Crafting the Future of Medicine
Explore how the history of craftsmanship can inform and inspire positive change in modern medicine.
This blog is based on topics covered in Episode 2: Demystifying Organizational Behavior in Healthcare, with Professor Amy Edmondson.
If you haven’t listened to it yet, check it out on Apple, Spotify, Substack or wherever you get your podcasts.
A Brief History of Crafts.
Throughout every civilisation, humans have applied their collective knowledge, culture and technology to create1. This creation process required the application of special skills is described as a craft2.
Crafts were typically handmade, learned via apprenticeships, had protected specialist knowledge and worked at a limited scale. Over time crafts became highly sought-after, expensive, and venerated. These features morphed skilled workers into occupations and later artists.
Early healing practices followed a similar journey, often wrapped up in supernatural and religious understandings. While modest progress was made in some areas of healing, it wasn’t until the paradigm shift of the scientific method in the 19th century, that our understanding of healing became closer to the medicine we know today3.
Upon completing training in a craft, apprentices would become Journeymen and leave the area to establish their own practices. Endowed with a title and unique set of skills, these individuals held a special place in communities, allowing them to ply their profession via an implicit social licence.
As the numbers grew, guilds sprang up as a way to oversee and protect the reputation of these trades. These were the earliest professional associations.
A Radical Shift.
The Industrial Revolution brought about significant changes to crafts. The introduction of new machines and manufacturing methods drastically enhanced the scale, quality, and accessibility of products, while lowering the cost too. While this was often at the expense of individual workers, the commodification of tasks offered up new ideas and approaches to our understanding of work.
At the turn of the century, influential thinkers like Fredric Taylor and William E. Deming furthered our understanding through various management theories. Taylor (Taylorism) applied scientific thinking to labor productivity, an approach which supported the success of Henry Ford’s “Model T”4. Deming kickstarted the quality movement and went on to support the post-World War II economic boom in Japan and the US.
Simultaneously, other technological and geopolitical factors created new professionals and industries - ripe for new approaches to work. Mere decades after the first aeroplane flew, World War II saw the necessity of transforming thousands of untrained civilians into combat-ready pilots through the use of standardised training, procedures and checklists. Safety-critical industries such as nuclear power plants also emerged benefiting from these ideas, resulting in the particular features described as High-Reliability Organisations5.
A Unique Path.
Healthcare did not follow the same trajectory as other crafts.
This divergence is often put down to the complexity of being at the intersection of human biology, pathology, population health, ethics, culture, technology and politics. While this is reasonable, it is worth considering other factors that have influenced the ultimate direction of medicine.
Professional Blind Spots.
In the 20th century, most medical education primarily focused on understanding the body as a purely biological system. Emphasis was on anatomy, physiology, pathology and pharmacology. The goal was to create autonomous technical experts capable of making biomedical decisions.
This worldview fossilised through highly competitive and hierarchical work environments. It was assumed that this would enhance decision-making under pressure, or at the very least, be an informal right of passage.
These factors created a strong ingroup identity amongst practitioners. As a result, parallel hierarchies are formed within organizations and loyalty to the professional body over that of the organization that hired them. Subgroup identities created additional layers of status and culture.
“A lot of professionals don’t think of themselves as having a boss who guides their activity…often it’s not managerial hierarchy but professional hierarchy”
— Professor Amy Edmondson
Tug of War.
Due to the specialised nature of any professionals’ skills, holding them accountable for their actions and outputs can be challenging6. This is exacerbated by the relatively independent way in which skills are deployed, and the, at times, bespoke care given to patients in the grey areas of clinical knowledge.
For example, as a non-expert, if I were asked to assess a bridge built by an Engineer, I would have to rely on standards and trust independent advice. This would mean proxies for quality and safety would be used, rather than my own requisite knowledge of that field. The same could be said for an Administrator holding me accountable for my care practising doctor, relying on quality and throughput measures as a proxi measure of performance.
Professional bodies and Universities have also expanded to maintain standards of quality and safety. In doing so they have become embedded in social and political structures, formalising their influence and power. While this helps the experts ‘police’ the experts, it also offers the risk of deepening blindspots and innovation inertia7.
From an organizational perspective, addressing the challenge of accountability necessitates administrative mechanisms of policies and procedures. Clinicians are seen as too expensive to not be on the frontline, however, this siloing between administration and healthcare creates friction when goals can be at odds. This impacts professionals’ satisfaction as their sense of autonomy, and mastery is challenged, straining collaborative efforts between disciplines.
A Step forward.
Thankfully, healthcare has come in leaps in bounds from the last century, kindly helped by sanitation, immunisation, anaesthesia, and many other efforts. Medical education has broadened its understanding to recognise people as multidimensional in a holistic bio-psycho-social worldview. Healthcare has become deeper by starting to embrace concepts of Social Determinants of Health and Equity, which aims to improve the drivers of well-being and fairness.
However, given the multitude of crises facing healthcare today, we can’t be complacent.
Stubbornly high Quality and Safety issues from Iatrogenic harm (harm caused by healthcare).8
Challenges with Doctors using evidence-based guidelines.9
Workforce crises deepened by professional protection and institutional friction.10
This is why new lenses are essential. By expanding our perspectives through fields such as Organisational Behavior, History and Anthropology - we can shine a fresh light on both age-old challenges and emerging opportunities.
This doesn’t mean a sharp turn into depersonalised conveyor belt medicine or compromising values. But it does mean letting go of some power, learning from others and taking calculated risks.
Let’s pave the way to collectively dream bigger, free of the constraints of our own professional history and cultural biases. To achieve this, we must be courageous and humble in our introspection - and curious in our invitations to collaborate.
“It’s hard to learn when you already know, and you’ve been trained to know”
— Professor Amy Edmondson
https://www.worldhistory.org/crafts/
https://www.merriam-webster.com/dictionary/craft
https://www.britannica.com/science/history-of-medicine
Scientific Management Theory and the Ford Motor Company. The Saylor Foundation. https://resources.saylor.org/wwwresources/archived/site/wp-content/uploads/2013/08/Saylor.orgs-Scientific-Management-Theory-and-the-Ford-Motor-Company.pdf
Gaba D. 2000. “Structural and Organizational Issues in Patient Safety: A Comparison of Health Care to other High-Hazard Industries.” California Management Review.
Structure in Fives - Designing Effective Organizations by Henry Mintzberg.
What is a Professional Service Firm by Andrew von Nordenflycht.
To Err Is Human: Building a Safer Health System. Institute of Medicine. 1999
Hayward RSA. Clinical practice guidelines on trial. CMAJ. 1997;156:1725-1727
S Nancarrow. 2005 “Dynamic professional boundaries in the healthcare workforce”. Sociology of Health and Illness.
A very well put together piece to read over a morning coffee. Thanks