"A science of uncertainty and an art of probability..."

William Osler once said, "Medicine is a science of uncertainty and an art of probability."  I suspect that Dr. Osler, one of history's greatest physicians, would agree that medicine, as both art and science, requires both customization as well as standardization.  Please let me explain.

I've posted about the need for standardization medicine in the past (see, for example, "The History of Standardization - 200 BC to 1945" and, in particular, "HRO: Sensitivity to Operations").  Here is what I had to say about standardization in a very early post from 2016 referring to a common complaint that I hear (still) from a lot of physicians equating "standardization" with "cookbook medicine":

I whole-heartedly agree that "patients are not widgets" and that "we shouldn't practice cookbook medicine."  Standardization, one of the key elements in operational excellence, is NOT "cookbook medicine."  There is simply no justification for why we should not standardize the care of common conditions (e.g. management of diabetic ketoacidosis, acute chest pain, or acute asthma exacerbation) or processes (e.g. care and maintenance of central lines, urinary catheters, surgical time-outs) - these are the kinds of conditions and processes that should be managed the same way, every day, by each and every member of the health care team.  With the care of common conditions, there is some room to maneuver, so to speak.  For example, if a patient deviates from the expected clinical course, then and only then should we deviate from a standardized treatment protocol.  However, there is no reason why we should deviate from standardized protocols for surgical time-outs, shift hand-offs, or maintenance of central lines.

With that in mind, I came across a great argument for standardization from former Marriott Hotels CEO Bill Marriott.  He said, "Mindless conformity and the thoughtful setting of standards should never be confused.  What solid SOPs do is nip common problems in the bud so that staff can focus instead on solving uncommon problems."  It makes such great sense when you think about it.  Why would you want to waste limited brainpower on the tasks that are straightforward, easy, and simple?

A similar analogy applies to leadership in general, specifically in what is known as the contingent theory of leadership, which states that effective leadership is dependent upon the situation at hand.  Rather than using the same leadership style for every situation, apply the best style to the what the situation requires or dictates.  The same concept applies to problem-solving!  I'm thinking in particular about Keith Grint's wicked versus tame problem framework.  Wicked problems require a different kind of approach, while so-called tame problems can be easily solved using common, standard approaches.

Just as important, as Henry Ford said, "If you think of standardization as the best that you know today, but which is to be improved tomorrow; you get somewhere."  In other words, protocols and SOP's can be changed, when there is evidence that suggests a better way of doing things.  High reliability organizations, as learning organizations that emphasize continuous improvement, will always modify or adapt their protocols when necessary.  

Cookbooks are incredibly useful tools in the kitchen!  The same is true for standard operating procedures, care guidelines, and protocols in the hospital.  The important consideration, however, is knowing when to apply them and when to change them.  Maybe that reflects part of the art of medicine?