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Liberating Structures: Engaging Everyone in ChangePlexus InstituteJeff CohnLisa Kimball

Jeff@plexusinstitute.org lisa@plexusinstitute.org

1Structure of Speed NetworkingSpaceOpenStanding face to faceParticipationEverybody at once and at the same time + equal time for allConfigurationsPairsStrangers preferably

4. Time allocation2 minutes per person3 rounds5. Conceptual Framework1 issue question1 solution question

Remember the process we used at the beginning of this session? Here are some of the elements of that structure. What are some of the things you might notice about how this way of starting a meeting is different? Standing energy is different from sitting energy. Everyone gets a sense of being part of the whole group because ideas are woven through the system. 2Components of all StructuresSpace: physical arrangementsParticipation: who is included, how, when and how muchConfigurations: sizes and composition of groupsTime allocation: time spent in each configurationConceptual framework: a concept, a question or a purpose that informs the interaction

The Science of Change

5Technical ChallengesAdaptive ChallengesKnown solutionsSolutions unknown (and unknowable in advance)Best (or good enough) practicesSolution that is fit for purposeExpertise beneficialBeyond authoritarian expertiseCurrent structures can be usedChange in behaviors, structures, beliefsStandardization, minimize variationDiscovery, exploration, learningImplementationEmergence6Awareness Iceberg

4% known to top leaders9% known to middle managers74% known to supervisors100% known to the front line Internationally acclaimed study conducted by Sidney Yoshida, initially presented at the International Quality SymposiumAction unleashed @ the front lineThis internationally acclaimed study conducted by Sidney Yoshida, was initially presented at the International Quality Symposium, Mexico city, 1989. It indicated how management's failure to understand its processes and practices from the perspective of its customers,suppressed the company's profits by as much as 40%.

Tactic #1Change the Conversation

9Changing the Conversation Changes. EVERYTHING

10At the heart of all conversations is the relationship among those who are in it.Polite Conversation

Decentralized, Small TalkAutonomousUnconnectedUnstable relationshipsDiverse Random davidfawcett.co.uk11

Centralized, Ordered DiscussionLargely dependentConnected by power/permissionFixed relationshipsUniformTop down, center out

Facilitated, Bureaucratic Talk12

Distributed, Generative TalkLargely autonomous contributionsConnected by simple rules that guide local relationshipsDiverse and uniform participationGrowth from any point in any directionOrder arises out of local interaction & conversationMessy, Loose, Complex & Creative13

Jamming happens spontaneously, whenever two or three or (best case scenario) a dozen or more are joined in common purpose , common practice, and common desire to raise the bar for everyone involved.Liberating Structures NO

Best practices imported

Top-down, outside-in

Deficit based Whats wrong here?

Technical, analytic expert training

Mountain-top personal development

Buy-in and alignment strategies to overcome resistance in sub-groupsYES

Self-discovery in groups

Down-up, inside-out

Asset based Whats right here?

Simple methods for mundane & sublime challenges

Personal development within a complex social milieu

Attracting and inviting ownership + unleashing the wisdom of diverse crowds

New Option for Transformation Same people Same incentives Same organizational structure NEW CONVERSATIONSJazz is a great example of a liberating structure. Jazz is made up of simple rules around which there are infinite degrees of freedom for different musicians to explore. Without the simple rules we couldnt play together. With the simple rules people who have never played together before can create wonderful music. We need similar liberating structures for our interactions around work. Thats our theory of action: Changing the conversation changes everything. Changing the conversation means changing; who is invited, who creates the agenda, the relationship of input and grappling with the input, what we do with the results of the conversation, how long we stay with a topic before moving on, where we have the conversation . Etc..Tactic #2Change How You Solve Problems

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20The Powerof Positive Deviance Solutions before our very eyes

Every community Certain individuals/groupsUncommon practices/behaviors Better solutions Same resources

21Focus on Practice Rather than KnowledgeIts easier to ACT your way into a new way of THINKING, than to THINK your way into a new way of ACTING

22Fixed Solution Space

Traditional Flows from problem analysis towards solution Expanded Solution Space

Transformational Flows from identification and analysis of successful solution to problem solvingExpanded Solution SpaceActual Problem ParametersActual Problem ParametersActual Problem ParametersPerceived Problem ParametersPerceived Problem ParametersPerceived Problem Parameters Problem Solving Approaches23

TRADITIONAL VS TRANSFORMATIONAL PROBLEM SOLVING APPROACHESTRADITIONAL

Externally Fueled (by experts or internal authority)

Top-down, Outside-in

Deficit Based Whats wrong here?

Begins with analysis of underlying causes of PROBLEM

Solution Space limited by perceived problem parameters

Triggers Immune System defense responseTransformational

Internally Fueled (by people like us, same culture and resources)

Down-up, Inside-out

Asset Based Whats right here?

Begins with analysis of demonstrably successful SOLUTIONS

Solution Space enlarged through discovery of actual parameters

Bypasses Immune System (solution shares same DNA as host)24What do you know about engaging staff so development efforts stick?

What do YOU do to make PD efforts stick?

What keeps you from doing that 100% of the time?

Has anyone found a way to get around those obstacles? How?

What ideas would you like to try to get around current barriers?

What would it take to make that happen? Who else would need to be involved?

What action(s) are you willing to commit to?25Through addressing a discrete part of a complex problem (.. a fractal of the whole) we impact all the underlying structural issues.

Picking a Place to Start26Key Attributes of a Good FitBehavior change of others neededLarger community cares about challengeGlobal practices not spreading locallyChallenge widely distributedPockets of positive change in local settingsIntractable, inducing painGroup of leaders interested in trying something new/bold

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Where do you find MRSA in Hospitals?Everywhere!

28Why is MRSA a growing problem?With millions of asymptomatic carriers in the country there is a daily inflow of MRSA introduced in all healthcare facilities.Prevalence rates in hospitals are much higher than in the general population and typically can be between 10 to 20% in ICUs.MRSA is invisible and carriers are unknown unless an infection erupts.MRSA is a hearty bacterium that can survive for weeks on any surface: skin, clothes, beds, handles, switches, papers, foods, stretchers, wheelchairs, furniture, stethoscopes, blood pressure cuffs, and walls. MRSA continues to adapt and become more resistant to antibiotics. Scientist fear MRSA will soon be resistant to all antibiotics and leave clinicians with no effective antibiotics to treat infected patients.Because MRSA is spread by contact, anybody who touches a contaminated surface, a carrier or an infected person is a potential source of transmission.Anybody means not only doctors and nurses but all personnel as well as patients, their visitors, and even chaplains.Because touching is an essential part of patient care and human interaction, thousands and thousands of unnoticed opportunities for transmission occur daily in healthcare institutions.

28All invited and included

The most critical characteristic of the Plexus MRSA bundle is a set of strategies and techniques to engage everyone from the medical staff to the cleaning staff to the administrative staff and even to patients and their families in the effort to find WHAT WORKS to combat MRSA.29The Palmer Method

3030Jasper Palmer, a transporter at Albert Einstein Medical Center, Philadelphia, PA solved a trash overflow problem caused by increased gown use associated with better infection control practices. His inventive process for taking off his gown and gloves such that everything ends up in a tight little ball that can be easily thrown away is now known as the Palmer Method and has been adopted not only by his colleagues at AEMC but by others at hospitals across the country. This is a great example of how engaging the unusual suspects in the process of talking about and solving problems results in unexpected breakthroughs. We cant afford to miss out on the knowledge and experience of ANYone in the fight to STOP MRSA.Engagement, engagement, engagement!in an array of proven social change processes, featuring Positive Deviance, designed to engage everyone in:

Discovering which of their practices can play a role in the transmission of MRSA

Spreading effective practices, creating new practices and deciding what changes they need to make personally and togetherAt the core of the PLEXUS MRSA Bundle is a behavioral change approach called positive deviance that is based on the notion that, within any group or community, there are already people who have discovered practices that work, that get around the barriers that prevent others from complying with important precautions. Discovering these positive new micro-practices and amplifying creates a natural diffusion effect across the system.31One of the most powerful lessons for leaders is to generate simple or minimum rules rather than maximum specifications.

This fosters innovation solutions evolution.

Less is more. 32Simple & Complex ApproachesSimple

Plan then act Create explicit plans Look for agreement & a clear outcome Limit type of actions Drive implementation & set targetsComplex

Act-learn-plan at the same time Look for divergence Use multiple actions & min specs Tune to the edge Build on what emerges & grows

Oct-13Simplicity on the Other Side of Complexity33These are a few of the BIG implications.

Both Simple and Complex methods are useful in the right setting and they can change from simple to complex or complex to simple over time.

A clinical example follows...The 15% PrincipleLearning how to flow with & tune to change in complex systemsW. Edwards Deming suggested that everyone -- from the CEO to the front line worker -- has influence over 15% of their system. The other 85% is beyond their discretionary control. Recognize that you have 15% discretionary influence it may sound small but you can use it to make a difference that makes a difference.

Oct-13Simplicity on the Other Side of Complexity34I usually tell stories that Gareth Morgan tells from an Ireland plant (polishing the floor, putting a mirror by the elevators).

You may want to illustrate with one of your own 15% stories or ask the participants to tell a few.How To Disturb & AmplifyAllow new information into the system Work with organizational boundaries Connect systems to environment Question differencesChallenge assumptions Take advantage of chance and serendipity

Adapted from: Jeffrey Goldstein, The Unshackled OrganizationOct-13Simplicity on the Other Side of Complexity35