Center Directors:
I could use your observations, strategies, images, phrases, or any other wisdom on the task below:
A group of 6 of us from same organization heard the quote (in the title of this post) from a keynoter (Bruce Bagley, MD) at a November '07 Family Medicine practice improvement conference, getting at the idea that people working in healthcare are buried in seemingly separate initiatives and projects that are experienced as an interminable sequence of burdens "in silos" that gradually burn up the available "change capital" that leaders have to work with. Something tells me this is not just an issue for healthcare organizations.
The message was to find a way to simplify the picture so that people can relate to it and feel energized rather than overwhelmed by it. I added the famous Einstein quote to the mix: "Everything should be made as simple as possible, but not more so". So with these twin mottos in mind, we as leaders (and consultant) are beginning to "simplify" in a major medical school Department of Family Medicine.
So far we have two high-level strategies:
1) Put all the existing projects, initiatives, goals, paradoxes, etc in the middle of the table, each on one sticky note. Then organize them in organic form on the wall so that the few fundamental themes or components emerge, with subsidiary or equivalent ones beneath, e.g., "Stepped care algorithm" has two versions: "Stepped care for depression (DIAMOND initiative)" and "Staged Diabetes Care (SDM project)". We have now turned three free-floating things into basically one understandable pattern. And so forth for the rest of it. We tried this last week and I am now converting the contents of the digital photographs I took of that big wall onto paper.
2) Put in place an orienting mindset or metaphor from another industry--something that is obvious and non-threatening when applied to someone else's industry but when applied to your own brings clarity and makes you ask the questions differently. For this I am using the fact that healthcare delivery is full of interesting demonstrations and pilots and one-off transformations--but that a reformed way of doing care has yet to hit the mainstream of American healthcare--the innovation is yet to come. There is a parallel story in the development of air travel as a way of life with the 1935 McDonnel Douglas DC-3--which is credited as the aircraft that ushered in the era of commerical air travel. In this story called "From Idea to Invention to Innovation" (Peek & Heinrich,1995) I build on Senge's 1991 distinction between "invention" and "innovation" and how the DC-3 was the first plane to simultaneously combine 5 "component technologies" in one aircraft--and promptly blew away the competition (one partially successful plane after another) and quickly ushered in the era of commercial aviation that we enjoy today. So after telling this story in 2 pages (I can send you this if you like), we have posed the question: What is the minumum number of "component technologies" for ambulatory care that will be needed to usher in the era of truly successful care delivery?
Both these approaches seem to appeal to people. Now my question: What additional or alternative strategies, metaphors, or methods can you suggest to "make everything as simple as possible but not more so".
C J P
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3 comments:
“Great leaders are great simplifiers” – very good, very useful – but is it exactly on the mark? I suspect the issue is less simplifying and more clarifying – great leaders are great clarifiers. Einstein’s quote is to the point here. Things can be made too simple (remember Ossorio’s “Don’t count on the world being simpler than it has to be.”); I doubt if they can be made too clear.
High praise for your first strategy – creative and to the point. Here’s a variation that might yield different results: Take each “sticky note” and ask the significance question: “What are we doing by doing that?” Cluster sticky notes on separate flip-chart sheets according to their significance. Then one more pass: take a step back from the sheets, ask and write down: “What simple declarative sentences describes what we see here?” Go for the brutally obvious first and allow the subtle to emerge. Tweaking these sentences can yield an anchored-at-the-top picture of what we are doing that is clear and as simple as it has to be.
One thought about your second strategy (which you have used to good effect for years): I have been getting good mileage from getting people to apply the Ally relationship concept, which was born in the service marketing world, to other service relationships such as care-provider and leader. Much to say about this one …
Tony: This is very useful--thanks very much. I love the comment that you can simplify too much (and thanks for the Ossorio reminder there too) but can't ever be too clear.
1) We will next ask the "significance question" for the sticky notes and cluster as you suggest. When combined with the first sticky note sort, we will have two pictures:
A. The first sort is more "anatomical"--all the projects shown in context of assemblies, subassemblies, proximities, etc.
B. The second sort is more "physiological"--functional relationships and purposes--what is ultimately getting done by this anatomy.
Just as in medical school we need both "anatomy" and "physiology" type pictures here. The latter should become a paraphrase of the mission--what benefit we are bringing to whom--why we exist in the first place. If this picture and the mission are placed side-by-side and don't compare well, one of them needs a second look.
As for the Ally relationship in this context, I'd like to hear more. What I already do is apply one nugget I learned from the book (which is a great read in my opinion). Make sure the other person is feeling smarter about their issue when you walk out than when you walked in. My experience with this is that it is almost like an Ossorio "move 2"--in which you walk in the door already working (and acting as an ally) for the person and the person would have to positively stop this from continuing, rather than positively ask you to start.
I agree that both approaches will be fruitful, and as usual you come up with a simile that is both apt and clever. Yes, the significance approach will yield something like the actual mission -- and comparing it with the stated mission, as well as the first "what we do" cluster, should raise some interesting action points.
As requested, more on Ally Relationships. Most really valued, high-quality relationships -- spouse, partner, friend -- are reciprocal. But a care-giving relationship is essentially one-way : one gives, one receives. Going from one of the valued relationships to care-giver can seem like a loss, because it is.
You can enact the role of care-giver as a service source (what you're there to do is provide specific services and that's it), or as a problem solver (provide solutions to the problems the person faces). These are a real step down from spouse or partner or friend and yield significantly less satisfaction on both sides.
Or you can enact care-giver as Ally -- what you're there for is to contribute to the well-being and success of the other person. Ally is a really valued, high-quality relationship that is essentially one-way. You can be each other's Ally, but that's not built into it.
Helping people see and enact care-giver as Ally can help provide continuity and diminish the loss of quality. A husband who is care-giver for a progressively disabled wife can see that they have always been each other's Ally and while she may no longer be able to be his, he remains hers. A high-quality and valued relationship continues (and provides its satisfactions) while reciprocal relationships break down.
BTW, thanks for the kind words about the book. You hit upon the most important outcome -- "Make sure the other person is feeling smarter about their issue when you walk out than when you walked in." But I think this is more a Move 1 than a Move 2 in that you initiate this form of relationship and, as you said, they have to positively stop this from continuing (which they never do.)
Leader as Ally next.
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