My mother is a retired general-practitioner (family doctor), and still has the BMJ (British Medical Journal) delivered here each week. It’s always a useful contrast to my ‘day-job’ in enterprise-architecture, and every-now-and-then there’s a real jewel of an article there that reflects right back into my everyday work.
This morning was one of those times.
Des Spence writes a regular half-page column in the BMJ, titled ‘From the frontline‘, usually reflecting on the blunt realities of his work as a general-practitioner in Glasgow. Most articles in the BMJ are hidden away behind a paywall on their website, but fortunately Des also republishes his columns on his own weblog, and his article this week, ‘A conspiracy of anonymity‘, strikes right at the heart of much of current enterprise-architecture. His own context is the health-services, of course, but much of it reads as if it was written just for us:
…the themes of medicine are constant in time and geography. They are important but abstract, and completely ignored in medical education: doctoring is about reading people, knowing when to listen and act but also knowing when not to listen and not to act. At its core, doctoring is the willingness and requirement to accept responsibility.
If we think of enterprise-architecture as a discipline whose main responsibility and focus is the health and well-being of our organisations – especially in the longer term – then the analogy here is painfully accurate.
And yes, it gets worse:
Continuity is a broken, forgotten, rusting hulk for simple reasons. … The vast archipelago of new specialties (medical and nursing) comprises small, separate, distant islands with fiercely insular medical tribes. And despite huge expansion in consultant numbers regrettably they seem no more accessible. More resources, paradoxically, have made the problem worse.
Again, no trouble in seeing the analogy for us there. And, as in our own domains, there’s a direct link to the loss of awareness of the need for generalist disciplines to hold everything together:
Generalism has been dismissed as inferior, has been left fatally undermined, and is dying, if not already dead. Anything encountered that is outside the modern telescopic specialist training programmes results in referrals to other specialties, choking the system in needless referrals.
How often do we see this in our own practice, with specialists rarely connecting with other specialists, and no-one left to ‘join the dots’?
More, there are the same broader cultural issues that impact our own domains, too:
But we can’t blame modern medicine because it only reflects modern society, which is risk averse, unable or unwilling to accept uncertainty, and left in a paralysis of indecision.
There’s also a bleak echo of our own challenges around user-experience, customer-journey and social-business, and in getting others in the organisation to understand why such matters are important:
There has been a homeopathic dilution of medical responsibility, and patients are increasingly anonymous and faceless in the NHS [UK National Health Service]. The goal of personalised care is but a delusional myth.
To me, responsibility is the key to all of this: yet how do we support it, or create it, in a culture where the only real driver is evasion of responsibility – the relentless quest to convert as much as possible into a conveniently-invisible Somebody Else’s Problem?
I don’t have any easy answers to any of this. But at least people such as Des Spence are still asking the questions that matter here: and that’s something to hold some hope for the future, I guess?