House MD: Solving Complex IT Issues Using Differential
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House MD: Solving Complex IT Issues Using Differential Diagnosis In this presentation I will explore how we as IT professionals can learn from the medical profession when it comes to diagnosing ...

House MD: Solving Complex IT Issues Using Differential Diagnosis In this presentation I will explore how we as IT professionals can learn from the medical profession when it comes to diagnosing particularly complex issues. The human body is complex, as are the applications and computer systems that we are responsible for. These systems sometimes experience “issues”. This can be diseases in patients or for us a site outage or slow-down. Medical doctors have been fixing people longer than we have been tinkering with computers. The first medical diagnosis textbook was dated 1069-1049BC. I will take you through how to manage the problem using “Differential Diagnosis”, which is a widely used mechanism for solving those particularly hard cases. It is particularly useful when trying to problem solve with a team. We will touch on the culture that is needed to allow these methods to flourish in your organisation, as well as a few of the do’s and don’t when trying it out for yourselves. I hope the audience will be left with an understanding of how to apply these processes to reduce your own TTR and make your boss smile.

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House MD: Solving Complex IT Issues Using Differential Presentation Transcript

  • 1. House MD: Solving Complex IT Issues Using Differential Diagnosis Steve Bennett Steve@DaemonSolutions.com @DaemonSteveSaturday, 30 June 12
  • 2. AGENDA A Brief History Of Medical Diagnosis. Why & How You Should Prove Yourself Wrong. Differential Diagnosis. Diagnostic Approaches. Diagnostic Thresholds. Do’s, Don’ts & Application.Saturday, 30 June 12
  • 3. Who’s This Guy?Saturday, 30 June 12
  • 4. Why...?Saturday, 30 June 12
  • 5. Saturday, 30 June 12
  • 6. http://www.technologyreview.com/tr35/profile.aspx?TRID=1108Saturday, 30 June 12
  • 7. Saturday, 30 June 12
  • 8. http://flic.kr/p/npaoTSaturday, 30 June 12
  • 9. http://4.bp.blogspot.com/_lSXhEtQUdtA/S-EL5w7dt3I/AAAAAAAAANE/G0oc_cGPXAY/s320/USAirways+in+the+water.jpgSaturday, 30 June 12
  • 10. Medical DiagnosisSaturday, 30 June 12
  • 11. http://4.bp.blogspot.com/-cCTr1WWve1E/TfefWAn8zvI/AAAAAAAAAA0/aXO50-syXuE/s1600/Imhotep_Museum-hd-1.jpg Imhotep - 2600BCSaturday, 30 June 12
  • 12. http://en.wikipedia.org/wiki/File:Edwin_Smith_Papyrus_v2.jpgSaturday, 30 June 12
  • 13. http://www.sculpturegallery.com/two/hippocrates3.jpg Hippocrates - 460BCSaturday, 30 June 12
  • 14. http://www.sculpturegallery.com/two/hippocrates3.jpg Galen - AD131Saturday, 30 June 12
  • 15. In Summary; It’s Been Around A Long Time..Saturday, 30 June 12
  • 16. Hypothetico-Deductive ModelSaturday, 30 June 12
  • 17. William WhewellSaturday, 30 June 12
  • 18. "No amount of experimentation can ever prove me right; a single experiment can prove me wrong." Albert EinsteinSaturday, 30 June 12
  • 19. Hypothetico-deductive modelSaturday, 30 June 12
  • 20. Something unexplained happens.Saturday, 30 June 12
  • 21. http://www.flickr.com/photos/dougcaldwell/4213877479 Hypothesize.Saturday, 30 June 12
  • 22. Plan a test that can falsify. Predict the result.Saturday, 30 June 12
  • 23. Test. http://www.flickr.com/photos/kenilio/3351824931Saturday, 30 June 12
  • 24. Hypothesize. Plan a test that can falsify. Predict. Test.Saturday, 30 June 12
  • 25. An Example.Saturday, 30 June 12
  • 26. I went shopping..Saturday, 30 June 12
  • 27. Saturday, 30 June 12
  • 28. Saturday, 30 June 12
  • 29. Failed Card http://flic.kr/p/9MShdESaturday, 30 June 12
  • 30. Saturday, 30 June 12
  • 31. Hypothetico-deductive modelSaturday, 30 June 12
  • 32. Something unexplained happens.Saturday, 30 June 12
  • 33. Hypothesise.Saturday, 30 June 12
  • 34. I’ve Spent Too Much On SSD’s My Wife Has Been Shopping Hypothesise. There Is A System Problem I Didn’t Pay My Bill In TimeSaturday, 30 June 12
  • 35. Plan a test. Predict.Saturday, 30 June 12
  • 36. Test: I’ll call the credit card company. Plan a test. Predict.Saturday, 30 June 12
  • 37. Test: I’ll call the credit card company. Plan a test. Predict. Prediction: I have sufficient funds. (If correct will falsify 3 hypothesis)Saturday, 30 June 12
  • 38. Test.Saturday, 30 June 12
  • 39. Test. Result: I have sufficient funds.Saturday, 30 June 12
  • 40. I’ve Spent Too Much On SSD’s My Wife Has Been Shopping Hypothesise. There Is A System Problem I Didn’t Pay My Bill In TimeSaturday, 30 June 12
  • 41. Hypothesise. There Is A System ProblemSaturday, 30 June 12
  • 42. Hypothetico-Deductive Model Hypothesise. Plan a test that can falsify. Predict. Test.Saturday, 30 June 12
  • 43. Differential Diagnosis.Saturday, 30 June 12
  • 44. Or DDxSaturday, 30 June 12
  • 45. What is it?Saturday, 30 June 12
  • 46. It’s that thing that House does.Saturday, 30 June 12
  • 47. Its a framework for problem diagnosis.Saturday, 30 June 12
  • 48. Its best used alongside the hypothetico-deductive model.Saturday, 30 June 12
  • 49. Process of elimination.Saturday, 30 June 12
  • 50. Assume most obvious. Until proved otherwise.Saturday, 30 June 12
  • 51. "When you hear hoof beats, look for horses, not zebras"Saturday, 30 June 12
  • 52. Saturday, 30 June 12
  • 53. Probability is your friend. http://www.flickr.com/photos/nashnosh/5922580484Saturday, 30 June 12
  • 54. Personalised probability is your best buddy. http://www.flickr.com/photos/el5ajoola/3868649830Saturday, 30 June 12
  • 55. Here’s how it works.Saturday, 30 June 12
  • 56. Something happens.Saturday, 30 June 12
  • 57. Something bad happens.Saturday, 30 June 12
  • 58. Something bad and complicated happens.Saturday, 30 June 12
  • 59. Gather the facts...Saturday, 30 June 12
  • 60. Gather the facts... SymptomsSaturday, 30 June 12
  • 61. Gather the facts... Symptoms Subject history Previous test results General observationsSaturday, 30 June 12
  • 62. What else do we know?Saturday, 30 June 12
  • 63. http://www.flickr.com/photos/dougcaldwell/4213877479 Hypothesise.Saturday, 30 June 12
  • 64. List Hypotheses.Saturday, 30 June 12
  • 65. Immediately discount. Apply probability.Saturday, 30 June 12
  • 66. Prioritise hypothesis based on risk and probability.Saturday, 30 June 12
  • 67. Plan tests. Predict results.Saturday, 30 June 12
  • 68. Test. Or Treat.Saturday, 30 June 12
  • 69. Feedback results.Saturday, 30 June 12
  • 70. Continue until diagnosis is confirmed. http://www.o-min.com/wp-content/uploads/mobius1-300x225.jpgSaturday, 30 June 12
  • 71. Differential Diagnosis. Gather the facts. Hypothesise. Apply Probability. Prioritise. Test or Treat. Loop.Saturday, 30 June 12
  • 72. Diagnostic ApproachSaturday, 30 June 12
  • 73. PossibilisticSaturday, 30 June 12
  • 74. Possibilistic All Possibilities Are Equal Test EverythingSaturday, 30 June 12
  • 75. Possibilistic All Possibilities Are Equal Test EverythingSaturday, 30 June 12
  • 76. ProbablisticSaturday, 30 June 12
  • 77. Probablistic Selection Based On Probability Prioritise The Most LikelySaturday, 30 June 12
  • 78. Probablistic Selection Based On Probability Prioritise The Most LikelySaturday, 30 June 12
  • 79. PrognosticSaturday, 30 June 12
  • 80. Prognostic Selection Based On Most Serious Prioritise The Most SeriousSaturday, 30 June 12
  • 81. Prognostic Selection Based On Most Serious Prioritise The Most SeriousSaturday, 30 June 12
  • 82. PragmaticSaturday, 30 June 12
  • 83. Pragmatic Selection Based On Responsiveness To Treatment Prioritise The Most Easily TreatedSaturday, 30 June 12
  • 84. Pragmatic Selection Based On Responsiveness To Treatment Prioritise The Most Easily TreatedSaturday, 30 June 12
  • 85. When do I use each approach..Saturday, 30 June 12
  • 86. Do something and do it fast... Pragmatic.Saturday, 30 June 12
  • 87. If it really is that, we are in a world of hurt. Prognostic.Saturday, 30 June 12
  • 88. Default = Probabilistic.Saturday, 30 June 12
  • 89. I want more probability...Saturday, 30 June 12
  • 90. Pre & Post Test Probability. Current Probability: 30% If the result is X; There is 60% chance of hypothesis being correct. If the result is Y; There is 0% chance of hypothesis being correct.Saturday, 30 June 12
  • 91. This is easier in medicine.Saturday, 30 June 12
  • 92. ! Differential Diagnosis... ! Diagnostic Approach...Saturday, 30 June 12
  • 93. Diagnostic ThresholdsSaturday, 30 June 12
  • 94. Define the point at which something is worth testing.Saturday, 30 June 12
  • 95. Probability of Diagnosis 0% 100% Test Treatment Threshold High Priority Tests Threshold Not Worth Worth Testing Worth Testing TreatingSaturday, 30 June 12
  • 96. Mnemonics.Saturday, 30 June 12
  • 97. Doctors Love Mnemonics.Saturday, 30 June 12
  • 98. Mnemonic for DDx.Saturday, 30 June 12
  • 99. Vascular Idiopathic/Intoxication Neoplastic Degenerative/Deficiency Inflammatory Congenital Autoimmune/Allergic Traumatic EndocrineSaturday, 30 June 12
  • 100. Mnemonic for Acute Pancreatitis.Saturday, 30 June 12
  • 101. GET SMASH’D Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion bites Hyperlipidemia Drugs(azathioprine, diuretics)Saturday, 30 June 12
  • 102. Mnemonic for the web...Saturday, 30 June 12
  • 103. Users Operating system Web server Network Cache/Code Application engine Hardware Services (Third Party) Database/DatastoreSaturday, 30 June 12
  • 104. Cache/Code Application engine Services (Third Party) Hardware Web server Operating system Users Network Database/DatastoreSaturday, 30 June 12 CA$HWOUND
  • 105. These are used to follow a path through trees.Saturday, 30 June 12
  • 106. C A $ H W O U N DSaturday, 30 June 12
  • 107. How can this all help me?Saturday, 30 June 12
  • 108. It makes you more thorough.Saturday, 30 June 12
  • 109. It can help you fix things faster.Saturday, 30 June 12
  • 110. By working as a team.Saturday, 30 June 12
  • 111. By working more efficiently.Saturday, 30 June 12
  • 112. Reduces Thematic Vagabonding. http://www.flickr.com/photos/neloqua/166353267Saturday, 30 June 12
  • 113. Reduces Lone Wolf Heroism. http://www.flickr.com/photos/tambako/3559257456Saturday, 30 June 12
  • 114. Reduces Encystation http://www.flickr.com/photos/tambako/3559257456 http://www.flickr.com/photos/emmacoulston/4442688125Saturday, 30 June 12
  • 115. This is what it looks like.Saturday, 30 June 12
  • 116. Saturday, 30 June 12
  • 117. I’ve run out of diagnosis.Saturday, 30 June 12
  • 118. You suck. :-)Saturday, 30 June 12
  • 119. Then you’ve missed something.Saturday, 30 June 12
  • 120. Question your results, symptoms and observations.Saturday, 30 June 12
  • 121. Re-test if in doubt.Saturday, 30 June 12
  • 122. Call in a fresh pair of eyes.Saturday, 30 June 12
  • 123. Do’s and Don’tsSaturday, 30 June 12
  • 124. Assemble a team.Saturday, 30 June 12
  • 125. Get the right experts in the room.Saturday, 30 June 12
  • 126. Experts and generalists.Saturday, 30 June 12
  • 127. The diagnostic lead.Saturday, 30 June 12
  • 128. Diagnostic Lead, controls the pen. http://www.flickr.com/photos/scttw/1819085915Saturday, 30 June 12
  • 129. Take it in turns to lead.Saturday, 30 June 12
  • 130. Culture.Saturday, 30 June 12
  • 131. http://www.flickr.com/photos/41427839@N07/5973163369/ Openness is key.Saturday, 30 June 12
  • 132. Encourage people to challenge.Saturday, 30 June 12
  • 133. And be challenged.Saturday, 30 June 12
  • 134. http://www.neale-wade.net/blog/wp-content/uploads/2008/08/100_1241.jpg Collaborate.Saturday, 30 June 12
  • 135. Do not immediately dismiss ideas... http://www.flickr.com/photos/albaflickr/4416770182/lightbox/Saturday, 30 June 12
  • 136. Do not immediately dismiss ideas... that were not yours... http://www.flickr.com/photos/albaflickr/4416770182/lightbox/Saturday, 30 June 12
  • 137. Do not immediately dismiss ideas... that were not yours... or your team’s... http://www.flickr.com/photos/albaflickr/4416770182/lightbox/Saturday, 30 June 12
  • 138. http://www.flickr.com/photos/straubin/4541508733/ There is a time to debate and a time to act. http://www.flickr.com/photos/54182266@N02/5017666438Saturday, 30 June 12
  • 139. Get better at making group decisions.Saturday, 30 June 12
  • 140. Build a culture that encourages creative suggestions.Saturday, 30 June 12
  • 141. Practice makes perfect.Saturday, 30 June 12
  • 142. When do I use this..?Saturday, 30 June 12
  • 143. Complex Problems.Saturday, 30 June 12
  • 144. Active Problems.Saturday, 30 June 12
  • 145. Post MortemSaturday, 30 June 12
  • 146. ConclusionSaturday, 30 June 12
  • 147. Try and prove yourself wrong.Saturday, 30 June 12
  • 148. DDx is a framework that YOU can use to resolve & manage your complex problems.Saturday, 30 June 12
  • 149. Be aware of the Diagnostic Approach that you are using and why.Saturday, 30 June 12
  • 150. Create a Mnemonic for your system. It acts as a checklist.Saturday, 30 June 12
  • 151. Saturday, 30 June 12
  • 152. Watch House.Saturday, 30 June 12
  • 153. Further Reading; The Process of Diagnosis (AMA) - http://medicine.ucsf.edu/education/resed/articles/jama6_the_process.pdf Jessie Robbins - Creating Resiliency Through Destruction- http://www.slideshare.net/jesserobbins/ameday-creating-resiliency-through-destruction All of John Allspaw’s presentations- http://www.slideshare.net/jallspaw House MD http://www.fox.com/house/Saturday, 30 June 12
  • 154. Thank You. :-)Saturday, 30 June 12