A 1500 Day Collaborative Journey

In November 2006, the Council of the College of Registered Nurses of Nova Scotia (CRNNS) embarked on a 1500 day collaborative journey, the likes of which they could hardly imagine was possible at the time.  What was clear was that the College had a vision and a mandate to grow inter-professional collaborative practice (IPCP) from pockets here and there across the province to a more widespread practice as one of the responses to a health care system in need of shifting the way services were delivered.

They knew this was not a mandate that could be achieved alone and they weren’t quite sure how to invite other professions into the conversation.  They contacted an Art of Hosting colleague of mine who invited me into the process and we worked with a team from the College to begin to clarify the work.

Early on we identified that this would likely be a long term process that would use Theory U to define the journey and Art of Hosting as the operating system. Before the journey could even begin, others needed to be invited into the conversation so that other people and organizations could identify what contribution and what level of support or commitment they were willing and able to offer.

The College hosted its first assembly in November 2006 to announce its mandate, speak what they were hearing in the system and being called to do, invite a broad array of health care professionals into conversations using processes like Appreciative Inquiry, World Café and circle which many participants experienced for the first time ever that day.

Out of this assembly a core team of about twenty-five people and financial support from a broad range of health organizations self identified to commit to a multi-year process that included two Art of Hosting retreats (one a sensing retreat and one a presencing retreat) to train the core team, deepen their understanding of the purpose and principles of the work and identify a strategy to move this mandate forward.  We called on Art of Hosting colleagues doing similar work in Ohio and in England to come and also support this initiative, bringing with them a wealth of experience and weaving in the stories from other places that increased the anticipation of successfully shifting the shape of collaborative health care in Nova Scotia.

The collaborators included: Annapolis Valley Health, Capital Health, College of Licensed Practical Nurses of Nova Scotia, College of Physicians and Surgeons of Nova Scotia, Dalhousie University, IWK Health Centre, Nova Scotia Association of Health Organizations (now Health Association of Nova Scotia), Nova Scotia Department of Health, Pharmacy Association of Nova Scotia, Registered Nurses Professional Development Centre and the Pictou County Health Authority.  The team included people from many of these organizations and was itself inter-disciplinary.

In between the two retreats, the core team embarked on a series of sensing strategies to broaden their own understanding of the health care system in Nova Scotia, identifying challenges and opportunities without assuming they already knew all the answers.  One purpose in this was to also engage a more stakeholders and learn from them what would capture their support, interest and imagination.  Seven group interviews and thirty five individual interviews were conducted, designed to elicit their private voice more than their public voice.  It is in the private voice that deep despair and incredible hope both reside.

The information that came back from these interviews was powerful.  So powerful it was used to invite back a large assembly of stakeholders in May of 2008 to hear the results and, most importantly, to hear the voices of the system spoken back into the room.  In response, somebody said, “What we are seeing is a crisis of the soul.”

We asked people: “What would you do that you’ve never done or dreamed of doing to change the future of healthcare?” They responded:

  • Change the way we deliver health care
  • Change the focus of health care
  • Change education of practitioners
  • Change what we say to communities
  • Change governance of health care
  • Change relationships and how we work together

We asked, “What should the purpose of the health care system be?”  To which they responded:

To create and maintain holistic, accessible support and care so that Nova Scotians may live well in a place they call home.

 

To facilitate and empower the individual and the community to create and maintain

optimum health as defined by the individual.

 

The purpose of the healthcare system is evidence based, person-focused, preventative, holistic, and uses a collaborative approach to optimize the health, safety, wellbeing and environment of people within their communities.

People made commitments that day and the College made a commitment to check back in later with their last assembly to acknowledge and celebrate progress.  That day happened in June 2010.

Six champion collaborative practice teams currently providing services in Nova Scotia were invited to present at the Assembly, modeling the way and illuminating the steps to successful collaborative care in Nova Scotia.

Have all the ideas identified in May of 2008 been implemented?  No.  But in 2010, there was far more collaborative care in Nova Scotia than there was in 2006 when the College began its quest and invited in collaborators, retaining its willingness to be a champion of this work and, at the same time, “letting it go” so that it could be co-created throughout the whole journey with those who stepped forward to share the leadership and responsibility of this work in Nova Scotia.  Other initiatives focusing on Collaborative Care also emerged during this time helping to expand awareness and the field of practice and this does not lessen the impact of the Inter-Disciplinary Collaborative Practice initiative in generating impactful responses to a system in need of change.

Some things have fundamentally changed.  Some things are still to come.

New Models of Organization and Work – Are We Ready?

The shape of the world is shifting, pretty dramatically and quickly, right now.  Are we ready?  Are organizations and systems ready? These questions have completely captured my attention fueled by the conversations and places I’ve been in lately.

I’m not sure we are ready and I’m not sure we will ever actually be ready for the shift that is emerging in the world right now.  Systems and organizations are designed to be self perpetuating.  Threat and opportunity are viewed through the lenses and structures of the system or organization – we usually believe that we only have a certain amount of scope within which to bring about change – we can only get certain people’s attention for brief periods of time, we need to work within the system, within the structures, because there are some things you cannot change, some things that will not work.  They may reflect current reality but they are also limiting beliefs and as long as enough people buy into them, radical change will be stalled.  Yet radical change may be what is lurking right around the corner, ready or not.

What gives me hope?  One is the conversations I’ve been in lately around the 2 Loops of Systems Change with my Berkana friends and beyond.  You can read a bit about it here and you can find my own hand drawing of the model here: 2 Loops of System Change

This model shows that in the peak and the beginning of the decline of the mature systems, there are alternatives already beginning to appear.  These alternatives need space to find their way.  Some will grow stronger and some will fail.  The ones that do grow stronger need to begin to connect with each other to grow collective and individual strength and capacity.  There are people in the mature system (stewards or sometimes called “toxic handlers”) who see and understand the importance of this work and who hold the space and clear the way for these alternatives to grow.

The alternatives do tend to fly under the radar and are often not widely known, but they are there.  Maybe they will be ready in the event of collapse of the old systems although it is hard for me to fully imagine what a collapse of the old systems will look like.  Maybe we are already seeing it but just not recognizing it for what it really is.

While existing organizations are entrenched in their structures and processes, newer, usually smaller organizations  have greater flexibility, resourcefulness and resilience and the greater capacity to totally rethink how they are structured, how they deliver their goods or services to the world.  They often can do this at less cost because they don’t have as much “bricks and mortar” in place as larger organizations and it feels less risky because they have “less to lose”, or so it might seem.

What has me excited is the possibility of new business models that can emerge now.  I have found myself sharing stories about networks – the Art of Hosting network, World Cafe, Berkana to name a few – because these networks recognize themselves as networks, organic and emergent.  They trust in the capacity of people to self-organize and are held together and flourish because purpose and principles are clear.  They have a minimum structure and sometimes struggle with how to live models of organization that are outside of traditional structures, particularly because in times of stress people push for what they already know and are comfortable with.    They are open source, openly sharing knowledge and new learning in recognition that this sharing grows the body and field of knowledge.

I share what I know about these ways of organizing with businesses and other organizations I am in conversation with, not because I think they should adopt the specific models, but because I think there is wisdom in these ways of organizing that could inform new business models – especially business models that see the value in operating from a place of openness and open heartedness – which I seem to be running into more often lately.

More than ever, I feel we are on the brink of unprecedented social change around the world and I have a greater awareness of just how connected we all are.  I can’t imagine what exactly it looks like but I continue to grow my comfort and skill working at the edges of my own not knowing – thanks to collaborative relationships with people I am privileged to call friends.

Are we ready?  I don’t think we really are.  Does it matter?  This shift will happen whether we are ready or not.  Our greatest path to readiness is to grow our own capacity for resilience, dealing with chaos, complexity, simplicity and not knowing.

My next posting will look at some of these new models of organization to see what we can learn from them and maybe, just maybe, grow our level of readiness even just a tiny bit.

Can Large Organizations Navigate The Shifting Shape of the World?

Can large organizations (including government) that have an abundance of structure and control actually navigate the shifting shape of the world and survive?  Are they even aware of the degree of shifting that is going on in the world and and the need to dramatically reformat structures, processes and ways of thinking?  I’m not even sure they need to be large or have too much control.  Maybe we are just stuck in old ways of doing things and can’t imagine it might not be possible to simply tweak what we do to survive.

I didn’t realize the intensity with which I have been sitting with this question until now as I find it bursting out of me thanks to the conversations I have been in with people from around the world over the last six months and the reading that I’ve been doing lately.  I don’t think this question was even formulated in my mind but I could feel it working in my being, nudging me this way and that, puckering my brow in moments of concentration, confusion and curiosity contrasted with moments of complete openness and open heartedness – taking it all in, beginning to congeal in the most unexpected ways – for me anyway.

The congealing factors seem to be the book I’m reading by Nick Bilton: I Live in the Future and Here’s How it Works and a video on the younger generations and how they experience life and work: We All Want to Be Young.

Bilton writes that “a universal brand is not enough for today’s consumers”, “people will pay for well-packaged offerings – even in the face of free alternatives” and “it is evident that the smaller start-up companies are innovating and pushing the boundaries… They are listening to their customers and creating content that customers are willing to pay for and delivering it to the devices where they want to enjoy it.”  This is in his first chapter on bunnies, markets and bottom line, porn leads the way.  He does write about other things in this book – texting, video games, how communication is changing, storytelling.

Quite frankly, I was surprised to find myself reading about the porn industry but his points really hit home for me.  Bricks and mortar will have a hard time being responsive to what their customers are looking for. The new economy is open source and crowd sourcing.  Businesses that have made a living off of protected content and protected product development will find themselves hugely challenged as a result of the new economy.   They will — they are — losing their relevance and many are losing their margins on the bottom line.

We have been saying for a long time that our systems – financial, health care, education – are falling apart and/or not serving us well anymore.  But we are stuck.  We don’t know how to shift the systems and, it is really beginning to dawn on me,  maybe they are not shiftable.  Maybe they really will collapse before any real shift can take place.  I don’t know for sure, but when I think about how technology has shifted the marketplace and made information accessible with a few clicks of the mouse, it is hard for me to imagine how large organizations and systems can actually gain the resiliency necessary to navigate the complexities and the simplicities of the shifting shape of this world.

Organic, emergent networks – like social media, the Art of Hosting, the World Cafe, Berkana – are shifting the shape of how we are in relationship with others and with goods and services.  Smaller, innovative organizations know how to tap into these networks in ways that leave larger organizations in the dust.

There is still a big question about how some of these smaller organizations or networks will make money but there are all kinds of conversations going on about money systems, gift economies and finding other ways to recognize or exchange value.  It wasn’t that long ago that the idea of a debit card seemed far fetched to me and now I have a few of them in my wallet.  Just because I can’t see it or imagine how it would work doesn’t mean it isn’t already on its way.

And, we are underestimating our youth.  They represent new language and new behaviours.  The way they think has been influenced by technology in ways that older generations cannot comprehend. Instead of really paying attention to how they will shift the shape of the world, they are discounted as are their values and their work ethic.  But we are trying to fit them into systems designed for a different time (as this video on educational paradigms so beautifully illustrates) and then faulting them for failing to conform.  They gravitate to networks and social innovation.  They are the most plural youth in history with extended social networks.  Traditional career plans and structures are losing strength as the younger generations seek to unite work and pleasure, not in hedonistic ways but in pragmatic and realistic ways, looking to make small dreams possible.    They are already shifting the shape of the world.  How will large organizations navigate these shifts successfully?  Is it even possible?

In my next blog, I will write about the emergent, networked organizations and initiatives that I am either part of or know a bit about because I’m connected to people who are connected to them – like Art of Hosting, Berkana, World Cafe, the Oasis Game, Swaraj University.  All of these networks are modeling new ways of organizing and working in the world.  I’m believing that there are huge lessons in them for new business models and when I tell stories about these networks it is often in this context.  When I even begin to sniff the possibility of new business models I get excited although I’m not yet sure what they will look like but look forward to co-evolving a few of these over the next few years.