Consistency#

In Civilisation and Its Discontents, Freud wrote of an irreducible tension between the individual (seeking freedom for autonomous action) and civilisation (demanding a necessary conformity) (Freud, 1930). Similarly, Greenhalgh has argued that the tension between standardization and contingency can never be resolved, but rather must be actively managed, a task that gets harder as the domain of application gets larger (Greenhalgh, et al., 2009). Thus standardisation cannot be a universal approach to quality and safety, but will always require continual grounding and judgment if it is to be used safely and effectively. (Wears, p. 8)

5 problematic aspects of standardisation (Wears, 2015)#

Lack of specificity#

Standardisation discussions can be "improved by increasing their specificity" in terms of what should be standardised, at what level, along what dimensions, by whom, for what purpose.

Building materials are standardised, but buildings less so, neighbourhoods even less
standardised roads, but not travel paths; grammars but not stories; instruments, notes, and scales, but not music

Some standardisation in medicine has arisen bottom-up, rather than top-down. Highlighting another dimensions on which discussions of standardisation could occur.

Philosophical basis#

inextricably associated with the industrial revolution, Tyalorism and ultimately the rationalism of the Enlightenment
Newtonian-Carteisan views provide the philosophical underpinnings - "the world as complicated, but ultimately decomposable, understandable and linearly predictable domain" (p. 4)
Which doesn't fit with complex, self-organising systems - "comprised of a large number of mutually interacting elements, with multiple enhancing and inhibiting feedback loops; they are open to the environment, and their boundaries are hard to define; they operate far from equilibrium; they are path dependent (i.e. their past is partly responsible for their present behaviours); their structure does not come from a priori designs, and it changes dynamically to adapt to changes in their environments"
the trajectory of CAS cannot be predicted "from fundamental principles and its current conditions"..."thus, overly ambitious efforts to standardise are likely to create disorder, either in the target area or elsewhere in the system"
side effects/unintended consquences are not a feature of reality, but a sign that our understanding of the system is narrow and flawed (Sterman, 2000)
“At its worst, this sort of standardisation becomes the ‘arrogance of design’, a privileging of the ex ante judgment of remote designers over that of the worker situated in a specific context (Bisantz & Wears, 2008).” (Wears, 2015, p. 4)
In some work situations the task is more "about making sense of an uncertain and ambiguous jumble of unfolding phenomena, and in doing so developing contextual judgements, explanations and situated actions that support and help revise shifting goals, than it is about rule-based decisions"

Psychological and organisational comfort#

“Rather than having to deal with the uncomfortable reality of a world full of risk, ambiguity, chance, and disorder, the rationalist model underlying standardisation offers clear, explicable, understandable explanations” (Wears, 2015, p. 5)

Berg (1999) points to no clear benefit from attempts at IT enforced standardisation beyond perceptions of management about the benefit of alignment
"the benefits of standardisation are entirely aesthetic - things look better on paper, whether they actually work better or not"

Non-neutrality#

origins in "rationality" lead to standardisation being "depicted as a technical, politically neutral exercise; one best performed by experts, not involving negotiations, socio-political considerations, and certainly not involveing winners or losers"
in reality standardisation priveleges one view of the world of another, one group over another
restructures of work environment and changing relations between people can create additional negotiation and conflict e.g. elevating the role of manager/technocrats who organise/plan over that of the front-line workers who merely execute instructions (Kanigel, 1997)
making invisible the articulation work of those who fill the gaps between prescriptive standards the messy uncertaintites of real work (Nemeth et al, 2008)

Heterogeneity#

Assumes that heterogeneity and variation are inherently undesirable and should be eliminated/minimised

This is where perhaps my problem with consistent course sites arises. What is it that they aim to eliminate? Students complaining about not being able to find things. Which is an example of poor design. Standarised designs that fail to respond to inherent heterogenity is an example of a design that's not fit for purpose.

The other problem with consistent course sites is the other form of heterogeneity - "change over time"

applied to static manufacturing systems standardisation makes sense...also if applied to task management, but applied to "complex, open, sociotechnical systems composed of multiple mutually influential elements, constantly changing, and evolving over time" is problematic

But to the extent that the clinical problem space is heterogeneous, this assumption clashes with three real world properties of complex systems: the Law of Requisite Variety (Ashby, 1957, 1958) (that every controller of a system must exhibit at least as much variety in behaviour as the system under its control); the principle of equifinality (that there may be many, equally good paths to a goal); and the principle of multifinality (that similar initial conditions may result in dramatically different final states). (p. 6)

Advice for standardisation#

Perrow (1967) and Reason (1997) suggest two dimensions for juding if standardisation maight be helpful or harmful

The number of exceptional cases - the degree to which difference will arise
The difficulty of the search process i.e. how easy/hard is it to understand and solve a problem with analytical reasoning

	Low # exceptional cases	High # of exceptional cases
Poorly understood solutions	Mix of strategies	Discretionary control (e.g. combat operations, crisis management)
Well understood solutions	Standardisation (e.g. assembly line operations, traditional construction )	Mix of strategies

Question Might one way to mix strategies be to have discussions about the dimensions of standardisation? Vary different dimensions, or look for dimensions that can help improve understanding?

e.g. one reason why solutions are poorly understood is due to the paucity of the available tools (e.g. course sites)

References#

Wears, R. L. (2015). Standardisation and Its Discontents. Cognition, Technology & Work (Online), 17(1), 89--94. https://doi.org/10.1007/s10111-014-0299-6