Begin by having a group identify a difficult issue. In my seminars of quality leaders, I've found that a good one is to identify the problems they run into with various groups/departments
when trying to implement the results of a project. In a healthcare environment, groups typically mentioned are physicians, nurses, medical support staff, middle managers and executives. I ask them to:
1. Allocate the 100 percent of the blame among the groups.
1a. Admit what percent of the blame they themselves are willing to accept for the situation.
2. Describe the specific behaviors they've
encountered from each of these groups and list every one on a flip chart.
- They said…, They did…, They forgot…
2a. Admit what behaviors they themselves exhibited that might not be helpful.
- I forgot…, I thought…, I neglected…
Time out: I once had a class of 30 nurses in an emotional intelligence class I was teaching using Faith’s book. One nurse suddenly blurted out, “I’m sick and tired of not getting any respect
from physicians!” to which I could hear the “yeah, yeah” murmurings from the rest of the class.
So I asked the group, "What percent of this situation would you say is the physicians’ fault?" Most thought it was around 85 percent, although a non-trivial number said 90 to 95 (one even said 100!). But they finally reached consensus on accepting 15 percent of the blame for the situation.
When I asked for descriptions of the
behaviors they encountered, they filled five pages of flip chart paper. I then asked for the behaviors to which they themselves were willing to admit contributed to the situation, and, if I remember correctly, there were five.
I then proceeded to step three by stating:
3. “You are now 100 percent responsible for the situation.”
This step consists of going back to revisit each listed
behavior and asking the group, “What could you have done that would prevent this from happening?”
As soon as I mentioned the need to assume 100 percent responsibility to the nurses, I heard a collective group gasp. Yet, as I revisited each physician behavior, there was something
they could have done to prevent every one.
4. Without judgment (very important!), ask them to be honest and admit why they don’t do the behavior that would prevent the situation.
- Didn’t have skill, time, permission, willingness, etc.
As this dialogue proceeds, determine which of the reasons are: (1) based only in a perception of fear and (2) true cultural handcuffs that any individual nurse knows would
be futile to attempt to address on his or her own?