Knowledge Binding

Few (if any) contexts are pure Known/Knowable. If a human is involved, there's at least a few Complex threads. Which means that there's usually a trade space involving when to bind Knowledge to Context.

I was reminded of this late last year when I heard an NPR piece on reducing catheter-related infections in the ICU. The traditional approach was to create a more sophisticated (and expensive) technology...that seemed to be more "idiot-proof." The non-traditional approach was to create a process and roles that made the existing technology less risky.

Here's a few observations:

Technology solution - antibiotic-coated catheter

• Complicated point technology
• Intended to reduce risk in a range of contexts
• Expensive; one-size-fits-all "silver bullet"
• Knowledge is statically bound to all potential contexts at the time the the technology is designed and created
• Unanticipated risks are not mitigated
• Infection rate remains unacceptably high

Process/roles solution - checklist to control infection sources, non-traditional roles/responsibilities to increase organizational reliability

• Simple process
• Intended to ensure the Context is low-risk
• Cheap; humans ensure fit between context and technology
• Knowledge is dynamically bound to a specific context at the time of need
• Unanticipated risks are addressed when cather is inserted
• Infection rate drops to near-zero

As technology becomes more sophisticated, agile, and adaptable, the temptation to create sophisticated "silver bullets" increases. And, it gets easier for a designer to be seduced by the illusion that smarter technology can move the Complex into the Known/Knowable.

When you add in the fact that financial incentives tend to be biased toward Technology (i.e., a product or system that's easily monetized) and away from Process/People/Organization, it's not surprising that the doctor in the NPR story had a difficult time getting hospitals to adopt his very successful solution.

Bottom line: Complex threads require late knowledge binding (driven by Context)...which often means humans in/on the loop. And, short-term financial incentives often point away from the most effective solution.

See also the original New Yorker article.