Tuesday, January 12, 2016

Apprenticeship vs. Mobbing

Last week, I had a weird experience at a medical clinic in USA. For a full week, I hang out to see various kinds of medical tests performed to isolate symptoms into causes, with a bunch of medical specialties involved in a process. Very unlike what I'd expect, these different specialties collaborated during the week, having discussions and reading a lot of the texts that the other specialties left behind in the systems.

Towards the end of the week, the experience got more weird as the patient I was accompanying decided to invite the general doctor to a mob programming conference in May 2016. What if the doctors would, instead of co-creating a diagnosis, actually collaborate more deeply and even address the patient all at once? Would that change things?

The doctor's response was interesting and reminded me of many of the responses mob programming gets in the software development world. First of all, the doctor pointed out that the medical industry used to do this in the past. They used to have rounds, where all doctors would together meet the patient. The rounds that I've experienced personally from a patient perspective were always within specialty as a means of transferring knowledge, like apprenticeship. Let the juniors see the seniors do the work to mimic behaviors. And let the juniors try doing the work so that seniors are there to correct. The doctor here pointed out that they also have used to have cross-specialty rounds but that was considered inefficient leading to the current ways of working.

During the week, most of the specialty doctors (we saw 6 different specialties) asked exactly the same questions when working on the same problem. We would have loved to give that information once. We would have loved seeing the doctors comments influencing the others perception. And especially on details where they did not agree in the end, it would have been lovely to see how the argument would have developed to the "specialty doctor will have a final say on this" we saw in the end with co-creating the diagnosis.

All of this left me thinking that apprenticeship seems relevantly different than mobbing, even if apprenticeship happens in a group setting. What the doctors used to have was apprenticeship. It was based on a clear senior-junior hierarchy with switch on task -rotation of roles. There would be traditional pairing over strong-style pairing: they would review and monitor what happened over making it happen together.

Also, specialties can easily get in the way. The cool biofeedback techniques the psychologists teaches for managing fears could easily be taught by other specialties. The summaries of overall status could be done by a specialist. It seems that inefficient might mean optimizing for people's time, not the patient throughput to a diagnosis and treatment. It was a great reminder again on the potential harm siloed specialist roles can have, if we are not willing to be flexible with our role boundaries.

All groups programming are not doing mob programming. And while finding the common ground with different individual in groups takes more work for the team to form, a mixed group will produce different results.



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