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Tag: scope of practice

Scope of practice: a careful borrowing from medicine to agile

Update: turns out Esther Derby and Sal Freudenberg wrote this much better than I did in their blog post Guidelines and Guardrails back in April 2018, including ten very useful questions to ask yourself to see if you are indeed extending beyond your scope of practice.

When I’m not too scared to go to the gym (because COVID-19 + everyone breathing heavily + mask wearing not mandated = a whole lot of nope from me), I squat, bench, and deadlift for the good of my health. Chief among my guides to the art and science of lifting heavy objects and setting them back down again without hurting myself are the good Drs Feigenbaum and Baraki at Barbell Medicine, my pals* Eric Trexler and Greg Nuckols at Stronger by Science, and Omar Isuf and Eric Helms of Iron Culture.

Lifting has been a major theme in my life for nearly three years now, and I’m #grateful for everything my hours under the bar have taught me; it’s one of those things where the benefits just keep on compounding so long as you commit to the practice. Being able to listen to podcasts, watch Youtube, and follow the Instagram lifting of the major experts in several different parts of the field is one of the great privileges of our connected age, and it adds considerably to the learning I get from my own practice.

One of the reasons I admire and appreciate the folks I choose to follow in the lifting world so much is that despite their having deep expertise they all very actively recognise where their expertise ends. For example, on their podcasts they all conciously and routinely call out when they’re reaching the limits of their own knowledge. As I understand it from listening to them, self-knowledge and reflection is really important for sports and health professionals given their power over others with regard to programs of training and treatment, and it is from the Jordan Feigenbaum at Barbell Medicine that I first came across the concept in medicine of scope of practice.

The UK Health and Care Professionals Council, who regulate the use of a number of protected job titles in health care, define scope of practice as

[…] the limit of your knowledge, skills and experience. It is made up of the activities you carry out within your professional role, provided that you have the knowledge, skills and experience to do them lawfully, safely and effectively.

UK Health and Care Professionals Council

A good example of a medical practitioner working within their scope of practice would be your GP choosing to refer you to a specialist for further treatment. If you needed heart surgery, both you and your GP would like it to be performed by a heart surgeon with the necessary knowledge skills and experience to have the best chance for it go well. Scope of practice is a regulatory and legal concept within medicine, and GPs performing heart surgery would be prosecuted for doing so while unqualified.

Which brings me to thinking about how as agile coaches we love a new technique, and how eager we often are after conferences or meetups to try new techniques on our teams. Folks in the software development industry tend toward being early adopters: we like shiny new things and it is literally our job to be innovative and foster innovation. With this, I think, comes an adjacent tendency towards borrowing from other fields. Sometimes we do this well, but frequently we do this without sufficient regard to the contexts of those fields, and much too often we fail to appreciate the years of training and practice needed to develop expertise in those fields. In trying to think a lot more about the importance of both context and expertise, I have been deeply influenced by Dave Snowden’s work, and also the blogs of What’s the Pont (Chris Bolton) and Complex Wales.

In particular, I fear that I have seen many agile folks use therapy-type techniques on other people without knowing what they’re doing, and it greatly worries me. One of the main risks scope of practice aims to mitigate is an individual’s ability to harm others in applying techniques they are unqualified to perform, and I’m afraid that some of the things I’ve seen advocated by agile coaches recently have the potential to cause harm.

Here in the UK it takes the better part of 10 years to become a registered counselling psychologist, a job title regulated by the aforementioned Health and Care Professionals Council. Professionals in this field have spent three or four years working towards an accredited undergraduate degree, and graduated with a 2.1 or above. Following this they’ve completed either a doctorate or a postgraduate qualification, which takes another three or four years. Let’s further note that both of these qualifications have significant mandatory ethics components, something which is currently missing from many Comp Sci and other science degrees. Once qualified, psychologists are required by their regulatory bodies to undertake continuous professional development in order to maintain their skills as a practitioner.

And so, unless you are in fact a qualified and practicing psychologist keeping up their CPD in addition to being an agile coach, you are an agile coach and not a psychologist! Same goes for not being a therapist: retros are not and should not be group therapy, because you are not a trained and experienced therapist. Techniques used in marriage counselling are probably not appropriate for use in the context of the workplace. In particular, and this is really what has prompted this whole blog, I very strongly suspect that the recent trend of inserting enforced giving and receiving of appreciation into team ceremonies does not work the way you think it does for creating connections among teammates. I’m really pushing the bounds of my own scope of practice here, so I’ll caveat this, but if this technique were being inflicted on me the bonding with my teammates would likely come from the complaining about it in the queue for the coffee machine afterwards.

Medical practitioners and allied professions spend a lot of time and effort balancing risks of treatment against the benefits. As agile coaches, even if we see the benefits I think we really need to stop using therapy techniques we don’t fully understand the risks of on our colleagues! And in a not entirely unironic fashion, I think we can carefully borrow the concept of scope of practice from medicine to help us think about this. To be really clear, I’m not saying that we should regulate our profession, although you can insert your own joke about Certified Scrum Masters here. What I am saying, though, is that I think we might all be better, more ethical, and more people-centred agile coaches if we take some time for personal reflection about where the boundaries are (or should be) of our own practice, and start recognising and respecting those boundaries in our work.

Ann 🦉

*Disclaimer: Eric and Greg are alas not my pals IRL, but I sure wish they were.