Inventing Diagnostic Tests and A Theory of Wellbeing
We wish to thank those we met at Alere Scarborough in 2010 for their generosity and inspiration and thank all the employees working there for helping us understand how social wellbeing generates high performance, innovation, and extraordinary productivity.
Dennis Sandow, Reflexus Company
Sebastian Gaggero, Matriztica
April 23, 2020
Scientists, policymakers and public health officers from all over the world are calling for an increase in COVID-19 virus testing. Without adequate testing data, individual diagnostics cannot be done, the impact on the public cannot be estimated and data-based actions cannot be taken. Until diagnostic and antibody testing data is available millions of people are isolating themselves in what has become the most significant social, and, economic disruption of our lifetimes. Testing data continues to lag well behind demand and testing for the coronavirus had been taking 7 days to produce results until on March 30 Abbott Laboratories launched ID Now, a molecular diagnostic test that takes 15 minutes to produce results at the point of care like CVS and Walgreens drive through testing sites (Repko, 2020). On April 1 Abbott began producing 50,000 tests per day at its Scarborough Maine site (Board, 2020)an accomplishment cited as a “game-changer” in the fight against the coronavirus. Abbott also announced a COVID-19 antibody test kit and is significantly scaling up it’s manufacturing for antibody testing, expecting to ship 4 million tests in April and 20 million tests in the U.S. in June.
This didn’t surprise us. In 2010, Sebastian and I spent several weeks at the Scarborough site studying how they invented, manufactured, sold and distributed diagnostic test kits for the H1N1 pandemic. The Scarborough team’s performance was, and apparently still is, astonishing. During the H1N1 flu pandemic of 2009 they were making 7,000 flu kits per week (750,000-1.2 million tests) for six months while maintaining or increasing production of other products.
The insights we learned from the Scarborough team are as valuable today as they were ten years ago because they describe a workplace culture of wellbeing. This is especially significant when considering a recent study showing that out of 4,200 research scientists 25% reported that their workplace culture had a negative impact on their research and 55% said they had a negative impression of scientific workplace culture (Financial Times, 2020).
Understanding social systems
To understand social systems we make two distinctions regarding systems in general – organization and structure (H.R Maturana, 1975).
The organization of a social system is the relationship amongst those in a collaborative network of conversations. In order to define a network of conversations as a system, we listen to those in the network of conversations reflect upon their collaborative network of conversations that generate wellbeing.
The structure of the network is a construct and in the case of social systems, a map of the relationships in a particular network of conversations. Structure refers to the people in the collaborative network of conversations. We created our network map by asking each person who they collaborated with while inventing, producing, selling and distributing the H1N1 diagnostic test kit. For example, if Dennis answered “Sebastian”, we drew a line from Dennis with an arrow pointing to Sebastian – Dennis –> Sebastian. If Sebastian, answered “Dennis” we drew the line with two arrows Dennis <–> Sebastian, showing that Dennis and Sebastian named each other as collaborators. In our understanding, inspired by Maturana and Davila’s cultural-biology (Maturana Romesin & Davila, 2006; Maturana Romesin & Davila Yanez, 2016; Romesin Maturana & Dávila Yáñez, 2008), structure is not limited to a physical three-dimensional space but is a psychic space of relational networks of conversations coordinating collective actions in the present we live in.
We realize that these social network maps are not the only representation of the network of conversations, just as a topological map of a river basin is not the only representation of the experience of diving into a cool, flowing river. What makes the map salient is that it replaces the organization chart, the iconic image of industrial organization. What is needed is a valid structural image of how organizational wellbeing arises in a network of networks of collaboration that conserve, expand and contract the relational wellbeing in its’ organization. Mapping social network structures can help restore the symmetry or balance between how value and wellbeing are created and how the organizations managers perceive value and wellbeing are created.
The H1N1 flu diagnostic network
We mapped three networks. A wound assay network and assay technology network showed us a collaborative network structure integrating functional silos, multiple companies, and geographies. The third network we show here is the diagnostic device to detect the H1N1 flu virus that generated $66.5 million in sales (Alere Inc., 2010). The social network was collaborative (blue lines) and trans-organizational, integrating departments with over seventy collaborators from six states in the US, and from China, Ireland, and the UK.
Structural coherences are regularities amongst two or more social networks. Structural coherences of the three Scarborough networks include:
- Collaboration – those in the network map identify each other as collaborators.
- Change – social network structure is constantly changing.
- Global – those in the network lived in the US, Europe and China.
- Cross-organizational – the social network structure connected collaborators across organizational silos.
- Network of networks – the three social systems were interconnected with some collaborating and contributing in all three networks.
What’s missing from the social system structure?
What was missing from the network maps is curious to us. There was no hierarchical top or bottom to the network. Neither was there separation of functional specializations, or “silos”. And, there was no social separation of scientists even though they collaborated across the divisions of the parent company, across multiple institutions and global geographies. This presents an opportunity to bring formal organizational development practices in harmony with how value and wellbeing is being accomplished in collaborative social networks.
The organization of work
We cannot understand a social system by only studying its social network structure. Understanding social systems requires listening to those collaborating explain how they do what they do in accomplishing what they are accomplishing.
Organization in social systems refers to that which defines the identity of the network of conversations. Understanding social systems comes from listening to the coherences arising from listening to two or more people. This listening happens without expectations, reaching premature conclusions, demands, or interruptions. After listening to one person after another explain how they do what they do we begin to perceive these coherences. This is discovery science, beginning with no hypothesis and guided by emerging data. Data is language – the consensual coordination of actions and must be timely, actionable, valid and accessible. Explanations people explain how they do what they do when they accomplish valued accomplishments is the source of our data on organization.
Openness occurs when the flow of conversations in a social network are not restricted, controlled or hidden, but open others to join and participate.
- “Knowledge is useful when you let it be used. To keep knowledge is the old way. You want to learn something new and share it. If you hold knowledge you will become obsolete.”
- “The overriding positivity of the relationship comes from openness and because of the level of trust we can talk about any aspect of the project with them and vice versa.”
- “What is different in this project is the transparency of the work. We share our work with everyone and that is very efficient. We don’t hide anything.”
Freedom is the absence of social control by supervisors, managers and ourselves.
- “I’ve never felt micro-managed here. There is trust that you are here to do your best and nobody has to watch over you. You could pick any moment in any day and see exactly what I am talking about.”
- “We are free to talk to anyone. Anyone from any group can also talk to me directly without going through my manager.”
- “As a group we share ideas and thoughts about new technologies or new ideas freely with each other and the R&D managers support and encourage this communication.”
3. Social support
Social support arises in a network of conversations when one gives and receives help and care to and from others.
- “I think that as a whole every single person on that team has been helpful, patient, supportive and understanding.”
- “They just support you here. It’s been amazing.”
- “They take really good care of you.”
4. Recognition, respect and reward
Recognition occurs when one feels respected and understood by another. A reward is a gift one receives from being recognized by oneself or others.
- “The team at Scarborough is outstanding.”
- “Credit to who? Everyone!”
- “Being appreciated is a way of being here. We’re all about doing work. “Your success means my path will be easier.”
5. Social collaboration and social cohesion
Collaboration occurs when work is done together in networks of conversations arising from love, mutual respect, having fun, and a preference to live well together.
- “I would really love to bring many R&D groups around the world all together, because through conversation and sharing coffee we come up with great ideas.”
- “Now there’s a lot of young people willing to collaborate at work, having fun. The management has changed, and it’s been great.”
- “When I got here, I noticed that everybody was cohesive. It flowed. There were no departmental boundaries. It was very lateral. It helped me in my job.”
Knowing is living and learning is a reflection on how we do what we do in our daily living.
- “What I didn’t know people taught me and what I did know was accepted with open arms.”
- “Folks here are excellent teachers. They actually want to know if you understand.”
- “If we pair up and learn from each other we may be able to resolve their problems.”
Our biology is such that we cannot discern between illusion and perception (Maturana Romesin, 2014). Mistakes are perceptions that we later realize were illusions, so mistakes happen in the future.
- “You don’t feel stupid asking questions and that helps everyone feel productive.”
- “If we have a mistake, instead of placing blame we’ll work it out.”
- “Science is about making mistakes. Making mistakes is how you learn. He’s very good with mistakes and asks you what you have learned when you make a mistake instead of hounding on the mistake.”
8. Well-being at work
Well-being at work occurs when our relational behaviors coordinate consensual work actions and living well together at the same time.
- “Because of the cooperation and team spirit, I feel that I have the lowest anxiety level I have had in my adult life.”
- “For me this place is very stress free, comfortable and anyone could be a friend outside of work.”
- “There is always cake.”
What’s missing from the Scarborough’s H1N1 diagnostic test organization?
There was no mention of theories. When we presented our findings to the scientists and their colleagues, the data we collected did not trigger a discussion on theoretical abstractions such as leadership, models, frameworks, roadmaps, or theory of change. Just as the structural data can help managers restore balance, the organizational data can restore harmony between how people feel accomplishing their accomplishments and how managers feel about their organization’s accomplishments.
A Theory of Wellbeing
Science is the explanation of the coherences of our daily living with the coherences of our daily living, from a set of procedures and operations that, if set in motion, would bring forth the phenomena explained (H.R. Maturana, 1988). Social science is the explanation of the social coherences of our daily living with the social coherences of our daily living. And what are social coherences? They are regularities in the flow of relational behaviors that constitute social systems.
And what are social systems? They are networks of networks of collaboration producing valued accomplishments and living well together all happening congruently in a spontaneously changing present. In our paper, we have presented the social coherences of a network of scientists who through their collaboration, invented a diagnostic device to detect the H1N1 virus, a wound assay, a new assay technology and who coinvented a molecular diagnostic kit for the COVID-19 virus that runs tests in 15 minutes instead of 7 days (Repko, 2020)and now producing COVID-19 antibody tests which according to University of Washington virologists has a very, very high degree of reliability.
We live in language
Humans are mammals that live in language and language is how we coordinate our actions. Language happens in the present moment as we follow the path of our desires whether they lead to us to a path of collaboration, competition, or caring for others (Maturana Romesin & Verden-Zöller, 1996). These desires happen in the constantly changing present, guided by our inner feelings and emotional-relational behaviors.
We understand each other
We follow the path of our collective desires when we collaborate. This comes naturally to us in our desire to conserve our preferences for living well together. Collaboration is a flow of conversations in a network of networks of relational behaviors that produce valued accomplishments and conserve our preferences for living well together in our daily living. Our collaborating generates listening and from our listening understanding emerges. Understanding is not a claim made by the listener. Understanding is a feeling another person feels about the listener’s listening. This manner of understanding becomes the criterion of validation for what has been heard by an observer. When understanding occurs, trust emerges and conserves and expands collaboration in a continuous recursive cycle of living well together while producing a valued accomplishment.
We trust our preferences
When we realize that our preference to live well together at work is to collaborate and we understand that collaboration is the source of innovation, productivity, and wellbeing, we trust that we can live well together and do our best work. Trust is a feeling that our collaboration will be conserved. In our case study, the scientists, their managers, and their colleagues trusted that the management culture would be an open one where scientific knowledge is shared. They also trusted that the culture would give them the freedom to do their work and that time for social support would be available to all. They trusted that they would be recognized, respected and rewarded for their work and that their preferences for living well together at work would be conserved. Finally, they trusted that their preferences to collaborate would conserve a network of collaborative conversations that simultaneously produce value for their companies and living well together.
Collaboration happens in an ethical, social network where everyone in the network cares for everyone else in the network including themselves. Mutual caring for the wellbeing of others in the ethical social network arises from our collective emotions of love as everyone in our network of collaborative actions sees everyone else in the network as a contributor to the wellbeing of others and themselves.
This is our natural preference – to collaborate and conserve our preferences for living well together – and this forms a network of networks of conversations we call social systems. The social systems form in a flow of conversations that conserve and expand our living well together and we transform this flow of living into an object and turn the verb of living well together into the noun – social wellbeing. The noun social wellbeing can be frozen and analyzed while living well together is felt as a feeling in the present moment we live and is constantly changing.
Social systems are not organizational networks although they may occur in organizations. Hence organizations are not social systems, nor are they living systems. Social systems are embedded in a much larger social matrix that brings forth our collaborative social relations formed in the conservation of our preferences to love, care, and collaborate. The social matrix forms in systems of communities that bring forth living well in communities and social systems at work.
At work, we prefer to live in a network of conversation that conserves our living well together in a constantly changing network of relational behaviors that generate social systems we realize when everyone in the network of conversations conserving our living well together feels that everyone else in the network of conversations conserving living well together are collaborating in their network of conversations consensually coordinating work tasks. We wish to be seen, heard, felt, and understood and to mutually support, respect, and co-inspire ourselves and others to be most productive while we do our best work.
This manner of explaining our process of explaining wellbeing may or may not be validated at any moment we are living. The Industrial Era’s logical metaphysic separated science from psychic space, and because space was defined as a third-dimensional presence where systems, spirit, emotions, ethics and relational behaviors were outside its boundaries. In the Biological Era value is placed on living and cultural-biology takes us beyond the boundaries of the physical metaphysic and allows us to explore new domains of relational systems.
In cultural-biological, knowing arises through our humanness, living as biological beings that live in systemic relational-emotional flows of ethical networks of networks of conversations caring for ourselves and others, whose caring in the conservation of wellbeing make transparent our emotional, spiritual, ethical and relational behaviors. In our daily living this brings forth the validation of our explanations of explanations of wellbeing as we re-cognize, (as “to know anew”), the world of wellbeing we create, conserve and expand.
Re-cognizing wellbeing evokes living well together
Social action research is not a linear-sequential process. It is circular-recursive. And what does social action encircle? It encircles the conservation and expansion of reflective networks of collaborative conversations that bring forth accomplishments and living well together.
So, what social actions did our findings evoke at the Scarborough site? Following the social action research, the scientists and their colleagues created a wellness program. It started by replacing sugary snacks in vending machines with healthy choice snacks. A wellness team hosted free fruit smoothies during breaks and gave employees healthy recipes. They also created a “Fall into Fitness Challenge” consisting of five weeks of low impact aerobics practiced 30 minutes four times per week. This was followed by three weeks of high impact aerobics including jump rope, a two-mile run, and a relay race. They had weekly brain teasers about health and a culinary challenge for employees to cook a delicious meal under five hundred calories that included fruit, grain, vegetables, or protein. Together we invented a person-centered platform with diagnostic, step, and weight data that we later expanded in collaboration with the California Black Health Network and five pastors in Sacramento, California.
The Theory of Wellbeing is constantly changing
The theory of wellbeing then is generated in a continuous social action learning network of reflective conversations concerning how we do what we do in conserving and expanding living well and living well together. The theory of wellbeing at work occurs in a regular reflective conversation coordinating our collective work tasks intermeshed with the regular conversations conserving our living well together. Hence, the theory of wellbeing that we validate in the work culture today is not the same theory of wellbeing that we will discover tomorrow. We propose that the theory of wellbeing be regularly studied, conserved, and expanded in scientific work cultures.
Lastly, by understanding that the joint creation of value and wellbeing arises through conversations in mutual respect, in which openness, freedom, and caring for one another is crucial, the way in which we observe these relational dynamics should evoke living well together. Saving people from the coronavirus, climate change, unhealthy workplace cultures and other threats to our health and wellbeing require a process of listening in which the joint creation of value and wellbeing should be at its core. We invite other scientists in social and organizational fields to allow themselves to practice our theory of wellbeing and validate what we claim here in their own daily living. This is not a process that will lead to right or wrong answers, but an inductive scientific study of what is being collectively accomplished, in a never-ending process of expanding value and wellbeing.
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