Roots of knowledge

Why the tree of knowledge should be reimagined as a banyan

Rather than the European fruiter with its single trunk, knowledge should be pictured as a banyan tree with multiple roots.

In European societies, knowledge is often pictured as a tree: a single trunk – the core – with branches splaying outwards towards distant peripheries. The imagery of this tree is so deeply embedded in European thought-patterns that every form of institution has been marshalled into a “centre-periphery” pattern. In philosophy, for example, there are certain “core” subjects and other more marginal, peripheral, and implicitly expendable, ones. Likewise, a persistent, and demonstrably false, picture of science has it as consisting of a stem of pure science (namely fundamental physics) with secondary domains of special sciences at varying degrees of remove: branches growing from, and dependent upon, the foundational trunk.

Knowledge should indeed be thought of as a tree – just not this kind of tree. Rather than the European fruiter with its single trunk, knowledge should be pictured as a banyan tree, in which a multiplicity of aerial roots sustains a centreless organic system. The tree of knowledge has a plurality of roots, and structures of knowledge are multiply grounded in the earth: the body of knowledge is a single organic whole, no part of which is more or less dispensable than any other. “Stands an undying banyan tree,” said Krishna in the Bhagavad-Gītā, “with roots above and boughs beneath. Its leaves are the Vedic hymns: one who knows this tree knows the Vedas. Below, above, its well nourished branches straggle out; sense objects are the twigs. Below its roots proliferate inseparably linked with works in the world of men.”

From Jain philosophy

There is a right way and a wrong way to get this new picture of knowledge off the ground. An epistemic pluralist claims that just as a banyan tree has many different but equally valuable roots, so there are many different but equally valuable ways of interrogating reality. The wrong way to fill in the picture is to think that a “way of interrogating reality” consists in a collection of what Paul Boghossian at New York University has called epistemic principles, general normative propositions that specify under which conditions a particular type of belief is justified. That is, we should resist any temptation to say, for example, that as modern science justifies its claims on the basis of observation and testing, so pre-modern societies justified theirs on the basis of divination and witchcraft, and each sort of epistemic principle is therefore just as correct as the other. That would lead down a slippery slope into relativism and social constructivism – to a forest of trees isolated from one another, and not to the single organic epistemic system that the image of the banyan tree represents.

The right way to formulate epistemic pluralism has actually already been provided for us from within the pluralist cosmopolis of Sanskrit. The remarkable Jaina philosophers make a distinction of fundamental epistemological significance when they say that as well as and in addition to epistemic principles (pramāṇa), there are also nayas, epistemic standpoints or stances, and that both are essential constituents in an epistemic culture. A naya is not a proposition but a practical attitude, a strategy or policy that guides enquiry: it is an approach to the problem of producing knowledge, not a proposition about the sources of justification.

One such policy might be to attend only to what is immediately present in experience, another might be to enumerate everything one encounters without making any categorical distinctions, another to attend to stasis rather than flux, or to causal interconnections rather than to essential attributes. The philosopher Anjan Chakravartty at the University of Notre Dame in Indiana stresses that “One does not believe a stance in the way that one believes a fact. Rather, one commits to a stance, or adopts it.”

Here is an analogy. Think of a route up a mountain as a guide to performing the action of reaching the summit. There can be different routes up the mountain, with different benefits and drawbacks, but equally good for the ultimate goal of reaching the top. One path might be steeper but shorter, another more scenic, another better served with teashops. Walking up clockwise is incompatible with walking up anticlockwise, though in both cases one does reach the top.

The existence of a plurality of equally good approaches, does not entail that we cannot evaluate them according to some standard of better and worse. The appropriate norm of evaluation is not the binary standard of truth versus falsity, which excludes plurality. Rather, a stance is evaluated as being well- or ill-advised, conducive to certain ends, easy or difficult to administer. So one can order stances: as a strategy for reaching the summit, taking one step forward and two steps back is a very bad one.

Multiple routes

The second major innovation of the Jaina was to insist that we must adopt stances non-dogmatically, meaning that I can acknowledge the value of your way of interrogating reality while pursuing an alternative path myself. To say mine is the only correct one is to commit what they describe as an act of epistemic violence (hiṃsā). This is just to acknowledge that the ordering among stances is a partial one: some pairs of stances can be equally good, by the lights of the standard of goodness that stances are responsible to.

The mountain is metaphysically complex, its variously shaped sides offering different aspects to the climber and so different potential routes to the top. Rejecting the idea that things have a single unique essence, the Jaina instead say – and this is their third theoretical innovation – that reality is in some sense manifold or multifaceted (the Sanskrit term is anekānta).

“The real thing, whose essence is multifaceted, is the domain of all acts of awareness; an object qualified by one facet is known as the province of a standpoint (naya),” said the 5th-century Jaina thinker Siddhasena in Nyāyāvatāra. “The real thing, both external and internal, endowed with a form that is under the sway of muliplex essential natures not separate from each other, unfolds itself to all epistemic principles (pramāṇa),” added Siddharṣigaṇi. Whichever route is selected, each mountaineer is in principle able to avail of the same tools and techniques, the same crampons, maps and axes; but the mountain unfolds itself differently to every one. The toolkit of the responsible enquirer contains empirical observation, logical techniques of deduction, induction and inference to the best explanation, and the pooling of discovery through testimony. But there is no single correct way of using those tools in one’s interrogation of reality.

Epistemic stances are not exactly like routes up a mountain. It is not so much that each stance interrogates a part of reality as that each aspires to interrogate the whole of reality, but does so in a particular manner. Nāgārjuna, the Buddhist philosopher of the Middle Way, devised a technique to approach reality from a structural or inter-relational point of view. Kaṇāda, the sage of the Vaiśeṣika school of philosophy, found a way to study reality in terms of its ontological categories. It would be an error to dogmatically infer now that reality is only structure or that it is only category. Similarly, modern science is an epistemically plural undertaking, despite the official narrative. Science excels in producing descriptions of causal connections and providing for their explanation; but there are other ways to interrogate the reality we share.

The picture of knowledge as a banyan tree encourages a certain epistemic ideal: that these different but commensurably valuable sources of epistemic nutrition can belong within a single epistemic organism. Of all the departments of knowledge within a modern university, it is philosophy that seems most addicted to the centre-periphery picture of enquiry, to the old European tree. Were it able to re-imagine itself according to this new ideal, its practitioners would find themselves freed from their terror of not being quite “at the centre”, and the profession might finally emerge from its long struggle to overcome its inability to conceptualise diversity in content and composition.

This article first appeared on Aeon.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

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Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.