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Conversation, Engagement and Front-Line Ownership

Posted By Prucia Buscell, Thursday, April 18, 2013
Updated: Wednesday, April 17, 2013
Everyone 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.

Questions 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
(MRSA) 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.

The authors are Brenda Zimmerman, Paige Reason, Liz Rykert, Leah Gitterman, Jennifer Christian and Michael Gardam. Liz is a former Plexus Institute trustee.

Tags:  buscell  complexity matters  engagement  healthcare  positive deviance 

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