Enabling Environment:
Clinical Context
02/03/2022 Compiled by Valmeek Kudesia
General Context
Characteristics
Allows a person, who is not an expert in a subject matter to accomplish meaningful goals in the same subject matter AS IF that person was an expert in the subject matter
Real-world feasibility usually requires focus on specific subject matter and specific meaningful goals in the subject matter.
"Specific" = most, many, some, or few of the meaningful goals in the subject matter area
"Specific" = not ANY arbitrary goal in subject matter area
Focuses upon growth or action with direct instead of indirect relationship to end-to-end real-world outcome
Does not focus upon
Simplified or artificial distortions of meaningful goals within a subject matter that an expert would not consider authentic
Specific steps that an expert performs to achieve the meaningful goals (usually achieves the meaningful goals via a method derived from method of a subject matter expert.
Real-world relevance of each meaningful goal in a subject matter area may vary widely i.e. 80% of real-world end-to-end outcomes is concentrated on 20% of meaningful goals within a subject matter area.
Usually, support of >50% of end-to-end real-world outcomes in a consistent and repeatable fashion yields a solution for general availability
Uses abstractions to boosts performance of novice e.g.
Expands the awareness of important information available to novice
Expands the range of actions available to novice
Expands the upper bound of novice capability
Enables of related additional capability by a novice
If abstraction is a virtual system, this usually follows a known progression pattern e.g.
have visibility more like an expert
have the capability more like an expert
Illustrative Examples
An navigation app on a consumer-grade mobile device that allows a person to
arrive at a specific restaurant (must be documented prior, not any arbitrary restaurant)
in a specific unfamiliar city (must be mapped prior, not any arbitrary city)
AS IF that person had detailed knowledge of streets and traffic patterns in that city
SO THAT a person who lives in that city would find the route plausible
Specialized consumer-grade kitchen appliances e.g. bread maker that allow a person to
produce a specific range (must be documented prior e.g. whole-wheat bread, sourdough bread, not any arbitrary type of bread)
of specific foods (must be defined prior e.g. only breads, not any arbitrary type of bread or pastas, or cakes)
AS IF that person had detailed culinary knowledge of those types of foods
SO THAT an expert in the type of food (e.g. expert baker) would find the food acceptable
Illustrative Counter-Examples
A solution that only made the car's steering wheel easier to turn; this would reduce the effort needed to steer the car easier but unlikely to substantially improve a person's likelihood of real-world arrival at the restaurant in an unfamiliar city
A solution that focused on identifying the best bread-baking pan out of a wide selection of pans; this would address a challenge likely only faced by expert bakers who have a wide selection of different baking pans.
Real-World Impact
Based on Gulf between desire and acceptability, real-world behavior may self-limit to favor the generally available solution given constraints (e.g. convenience, reliability, price) and expand the real-world impact of a given solution e.g.
Patrons start to favor dining at specific restaurants that are find-able via a navigation app
Individuals start to favor specific types of bread with more convenient availability
Clinical Context
Characteristics
Allows a person with a given level of training, experience, or license to
Consistently achieve a specific range of outcomes in a specific clinical area
AS IF that person had a higher level of training, experience, or license
SO THAT another person with higher level of training or experience would find outcome acceptable
Illustrative Examples
A calculator that performs
dose adjustment of warfarin (specific medication)
based on specific patient characteristics and is available for any prescribing clinician
AS IF that clinician had specific training at an anticoagulation clinic
A system that allows a
specific clinician to quickly order
specific pharmacy to quickly receive and dispense urgently needed medications
AS IF the clinician and pharmacy had many years of working as a team with well-established communication practices and well-known areas of potential confusion
A system that allows a
specific care manager to know when their assigned patients
visit specific emergency departments or are admitted to specific hospitals
AS IF the care manager had many years of professional relationship with the staff at those facilities
Illustrative Unsuccessful Counter-Examples
A solution that only made it easier to enter numbers into a general purpose calculator
Lowers effort needed to type numbers
Unlikely to substantially increase likelihood of real-world correct dose adjustment of warfarin for patient characteristics
A solution that only increased the speed of which the clinician wrote by hand the prescription
Lowers the effort needed to hand-write a medical prescription
Unlikely to substantially reduce the time needed for a pharmacy end-to-end receive and dispense a medication.
A solution that only automated the dialing of a desk phone to call the care manager for a verbal conversation between on-site staff and care manager
Marginally reduces the barrier to alert a care manager
Likely to increase barrier for on-site clinicians to place a phone call to other important locations e.g. on-site laboratory
Real-World Impact
Real-world clinical behavior may self-limit to the generally available and more reliable solution e.g. prescribing clinicians may favor specific pharmacies that reliably receive and dispense medications