Further up the ladder of inference

15 02 2009

I’m grateful for the interest in this blog. The hit count has now passed 2000 as I record my learning journey into Clinical Leadership through Action Research. One of the posts that has received the most hits has been on The Ladder of Inference and I intend to further explore that as a necessary part of my Thesis on the “Interaction between Clinicians and Medical Management.”










What did you see?

Anything else other than a simple description?

The Ladder of Inference, originally described by Agyris and further developed by Senge in the book The Fifth Discipline Fieldbook looks into our perception of the world. From the information provided we select pieces of data. Upon this  assumptions are made and then conclusions are drawn. These are then filtered according to beliefs and understandings of our world and ultimately actions are then taken. Diagram here.

Going back to the photograph provided I would expect most people would recognise a sheep. Was it a happy sheep? Did the straw make you feel comfortable about the sheep’s well-being? How about the backdrop of bricks? Is that her pen or even the slaughterhouse? Did you perhaps recognise the image as one of photos that changed the world? If you now recognise “Dolly the Sheep,” does that change how you feel about the image and perhaps how Dolly was “conceived” and even your feelings about how long she survived and ultimately died?

Of course it does. That is the ladder of inference.  It affects every single piece of information and interaction we have and we must be aware how our perceptions change. Going back to the sheep, do you now feel positive or negative about her? Does the brick wall of the pen make you angry that she wasn’t allowed to roam a hillside or knowing that people vowed to kill her make it understandable she had to spend all her life in secure circumstances? This is how information changes our perceptions.

Clearly, in all our interactions, whether they are social or professional there is a ladder of inference.  The temptation of “jumping to conclusions” based on previous experiences and interpretations, each with their own inference, must be addressed. In order to overcome these, we first of all should critically accept the existence of such perceptions and then utilise both inquiry and advocacy seeking the true, rather than filtered or blinkered data from the source before make our actions explicit and understandable on the basis of the truth.

Leading by example may encourage others to do the same.


“History teaches that history teaches us nothing “- Hegel

28 12 2008

I previously mentioned the MIT video with Henry Mintzberg and Ricardo Semler discussing the value and future of MBA and management teaching. Semler makes the point, “How is it possible to teach for the future (of management) when we only have a poor understanding of the past?”

Semler is pointing out that Management as a science is not as proven and strong as it might be. The poor assessment of the past (albeit interpreted retrospectively) makes interpretation of management action and reaction difficult and necessarily brings into question the teaching of future managers.

Importantly, this is not to devalue or criticise established thinking on Management practice merely point out that it doesn’t appear to be working as well as we are all hoping it would. (insert appropriate example- Mintzberg rather drew a bead on President Bush…)

tay-bridgeNow, coming from a different paradigm I am actually used to things not be quite as we are taught but not throwing my hands up and rejecting everything. Up to the early 1980’s no-one seriously believed that a bacterium could live in extreme acid environment of the human stomach. Now, it is recognised that not only does H pylori exist but thrives in pH =1 and that, contrary to established knowledge, it  is the principal cause of  gastric ulcers and gastric malignancies. Moving rapidly on from that new knowledge it has been found that by eradicating the bug from a stomach it might even cure those diseases within it. Medical science has recognised an error of knowledge, corrected it and progressed.

Management science must also make this sort of progress.

It strikes me that on a personal level this should be achieved thru’ the reflective and iterative processes of Action Research. Hegel of course is right as we seem to learn very little from history in a global sense. However history teaches us nothing only if we fail to observe the past, ask appropriate questions and learn from the results. Furthermore, if the answers we develop don’t work, we should ask the questions again and again testing our answers to see if we have made progress. It’s not rocket science really, is it?

What has history taught you?


edit- Bob C kindly sourced the full quote found ‘Lectures on the Philosophy of History’: “But what experience and history teach is this, – that peoples and governments never have learned anything from history, or acted on principles deduced from it.” This can be read in context here.

The Four Arts of a Scholar – 四艺

23 12 2008

As I mentioned in a previous post, my nom de plume comes partly as an expression of my learning status; insei, a student.

The ancient Chinese believed that a Scholar needed to learn and study to be proficient in the four arts; qin琴, qi棋, shu书, and hua画  and thus become accepted in discussions amongst other educated men.  Importantly these skills themselves of playing a musical instrument, playing a complex board game, calligraphic poetry and painting were not the end point for the scholar. Acquiring these skills was a demonstration of the individual’s strength in reason, creation, expression and dexterity.

We recently watched a video presentation from MIT involving a discussion between Ricardo Semler and Henry Mintzberg in which the latter bemoans the current state of management and leadership. I intend to discuss a few of the points made in later blogs but concentrate in this on this concept of training for management.

Mintzberg comments in the video that he believes candidates for MBA courses should not be sought directly from graduate schools but from industry itself. He believes the candidate should have learnt the arts and crafts of their business by experience, progressed upwards through the organisation so that then, when training in management they might apply their own experience to their learning of management principles rather than take the learnt experience of others and apply it to a job they don’t understand.

The ancients (and I don’t mean Prof Mintzberg) appreciated that to take on such responsibilities one must have experience and understanding of  life expressed in “the four arts” before taking on scholarly pursuits and similarly Mintzberg feels that experiential understanding of the organisation is central to the training of a manager why then do so many clinicians in the NHS move directly into management with no formal training in what is clearly a complex and difficult task?

I believe I have learnt my arts of the scholar (ars longa vita brevis) and now I am learning the skills required for management and clinical leadership. I am being encouraged to take on a managerial role in my organisation without having any experience or training in such a task.  Should I do so and learn by my mistakes or is it better to listen to those with wisdom and first gain insight to then apply that knowledgeably?

I would value, as always, comments on this.

“You’ve changed!”

17 12 2008

Scary words for any man to hear and I’ve had them addressed to me twice now within a single week. And not because I shaved off my charity moustache either!


I’m not sure exactly how or even why but it is clear to those around me that this study of Leadership coupled with self reflection is bringing about positive changes in me particularly in terms of coping with work and management issues.

One of the things I’m supposed to be doing as part of my Action Research is “journalling.” Now, whilst I get over the problem of turning a noun into a verb, I am a little unsure how I would incorporate external opinion into such a work but I’ll just leave it here for future reference.

So thanks to those who have supported me before the changes, thanks to those who have initiated it and thanks to those who have encouraged it.

I’m changing. Are you?

The white mice in action research

24 11 2008

As I chat over this project with various friends and colleagues I frequently have to explain them what Action Research actually is.

As part of our course we developed a wiki explaining this and I make no apologies having borrowed significantly from that source.

Action research describes a method of social research upon a specific issue of practice or behaviour from an active, subjective and descriptive perspective (Dick, 1999). This is in stark contrast to the paradigm of logical positivism (what i used to think of as my scientific background) thus rather than being seen as a test or experiment in empirical research with quantifiable and finite results, action research outlines by subjective involvement an improved understanding of both self and the issue in a qualitative and descriptive manner.

Make any sense to you? didn’t to me either until i stumbled upon this analogy I developed from the book “The Hitchhikers’ Guide to the Galaxy” (Adams 1979)

Rather than the experimenter looking down on the maze and experimenting on the white mice within it (logical positivism) we should understand that the action researcher is one of the white mice, working over time with his colleague mice to better understand how they might work together within the maze and the humans experimenting upon them.

action researcher

action researcher

I’d strongly recommend you read The HitchHiker’s Guide to the Galaxy but if not, and you have the time, go here, use your browser “find” and go to the section that starts, “Slartibartfast coughed politely.“

So does that ring true as an effective analogy or do i need to try again?

This week, I shall mostly be being a white mouse.

Adams, Douglas (1979) The Hitchhiker’s Guide to the Galaxy

Dick, Bob (1999) What is action research?

The ladder of inference

19 11 2008

An essential part of Action Research is reflection. Clearly such reflection is personal and we must assume, accept and interrogate our understanding of this reflection in the knowledge that all of our perceptions are affected by previous knowledge and experience. This therefore gives a reflection on the action that may not necessarily be shared by others. This method of research is in stark contrast to the paradigm of logical positivism where such personal involvement is essential forbidden.

This difference leads to an essential and probably defining concept within such research of recognising and detailing what assumptions are being made upon the basis of this reflection and at the same time offering personal opinion and beliefs for discussion and examination.

Argyris et al. 1985 describe a ladder of inference to help develop understanding of how perceptions are developed of observable data and events such that previous experience will affect how an outcome is perceived. Clearly this is describing reality and the effects of this ladder are not to be removed merely accepted as existing. the ladder of inference

From my personal experience I was approached by a Consultant colleague and asked if I could allow him to operate on a complex case on my Thursday list some 8 weeks in advance. We discussed the matter, agreed the date, emailed the waiting list department to ensure the list was currently empty, booked the patient as the only case for the day, informed the anaesthetist and all was well. Until I received a call at 6pm the night before the list from a ward clerk saying there were four additional patients booked for the list the next day (by a booking clerk). I explained this was an error, that the major case was scheduled 8 weeks earlier and would be the only operation possible that day as had originally been arranged.

At 915 the following morning I received an email from a junior manager,

I understand that you have cancelled your operating list for today, unfortunately it only appears to have come to light as of last night. Please can you let me know:

  • When you cancelled the list
  • What the reason for the cancellation is
  • Who you informed

For whatever reason the patients have not been cancelled until last night which is obviously far from ideal and this morning it is important to work out what went wrong here.”

The ladder of inference is interesting and presents many possible interpretations of events. Such ladders are possibly as stable as the picture above. They clearly exists however and we all need to accept that we are all balanced precariously on our own ladders of inference before acting and responding.

addition- there is a further post on this topic here.

Argyris C., Putnam, R. and Smith, D. (1985) Action Science. San Fransisco, CA: Jossey-Bass

The Journey starts…here!

19 11 2008

Welcome to my journey of learning thru’ Clinical Leadership.


I’ve migrated here from the University of Glasgow site as there is no (current) option for comment and I feel that discussion is perhaps the most helpful part of the blog scene.

So come on in, make yourself at home and let’s hear what you have to say. Forget the niceties, expose the cynicism, express your biases and share your miseries. I know I intend to.

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