The Professional Service Management Framework (PSMF) explores how doing service management in our organisations involves more than just ITIL processes. Here Richard Horton takes a tangential view of some of the specific skills required within the clinical health research arena. Could these have wider relevance?
When I was 12 and three quarters I started keeping a diary. I was using an office diary where weekdays were split up by ‘lunch’ and ‘evening’. I took my cue from the first of these, and extended it. For the next 3 months I dutifully recorded, not just what I had for lunch but what I had for every meal. Looking back now it is, for me at any rate, a fascinating document, covering as it does school meals, meals at home, and a camping holiday in Germany. Some of what it records, like my enthusiastic demolition of seconds of various dishes, aligns with my memory and won’t surprise anyone who has seen me at a buffet. Elsewhere, as in how quickly school fish led to a dislike of fish in general, it seems to differ, taking longer than I had thought.
Our memories, of course, are fallible, and even when we choose to write things down, how accurately and fairly we record things matters a lot, as does what we deem worthy of recording in the first place. When we record things we don’t necessarily know how our record will be used, and what seemed important or relevant at the time may now seem insignificant, and vice versa. Despite these caveats the imperfect records that diaries offer are likely to add structure, content and accuracy to our memories.
The organisation I work for is part of the fabric of clinical research in this country. In such a world teams seek to improve knowledge about how to treat people effectively. Something more thoughtfully structured and controlled and collaborative is required than, say, a solo doctor’s memory of what potential treatments they might previously have tried with success. Trial and error, if not structured appropriately, is likely to lead to recurring errors.
Does this matter? Well, when dealing with difficult questions like how to treat scurvy, the subject of the original clinical trial, it can be the difference between failure and success.
We may know about scurvy now, but big unanswered questions remain for the clinical research community, like ‘what causes dementia?’ How do we approach such a question? When you don’t understand causes, knowing what data to collect is difficult. Through a careful approach of asking specific questions, gathering data meticulously, structuring trials, analysing, and then being able to split true causes from coincidental happenings, researchers make progress. This painstaking approach can, over time, produce dramatic turnarounds. There are conditions, like certain testicular cancers, which 30 years ago had a terminal diagnosis, but where now there is a success rate in treatment of over 90%. Maybe in 30 years’ time we will be looking back on a similar turnaround with dementia. Well, it’s something to aim for and would have a substantial benefit for individuals and society if achieved.
The scientific method is known for tackling problems by posing appropriate questions and verifying whether hypotheses are correct or not. However, the value of such an approach is not confined to science. It teaches us much about how we can intelligently approach uncertainty in other areas of life. In a world where about 70% of projects are reckoned to fail, my sense is that skills of this kind are underused.
At first sight diaries appear a completely different world. No one sets a question and there is no evaluation of your method or whether you have met any objectives. Any relevance to the world at large, unless you are a politician writing with publication in mind which is a different kettle of fish, is likely to be posthumous. However, probing at what might be important to you, and exploring ways of recording it, seems to me to be laying some foundation stones for the sort of observation, attention to detail, and questioning required in effective problem solving or research. Well, as a diarist, I would say that, wouldn’t I! More generally, space without an agenda to creatively explore how the world works helps us build skills to tackle subsequent specific issues which don’t have a predetermined solution.
I no longer chronicle every meal, but I do still keep a daily diary. And I do now eat fish.
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