Lean nursing: a foreign concept in EC and ICU?

“Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it. And then he feels that perhaps there isn’t.”                                                                                                                            – A.A. Milne, Winnie-the-Pooh

Recently I started doing some in-hospital shifts again. Since my first shift, I’ve been pondering whether I should say something or if I should just suffer in silence. This blog is about my experience in one private hospital group. I’m well aware that, by posting this blog, I’m exposing myself to not working in said hospital group again. So, why risk future shifts and cash flow by posting this blog? Because I feel that I have to be true to me and what I stand for. And I don’t think that these experiences are specific to the hospital group or applicable to only nurses.
It’s my experience that most nurses working in hospitals feel like Edward Bear: they have a feeling that maybe their working conditions could be different, that there should be another way than the daily struggle that has been normalized. Maybe because I have worked outside of the industry, and as manager within the industry, I know that the daily conditions of clinical nurses can and should be different.
In his book Lean Hospitals, Mark Graban says that healthcare providers often think that our job or the value that we bring to the hospital is our ability to deal with problems and just work around the issues and get on with things, to improvise and cope. We think that it makes us heroes to go home broken after a tough shift. We do things that should not be done; we work hard at the workarounds that adds no value to the facility, to us or most importantly to the patient. I think that it’s especially true about nursing. Here is why:
1) Inefficient systems and waste within nursing
After being involved in LEAN projects, I look at most nursing processes and see them as beyond absurd. The amount of waste, workarounds and the inefficiencies are downright ridiculous. There is much more to LEAN than it being a process improvement philosophy, but I’m going to describe it as that for now. I do think that the LEAN approach at times tends to oversimplify complex issues, but it’s generally a good approach for linear problems. LEAN thinking categorizes wastes (inefficiencies) in the system that any organization should attempt to reduce such as:
The waste of unnecessary motion: Walking up and down to fetch medication, equipment, linen, water, bedpans, etc. are not always necessary. I’ve been tracking my kilometers walked per shift. My average over 2 months is 5.2km per 12 hour shift. To walk 5.2 km on a flat surface takes about an hour, implying that I spend one hour a day walking, not nursing. Most of my shifts have been in ICU, where the patients are within close proximity to each other and the ‘specialized nurse’ is supposed to be mostly at the patient bedside. Thus, one would expect that ICU nurses walk less than nurses in other units. So how much time do nurses in, say, surgical units spend walking versus nursing?
The waste of waiting: I also work in the emergency center (EC). A well-described concern in ECs across the world is access block. Yet, from a nursing perspective, there seem to be more constraints keeping the patient in EC, than processes that enables the flow of patients through the EC. The EC is at its busiest after hours and on weekends. Yet, this is typically when other services in private healthcare slow down and operates on skeleton staff– including radiology and pharmacy. Inevitably, the EC nurse becomes a gatekeeper for these systems, e.g. the EC nurse needs to call the radiographer prior to a patient going to X-rays. This increases the workload on the nurse and waiting time in the EC, and not to mention that after hours the patients are only allowed to X-rays one at a time.
The waste of overproduction: Again in EC, we overdo the administration. Why, for a follow up patient that only needs to see the doctor for a quick checkup requiring no nursing input, does the nurse need to complete a 4 page document? And, for admission, does the nurse need to copy 8 pages of nursing notes and the doctor’s notes? I know it’s for auditing purposes, but what is the value? With only one printer shared amongst EC and reception staff another delay is created for no obvious reason.
To transfer a patient from ICU to the ward requires similar overproduction of nursing notes. There is the implementation record, the transfer record and the ICU chart. Then, there is the ward documentation that some wards insist that the ICU nurse should complete. Again, overkill. Ordering simple blood tests is another complicated process. The doctor writes up the request (this can be on one of two places, so the nurse better check both!). Then, the nurse ticks it off on the blood request form, writes the bloods, patient name and bed number into a diary for pathology and has to write it into her notes. Re-writing the blood request that might be written in two places into three places increases the chances of error or omission of a test (and it happens regularly, especially when the unit is busy).
The waste of overprocessing: Overprocessing means doing things not wanted by the client. In the EC, the patient is required to sign out at two places before they can be discharged (creating a delay): once to say that they did not handover any valuables or received them back and then to agree to discharge. Asking why we need to do this, the answers varied between ‘it’s the hospital’s rule’ ‘its proof of our input, should the patient complain’ and ‘it’s for auditing purposes’. Considering the risk/benefit profile, is it really true that the risk of a patient complaint is worth the time lost and the compromise on patient flow?
And why do the nurses need to rewrite everything that the doctor wrote down? Would a simple nursing checklist on the doctor’s notes, especially in EC, not improve patient flow?
2) Conflict between job description and client expectation
Patients in private healthcare often state that they are paying a premium for the care that they receive and, as such, they have a right to demand a certain level of care. More often than not, the nurse is responsible for meeting these patient demands. Often, these requests are in conflict with the described nursing functions. In a way, this has created a reverse incentive, where, if the nurse meets the patient’s demands, then on paper it will appear as if the nurse didn’t do their job. But, meeting the job description and doing the job on paper means not meeting the patient’s expectations. Is the exhausting paper trail that nurses must leave (which, it seems, is mostly for auditing purposes) really patient centric and valuable?
It’s a core nursing function to coordinate all other service providers (e.g. physiotherapy, dietician, food requests, and radiology) and all of these services have preconceived ideas of what the nurse’s function and responsibility is. So, it is not surprising that nurses’ end up feeling pulled in every direction and is consistently told that they are not meeting someone’s expectation of what they were supposed to do that day.
3) Doctors behaving like toddlers
Doctors still throw their toys out of the cot…and nurses are still required to pick it the toys. I count quite a few doctors as close friends, so I felt apprehensive making such a blanket statement. But, hear me out – there is no formal process that prevents doctors (and other service providers) from behaving poorly towards nurses. When I worked on the cruise ships, there was a guest vacation policy. Guests could be asked to disembark or leave a public space if they behaved rudely towards the ship’s staff. Perhaps hospitals need to implement a similar kind of policy for inappropriate behavior towards nurses. Nurses are at the core of service delivery in private healthcare and, as such, the hospital and nursing management should ensure the psychological safety of their nurses.
On a recent shift, a doctor behaved poorly in front of patients, visitors, and other staff by shouting at a nurse. He had the nurse in tears for something that was completely out of her control. When he eventually left, even the patient was in tears. How is this patient-centered? And, why should the nurses still be expected to cover for this type of behavior, smooth things over and apologize on behalf of the doctors to the patients and their families?
Another LEAN principle is respect for people…nurses are also people and should be treated as such.
4) My time is valuable
This has probably been the toughest part of returning to clinical nursing. Covering the unit is the most important aspect of a nurse’s life. Family events or plans after work simply need to be adjusted according to the unit’s needs. Fulltime staff members’ shifts change regularly, sometimes at incredibly short notice. If a shift change happens late, the other shift just needs to stay on, no explanation needed. Even though a part of me gets that, a part of me also rebels against the frequency with which it happens.
As an agency nurse, there is the opportunity cost of being booked for a shift. The agencies have the right to cancel your shift up to 2 hours before your shift was due with no financial compensation. Yet, you probably said no to other work or gave up on other opportunities in order to be available for the agency. Taking into consideration that you are required to be on shift 15 minutes early and sometimes have a 30-60 minute travel time, they basically cancel you as you are already on your way to work. Not really fair….and, beware- should you cancel a shift, you are ‘punished’ by not being booked for a few days.
5) The absence of nursing leadership
There are good nursing managers out there. But, are they showing leadership and advocating for nursing care? As I’ve been told: you can see that the unit is busy because the unit manager is hiding in her office behind a closed door.
Why do they do hide? Are they ignorant of the issues on the floor? I think not. I think it’s more a case of the managers feeling as helpless and disempowered as their staff… and they are caught between the staff and the higher levels of management.
Again referring back to LEAN, ‘Go and See’ is crucial. What the nurses on the floor need is for the nursing managers (hospital managers, head office representation) to be there, to be involved, to produce policies that enable them to do their job, to remove constraints and workarounds, basically to operationally manage the unit. By going and seeing those positioned to improve circumstances can experience the current conditions and frustrations. Currently  they remain removed from the daily grind and they hide behind their audits, checklists and paperwork. Nursing and nursing management has become paper and audit driven rather than patient driven. Why this irrational fear of protection with administration?
6) Level of dissatisfaction
In the short time that I’ve been doing shifts again, I’ve really felt disheartened with the level of frustration expressed by nurses. Not to mention the lateral violence, where nurses take out their frustrations on peers or those lower qualified. I daresay that the lateral violence is a direct result of the daily frustrations with waste and inefficient processes, the behavior of doctors and lack of nursing leadership. There is very little psychological safety within the current nursing environment and, again, as someone told me: the managers don’t have our backs.
The LEAN philosophy describes another waste: the waste of human potential. It’s my belief that the current hospital environment wastes nursing potential and therefor is losing great nurses.

When-a-flower-doesn_t-bloom-you-fix-the-environment-in-which-it-grows-not-the-flower
Summary
A quick unscientific Facebook stalking of my university nursing friends revealed that maybe 3-5 of them are still clinically nursing in hospital. Something must be wrong. Especially seeing that people love telling us that nursing is a calling. If that is true, then we all seem to have lost our calling…
Or, is it that the environment has become so detrimental that nursing is no longer appealing or sustainable as a long-term career option? I wrote this blog because I believe that we can and should change the environment. But, it will take strong nursing leadership. Step one of being the patient’s advocate is by being a nursing advocate, advocating for better nursing conditions so that we can be better patient advocates.

Firefighters, tacit knowledge and rapid decisions

For the past week, Cape Town firefighters have relentlessly been battling fires across the city and it appears that every hour on the news there is another fire to manage.  It’s been said that every fire is different, so have you ever wondered how firefighters decide on the best course of action with so many variables and very little time to exhaust all the possible options and outcomes?

In the late 70’s Gary Klein explored the above question. One of his first discoveries was that the laboratory models of decision-making were not sufficient for the conditions that firefighters work in.  Furthermore during interviews many firefighters were unable to explain how they reached their conclusions and some experienced firefighters stated that they’ve never made any decisions. This led to some fieldwork observing the firefighters and conducting post-incident interviews to explore whether and how firefighters make decisions.  The findings and further work on decision-making resulted in the Recognition Primed Decision-making model (RPD), naturalistic decision-making and recently the shadowbox concept.

Initially Klein hypothesized that firefighters narrow their options to two and then choose the best option of these.  Findings demonstrated that 80-90% of the firefighters used the same RPD strategy to decide:  They would only generate one option based on cues in the environment. Once they’ve selected their option, they would mentally imagine the next step e.g. how the fire are likely to spread, which houses are likely to collapse and then act on that.

Klein discovered that in high-stress, uncertain situations the level of expertise of the decision-maker plays a major role. Decision-making are based on tacit knowledge where the ‘new’ situation contains something familiar or a cue that allows the decision-maker to act on a ‘prototype’ of what worked before.  Experienced firefighters can thus rapidly match current situation to past pattern and literally instantaneously and seemingly intuitively know what to do.

As an example, Klein refers to an interview where firefighters had to enter a house that was on fire.  Within seconds the commander ordered everyone to leave the house, literally as the last firefighter escaped, the floor collapsed.  In retrospect, the commander explained that the fire was too quiet and that was unusual, he also felt that his ears were too hot.  The combination of these impressions prompted the reaction.  At the time he didn’t know what was wrong, but he knew something was amiss.  It turned out that the heart of the fire was not on the first floor where they entered, it was in the basement that they didn’t know about.  If the commander didn’t pick up on the subtle cues, the entire team could’ve been killed.

Because fires grow exponentially, the faster the firefighter can react, the more likely it is that the fire can be contained. It was found that in these situations, the decision-maker opts for the first workable idea and not necessarily the best option (satisficing).  It should be mentioned that experienced decision-makers are very likely to generate a plausible first option. Laboratory decision models that require comprehensive evaluation and multiple options are simply not feasible as the fire would be out of control by the time a decision has been taken.  It’s thus unlikely that reflective deliberation is the key to successful decisions whilst firefighting.

All of the above was described in the Recognition Primed Decision model (RPD).  In the RPD model, a suitable reaction is immediately considered and recognized.  RDP relies on the intuitive pattern finding, where people use their experience to match the situation to patterns that they have learned.  This is followed by conscious analysis in the form of visualizing or mental simulation to ‘test’ the option. Both intuitive pattern finding and conscious analysis are required. According to the RPD model it becomes a cycle where the decision-maker creates a mental picture of what a reasonable solution looks like, the actions required to reach the ideal outcome and then mentally evaluates the effects of the action.

 

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RPD model

 

These findings have been replicated in other environments including military command and control, management of offshore oil installations and neonatal critical care nurses.  These environments are all dynamic, constantly shifting, outcomes are uncertain and decisions are time-critical.

I think that the RDP model enforces the importance of tacit knowledge in high stress environments.  This is knowledge that is deeply rooted, often people are not aware of the extent of their knowledge e.g. firefighters saying that they don’t make decisions. Tacit knowledge is the know-how that is not contained in the procedure manuals or policies.  It is what allows people to perform tasks and provide local knowledge without focused attention.  There is only one way to obtain tacit knowledge and that is through experience, and preferably this experience should be guided by an experienced mentor.  Sadly tacit knowledge is lost when experienced people leave an organization or industry.

Emergency care is an industry in which tacit knowledge is really important. Even just driving an ambulance into some neighborhoods requires tacit and local knowledge.  Rapid and effective decisions are required prehospital, during major incidents and in overcrowded emergency centers. In these situations the decision-making density is high; decisions are made amidst constant, dynamic change.  The information available to the decision-maker is incomplete, ambiguous or not available. Decisions are often required within seconds rather than minutes.

The RPD has two preconditions namely

1)      There needs to be adequate cues in the environment to assist the decision maker

2)       The opportunity in an environment to learn from the cues as it takes time to reach the point of expertise to make these decisions

These preconditions can be used as pointers on how to improve decision-making in emergency care situations.  The first is building a repertoire of patterns that will assist decision-making.  A great method that is used clinically is simulation training; this could and should be extended to operational decisions during crises situations. In the prehospital environment this is already well-established during training.

The other precondition is the one that I think emergency care and greater healthcare industry often disregards: tacit knowledge.  It takes time to build adequate experience which allows good decisions.  Consider the vast amount of nurses, paramedics and firefighters that has left the industry in the past ten years, I daresay that the industry disregards the expertise that comes with 20 – 30 years of hands-on experience in the field.  These experts are not only leaving because of better salaries, but it’s for better work conditions, opportunities, career progression and to feel acknowledged. Tacit knowledge should be aggressively guarded by the industry!

Novices see only what is there; experts can see what is not there – Klein

Read more by searching for any work by Gary Klein including his work on macro cognition; sources of power, gaining insights, naturalistic decision-making and sense-making

https://www.researchgate.net/profile/Gary_Klein6/publication/235418838_A_Recognition_Primed_Decision_RPD_Model_of_Rapid_Decision_Making/links/565512fd08aefe619b1a44f0.pdf

 

Communication: Semmelweis vs Florence Nightingale

A comparison of two intriguing nineteenth century change agents.

The lady with the lamp: Florence Nightingale, founder of modern nursing, demonstrated the effectiveness of hospital design and administration.

The saviour of mothers: Ignaz Semmelweis, demonstrated statistically that puerperal fever could be reduced by hand washing and implemented hand hygiene at the point of care.

The one was acclaimed during her lifetime; the other died an outcast of medical society in a mental institution at the age of 47.

Similarities

Semmelweis (DOB 1818) and Nightingale (DOB 1820) lived in the same era of health care development.

Both had novel ideas that challenged the existing status quo.

Both used statistics to demonstrate their findings (not commonly used at the time).

They made their world-changing discoveries roughly at the same time (1847 and 1854)

Their discoveries were in the same branch of medicine: spread of disease.

Neither one was completely right.  Semmelweis failed to realize that puerperal fever is an airborne and contact disease.  Nightingale lacked “scientific” insight into the spread of disease.

Brief backgrounds

Nightingale was a lady from the upper class in the Victorian era of British history; women had no legal rights and a Victorian lady’s world was strictly confined to home and family.  Florence’s father held progressive views on the education of women and she was well-educated.  However it remained a radical concept that a privileged lady would want to have a career, especially as a nurse!  Nursing was considered a job for untrained, uneducated women with no other prospects and of poor social standing.

Semmelweis was born in Hungary, the 5th child out of ten in an affluent family from German ascent. He was a physician and worked in a large training hospital in Vienna.  There must’ve been a degree of underlying tension for the Hungarian physician working in Austria due to the European political framework of the time.

How did they communicate their findings?

Florence Nightingale consistently communicated and consulted widely, publishing approximately 200 books and 12 000 letters.   Nightingale was strategic in her allegiances.  She attracted talented and powerful collaborators, connecting with a variety of influential people.  She networked across boundaries, even internationally.  Her collaborative efforts with Sidney Herbert are well-known and demonstrate her ability to influence the right people.  Sidney Herbert carried weight in social circles, he had an influential position and enough access to the Queen to make promise Florence prior to Crimea “unlimited power of drawing on the government for whatever you think requisite for the success of your mission.”

Semmelweis was a reluctant communicator and words used to describe his style includes dogmatic, arrogant and ego-driven.  He displayed a tendency to describe his peers using words such as irresponsible murderers, criminals, adversaries and partners in the massacre.

With the implementation of Semmelweis’s hand washing at point of care idea the mortality rate dropped from 18 – 1%.  For reasons unknown he refused to communicate his reasoning and findings to the learned circles. Only fourteen years after the experiments and after he has left Vienna did he publish a book.  The book was poorly received as it was reportedly poorly written and hard to follow.  Semmelweis responded to the reviews by writing public letters, which did little to win support within the scientific community. He died four years after the publication in a mental institution.  His admission to a mental institution is filled with myth.  He’s reasoning was only accepted 20 years after his death with the further discoveries on the germ theory of disease (Louis Pasteur) and antiseptic techniques (Joseph Lister).

Could Semmelweis have had a greater impact if he could communicate differently? I think yes…

The power to influence

Obtain buy in.  Most of us view ourselves as individuals making independent decisions based on facts, however the behaviour of similar others (our peers) have an influence on our decisions, not to mention our preconceived notions.  When the way that we interpret facts are questioned it threatens our truth and the way we see the world resulting in self-defensive behaviour. The gentlemen doctors in the nineteenth century did not believe that their hands carried germs.  For fourteen years Semmelweis declined to share why he was so forcefully challenging this status quo and insulting his peers.  Semmelweis behaviour made it easier for his peers to shun him than to challenge their own beliefs and buy into his message.

Don’t force your opinion (even if it’s right). Semmelweis felt passionately about his message and his statistics proved that he was “right”.  So he forced his message and when it didn’t work, instead of reviewing and adjusting, he raised the tone, making it more aggressive.  He kept pushing, refusing to consider other’s inputs and views.  It’s not only about the facts; it’s also how we go about communicating and adapting our message that counts.

Use a consistent message in different ways. Nightingale used various ways to communicate the same message.  She wrote letters, books, presented statistics, comparing English and French outcomes and collaborated widely.  She wrote in simple English and innovated difficult statistics into easier visuals ensuring that her message was clearly articulated and understood.

Apply some charm. In addition to our bias, we are more likely to follow the lead of people that we like.  This makes charisma an important leadership and change agent trait. Charismatic people are skilled communicators communicating using just the right amount of emotional appeal to lend credibility to their message.

Nightingale’s background prepared her to be an intuitive and skilful communicator.  She innovated to clarify her message (statistically); she used her influential collaborators and she was persistently persuasive. The power to influence people and get them to work with you or even on your behalf is and advanced form of social interaction. I think Nightingale was a clever strategist and communicated with intent.

Summary

There is a Chinese proverb that states that he who threads softly goes far.

Communicating is a skill. When challenging the status quo we need to be intentional, adapting our personal style yet remaining true to ourselves and our truth.

Footnote:  Semmelweiss was able to make his deductions after comparing a nurse driven clinic (low mortality rates) and a doctor driven clinic (high mortality rates), Nightingale made her deductions from nursing experience.  Both cases illustrate the important role of nurses in improving and advancing health care.

Mentalities….Business firefighting versus real-life firefighters

In business language the firefighting mentality is not meant as a compliment.  Instead it refers to poor strategic planning and a disjointed organisation that is spending it’s time fighting unnecessary issues that could’ve been prevented with better management practises.

I’ve always felt uncomfortable about this accepted “business definition”.  My feeling is that whoever coined the term had no idea about the intricacies and complexity of real-life firefighting. At first I thought that maybe I just don’t get what is meant in a business sense, so I kept quiet about the fact that I completely disagree with the analogy.

However after this week’s devastating fires that swept through the Southern Peninsula and yet again observing the firefighters at work I need to say this:  Perhaps organisations need to develop a firefighter mentality.   11046952_398822600291088_530584084941375836_n

According the business definition a firefighting mentality is one where the organisation’s members are frantically rushing, making impulsive decisions; applying “Band-Aids” to problems without in-depth investigation, suppressed problems with short-term solutions.  According to the business analogy if you are proactive you won’t have many fires to fight.  I disagree.  In both nature and business, fire is a natural occurrence, it happens despite measures to prevent it.  There are always uncontrollable forces that organisations cannot influence.  So rather expect the fire, be prepared, train and vigilantly monitor for fires.

The business definition ignores how firefighters actually do their job.  Organisations can learn some principles on teamwork and decision-making from firefighters.

The REAL firefighter mentality

  1. Preparedness.  When not actively firefighting, fire fighters are preparing for the next fire.  If you visit a fire station you will find that the gear is ready and checked first thing on the shift, the vehicles are ready, fire suits ready, the control room is manned.  There is regular practise for emergencies and when the call comes in, everyone are trained and knows their role.  There is no need to add to the complexity of a fire situation by figuring out task allocations or panic about readiness and what next.  Firefighters know what is controllable and what is not controllable.  Controllable is preparedness, uncontrollable is wind direction.  By preparing for what can be controlled, decision-making during the fire is simpler and only targeted to strategies to deal with this fire now.  The groundwork to enable this focus has been done way before the fire.
  2. Consistent communication.  Close up to where the fire is being fought you can hear the fire fighters calling for more water, move closer, watch out, etc.  They are constantly speaking and updating each other, nobody is left out of the communication loop.
  3. Implicit trust.  During a major event the in-charge or commander are removed from the incident.  Decisions with a major impact such as evacuation of homes or mobilisation and withdrawal of resources are made relying on the feedback and opinion from the persons on the forefront.  Think about this….there is no time to check the integrity of a report, to micro-manage or to-do-it yourself.  There is limited time to question; Fire chiefs trust their team with life threatening decisions in a way that few managers trusts their team with minor decisions.
  4. Team approach.  Ever opened a fire hose?  The water comes out at a high pressure and it’s advised to have a buddy standing behind you for support.  Firefighters know that you can’t fight a fire on your own.  A team is dispatched to a fire and not a lone firefighter or fire chief.  Firefighters move together, they work together and they look out for each other, no one is wandering off doing their own thing.

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    Photo credit: Sullivan photography. Picture posted on Facebook.

  5. Strategic planning. Firefighters do not simply rush into a fire.  They arrive prepared, they make a decision and then they execute it rapidly.   What from the outside may appear as impulsive is actually an ability to stay calm under an immense pressure combined with experience and hours of simulation practise.

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                             Working together

  6. Practise. Firefighters practised and simulate various scenarios so many times that when they arrive on scene they are not even aware of making decisions.  If you are interested in reading more about how firefighters make decisions, Gary Klein has done fascinating research on how firefighters build a repertoire of patterns to help them frame a situation and make split second decisions.   It’s a combination of tacit knowledge, intuition and experience.

    Practise makes perfect

                   Practise makes perfect

  7. Courage and ability to remain calm under pressure.   Approaching a fire is scary and firefighters put themselves and their team members at risk with each decision they make.  It takes courage as well as physical and emotional strength.
  8. Humour during stressful situations.  Firefighters and other emergency workers relief tension by laughing, joking and teasing each other during stressful times.   I can think of plenty management moments where a smile, a joke or even just some friendliness could relief the tension.

To all the firefighters I salute you.  Well done.

To see what these brave men and women at work during the Southern Peninsula fires: http://ewn.co.za/media/2015/03/04/inside-the-flames

To read some more about decision-making process of firefighters, ICU nurses and fire fighters:

Brockman, J. (2013) Thinking: The New Science of Decision-Making, Problem-Solving and Prediction.  HarperCollins, New York.

Klein, G., Ross, K.G., Moon, B.M., Klein, D.E., Hoffman, R.R., Hollnagel, E. (2003) Macrocognition.  IEEE Intelligent Systems. May/June 2003 pp.81 – 84

Klein, G., Hoffman, R.R. (1992) Seeing the invisible: Perceptual-cognitive aspects of expertise.  Cognitive Science Foundation Instruction.  pp 203 – 226

Harmony – should lean organisations strive for this?

Paging through textbooks on how to manage people I noticed how much time is dedicated to the importance of establishing harmony within the workspace.  The picture is painted of the utopian workspace where everyone is in agreement on everything all of the time and they are working together without a hitch. According to this literature, creating this harmonious workspace is the ultimate goal and measurement of the good manager.

I disagree.  Harmony is an undesirable goal in a functional workspace.  The objective is not to create a workspace where everyone is agreeing.  The objective is to build a workspace where the capability is developed to recognise hitches, speak about it and experiment with countermeasures.  It’s the manager’s role to facilitate time, resources and a safe space to allow for countermeasures.  The manager also needs to be aware that managers are often poorly positioned to provide countermeasures to on-the-floor issues.

harmonious workers

Any manager that views harmony as the goal of teamwork is setting themselves up for failure.  Diversity in personality, culture and generational gaps in the modern workspace make it an impossible goal.  Managers should aim to celebrate the diversity of opinions and to create space for constructive conflict.  Conflict should be seen as a sign of diverse perspectives and people that are thinking about what they do and how they do it.

If everyone is thinking alike, then no one is thinking.  Benjamin Franklin

A team that is focused only on harmony will not perform well; people might not speak up due to the fear of creating conflict.  This leads to stagnation and the stifling of good ideas.  What a good team needs is a bit of substantive conflict that is solely focused on tasks, policies, and work problems (rather than individuals).

This type of conflict stirs creativity, new thinking, experimentation and leads to improved ways. It is conflict that challenges the way things are done, never settling for less than what is best at the time.

A note of caution: extremes are never good and as much as too much harmony may lead to stagnation, conflict that is not managed well or allowed to become affective and uncontrolled is dysfunctional.  So a balance must be found.

Ways to balance conflict:

  • Psychological safety.  The manager needs to create an environment where people feel safe enough to speak up, and where they are willing to experiment without the need to defend themselves.
  • Address issues appropriately.  Use facts such as measurements to tackle a problem as opposed to tackling a person.
  • Establish ground rules.  Establish parameters within conflict behaviour within teams, where people can treat each other with respect throughout the conflict.
  •  Accountability.  Allow for people at the lowest possible level in the organisation to be accountable and take responsibility for resolving issues at their level, prior to escalation.
  • Coaching on communication and listening skills.  In most organisations little time is spent on personal development, and people using constructive communication is vital in managing conflict effectively.
  • Formal problem-solving techniques.  Train everyone in the organisation on how to use methodologies such as the A3 process to address problems, whichever technique is used it should be focused on the problem or causes of conflict as opposed to people.
  • Explore alternative hypotheses.  Assign a responsible person for this role, and support them in testing these alternatives whilst using a standardised problem solving technique.
  • Manager as mentor. The manager needs to set the example by welcoming conflict and demonstrating that challenges can be dealt with constructively.

If we want team members that question, always strive to work better and improve, and who always find new ways to add value, we need to ask ourselves:  as manager, is our ultimate goal that of harmony or is it one of creative tension?

A great team is not the absence of conflict.  It’s the presence of a reconciling spirit.  When a team shares a strong sense of community, team members can resolve conflict in such a way that strengthens relationships, rather than weakens them.