Four Problems with Master Plans: (2) Imprecision

Dear Reader,

Yes, after the first criticism this second one doesn't seem fair, but it's true. Life, which isn't a logical syllogism, is filled with seeming contradictions. Here's one: not only are master plans too precise, paradoxically they also aren't precise enough.

Specifically while they're too precise about what the future solutions should look like, they're far too vague about the nature of the problems they're supposed to solve. As a result, even in theory master plans only address some parts of the problem and not others.

This is bad but understandable.

Master plans can't possibly identify, let alone address, the full scope of the problems they're supposed to solve because they're created at the beginning, before any serious effort has been made to solve the problem, and thus before Murphy's Law has had its hundreds of chances to teach us how wrong we are about the full extent of the problem. At the time we write a master plan, we just don't know enough about the problem to get its details clear in our heads, and without those details we can't really solve the problem, only take a clumsy swipe at it.

This is understandable but bad.

How bad?

Sometimes it's inconvenient.

Maybe while planning your day, you fail to pay attention to what you're doing at the moment and lock your keys in the car, thus ruining your plans.

Maybe to save three million dollars you replace a deep, stiff bridge design that lets the wind pass through it with a cheaper, shallower, more flexible one that makes the wind pass over and under it, creating aerodynamic lift so it flutters in the wind, tears itself apart, and collapses into the deeps.

Maybe you overplan your bombing runs by putting precisely the right amount of gas in the planes for them to fly out, bomb their targets, and return, but then they encounter a headwind that makes them burn up extra gas so they drop out of the skies before returning home, forcing the pilots to parachute to safety.

Sometimes it's catastrophic.

Maybe you use an explosive gas for airship buoyancy and then try to control all the many scenarios that could cause it to ignite, only to discover that sooner or later your planning or control slips, killing thirty-six people.

Maybe it seems inconvenient to standardize your fire-hose couplings, so you don't, so when your city catches fire the fire engines from neighboring cities arrive only to find they can't help you, and your city burns to the ground.

Maybe your regulations only require a total lifeboat capacity of 1,178 people, even though your ship can carry 3,547, causing the deaths of 1,517 people.

Details matter.

It is the details of problems that make them problems. Something as small as an O-ring seal can kill you if you get it wrong. Engineering is the discipline where Don't sweat the small stuff is a recipe for disaster (and where . . . and it's all small stuff is criminal negligence).

In medical informatics, more starkly obvious than in much of life, the problems we face seem to shift when we discover their nature is different than we at first thought, and they also actually shift as the nature of medicine and software shift around us. The details of our solutions have to be able to shift along with the problems or we can't solve them.

Master plans prevent that dance of solutions with problems in four ways.

First, they emphasize the big picture over the details, wasting energy on prophecy that should have been spent on understanding the problems better, so the necessary details of the solution are missing or vague.

Second, what details they do specify are shaped by design to create (i.e., to serve) the totality, not by discovery to actually solve the problems, so they tend to be out of sync with the reality of the problems (i.e., wrong).

Third, they rigidly lock in those details, preventing them from moving with the problems as the problems shift, soon making any accurate details outdated and incorrect.

Fourth, the nature and interactions of the problems we aim to solve are far too complex to capture in a plan to begin with, ensuring that no matter how much effort goes into a medical-informatics master plan, its worldview always ends up being a ridiculous cartoon of the situation it is meant to deal with.

Any one of these characteristics would be enough to cripple a master plan. Together, they create irresistible forces that cause all VISTA master plans to converge on the same brief lifecycle of (1) ballyhoo, (2) bogging down, and (3) breakdown. And yet the inevitability of failure evidently can't compete with the intoxicating feeling of control a master plan creates, judging by the relentless parade of VISTA-replacement (or "modernization") boondoggles. It would be tragic if after fifteen years it weren't so drearily risible.

Still, at least we can serve as an object lesson to validate Alexander's point:

Master plans fit the shape of the problems with too little precision, and so they fail.

Yours truly,
Rick

Postscript: And so, Alexander's critique of architectural master plans holds even more true for enterprise-scale medical-informatics than it does for architecture: Thus, as a source of organic order, a master plan is both too precise, and not precise enough. The totality is too precise: the details are not precise enough. It fails because each part hinges on a conception of a "totality," which cannot respond to the inevitable accidents of time and still maintain its order. And it fails because as a result of its rigidity, it cannot afford to guide the details around the buildings which really matter; if drawn in detail, these details would be absurdly rigid.