Reminder: I’m doing a free informational webinar tomorrow about the “ExperienceChange” workshops that I’m now facilitating. The session also includes a demo of the “Lakeview” hospital-based simulation. Update: You can view the recording on this page.
As I’ve worked with hospital and healthcare people over the past ten years, one personal benefit to me has been exposure to new ideas and new influences. As an engineer with an MBA, my reading and learning tended to focus on books about Lean, systems thinking, and leadership (see my book recommendations here, even if the list might be a bit out of date… there are some classics there).
I’ve been exposed to ideas from the social sciences, ideas that have been thought provoking and helpful. I find it interesting that some of my favorite Lean authors, such as Jeffrey Liker (PhD in sociology) and David Mann (PhD in psychology), come from social science backgrounds instead of engineering. I mean no disrespect to engineers of course… I’m just saying we benefit from a diversity of perspectives in the Lean world, and that includes the perspectives of nurses and others who work in this field.
I’ve said many times, only half jokingly, that if I were to ever get another formal degree, that it would be in counseling or family therapy, even if I didn’t go to work in that field.
Family Systems Theory
A few years back, a lab director at a hospital (who had retired from a career in military medicine, another diverse background) introduced me to the idea of “family systems theory.” Even with the word “family” in there, some concepts were very applicable to the workplace. This included “triangles” (encouraging people to deal directly with each other instead of bringing a third party into the conflict).
Another helpful concept is the idea of “overfunctioning and underfunctioning,” where a manager might give answers to their employees (overfunctioning) which only reinforces to the employees that they need to just be quiet and follow orders (underfunctioning) and this leads to a downward spiral of one behavior reinforcing the other over time. Telling people what to do might seem efficient in the short-term, but it really undercuts people’s ability to improve in the long-term.
Proper Kaizen coaching helps break those cycles, as managers step back from giving answers and ask employees to speak up and try out ideas themselves — it’s a tough cycle to break, isn’t it?
Listen to Mark read this post:
When I was at the recent Lean Startup Conference, somebody I know somewhat randomly introduced me to another attendee. As we chatted, I learned her background was social work and she was founder of a technology startup that solves a problem that was important to her and her work. I never met people like that when I worked in manufacturing… again, I’ve really grown to appreciate the perspectives and experiences of those who have different educational backgrounds than my own.
We were talking about healthcare, continuous improvement, and such topics and she suggested that I look into a framework called “motivational interviewing” (MI) as something that might be helpful in my Lean coaching.
I took her recommendation and, by the time I was on my flight home (hooray Kindle!), I was reading a free sample of the seminal book on this approach, Motivational Interviewing: Helping People Change, 3rd Edition.
The book gives a layman’s definition of MI as:
“Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.”
I was instantly hooked. I try to help people change in a number ways (through this blog, my books, my work, etc). While MI was developed as a more effective way to help people with addictions, I think this really applies in the workplace. People might be “addicted” to old management behaviors… or they might have a real “ambivalence” to change. They can see reasons to change (why they should adopt Lean practices) but they also talk themselves out of it (they might be afraid or there are some personal positives that come from the old approach they are sticking to).
“Ambivalence is simultaneously wanting and not wanting something, or wanting both of two incompatible things.”
Miller, William R.; Rollnick, Stephen (2012-11-11). Motivational Interviewing, Third Edition: Helping People Change (Applications of Motivational Interviewing) (Kindle Locations 254-255). Guilford Publications. Kindle Edition.
I’ll write more about MI, but a number of things jumped out at me from the book in the first few sample chapters.
MI recommends a style called “guiding.” Being “directive” doesn’t work, in therapy or in our Lean efforts. When being directive, we fall into the “expert trap” and our “righting reflex” kicks in. Instead of being helpful, that causes defensiveness and other barriers to change.
The “righting refex,” as the book points out is usually well intended. We want to help others and we feel like we’re helping them by giving them answers or telling them what to do.
MI is about helping people articulate their need for change and to discover their own path.
This next bit will remind you of the Toyota Kata approach, I think:
“The path out of ambivalence is to choose a direction and follow it, to keep moving in the chosen direction.”
I guess Toyota Kata would also include a series of experiments or tests of change that would move us in that direction. A therapist can’t give an addict a specific playbook of steps and answers any more than a TK coach could, right?
Co-author Rollnick wrote:
“I realized with some shock that the personal and professional inclination to blame, judge, and label others for being “resistant” and “not motivated” was not confined to the addiction field. It popped up in just about every care setting I came across. MI provided a different way of approaching these conversations about change.”
So, when a coach tries to tell people what to do (I’ve been guilty of this, believe me), we breed “resistance:”
“Argue for one side and the ambivalent person is likely to take up and defend the opposite. This sometimes gets labeled as “denial” or “resistance” or “being oppositional,” but there is nothing pathological about such responses. It is the normal nature of ambivalence and debate.”
This sort of resistance is NORMAL. That’s a big insight for me. Telling people what to do leads to the coachee feeling “angry, defensive, uncomfortable, powerless.” Shaming people about their bad behavior doesn’t lead to personal change either, a key lesson I need to keep in mind.
I’ll share one last quote from the book, that I had previously tweeted as a screenshot from the book:
Powerful stuff. There’s more to Motivational Interviewing than merely “leading by asking questions.”
I’ll share more from the book and more reflections over time.
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Now Available – The updated, expanded, and revised 3rd Edition of Mark Graban’s Shingo Research Award-Winning Book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. You can buy the book today, including signed copies from the author.