The Land that Time Forgot….
… is Eastern North Carolina when healthcare reform requirements are robust–but the economy is chronically weak and there is no government funding support for the legislation.
Our colleague Bruce Flye has done really fine strategy work using scenario-creating conversations. In this case he is facilitating his home institution, The Brody School of Medicine (BSOM). The full story is posted on his blog Making Voices Visible. I have excerpted key parts connected to his use of the LME cards within digital artifacts such as the Vue mapping tool, and in his hand rendered graphic illustrations.
Regardless, thousands of new patients are entering the system.
Without commensurate funding, the medical community stretches
Skills and abilities previously unrecognized:
Day by day
Still unsure of the long-term path
But with renewed commitment to the need.
In late 2009 the Dean sent me a review of Scenarios: The Art of Strategic Conversation by Kees van der Heijden. His note said simply “A different form of visioning?” I was still relatively new, and I wondered what his intent was, but I decided I better get a copy and read it.
The approach advocated was stunning, in part because the rationale merged many things I had learned in other disciplines. The principles of systems thinking, visual language and Appreciative Inquiry were coming together although not necessarily explicitly. Overall, the strong argument for emergent practice and participative approach resonated.
While reading Strategic Conversations, I was aware that BSOM “had a strategic plan,” but I was also aware that the Dean, having been here just two years, was already thinking differently. In many ways he was in a mindset of Ackoff’s Idealized Design. Wouldn’t it be great if we had a few more people to think along with him? Engaging with Scenarios would allow us to map the current system and the trends in the external context.
To assure relevancy in the scenarios we began with one-on-one interviews of 26 of the leaders in our BSOM community –faculty, chairs, administrators, board members and hospital executives. The protocol was designed to elicit what they were thinking about and paying attention to. Handwritten interview notes were then transcribed into mindmaps, and these were then separated into external and internal subject matter, with the internal being those over which we can exercise some control. The external issues were organized by the themes that seemed to emerge from the interviews. This was done by a qualitative analysis using the mind maps to explore relevancies. After informally testing these for reasonableness with a few individuals, a report was compiled for distribution to the scenario team.
To assemble the team, the Dean invited 25 people who were good thinkers and who collectively represented a cross-section of the school.
Another component of van der Heijden’s process is The Business Idea, typically a visual depiction of a positive reinforcing loop that describes what we believe is actually happening when we perform well; it also translates into a simple narrative. Transcending static statements of values and vision, it portrays a living “engine of success” as we see it. One way of testing the accuracy of a Business Idea is to ask “Is it reflective of how we think and act as an organization?” An accurate depiction is useful in that it can be compared to the scenarios and adjustments made accordingly. It’s highest and best use, however, is in stimulating conversations about the relationship between thinking and acting.
The Business Idea here was shared in a short workshop with the department chairs. In small teams we had them converse about the depiction and the questions it raises.
At the end we asked for a “fist vote” of how well it represents our thinking. Although there was confusion about the Business Idea versus a business model (and even a vision) we seemed to be fairly well on target.
Until this point all of the analysis, preparation and distribution had been done by just me; now it was time to turn it over to the Scenario Team. Contrary to the norm, the first workshop did not begin with presentation and debate about the findings to date. We stipulated in advance that the material must be read before the workshop, and we began processing it with a focused conversation designed to see what people were thinking without the need to get to any kind of agreement.
Working in small groups, the team was tasked with a process of working with the 11 themes in the report and deriving the Critical Uncertainties that should be considered in our stories. These then were the material for a second workshop in which we invited John Prescott to come in as our “outsider” and comment on the Critical Uncertainties. John stayed and worked with us as we identifies important drivers of the future, their polar outcomes and ultimately the two dimension around which we would develop four scenarios.
As we reached this point close to the holidays, writing the scenarios took three separate workshops. Our first was a “beta” with just a few of us to test the methodology. One of the things we discovered was that visual tools helped the necessary conversations take off really fast.
The next two scenarios were written in a Monday morning workshop just a few days before Christmas. We helped two small groups through a process wherein they first developed an end state, and then they crafted a narrative around how it would come about. To capture their narratives without bogging down over writing, we had a videographer come in at the end of the meeting to capture the stories as they were verbally presented using the graphic material on the tables.
The last scenario was written in a bar. In an effort to get people together quickly after Christmas, I offered to buy the beer; I was also curious about the interaction of alcohol and creativity. In some ways, this evening produced an especially crisp view of the future.
This work grabs some but not others. The interviews with the leadership were almost all lengthy and intense, with the leaders energetically engaged. The initial workshop with the scenario team was also a high engagement event; however, only two thirds of that team stayed with us for the duration.
The energy in these conversations about the outside world suggest that although it’s not the school’s usual subject matter we are constantly thinking about it. Naming the four scenarios seemed to help have more presence in our interactions.
The workshops themselves were carefully scripted, but the actual work was carried out by self-organizing teams. They were quick to grasp the intent, and willing to work hard. We found that we really can interact in forms other than debate, and that there is a higher than expected tolerance for ambiguity.
Doing this work as visually as possible seemed to be a real help. Graphic templates made the more complicated components easily manageable by the teams. Visual tools like Visual Explorer and Leadership Metaphor Explorer seemed to actually productively jump-start conversations.
The final narratives were posted on a website along with details of the process. Attention is being called to them in arenas such as the full faculty meeting and the Dean’s Blog.
Since their completion, they have served as the launch point for a strategy initiative that will focus initially on the creation of Premium Partnerships for the School. It is anticipated that the Business Idea will resurface as a framework for new directions.