Humility and Courage

Dear Reader,

VISTA humility requires that when Congress asks us how long something will take, our answer is "I don't know," unless it's something we've done repeatedly and consistently.

For example, we can answer how long it'll take to add a simple new report to a package we know extremely well. Or, if we've already written an interface between the McKesson Series Scheduling package and VISTA and installed it at numerous sites, we're within our rights to report how long it's taken the last five times we installed it and to suggest a similar timeframe.

If, however, we're asked how long it'll take to write an interface between a VISTA package and an external clinical system to keep the two systems in sync, we have to say "I don't know," even if we think we understand the scale of the problem. There's all the difference in the world between visualizing a solution and actually solving the problem that seems to elude most VISTA hardhats and managers alike.

Usually, about the only honest answer to questions about how long a task will take with VISTA is "Longer than either of us thinks." We're guessing about anything we haven't done repeatedly and consistently with VISTA. The moment we peg down a date on a task outside this rather confined circle of experience, we are lying. We have left humility and caution behind in favor of bold hybris, which feels intoxicating, sure, but is fraught with peril.

Why?

Because VISTA is bigger than we think it is. VISTA's ugly facts will sink your beautiful theories. VISTA sneers at your petty delusions of predicting the future. VISTA is filled with surprises.

Because these things are true of medical research, as well. Ask yourself how many times so far the answer to the question "When will we cure cancer?" has been correct. Does the comparison seem unfair? Then you are still underestimating the scale of VISTA. When I told you you were getting it wrong, you thought I was resorting to shallow rhetorical flourishes, but I'm not. From one perspective, VISTA's function is to eventually capture and represent everything we know about medicine in a consistent and logical system of data and programs that can reliably support medical practice. Is the entire field of medicine complex enough to get your attention, to make you even for a moment set aside your genetic predisposition to overconfidence and begin to quail at the scope of it? Imagine trying to sort out and systematize that field to the level of mind-numbingly stringent literalism that a computer requires.

Because medical-software engineering is not as trivial a discipline as building planes that don't crash or rockets that don't blow up on liftoff. They only have to deal with physics and weathering (and human error and politics and economics and the other universal problems). Medicine makes a lot less mathematical sense than physics, and software engineering's much easier to get wrong than materials engineering because of the relative lack of physical constraints, yet computers are vastly less tolerant of sloppiness in specification than human pilots are. Put that all together and you get a messy, difficult, complicated situation.

Because at its best software engineering is more like research and development than like engineering a bridge. The discipline of software engineering, when practiced correctly, is nearly the opposite of the discipline of physical engineering. The omnipotent malleability of software collides with the highly idiosyncratic needs of software users to create vast and shifting uncertainties. Properly practiced, software engineering is designed to be highly adaptive to the ocean of unknowns we have to deal with.

Because nine times out of ten our statement of the problem is wrong. We think we know what we're asking about, but the truth is we've grossly underestimated how much we really need or how many other features are actually involved in what we thought of as a simple, stand-alone feature.

At multiple points in the process of developing anything but the simplest changes, we're going to get checked by reality. Surprises and adjustments creep in. Sometimes it's not until the moment we begin seeing drafts of the "finished" software and realize something's very wrong here, but often the programmers return after just barely beginning the task to report they already need to change the plan because it left out something important. And usually, those two patterns occur over and over (and over and over and over . . .) throughout the development process.

Traditional project management loathes this kind of shifting of the parameters of a task. They call it "feature creep" and blame it on the users and programmers. They believe the way you keep projects on time is to stop feature creep. That's an idiotic position to take, because it leads to delivering the wrong thing on time and actually being proud of that accomplishment. It's an example of how hybris can twist people into the most ridiculous postures, into defending the most indefensible positions.

I believe, practiced properly, feature creep is the key to VISTA's success.

Giving medical practitioners what they actually need rather than the gross caricature we envision at the start of a project is what results in software that doctors and nurses can actually use to improve health care. When you're making a game or a word processor, maybe it's okay to sacrifice features to meet a deadline, but when you're making medical software do you really think it's a clever idea to pressure your programmers to cut corners or to ignore the negative feedback from doctors about early drafts of the software, just so you can meet a date that - let's face it - you had no right to give in the first place, that no matter how you came up with it was in the end a ridiculously arrogant attempt to predict the future?

To sacrifice medical science on the altar of project management is a form of human sacrifice.

There are better ways to manage medical-software projects. There are specialized forms of project management that do not begin with the pretense that R&D can be controlled, that instead harness it like an ecology, like a garden that regularly produces good things on its own schedule so long as it's properly cultivated. In a nutshell, that's precisely the VISTA software lifecycle's approach to project management.

But it all begins with admitting that VISTA development is, in fact, R&D, that it's filled with unknowns and surprises, that, in fact, "we don't know" how long significant projects will take to complete, with only the rarest of exceptions.

So here's the problem with the principle of humility.

Good VISTA-project management begins with recognizing the difference between hybris and humility, a subject that most people think they understand but that the evidence of history soundly proves otherwise. Most people, while engaged in acts of the utmost hybris, feel they're acting in a professional, responsible, and cautious manner.

In the case of VISTA managers, this is often because the political pressure they endure from Congress makes them feel small and powerless, afraid for their careers and for the future of VISTA. It is while in this mindset that the worst acts of hybris take place.

It can be very confusing, so I'll make it clear.

You should be more afraid of VISTA than you are of the President of the United States himself. If POTUS demands you tell him how long it'll take to replace the VISTA Laboratory package with a modern, off-the-shelf or custom-built proprietary solution, humility requires you to refuse to take the bait. Humility requires you to say the following:

"Mr. President, I don't know, and neither does anyone else. Most software projects fail either partly or completely, and big ones fail most of all. Replacing VISTA Laboratory's on the far end of big. Anyone who tells you such an undertaking's likely to succeed let alone when is ignorant or lying and probably both. I advise against it, Mr. President."

If you couldn't give this answer, if it seems arrogant and dangerous, it's because you haven't yet really come to terms with the degree of humility VISTA management demands of you. You're still afraid of the wrong things.

You still think angering powerful people or institutions is the worst thing that could happen to you. You are so wrong. POTUS is merely an extremely powerful man. He can only bring the human world against you if you cross him. (Besides, you never know, the President might prefer people who tell him the truth).

If to avoid disappointing him or any other man you go up against the laws of information science, it's the cosmos itself that'll grind you down. The laws of information science are as implacable as the laws of physics and far less well understood.

You should be humble. You should know your place. The health of patients cared for by the hospitals, clinics, and offices that use VISTA depend upon you to respect and fear the seriousness of your work. They need you to protect them from your hybris, no matter how the mighty incite you to it.

Managing VISTA requires humility; and, in the human world, humility requires courage.

Yours truly,
Rick