Tuesday, 1 September 2009

When we adapt do we spread & implement effectively?

The script often spoken and written by people involved in the spread of good practice goes along the lines of "we need to customise the process / protocol / idea so it fits best in our context", or "we need to expect the process / protocol / idea will be customised".

Part of me fully support and understands this. Yet another part of me is questioning what we mean by adaptation. When we use the term is it because:
  • we didn't have the time and/or inclination to discover the important contextual variables and then design with and around these
  • we are so in love with our solution (see earlier post about "inventoritis") that we expect others to copy it as it is, or maybe with just a few small tweaks
  • we are too afraid to work through the adaptation process and how the solution might be adapted because we may discover the desired outcome may not be achieved
  • we can't figure out how another place or team might use the process or idea so we defer to adaptation as the way round this
  • we know the new process will require quite a lot of facilitation and support to make it happen so we use adaptation as a means for engaging others (so they don't think they are adopting someone else's idea) and as a means for garnering implementation support
  • we can spread partly formed ideas and processes, or ones still in their innovative design state

So what is the adapting process? In a foreword by Richard Dawkins in Susan Blackmore's book about memes, is a couple of examples which got me thinking.
  1. Are you expecting a copying process, knowing there will be some natural adaptation. Dawkins uses the example of copying a picture. One person copies a picture, passes to another to copy and so on. After a number of copies the picture may not resemble the original very much. In fact, I suspect some may start to put their own context, thoughts and ideas on the picture, thus rendering it something different both in visual status as well as in meaning.
  2. Do you intend someone to copy instructions? If I am shown how to make a complex origami figure using a set of 30 simple instructions, then I can teach someone else, using the same instructions. That person can then teach someone else and so on. In this case, most of the time, we can posit that after 20 teaching/replications the origami figure would look the same. By focusing on the instructions then someone can even correct a minor slip when they make their copy. However, if once of the instructions gets left out and this omission is replicated then the paper figure will end up an entirely different shape.
So this brings me to issuing clinical guidelines and the expectation of their adoption and use, and sometimes adaptation for local use. Some questions I have are:
  • Do we know what happens when we issue guidelines and say "may them local". To what extent do they match the fidelity of the original in terms of outcome?
  • What happens when one of the guidelines instructions is omitted (accidentally or purposefully)? How much of the original outcome is retained?
If you have any thoughts on this topic of adaptation them please comment or email me.

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