Working with an Intensive Care Unit: OD Experiments at Stanford University Medical Center — VIII
[Continued from Horse-Sense and Reality of Academic Incrementalism: Encounters with Stanford Graduate School of Business — VII…]
One day I was contacted by the Director of the Pediatric Intensive care Unit (PICU) at Lucille Packard Children’s Hospital. The PICU is an area within the hospital specializing in the care of critically ill infants, children, and teenagers. Because of the acuity of PICU patients and the risk of life-threatening complications the ratio of professionals to patients is generally higher than in other parts of a hospital. Further, complex technology and equipment such as mechanical ventilators and patient monitoring devices is often in use. This means that the PICU generally has a larger operating budget as compared to other areas of a hospital, and typically has more organizational development related issues.
The Director had heard about the approach I employed in helping leaders and departments and wanted to engage in a 3-month project.
We kicked off with a 1-day training and orientation in which the PICU Leadership Team was initiated into the world of fractals, and the real choice they had in accepting or changing their operating reality by making small personal changes in their active states of being. The PICU could do with an improvement in Employee Engagement and Patient Satisfaction scores. All leaders knew that there was a direct correlation between these scores and future revenues. Further, given the nature of the work, employee stress tended to be higher than usual.
The 1-day orientation is critical and grounds participants in self- and team-awareness. The day starts with some hypothetical exercises. For example: “Imagine you are all working for a very demanding and self-serving boss who wants more than anything else to meet their own goals, regardless of what that implies for their staff. Now imagine there was a fire in one of the local schools and many children are being rushed to be treated at the hospital. The PICU rapidly fills up, and stress-levels amongst nurses quickly escalate. This affects decision-making and continues to put the department and hospital at higher than normal risk. You have to get the environment back to normalcy as quickly as possible. What are you experiencing? What do you perceive your colleagues on this team are experiencing? What is the nature of decision-making? How are you handling conflict as a team?”
The participants all have access to a SaaS-based Team-Development environment and record their perceptions of self and of others in the leadership team. All entries are anonymous, but contribute toward a single “team dashboard” projected in real-time. Entries are both objective and subjective, and are hinged around experienced or perceived states of being. There are about 40 states of being to choose from, ranging from lethargy, boredom, fear, anger, frustration, to joy, courage, synergy, and so on. Objective entry allows duration and intensity of the different states to be entered. Subjective entry allows commentary about states through micro-blogging.
Since states of being are something that is viscerally felt it tend to influence the working culture of the team much more powerfully than ideas or thought in the short-term. As participants continue to reflect on the questions in the context of the hypothetical situation definite patterns emerge which are immediately reflected on the summary team screen. After 30 minutes of entry the team then switches gear and begins to analyze this data. What is the emergent-pattern indicating about the situation? Since patterns will repeat themselves on different scale, that is, on the individual, and the department level, what is the pattern going to indicate about how the department is likely to operate in this scenario?
Different patterns indicate different operating realities and by looking at a pattern one can tell the nature of the operating reality and the stage of development of the team/department quite conclusively.
Now that the team has had their feet wet with the idea of states of being, self- and other- awareness, and the fractal imprint and reality of patterns, the second half of the day switches to real scenarios. Typical scenarios latch onto real and critical projects or changes that the department is currently going through, or on the nature of leadership that is being felt by the team. I always offer a choice on this, and further, allow the team to decide whether entries should still be anonymous or not. My recommendation has always been that anonymity be maintained until the team begins to gel together in a different way, and this may take anywhere from 1 to 6 months or more, depending on the team in question.
For this first-day orientation the PICU Leadership Team decided to focus on a department restructuring they were currently in the midst of. But I have had other leadership teams at this very same hospital elect to focus on the nature of leadership being offered by the Director, and that too, by removing anonymity so that it is known who is saying what about whom!
We end the first day by analyzing the pattern being displayed. This gives us a quick visceral insight into the nature of the problems and issues and the summary gestalt being experienced because of the restructure. What are people confident about? What do they fear are the big obstacles? Are there personalities coming in the way of the work? What is the general mood in the environment? How much conflict is being swept under the carpet to perhaps surface in other and often more destructive ways?
As with most teams, the summary pattern being displayed indicated that the team was somewhere between the forming and storming stage, even though the leadership team had worked together for over 1 year, and the project was already a few months past the launch phase. This was a less than positive prognosis and quickly generated a number of hypotheses into how employee engagement and patient satisfaction scores could improve.
At the end of the day the team contracted to use the Team SaaS environment on a regular basis. I advised them to at least use it every time they had a team meeting, or an interaction with one another. It typically takes only a few minutes to enter one’s feelings and thoughts. We agreed to meet at the end of the month and analyze the data together. I also entered into a coaching arrangement with several of the leaders to help them see the reality they were creating through who and what they were or were not being and doing.
We went through a few iterations of this cycle — of the team entering observations for a month and being coached — and then collectively analyzing the patterns and their implications.
The awareness of the leaders, in particular the impact of who they were being on their environments, went through an acceleration. The mirror-in-your-face approach forced the leaders to see things that they would not normally focus on, and forced them to take actions they would not earlier have taken. As a result the team maturity accelerated, as did the active management of the restructuring project. The foundation for sustainably improving employee engagement and patient satisfaction scores was arguably put in place.
[To be Continued…]
