Increase Knowledge, Improve Health

22 Oct

In the previous article I made a case for health and well-being strategies aimed at prevention placing at least some focus on increasing a communities requisite variety (Weick and Sutcliffe, 2007) and adaptive tool kit (Gigerenzer, 2008). To achieve these aims an emphasis needs to be placed on knowledge acquisition. In this follow up article I’ll unpack what I mean by knowledge acquisition in this context and the role it can play in strategy and evaluation.

Health and well-being strategies are so complex that it is easy for the teams who design strategies to become disconnected from the people who implement and receive strategies (Klein, 2007). When the aim of a strategy is to improve prevention of poor health and well-being outcomes, then I’ve argued a key to delivering this strategy is a focus on knowledge acquisition, a quick re-cap. Prevention improves by increasing the amount of related knowledge within a community. Improved knowledge improves the quality of decision making, and it also increases the amount of coping mechanisms available to a person and community, thereby increasing resilience. However, this knowledge counts for nothing if it is to complex, hard to understand and very difficult to apply. For example, if you have been introduced to a new technique and it is complicated, what are the chances you are instinctively going to apply it when placed under pressure? The chances are you will apply previously ingrained techniques, after all, they are familiar and intuitive, regardless of how dysfunctional they might be.

So, what are sources of simple and effective knowledge? These sources are created and applied by the implementers and receivers of a strategy. When aims, objectives, procedures and processes hit reality they rarely maintain the theoretical form. They can become discarded or bypassed (a bad outcome) or they can become adapted and customised to meet a variety of challenges and applications (a good outcome). The problem is that when these highly effective customisations occur, they rarely become recorded and shared because they are taken for granted events during the course of a day. When these same aims, objectives, procedures and processes become evaluated, particularly if there is distance between planners and implementers, they can become tidied up into data which sanitizes the reality. Distance between planners and implementers can be created by culture and\or overly clinical and abstract feedback loops. In other words, the feedback loops provide only surface detail and fail to capture the reality of the strategy’s “ground truth”.

Seeking to improve health and well-being through prevention should aim to tighten these feedback loops not just between planners and implementers but also between partner service providers and across a community. A method of achieving this is focusing an evaluation and feedback strategy on the development of requisite knowledge and adaptive toolkits. Practically, the researcher should aim to collect simple rules of thumb which people have used to solve challenges, avoid or recover from mistakes or manage non routine events. There are a numerous methods which can be built into an evaluation and feedback strategy to gather this type of data, but I’ll outline an example below.

Tough Case Scenarios (TSC) have been used extensively within decision making research (Crandall et al, 2006, Klein, 2007, Rugg, 2013 all provide good examples) to focus a practitioners mind on non-routine cases. Non-routine cases mean that a respondent can’t just apply routine, they have to apply expertise and experience. My colleagues, Professor Wilf McSherry, Adam Boughey, and I conducted a recent study in dementia care. We used a TSC to gather expert knowledge from health care professionals who had recently trained in dementia care. The TSC enabled us to pick up sense making and craft techniques which extended beyond basic procedures, allowing us to access the professional’s expertise. Conducting a TSC across multiple groups gathers the requisite variety and adaptive toolkits which professionals and participants apply to handle tough situations.

The feedback TCS’s supply is the rules of thumb and craft skills people use in operation. These lessons can then be shared and applied across service providers, and an entire community, increasing the adaptive toolkit and requisite variety. For planners, the feedback provides insight into how the strategy plays out in practice, on the ground. The overall effect is increased usable knowledge, strategic awareness and insight into how and when to adapt a plan.


Weick, K. E., & Sutcliffe, K. M. (2007). Managing the Unexpected: Resilient Performance in and Age of Uncertainty, Second Edition. San Francisco, CA: Jossey-Bass

Gigerenzer, G (2008) Gut Feelings: Shorts Cuts to Better Decision Making. Penguin

Crandall, B. Klein, G. Hoffman, R. (2006) Working Minds: A Practitioners Guide to Cognitive Task Analysis. The MIT Press

Rugg, G. (2013) Blind Spot: Why We Fail to See the Solution Right in Front of Us: How Finding a Solution to One of the World’s Greatest Mysteries. Harperone. With D’Adnese. J.

Klein, G. (2007) The Power of Intuition: How to Use Your Gut Feelings to Make Better Decisions at Work. Currency

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