4 ms·

I think this article raises a lot of good points about the weekend prototype, but I also think there is some merit in the question of “what do all those people

by moksly 5y ago

I think this article raises a lot of good points about the weekend prototype, but I also think there is some merit in the question of “what do all those people do?”. I’ve worked in digitalisation in the public sector of Denmark for quite some time. A few years ago I was part of the group who redefined our national principals for architecture in municipality IT systems. The whole thing is called rammearkitekturen which translates directly into “the framework architecture” and without getting into too much details it was made because we had 98 muniplacities times 300 average IT systems ways or defining what a person was. Which made buying and integrating IT hard. Rammeaekitekturen still hasn’t fixed that, but that’s not what I want to talk about. One of the things to come out of this mindset was how to design an IT system for eldercare. Where there used to be a physical folder with a printed note containing all the “Moksly may attempt to hit you during showers and this requires two caretakers” and so on as well as hand written notes for day to day things, medicine used to come in little sorted bags clearly labelled “MORNING” and so on, and every morning people would get a printed list of their route that was adjusted for coworkers who were off sick and so on, and that was pretty much it. Today we have multiple different billion dollar systems to handle those basic things, and after two years of being used they still can’t handle differences between day and night-shifts or giving call-in temps the correct sorts of data access. Instead of having two planners and a subscription to a pharmacy for the sorted medicine bags, we now employ almost 50 people as full time support staff to operate this system as well as throwing endless amounts of resources after project managers, lean consultants, educators and so on to get this system to work. When polled everything single citizen and caretaking employee replied that the old non-digital systems were better. At no point has anyone asked whether or not it made sense to digitalise this area or if it makes sense to continue trying to implement it. So I do think that it’s sometimes reasonable to wonder just what all those people are doing in some organisation. Because sometimes systems have a way of making themselves important to the organisation without actually being important to the organisation.

shuckles 5y ago
In cases like this, it’s always useful to have an expansive definition of “user”. For example, day to day experiences for caretakers might have degraded under the new patient information system, but maybe it’s now easier to produce charts which bosses want. For better or worse, they are users of the system as well. To whom a change is worthwhile often leads to unexpected beneficiaries with unexpected motivations.
- WesolyKubeczek 5y ago
  So maybe let the caretakers work in peace and have one additional person draw pretty charts out of thin air which would be just as good? I've been working on a product which everybody was convinced had Gantt chart functionality. Said functionality was using the venerable Math.random() top to bottom, with nobody being the wiser.
  - shuckles 5y ago
    Malicious compliance is certainly one approach, but an org which relies on it is probably messing up in a way that will leak to everything else. I never said the desire for reporting was useful, but it is fundamental to how management works in most places today.
NortySpock 5y ago
Thinking back on the overall strategy, would it have been better to "just" digitize, OCR and timestamp the coordinating documents for logging and audit purposes? A "document management system" rather than "an eldercare management system"? That way it's "just" "Pull up the most recent documents relating to or updated for patient Doe, Jane" or "What has changed in the medications prescribed in this district?" The Document Management System would still manage all the PDFs or caretaker notes, but would (eventually) be searchable, and would still support the primary workflow of "I just want to see all the recent documentation for my patient" or "This is caretaker Alex's most recent route assignment document".
- Jtsummers 5y ago
  Right. When I've seen these kinds of efforts they seem to take one of two paths: 1. Specialized, monolithic systems. These try to do everything for everyone and usually end up devolving into the 12-month (or longer) release cycles. "Monolith" doesn't mean monolith vs microservice in this context. Just that the system is trying to be all encompassing. This is the norm. It rarely works well because it massively increases the cost for change (money, personnel, and time) even for what should be minor things (Oh, you need a custom report? We'll get it to you next year.). 2. Generalized, flexible systems. A document management system like you discuss would be one potential solution. These tend to be more data-oriented (sharing a common database or a common set of databases) with potentially custom front ends. The front ends tend to permit flexibility for the user, including generating their own queries and workflows. These usually work out better, but are not that common among mega corporation or government digitization efforts. The former is easier to "sell". You get to manage a massive contract, it looks more productive than it is. The latter tends to be more grassroots, an internal effort. The former is highly visible, the latter is nearly invisible. Related, people tend to overvalue work that appears difficult and undervalue work that appears easy. The second approach tends to make modifications "trivial", so the managers ask, "What are we paying you for?"
tshaddox 5y ago
> I also think there is some merit in the question of “what do all those people do?” There is merit in the question, but I think the answer is less "the core product is a lot more complicated than it seems" and more "a big software company with lots of eyes on it can make even more money by hiring more people to create more products that are ancillary to the core product."

by moksly 5y ago

shuckles 5y ago

In cases like this, it’s always useful to have an expansive definition of “user”. For example, day to day experiences for caretakers might have degraded under the new patient information system, but maybe it’s now easier to produce charts which bosses want. For better or worse, they are users of the system as well. To whom a change is worthwhile often leads to unexpected beneficiaries with unexpected motivations.

WesolyKubeczek 5y ago
So maybe let the caretakers work in peace and have one additional person draw pretty charts out of thin air which would be just as good? I've been working on a product which everybody was convinced had Gantt chart functionality. Said functionality was using the venerable Math.random() top to bottom, with nobody being the wiser.
- shuckles 5y ago
  Malicious compliance is certainly one approach, but an org which relies on it is probably messing up in a way that will leak to everything else. I never said the desire for reporting was useful, but it is fundamental to how management works in most places today.

NortySpock 5y ago

Thinking back on the overall strategy, would it have been better to "just" digitize, OCR and timestamp the coordinating documents for logging and audit purposes? A "document management system" rather than "an eldercare management system"? That way it's "just" "Pull up the most recent documents relating to or updated for patient Doe, Jane" or "What has changed in the medications prescribed in this district?" The Document Management System would still manage all the PDFs or caretaker notes, but would (eventually) be searchable, and would still support the primary workflow of "I just want to see all the recent documentation for my patient" or "This is caretaker Alex's most recent route assignment document".

Jtsummers 5y ago
Right. When I've seen these kinds of efforts they seem to take one of two paths: 1. Specialized, monolithic systems. These try to do everything for everyone and usually end up devolving into the 12-month (or longer) release cycles. "Monolith" doesn't mean monolith vs microservice in this context. Just that the system is trying to be all encompassing. This is the norm. It rarely works well because it massively increases the cost for change (money, personnel, and time) even for what should be minor things (Oh, you need a custom report? We'll get it to you next year.). 2. Generalized, flexible systems. A document management system like you discuss would be one potential solution. These tend to be more data-oriented (sharing a common database or a common set of databases) with potentially custom front ends. The front ends tend to permit flexibility for the user, including generating their own queries and workflows. These usually work out better, but are not that common among mega corporation or government digitization efforts. The former is easier to "sell". You get to manage a massive contract, it looks more productive than it is. The latter tends to be more grassroots, an internal effort. The former is highly visible, the latter is nearly invisible. Related, people tend to overvalue work that appears difficult and undervalue work that appears easy. The second approach tends to make modifications "trivial", so the managers ask, "What are we paying you for?"

tshaddox 5y ago

> I also think there is some merit in the question of “what do all those people do?” There is merit in the question, but I think the answer is less "the core product is a lot more complicated than it seems" and more "a big software company with lots of eyes on it can make even more money by hiring more people to create more products that are ancillary to the core product."