Terry shared about a hospital during crisis, low morale, and intense public pressure, and how, as an OD consultant, he had to create a sensemaking project in the aftermath.
Presented "A model for sensemaking" (Snowden) from cognitive-edge.com.
Narrative and workplace stories define an organization's culture. The challenge is that we need to be able to see multiple perspectives. Terry used narrative capture as a tool for to make sense of how all of the people involved (healthcare providers, management, patients, and families) experience their system and how solutions were identified to encourage change.
Proposed to collect stories from people. Within 6 hours, the network produced 20 people, trusted by the "system" who were ready to share stories.
Formed a front line design team to capture narrative
- Staff designed, staff implemented
Used mass narrative capture to diagnose the system
Created conditions for capturing stories
Created prompting questions (listen to voice recorder for examples)
Took a look at a sample story sheet (Eric talking here)
1. Collect narrative
2. Asked some questions:
The title I would give this story is ... ___________
From whose perspective was this story told?
- A patient
- a patient's relative or friend
- a care provider
- a physician
- hospital support staff
- hospital management
How experienced are the key care providers in this story?
not at all somewhat very
How common is the situation or event described?
not at all somewhat very
What would you say is the emotional tone of the story?
strongly negative negative neutral positive strongly positive
Transcribed all narratives, depersonalized them (removed all identifying references) and entered them into a system for analysis.
Next, asked the story teller to classify the story they just told...
Think about the story you just told. For each of the following 6 "scales", color in the ONE bubble that you think best signifies what was going on in your story..
If you think a scale does not apply to your story, leave it blank
Compassion & respect shown towards people in this story is...
nonexistent _ _ _ _ _ _ _ _ Excessive, smothering
Decision making & teamwork reflected in this story is ...
Rudderless, confused, group paralysis _ _ _ _ _ _ _ _ Total Dictatorship, working in silos, do it my way.
People's personal accountability in this story is...
Total abdication, that's not my job _ _ _ _ _ _ _ _ Taking on too much. Spreading one's self too thin
The concern for patient safety & quality health care reflected in this story is...
Absent altogether _ _ _ _ _ _ _ _ Over the top, paranoia, gross over treatment.
Next, they created archetypes, had an illustrator create each, to be shared.
Finally, they presented the archetypes and narratives to teams to review and determine actions.
Shifts in type of senior leadership
- using contextual decision making framework
- getting the right people at the table
Staff are becoming engaged
- Delivering leadership and communication workshops
- Facilitating tricky decisions
- Don't fight multiple approaches
- Dedicated resources required for change
- Plan beyond the scope of the project
- Brace for setbacks
- Don't forget the "middles"