I recently facilitated a workshop on Polarity Management to a group of surgeons and doctors, who found it extremely beneficial. I had a “before and after” experience when I learned the model – after you see it, you think, “This is so obvious; how did I not know about this model?” In the workshop, we used the tool to discuss the polarity of focus on Cost AND focus on Quality, in which people identify the upsides and the downsides of both poles. The reason this is AND rather than “versus”, is that in a polarity both poles are interdependent and necessary to the system. You can’t get rid of a focus on cost, just like you can’t get rid of concern for quality – you need both to make the system work.


The discussion helped surface several other polarities that happen in their hospitals, and uncovered assumptions that some staff have. For example, one assumption is that “anybody going after quality is blind to cost”. Something else that goes unstated is our interpretation of “quality” – how each of us defines it, and how we as a group define it – another necessary conversation. Each case calls for a facilitated discussion in which there is collective “sense-making”. That means that people share their interpretations and surface their assumptions, so that the group comes to an agreement about the definition of terms.

The workshop also helped identify some discussions that are calling to be had in health systems, especially in light of the Affordable Care Act (ACA). For example, one participant articulated this important question: “How do we set different measurement standards to help us resolve this polarity?” Some participants commented that many doctors are anxious about how the ACA will affect patient care, and their income. Others question physicians’ motivation for choosing medicine, which for some/many seems to have changed over the years, from initial idealism to a focus on money. So you can see the value of the conversation that went beyond the initial polarity.

Lastly, the piece that emerged for me as a facilitator is my interest in providing a safe space for health care providers to talk about their fears and concerns. One format for this is to invite physicians from various health centers to a group conversation; being the sole representative from a health center might give people the freedom to say what they really think, without fear of their colleagues’ disapproval or condemnation. I imagine other people have been thinking about this. What ideas have you heard for this safe arena for sharing?

For anyone who creates or oversees the creation of learning events:

Hackman bigYou generate learning events to deliver professional development, at monthly meetings or at conferences. How are you ensuring high-quality sessions from your presenters?

Five steps towards dynamic programs:

  1. FORMAT:  Identify a format that works best for your members. What’s important to them? Networking, learning new tools, peer coaching?
  2. NETWORKING:  You can include informal networking time before your meeting, and you can create something more structured, for example:  have people introduce themselves in their small groups.  Give them a guiding question, such as:  What brought you here today?  What would you like to get out of this meeting?   Bonus step:  connect the guiding question to the topic of the meeting!   I.e. “What’s a current challenge you’re working on relative to (topic x)?”
  3. STANDARDS: Define standards of excellence for your programs, for example: Members will have a chance to get to know 5 new people; Participants will report feeling engaged and able to contribute knowledge; There will be a buzz in the room from small group discussions; People will leave with 2-3 skills or tools that they can apply in their work or practice.
  4. ENSURE SUCCESS: Coach presenters in advance on the desired format and standards. Review their agenda to make sure it conforms with your standards. Tell presenters: I want to be sure that you’ll be successful with our audience!
  5. DURING THE MEETING:  Don’t be afraid to intervene gently but firmly during the session if the energy is lagging. If necessary, engage someone with facilitation skills who can do this for you.

When we create learning events, we often focus on what the presenter can provide to participants – at the same time, participants want to feel that they are contributing value to the conversation; members bring their own knowledge to the table, so an ideal meeting will include both!   When you coach the presenter, you might suggest that they build off the wisdom in the room.

If you have a topic or question about program design that you’d like to see featured here, let me know.

How Can I Help You?

Has this ever happened to you?  Someone asks you for advice or suggestions, and when you respond, s/he gets upset that you didn’t deliver what they were asking for.   Darn.   You/we both forgot to clarify what s/he wanted from the conversation.  We can actually help our friend get clear about what they want, and also be more clear about what we can offer.

Try this approach: when someone asks for assistance,  begin by asking:  What is it that you’d like from me?   How would you like me to help you?

  1. Do they want you to ask questions to help them figure it out for themselves?
  2. Do they just want to vent and have you listen?
  3. Would they like you to give recommendations or to help brainstorm solutions?
  4. Are they asking for your opinion?

That way you know what’s expected from you, and you can decide whether or not you’re in a position to deliver.   Anything we can do to clarify the framework of communication can only be for the good.

As a leadership coach, I always attempt to clarify what my client is asking for.   Coaches are trained to ask questions, and to help the client gain clarity, and I try not to give advice unless someone asks for it.  It helps with friends too!

“Real communication is a creative process at the highest level of human potential. When human beings come together for this purpose, something new is literally created in consciousness. Miraculously, the mind of enlightenment itself begins to emerge through the collective and an extraordinary potential is revealed.”  Andrew Cohen

group convo cloudsThis is music to a facilitator’s ear :)

This resonates with my premise when I’m facilitating:  Groups have collective experience and wisdom and it is my job to bring that out.  Participants know when they’ve created something new in their discussion.   You know when you’ve been witness to a unique conversation.  At the minimum, people are sharing what they know with each other; it’s not generally a process of creating new thought.   Enlightenment occurs when we discover some new truth or new possibility together, and that generates energy and excitement – which are the foundation for creativity and innovation.

training and new skillsPicture this:  Your organization is delivering skill-building programs to several project teams, all at different stages of team development.  Do you have one curriculum for all these teams?  Hopefully not – you/we need to adjust the curriculum to the different stages of development of the teams.  For example, if team members are doing very well at figuring out the distribution of roles among the team, then you can skip that.

I saw this in one client’s training programs and advised them to adjust the curriculum.   The case studies they/we use should also come from the industry or work examples of the participants.  If you’re working in health care, you wouldn’t use an example of a museums board of directors.  Adult Learning 101.  In addition, the trainers need to identify more clearly the learning objectives of the different teams – which they could do through a survey or a focus group.  Whatever’s necessary to streamline the workshop to the needs of the participants – and to get them off their blackberrys ;)

I also noticed that the trainers were facilitating the discussion among team members (on project content), while the team leader was sitting down and participating in the discussion.  Why?  If we’re trying to build capacity –  that’s what training is for – then the trainers should let the team leader facilitate the discussion, and then they can sit in the back and be available to coach the team leader if necessary.   That might be a new role for trainers, but could be fun learning to observe and comment only when needed.   That’s capacity-building at many levels!

Example 2:  Health Care Improvement:

Checklists anyone?  You’ve probably heard of checklists by now, made famous by surgeon Atul Gawande,  author of “Checklist Manifesto”.  It is now accepted that surgeons  should use checklists to improve patient safety and outcomes of surgery. As you probably know, “wrong site surgery” sometimes occur, where surgeons operate on the wrong side of your body.   There are several steps in the checklist to prevent this from happening:

  • they mark your leg or arm with a special marker (which should not be erased when they cleanse the area during prep);
  • they check with others on the team, and they ask the patient “What side are you having surgery on?”

I recently heard a surgeon describe what happened when his hospital implemented this procedure – they ask the patient “which side?” so many times that the patient loses confidence in the clinical staff, and wonder whether they’re paying attention ;-)  Ouch – unintended consequences!

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I’ve been keeping my eye out for examples of Organizational Learning, successes and problems.  I recently came across 2 fascinating examples:

1.  Working with a client group last month:

A group of staff,  leaders in the pipeline, were encouraged to develop a strategy for their own on-the-job leadership development,  ways that they could learn from, and share new skills, with one another;  on-the-job learning is even written into their job description.  They are supposed to have x% of their work time devoted to learning.  Problem was, no-one was protecting that time; neither HR nor, in many cases, the supervisor, unless s/he thought it was important.  So the intention is there, but not the follow-through.  My job as a consultant was to point out this structural problem to them, and to boost their own suggestion that they raise this to senior management.  It’s not worth staff time and energy to invite employees to brainstorm ways that they can learn on the job if management can’t back that up with time to implement or structural  support.   How to keep employees engaged?  Give them the support they need to implementing ongoing learning.

How does your organization rate on Organizational Learning? Are your staff sharing knowledge and teaching one another what they know – about your clients or customers, about best practices? Who has valuable knowledge that’s not being tapped into?

“Learning Organizations” refers to continuous improvement of organizational practices, through reflection, sharing feedback and evaluation of outcomes.  In learning organizations employees reflect on what works and what doesn’t work in business practices; they also discuss how effectively people are working together, in teams and departments. Companies who want their employees to learn and grow spend time developing a strategy for knowledge-sharing, which can include any of these activities:

  • Provide time for employees to reflect on what’s working and what’s not, and have them generate recommendations to improve business processes. Make sure HR and management are committed to giving staff time for these conversations.
  • Create Action Learning teams with people from different departments who come together to solve an organizational problem. They’re like an ad-hoc team, meeting for the amount of time it takes to generate a working solution. Use an Action Learning coach to guide the team to harness their learning and to develop their leadership skills during the course of the team’s work.

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As an OD consultant (Organizational Development), I’m interested in organizational learning, building the capacity of teams and staff to learn from their experience in order to improve future performance.  I help organizations create the practices of ongoing reflection and learning, gleaning lessons from what worked and what didn’t work.  Learning from mistakes in high stakes situations is of paramount importance and interest, for example, in health care.

You’ve have probably heard stories about wrong-side surgeries, where patients wake up and wonder why the bandage is on the wrong side ;)  I was very interested in how Beth Israel Deaconess handled this 5 years ago, when then-CEO Paul Levy wrote about it in his blog, Running a Hospital.  Now I’m enjoying his new book, Goal Play, in which he connects leadership to lessons from the soccer field!  Levy talks about creating organizational cultures that “learn from mistakes”, which I think was a highlight of his tenure at Beth Israel.  There was a highly-publicized surgery mistake in his hospital, and the administration was very open about what happened.  They did not fire or punish the surgeon.  When challenged about that, Levy maintained that if you want people to disclose errors in the future, you can’t respond in a punitive manner.  Hence a learning organization – they were creating the conditions for people to be able to disclose and learn from their errors.  There were also other measures and tools that they implemented to improve the way people worked together.
Read on… Continue Reading »


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