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.”


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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.





Management- there has to be more to it than meets the eye.

12 02 2009

It is likely that my action research project will be on the interaction between clinicians and medical management. I’d value thoughts and insight into both the project and the concept itself.

Importantly, one should understand that from the action research point of view what is equally important to the outcome of the assessment and interventions is a description of the journey taken. This entails increasing understanding of self, ladders of inference in perception and describing and discussing adjustments made on the basis of external influences. Close friends will be amused and intrigued I’m sure, but I’m quite looking forward to it.

One of the reasons for choosing this project is that my overall experience of “management” has not been good. I completely accept that this may be due to ever increasing negativity and cynicism on my part founded upon increasing layers of poor perception as well as the fact, that for most physicians, our only effective contact with “management”, in all its various guises, is in a negative or confrontational context. Clearly seeing only such negative events strongly affects our views and I should be the first to accept that this may represent only a numerator in the equation rather than the denominator. One of my challenges therefore is investigate the latter and see what else goes on that I don’t see or experience and try to gain a more balanced view of management. Recording it here is the first step.

The difficulty with describing something purely on what you can see is totally reasonable but was (possibly) where the crew of the Titanic went wrong.
iceberg121





The value of blogging and reading blogs; more than just a footprint in the garden

19 01 2009

The hit count for this blog has now passed 1000.

Thank you for your interest and thank you particularly to the commenters:

  • B, gnomechompski, anne marie cunningham, nathan, sue massey, marco, graeme, ubertech, ken long, strategicseneinc and stuart

Reviewing the various entries I felt it appropriate to express my feelings on why I believe blogging is NOT pointless.

I’m currently undertaking a part-time degree in Clinical Leadership. The value of the course is not simply in the lectures but the more open, tutorial type approach that we engage in with our tutors and each other. This is augmented by online discussion although, as a group, I don’t think we have fully bought into that idea.

This discursive approach to learning is in stark contrast to my original training ( four arts) where facts are transmitted in a more didactic and Hypocratic (sic) manner as one would expect. The value of interrogation of concepts by debate cannot be underestimated. It allows for correction but also solidification in expression.

Everyone has experience of management and, for my Action Learning, I have to journal my pre-understanding of the situation whether that be true, bad or influenced by concepts such as the ladder of inference. It is to be hoped that as time moves on my understanding will deepen and perhaps some negativity may be replaced by more positive stories.

The truth hurts sometimes but so does perception of the truth. We could debate whether the two are in fact the same but therein lies the value of recording pre-understanding so that my journey into Clinical Leadership is documented with honesty and may be interpreted appropriately. There is no doubt that the hit counter prompts me to continue writing. I am sure if this had steadfastly remained evidence of only my Dad reading the blog on a daily basis (thanks Dad) that I would have given up. There is encouragement in this readership but as gnomechompski pointed out the value of the blog is not about seeking approval.

Finally there is value in the discipline of writing. This cannot be over-estimated. So many thoughts prosper without exposure to fuller expression. They may germinate in the mind and develop into full grown plants nurtured by fleeting showers of mis-construed impressions in the fertile soil of isolation. The problem is that such plants are frequently weeds and choke the shoots of value and of clear thinking. Once these weeds are actually exposed to the gardening of preparation, writing and discussion they might be seen for what they are and either wither in the glare or are plucked by the insightful gardener and tossed onto the compost. Of course it is true that this process happens in open discussion, over coffee, in pubs and anywhere like minds gather and share ideas. My only question to you would be, do you meet and discuss such thoughts with like minds often or only in the quiet garden of your mind?

Thanks for coming by, please leave more than just the footprint of passage. Make a comment, ask a question, join the debate. It adds so much.

inseiffolliet





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








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