Hospital checklists and Inviting Participation

5429335563_ebe9be20dcJohnnie Moore pointed to an interesting article on why checklists don’t always produce the kind of positive results expected in hospital operating rooms.

I remember a few years back when I had major surgery. I had been rolled into the operating room. I was looking around and I commented on the team’s use of a checklist. They looked at me, surprised that I noticed. I said I’m interested in group process. With that, they gave me my anesthesia. I think one of the things on the list was to shut up talkative patients. 🙂 But I wondered, did the checklist make a difference for that team? It seemed like they were comfortable and well-practiced…

Outside of hospital operating rooms, where I have no expertise other than as patient, I’m fascinated by what sort of invitation gets people to engage with tools that can increase their individual and collective performance. It seems to me the invitation is as important as the checklist. Here is a related snippet from the article:

Dixon-Woods did identify one exemplary ICU, in which a high infection rate fell to zero after Matching Michigan began. The unit was led by a charismatic physician who championed the checklist and rallied others around it. “He formed coalitions with his colleagues so everyone was singing the same tune, and they just committed as a whole unit to getting this problem under control,” says Dixon-Woods.

I don’t think the intention here is blind lock-step and I cringed a bit at “singing the same tune.” What I do think matters is that people understand the value of something they are asked to do, and that leadership walks the talk. That starts with an informed, intelligent invitation to participate. Not blind obedience. Not “because you have to.” And the ability to critically question an invitation, checklist or whatever, because in complex settings, not everything is predictable.

I’m currently reflecting on the last two weeks where a team of us co-facilitated 2 rounds of a week long learning experience for professors at the University of Guadalajara system in Mexico. (More to come on that.) I suspect where we created warm, intelligent INVITATIONS to experiment with mobile technologies for engaged teaching and learning, we had more professors “accept,” dive in and learn. Where we focused too much on content, we started to lose people. Interesting, eh?

Source: Hospital checklists are meant to save lives — so why do they often fail? : Nature News & Comment

Collaborating for Impact in Large Development Organizations

km4devimage1What feels like a long time ago and far far away, Rachel Cardone of Red Thread Advisors, Aldo de Moore of Community Sense and I decided to wrestle with some questions that were cropping up across our diverse work. We kept having clients say “we want to collaborate with our distributed teams,” and “what software should we buy.” Time and again, we saw so many of these initiatives fizzle out. It was our sense that we needed to look at the problem differently, with an appreciation for complexity and the diverse contexts across large international development organizations.  That really interesting things were happening on the edges, but they didn’t seem to penetrate deeply into the organizations.

Thanks to some support from IFAD (thanks, Helen!), we had some seed money to begin thinking together, along with friends/volunteers from five development organizations (listed below). What resulted is the following paper from the KM4Dev Journal.

Learning 3.0: collaborating for impact in large development organizations

Nancy White, Rachel Cardone, Aldo de Moor

Abstract

This discussion paper builds on the body of research and practice about technology stewardship originally explored in Digital Habitats, and on the findings from an initial probe into the experiences of five development agencies using collaboration platform technologies. The probe was conducted from September 2013 through February 2014. We propose a framework for looking at productive practices in selecting, configuring and supporting use of collaboration technologies in international development organizations by focusing on the opportunities that exist in the boundaries between different parts of a development organization and different kinds of interactions that lead to learning and development impact. We suggest that there is a very useful opportunity to expand this initial probe using collaboration pattern language and a complexity lens to develop a useful repertoire of technology stewarding practices for collaboration in international development with the goal of supporting greater impact of development work.

via KM4Dev Journal.

This snippet gives a bit of the context for the action learning agenda:

We worked with key staff from the International Fund for Agricultural Development (IFAD), Oxfam International, German Federal Enterprise for International Cooperation (GIZ), the World Bank Institute, the UN Development Programme (UNDP – special thanks to the ever enthusiastic Johannes Schunter!), and the Bill and Melinda Gates Foundation (BMGF). Our objective was to determine if common patterns or dynamics exist across international development organizations that could suggest models, approaches or methods organizations could use to increase value for money when making investment decisions in support of collaboration. We drew on the collective experience of our action research partners, and our own experiences working to establish, advise and manage collaboration technology platforms. Through a series of discussions, we developed an analysis of the contextual factors relevant to the international development sector.

You can find the full text PDF here. I’d love to hear your thoughts and feedback!

Updating My Cynefin Resource Image

I had not realized I was using an older version of Dave Snowden’s Cynefin image. It is so useful, I am plopping the June 1, 2014 version here in my blog, both so you, dear readers, might see the latest, and I can always go back and find it. 🙂 (Edit: I was sensitized to this updated image via a very nice post on Cynefin in software development http://lizkeogh.com/cynefin-for-developers/  And Dave noted the post headline was not so useful, so I edited that as well. Thanks, Dave!)

Cynefin_as_of_1st_June_2014
Cynefin as of 1st June 2014” by SnowdedOwn work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

via Cynefin as of 1st June 2014 – Cynefin – Wikipedia, the free encyclopedia.

Chris Corrigan “Understanding where you are, not where you think you are”

communitylabI love, love, love this blog post so I’m just posting a link with my deep wish that you go read it. Understanding where you are, not where you think you are: some tips and a process – Chris Corrigan.

I’m working on two project right now where there is such a strong desire to determine “the right, easy way” of doing things where there is no “right, easy” way. We need all the wisdom, tools and processes to keep from falling into the traps!

Continuing My Ecocycle Experimentation

GenderinAgResearchIn January I was working with the CGIAR Gender in Agricultural Research Network during their meeting. My wonderful client, Jacqui Ashby trusted me to use many of the Liberating Structures with the group. We used the Ecocycle Planning structure early on to help think about the network member’s work in a slightly different ways.

This is the third time I’ve used the Ecocycle Planning “full on,” in other words, I hung a meaningful part of an agenda on to it. I am getting more confident in how I launch the process and appreciate the value of practicing and observing others (like Keith McCandless) running the process and learning from them.

ciattweetSimone Staiger, of CIAT, wrote about the experience on her Knowledge Management blog during the meeting. The tweet was apparently provocative. A few days after Simone tweeted the blog link, she received the most retweets and links than any other post she has tweeted out. Is it the phrase “destructive process” that caught people’s eyes and imaginations?

As it turns out, the conversations around the creative destruction phase of the ecocyle were very interesting to me, and it appears that they were of interest to the participants. Here are the combined notes Simone and I wrote up:

Participants struggled a bit with “Creative destruction.” At first, there was some reluctance to place things in the “creative destruction” area, thinking that this was a negative activity. After some discussion, many groups identified this as a rich area of potential and possibility, the space of innovation and renewal. One participant gave as an example the need to deploy our listening skills to some of their diverse co-workers in order to be able to change mindsets and create and work together.  It was also mentioned that it is important that we involve a larger group of “next users” and partners in the creative destruction and renewal phase. This increases the chances for them to support the birth and implementation of ideas and activities.

Are we both excited and afraid of destruction? Is that the power of this area?

Conversations about the Poverty Traps and Rigidity Traps are always useful. It’s like we put a name on something familiar, but often unspoken. Being able to frame and discuss these issues is critical.

The other area that held some useful insights was the area of maturity. Not so surprisingly, what one categorizes as a “mature” practice can vary wildly between individuals depending on their experience, what activities they prioritize in their work and other contextual factors. What is often enlightening is the realization that there may not be a shared understanding of those mature practices and therefore a high potential for misalignment.

From a facilitation standpoint, I was worried that the groupings we created for the maps would not work. We had to group people working on different projects together, and in the past, I’d seen better results when an intact team or group maps their project. But I was surprised how much cross project relevance and resonance emerged. I’m not sure we really mined that as much as we might have.  There was more to harvest and we left it on the table!  Going forward I need to think more deeply about this opportunity.Resonance and dissonance are always rich spaces.