Healthier Health Care Systems Now!

Most of us know the intractable challenges of health care, no matter where we live. Many of us are battle tested, battle weary and battle scarred.  Yet, we continue to have high hopes for healthier healthcare.  We have irrepressible dreams for healthcare systems that thrive and are committed to wellness.  Just because some of us have been in this conversation for awhile, doesn’t mean the shift won’t happen, no matter how discouraging it gets at times.  Really how do we nudge the big machine of the system when it seems to be hunkering down that much more? What is the staying power we need to do this work in the midst of chaos and serious push back?

What do we do when we are asked to be different but the “system” wants us to do all the same things?  We are being asked to transform but please don’t look any different than you do right now?  These are tough scenarios, impossible push backs from a system that is seeking its own next evolution and afraid to go there at the same time.

Just because we can’t see the way, doesn’t mean it doesn’t exist.  But what does it take to stay the path of pioneering, shift and change?

My good friends and colleagues Tenneson Woolf, Steve Ryman, Dr. Marc Parnes and I have put out a call to current day pioneers in health care systems change to gather in Salt Lake City, Utah from January 11-13th to unearth the deeper questions that sustain us and propel us forward on this mission for healthier health care systems now.

The more we are in conversation as a hosting team, with those planning to attend and those who wish they could be there but for various reasons find it impossible, the more inspired I become about how THIS conversation can and will be different and more than all the ones I’ve been in over the last 5 or 6 years.

I am particularly inspired about what connection can be made between this event and a global conversation on health care.  As we come out of a retreat together, what is it that we could collectively offer, or even teach, others about what we are leaning?  We see a Community of Practice emerging from this.  What does the CoP do together over a period of time that none of us can do alone?  What is the conversation that needs to happen in health care right now – today – that cracks it open in a new way?  What is the unifying force and what happens if it gets unleashed directionally?  How do we use the amazing technology platforms available to do this in whole new ways?

Other thought provoking questions that have been arising through the many conversations:

  • “The system doesn’t work that way” is not a good enough answer anymore.  How do we create systems that make sense to any of us?
  • Systems are more complex that we can manage – how about simpler systems?
  • What’s at the edges that if we could see it and understand it, might help us open up the middle?
  • What happens when we tell our stories of inspiration, especially the ones that are in danger of getting lost?  Can we revitalize these real world stories and our own capacity to be in the journey for the long run?

I am inspired by the Occupy movement, even as it struggles to understand what is next – like health care, like community change, like financial systems….  Charles Eisenstein writes about Occupy in this post on Where next for Occupy.  One of the things he says is, “We want to change the psychic and interpersonal substructure of the system we live in.”  Is this what we mean when we talk about health and wellness systems instead of illness systems?  What would happen if we could change the psychic and interpersonal substructure of health care?  What does that even mean?  I’m not sure but would love to be in that conversation.

Our hosting team has also been inspired by our friend Peggy Holman’s work on Journalism that Matters.  What if this gathering on health care that matters produces a similar set of principles; something like:

  • Health care professionals are stretched, refreshed and inspired to pursue innovations
  • New and often unlikely partnerships
  • Breakthrough initiatives
  • A community of health care innovators
  • A growing culture of innovative health care

We are not in this because it is easy.  We are in it because it matters.  Because we have tried many things, seen success with some and know there is what appears to be a long ways still to go.  Because “the system doesn’t work that way” is not a good enough answer anymore even if we haven’t quite seen the path forward.  Because we know we need to be in this together.

Because we feel in our very beings it is actually possible to create healthier healthcare and we know that it must happen more systemically. We are gathering with people who want to see and do leadership differently for the future of healthcare. With people who are hungry for new conversations. Who feel a responsibility for imagining and contributing what hasn’t been imagined before. With people who know that the way to take on big stuff is to turn to each other. Muck it up. Get curious. Stay focused.

I grow hungrier every day for this conversation now.  Wondering how much bolder I need to become…. we need to become… in a age that needs boldness and daring like never before.  What a good way to kick off a new year – and a prescient one at that!

Becoming an AoH Practitioner

One of the things that stands out from my Envision Halifax days when a team of us co-designed and co-delivered a nine month leadership program, meeting with the group once a month for either a retreat or a learning day, is how often people talked about getting their Envision “fix” – essentially being able to step out of the craziness of their workplaces into a deep breath of a different kind of space, where we often began with check-in circles and always entered into a conscious, intentional practice field of learning focused on self-leadership, team learning and community reflection and engagement.

The desire and need for this “fix” is directly related to how challenging people find it to bring their learning about new ways of interacting with people, creating the conditions for different conversations that lead to different results back into their work environments – and it is also what I hear from people who have just stepped out of their first Art of Hosting training ground.  “It is okay to do this here, but back at work, well, that’s another story.”

At the risk of stating the obvious, becoming a practitioner of anything takes…. well… practice.  And, I am aware of how risky it feels to try out new group processes or new ways of inviting conversation at work.  How many times we hear things like, “I could never use a talking piece at work.”  “I could never get our group to agree to use World Cafe.”  “People I work with would find this language strange and it may turn them off of even trying something new.”  Yes, all true AND there are always ways to begin practice.

People feel their credibility and reputation are most at risk trying something new with the people they work with all the time.   So one of the simplest possibilities is to look for other places to practice – with another team or department, in a volunteer capacity, with someone else who also wants to practice.

When we just begin to know the many and varied practices that are available through the Art of Hosting field and have little experience with them, we have less confidence in and knowledge of how the processes work and how people can be well and fully engaged in them.  Our own lack of confidence and fear can influence how the process unfolds.  For example, if the group has never participated in an Open Space before, it  may take a few minutes for them to warm up to inviting their own conversations when we open the space for their questions.  With experience, we know to be easy in that pause.  Without experience, it ignites our fears and then we want to jump in to make it happen, often over facilitating the space or the process, sometimes resulting in less than hoped for outcomes.  As grow our own experience and confidence in the impact of the process, we relax more which invites more flow and synchronicity into the space.

As for language, if it will be a barrier, don’t use it.  Rather than talking about circle practice, you could just say, “I would like to make sure we hear from every voice.  Maybe we could just go around the table and as each person speaks, the rest of us could just listen well to what they have to say.” Or, of course, whatever language suits you best.

Begin your practice in little ways.  Take little risks.  Change how you listen and see what difference shows up.  Use more questions, powerful questions, that invite people to respond differently.  Bring more curiousity to the conversations you have in the work you do.

Find places to practice the skills you want to develop more.  Find people to practice with.  Look for like minded people inside your organization with whom you can have conversations of discovery and potentially opportunities for practice.  Think of how you can intentionally shift the shape of your world.

Look for places outside of work to practice.  Take yourself back to another Art of Hosting training to deepen your understanding and skills and grow your courage.  Share success stories, small and large, so you and others can see the impact of making even small shifts.  Maybe you have an opportunity to be part of a calling team for an Art of Hosting in your organization or community.  You could look for an opportunity to apprentice in an Art of Hosting training with experienced practitioners and stewards so you learn to pay attention to and look for the nuances that can influence design, hosting and results.

Grow your confidence through practice and your practice will grow.  Don’t be discouraged easily.  Keep your eyes and ears open for opportunity, openings and invitations.  If you look for them, you will be delightfully surprised at how often they show up.

Join a community of practice.  If there isn’t one in your area, start one – even if it is just with a few people.  Join the on-line conversations and communities.  Observe and contribute when and as you are ready.

Whenever and however you can practice, do so.  Grow your courage through small victories and those victories will also grow.  You didn’t show up at an Art of Hosting training because you are risk averse.  You came because something called you.  My guess is, this work will continue to call you and you will continue to respond.  And there is a global field of practice that responds with you.  Be intentional, thoughtful and mindful and practice well.  Before you know it, you will recognize the Art of Hosting practitioner that is you.

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.

Relationship With Self: Base Point for All Other Relationships

The most important relationship to focus on, understand and heal is the one with self.  As you develop mastery in that pursuit, all other relationships automatically achieve a greater level of understanding and you put yourself in a place of conscious, intentional choice around each one.

This is a really difficult concept to grasp.  We live in a relational world.  We are always interacting with others and some people have a tremendous impact on our lives – good and bad. The Law of Attraction says we are consistently attracting to ourselves that which we focus on and tells us that we could actually attract anything we truly desire whenever we desire it.  Many of us have tried…. and failed.  I know I have.  But I have been successful too and the learning is that it doesn’t have to be hit and miss.  It could just as easily be consistently good as it has at times been consistently bad.

But in such an intertwined world how are we to know exactly how much power and impact we have as an individual?  Can’t our individual ability to attract be canceled out or muted by other people we live with, work with or are close to?  Or would we perhaps cancel out what someone else is trying to attract?  This is the question I have lived – and lived into –  for years now and even as I write this I see how either/or this scenario is.  Either I get what I want or someone else gets what they want but we both can’t get what we want unless we want the same thing.  What if it is actually different than this kind of scenario and many possibilities exist all at the same time?

I distinctly remember a few years ago feeling completely out of control and overwhelmed.  There seemed to be so many external circumstances (aka people for the most part) who impinged on my well being, my sense of self, my own competence and my clarity.  They created stress in my life, drained me of energy and fed habitual thought patterns in my own mind that I knew were not serving me and had the potential to make me gravely ill.

And I knew that I had attracted to me, and even created, even embraced, some of these circumstances.  What I had more difficulty grasping was how much of these difficult relationships and circumstances was me and how much was external to me or someone else.  And why?  Why did I attract such undesirable circumstances and relationships to myself because I would certainly never consciously have invited some of these things into my life.

Intellectually I grasped these concepts.  Living into them was a totally different story.

Then came the point, I also distinctly remember, when I knew I had to turn away from all the external stimuli and blame and turn inwards, turn off the vitriolic self talk,  to find the answers I was seeking.  Thus began an intense, deep, concept shattering phase of growth which began as an internal battle with loads of resistance and gradually shifted into a surrendering which now allows a beautiful, simpler unfolding of self and story which I embrace as part of my ongoing evolution or journey into open-heartedness.  And I couldn’t have done it without the support of a couple of different coaches I worked with over that period of time, dear friends and amazing healers.  The discovery and eventual joy in my journey was amplified because I learned to call on and lean into the support that was and is readily available to me.

I couldn’t change the people around me.  I tried.  I hoped.  I prayed.  I rationalized and bargained, “Yes, I know I’ve attracted this and contribute to it, but…..”  When I was out of options, out of hope and feeling myself slip away into a haze of oblivion I finally turned to the only relationship that I actually have the power to influence, shift and change: the relationship with self.  Sure I wanted to…. but did I have to go so deep?  Did I have to fundamentally change my views of myself and my life?  Did I have to let go of my sense of having been wronged and even harmed by others?   Couldn’t I just skate across the surface or go just under the surface?  Couldn’t I still hold onto some version of being right?  Did I have to fundamentally examine everything about me, take it all apart in order to invite the kind of dramatic change into my life I knew I was needing?  Damn.  Resistance.  Strong enough that it  required pushing through at times.

I learned, thanks to the lovely Sarita Chawla, that my emotions were the doorway into understanding what was really going on with me and I learned that when I  dissociated from my emotional state I was putting up strong barriers to the learning that was available to me.

As I broke down walls and reclaimed more and more of the essence of who I am, I began to stand stronger in the world.  I learned about healthy boundaries and I learned about allowing myself to show up more fully in the world and in my relationships.  I became clearer and clearer on what I wanted, what I didn’t want and what needed to shift in me in order for the dynamics of my relationships and my world to shift.

As I came to understand the relationship I had with myself better, I found ways to stand in my strength and my power and grew clarity about “my stuff” – what was mine and what wasn’t – and all the relationships around me began to also shift.  I found strength to walk paths I had cowered on before and I found the capacity to change the conversation.  I began to choose with who and how I wanted to be in relationship and more and more layers of protective coating began to fall away so I could show up in – and attract – more and more joy, delight, beauty and graciousness until I have come to the understanding that THIS is the baseline way of being.  Now I know that when my emotional state is anything other than joy, delight, beauty or love it is a signal to inquire into what’s going on, resolve within myself whatever needs tending to and reaching out, time and time again, for the assistance I need when I need it – because it is readily available and because we amplify possibility and healing when we do so.

I have learned more and more of the truth that it all begins and ends with my relationship with self.  When that it grounded, solid and resilient, so too is my capacity to show up in all the other relationships in my life – including the most challenging ones, the most beautiful ones and everything else in between.

Art of Hosting: Example of a Collaborative Network

The Art of Hosting is an example of a collaborative network.  It’s not the only one but it is the one I am most familiar with and it is the one I find myself speaking about most often when the topic of new models of organization or business comes up.

The Art of Hosting network emerged organically, even before it was called Art of Hosting (AoH) as practitioners of dialogic processes gathered to inquire into what it was they did that was different and what were the conditions that contributed to their successful consulting or process work.  They created the conditions for relevant and meaningful conversations to occur in such a way that the conversations individuals, organizations and communities had were different and more impactful than the ones they traditionally had had and where wiser, more informed action often emerged.

As trainings were offered – always co-hosted by a team, they were a place of co-learning and open source sharing and such a meeting of mind, heart and spirit that people naturally wanted to stay in touch to continue sharing and learning.   Teams of hosts were invited into the same work together and variations of these host teams emerged as people newly introduced to AoH who wanted to deepen their understanding and practice began to call AoH trainings and join host teams.

Somewhere along the way, the AoH listserve was born and, as is typical of listserves, there are sporadic bursts of activity around themes that catch fire among some list serve members and there is also silence for some periods of time.

There were always people who carried a deep curiousity about this work and what, for many of the AoH practitioners I know, is a sense of deep calling.  They – we – work together often, deepening learning and often find each other at other gatherings like, for instance, ALIA.

From early on the notion of stewarding began to emerge and there have been many conversations along the way about what is stewarding, what is a steward, who is a steward, what is the AoH, how do we protect the integrity of this work, is there a brand, what do we do when someone calls an AoH training and no one in the network seems to know who they are.  These kinds of questions are integral to gatherings of stewards – practitioners who do not just use the AoH in their work but tend to the larger field.  A steward seems to be someone who understands deep within themselves what we call the DNA of the AoH – the formative field from which the AoH emerged.

Over the last decade, the number of AoH offerings has grown exponentially through public offerings and through client work that many of us are engaged in. These offerings have now occurred literally around the world, although not in every country yet.  We have experimented with forms of AoH like the Art of Participatory Leadership, the Art of Collaborative Leadership, the Art of Social Innovation, the Art of Harvesting, the Art of Protection, the Art of Humans Being and I’m sure there are more.

The AoH network is not without its faults or its own shadow.  It resists defined structure, hard and fast rules and continues to be organic despite calls from time to time for definitive answers.  It resists responding in traditional ways and roles.    Not everyone is happy with the way it works. And it works exceptionally well.

There is no central office and there are no staff.  While not a perfect system, AoH host teams are invited to share a percentage of the revenue earned in trainings to help support the technology that is key to connecting this global community and to offer something to those in this network who host this on our behalf.  And any of us can also contribute personally.

The AoH community is held together by a strong sense of purpose and principles in the work, a commonality of language and practice and core methodologies, processes, and world views. We understand that before we can host others, we must host ourselves and that we grow the body of knowledge and our own knowledge and practice through communities of practice.

It is easy to find people to work with on small and large projects and on systemic change work because there is such a strong alignment of principles and values.  I’m a sole practitioner but I’m not a sole practitioner because at any given time I either draw on the body of knowledge of the AoH or the mates I have in this network.  I have the privilege and benefit of often working on international hosting teams – here and elsewhere.

As the network grows, the sense of caring for the core of the AoH grows stronger amongst those of us who feel we are stewarding something here,  recognizing that it is completely impossible to control how it spreads, nor would we want to.  That is both the beauty and power of it – and the frustration.   It is a chaordic organization.

When we come together as teams to work together there are no hard and fast rules but there is certainly a sense of honour and integrity in relationships and of patterns of hosting and relationship.  We operate by agreement and we determine who and how host team members get paid by agreement achieved in conversation each time we gather.    People who are not part of this network sometimes have a hard time understanding that we don’t necessarily need a written contract to work with each other (like when one of my good friends was trying to get into Halifax to co-host with me and others and the customs officials asked several times to see the non-existent contract).

We care deeply about this work, about this body of knowledge, about this community and about the relationships we have entered into that are enduring for many of us.  We have a lot of conversation – purposeful conversation.  We don’t have a lot of structure.

A lot of information on AoH can be found on the website and on the community ning.  What I’m offering here is just one version of a very large story, the beginning of which I did not actually witness.  I don’t think this form of organization is the right form for every organization but with the clients I work with who are in a question of what next and how to structure their organization, I offer it out as an example to take some learnings from.  I also talk about World Cafe and Berkana, among others, as organizations experimenting with different organizational models.  Built on trust.  Built on relationship.  Purpose.  Principles.

And, it will be one of the collaborative networks used as an example during the Art of Collaborative Leadership next month in Halifax as we explore the conditions that foster good collaborative networks and what their role is in shifting the shape of the world.

Shifting Patterns of Hurt and Guilt

Recently, in a situation I was both peripherally and deeply involved in, I could see the paradox in that situation and was aware of old patterns of behaviour, interaction and showing up beckoning at the door.  I knew in my heart it was an opportunity for me to see just how much I may have shifted the shape of my old patterns.   I wanted to enter into the space and conversation being demanded of me in a way that was open but with clear boundaries, with compassion and the ability to listen rather than be defensive.

I had the good fortune of receiving wisdom from a dear friend, a Warrior of the Heart.  What he told me resonates with me weeks later – a clear indicator of just how powerful his advice was for me in my journey.  He said it was okay to be clear about my boundaries, to even identify that I had a limited amount of time available for the conversation if need be.  And then he said the thing I still sit with: “You will only absorb us much hurt as you feel guilt.”  That landed with a quiet but powerful thud, breaking into my awareness with precise clarity.   “You will only absorb as much hurt as you feel guilt.”   Wow!

I had a bit of time to reflect on what, if anything, I might have felt guilty about in this particular situation.  Just having the opportunity to ask myself the question released anything that may have been lingering, unaware and unconscious,  under the surface.   Which meant it did not show up energetically in my field as part of my shadow.

I was then able to enter a potentially difficult conversation with far more openness and receptivity than I would otherwise have had available to me and there is no question in my mind it shifted the shape of the conversation.  I had no need to overtly claim boundaries – they were honoured in the conversation.  I was able to acknowledge the experience of the other person and knew exactly what support I was authentically able to offer, support that was acknowledged graciously – and that would not have been the case in past interactions.

Since this particular incidence, I have been sitting with this amazing, unexpected little gift: You will only absorb as much hurt as you feel guilt.  I can see how this dynamic and pattern has clearly played itself out in my life, over the whole course of my life.  Absorbing hurt was just what I deserved for whatever wrong – real and imagined – I committed against others.  Fortunately, I don’t feel the need to closely examine every little (and big) example of this throughout my life (that would probably take another whole lifetime) but now being able to consciously ask myself this question going forward is a gift to me for clearing shadow in beautiful and unexpected ways leading to results I might not have thought possible.

What’s your reflection on how understanding this little statement: You will only absorb as much hurt as you feel guilt, shifts the shape of your experience?