H. Dominic Covvey, National Institutes of Health Informatics
It might be interesting to reflect on what might be some of the roots to problems that plague us in Health Informatics and eHealth. My Catholic upbringing taught me about the Seven Deadly or Capital Sins, those that are seen to be at the roots of other sins. I looked them up (not that they aren’t normally in my consciousness…hmmm) and noted that they had significant relevance to the mistakes we often make in this field and that, indeed, these mistakes were often at the roots of other mistakes. Even as a no-longer-Catholic they stand out and I thought that, just maybe, they’d lead to some reflection and a basis for the later introduction of a set of ‘Beatitudes’ that help us avoid these naturally human pitfalls.
I also decided to have a little fun. My son is an artist (not from my genes; I can’t even draw flies!) and an illustrator working with digital media. So, I presented him a challenge: to co-operate on an article. He took the bait and he’s used his skills in drawing 3-D monsters to help me make this more interesting and colorful – and, maybe, get the points across a bit better.
The Seven Deadly Sins are usually listed as Lust, Gluttony, Greed, Sloth, Wrath, Envy, and Pride. I’ll deal with the first four of these in this space and finish the rest the next time. Further, I’ll make them relevant by prefixing the terms with an ‘e’.
Lust is the intense, sometimes overwhelming, desire for something, usually focused on the sexual, but also on money, fame or other things.
eLust is the over-focus on technology, the devices and systems that serve as the infrastructure for what we do. When we initiated this field decades ago, technology was our focus – we had too little, it was of limited power, it cost a lot and it took a yeoman’s effort to get it to do anything at all. Therefore, it was a good driver to get people interested and involved. Furthermore, size mattered then; the person with the biggest computer, data center or set of peripherals was ‘the man’ – the extant gender. When did eLust emerge as a sin? Well, the field matured and our focus is now on health and health care, improving workflow, and integrating systems with health care in a way that enables productive evolution. Hardware became a commodity and is going into ‘The Cloud’; and software is in transit to commoditization.
Focusing on technology in today’s world will distract and deviate our efforts in unproductive directions. eHealth no longer delivers systems; it must deliver more productive enterprises. We need to move past eLust and have a more mature relationship!
Gluttony is the sin of overindulgence to the point of waste (or waist!) particularly of food, but also of other things. It has the side effect of depriving the needy.
There are many potential temptations to eGluttony. The one I’ll cite is megaprojects. We have a plethora of evidence that megaprojects often fail, taking megabucks with them. Consider the National Health Service (NHS) eHealth megaproject in the U.K, the Australian effort, and possibly even what we’re doing on this continent. Consider also the many other ginormous projects in other fields: the failed FBI and FAA systems, for example. Despite the evidence, people keep biting off what they can’t even chew. My mother’s line was “Your mouth is bigger than your stomach”. In fact, it’s the dynamic nature of a complex health system, and the limits of our abilities (including our inability or unwillingness to estimate effort and cost honestly) that make large projects vehicles to disaster. So why do we over-estimate our capacities and overindulge? I guess that’s what ‘sin’ is about.
The message is right there on the wall: eGluttony leads to ego-obesity and virtual demise. We have to rethink our project definitions and strategies so we take on more reasonable challenges that may not inflate our egos and coffers, but that have a reasonable probability of success. After all, it’s the taxpayers who pay for the feast!
Greed and avarice describe the excessive pursuit of material possessions; avarice also connotes disloyalty, and betrayal.
eGreed is the seeking to acquire and control everything for ourselves. ‘Greedy’ describes those who want to ‘own’ everything, do everything on their own or under their leadership. It’s their project or no project; their way or the highway. One thing that we have learned is that we need teams with distributed leadership. We must involve even the ‘outliers’ and naysayers. We have to listen to and engage the fringe. Top-down, militaristic leadership isn’t compatible with the human dimensions of healthcare projects and it can suppress innovation.
We need to learn that we lead from behind and through others. That gives everyone a stake, engages them and takes full advantage of their talents.
Sloth is laziness, physical or spiritual, the unwillingness to rise to the occasion and play our needed roles.
Perhaps the worst form of eSloth is the failure of our professionals to improve their competencies. Like other sins, there are factors that encourage eSloth, like health organizations that don’t support professional advancement and let their staff intellectually run down like one-use batteries. But, the roots of eSloth are in the person. Few seem to realize that improving their knowledge, skills, experience, attitudes and values is essential to surviving and thriving. How many keep up with the literature, go to conferences, take courses, participate in workshops or otherwise commit to life-long learning? How many simply sit on their laurels and slowly decline into obsolescence? Is this good for themselves or their employers? Heck no!
eSloth also stands against ‘agility’, the use of approaches that enable the addressing of complexity, like agile development, planning and budgeting.
eSloth cheats ourselves and those who depend on us. That’s what makes it a sin. It is, though, one that can be easily overcome and guess who will benefit!
As one sinner to another, I now feel a bit like Elmer Gantry in a paper tent! The point, though, is that there are deep failings into which we can fall. I’ve never liked the concept of ‘sin’, but it does capture a key idea, that humans have foibles and that clearly identifying and avoiding them may help us be better and do better.
Dominic Covvey (FACMI, FHIMSS, FCIPS, SMIEEE, ITCP) is an Adjunct Professor at the University of Waterloo and the University of Ontario Institute of Technology. He is also the President and Director of the National Institutes of Health Informatics. He was the Founding Director of the Waterloo Institute for Health Informatics Research at the University of Waterloo (2003-2010). His research is in the representation and analysis of healthcare workflow, the definition of competencies and curricula in Health Informatics and the design of the Electronic Health Record.