Enter the CCG on wall washing and sex

How do you wash a wall?

Most of us get a bucket of hot water and detergent, dip a cloth in it, and start scrubbing. When the rag becomes too dry, we rinse it out in the bucket, then continue to clean the wall.

After a time, the water becomes too dirty to use, so we empty the bucket and fill it up again with clean soapy water.

But that isn’t the most efficient way. The secret is to use two buckets – one of soapy water and the other empty.

Dip the cloth into the soapy water, and then start cleaning the wall. When the rag is dirty and/or needs recharging, dip it gently (don’t stir!) into the bucket of clean water.

Then remove it and then wring it out into the empty bucket to get rid of the dirt. Now dip the rag into the clean water again, and continue washing the wall.

In this way, there is minimal transfer of dirt from the cloth to the soapy water. The progressive reintroduction of dirt onto the wall is minimised and you won’t need to replace your bucket of soapy water half way through the task.

I discovered this in Don Aslett’s 1980’s book ‘Is there life after housework?’

In it he also pointed out — crucially — that know-how about cleaning is typically passed almost solely from parent to child: typically, house cleaning isn’t performed communally.

As a result, new ideas on cleaning don’t spread that quickly. Have you ever heard of the two-bucket technique (assuming you haven’t read Aslett’s book)?

Communicating information from senior to junior in this way is a bit like asexual reproduction: there’s no input of external information into the gene pool. Consequently new ideas (even good ones) develop and spread only slowly: there’s very little evolution.

The problem of isolation

Whenever we practice any skill in isolation we’re always at risk of stagnation of knowledge: failing to spot new opportunities, failing to develop or introduce new techniques, and — perhaps worst of all — failing to recognise our bad habits.

Computing knowledge can be like this. We may think we share our abilities — with our colleagues in the practice or the office perhaps — but do we really learn all that much from those around us?

If no-one locally uses Excel other than as a database (yeuk!), will the techniques and tricks that might solve your next problem simply remain unknown to you?

Bearing in mind the complexity of most applications it’s no wonder if each of us learns only a small percentage of their features.

But there’s worse to come — with no-one in our immediate group to show us a better way, we may have no concept of how limited our knowledge actually is.

This also applies to knowledge of alternative programs — or that they even exist. Have you come across Doodle for arranging meetings, Wrike for organising group work, Alfresco for document sharing….?

It’s amazing how many applications there are, and how few of them each of us knows. Yet this is what happens when we only acquire expertise locally, in isolation. Again, this is just like asexual cell division — there’s no enlargement of the gene pool.

The antidote is a bit of sexual reproduction… if you see what I mean. Arrange meetings outside the office!

The benefits of cross-fertilisation apply equally to the spreading of information about washing walls, the development of new varieties of plants, or the better use of IT.

Cross-fertilisation creates evolution

I’ve been thinking about this because currently I’m helping design a national IT conference.

This is always an interesting experience: inevitably I get confronted by new ways of using the software, including ideas and areas I may well never have encountered before.

Sometimes this is because, as a GP, I don’t use areas of the software intended for specialised use — say, by hospices or prisons.

In other cases it’s because I’ve simply not come across a particular way of using the application that people in other parts of the country or other organisations have adopted almost as a routine. It’s almost like discovering a regional accent in computing!

Dealing with this is the whole point of a conference: to share ideas — to discover that helpful feature, setting or program which solves a problem you didn’t even realise you had; or to learn an esoteric feature of a common application that solves exactly the problem you are encountering. (Did you realise that you can drag and drop cells in Excel? I didn’t, until ten days ago.)

It’s often said that the main benefit of a conference isn’t the lectures, but everything that goes on in the coffee breaks: the networking, the casual conversations, the chance meetings. That’s one of the reasons why in planning the conference we’ve spent some time thinking around ways to maximise these random interactions.

But there’s a frustrating side to this as well: dealing with those (and there are always some) who are convinced that they won’t benefit much from other people’s insight and knowledge.  In IT we all have Donald Rumsfeld’s ‘unknown unknowns’ — and sometimes these can be extensive.

Little things matter

Although much of my clinical commissioning group informatics work relates to ‘seeing the big picture’, the little things can sometimes play just as important a part: passing on good habits and tips, and helping to get rid of bad ones. 

Sometimes, small changes can make a bigger difference across the entire unit than big ones: my favourite example is that simply installing an electronic call-in board may save practices an hour a week per clinician.

Indeed, it’s amazing just how much more efficient your work can become – and how much less stressful – just by learning some neat tweaks you’d never previously come across.

That might be brought to you by another delegate (not even a lecturer) whom you’d never met before — but who nevertheless has discovered something simple but special; something that could do with spreading more widely; something that ‘widens the gene pool’; something that triggers evolution — or even a revolution.

And that’s the whole point of conferences, user groups, journals and websites — to put us in greater touch with each other, and to help disseminate information that we didn’t know we didn’t know.

Funny, that word ‘disseminate’:  its root word is ‘semen’… so we’re back to sexual reproduction again. ‘The Joy of IT’… who’d have believed it?

Dr John Lockley

Dr John Lockley is clinical lead for informatics at Bedfordshire Clinical Commissioning Group and a part-time GP.