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楼主: icchina

SIFIC筹划2012年出版《感染预防与控制最佳实践》,招聘若干名有良好英文基础者加盟!

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发表于 2011-7-16 06:54 | 显示全部楼层
找到了,呵呵。感谢几个月以来论坛老师们给予我的帮助。希望能为论坛尽点力!
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发表于 2011-7-16 16:45 | 显示全部楼层
回复 19# icchina
Thanks for Pro.Hu's encouragement,we will do our best for dream.
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发表于 2011-7-16 18:24 | 显示全部楼层
对于SSI和口腔科感染控制内容非常感兴趣,希望能参与这两部分内容的编写。当然,也请胡教授分配别的内容。SIFIC是我刚进入感控专业是的引路者,因此,也希望能回馈SIFIC。
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发表于 2011-7-16 21:02 | 显示全部楼层
胡教授辛苦了!梦想让动力化成永恒!
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发表于 2011-7-18 10:54 | 显示全部楼层
刚刚从学校就上工作岗位,一定努力学习,虚心请教,在SIFIC学到更多前辈们精心总结的感控经验。
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发表于 2011-7-18 11:04 | 显示全部楼层

与各位分享一篇关于最佳实践(Best Practice)的文章,作者DanNorth,译者郑柯,题目《更好的最佳实践(Better Best Practices)》。作者从应用最佳实践的动机、Dreyfus学习模型、最佳实践和Dreyfus模型的关系和最佳实践模式等方面对“最佳实践”进行了独到的分析,希望能给SIFIC的新作——《感染预防与控制最佳实践》的编撰带来一些思考。

中文版连接:http://www.infoq.com/cn/articles/better-best-practices

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发表于 2011-7-18 11:08 | 显示全部楼层
胡教授,我把信息已发给你了,谢谢,希望胡老师能多给我们年轻人机会,我们会更加努力的
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发表于 2011-7-18 14:40 | 显示全部楼层
回复 1# icchina
感谢教授给我们这样一个好的学习平台!
版主能否报名呢?!
已将个人信息发给您,请您审核,愿为我们的论坛做出自己的努力!
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发表于 2011-7-18 15:47 | 显示全部楼层
回复 15# icchina
SIFIC论坛,是一个富于吸引力,让感控人感动,有激情,激发灵感的地方!
英文水平太差,不能做什么,就顶一下帖子吧{:5_642:}
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发表于 2011-7-18 15:58 | 显示全部楼层
回复 26# mickeypank
很好的文章,将之贴出来:
The motivation for Best Practices
People implementing a business change program usually have good reasons for rolling out Best Practices across their organisation.
•        They ensure consistency. We are introducing [insert initiative] and we want to ensure that everyone goes about it the same way. We don't want to abandon people without offering them any direction and the alternative would be chaos.
•        They support learning. We are trying to get everyone up to speed on this new approach with the minimum of fuss, and having a standard set of well-structured material means people can see exactly what they have to do, and ideally how well they are adapting.
•        They help limit (potential) impact or damage. (Now we are starting to see their true colours.) In any organisation there's a bell curve of people's abilities, and we know that a small but significant number of people will be at the wrong end of it. Implementing this program badly could leave us exposed to significant financial or legal business risks, so we're going to need very clearly defined practices to protect ourselves. They are called Best Practices because they are tried and tested so I can be reasonably sure they are going to work.
•        They help to build a more mobile and flexible workforce. In these fast-moving times, projects can materialise or be cancelled almost overnight. People move between project teams, projects move between offices, countries or timezones. With all our people trained up to use the same Best Practices we - and they - have many more options in terms of career mobility. We call it "commoditising resources".
•        They allow us to enforce control. In a large, hierarchical organisation, this is the real crux of the matter. A division manager or vice president may well be responsible for thousands of people. The only way to provide accountability on that scale is to have a system of clearly-defined and strongly-enforced Best Practices.
In other words, best practices are used as a device to manage risk.
The nature of risk
Risk is an interesting phenomenon. In business terms, "risk" usually means the probability of things going wrong. We assign a likelihood (high, medium or low; percentage points; statistical quantiles) to various events we are concerned about.
But what is risk other than a formalisation of fear? We consider things we fear as risky, and similarly we are less concerned (i.e. associate less risk) with things we don't fear. In other words, with apologies to George Lucas:
•        Fear leads to Risk
•        Risk leads to Process
•        Process leads to Hate (and meetings, and Gantt charts)
Now fear comes in two flavours, namely rational and irrational. Rational fear is healthy and useful. Lions are bad. Fire is hot. Trucks hurt. This is fear based on good information, either wired in via evolution or learned through cultural or individual development.
Irrational fear is the source of prejudices, phobias and knee-jerk reactions. The earth is flat and you'll die if you go over the edge. Hanging up dead rats by their tails wards off the plague. Putting coconut shells on your ears makes the freight aeroplane appear.
The problem is that from the inside they both appear the same. The sense of fear of spiders is no less intense or real to an arachnophobe than the sense of fear of a lion.
At a basic level, most fear is irrational, especially in a business context. If a system is delivered late, in most cases no-one is actually going to die. You probably won't even risk injury or go hungry. At worst you might get a slightly critical review.
Pretty much all the software you are using in your everyday life - the office suite you use at work, the games console at home, the browser you are reading this article with - it's likely that all of these were delivered late. And not working properly. And there was a hotfix / service pack / automatic update that appeared a few days or weeks later to fix some glaring functional omission or security hole. Or it still hasn't appeared but your vendor is keeping you blissfully unaware of how exposed your phone/computer/console is right now.
Rational fear is good - it stops us getting killed. We should embrace it and cherish it as a guardian of our well-being. Irrational fear is just a drag, but fortunately we have a strategy for dealing with it:
Because irrational fear comes from ignorance, we can learn our way out of it!
Introducing the Dreyfus Model
In the late 1970s two brothers spent some time exploring the nature of learning. They were interested in the nascent discipline of Artificial Intelligence, and they wanted to program a computer to learn a non-trivial skill like playing chess. It turned out there was very little by way of established knowledge around learning, certainly nothing they could use as the basis for a computer program, so they set about researching the learning process themselves.
The result was the Dreyfus Model of Skills Acquisition, which describes how people go from being brand new at something to being able to do it quite literally without thinking.
There are many models of learning and acquiring skills, but there are a couple of things that makes the Dreyfus model stand out. Firstly, it is based on real evidence and experience, and has been proven to work. (It was used to great effect in the early 1980s when the US health service was facing a nursing crisis - http://tinyurl.com/32afwt) Secondly, it isn't just a passive observation of development. It also describes what people respond to at each stage and therefore how to help them grow.
When you start learning a new skill, you don't have any understanding of context yet so you require specific direction. In other words, you have no instinct and you have to be told what to do. As your contextual awareness increases, your need for direction diminishes. In fact you could consider the nurturing of this awareness as fundamental to skills acquisition.
The Dreyfus model divides the learning process into five distinct stages or levels:
A Novice needs detailed instructions - step-by-step recipes. Novices can't tell whether the instructions are working or not or which ones are important because they have no context to assess them against. Because of this the novice wants frequent quick wins and regular feedback. A good recipe book has plenty of pictures and lots of reassuring messages.
An Advanced Beginner is familiar with the basic steps - the individual tasks - and can put sequences of them together. The advanced beginner is still very much task-oriented rather than goal-oriented, but they are starting to get some perspective. This is the stage at which a learner is most dangerous - they know enough to think they know more, but not enough to keep themselves out of trouble! Toddlers are advanced beginners at lots of things. With experience, an advanced beginner becomes Competent. At the competent level they are goal-oriented - they can figure out a sequence of tasks to accomplish a goal. It might not be the best sequence, but it will usually work. Competent people like to be given a goal and then to be trusted to achieve it. Conversely you can upset a competent person by trying to give them detailed instructions - rather like back-seat driving.
Most people don't get beyond the competent level at most skills, even those they use in their everyday work. This is a basic human trait - we don't like to expend energy once we have achieved an outcome, and for most activities the outcome is simply getting the job done.
At the Proficient level solutions start to "just appear", usually fully-formed, in the person's mind. They have developed enough of an instinct to firstly pick out the salient details of a situation, and then to match them to their bank of prior experience. A proficient person wants to understand the wider context of their actions, and enjoys metaphor and maxims (and their counterpart in anti-patterns). They will still refer back to their rule-based training to verify their actions, but by this stage they are learning to trust their own judgement.
Where the progression from Novice to Competent is fairly linear, the transition to Proficient represents a step change. For a start, it has to be an active choice. You can become competent at something just by doing it enough times, but you have to want to become proficient.
As with the transition from competent to proficient, the transition to Expert is also non-linear. It may take many years of dedicated effort to become an expert in a particular discipline. These people work almost entirely from instinct, and are rarely wrong.
An expert lives in a world of ambiguity. She takes a pride in her ability and likes to calibrate and brush up on her skills by spending time with other experts. Interestingly, people at more junior levels tend to overstate their ability, and those at the higher levels are more modest.
When worlds collide
An unfortunate characteristic of an expert is that they are unable to explain their decision-making process. This makes sense when you consider they are operating on autopilot: the solution is being presented to them, fully-formed, by their unconscious. A professional tennis player just "knows" how to return a ball with a topspin. A professional musician sees their instrument as an extension of themselves rather than as a device they manipulate.
Remember that most people are advanced beginners or competent in most of the things they do, and this is also true in a professional context. This means an expert programmer - or tester or analyst - will have a boss who is at best competent and most likely an advanced beginner. (How many project managers do you know who were talented programmers until quite recently? The Dreyfus model applies to them too.)
These people are thinking in tasks, or at best in goals made up of an identifiable sequence of tasks. This frame of reference is not comfortable processing something like "I've been delivering applications for 15 years and I just know we shouldn't be using an ESB". (There's that word "just" again.) Of course the proficient or expert manager would be more than happy with that explanation, and in fact would actively seek out experts to provide them with the instinct-level solutions in the first place - and then vigorously defend their decisions.
Best Practices and the Dreyfus Model
Armed with our novice understanding of the Dreyfus model it's time to revisit the term Best Practices. What does the phrase even mean? Practices are things you do. They are specific behaviours and activities. They are prescriptive. "Best" is an absolute qualifier (as opposed to the conditional "better" or the more moderate "quite good"). It is context-independent and unambiguous. It is a declaration that there are no better practices than these ones.
So by this definition, Best Practices are a set of context-independent, unambiguous, prescriptive activities. They are the tasks that form the basis of task-based learning. So how do the different skill levels respond to a model like this?
Best practices help beginners
The novice needs best practices. They can't function without them. Practices show the way - the more detail the better.
The advanced beginner uses best practices. These help define the edges, the boundaries over which the advanced beginner will doubtless step in their error-prone journey towards competence.
The competent person defines best practices. Remember, they are goal oriented but still rely on sequences of steps to achieve those goals. They remember being an advanced beginner. They remember all the mistakes they made, and they want to protect the next generation of novices from themselves. More about this later.
Best practices constrain your top people
A proficient person refers back to best practices. They are learning to trust their instinct but their instinct isn't always enough. Best practices can be both a help and a hindrance at this stage. If your instinct is to do something off limits, you stop yourself out of a misplaced loyalty to the written rules.
Finally, the expert simply doesn't use best practices, because they don't use any practices at all! In fact the expert subverts best practices in order to get work done (or rather, subverts the policing processes that inevitably accompany best practices). Best practices are a necessary evil that must be lived with but should not be allowed to hold them back.
These last two levels, and especially the expert, can quickly come to resent practice-based initiatives, in exactly the same way that the competent person resents being given task-level detail. ("Put the red eight there, under the black nine, then you can free up that ace."). You aren't just back seat driving when you constrain an expert to rules, you are invalidating their hard-won instinct and intuition.
Best practices are driven from the centre
Most practice-based process initiatives come from competent-level people. I don't have any statistical evidence for this but I am convinced it is true. At the competent level, you believe that the mistakes you made at the lower levels must have been down to a lack of rigour or completeness in the description of the tasks you were taught. If we can only get the practices right, we can get people from novice to competent without all that wasteful stumbling through the advanced beginner stage. The competent person hasn't yet tasted proficiency at this skill (and remember, you start as a novice at everything, including learning about learning, and learning about teaching) so they have no reason - or evidence - to trust instinct or intuition. Whatever the experts are doing, it must be possible to decompose it to a set of repeatable practices - to "de-skill" it - so that our less skilled - and let's face it, less expensive - people can perform the same tasks.
We could have a small group of experts defining best practices from a Centre of Excellence or Best Practice Group, and we could roll these out across the enterprise.
In this context, "expert" doesn't mean expert in the Dreyfus sense, but someone who is very competent. There is an important distinction here. A computer such as IBM's Deep Blue that can beat a world grandmaster is not an expert. It is simply able to cover a vast amount of possible search space very quickly (The Deep Blue example is considered canonical because chess was the original problem the Dreyfus brothers chose to explore with artificial intelligence, and Deep Blue beating Garry Kasparov in 1997 was obviously a landmark event in computerised chess). In this sense it is very, very competent! Recent neurological studies showed that experts in a particular field don't process things faster than non-experts. Instead they process fewer things. There is less brain activity in an expert looking at the same problem as a non-expert. In other words they instinctively pare down the solution space and have a well-developed sense of which parts of it are most likely to yield results. (The chess computer example comes up a lot because that was the original problem the Dreyfus brothers chose to explore with artificial intelligence, and Deeper Blue beating Garry Kasparov ).
Better Best Practices
In the context of the Dreyfus model, we can start to establish a more suitable model for propagating knowledge without disempowering our experts - the very people who are the inspiration for the next generation of knowledge workers in your organisation.
Firstly you should provide context, both for the practice and the practitioner. You can describe the same principle from several angles and at different levels of abstraction depending on the Dreyfus level of your intended audience. One thing is for certain, you won't be able to speak to them all with a single definition of a practice.
Secondly, the practice should be descriptive rather than prescriptive. In other words describe the desired outcome and maybe illustrate several alternative ways to achieve it. For the novices it is helpful to identify a preferred one. Feeding the steering wheel hand-to-hand is a very safe way to steer a car. As a competent driver it might not be the most effective way to turn quickly while reverse parking, but they'll get to that later. What you don't want is to have your expert having to trade their instinct against possible repercussions right in the heat of a crisis when they most need their wits about them.
It should describe the pros and cons of the practice. I can't think of any practices that are all upside. There is a trade-off for most things. Again, your novices won't benefit much from this, but you are building in the wiggle room for your proficient and expert-level people to be able to perform whilst remaining inside "the rules".
Patterns as Best Practices
In fact, it seems the more you adapt a best practice to be applicable across the Dreyfus range, the more it starts to look like a pattern!
An Alexandrian pattern - named after the architect Christopher Alexander - describes a context, the various "forces" (external factors) it resolves and introduces, and typically several examples. In Alexandrian terms, patterns only work in conjunction with one another, creating a system of interacting forces that need to be balanced to create harmony.
Applying this philosophy to Best Practices would allow you develop a whole variety of interdependent, co-operating practices that the novice can use in a cookbook fashion, the intermediate levels can experiment with and the experts can argue over. In fact, the process of providing a context in the first place can be a very useful exercise in terms of identifying the value of a particular practice or set of practices.
Conclusion
People are risk averse. In layman's language that just means people have fear, and that's ok. For the things we should (rationally) fear, it is perfectly appropriate to want to assess the likelihood of encountering them, and to spend effort averting them.
Best practices are about providing guidelines for novices. People will make mistakes as they learn because making mistakes is learning! However tempting it seems, you can't sidestep the advanced beginner stage and go from novice to competent without ever stepping outside the lines. The human learning process simply doesn't work like that. Software development is a skill, whichever part of it you are involved in - as a programmer or tester, as an analyst or project manager - so the highest performers will work predominantly from instinct. It's a pretty good indication of their expertise if they are unable to explain their decisions. (Of course you shouldn't confuse this for a lack of basic communication skills!)
To create consistency across a multi-skilled organisation, Alexandrian patterns provide a much more workable strategy than the clear-cut absolutes of Best Practices.
In fact, the best Best Practices are neither Best nor Practices.
Acknowledgements
Former ThoughtWorks colleague Robin Gibson was the first person to introduce me to the Dreyfus model. PragDave Thomas gave an excellent talk at QCon 2007 about it which led me to Patricia Benner's book "From Novice to Expert", which is an informative and uplifting book full of anecdotes from the nursing profession. Michael Tiberg, the organiser of Øredev, kindly allowed me to do a talk at his conference and gave me Best Practices as a topic, which was the origin of this article. While I was there I got to spend time with Andy Hunt, whose wife seems to be responsible for introducing the software community to the Dreyfus model in the first place! Andy is currently working on a book that will feature the Dreyfus model heavily as well as lots of other goodness about how people think. And of course thanks to Niclas Nilsson for suggesting I should write this up and offering to publish it.
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发表于 2011-7-18 15:59 | 显示全部楼层
回复 30# 鬼才
译文:
应用最佳实践的动机
推行业务变革计划的人们,总是能够为在组织中推行最佳实践给出种种理由。
•        应用最佳实践可以确保一致性。我们正在引入[此处插入最佳实践名称],而且希望确保每个人都能与我们保持方向一致。我们要给人们提供方向指引,以避免他们被落下;否则只能造成混乱。
•        应用最佳实践可以支持学习过程。我们要让大家在尽量不产生焦躁情绪的状况下,彼此保持步调一致;而且我们拥有一个标准化的、结构齐备的运作材料,这就是说人们可以明确了解自己该做什么,以及在理想化状况下他们能够做到多么好的程度。
•        应用最佳实践可以限制(潜在的)冲击或破坏。(现在让我们看看它们到底是怎么一回事吧。)在任何组织中,人们能力总是会构成一条钟形曲线[注1],我们知道有少数非常杰出的人会被错误对待,导致他们处于钟形曲线错误的一端。错误地推进变革计划,会让我们面临重大的财政或法律风险;为了保护我们自己,要将实践的流程和方式定义得非常清晰。它们之所以被成为最佳实践,是因为人们曾经尝试过它们并且证明它们是有效的,所以我可以明确保证它们一定能够起到成效。
•        应用最佳实践可以帮助建立更加便捷、灵活的劳动力环境。在目前高速发展的时代中,项目的实现或是取消都是一夜之间的事情。人们在项目团队之间转换,项目在不同办公室、国家或时区之间变动。让所有的成员都能接受针对同样最佳实践的训练,我们——和他们——就能在工作的灵活性上拥有更多选择。我们称之为“资源商品化”。
•        应用最佳实践可以帮助我们加强控制。在一个大型的、等级森严的组织中,“加强控制”是问题的关键。一个部门经理或者副总可能要负责几千人的管理。在这种规模下,拥有一个清晰定义并能得到强有力实施的最佳实践是进行有效管理的唯一途径。
换句话说,最佳实践被用作管理风险的手段。
风险的本质
风险是一种有趣的现象。在商业用语中,“风险”通常意味着事情发生问题的概率。我们将一种可能性(高、中或低;百分比;统计数量)分配给我们所关心的事件之上。
可风险不就是恐惧的一种形式化方式吗?我们将畏惧之物视为风险,类似地,对于不害怕的东西,我们就不太关心(也就是风险较小)。换个方式来说,篡改下乔治•卢卡斯的话[注2](向他表示歉意):
•        恐惧导致风险
•        风险导致流程
•        流程导致憎恶(还有会议,还有甘特图)
现在,恐惧变成了两种:理性的恐惧和非理性的恐惧。理性的恐惧是健康而且有益的。狮子是不好的动物。火很热。卡车可以造成伤害。这些是基于有益信息的恐惧,要么是通过进化而来,或者通过文化学习而来,或者是来自个人发展的经验。
非理性的恐惧是偏见和恐惧症的根源,膝跳反射也是因此而发生。下面这些都是非理性的恐惧。地球是扁平的,你要是走过了它的边缘就会有生命危险。用老鼠的尾巴把它吊死就可以避免瘟疫。把椰子壳放在耳朵上,就会看到货运飞机的出现。
可问题在于,从害怕的人的角度来看,这些畏惧都是差不多的。对于一个害怕蜘蛛的人来说,对蜘蛛的恐惧感与狮子带来的恐惧感程度相当。
从基本层面来看,大部分恐惧都是非理性的,特别是在业务环境之中。如果一个系统延迟交付,在大多数情况下是不会死人的。你也不太可能会有受伤或者挨饿的风险,最多不过是得到一个有点严厉的评语而已。
我们日常生活中用到的大部分软件——工作时使用的办公套件、家里用到的游戏控制器、阅读这篇文章时使用的浏览器——都会遇到延迟交付的问题。而且它们可能出问题。而且在几天或者几周之后,就会有一个漏洞修补程序/Service Pack安装包/自动更新用来修正某个重要的功能缺失或是安全漏洞。或者还没有出现问题,因为厂商并没有让幸福的你意识到:你的电话号码/电脑信息/控制台信息正在被泄露出去。
理性的恐惧是好的——它可以让我们避免被伤害。我们应该拥抱它,而且珍视其为我们安定生活的守护神。非理性的恐惧只不过拖累而已,还好我们有应对之道:
非理性来自于无知,我们可以通过学习来克服它。
Dreyfus模型介绍
上世纪70年代后期,有兄弟俩花费了一些时间来研究学习的本质。他们对刚刚出现的人工智能发生了兴趣,并希望让电脑可以学习诸如下棋这样复杂的技能。当时对于围绕着学习过程所建立起来的知识还很少,也就没有什么可以让他们用来参考去编写计算机程序了,所以他们决定自己研究学习的过程。
他们的研究成果就是Dreyfus技能获取模型(Dreyfus Model of Skills Acquisition),描述了人们如何从对某物一无所知,到无需思考即可熟练运用的过程。
虽然现存有许多种学习和技能获取模型,但Dreyfus模型独具的特色让其脱颖而出。首先,它基于真实的证据和经验,而且被证明是可以实际运用的。(在1980年美国公共医疗卫生服务面临护士危机时,它发挥了巨大作用——http://tinyurl.com/32afwt)其次,它不仅仅是对发展过程的消极观察,它同时描述了人们在不同阶段应该如何应对,以及因此而为他们带来的成长。
当你开始学习新技能时,你对于上下文没有任何了解,所以需要一些特定的方向指引。也就是说,你不知道面对着什么,必须有人告诉你应该做什么。随着对上下文和背景知识的深入了解,就不再需要对方向的指引了。实际上,你应该考虑如何更进一步加深了解,以作为获取技能的基础。
Dreyfus模型将学习的过程分为五个不同的阶段或水平:
新手(Novice)需要详细的指导——要手把手地教。新手不知道这些指导是否有效,或者哪些指导更加重要;因为没有上下文知识可供他们使用进行评估。因此,新手需要频繁迅速的成就感和有规律的反馈。一本好的入门指导书籍要提供有足够多的图画和充足的可靠信息。
高级初学者(Advanced Beginner)对基本步骤——单独的任务——已经熟悉了,而且可以把它们进行有机的组合。高级初学者仍然在很大程度上是面向任务而不是面向目标的,不过他们已经开始有些概念了。这也是一个学习者最危险的阶段——他们知道自己学到的已经不少了,但是这还不足以让他们远离麻烦!刚学走路的孩子在很多方面都是高级初学者。有了足够的经验,高级初学者就能拥有足够的能力以胜任某些工作。在“胜任(competent)”水平上,他们就走到面向目标阶段了。他们可以组合一系列任务以达成某个目标。也许任务的组合顺序不是最佳的,但是通常都可以发挥作用。有能力的人希望给定一个目标,然后能够得到别人的信任来达成这个目标。相反,如果要是试图详细告诉他们应该怎么做,这些有能力的人就会觉得很烦躁,就像是汽车里被坐在后面座位的乘客指手画脚的司机一样。
大部分人在大部分技能上很难超越“胜任(competent)”水平,即使他们在每天的日常工作中使用这些技能。这是人类的基本特性——一旦有所收获,我们就不想再投入精力了,而且对于大部分活动来说,所谓的收获只不过是把工作做完而已。
在精通(Proficient)水平上,解决方案开始在人的心目中“慢慢浮现”——而且通常已经完全成型。他们已经具备了在直觉中形成解决方案主要部分细节的能力,之后就可以根据自己先前的经验积累来对解决方案进行映射。一个精通的人需要对其行动的上下文有更广阔的了解,并且开始享受隐喻和格言(以及相反的类似内容)带来的乐趣。他们仍然会回头根据接受的基于规则的训练,来验证自己行为的正确性;但在这个阶段他们已经学着相信自己的判断了。
从“新手”发展到“胜任”阶段基本上是线性的过程,而到“精通”阶段代表了一个台阶的提升。一个人必须积极选择才能促成这个转变的开始。通过对某件事情重复足够的次数是可以达到“胜任”的,但要变想得“精通”,必须要有明确的心理诉求才行。
正如从“胜任”到“精通”的转变一样,转变为“专家”也是非线性的过程。要想成为某个领域的专家,可能要花费数年的努力才能达成。这些人工作时几乎完全是从直觉自发的状态,而且很少犯错误。
专家生活在模糊的世界之中。她以自己的能力为傲,而且喜欢通过与其他专家交流来校正和提高自己的技能。有趣的是,处于初级阶段的人们倾向于过高估计自己的能力,而在较高阶段的人则更加谦逊。
当世界发生碰撞之时
很不幸的是,专家无法解释他们的决策制定过程。不妨把他们想象为处于自动导航状态的飞机:由潜意识产生的、已经成型的解决方案,直接在他们面前显现。职业网球运动员就是“知道”如何回一个上旋球。职业音乐家将手中的乐器视为自己身体的一部分,而不是他们操纵的某种设备。
要知道大部分人在自己所做的大部分事情上还处于“高级初学者”或“胜任”阶段,这在职场中同样适用。这就意味着一个专家级的程序员——或者测试人员、分析师——可能有一个处于“胜任”阶段,甚至更有可能在“高级初学者”阶段的上司。(直到最近,你认识几个曾是天才程序员的项目经理?Dreyfus模型对他们同样适用。)
这些人以任务为核心进行思考,乐观一点,也是以一系列有明确顺序的任务所要达成的目标为核心。他们的思维无法接受类似“我已经有15年的应用交付经验了,我就是知道我们不应该使用ESB”这样的话。(“就是”这个词又出现了)当然,“精通”或者“专家”级别的人会接受这样的解释,实际上他们愿意首先主动去寻找专家来提供直觉自发的解决方案,并在以后坚决支持他们的决策。
最佳实践和Dreyfus模型
对Dreyfus模型有了一点点“新手”的理解之后,不妨再回顾一下“最佳实践”这个词汇。它到底是什么含义?“实践”就是我们所做的事情。它们是一些特别的行为和活动,是被规定好了的。“最佳”是一个绝对化了的限定语(与有对照的“更好”或者更为温和的“很不错”相对来说)。它与上下文无关,并且毫不含糊。用“最佳”一词就表明对于这些实践来说,不存在更好的实践。
所以根据这个定义,“最佳实践”就是一系列与上下文无关的、明确无误的、规定好的活动。在基于任务的学习中,它们就是任务。那么不同的技能水平又如何回应到这样的模型上呢?
最佳实践可以帮助初学者
“新手”需要最佳实践。没有它们,他们的工作就不能正常进行。实践为他们指明了前进的方向——越详细越好。
“高级初学者”使用最佳实践。他们在迈向“胜任”这个阶段的旅程中,会很容易越过正确与错误的边界,而最佳实践可以帮助他们看清这个边界在哪里。
处于“胜任”水平的人可以制定最佳实践。不过要注意,他们是以目标为导向的,但仍依赖于具体的执行步骤和顺序来达成这些目标。他们记得成为“高级初学者”的过程,记得犯过的所有错误,而且他们希望让以后的“新手”不要重蹈覆辙。这一点后面再详细讨论。
最佳实践会限制你最棒的人才
已臻“精通”境界的人有时会回头复查最佳实践。他们正学着相信自己的直觉,可直觉不一定总是足够的。在这个阶段,最佳实践可以起到帮助和阻碍的双重作用。如果直觉要你做一些超出条条框框的事情,你可能为了要遵守最佳实践给定的规则而止步不前,从而无法以最有效的方式达成目标。
到了最终阶段,“专家”是不会使用最佳实践的,因为他们根本不使用任何实践。实际上,专家们会为了达成目标而“颠覆”最佳实践(或者,颠覆紧密伴随着最佳实践的僵化流程)。纵使最佳实践是必须与之相伴的无可避免之弊,也不能让它束缚住手脚。
上述后两级别的相关人士,特别是专家,会很快对基于实践的做事方式表示厌恶;已经到达“胜任”级别的人,对被给予任务级别的做事细节指导也十分厌恶,而这两种厌恶完全相同。(“把红8放在那儿,黑9的下面,然后老A就可以自由移动了”。)当要求专家遵守规则的限制时,就不仅仅是坐在后面座位对司机指手画脚了,你正在对他们很少出错的本能和直觉提出质疑。
最佳实践应由中心驱动
绝大部分基于实践的流程和主张都来自处于“胜任”级别的人。虽然没有任何统计学上的证据,但是我坚信这一点。处于在“胜任”级别的人,相信他们在低水平阶段所犯的错误是源于被分配任务的描述不够严格和完整。如果我们能够提供足够好的实践,就能让大家从“新手”直接到达“胜任”阶段,而不必在“高级初学者”阶段浪费努力,徘徊不前。可是在“提供实践”这个技能上,处于“胜任”级别的人还不知道 “精通”是什么感觉(要牢记:做任何事情都是从“新手”开始的,包括对“学”的学习,以及对“教”的学习),所以他们没有充足的理由——或证据——来相信自己的直觉或本能。专家所做的任何事情,总是可以被分解为一系列可重复的实践的——这也可被成为“技能分解(de-skill)”过程,这样技能水平稍差——直接面对吧,收入也略少——人士们就可以完成同样的任务了。
我们可以有一组来自“卓越中心(Centre of Excellence)”或“最佳实践小组(Best Practice Group)”的专家,让他们制定最佳实践,并将其在整个企业中推行。
在这个上下文中,“专家”并非意味着Dreyfus模型中的专家,而是某个十分胜任其工作的人。这里有一个非常重要的区别。像IBM的深蓝计算机那样可以击败国际象棋大师的电脑不是专家。它只不过是能够飞速覆盖大量的概率搜索空间而已(深蓝计算机这个例子非常用在这里非常恰当,因为Dreyfus兄弟当初在研究人工智能时就是选定象棋作为最初的问题,而1997年深蓝击败加里•卡斯帕罗夫是计算机国际象棋研究中的一个重大里程碑事件)。从这个意义上来看,它确实非常、非常胜任!最近在神经学上的研究显示,在某个领域的专家处理问题的速度并不比常人快多少。实际上,他们处理的东西更少。在处理同一个问题时,专家的大脑活动要少于非专家。换句话说,他们会本能地削减解决方案空间,而且对于哪一部分更有可能产生结果,他们的感觉更加敏锐。(国际象棋计算机的例子反复出现,是因为Dreyfus兄弟当初在研究人工智能时就是选定象棋作为最初的问题,而且深蓝击败了加里•卡斯帕罗夫。)
更好的最佳实践
在Dreyfus模型的上下文中,我们可以开始建立一个更加适宜的模型,在不削减专家权威的同时还可以传播知识。而专家正是激发组织中下一代知识工作者成长的关键人物。
首先,要提供上下文,要将实践和实践者的上下文都包括在内。基于受众的Dreyfus级别,要从不同的角度和不同的抽象水平叙述同一条原则。可以确定的是,你不可能对他们以同样的定义来阐述同一条实践。
其次,实践应该是可表述的而不是规定好的。换句话说,要描述期待的产出,或者展示达成目标的不同方式和途径。对于新手来说,能够选择一种他中意的方式来做事是很有益的。以手把手握着方向盘的方式教人开车,是非常安全的驾驶方式。对于熟练的司机来说,用快速转弯的方式进行倒退停车,这也许不是最有效的方式,但他们总是可以学会的。对于专家来说,在面临危机时,他们最需要的是发自本能的智慧,千万不要在一旁指手画脚,分散他们的注意力,引起他们情绪上的反弹,从而影响问题的解决。
要列出实践的利弊之处。我不知道有什么实践是完美无缺的。大多数事物都是在权衡和妥协中发展起来的。再次说明:新手很难从中获益,不过这样为达到“精通”水平的人士和专家提供了在“规则”内充分发挥自己能力的空间。
最佳实践模式
实际上,当一个最佳实践在Dreyfus模型的范围内愈加适用,它就愈像一个模式了!
一个“亚历山大”模式——以建筑师克里斯托弗•亚历山大而命名——描述了一个上下文,它所应对和引入的不同的“外力”(外部因素),以及一些典型的示例。在亚历山大模型体系中,一个模式只有在与其他模式联合使用时才能发挥作用,因为只有这样才能创建交互作用力的体系,以互相平衡,产生和谐。
将此哲学应用到“最佳实践”上,可以开发出一整套互相依存、彼此合作的实践体系。新手可以像使用“烹调指南”一样用之指导自己的工作;中等级别的人可以用之实践,而专家则可以对之品评。实际上,首先提供上下文是一种非常有用的练习,对识别某个或某组特定实践的价值非常有帮助。
结语
人们不愿意冒险。一般人认为是由于畏惧使然,这没关系。对于我们应该(从理性上)害怕的东西,去评估遇到它们的可能性并努力规避,这是完全正确的。
最佳实践的目标是为新手提供指南。人们在学习时会犯错误是因为犯错误就是学习的一部分。无论看起来多么诱人,你也不可能跳过“高级初学者”的阶段,从“新手”直接达到“胜任”水平而不犯任何错误。人类的学习过程不是这个样子的。软件开发是一种技能,无论你从事的是哪一方面——作为开发人员还是测试人员,作为分析师还是项目经理——表现最出色的人明显是从本能出发进行工作的。如果他们不能解释决策的过程,这就是他们具备高级专业技能的显著标志(当然,不要把缺乏基本的沟通技能与此混为一谈!)。
要想在一个要求多种技能的组织里创建某种一致性,相对有明确分割界线的最佳实践,亚历山大模式提供了一种更加实用的策略。
实际上,最好的“最佳实践”既不是最佳的,也不是实践。
致谢
ThoughtWorks前同事Robin Gibson是第一个向我介绍Dreyfus模型的人。“实用程序员”Dave Thomas在QCon 2007上就其做了一个精彩的演讲,也将我引向了Partica Benners的书《从新手到专家》(From Novice to Expert)。这是一本让人大开眼界、令人为之一振的书,其中充满了各种趣闻轶事,而其作者是一位护理学方面的专家。Øredev的组织者Michael Tiberg,好心地允许我在他的会议上进行以“最佳实践”为题的演讲,这也是本文的缘起。在会上,我与Andy Hunt进行了交流,发现他妻子似乎是将Dreyfus模型引入到软件社区的第一人!Andy目前在写一本书,Dreyfus模型是其中的重点,此外还涉及其他一些关于人们优秀的思维方式的内容。当然,还要感谢Niclas Nilsson建议我写这篇文章,而且为我提供公开发表的机会。

译注1:所谓钟形曲线又称正态曲线,它是一根两端低中间高的曲线。它首先被数学家用来描述科学观察中量度与误差两者的分布。比利时天文学家奎斯勒首先提出大多数人 的特性均趋向于正态曲线的均数或中数,越靠两极的越少,从而把正态曲线首先应用于社会领域。以后在高尔顿爵士推广下,正态曲线被借用至心理学,用来描述人 的特质量值的理论分布。PeopleSoft全球首席顾问韩斯瑞(Row Henson)女士根据钟形曲线的研究发现,若以工作绩效与能力区分,钟形曲线的中间突起部分,可以视为企业员工表现的平均值;经统计得知,企业内表现值最高的前10%的业务员,大约可为企业带来60%的营收。也就是说,位居企业内前10%的高绩效员工所创造的绩效,将高达整体员工共创绩效的60%。若企业能成功掌握这10%员工的动态,并在必要时刻从另外90%的员工中做出裁员决策,不但无损于绩效创造,更有助企业精简人事成本计划的执行。
译注2:原话为乔治•卢卡斯在《星球大战》系列影片中为尤达大师编写的一句台词:“恐惧导致愤怒。愤怒导致憎恨。憎恨导致痛苦。(Fear leads to anger. Anger leads to hate. Hate leads to suffering.)”

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发表于 2011-7-18 22:48 | 显示全部楼层
感谢胡教授给我们提供一个这么好的学习平台,期待着新书的出炉,指导我们院感染控制工作。现在看来英语是太太重要了,可英语是怎么也学不会了。
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 楼主| 发表于 2011-7-18 22:52 | 显示全部楼层
到7月20日22:48,已经有24位论坛会员报名,欲参加本书的编写工作。
报名截至日期为7月20日。
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发表于 2011-7-18 23:34 | 显示全部楼层
回复 1# icchina


尊敬的胡老师:
我已经发送站内信息给您了。我想尝试下这个工作,也为论坛为广大会员尽一点绵薄之力。
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发表于 2011-7-19 00:16 | 显示全部楼层
回复 19# icchina

在感染管理领域,我感兴趣的领域是手卫生、ICU目标性监测、供应室管理。
当然我也是一枚螺丝钉,哪里需要就到哪,服从安排。集体利益高于个人利益。

对于本书的编写,以下是我的拙见,权当抛砖引玉,让大家讨论:
院内感染管理是传递新知识、新观念给医院的其他相关人员,让他人去执行措施的一个过程。
我们不是各种措施的执行者,而是观念的传播者。
写书的目的不外乎:
1、提供新知识,作为院感人的工作参考书,遇到问题时可以查阅和参考。
2、提供新观念,作为其他专业人员的参考书,需要医师和护理人员自己来看书。
因为医护人员只靠院感培训是远远不够的。
但是医师和护理人员都只喜欢看自己专业的术,似乎其他专业和他们没有关系。
让本书变得具有可读性,而不仅仅是一些数字和条款,或许可以吸引更多的读者。

是否可以以故事的叙述手法展开,通过故事引出在医疗护理过程中的关键点的院内感染知识与实践。(现状、措施、展望); 故事与知识相互交叉进行写作。

例如:外科手术部位感染SSI
5:00,OOO就醒了,病房的病友还在睡梦中。她轻轻起身,今天是她做胆囊手术的日子。
6:00,护理人员来给她测体温,量血压,让她换上病员服。并在她的右手臂上打上留置针,告诉她,这个针到手术室才会使用。
7:00她被推进了手术室,这是她第一次进手术室。
7:00  OO 医师已经到了病区,护理人员告诉他他的第一台手术患者已经接进手术室了。
7:45 病房医护人员开始交班。
8:30 OO 医师准时出现在手术室。换上熟悉的刷手衣,开始刷手;

全世界每年有外科手术    台,中国没有有    ,通过手术挽救了无数人的性命。但是术后的切口感染也造成一系列严重的后果。这个问题一直也困恼医师的。
叙述外科手术切口感染的定义、目前情况。

再回过头写手术室里发生的事情,写相关感染控制措施、做法与实践。
以上是我自己的不成熟的想法,欢迎大家讨论!

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发表于 2011-7-19 08:17 | 显示全部楼层
盼望新书快些出炉,这个感控论坛真是我们感控人员的家,谢谢帮主!
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发表于 2011-7-19 10:54 | 显示全部楼层
希望这部指导书能对各个层次的医院的院感工作有引领和实际指导作用,万分感谢,期待!
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发表于 2011-7-19 11:42 | 显示全部楼层
不好意思,我的英语水平低,不能胜任。
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发表于 2011-7-19 12:10 | 显示全部楼层
回复 20# 相约感控

将鼠标移至icchina头像上,可以看到头像下发有个“发短信息”,点击即可编写短信内容。
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发表于 2011-7-19 12:11 | 显示全部楼层
回复 9# icchina
8月份召开编委会,是不是版主都要参加啊?
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