Standardisation and its discontents

Summary and thoughts of

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

Problems with standardisation 1. Lack of specificity 2. Philosophical basis 3. Psychological and organisational comfort 4. Non-neutrality 5. Heterogeneity

Notes

Annotations(4/27/2022, 12:23:14 PM)

“Efforts to improve the quality, safety, and efficiency of complex work often call for increasing standardisation of tools, supplies, and procedures as a fundamental strategy (Berwick, 1991; Berwick, Godfrey, & Roessner, 1990; Smith, 2009)” (Wears, 2015, p. 1)

“Standardisation, in this view, is seen as the natural outcome of the Enlightenment, producing order, reason, and reproducibility in care; a technical solution to the problem of complexity that could only be opposed by the irrational, perverse, or deluded.” (Wears, 2015, p. 2)

“Standardisation fits nicely with other elements of the ‘program of technical rationality’ such as practice guidelines and evidence-based medicine and so is synergistic with many other current influences on healthcare (Timmermans & Berg, 2003).” (Wears, 2015, p. 2)

“Standardisation promotes routinisation, which enables organisations to exploit their accumulated knowledge, thus increasing process efficiency (and to some extent, personal efficiency since actors following standardised procedures may not have to acquire the knowledge that underpins those procedures)” (Wears, 2015, p. 3) But at what level does standardisation happens. e.g. in L&T we standardise on the LMS, but the LMS by itself is too low level a technology to be overly useful. It has to be orchestrated with other technologies (including pedagogy) to be useful. Perhaps it's not the LMS that needs to be standardised but the methods used to create and share orchestrations(assemblages)

“Yet at the same time, this routinisation presents a risk: when organisations are guided by old knowledge, they do not create new knowledge, unless special (and by definition, inefficient) efforts are made to understand gaps between standardised processes and the context in which they are deployed (Hunte, 2010).” (Wears, 2015, p. 3)

“Many calls for standardisation in health care lack specificity and have an almost magical, “wishful thinking” quality (see Section 2.3), as if standardisation were some universal good in itself.” (Wears, 2015, p. 3) Perhaps touching on the reusability paradox?

“Discussions of standardisation could be improved by increasing their specificity in all these areas.” (Wears, 2015, p. 3)

“We have standardised roads, but not standardised travel paths; standardised grammars but not standardised stories, standardized instruments, notes and scales, but not standardised music” (Wears, 2015, p. 3)

“Thus, by limiting one’s vision only to the dimension of data, the standardisation already present is missed” (Wears, 2015, p. 4)

“This is exacerbated by the problem that this standardisation tends to have arisen “bottom-up”, organically and emergently from the work context, rather than being engineered “top down” by managers” (Wears, 2015, p. 4)

“Standardisation is inextricably associated with the industrial revolution, Taylorism and ultimately the rationalism of the Enlightenment (Berg, 1997b).” (Wears, 2015, p. 4)

“Its philosophical underpinnings in a Newtonian-Cartesian understanding of the world as a complicated, but ultimately decomposable, understandable and linearly predictable domain are seldom examined by its proponents, who generally show little awareness of even the possibility of other philosophical stances (Dekker, 2010; Dekker, et al., 2011; Dekker & Nyce, 2012; Dekker, Nyce, van Winsen, & Henriqson, 2010; Kneebone, 2002; Wears & Kneebone, 2012; Xiao & Vicente, 2000)” (Wears, 2015, p. 4)

“Clinical work systems have many of the characteristics of complex, self-organizing systems: they are 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 (ie, their past is partly responsible for their present behaviour); their structure does not come from a priori designs, and it changes dynamically to adapt to changes in their environments (Cilliers, 1998)” (Wears, 2015, p. 4)

“it is important to note that “side effects are not a feature of reality, but a sign that our understanding of the system is narrow and flawed” (Sterman, 2000” (Wears, 2015, p. 4)

“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)

“It is about phronēsis rather than techne (Greenhalgh & Wong, 2011; Hunte, 2010); practice rather than prescription.” (Wears, 2015, p. 4)

“Thus at least some of the resistance of frontline workers to standardisation is explicable, because the” (Wears, 2015, p. 4)

“models of work inscribed in standardised routines clash to strongly with their actual work” (Wears, 2015, p. 5) Getting at the potential value of lightweight development that emerges out of contextual needs and response to local requirements.

“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)

“; the linearizing orderliness of standardization provides a bulwark against the unpleasant realities, and holds forth the reassuring prospect of control (Dekker, Nyce, & Myers, 2012).” (Wears, 2015, p. 5)

“The artefacts are not occasioned to afford the emergence of new tasks, but to ’standardize’ already existing ones. They are not allowed to potentialize anything: in a misplaced equation of ’standardization’ with ’quality’” (Wears, 2015, p. 5)

“Given its roots in Taylorism and the rationalism of the Enlightenment, it is not surprising that standardisation often depicted as a technical, politically neutral exercise; one best performed by experts, not involving negotiations, socio-political considerations, and certainly not involving winners or losers.” (Wears, 2015, p. 5)

“standardisation efforts are not neutral activities; they privilege one view of the world over another and so often one group over another.” (Wears, 2015, p. 5)

“For example, standardisation tends to elevate the role of the managers and technocrats, who organize and plan the work, over that of front-line workers, who merely execute their instructions (Kanigel, 1997)” (Wears, 2015, p. 6)

“It makes invisible the articulation work of those who fill the gaps between prescriptive standards and the messy uncertainties of real work (Nemeth, Wears, Woods, Hollnagel, & Cook, 2008).” (Wears, 2015, p. 6)

“Finally, standardisation assumes that heterogeneity and variation are inherently undesirable properties that should be eliminated, or at the least, nuisances to be minimized.” (Wears, 2015, p. 6)

“the law-of-requisite-variety 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)” (Wears, 2015, p. 6)

“In health care settings, standardisation presumes that average results will be equally obtainable by everyone despite individual differences, but this is hardly ever the case” (Wears, 2015, p. 6)

“Finally, there is another form of heterogeneity – change over time – that poses a peculiar challenge to standardisation efforts.” (Wears, 2015, p. 6)

“Just as unthinking application of standardisation as an improvement strategy results in the sort of problems outlined above, fairness demands that we admit that unthinking opposition to standardisation raises issues of its own” (Wears, 2015, p. 6)

“Claims of special knowledge and corresponding immunity to standardisation can be self-interested.” (Wears, 2015, p. 6)

“For example, situations in which exceptional cases are commonplace and in which solutions are poorly understood or identifiable via analysis are poor candidates for standardisation, and are best left to discretionary control.” (Wears, 2015, p. 7)