Expertise is all around - it's just not evenly distributed.
Writing down remediation items is a seductively simple outcome for a post-mortem. It’s satisfying. “Yea, there was an issue but if we do these 3 things, we will be better off”. It’s all wrapped up in a nice bow. Although remediation feels like the right outcome, it’s not the most powerful reason to do a post-mortem. The most valuable part of a post-mortem is the ability to radiate expertise into your organization. It feels counter-factual. Why, if our organization is expert, did it fail?
“The future is already here – it’s just not evenly distributed.” - William Gibson, The Economist, December 4, 2003
Expertise is similar to the future. It’s at your organization, but it’s not evenly distributed. It might make sense though when we consider what we actually do everyday. We are mostly just trying to get things done. Learning is important, but I can’t spend my whole day learning, I must produce something of value after all. So, I work, we all do, and through our work we learn, sometimes we learn without fully articulating what we’ve learned. This leads to pools of expertise that have a hard time flowing into other parts of your organization. It’s not uncommon for expertise to be hard to explain.
“Experts in making diagnoses are not necessarily experts in explaining their process of diagnosis.” (Michalski & Chilausky, 1980, p. 63)
We don’t find it just in diagnosing, what about baking chocolate chip cookies, knowing when it’s going to rain, or tilting while making a ski turn. These are all expert things, that are subconscious at times. Even though our work can be technical, we can still develop non-technical or unexplainable responses to technical phenomena.
I’ll bet you already do this. Imagine for a moment, you open your laptop and turn on Slack, or your organization’s internal chat mechanism. I’ll bet you might already have a sense of what’s going on based on the number and nature of notifications you see. Your body is probably reacting to it before your mind catches up.
I know for some of you I might even have triggered a sense of anxiety, notifications for some folks mean a problem. I’m sorry, I’ve been there.
Now, even if you agree with me so far, you might be surprised to learn that one of the best ways of accessing the expertise in your organization is through incident reviews. It’s sometimes referred to as the “New View” of safety. And, amazingly the essence of this practice is boiled down into this guide: Etsy’s Debriefing Facilitation Guide. For its size, is such a brilliant document. It makes the most helpful postmortems attainable.
By letting safety and learning guide these discussions, you can begin to unearth the tacit knowledge in your organization. Hopefully, it will help radiate expertise through your organization. You can begin to systematize expertise and I think most importantly you can find what is limiting the capacity of individuals in your organization thus creating a virtuous cycle of building capactiy in your organization.