can learn processes to generate and maintain organizational change.
Organizational achievements can blossom when everyone is engaged. Safety
culture in hospitals flourishes when front line staff members take
ownership of safety issues.
Three articles by people affiliated with Plexus Institute examine how these ideas can benefit organizations and the people they serve.
Lisa Kimball's article, "Changing the Organization One Conversation at a Time,"
(pdf) describes processes that help facilitate productive large group
meetings, intervene in whole systems, and maintain the enthusiasm that
emerges from provocative discussions in newly formed relationships.
Liberating Structures (LS), for instance, form a framework for designing
processes that support high quality conversations. The structures are
easy to learn and their use can promote creativity and engagement, not
only at meetings but when people return to their daily routines. Lisa
describes them as "Lego-like components that can be mixed and matched"
for use anywhere people gather. The payoff, she said, comes when the use
of these helpful processes becomes so widely distributed that it is the
norm rather than the exception. Some useful LS processes include wicked
questions, silence, and 15 percent solutions.
are "wicked" when tension and paradox are embedded. There are no
obvious solutions, and no right or wrong answers. Wicked questions
expose assumptions and elicit new ideas. An example might be: How can we
maintain top-down discipline needed for safety at the same time we
level the playing field for bottom-up creativity? A brief silence
creates a boundary between past activities and the present phase of a
discussion, and it's a good reset technique if a discussion is veering
off track. Peter Drucker suggested that most people control only about
15 percent of their work situations, and the other 85 percent is shaped
by the existing structures, systems, events and culture in their
environment. People who make the best use of their own 15 percent can
create small changes that have outsized impact. Lisa's article appears
in the Spring 2013 issue of the OD Practitioner, the Journal of the Organizational Development Network. Lisa has served as a Plexus Institute trustee and is its former president and CEO.
"More We than Me: Using Positive Deviance to Engage Everyone
(pdf) by Prucia Buscell, appears in the same issue. It describes how
people from many departments and different disciplines at the Albert
Einstein Healthcare Network in Philadelphia worked together using the
Positive Deviance (PD) approach to drastically reducing the incidence of
healthcare associated Methicillin Resistant Staphylococcus Aureus
infections. PD is based on the idea that in every community there are
individuals or groups who solve problems better than colleagues who have
access to the same resources. In healthcare, PD bridges the gap between
what care-givers know and what they do. They know infection reduction
protocols, but don't always follow them. At Einstein, all individuals in
the healthcare environment-physicians, nurses, aides, therapists,
housekeepers, and staff in all support services-engaged in the effort to
prevent transmission of pathogens that might happen in their own work
areas. People from different departments met and collaborated on ways to
remove barriers to consistent adherence to known infection control
practices. Asked if their achievements could be sustained, several
healthcare workers emphatically said "yes." It would last, they
insisted, because it was their own process. Prucia is communications
director at Plexus Institute.
"Front-Line Ownership: Generating a Cure Mindset for Patient Safety" will appear online April 26th in Healthcare Papers: A New Model for the New Healthcare,
Vol. 13, No. 1, 2013. While great advances have been achieved in the
field of infection prevention and control, the authors of this article
believe even greater progress has been hindered by power gradients,
dysfunctional relationships, and lack of "safety mindfulness" in
hospital and healthcare environments. One successful approach to these
problems, they suggest, is front-line ownership, or FLO. Ownership
involves having people who do the work develop ideas for design and
implementation of solutions. The authors discuss the logic involved in
safety, the need for inter-connectivity to amplify safety efforts, and
the importance of context and social proof in developing a safety
culture. The underpinnings of the FLO approach, they write, are Positive
Deviance, and a complexity science analysis of complex adaptive systems
and resilience. Their work also used social network mapping, Liberating
Structures and insights from the field of organizational development.
Their 18-month study at five Canadian hospitals provided evidence that
FLO reduced the combined pathogenic organism rate at study sites and
allowed different groups to attain best practices in ways that worked
most successfully in their individual settings.
authors are Brenda Zimmerman, Paige Reason, Liz Rykert, Leah Gitterman,
Jennifer Christian and Michael Gardam. Liz is a former Plexus Institute