Specialization, Generalization, and Effectiveness in Software Teams: Clinical Metaphors

I was thinking about the relative value to a team of a developer with specific skills (say UI development) versus adding someone who was more of an end-to-end developer. Two stories about medical practice that provided some insight into the question.

I recently read Better, Atul Gawande's book about improvement in medical professions. In this book he relates a story of a clinic in rural India that is poorly staffed and funded, and where doctors manage to successfully perform procedures that are outside the realm of their training. They are able to practice these skills effectively and saved lives.

A story on This American Life, discussed a doctor  in Kermit, Texas who practices in areas beyond his stated training, with poor results. In the end nurses who worked with the doctor filed complaints against him for mistreating patients. This doctor worked alone, and collected information from questionable sources, and ignored the availability of better qualified resource near by.

In both situations doctors practiced beyond their training, yet in one case this improved care, in the other it degraded care.  Two of the key differences seemed to be that the doctors in India frequently met to discuss each other's cases and learn from each other, and  the doctors in india worked beyond their area of specialization in order to keep the clinic functioning and performing useful work. There was no way to wait for a specialist to do the work, and still keep the patient alive.  Gawande credits the camaraderie of the group in India as well as their daily discussions of their cases, their decisions, and why they made those decisions, for their ability to improve their range of practice.

Even though the dynamics in software teams differ from those in a hospital, there are lessons from these stories that software teams can apply to better develop teams of generalizing specialists, and more effective agile developers:

• An ethic of continual learning, both from outside resources and each other can help a team of generalizing specialists to be effective; Having the ability to work across a stack isn't as important as a willingness and ability to learn how to fill gaps in knowledge.
• The flow of the project is  important  to consider when deciding who should work on a task, consider the overall flow of the project. If the specialist is available, there you may as well have the "expert" work on the task (after the team agrees on an approach ). But if waiting for the specialist would delay the project, and there are other people on the team who don't have a full backlog of work, consider having someone else work on it. The specialist can provide advice, and perhaps improve on the work later. But you will have functional software sooner.
• It's important to take time to review and discuss decisions as a cross-functional team to understand what you did, and what you can do better next time.

So it seems like it's best add to a person to a team who has a skill that the team might be weak in, but who enjoy working on the whole application when the team thinks it makes sense. Self-organizing, cross-functional teams are a central part of agile practice, and the combination is important. Just having cross functional people doesn't work; they need to work as part of a team working towards a common goal.