Imagine you are a hospital doctor. Some patients die. But how many is too many before you or your hospital are labelled killers? If you check out the BBC page
So is the map dead? Not at all – the value of a map in providing a sense of perspective, context and location is just as useful as ever. And there are many sorts of maps apart from the static, structural, geographical maps ones we are used to. The really exciting maps are the dynamic ones – the functional maps. These are maps that show how things are working and flowing, not only where they are. Imagine if your SatNav had both a static map and was able to access a real time dynamic map of traffic flow. Just think how much more useful it could be? However, to achieve that implies that each person on the road would have to contribute both their position and their intended destination to a central system – isn’t that Big Brother back. Air traffic control (ATC) systems have done this for years for a very good reason: aeroplanes full of passengers are perishable goods – they can’t land anywhere they like and they can’t stay up there waiting to land for ever. You can’t afford to have traffic jams with aeroplanes – so every pilot has to file a flight plan and will only be given ATC clearance to take off if their destination is capable of offering them a landing slot in an acceptable time frame – i.e. before the plane runs out of fuel! Static maps will always be needed to provide us with a sense of perspective – and in the future dynamic maps will revolutionise the way that we do everything – but only if we are prepared to behave collectively and share our data. We want to see the wood, the trees and even the breeze through the leaves! The problem arises when this seat-of-the-pants incremental invent-patch-and-fix approach is applied to real systems – in particular a healthcare system. We end up with the same result – a Heath-Robinson contraption that is held together with Red Tape. The complex bureaucracy both holds the system together and clogs up the working – and everyone knows it. It is not harmless though – it is expensive, slow and lethal. How then do we remove the Red Tape to allow the machine to work more quickly, more safely and more affordably – without the whole contraption falling apart? A good first step would be to stop adding yet more Red Tape. A sensible next step would be to learn how to make the Red Tap redundant before removing it. However, if we knew how to do that already we would not have let the Red Tapeworms infest our healthcare system in the first place! This uncomfortable conclusion raises some questions … What insight, knowledge and skill are we missing? That doesn’t sound like a large price to pay for improvement! Carl Jung described a theory of psychological types that was later developed into the Myers-Briggs Type Indictator (MBTI). This extensively validated method classifies people into sixteen broad groups based on four dimensions that are indicated by a letter code. It is important to appreciate that there are no good/bad types or right/wrong types – each describes a mode of thinking: a model of how we gather information, make decisions and act on those decisions. Everyone uses all the modes of thinking to some degree – we just prefer some more than others and so we get more practice with them. The purpose of MBTI is not to “correct” someone elses psychologcial type – it is to gain a conscious and shared awareness of the effect of psychological types on interpersonal and team dynamics. For example, some tasks and challenges suit some psychological types better than others – they resonate – and when this happens these tasks are achieved more easily and with greater satisfaction. “One’s meat is another’s poison” sums the idea up. Just having insight into this dynamic is helpful because it offers new options to avoid frustrating, futile and wasteful conflict. So if you are curious find out your MBTI – you can do it on line in a few minutes (for example http://www.personalitytest.net/types/index.htm) and with that knowledge you can learn what your psychological type implies. Mine is INFJ … Have you ever had the uncomfortable experience of joining a new group of people and discovering that your usual modus operandi does not seem to fit? Have you ever experienced the pain of a behavioural expectation mismatch – a clash of culture? What do we do when that happens? Do we keep quiet, listen and try to work out the expected behaviours by observing others and then mimic their behaviour to fit in? Do we hold our ground, stay true to our norms and habits and challenge the group? Do we just shrug, leave and not return? The other side of this common experience is the effect on the group of a person who does not match the behavioural norms of the group. Are they regarded as a threat or an opportunity? Usually a threat. But a threat to whom? It depends. And it primarily depends on the emotional state of the chief, chair or boss of the group – the person who holds the social power. We are social animals and we have evolved over millions of years to be hard-wired to tune in to the emotional state of the pack leader – because it is a proven survival strategy! If the chief is in a negative emotional state then the group will be too and a newcomer expressing a positive emotional outlook will create an emotional tension. People prefer leaders who broadcast a positive emotional state because it makes them feel happier; and leaders are attracted by power – so in this situation the chief will perceive a challenge to the balance of power and will react by putting the happy newcomer firmly in their place in the pecking order. The group observe the mauling and learn that a positive emotional attitude is an unsuccessful strategy to gain favour with the chief – and so the status quo is maintained. The toxic emotional waste swamp gets a bit deeper, the sides get a bit more slippery, and the emotional crocodiles who lurk in the murk get a tasty snack. Yum yum – that’ll teach you to be happy around here! If the chief has a uniformly positive emotional approach then the group will echo that and a newcomer expressing a negative emotional state creates a different tension. The whole group makes it clear that this negative behaviour is unwelcome – they don’t want someone spoiling their cosy emotional oasis! And the status quo is maintained again. Unfortunately, the only difference between this and the previous example is that this only-happy-people-allowed-here group is drowning in emotional treacle rather than emotional turds. It is still an emotional swamp and the outcome is the same – you get stuck in it. This either-or model is not a successful long-term strategy because it does not foster learning – it maintains the status quo – tough-minded or touch-feely – pessimistic or optimistic – but not realistic. Effective learning only happens when the status quo is challenged in a way that respects both the power and authority of the chief and of the group – and the safest way to do that is to turn to reality for feedback and to provide the challenge to the group. To do this in practice requires a combination of confidence and humility by both the chief and the group: the confidence to reject complacency and to face up to reality and the humility to employ what is discovered to keep moving on, to keep learning, to keep improving. Reality will provide both positive and negative feedback (“Nuggets” and “Niggles”) and the future will hold both positive and negative challenges (“Nice-Ifs” and “Noo-Noos”). Effective leaders know this and are able to maintain the creative tension. For those of us who are learning to be more effective leaders perhaps the routes out of our Toxic Emotional Waste Swamps are drawn on our 4N charts? The model of learning that I have sketched is called the Conscious-Competence model or – as I prefer to call it – Capability Awareness. We all start bottom left – not aware of our lack of capablity – let’s call that Blissful Ignorance. Then something happens that challenges our complacency – we become aware of our lack of capability – ouch! That is Painful Awareness. From there we have three choices – retreat (denial), stay where we are (distress) or move forward (discovery). If we choose the path of discovery we must actively invest time and effort to develop our capability to get to the top right position – where we are aware of what we can do – the state of Know How. Then as we practice or new capability and build our experience we gradually become less aware of out new capability – it becomes Second Nature. We can now do it without thinking – it becomes sort of hard-wired. Of course, this is a very useful place to get to: it does conceal a danger though – we start to take our capability for granted as we focus our attention on new challenges. We become complacent – and as the world around us is constantly changing we may be unaware our once-appropriate capability may be growing less useful. Being a wizard with a set of log-tables and a slide-rule became an unnecessary skill when digital calculators appeared – that was fairly obvious. The silent danger is that we slowly slide from Second-Nature to Blissful-Ignorance; usually as we get older, become more senior, acquire more influence, more money and more power. We now have the dramatic context for a nasty shock when, as a once capable and respected leader, we suddenly and painfully become aware of our irrelevance. Many leaders do not survive the shock and many organisations do not survive it either – especially if a once-powerful leader switches to self-justifying denial and the blame-others behaviour. To protect ourselves from this unhappy fate just requires that we understand the dynamic of this deceptively simple model; it requires actively fostering a curious mindset; it requires a willingness to continuously challenge ourselves; to openly learn from a wide network of others who have more capability in the area we want to develop; and to be open to sharing with others what we have learned. Maybe 360 feedback is not such a scary idea?Can We See the Wood for the Trees?
“The Map is not the Territory” but it is a very useful because it provides a sense of perspective; the bigger picture; where you are; and what you would need to do to get from A to B. A map can also provide the the fine detail, they way-points on your journey, and what to expect to see along the way. I remember the first computer programs that would find a route from A to B for me and present it as a printed recipe for the journey; how far it was and, best of all, how long it would take – so I knew when to set off to be reasonably confident I could arrive on time. Of course, there might always be unexpected holdups along the way but it was a big step forward. One problem was using the recipe as I drove, and another was when I accidently took a wrong turn, which is easy in unfamiliar surroundings with only a list of instructions to go by. If I came off the intended track I would get lost – so I still needed the paper map as a backup. The trouble now was I did not alwasy know where I was on the map – because I was lost. Two steps forward and one step backwards. Now we have Google Maps and we can see what we will actually see on the way – before we even leave home! And with SatNav we can get this map-reading-and-route-planning done for us in real time so if we choose to, are forced to, or accidentially take a wrong turn it can get us back-on-track. The days of heated debate between the map reader and the map needer have gone and it seems the only need we have for a map now is as a backup if the SatNav breaks down. (This did happen to me once, I didn’t have a map in the car and the only information I had was the postcode of my destination. I was pressed for time so I drove around randomly until I passed a shop that sold SatNavs and bought a new/spare one – entered the postcode and arrived at my intended destination just in time!).What Happens if We Cut the Red Tape?
Later in his career, the famous artist William Heath-Robinson (1872-1944) created works of great ingenuity that showed complex inventions that were created to solve real everyday problems. The genius of his work was that his held-together-with-string contraptions looked comically plausible. This genre of harmless mad-inventorism has endured, for example as the eccentric Wallace and Grommet characters.
Where do we need to look to find the skills we lack?
Who knows how to safely eliminate the Red Tapeworms?
Can they teach the rest of us?
How long will it take us to learn and apply the knowledge?
Why might we justify continuing as we are?
Why might we want to maintain the status quo?
Why might we ignore the symptoms and not seek advice?
What are we scared of? Having to accept some humility?Is this just a Clash of Personality?
Have you ever have the experience of trying to work on a common challenge with a team member and it just feels like you are on different planets? You are using the same language yet are not communicating – they go off at apparently random tangents while you are trying to get a decision; they deluge you with detail when you ask about the big picture; you get upset when their cold logic threatens to damage team unity. The list is endless. If you experience this sort of confusion and frustration then you may be experiencing a personality clash – or to be more accurate a pyschological type mismatch.Are we Stuck in a Toxic Emotional Waste Swamp?
Is this Second Nature or Blissful Ignorance?
I haven’t done a Post-It doodle for a while so here is one of my favourites that I was reminded of this week. Recently my organisation has mandated that we complete a 360-feedback exercise – which for me generated some anxiety – even fear. Why? What am I scared of? Could it be that I am unconsciously aware that there are things I am not very good – I just don’t know what they are – and by asking for feedback I will become painfully aware of my limitations? What then? Will I able to address those weaknesses or do I have to live with them? And even more painful to consider; what if I believed I was good at something because I have been doing it so long it has become second nature – and I discover that what I was good at is not longer appropriate or needed? Wow! That is not going to feel much fun. I think I’ll avoid the whole process by keeping too busy to complete the online questionnaire. That strategy did not work of course – a head-in-the-sand approach often doesn’t. So I completed it and await my fate with trepidation.
Health Care Systems Engineering Blog