#ThinkAboutIt 🤔
A system can be filled with competent people and still lack the right expertise for the person it is serving.
Imagine a patient with a highly complex cardiac condition being evaluated and managed through a labor-and-delivery framework.
The labor-and-delivery professionals may be excellent.
They may be highly trained.
Their protocols may be evidence-based.
Their assessments may be validated.
Their procedures may be followed perfectly.
But we would immediately recognize the problem.
The framework and expertise do not match the patient.
That doesn’t make the labor-and-delivery professionals incompetent.
It means expertise is not interchangeable.
The same principle deserves attention in systems serving people with developmental disabilities.
These systems have tremendous expertise in intellectual and developmental disabilities.
But some individuals within them also have profound medical complexity—complex neurological injuries, respiratory dependence, autonomic instability, airway needs, specialized medical equipment, or conditions in which seemingly small changes can become emergencies very quickly.
A nonmedical professional can accurately document:
“ventilator.”
“suctioning.”
“autonomic dysreflexia.”
“oxygen.”
“diaphragm pacer.”
But collecting medical information is not the same as understanding its clinical significance.
And that distinction becomes especially important when assessment information begins determining support levels, funding, staffing, or who is considered qualified to provide care.
Because there is a chain:
What the system understands
→ what the assessment captures
→ how someone interprets it
→ what level of need is assigned
→ what support is authorized
→ who is available to provide that support
→ what happens to the person.
If the necessary expertise is missing near the beginning of that chain, everything afterward can be procedurally correct and still produce the wrong result.
The assessment can be administered correctly.
The algorithm can calculate correctly.
The funding methodology can be applied correctly.
The paperwork can be flawless.
And the person can still be unsafe.
That is why “qualified” cannot always be the end of the question.
We also have to ask:
Qualified for what?
And:
Qualified to understand this particular person’s needs?
The same applies to the people interpreting assessments and determining support levels.
Who recognizes when the standardized result doesn’t make clinical sense?
Who recognizes the outlier?
Who understands the interaction among multiple complex medical needs?
Who has the authority to say:
“The model produced this answer, but this person’s clinical and functional reality tells us something different”?
A system should never have to become expert in every possible condition.
But it does need to recognize when the expertise it has is not the expertise the person requires—and have a reliable pathway to bring the right expertise into the decision.
That isn’t criticism of the professionals already there.
It’s good system design.
Because when the consequence of misunderstanding is an inaccurate form, we have an administrative problem.
When the consequence of misunderstanding is inadequate support for a medically complex person, we have a safety problem.
Perhaps one of the most important questions we can ask of any assessment or service system is simply:
Does the expertise of the person making the decision match the complexity of the person who must live with its consequences?
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