Saturday, April 6, 2013

Sketch the Map and Then Continuously Improve It

The science of improvement is to ask the fundamental questions shown in the diagram and then to iterate through the Plan-Do-Study-Act cycle. [Institute for Healthcare Improvement] Iteration is defined by Merriam-Webster as "a procedure in which repetition of a sequence of operations yields results successively closer to a desired result." This is not a randomized clinical trial, but it is the scientific method. As Donald Berwick put it, "Did you learn Spanish by conducting experiments? Did you master your bicycle or your skis using randomized trials? . . . Broadly framed, much of human learning relies wisely on effective approaches to problem solving, learning, growth, and development that are different from the types of formal science so well explicated and defended by the scions of evidence-based medicine." [Broadening the view of evidence-based medicine]

The process of improving Haz-Map has gone on for over 20 years. First it was a hobby, and in 2007, it became a full-time job. I took a two-year sabbatical in 1994-96 to work on Haz-Map while completing a fellowship in Occupational Medicine at the University of Washington. When I first started adding data to Microsoft Access from the NIOSH Pocket Guide in 1993, I found a book that helped me to answer the first question in the diagram:

"Intelligent databases are databases that manage information in a natural way, making information easy to store, access and use."
"Early maps only showed a few well-known features like the "Pillars of Hercules" (the modern Straits of Gibraltar) or the island of Sicily. Once the map was outlined in terms of its major features, succeeding generations of mapmakers filled in the details, and the coast-lines, mountains and river systems slowly became more precisely defined. Similarly, the concentric designer begins by sketching out the main features, based on the key constraints, and then successively elaborates these until the details are crystallized." [Parsaye & Chignell. Intelligent Database Tools and Applications. 1993]