In our previous article we discussed the approach of using safe to fail experiments to implement interventions in novel situations and with complex systems. The approach highlighted that understanding the emergent behaviour allows for the implementation of interventions that look to shift this emergent behaviour in the direction of the target.
So how do we do this at the individual level in real time?
As discussed the basis for healthcare is scientific practice. One such type of inquiry that makes science possible is the use of the philosophy of empiricism. Empiricism is the view that concepts originate in experience. Now this may sound obvious, but often in healthcare the use of the other side to knowledge inquiry, rationalism, pokes its head forward. Rationalism is the view that reason is the foundation of knowledge. It forms the theoretical basis for understanding and is often backed by mathematical reasoning. Why do I bring this up?
We spoke in our last article about the idea that we must measure the behaviours and implement safe to fail experiments based on the findings of these outcomes. It may be a minor or major adjustment in ones view of the world, but the key is that we must use the information that we gather to draw conclusions, irrespective of what our theroetcial basis for understanding may be at that time. I say this because often as professionals we will start to fit our bias to what we see to change what the data (or emergent behavior) is actually saying. Or in many cases not saying. To do this we must look at the information that emerges without trying to retrofit our ideas on why it is happening too quickly.
This type of approach seems more elaborate than it may actually be in practice. Individualizing the implementation is based on having clear understanding of the probable contributing factors to the emergent behaviour and then creating interventions that look to drive the needle on these behaviours based on what we see emerge.
If we go back to our hamstring strain example, the understanding of hamstring strain risk factors and probable contributors includes items such as eccentric strength and running mechanics. So during our rehabilitation period our interventions are likely to utiise activities that work towards improving these features. Developing this in real time requires the willingness to be consistently assessing the improvement in these features and being willing to extend or reduce the intervention application based on what you are seeing during the intervention.
For example you may be teaching a particular running skill that you have identified as a feature that will improve injury risk features such as excessive anterior tilt whilst running, as per the discussions of Mendigucha. If you see that an intervention that you are implementing is enhancing the performance you may choose to continue to complete further repetitions of this exercise to stabilise that skill behaviour, despite having other exercises that you had planned to use or other exercises that you believe to be theoretically superior. The fact this exercise is working is what matters. This form of autoregulatory approach utilizes the idea that if the emergent behaviour you observe is what you desire, in this case lumbopelvic control whilst running, then amplifying this is valuable, not your theory for why it is changing.
You can see in this way that the close observation will limit an intervention from being implemented without shifting in the direction of the desired outcome. The intervention can be individualized very quickly and relatively easily, even when your understanding of why it is changing is occurring.
- Once you have identified the behaviour that requires intervention, look to monitor this closely as you implement your intervention
- Use the data that you are observing in real time to extend or reduce the conversation
- Repeating this process consistently will lead to an intervention that moves the needle for that individual and that individual alone
This article concludes our series on approaching novel problems using first principles. Our hope is that it has given you some insight in how to apply principles thinking to any problem that you encounter.