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.

Shifting the Shape of Climate Change

I have been following the news  of the climate change talks in Copenhagen – mostly through friends of mine who are there – with growing interest.  I have never really been a big believer that government or our political leaders are going to lead us to the solutions to the problems we face in the world – big or small.  The culture they operate in – largely one of debate, negotiation and posturing – is very entrenched and makes it particularly difficult for them to shift.

If I only paid attention to the political conversations, it would be very disparaging indeed.  However, the conversations  that most capture my attention are around inner climate change.  This is something we can all do something about – and must do something about!

This morning on Facebook, my friend Mitch Rhodes wrote: “at a gathering in Copenhagen, Archbishop Desmond Tutu spoke about being on the winning side. With our hearts and minds we must firmly believe we are on the winning side and shift to that place with conviction and dignity. It’s an inner struggle as much as an outer struggle.”

He also posted: “Many activists/protesters have anger in their hearts. A theory U-activist holds the power of love in their heart and facilitates the emergence of a just future. Gandhi comes to mind as an example.”

I have been a proponent of Theory U since I first came across it in 2005.  I say yes to being a Theory U activist, holding the power of love in my heart.  The way to shifting the shape of the world in a conscious and intentional manner is by each of us putting our stake in the ground, changing our own thoughts and behaviours and understanding that our actions make a difference in the world and to the world – no matter how big or small.  By our thoughts and actions we will attract others who are also willing to shift and by doing so, we will build a larger and larger field of resonance for the greater shift we want to enact in the world.

Will you be lost in the apparent hopelessness of this large scale global crisis or will you contribute to healing the world (and self to as it turns out) fully, with your heart, mind and soul, firmly believing you are on the winning side, shifting to that place with conviction and dignity?  I will meet you on the winning side!

Leadership Means Crossing a Threshold

The Indo-European root of the word lead and leadership (leith) means to go forth, to cross the threshold or to die.

The challenges we face in the world right now – the big world or our own smaller worlds – are pressuring us to see differently, to sharpen and deepen our attention and to cultivate  our capacity to shift the inner place from which we operate – the place of presencing in Otto Scharmer’s U Theory.

So, why is it that so many of us – leaders in our organizations and our communities – protest the investment of a few days completely away to engage in stillness or reflective practices that enable and build the capacity to see and then cross the inner threshold that shifts the shape of individuals, organizations and communities? And, why are those of us who see the need and know the benefit reluctant to specifically request or recommend this to other leaders we know?

Have we fallen into the trap of limiting beliefs – believing it is not possible to invest this time, that people won’t make the investment or commit the time or that it truly is impossible for leaders to turn off the electronics and their accessibility even for a few days?

Is this a blind spot we need to illuminate?  Is this a reflection of the inner landscape that needs to shift in order to be available to the future that is wanting to happen?

Our awareness and our consciousness determines the qualities of our actions and results.  In Theory U,  Scharmer asks: How can we renew our culture so that every human being is considered a carrier of a sacred project: the journey of becoming one’s authentic self?

As long as we aren’t ready to face and confront the inner abyss, we will stay stuck in the patterns of thinking, behaviour and action that have generated our current results, results that many agree do not support the sustainability of the earth or our current lifestyle – on an individual and collective basis.

If we could truly see the value of shifting the shape of our inner world, knowing it would allow us to cross the threshold into a more integrated way of being with a more responsive capacity to work successfully with the institutional and systemic crises we are faced with, wouldn’t even a significant amount of time – not just days but weeks or months, on an annual basis – become a worthwhile investment?

What is the renewal of hope and inspiration needed to compel us into this pursuit of the sacred project – the journey of becoming one’s authentic self – to understand that as our inner self shifts  we build the capacity, individually and collectively, to tune into, more frequently and in greater numbers, the future that wants to live through us, more becomes possible and maybe our very future depends on it.

Sensing Into and Connecting With Future Possibilities

If studying and learning from the past only serves to create more of the same problems we are experiencing, as Otto Scharmer eloquently presents in his book Theory U, and the way to a different future is by sensing into and connecting with future possibilities – a view, by the way, supported in much of Peter Block’s work around Civic Engagement and the Restoration of Community, what is required to shift us – individually and collectively – into living into an emergent future rather than one that flows from the past?

This question excites me. Intuitively I completely get it – even as I work to get my head around it well enough to explain it to others and to live more fully into it in my life and work.

It requires tapping into new  or underused leadership skills and capacities like activating intelligences in addition to cognitive – the intelligences that come from an open mind, open heart and open will.

Shifting the shape of leadership – internally and externally is the most significant struggle I witness in the people, teams and organizations I speak to and work with.

In Theory U,  Scharmer speaks about the social field which he describes as the totality and type of connections through which the participants of a given system (organization, community, family, social network) relate, converse, think and act.  When there is a shift in the social field, people connect with a deeper source of creativity and knowing and move beyond the patterns of the past.  When this happens it is a memorable moment.   It results in outcomes that include a heightened level of individual energy and awareness, a sustained deepening of one’s authenticity and personal presence and a clarified sense of direction as well as significant professional and personal accomplishment.  It is felt individually and collectively.  And it has been far too rare an occurrence in the past, sometimes because it feels elusive rather than something you can create or co-create with intentionality and sometimes because it almost doesn’t seem real.

What does it take to more permanently shift the social field?  Awareness.  Intentionality.  The willingness to hold the space for this to happen and emergence to occur.  Presence.  Things that now and in the past we often say we don’t have time for because the business at hand is too pressing. We need results!  Current leadership practices and organizational and social culture do not support creating the conditions to sense into and connect with future possibilities and this is the point of resistance and struggle in many organizations right now.  Individuals see it, sense it, come close to it, yearn for it and then the risk feels too great to step partially or fully into needed new leadership practices.

Scharmer says the essence of leadership is to shift the inner place from which we operate both individually and collectively.  It may well be the single most important leverage point for shifting the social field in this century.  This is enormously exciting to me as I am more and more boldly emphasizing growing capacity through self-awareness, personal and, dare I say, spiritual journey – however that shows up for people.

How can we learn to better sense and connect with future possibilities that are seeking to emerge? Presencing is one means of sensing, tuning in and acting from one’s highest future potential – the future that depends on us to bring it into being.  There are many avenues to presencing, individually and collectively.  A few of them: meditation, physical exercise like running, mindfulness in any activity including walking, connecting to nature, yoga, Aikido and Shamanic practice.  Any practice that requires us to activate a different source of intelligence: the intelligence of the heart, which gives us much greater capacity to listen into the emerging field of the future.

I know this experience of listening into the emerging field of the future.  It is what happens when I follow the energy flow of intuition around work, life and the things that matter most in my life and journey.  It is what happens when I am willing to let go and let come, when I can let go of attachment (or at a minimum identify it when it shows up) and surrender completely into what is wanting to happen (instead of trying to direct it or manage it).

Taking a note from Scharmer’s work on Theory U, I am immersing myself in this study and will start by observe, observe, observe, then retreat and reflect, then act in an instant.  I am deeply curious about the future I am sensing into and connecting with and what magic will emerge for me and others as I do so.