The decision-making styles that evolve in the fast-paced setting in which potentially life-threatening clinical outcomes are at stake have significant value. They let team members assess large amounts of data in a rigorous manner while acting quickly. But when transferred to other settings, such as hospital boards and committees, this particular approach to conversation and decision-making can be problematic.

Given their backgrounds, healthcare professionals generally expect that their roles in meetings of teams, boards, or committees will involve advocating for their constituencies and mandating solutions to problems. While more directive approaches play an important role when decisions must be made or actions taken, in other contexts, they can undermine team learning. In addressing issues of organizational strategy, long-term planning, and creative problem solving, generative dialogue has proven more effective than one-way communication. Failure to shift to dialogue-based forms of communication will ultimately have a negative impact on an organization’s ability to rapidly adapt to changing market trends and to truly explore the questions involved in reducing medical errors and improving outcomes.

One Organization’s Challenges

In addressing issues of organizational strategy, long-term planning, and creative problem solving, generative dialogue has proven more effective than one-way communication.

The governing board of one healthcare organization was typical of many in the industry. Physicians attended meetings with the expectation of advocating for their constituencies. Managers learned to fear these meetings, as interactions often focused on criticism of the existing situation or proposed solution. The group rarely explored the challenges through healthy dialogue.

To help determine the board’s future role, board members and other stakeholders participated in a retreat. The following perceptions surfaced:

• Physicians and managers believed that there was value in meeting together regularly.
• Both groups felt that the organization needed to address certain strategic themes.
• Managers understood that they needed to collaborate with physicians to elicit the full range of possible approaches to these issues.
• Physicians wanted to help create ways to approach these themes, but wondered if they would have the power and control to make policies and decisions.
• Both groups had difficulty seeing beyond the current board structure, envisioning that the same struggles and limitations would continue to arise.
• Others in the organization were passionate about participating in the process, although they had not previously been invited to do so.

The Compass Group

The consensus from the retreat was that merely tweaking the existing board structure would be inadequate; nothing short of a complete destruction of the structure, norms, and paradigms would provide the organization with the freedom to explore new paths to achieve its stated goals. With this understanding in mind, the board dissolved its existing structure in favor of a dialogue-based forum that was organized around the stated organizational imperatives of customer service, employee satisfaction, strong physician relationships, and financial stewardship.

This forum came to be called the “Compass Group,” because the group felt that these strategic themes were analogous to the directions on a compass. The Compass Group was seen as a risky endeavor. Much of this fear was based on the uncertainty of where dialogue around these concepts might lead. The organization, however, was able to understand that any learning involves some degree of risk.

“Uncoupling” Old Norms

Cultural and conversational norms had been a major barrier to true learning within the organization. Many feared that the old ways would carry forward into the current efforts. A number of important steps were needed to ultimately “uncouple” the organization from existing ways of interacting, thus allowing for new ways to emerge and thrive.

Associating Pain with the Status Quo. A critical event during the retreat involved discussing aspects of the meetings that board members disliked. Surfacing these feelings markedly raised the group’s level of discomfort with the status quo. This discomfort created a compelling need to move the initiative forward.

Incorporating New Perspectives. The group felt strongly that the constancy of the board’s membership over the past several years had contributed to some degree of stagnation. Understanding that many others in the medical group had expressed an interest in participating, members agreed to open the group up to others who possessed fresh perspectives.

Eliciting Desired Norms and Expectations. During the retreat, board members mentioned rewarding and fulfilling experiences that they had enjoyed in other meetings and committees. Common among these experiences were being heard, contributing proactively, understanding one another, practicing mutual respect, and building upon collective contributions to generate creative approaches. By listing these desired norms and expectations, the group was eventually able to develop momentum for change.

Generating “Buzz.” Through reports from the retreat, others in the organization became aware that the Compass Group was no ordinary board or committee. The communications were lively, genuine, and informal; they carried with them a feeling of realism, openness, and innovation that was not typical of standard emails and memoranda. This “buzz” was instrumental in generating interest among others who might not have been comfortable in the traditional board setting, and in creating expectations that helped to overturn the norms of the past.

Setting the Stage for Dialogue

Because of the risk inherent in any team process, a great deal of planning went into the initial dialogue session. The goal was for people to relax, engage in collaborative dialogue, and explore creative possibilities for action. The Compass Group followed some of the principles used in developing a World Café (see “Framing Questions and Guidelines”).

Establish a Clear Purpose. Unless the group had a clearly defined purpose and objectives, along with concrete outcomes, participants wouldn’t perceive significant value. For the first of the Compass Group sessions, the management team chose to focus on the strategic theme of customer service. With this theme in mind, participants addressed a series of questions that ultimately led to greater insight and collective shared knowledge on the topic (see “First Compass Group Session” on p. 9).

Invite Great Guests. The management team decided to invite all interested physicians, nurse practitioners, and physician assistants. In doing so, they conveyed the sense that the Compass Group was “no ordinary board meeting”; this innovative forum would truly make a difference.

Plan for a Safe and Welcoming Environment. In planning the session, organizers paid close attention to creating a physical space that would be perceived as inviting, hospitable, and intimate. The goal was for participants to feel a high degree of psychological safety. The creation of a welcoming environment began with the invitations themselves. Rather than relying on email, organizers selected stationary and fonts with earth tones to convey the message that this experience would be different.

Form Powerful Questions. Well-structured, open-ended questions hold tremendous value. These questions are the most important determinant of a successful dialogue session. Because the theme of the first Compass Group session centered on customer service, questions related to service and to recent internal efforts in measuring service perceptions were developed in a logical progression of discovery.

Facilitate for Success. The facilitator’s role was (1) to model the process for internal facilitators in the future, (2) to provide a structure for the evening by facilitating between rounds of dialogue, and (3) to provide some training around the skills involved in dialogue, with a heavy emphasis on inquiry. Members of the management team had already received some training in hosting a dialogue session and in facilitating smaller conversations, mainly by encouraging a balance of inquiry and advocacy. To leverage these skills, one management team member served as a facilitator at each table. The other members at each table were carefully distributed to ensure sufficient diversity of conversations.

The session opened with a time for attendees to arrive, get oriented, and enjoy food and beverages while conversing with colleagues. Participants wrote the answer to the question, “What is the location of your most memorable service experience?” on their name tags. They were encouraged to use this memory as a starting point for conversation with others.

The session began with an overview of the evening and a brief session on dialogue. Each round of dialogue was structured around a series of questions. In this particular case, a review of the organization’s patient satisfaction data and video reenactments of actual patient experiences were used as the starting point for forming questions. During the rounds of dialogue, the facilitators at each table helped to encourage effective inquiry and to surface hidden or underlying assumptions. In addition, they recorded the predominant themes that emerged.

Between each round, the tables shared their discoveries and insights with the larger group. In addition, they commented on their success with using dialogue skills. As one of the goals of the Compass Group was to provide an opportunity to share best practices, the group used a separate flip chart to capture these ideas. In addition, items that warranted action, follow-up, or future dialogue were documented on another flip chart.

After the Session

The feedback from post-session surveys was overwhelmingly positive. Participants reported that they had achieved a high level of shared understanding and accomplished a great deal. They also felt passionate about continuing the conversations.

The themes and best practices that emerged from the table dialogues were distributed to all members of the organization, along with a clear plan for future dialogue sessions on the other strategic directions defined by the compass. In addition, efforts to continue the discussion around service were implemented by providing weekly questions for each manager, physician, and department to use with their staff.

As in other industries, healthcare organizations tend to depend heavily on one-way communication, debate, and criticism. Unfortunately, these dynamics present a barrier to learning and to developing organizations that are able to innovate and adapt effectively to tumultuous market conditions, a necessity in today’s marketplace. Dialogue, specifically the skills of understanding mental models and balancing advocacy with inquiry, is essential for building organizations that learn effectively. By challenging the assumption that committees and boards must always be structured in the traditional manner, organizations may be more likely to explore formats that are more conducive to dialogue. Shifting to dialogue-based forums focused on strategic imperatives can be one approach that fosters learning in all kinds of organizations.

Manoj Pawar, MD, MMM, is a managing partner with Nivek Consulting and is the chief medical officer for the Exempla Physician Network. He is committed to developing high-performing teams and organizations in healthcare. He can be reached at pawarm@exempla.org.

Special thanks to Gene Beyt, MD, Richard Hays, DBA, Charles Jacobson, MD, and Bob Myrtle, DBA, for their wisdom, and for their gracious and insightful contributions in the development of this article.

The post Dialogue-Based Forums for Healthcare Organizations appeared first on The Systems Thinker.

Acclaimed educator and writer Deborah Meier has spent more than 30 years thinking about these questions and about what it means to be an educated person in today’s society. As the founder and principal of several inner-city public elementary and secondary schools in New York and Massachusetts, she has made her career helping children in underprivileged communities build productive, meaningful lives.

To Deborah, the core mission of schools in a democracy is producing critical, thoughtful, interesting citizens and workers. From her experience, the current emphasis in the U. S. on standardized testing, as required by the 2001 “No Child Left Behind” Act, stands in the way of achieving that goal., “If Americans had an edge in the world, it was that they were presumably more ingenious, more self-initiating,” she says., “The special American genius was our inventiveness. That spirit of inventiveness is what schools don’t currently reward. It’s not what you’re supposed to be thinking of when you’re taking tests; you’re supposed to be thinking of the rules of the game, not how to break the rules or how to invent new rules.”

Dynamic Learning Communities

Deborah knows about inventing new rules. She became an educator in the 1950s, starting as a part-time substitute teacher in the Chicago public schools while her children were young. During that experience, she found that school was “for many kids irrelevant, and the extent to which it was relevant, didn’t produce lively minds. The same was true for teachers — the environment was barren and sterile. I thought it was amazing that they came to school each day.”

“If Americans had an edge in the world, it was that they were presumably more ingenious, more self-initiating. The special American genius was our inventiveness. That spirit of inventiveness is what schools don’t currently reward.”

While teaching kindergarten in Harlem in the early 1960s, Deborah began to work with education professor Lillian Weber of the City College of New York, who developed the “Open Corridor” concept. In it, three or four teachers work together to turn their hallway into a shared children’s space. By collaborating in this way, the instructors demonstrate cooperation and create an engaging and dynamic learning community.

In 1974, Deborah was recruited to apply these progressive ideas in launching the Central Park Elementary School in East Harlem, one of the poorest areas in the city. The school and three others she spearheaded became highly successful, with more than 90 percent of the students who entered the Central Park East Secondary School going on to college. More than two decades later, Deborah moved to Massachusetts to found the Mission Hill School.

Habits of Mind

The schools that Deborah has launched all share certain characteristics. They are relatively small; the Mission Hill School, with around 180 students, is about one-third the size of the average school in Boston for that age group. Classrooms look like a combination of art room, science laboratory, and library. Children from kindergarten through 8th grade study a common set of themes — American history in the first trimester, ancient history in the second, and science in the third — so that the older students can model certain “habits of mind” for the younger ones.

According to Deborah and her colleagues, these habits are crucial for exercising judgment on complicated matters. At Mission Hill School, developing such intellectual skills is a core part the educational process. They include:

1. Evidence: How do we know what’s true and false? What evidence counts? How sure can we be? What makes it credible to us?
2. Viewpoint: How else might this look if we stepped into other shoes? If we were looking at it from a different direction? If we had a different history or expectations?
3. Connections/Cause and Effect: Is there a pattern? Have we seen something like this before? What are the possible consequences?
4. Conjecture: Could it have been otherwise? Supposing that? What if?
5. Relevance: Does it matter? Who cares?

The habits of mind are supplemented by habits of work: meeting deadlines, being on time, sticking to a task, not getting frustrated quickly, listening to what others say, and more.

Because kids learn by seeing adults practice these habits as part of a democratic community, the school operates as a staff collective, with input from a board of directors composed of five teachers, five parents, five people from outside the school, and two students. Most meetings are open to all, including students, who are encouraged to submit proposals. Children then apply these skills to making decisions within their classrooms.

Mission Hill School also brings the classroom into the larger community and the larger community into the classroom. The school has close ties with local museums, a farm, and several sports programs. Older kids participate in a “school to community” initiative, in which they spend one morning a week for 12 weeks working at a nonprofit or business. “The main point,” Deborah says, “is that it’s a place where we know there are some interesting adults doing interesting things who love what they’re doing.” In a similar way, if the students are studying ancient Greece, “we try to find people who have ancient Greek expertise, either as hobbies or professions, so our kids see that there are people who study this all the time and to whom it is a life love.”

For inner-city kids in particular, finding and cultivating a passion can be a lifesaver. According to Deborah, “Over the years, we have gathered a lot of evidence that this approach has had an impact on kids: fewer of them drop out, get in trouble, or despair of their lives. The vast majority go on to post K–12 education; they come to think that having interesting occupations is a possibility for themselves, not just for other people; they are likely to have strong hobbies; they want their kids to have an education like this too.” She adds, “The other exciting thing is how many teachers come see our schools, hear our stories, and want to start schools like it. We started with just one in NYC and now there are hundreds. The same is true with parents. It speaks to something that we’re longing for in our lives.”

Real-Life Achievement

By law, students at Mission Hill School must take standardized tests, and overall scores exceed those of many other schools in Boston. Nevertheless, the staff doesn’t let test preparation alter the curriculum or the process for evaluating student performance. As a requirement for graduating from eighth grade, pupils present portfolios of their work in different fields of study to committees of five people, including external reviewers, a member of their family, and two members of the faculty. A younger student also sits in as a learning opportunity. The centerpiece of each portfolio is a single, extended piece of work. The committees question presenters and rate the depth and breadth of their understanding of the material. “We are pushing kids to look at themselves as learners,” comments Deborah.

Deborah sees the portfolio process as a better, if somewhat more time-consuming, way of assessing kids’ competence than standardized testing. She says, “Higher test scores are supposed to be a measure of some real-life achievement and yet we have isolated them from real-life achievement.” As an example of this discrepancy, Deborah points out, “Young people who started as students in the seventies — the period in which we started concentrating on testing — are reading precipitously less well than the students who started reading in the forties, fifties, and sixties. If you ask kids, they’ll tell you, ‘When testing is over, we stop reading.’”

Awakening to the Future

So what can we do as a society to ensure that students gain the skills and knowledge they need to be the leaders of tomorrow? According to Deborah, “I think we start off by deciding what’s important to us and how we would know whether we’re achieving what we had in mind.” Another step is to create ways for parents and teachers to get to know each other, through maintaining smaller classes, keeping kids with the same teachers for several years, and scheduling additional time for them to meet. Public policy could support this process by requiring employers to give employees time for visiting their children’s schools., “We could maybe make it a duty of citizenship, like jury duty is,” Deborah comments.

With many educators, parents, and politicians beginning to raise the alarm about the downside of high-stakes testing, Deborah hopes that we’re on the cusp of an awakening that “whoops, this is not what we’ve meant to be doing to children for 20 years, this has nothing to do with what we dream about, this is not what the American future is supposed to be, this is not how to lead a competitive race with the rest of the world.” The fact that the choices we make now will affect our ability to muster an effective workforce and an engaged and thoughtful citizenry well into the 21st century is something that everyone can agree on.

Janice Molloy is content director at Pegasus Communications and managing editor of The Systems Thinker newsletter.

The post From Students to Citizens and Workers: An Interview with Deborah Meier appeared first on The Systems Thinker.

I glanced around secretively, leaned over the table that separated us, and whispered to Diane, “You know, this transformational change is spiritual.” I feared making this statement out loud because I was convinced that had I described the change process as a spiritual journey, the mechanistic organization would have rejected me quickly. On the other hand, when I linked the change effort to materialism (reduced costs and increased revenues), I was provided heroic status—at least for a time.

“Spirit at work” is one of the recent themes of people seeking to help organizations adopt a holistic and organic worldview. And, like other well-intended and theoretically sound initiatives, it is in danger of being rejected as a fad. But spirit at work is not a quick fix to problems; it embraces the complexity of life and the human condition—and focuses on the difficult inner work followed by courageous actions needed to effect profound transformation.

The change effort I was involved in began in 1990 with the need to save the enterprise millions of dollars and respond to a union-organizing effort. In addition, demographic and market changes that demanded new ways of doing things were on the horizon. We all felt a sense of urgency and excitement.

A period of exploration and study about ideas new to organizational life began. We read books, attended conferences, and visited other organizations. Those who had caused the crisis retreated to the safety of their offices. We began to feel the end of the old ways, the confusion of chaos (which we welcomed), and the uncertainty of new approaches.

People responded to the challenge. The worries and frustrations of day-to-day life receded from awareness. A powerful sense of purpose became real. The rule books went out the door. Finding what worked was what was important. Barriers were eliminated. Those with the needed skills or information led, regardless of rank, and all who wanted participated in the creative process. People learned and adapted as they proceeded.

Employees were involved in the redesign of their work. Consultants provided facilitation and methods. Managers made sure the employees felt valued, involved, and informed during this change effort. Trust and credibility grew, and the union-organizing effort went away. The energy level was incredible. We were alive in the moment instead of toiling for an obscure future.

Operational results were phenomenal. Now when employees went to conferences they were presenters as well as observers. People began to visit to learn from the business unit. Consultants began to write about this work.

For a moment we were more of our natural selves: braver, smarter, and more creative than during more orderly times. We worked harder, cared for one another more, and accepted our differences. We were filled with hope for the possibilities we saw for us as people and for the life we lived at work.

As the change effort continued, its meaning became clear to me. I realized the ways in which leadership can bring forth mediocre organizations and dispirited people. I came to understand the powerful energy generated by a shared vision. I saw the courage summoned when people create together what they want most for their lives. I felt the inspiration born when people live by their deepest values.

This describes spirit at work. Spirit is not the move to teams, the quality efforts, the job redesign, and all the other tools we use to change organizations. Spirit is the profound energy, the creativity, and the commitment that emerges when free people live their highest and most authentic potential. For me today, spirit at work represents the expression of our deepest authenticity as, inspired by our sense of purpose and guided by our values, we step into the unknown and move courageously together toward a bold vision, feeling the aliveness of life experienced completely and humanity realized more fully.

Historically, spirit at work was effectively destroyed by industrialization when work was redesigned to make money for others. Our spirit at work at the newspaper was eventually destroyed by people who, afraid to look within, projected their fear, pain, and limitations outward and destroyed our creation.

Why is spirit important? Because, simply, our spirituality makes us human, connects us to all of life, and elevates us to our potential as caring people. The uncertainty of the times, the suffering all around us, our need to help others, and the grandeur of life focus our attention on spirit at this difficult time in our history.

Tom Heuerman is a leadership and organizational change consultant, writer, and wildlife photographer. His essays on life, leadership, and organizations are available at www.amorenaturalway.com.

The post True Spirit at Work appeared first on The Systems Thinker.