Reality – HCSE Blog

20/08/2011

Reality trumps Rhetoric

One of the biggest challenges posed by Improvement is the requirement for beliefs to change – because static beliefs imply stagnated learning and arrested change. We all display our beliefs for all to hear and see through our language – word and deed – our spoken language and our body language – and what we do not say and do not do is as important as what we do say and what we do do. Let us call the whole language thing our Rhetoric – the external manifestation of our internal mental model.

Disappointingly, exercising our mental model does not seem to have much impact on Reality – at least not directly. We do not seem to be able to perform acts of telepathy or telekinesis. We are not like the Jedi knights in the Star Wars films who have learned to master the Force – for good or bad. We are not like the wizards in the Harry Potter who have mastered magical powers – again for good or bad. We are weak-minded muggles and Reality is spectacularly indifferent to our feeble powers. No matter what we might prefer to believe – Reality trumps Rhetoric.

Of course we can side step this uncomfortable feeling by resorting to the belief of One Truth which is often another way of saying My Opinion – and we then assume that if everyone else changed their belief to our belief then we would have full alignment, no conflict, and improvement would automatically flow. What we actually achieve is a common Rhetoric about which Reality is still completely indifferent. We know that if we disagree then one of us must be wrong or rather un-real-istic; but we forget that even if we agree then we can still both be wrong. Agreement is not a good test of the validity of our Rhetoric. The only test of validity is Reality itself – and facing the unfeeling Reality risks bruising our rather fragile egos – so we shy away from doing so.

So one way to facilitate improvement is to employ Reality as our final arbiter and to do this respectfully. This is why teachers of improvement science must be masters of improvement science. They must be able to demonstrate their Improvenent Science Rhetoric by using Reality and their apprentices need to see the IS Rhetoric applied to solving real problems. One way to do this is for the apprentices to do it themselves, for real, with guidance of an IS master and in a safe context where they can make errors and not damage their egos. When this is done what happens is almost magical – the Rhetoric changes – the spoken language and the body language changes – what is said and what is done changes – and what is not said and not done changess too. And very often the change is not noticed at least by those who change. We only appear to have one mental model: only one view of Reality so when it changes we change.

It is also interesting to observe is that this evolution of Rhetoric does not happen immediately or in one blinding flash of complete insight. We take small steps rather than giant leaps. More often the initial emotional reaction is confusion because our experience of the Reality clashes with the expectation of our Rhetoric. And very often the changes happen when we are asleep – it is almost as if our minds work on dissolving the confusion when it is not distracted with the demands of awake-work; almost like we are re-organising our mental model structure when it is offline. It is a very common to have a sleepless night after such an Reality Check and to wake with a feeling of greater clarity – our updated mental model declaring itself as our New Rhetoric. Experienced facilitators of Improvement Science understand this natural learning process and that it happens to everyone – including themselves. It is this feeling of increased clarity, deeper understanding, and released energy that is the buzz of Improvement Science – the addictive drug. We learn that our memory plays tricks on us; and what was conflict yesterday becomes confusion today and clarity tomorrow. One behaviour that often emerges spontaneously is the desire to keep a journal – sometimes at the bedside – to capture the twists and turns of the story of our evolving Rhetoric.

This blog just such a journal.

06/11/2010

When Is Seeing Believing?

One of the problems with our caveman brains is that they are a bit slow. It may not feel that way but they are – and if you don’t believe me try this experiment: Stand up, get a book, hold it in your left hand open it at any page, hold a coin in your right hand between finger and thumb so that it will land on the floor when you drop it. Then close your eyes and count to three. Open your eyes, drop the coin, and immediately start reading the book. How long is it before you are consciously aware of the meaning of the words. My guess is that the coin hits the floor about the same time that you start to making sense of what is on the page. That means it takes about half a second to start perceiving what you are seeing. That long delay is a problem because the world around us is often changing much faster than that and, to survive, we need to keep up. So what we do is fill in the gaps – what we perceive is a combination of what we actually see and what we expect to see – the process is seamless, automatic and unconscious. And that is OK so long as expectation and reality stay in tune – but what happens when they don’t? We experience the “Eh?” effect which signals that we are temporarily confused – an uncomfortable and scary feeling which resolves when we re-align our perception with reality. Over time we all learn to avoid that uncomfortable confusion feeling with a simple mind trick – we just filter out the things we see that do not fit our expectation. Psychologists call this “perceptual distortion” and the effect is even greater when we look with our minds-eye rather than our real eyes – then we only perceive what we expect to see and we avoid the uncomfortable “Eh?” effect completely. This unconscious behaviour we all demonstrate is called self-delusion and it is a powerful barrier to improvement – because to improve we have to first accept that what we have is not good enough and that reality does not match our expectation.

To become a master of improvement it is necessary to learn to be comfortable with the “eh?” feeling – to disconnect it from the negative emotion of fear that drives the denial reaction and self-justifying behaviour – and instead to reconnect it to the positive emotion of excitement that drives the curiosity action and exploratory behaviour. One ewasy way to generate the “eh?” effect is to perform reality checks – to consciously compare what we actually see with what we expect to see. That is not easy because our perception is very slippery – we are all very,very good at perceptual distortion. A way around this is to present ourselves with a picture of realilty over time, using the past as a baseline, and our understanding of the system, we can predict what we believe will happen in the near future. We then compare what actually happens with our expectation. Any significant deviations are “eh?” effects that we can use to focus our curiosity – for there hide the nuggets of new knowledge. But how do we know what is a “signifcant” deviation? To answer that we must avoid using our slippery self-delusional perception system – we need a tool that is designed to do this interpretation safely, easily, and quickly. Click here for an example of such a tool.

13/03/2010

Inspired by actual events

This Sunday I was listening the Aled Jones on Radio 2 – as he was interviewing Mark Kermode of BBC.TV’s Culture Show. Mark posed a profound question:

When you visit the cinema, do you like to watch the kind of film that starts with a caption saying “This is a True Story” or maybe you prefer the kind with a caption saying “This is a story inspired by Actual Events”?

He suggested that it’s best to assume that the first kind is largely a fiction, whereas the latter is almost completely so. Personally, I don’t mind which ever kind it is, for sometimes I actually enjoy being fooled as long as it’s good harmless fun and it’s entertaining – AND as long as I don’t think someone is deliberately fooling me. But then I started wondering: How would I know if they were trying to fool me? Or more worryingly, whether I was fooling myself?

Since the 1850s there have been various “Realism” movements in the fields of cinema, art and literature – featuring the search for literal truth and pragmatism – a representation of objects, actions, or social conditions as they actually are without idealisation or presentation in abstract form – each of these movements was based upon a philosophy that universals exist independently of their having been thought up, and that physical objects exist independently of their being perceived. In this age of political and media “spin” maybe there’ll come a return to such a philosophy? In the mean time, as long as we are aware that the film we’ve chosen to watch is intended as fiction, and is billed as such, most of us won’t mind – indeed we might even view it as escapism – yet in many situations wouldn’t it be nice to feel that we are connected to a representation of events that’s more real, rather than just some one else’s imagined story?

When a patient in the healthcare system, I think I’d rather be treated by professionals who check and double check what they’re doing, and are working within a system that someone has designed to be fail safe – and is measured to be so. I’m hoping that the medics, nurses and administrators know the difference between what’s real and what is imagined. On this week’s Panorama (BBC March 8th 2010) it was suggested that some hospitals have much higher mortality than others, so this isn’t an insignificant hope. The three hospitals featured had all been flagged as having high mortality rates, yet had all been rated “Fair” or “Good” by the Care Quality Commission. This left me thinking that their may be more imagination around in the NHS than hard data.

The thing is, most everyone relies on data (via their 5 senses or their intuition) as if pure and unfiltered – under the assumption that this is all there is. But there’s always more to be known, and some of that missing knowledge may literally be the difference between life and death.

Numerical data in particular is actively avoided by many – even by professionals, be they the designers of the system or an individual who works within it. Many people left school determined to avoid numbers for the rest of their lives – when confronted by even the simplest statistic or numerical puzzle they will happily tell you “I don’t do numbers.” Since seeing the Panorama programme I’m now wondering how many people (clinicians, managers, inspectors) working within the health sector take such a view. Or maybe there’s a full-proof test that every prospective healthcare worker must pass before they’re allowed to practice? Can anyone reasure me about this?

A few weeks ago some very powerful yet delightfully accessible software was launched – called BaseLine©. It has been created so that people can have a kind of 3rd eye perception that mitigates the tendency to fictionalise – so that people can together assess what’s really happening. It’s designed to be a kind of dispassionate “fly on the wall” or a well-positioned “security camera” – and has been designed to be so easy to use that even the numerophobic will want to use it.

It’s actually free software, and even the full version costs under £50 – this is deliberate in order to maximize the possibility of it becoming a health sector standard. Having a standard tool will mean that people won’t have to debate the validity of the statistics, and can move directly to discussing the reality of what’s been happening, what’s happening now, and more importantly what’s likely to happen if nothing changes. Let’s see how long it takes clinicians and managers to discover its power?