Archive for January, 2006

Questions about edge work

Thursday, January 26th, 2006

by Philip Boxer

The following questions were asked by Larry Hirschhorn about the blog on empowering the edge role, following which are my responses:

Larry: You say that edge work is breaking out almost everywhere. Can you give me an example?

Philip: We worked recently with the members of a clinic providing through-life care to patients with chronic conditions. The hospital managed the clinic’s activities in terms of treatment episodes, and budgeted the clinic according to their annual episode throughput. Because patients stayed with them long term, their budget tended to keep increasing because more patients were referred to them than died or left the area. But their budget couldn’t keep increasing. So instead patient care was rationed, the result being systematic under-use of the treatments available, to the long term detriment of the patients.

Larry: Where does ‘edge’ come into that?

Philip: As part of an acute care system, it made sense to treat the clinic as part of the centralised drive to provide cheap treatments. In these terms, the patients had to fit in with the hospital’s programming to provide the most efficient use of its resources. But the conditions in the clinic needed to be treated on a through-life basis, each course of treatment being designed to fit the particular patient’s condition. This meant the clinic’s (and behind that the hospital’s) resources fitting in with the programming of the patient’s treatment.

Larry: What made the project challenging?

Philip: First of all, although the clinicians had high situational awareness of their patients’ conditions, their ability to synchronise the behaviour of their own and others’ clinics around the needs of the patient were very constrained by the hospital’s internal processes of referral. Secondly, there was no way of holding the clinicians accountable for the way they aligned treatments (and costs) to patients’ conditions. Thirdly, the senior management used fixed budgets as a way of controlling the aggregate performance of clinics, there being no way of flexing them according to the mix of conditions different clinics were being asked to treat.

Larry: And how do you relate these challenges to the failings of bureaucracy?

Philip: Bureaucracy works by taking a big problem and breaking it down into little problems. The assumption is that if you solve all the little problems, the big problem will be solved too. This is called ‘deconfliction’ – each little problem is defined in such a way that it can be solved independently of the other problems. So the clinics with their associated budgets were defined on this basis, and as long as the levels of demand were stable and there had been enough time for patterns of treatment to settle down, things could work okay. This might have been true when both treatments and conditions were simpler, and the medicine less advanced. But it is not true now. The increasingly chronic nature of conditions, combined with the need for treatments aligned to the particular patient, means that treatments have to be adapted to patients and not vice versa. Bureaucracy can’t cope with this.

Larry: So what did you have to do differently?

Philip: There were a number of things. Firstly, we had to alter the way clinicians made referrals to each other so that authority to determine treatments was delegated as close as possible to the edge. Then we had to support the way the clinicians needed to manage treatments in a way that could also hold them accountable for the performance of those treatments. Thirdly, we had to change the way budgets were allocated so that they were based on the mix of patient conditions being treated. And finally, we had to secure funding on the basis of the cumulative cost of securing long term patient health outcomes instead of on the basis of the short term incidence of acute conditions.

Larry: Were you successful?

Philip: We proved that it was much cheaper in the long run to organise the clinic in this way in 6 different hospitals. But to sustain the changes it meant reallocating budgets on a different ‘edge’ logic across clinics. This the larger systems weren’t ready to do.

Larry: Would you say that it created more effective government due to edge work?

Philip: More effective government requires three things: the political will to do things differently, the ability to create value at the point of contact with the citizen/patient, and infrastructures sufficiently agile to make change practicable. We failed on the third count. Our brief was to make the edge work better, not to change the agility of the infrastructure. And I think that is the particular difficulty. To make the edge work better, you have to change the agility of the infrastructure, and the vested interests of the former are very different to those of the latter.

Taking power to the edge by empowering the edge role

Tuesday, January 24th, 2006

by Philip Boxer

An edge role is on a task boundary in which the systems of meaning on either side of the boundary are different: some form of translation is required. The task facing a multi-disciplinary team is often such that its members are in edge roles with respect to the areas of specialism they represent. In such a team what is being but into question across any given edge is the identity of the specialism. The challenge for the individual in this situation can be expressed in terms of taking up such a role within the life of the enterprise. The normal assumption is that, if only the nature of the task itself was sufficiently deeply understood, then ways could be found to reach an accommodation between the differing systems of meaning in the interests of the task as a whole. This is, for me, the implication of identifying the problematics of the ‘mid-game’ with those facing the edge role.

But when the team is the enterprise itself, even if such an accommodation can be found between its members, there is a further challenge: the challenge of the particular nature of the demand being presented by the client. Now the team as a whole is on an edge between the system of meaning implicit in the way they work together, and the system of meaning required to satisfy the demand. So the experts may agree how to treat the patient, but the patient may not survive the long term effects of the treatment – the patient needs to play a different game to the one the experts want to play.

The relationship to demand
Two dimensions are proposed:

  • the first describing the form of the synchronisation of task activities needed to deliver the effect required by the demand. Here the distinction is between the ‘logic’ in terms of which the form of this synchronisation is defined. High situational awareness is needed if the form of synchronisation depends on the nature of the demand.
  • The second dimension is the dynamic relationship required between the timing and logistics of what is done and the demand situation itself. Here the distinction is between whether or not the two are coupled. With coupling comes the need to manage the synchronisation with the situation itself.

So we get the four characterizations of bureaucrat, intelligence analyst, SWAT team and edge worker. But what happens when we look at the way the enterprise is able to sustain such different forms of relationship to demand?

The double diamond
The diamond above, describing the relationship to demand, is the right hand diamond in this diagram. The left-hand diamond describes the way the enterprise sustains relationships to demand. Thus the two diamonds are symmetrical around the central vertical axis, and if some intervention creates a lack of symmetry between the positions on the left and right, then there will need to be some form of process of adjustment to bring them back into alignment. What is on the left side?

The alignment of the infrastructures

  • The first corresponding dimension is the form of responsibility given to the individual for how task activities can be synchronised. The distinction is between doing this through a span-of-control – essentially vertical relationships; or through a span-of-complexity – horizontal relationships. The span-of-control has built into it the means that imply the end, while span-of-complexity has to build means from assumptions about the end.
  • The second dimension is the form of accountability through which those responsible are held to account for the performance of the enterprise in relation to the demand. Here the distinction is between accountability in relation to hierarchy or to situation. From the point of view of hierarchy, means-ends relationships created under its aegis will by definition be transparent (regardless of what others might say were their appropriateness), while those created in response to situation will not be (because they cut across the boundaries defined by the hierarchy, and require horizontal forms of transparency).

So we get the same placing of bureaucrat, intelligence analyst, SWAT team and edge worker. And we can read ‘football player’ for SWAT team. But what about the positioning of the counter-insurgency player and of the chess player?

Who are we trying to talk to?
The chess player I have argued really belongs in the intelligence analyst position because of the underlying bounded nature of the problem space. But need the counter-insurgency position be in the intelligence analyst position?

If we contrast a ‘hearts-and-minds’ (HM) approach to counter-insurgency with a ‘helicopter gunship’ (HG) approach, then the HM counter-insurgency player will be in the edge role position, but the HG approach uses intelligence to find out where the baddies are, and then sends a SWAT force out to zap them… so what would bring someone employing the HG approach to take on the HM problematics facing the edge worker? The answer has to be based on its effectiveness in response to asymmetric forms of threat, although behind that answer there is clearly an issue of how power is used – an ethical issue associated with the long-term effects of using overwhelming force.

Ironically, the architect might be a better metaphor for the edge role position, because the form of the structure being asked for is much more arbitrary, and the challenges of aligning the available infrastructures in creating a satisfying response to the demand very evident. The architect faces the challenge of enabling the enterprise to take up a role in the life of the individual demand.

The elevator conversation
There was an article in the FT today about a study by Gartner surveying 1,400 CIOs:

CIOs had noted a shift from back-office functions towards front-office projects such as improving customer data management, looking to help the business stand out with strategic and innovative use of information, business processes, and intelligence in products and services.

To enable the business to stand out in this way is to enable it to take up edge roles… every business has to work out how to face this challenge in their own particular way.