Reflect first or plan first?
How one hospital's rejection of management orthodoxy won out
With young twin boys, I’m learning the hard way how plans and small humans do not always mix. In this article, I’ll share with you how humans can often achieve more through collaborating to enable emergent change than through careful upfront planning.
The failure of a traditional approach
In complexity thinker Ralph Stacey’s book “Strategic Management and Organisational Dynamics”, he relays the story of a UK hospital tackling falls amongst mainly elderly patients – one of which tragically resulted in a death. Managers first responded with a traditional approach of presentations, targets, action plans. This did have a dramatically positive impact initially. However, within a year recorded falls had returned to their usual rate of 1,500 per year.
The benefits of reflection
In a second attempt, managers relieved a senior nurse of her line duties and assigned her full-time to work with nursing teams. Instead of developing training courses and action plans, she worked with nursing teams to reflect collectively. After a patient fall, she would facilitate a discussion. She asked who was doing what, what could have been done differently and so on. This evolved into a systemic habit of reflection.
As Stacey reports, this approach led to a “31 percent drop in falls over the first year and has continued to drop over the subsequent years.” This is a single data point but it conforms to my belief that so much of modern management is a distraction tactic. It’s a way for middle managers to avoid discomfort, shame and tricky politics. Creating plans, blueprints and charts is often so much easier than having real, expansive and difficult conversations with people about what’s going wrong and what to do about it. Plans have their place of course, but we must always challenge the validity of investing in them and the real motives for focussing on them.
Free-flowing conversations are key
As managers and change agents, if we want to improve complex operations, our job is to create productive spaces for new ideas from people to emerge. These are spaces where people can share ideas and process their shame, guilt, anger and frustration. Our task is to encourage open and possibility-oriented conversations where we welcome a diversity of viewpoints. This is especially true where divergent views might be uncomfortable for some to hear. This approach ultimately broadens the ‘scanning range’ of potential options for us to test within the business. In the words of Ralph Stacey, leaders must:
constantly evoke and provoke further exploration by members of a group, as they act together into the unknown and then respond to what they produce.
If you want to get deeper into the complexity ideas I explore in this article, then check out our interviews with leading complexity thinkers Professor Dave Snowden and Chris Mowles for FirstHuman’s Being Human podcast.
** To download our complexity primer, click here **