Capturing Narrative to Understand Complex Issues: Adaptive Action to Shift Culture

Copyright © Tmiller 2016 . All Rights Reserved.

Welcome

Let’s get the ball rolling! Share an

experience. How much a patient gets involved in their own health care

may make a big difference in their well being and health

outcomes.

What example comes to mind that speaks to how health

care providers - or the patients themselves –

are truly embracing the idea of “patient engagement,”

OR give an example of how people are really missing the

boat when it comes to this approach?


Harnessing the Power of Narrative &

approaches for Navigating within

Complexity

• How to work on the “listening”

side of stories.

• Deepen your understanding of

how to better manage complex

problems & systems

• Tools & Methods (scalable)


There’s a time and place for sharing stories


Bringing up

father


Keep her

healthy &

safe

Show her

love and

kindness

Foster

independenc

e


Foster

Independence

Keep her healthy & safe

Model love

and kindness


Teenagers today are given too much freedom of

choice.

I strongly agree

I somewhat agree

I neither agree or disagree

I somewhat disagree

I strongly disagree

I prefer not to say

Traditional Surveys


Complex

OR

DE

RE

D S

YS

TE

MS

U

N-O

RD

ER

ED

SY

ST

EM

S

Obvious

Complicated

Chaotic

Cynefin Framework – ref Snowden

Rules, Policies

Rigid Hierarchies

Best Practice

Experts

Analysis, Metrics

Good Practice

Agents interact freely

Modify the system

Emergent Practice

Transitory

Crisis, Innovation

Novel Practice


Complex

Obvious

Complicated

Chaotic

Cynefin Framework – ref Snowden

Self organizing

networks

Stories &

metaphor

Too many

variables

to manage

Hang out in

Inquiry

“It all depends…”

“You need to know

this person…”

Adaptive

Action - Self-organizing

experimentation

- Guidelines


T-1

T-2

D-1

On a piece of paper,

duplicate these

shapes and lines.

D-2


Triad 1

circumstances

In this story, the challenge for the patient was their…

Not

applicable

understanding

attitude


Triad 2

understanding the

patient

In this example, the patient could have benefited if the

key health care provider was better at …

Not

applicable

providing quality,

timely care

working with other

health care providers


The patient’s engagement in their own health

was … too little

too much

D-1

The health care provider’s trust in this patient was …

absent altogether

blind trust, naïve,

unrealistic

D-2


Narrative Capture – a tool for

engagement

In most circumstances, people are eager to have their

voices heard.

Sharing experiences is part of our DNA.

Reflection is a form of normative learning.

“I realized that I have an obligation to my co-workers to do my

part in making this a better place to work.”

“Well, I came here with my list of problems I wanted to identify,

but I just heard 4 people in a row complain, and I’m going to

change what I was going to say. It’s not as bad as everyone

thinks….”

1

4


Distributed ethnography

Copyright © 2012 Cognitive Edge. All Rights Reserved.

Collection methods

• Live anecdote circle – recorded & transcribed OR written

• On-line

• I-Pad, I-Pod touch, I-Phone – Text OR Voice

16


Decision making & teamwork reflected in this story is …

Rudderless,

Confused, Group

paralysis,

Total

Dictatorship,

Working in

silos, Do it my

way

All perspectives

Nurse & other providers

Physicians

Understanding the nature of decision making


My Status at the hospital

I worked as a dietary aide, … when I would be around nurses and other staff, doctors et cetera you just kind of feel like you’re looked down upon in that they don’t really look at you. They just kind of walk by you in a hallway or on the stairs or. . .

But when I got promoted and moved up to admitting and I was in a uniform all of a sudden it was like I had advanced into an upper world. They were all saying, ‘Oh, hello,’ and ‘What are you doing now?’

It was like I was a different class of person.

I was in the invisible stage, I never really realized. I just kind of thought that’s how everybody was treated. And then when I moved up, I noticed the difference, big time.”


Understanding the world of Critical Incidents

(CI)

19


Understanding the world of Critical Incidents

(CI)

20

Wrist Surgery

We’ve had two incidences of

late in the O.R. and anesthesia.

When we called the first one in,

we got some pushback about

whether or not it was truly a

C.I. Most people who come to

have their wrists fixed aren’t

anticipating dying, so I’m not

quite sure how that wouldn’t be

a C.I.

Observation: more uncertainty about CI criteria in

more recent stories.

Copyright © 2012 Cognitive Edge. All Rights Reserved. 21

Scanning and monitoring in complex

environments

• Numbers derive meaning from their context.

• Understanding stories and experiences as collective

filters.

• Enables visualization - a key human sense-making

capability.

• Provides system to collect, analyze, inform, model

and monitor emerging strategic issues


So What?

How do we get more stories like these?

And fewer stories like these?

22


Complex

OR

DE

RE

D S

YS

TE

MS

U

N-O

RD

ER

ED

SY

ST

EM

S

Obvious

Complicated

Chaotic

4 – point contextualization exercise

Brainstorm elements

Negotiate domains

• Observe emergent

differences


• Large volume of information (patterns)

• Large proxy group

• Composite teams of physicians, managers & staff

• 30 action items developed (safe to fail probes) • Mgmt responsibility

• Staff responsibility

• Joint responsibility

Moving to action – Sensemaking workshop


Sticky Issue


Simple Rules for Senior’s Care (aka guidelines)

• Talk with all seniors about their

health plans.

• Support seniors where they call

home.

• Allow seniors to die when they

are ready.

26


Thank You


3

1

A comparison of approaches

Cognitive Edge Approach Traditional Survey Methods

Numbers with context of stories Numbers that do not inform the

context

Seeks narratives (experiences Seeks opinions of people

Use of indirect prompting questions

more honest and revealing

Use of direct questions which people

usually expect

Highlights visual alternative and

diverse points of view

Traditional statistical analysis often

“drowns out” weak signals

Capturing Narrative to Understand Complex Issues: Adaptive Action to Shift Culture

Healthcare

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