Seeing through William Blake's eyes |
Isn't this "Begriff" and "Verstand" stuff unnecessarily pedantic? Aren't we lost in the weeds from the practical problem of creating great medical software? I think not, and the reason why is best expressed in one of my favorite quotes, this one from the poet, artist, and visionary William Blake in his "Letter to Revd Dr Trusler," 23 August 1799:
"To the Eyes of a Miser a Guinea is more beautiful than the Sun & and a bag worn with the use of Money has more beautiful proportions than a Vine filled with Grapes. The tree which moves some to tears of joy is in the Eyes of others only a Green thing that stands in the way. Some see Nature all Ridicule and Deformity, and by these I shall not regulate my proportions; and some scarce see Nature at all. But to the Eyes of the Man of Imagination, Nature is Imagination itself. As a man is, So he Sees. As the Eye is formed, such are its Powers."
As a man is, so he sees.
This is our fundamental problem. The reason one person goes about creating a piece of architecture or software through the use of rigid, mechanistic plans that cannot succeed while yet another person goes about creating the very same thing using living processes that successfully produce organic order is that they see the world so differently that they might as well be standing on different planets - more accurately, they might as well exist in different universes that follow different laws of nature.
The dominant problem in the VISTA community for the past fifteen years has been its terrible policy and planning, which has squandered billions of dollars on foredoomed replacement projects when for just ten percent of that cost we could have had a VISTA renaissance. This doesn't just keep happening by accident, and it isn't a conspiracy. The people who keep defying the evidence to repeat over and over the expensive mistakes of the past do so because their failures are inexplicable to them given the way they see the world. The way they see the world, they had to do what they did, and they have to go on doing it over and over. They see no other choice. Their minds automatically rationalize away their own responsibility for their failures and instead scapegoat anyone and anything except the very causes of their failures, thereby leading to the belief that more of the same will yield different results.
It's not an accident, and it's not stupidity at work here in the creation of this colossal waste of taxpayer dollars, in this artificially created stagnation. It is the determined, conscientious work of intelligent people who are making the most prudent plans they can given the way they see the world. Until we understand how and why they see the world the way they do, we stand no chance of stopping the bleeding. They or people like them are going to remain in charge and they are going to go on squandering our precious resources on expensive failures unless and until we give them a new way to see the world that shows them a better way to go about improving our software.
More importantly, unless we understand how and why they keep making the mistakes they do, there's nothing to stop us from repeating their mistakes.
Seeing through Frankenstein's eyes |
For the last fifteen years, the central pair of problems in the VISTA world has been that (1) the people in charge don't understand the software well enough to manage it and (2) the rest of us don't understand the people in charge well enough to communicate with them, to show them how to solve their problem.
We (the people who understand the software) have been just as bull-headed as they (the people in charge of the software) have been. Surely it's time to say "Physician, heal thyself." Isn't fifteen years a long enough string of failures to teach us the error of our ways in how we've sought to solve our two big problems?
We need a new way to communicate with the people in charge. As a man is, so he sees. We need to learn how their eye is formed, in Blake's words. We need to study them, to learn how they see and why, to learn who they are, so we can communicate with them.
Communicate, not express ourselves. Our progressive era of self-esteem and self-expression has not been an unalloyed good. Our focus on self-expression has taught an entire generation of us to be incompetent at communication, because the much extolled self-expression is the opposite of communication. Self-expression is suitable for diaries, but when we're trying to cross the gap between one worldview and another, as is the case in the VISTA world - as is the case in all true acts of communication - we must focus not on ourselves and our opinions but on those we seek to communicate with and their opinions.
True communication is an act of translation into someone else's worldview and language. There is no such thing as communication in the abstract, only communication between specific people. How we communicate an idea to one person must necessarily be different from the way we communicate that same idea to someone else. That takes work, work that mere self-expression does not require, and it takes study, understanding, and the cultivation of taste.
We have grown lazy and prefer to bludgeon each other with our self-expressions, and we have paid for that laziness with a long string of failures to communicate. Anyone who is enjoying this failure should feel free to go on misunderstanding and failing to communicate with those in charge of VISTA. For my part, I'm done with that. It's time to get to know each other real well so we can have a meeting of the minds.
Seeing through Christopher Alexander's eyes |
Blake and Hegel and the Greek philosophers can help us understand and explain why we have been unable to explain these things to those in charge, to the VISTA policy-makers and planners. It is not that they are ignorant or blind that they do what to us looks so foolish. They look at the same software we see, and they look at the same failures we do, but they see differently because they think differently. We see them conducting Frankensteinian experiments on living systems and then blaming their victims for dying. They see a machine made of defectively shaped legos that are warped and fused together, so they're sure that if they can just replace the bad legos with good ones they'll gain the power to improve the software. If we learn this stuff, we can address the second half of the central pair of VISTA problems by learning to translate between these two alien worldviews.
Sure, we can probably never use terms like Verstand and Begriff to help them understand that the very way they think about the software creates most of their problems, leads them unconsciously but unerringly into failures with such a complex, living system. But. We at least privately need some terms by which we can accurately comprehend what are these two very different forms of thinking that lead us to see the same software (and, indeed, everything else) in such different ways, that lead us to such very different kinds of plans and results. And. English has no such terms to clearly and unambiguously differentiate the two modes of thinking at work here that produce such alien worldviews. In the fine old tradition of the English language, a bit of vocabulary theft is in order here to get us started on the problem of being clear with ourselves about our subject, about the nature of our problem.
Seeing through DeMarco and Lister's eyes |
Because what we have here is a failure to communicate. Until we understand each other, we will continue to fail, and I for one am done with that. It's time for more clarity on the nature of that problem so we can solve it and move on to new problems.
1 comment:
I agree. From the vantage of an end-user who uses VistA 30+ hours a week to fulfill my responsibilities as an RN in caring for my patients, I notice areas where the system is very beneficial as well as where it lacks.
Yet I understand that my perspective is shaped only by my own personal experiences. VistA is used by nearly if not all staff in hospitals, which includes not just nursing staff but medical staff, pharmacy, therapists, supportive administrative staff, etc.
There are different protocols in every unit, every facility, every VISN, and so forth. Vista faces problems in being flexible and customizable to each end-user and keeping its integrative features at the same time.
To justify, I suspect that many EHRs of private vendors experience similar problems, which is why there is an oversweeping initiative towards Meaningful Use. I look forward towards the evolution of EHRs and later stages of Meaningful Use which will aid in clinical decisions, collecting and analyzing data, ultimately leading to better patient safety, and hopefully, better workflow for nurses and all healthcare providers. I hope to play a part in this and experience the benefits in practice as well.
-Sheila Parinas
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