Complex Way of Connecting with Communities
Portions of the Rusch/Zastocki stories from above
on community health work told together and with reflections
by: Brenda Zimmerman and Curt Lindberg
science provided insights for relating hospital work to community health for two nurse
executives, Linda Rusch and Deborah Zastocki. They argued that the limitation in most
community initiatives is due to high levels of complexity, huge number of variables and a
desire to come to consensus before any action occurs. There is this belief that there
needs to be "the plan".
A framework presented by Ralph Stacey (1996), showed them consensus was an appropriate
approach in situations of relatively high agreement and high certainty. Issues of
community health and wellness rarely meet those criteria.
People are "paralyzed
with the consensus mode" and "tired of feeling like this is another meeting
where we discuss everything and nothing gets accomplished," said Zastocki. Instead
both Rusch and Zastocki provided opportunities for hospital and community members to get
together and agree to act in areas where they have influence. Rusch described it as
"chunking" (Kelly, 1994) or " using their 15% sphere of
influence" (Morgan, 1993).
They used notions of minimum
critical specifications. As a hospital group, they first decided what they need to hold
"sacred" and then engaged in and allowed for lots of actions within that
"I give the minimum
specifications of where we could think about going or what the worlds going towards
as much as we can predict it about partnership and community. The next thing I know, I
hear about these nursing units that are collaborating in all these different projects with
the outside public." (Rusch)
Rusch argued that a healthy
community means everyone takes responsibility. This involves more teaching and more
sharing of information. In her hospital, Rusch discovered that the operating room nurses
took the initiative to create a community forum to teach the general public about the
instruments used in surgery. She didnt initiate or direct this project. It was
another "sprout that emerged."
Zastocki and Rusch said the
teams learned from action. They did not try to plan their way through these community
initiatives. Feedback loops and reflection are key. "One of the feedback pieces we
have had is that the community groups see hope", said Zastocki. The hope resulted
from experiencing actions that happened in a thoughtful but not totally planned manner.
Rather than a community plan,
"we need to have a Mecca in some sense where people come together, they grow, they
act and they learn together - where natural spin-offs will occur that allow more and more
people to connect," said Zastocki.
Copyright © 2001, Brenda Jane
Zimmerman and Curt Lindberg. Permission