will ever be able to understand, however hard you try. Specialization is certainly not the answer we are looking for.

He understands that the construction of a mental model to simplify the complexities of the real world is an inadequate technical trick to make reality seem manageable.  It is this same error that was made in the concept of a “management system.”  The term and concept are always puzzling to those that begin work on accreditation for the first time because it is an entirely alien approach to getting their work done.  It eliminates the complexity of delivering a real service in order to make it suitable for systematic inspection.

Making the complex even more complex


The ISO management system is bizarre and irrelevant to efficient production and service. It would not have been invented independently of a standards organisation if the employment of inspectors had not been its goal.

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This entry was posted in Bureaucracy, Laboratory medicine, Management, Medicine, Practical problems, Psychology and tagged , , , , , , . Bookmark the permalink.

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