Tuesday, 18 March 2008

How do we know that what gets spread is of value?

I thought I was being radical in my last book, "Undressing the elephant; why good practice doesn't spread in healthcare" (2007) www.undressingtheelephant.co.uk when I wrote about the problem of the idea bias. Of course Everett Rogers and others have researched the issue over many years. I tried to be a bit more in your face when I wrote my chapter, challenging how egos, organisational politics and indeed, governmental Politics all let to inappropriate and questoionably poor value practices being implemented.

I'm still worrying.

I came across an organisation where a team leader proudly shared that his teams "best" practice in a safety issue had spread "virally" to all wards round his hospital. So I asked him some questions. I leave you to imagine some of the conversation we had.

How do you know it was "best" practice?
If it was proven as best for you, how did others who adopted it, know it was best for them?
How will they continue to know it is the best practice?
If it is not the best practice for some wards, then what should they be doing?
How can you use the dynamics of how this spread, to spread what you would prefer to have spread?
What really matters - the spread of the practice, or the improvement of results?

We retired for top up of coffee and both agreed that there is something very scary about self-organising systems, though perhaps not quite as scary as when one person tries to impose their value laden idea on a system that opposes it.

(c) 2008, Sarah Fraser

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