Dr Adeyemi can tell you exactly what is wrong with the clinic, and she can show her working.
Every prescription needs her countersignature. So the pharmacist interrupts her eleven times a morning. So consultations overrun.
So she writes her notes after seven — so the next patient's notes aren't ready, so that history gets taken twice, so that consultation overruns too.
That is not an opinion. It is a chain. It has parts, and each part could be wrong somewhere specific.
Four other people are carrying chains just as detailed, and they arrive somewhere else entirely.
The practice manager's ends at funding. A nurse's ends at the ten-minute appointment rule. Maria's ends at the referral backlog.
All of them are intelligent. All of them have been there years. All of them are certain.
And not one of those chains has ever been outside the head that made it.
Part two of three · Thinking in Systems
Why reasoning has to come out of your head before anyone — including you — can tell whether it's any good.
This is the thing standing between the clinic and its constraint. Not that nobody knows — five people have a theory. It's that there is no way to choose between them.
You can't do it by arguing, because you have been in that meeting. The winner is whoever is most senior, most confident, or least tired at four o'clock.
Try it yourself, on something small.
Take something you believe about why something in your life isn't working. Why the team misses deadlines. Why the meetings are useless. Why you never get to the gym.
Write it down as a sentence: X causes Y.
Two things tend to happen. The belief that felt crisp in your head goes vague the moment it has to survive on paper. And once it's written, it starts sprouting doubts you'd never consciously entertained while it lived comfortably inside your skull.
Nothing has changed except that it is now outside you, where it can be looked at.
Most of our thinking about complicated situations happens invisibly, in intuition. Intuition is fast, rich, and often right. It is also unexaminable.
When your instinct says the real problem here is funding, there is no chain of inference to inspect, because there is no chain. There is a feeling with a conclusion attached.
So disagreements between intuitions can't be settled by evidence. Only by rank, charisma, or exhaustion.
Now — plenty of people already draw diagrams. Flowcharts. Mind maps. Boxes on a whiteboard with arrows between them.
And people do argue with them. That shouldn't come before this. That box is wrong.
But watch what happens next. Nothing says what would make an arrow correct — so the objection is one more opinion, resolved the same way everything else in the room is.
The arrows are contestable. They are not checkable. There is no standard a challenge has to meet, and therefore none it can win by.
An arrow is only worth drawing if it can be shown to be wrong. And that requires rules.
So here are the rules. They are less a technique than a set of questions you are allowed to ask about any claim anybody makes.
Do I understand you? Not do I agree — do I know what you mean. A great many arguments that look like disagreement are two people using one word differently and getting steadily angrier about it.
Is that a claim at all? A complete thought, one idea, that could be true or false. "Funding" is not a claim.
Is that cause enough on its own? If we have fuel and a heat source, then we have fire. True? No. You forgot oxygen — because it is always there.
Could something else have done it? Remove your stated cause. Would the effect have happened anyway? If so, you haven't explained anything yet.
Have you got it backwards? Anglers on the bank did not cause good fishing. They are how you know it. The cause is that the river was stocked on Tuesday.
If you're right, what else would be true? If it's appendicitis, expect a fever and a raised white cell count. If they aren't there, it isn't — however confident you were.
And are you going in a circle?
Every argument has an oxygen: the condition so ordinary that nobody names it, right up until the day it isn't there.
Confusing the sign for the cause is how organisations end up managing their indicators instead of their problems. It is how you end up hiring a receptionist because the queue is at the desk.
Seven questions. Notice what almost none of them are about.
They are not about clinics. You do not need to know anything about running one to ask is that cause enough on its own? — and that is what makes the challenge survivable. You aren't disputing someone's fifteen years of experience, which you don't have. You are asking about the shape of an argument, which is on the page in front of both of you.
Answering is a different matter. Knowing that fire needs oxygen, or what else raises a white cell count, often takes exactly the expertise you lack. But the question can come from anyone, and a question nobody can dismiss is a great deal more than most meetings have.
And here something changes that has nothing to do with logic.
When reasoning is invisible, criticising someone's conclusion means criticising them — their judgement, their competence, their years. So they defend, and you push, and the meeting generates heat instead of light.
When the reasoning is out on the page, the page takes the criticism.
Two people can stand side by side, looking at the same diagram, hunting for the flaw together. Dettmer's phrase for it: not you against me, but you and I against the problem.
I don't see how this cause is sufficient — what am I missing? is not an insult. It's a legal move.
It doesn't always work. Some people won't update however cleanly their chain breaks, and a diagram can be gamed as easily as a meeting can. But when a group has genuinely tried to break a piece of reasoning and failed, they tend to believe it — not because they were told, but because they attacked it and it held.
Back to the clinic, and the five certain people.
Nobody has to decide who is right. Each of them puts their chain on the wall, and then everybody gets the questions.
Some chains won't survive contact. Two will turn out to be describing the same cause from different ends. Dr Adeyemi's countersignature and Maria's referral backlog may well be the same animal seen from opposite sides of the building.
What's left is not five opinions.
It is one map that five people built and none of them could break — which is a different kind of object entirely.
Though it does raise the question of what, exactly, you should be mapping. Why are we stuck turns out not to be the first question. It isn't even the most important one.
The eight rules are the Categories of Legitimate Reservation, set out in H. William Dettmer, The Logical Thinking Process (ASQ Quality Press, 2007), chapter 2: clarity, entity existence, causality existence, cause insufficiency, additional cause, cause-effect reversal, predicted effect existence and tautology. Seven are used here; two are merged, and the names are dropped in favour of the questions they ask.
The worked examples are Dettmer's own: fuel and heat without oxygen; a fever from either infection or exertion; the anglers whose full nets are the indication rather than the cause of good fishing (an example he credits to Charles M. Johnson); and appendicitis predicting a fever and a raised white cell count. So is the observation that a diagram without rules for validating its connections is "somebody's perception of the relationship" rather than a logic tool, and the framing of scrutiny as "not you against me, but you and I against the system."
The Ashfield clinic is a composite, continued from part one.