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	<title>Comments on: Practice to be best</title>
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		<title>By: Harold Jarche</title>
		<link>http://www.jarche.com/2010/07/practice-to-be-best/comment-page-1/#comment-204511</link>
		<dc:creator>Harold Jarche</dc:creator>
		<pubDate>Fri, 30 Jul 2010 12:47:10 +0000</pubDate>
		<guid isPermaLink="false">http://www.jarche.com/?p=4173#comment-204511</guid>
		<description>You&#039;re always welcome to comment here again, Ben. It was your comment on being dogmatic that triggered my response to clarify my sense-making process. I don&#039;t see my posts in isolation but neither do I expect anybody to read everything I post. Thanks for engaging, if only for a short while.</description>
		<content:encoded><![CDATA[<p>You&#8217;re always welcome to comment here again, Ben. It was your comment on being dogmatic that triggered my response to clarify my sense-making process. I don&#8217;t see my posts in isolation but neither do I expect anybody to read everything I post. Thanks for engaging, if only for a short while.</p>
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		<title>By: Ben</title>
		<link>http://www.jarche.com/2010/07/practice-to-be-best/comment-page-1/#comment-204507</link>
		<dc:creator>Ben</dc:creator>
		<pubDate>Fri, 30 Jul 2010 12:07:26 +0000</pubDate>
		<guid isPermaLink="false">http://www.jarche.com/?p=4173#comment-204507</guid>
		<description>You make some good points here, Harold, and I&#039;d like to go further with it, but your little footnote disclaimer has me on the ropes. 

I&#039;m not trying to engage in the &quot;nuance,&quot; but rather engage in a conversation with you about what you wrote in this specific post. If that requires me to understand the context of six years&#039; worth of previous posts, comments, and references, I can&#039;t really say it&#039;s worth it for me...especially for something that you describe as &quot;half-baked&quot; &quot;raw materials&quot; written mainly for your own benefit.

Consider me retired from commenting. The entrance fee is too steep.</description>
		<content:encoded><![CDATA[<p>You make some good points here, Harold, and I&#8217;d like to go further with it, but your little footnote disclaimer has me on the ropes. </p>
<p>I&#8217;m not trying to engage in the &#8220;nuance,&#8221; but rather engage in a conversation with you about what you wrote in this specific post. If that requires me to understand the context of six years&#8217; worth of previous posts, comments, and references, I can&#8217;t really say it&#8217;s worth it for me&#8230;especially for something that you describe as &#8220;half-baked&#8221; &#8220;raw materials&#8221; written mainly for your own benefit.</p>
<p>Consider me retired from commenting. The entrance fee is too steep.</p>
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		<title>By: Harold Jarche</title>
		<link>http://www.jarche.com/2010/07/practice-to-be-best/comment-page-1/#comment-204387</link>
		<dc:creator>Harold Jarche</dc:creator>
		<pubDate>Thu, 29 Jul 2010 12:04:45 +0000</pubDate>
		<guid isPermaLink="false">http://www.jarche.com/?p=4173#comment-204387</guid>
		<description>It&#039;s a blog post, nothing more &amp; nothing less*

I&#039;m a big fan of checklists and performance support tools. We used them in the hospital where I worked and I helped develop them for helicopter aircrew. Checklists are good for ERP (easily repeatable processes) especially when time is critical. However, more of our work is doing BRP (barely repeatable processes). 

Best practices for simple environments (there are simple aspects of medicine, like following a safety checklist)

Good practices for complicated environments (rules of thumb, guidelines)

Emergent Practices for complex environments (constantly evolving through use)

Novel Practices for chaotic environments (trying something new or from a different field)

My main concern is that too often we look at successful organizations and just try to copy what they are doing. This is not dogmatic, it&#039;s based on my observations of many organizations over a few decades.

---

* No blog post or article is going to address every angle or every consideration of a complex issue. This blog is mostly for me. These are my half-baked thoughts which I make public in order to share and to learn. This post will probably be edited several times and may become part of a longer article or white paper. What you see here is the raw material. Much of the nuance is in the flow of the conversations here for the past six years. Most posts are within the context of previous posts, their comments and the references.</description>
		<content:encoded><![CDATA[<p>It&#8217;s a blog post, nothing more &amp; nothing less*</p>
<p>I&#8217;m a big fan of checklists and performance support tools. We used them in the hospital where I worked and I helped develop them for helicopter aircrew. Checklists are good for ERP (easily repeatable processes) especially when time is critical. However, more of our work is doing BRP (barely repeatable processes). </p>
<p>Best practices for simple environments (there are simple aspects of medicine, like following a safety checklist)</p>
<p>Good practices for complicated environments (rules of thumb, guidelines)</p>
<p>Emergent Practices for complex environments (constantly evolving through use)</p>
<p>Novel Practices for chaotic environments (trying something new or from a different field)</p>
<p>My main concern is that too often we look at successful organizations and just try to copy what they are doing. This is not dogmatic, it&#8217;s based on my observations of many organizations over a few decades.</p>
<p>&#8212;</p>
<p>* No blog post or article is going to address every angle or every consideration of a complex issue. This blog is mostly for me. These are my half-baked thoughts which I make public in order to share and to learn. This post will probably be edited several times and may become part of a longer article or white paper. What you see here is the raw material. Much of the nuance is in the flow of the conversations here for the past six years. Most posts are within the context of previous posts, their comments and the references.</p>
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		<title>By: Ben</title>
		<link>http://www.jarche.com/2010/07/practice-to-be-best/comment-page-1/#comment-204381</link>
		<dc:creator>Ben</dc:creator>
		<pubDate>Thu, 29 Jul 2010 11:20:05 +0000</pubDate>
		<guid isPermaLink="false">http://www.jarche.com/?p=4173#comment-204381</guid>
		<description>Do you consider surgery to be a &quot;simple task&quot;? Hospitals that enforced use of a standardized 19-item safety checklist saw their patient mortality cut in half (no pun intended) and their rate of complications drop from 11% to 7% (NEJM, JAN2009). Talk to any surgeon, and they&#039;ll tell you that surgery is NOT widget-fastening. Every surgery is different. Yet, a simple checklist drastically improves outcomes.

There are times when it makes sense to re-contextualize, and there are times when it makes more sense to simply adopt someone else&#039;s best practice. 

Pronouncements like &quot;there are no easy answers&quot; and &quot;imitating what others do is not the way to make progress&quot; are dogmatic. 

&lt;i&gt;Sometimes&lt;/i&gt; there is an easy answer--like using a checklist that reinforces practices that you probably thought you were doing all along. &lt;i&gt;Sometimes&lt;/i&gt; imitating others does help an individual make progress--like when a poor performer slavishly mirros the behaviors of his successful co-worker.

Admitting this won&#039;t get you an article in Fast Company, and it probably won&#039;t make a great blog entry...but there it is.</description>
		<content:encoded><![CDATA[<p>Do you consider surgery to be a &#8220;simple task&#8221;? Hospitals that enforced use of a standardized 19-item safety checklist saw their patient mortality cut in half (no pun intended) and their rate of complications drop from 11% to 7% (NEJM, JAN2009). Talk to any surgeon, and they&#8217;ll tell you that surgery is NOT widget-fastening. Every surgery is different. Yet, a simple checklist drastically improves outcomes.</p>
<p>There are times when it makes sense to re-contextualize, and there are times when it makes more sense to simply adopt someone else&#8217;s best practice. </p>
<p>Pronouncements like &#8220;there are no easy answers&#8221; and &#8220;imitating what others do is not the way to make progress&#8221; are dogmatic. </p>
<p><i>Sometimes</i> there is an easy answer&#8211;like using a checklist that reinforces practices that you probably thought you were doing all along. <i>Sometimes</i> imitating others does help an individual make progress&#8211;like when a poor performer slavishly mirros the behaviors of his successful co-worker.</p>
<p>Admitting this won&#8217;t get you an article in Fast Company, and it probably won&#8217;t make a great blog entry&#8230;but there it is.</p>
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		<title>By: Jon Husband</title>
		<link>http://www.jarche.com/2010/07/practice-to-be-best/comment-page-1/#comment-204281</link>
		<dc:creator>Jon Husband</dc:creator>
		<pubDate>Wed, 28 Jul 2010 18:57:26 +0000</pubDate>
		<guid isPermaLink="false">http://www.jarche.com/?p=4173#comment-204281</guid>
		<description>&lt;i&gt;“The bell curve of performance keeps moving up, as long as you disseminate the best deviations across the curve and continue to discover new examples of positive deviance among the next group of best performers.”&lt;/i&gt;

A fundamental and core assumption underneath the theory that has spawned competency models.</description>
		<content:encoded><![CDATA[<p><i>“The bell curve of performance keeps moving up, as long as you disseminate the best deviations across the curve and continue to discover new examples of positive deviance among the next group of best performers.”</i></p>
<p>A fundamental and core assumption underneath the theory that has spawned competency models.</p>
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		<title>By: Harold Jarche</title>
		<link>http://www.jarche.com/2010/07/practice-to-be-best/comment-page-1/#comment-204279</link>
		<dc:creator>Harold Jarche</dc:creator>
		<pubDate>Wed, 28 Jul 2010 18:54:06 +0000</pubDate>
		<guid isPermaLink="false">http://www.jarche.com/?p=4173#comment-204279</guid>
		<description>And I just came across this most interesting article from Fast Company on encouraging positive deviance (best practices?) to effect change. Positive deviance cannot just be copied and applied. It also needs to be done within groups that share attributes and self-identify. Even if positive deviance is effectively disseminated, it will change the goals: &quot;The bell curve of performance keeps moving up, as long as you disseminate the best deviations across the curve and continue to discover new examples of positive deviance among the next group of best performers.&quot;

http://www.fastcompany.com/magazine/41/sternin.html</description>
		<content:encoded><![CDATA[<p>And I just came across this most interesting article from Fast Company on encouraging positive deviance (best practices?) to effect change. Positive deviance cannot just be copied and applied. It also needs to be done within groups that share attributes and self-identify. Even if positive deviance is effectively disseminated, it will change the goals: &#8220;The bell curve of performance keeps moving up, as long as you disseminate the best deviations across the curve and continue to discover new examples of positive deviance among the next group of best performers.&#8221;</p>
<p><a href="http://www.fastcompany.com/magazine/41/sternin.html" rel="nofollow">http://www.fastcompany.com/magazine/41/sternin.html</a></p>
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		<title>By: Harold Jarche</title>
		<link>http://www.jarche.com/2010/07/practice-to-be-best/comment-page-1/#comment-204266</link>
		<dc:creator>Harold Jarche</dc:creator>
		<pubDate>Wed, 28 Jul 2010 17:36:22 +0000</pubDate>
		<guid isPermaLink="false">http://www.jarche.com/?p=4173#comment-204266</guid>
		<description>Thanks, Ben. I never really considered this a training blog, but I digress ;)

The point of the New Yorker article, I believe, is that one cannot only look at what others are doing but must push at the envelope of knowledge &amp; practice. I like this definition by David Shaffer; &quot;&lt;em&gt;A professional is anyone who does work that cannot be standardized easily and who continuously welcomes challenges at the cutting edge of his or her expertise&lt;/em&gt;.&quot; The same goes for professional organizations, in my opinion. Non-standardized work doesn&#039;t tend to best practices, but there is still a need for high expectations of the results of the work.

The radical concept is that Best Practices just don&#039;t cut it because they cannot be copied but must be understood and then adapted, if possible, for a different context. Best Practices only translate directly for simple tasks: http://www.jarche.com/2010/07/managing-in-complexity/</description>
		<content:encoded><![CDATA[<p>Thanks, Ben. I never really considered this a training blog, but I digress <img src='http://www.jarche.com/wp-includes/images/smilies/icon_wink.gif' alt=';)' class='wp-smiley' /> </p>
<p>The point of the New Yorker article, I believe, is that one cannot only look at what others are doing but must push at the envelope of knowledge &amp; practice. I like this definition by David Shaffer; &#8220;<em>A professional is anyone who does work that cannot be standardized easily and who continuously welcomes challenges at the cutting edge of his or her expertise</em>.&#8221; The same goes for professional organizations, in my opinion. Non-standardized work doesn&#8217;t tend to best practices, but there is still a need for high expectations of the results of the work.</p>
<p>The radical concept is that Best Practices just don&#8217;t cut it because they cannot be copied but must be understood and then adapted, if possible, for a different context. Best Practices only translate directly for simple tasks: <a href="http://www.jarche.com/2010/07/managing-in-complexity/" rel="nofollow">http://www.jarche.com/2010/07/managing-in-complexity/</a></p>
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		<title>By: Ben</title>
		<link>http://www.jarche.com/2010/07/practice-to-be-best/comment-page-1/#comment-204259</link>
		<dc:creator>Ben</dc:creator>
		<pubDate>Wed, 28 Jul 2010 16:56:14 +0000</pubDate>
		<guid isPermaLink="false">http://www.jarche.com/?p=4173#comment-204259</guid>
		<description>If the medical world is looking for a model of how to put this into practice, they should should check out the CDOI movement in mental health. It&#039;s been happening there for quite a number of years now.

This kind of transparency and comparison is not really at odds with &quot;best practices,&quot; however. If Hospital A compares itself to Hospital B and discovers that Hospital B is getting better outcomes by doing XYZ process, why in the world WOULDN&#039;T they adopt XYZ process, too?

Not sure why articles on training blogs always seem so either/or, radical, or dogmatic.</description>
		<content:encoded><![CDATA[<p>If the medical world is looking for a model of how to put this into practice, they should should check out the CDOI movement in mental health. It&#8217;s been happening there for quite a number of years now.</p>
<p>This kind of transparency and comparison is not really at odds with &#8220;best practices,&#8221; however. If Hospital A compares itself to Hospital B and discovers that Hospital B is getting better outcomes by doing XYZ process, why in the world WOULDN&#8217;T they adopt XYZ process, too?</p>
<p>Not sure why articles on training blogs always seem so either/or, radical, or dogmatic.</p>
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