Lessons Learned

In this week’s ATTRACTORS Glenda shares a real-life story about a group of healthcare professionals who used Adaptive Action to create new perspectives and approaches to some of their most wicked issues. Explore with her the reasons Adaptive Action can help us find a path into our biggest challenges.

Fifty-four leaders from across the British Columbia healthcare system have focused on building their adaptive capacity this summer.  They are the latest cohort in a Transforming LINX program sponsored by BC Health Leadership Development Collaborative and designed, developed by Human Systems Dynamics Institute.  It has been a pleasure to work with Lecia Grossman, of HSD Institute, and Gabrielle Cuff, of Fraser Health Authority, to deliver and support this learning community.    

This innovative leadership program includes personal and professional assessments, organization culture profiles, executive coaching, residential sessions, and online conversations.  One powerful component of the program is the Adaptive Action Learning Team (AALT).  These are cross-functional and cross-organizational groups who come together to influence strategic challenges that affect policy, practice, and people across the province.  The AALTs have addressed a wide range of challenges including employee engagement, physician leadership, public health investments, response to adverse incidents, emergency room utilization, healthy seniors, and integration of acute and primary care.

Ongoing evaluations find that team members have learned about the power of networking, effectiveness of new skills and concepts, multiple perspectives from diverse stakeholders, and the excitement of working as a cross-functional team.  The major stretch for each of the teams was recognizing and responding to wicked problems behind their strategic challenges.  A wicked problem is one that cannot be solved.  It emerges from the messy interactions in complex, unpredictable, and massively entangled environments.  Examples of wicked problems in healthcare include the chronic health effects of adverse childhood experiences, palliative and end-of-life care, effective preventive medicine, and disparities in population health outcomes.  None of these can be solved completely, but healthcare professionals are called upon to engage with them nevertheless.  Wicked problems are very challenging to healthcare leaders because they:

• Expect themselves and others to solve problems.
• Are rewarded by setting expectations and meeting expectations of others.
• Work in environments that are supposed to be evidence-based and predictable.
• Commit themselves professionally and personally to good outcomes.
• Support patients who rely on them for answers to difficult questions and solutions to life-threatening problems. 
  
  

On the other hand, healthcare leaders are plagued by wicked problems because they:

• Deal with diverse patients with unpredictable physical constraints.
• Respond to lifestyle illnesses where causes are far beyond their control.
• Work within bureaucratic and political systems that have multiple, competing priorities.
• Manage enormous budgets that depend on uncertain economic systems.
• Care for populations with increasingly complex problems caused by aging, as well as cultural, social, and environmental conditions.
• Deal with difficult ethical and cultural questions that influence health and wellness for their employees and their patients.  
  
  

In the usual course of events, heath professionals set themselves up for failure by expecting to find sustainable solutions to wicked problems, which by nature are not solvable.  In Transforming LINX, the AALTs were invited to take a different approach in relation to their wicked strategic challenges.  The approach, Adaptive Action, allowed the teams to engage with their challenges and with each other by asking simple and powerful questions over and over again:

• What is a productive and meaningful way to look at this challenge?
• So what are the patterns that shape this challenge and hold it in place?
• Now what are actions we can take in the time we have and from the places we stand to shift the patterns and influence the problem?
• What is the consequence of our action, and so what will the next Adaptive Action cycle involve?
  
  

These Adaptive Action cycles may seem simple, but they are generating some extraordinary and unexpected changes in the BC healthcare system.  Besides the obvious outcomes and benefits to the system, teams are learning valuable lessons from engaging with their AALT challenges through the discipline of Adaptive Action.   

• The question at the core of the challenge is what really matters, and it changes over time.
• Looking for the next wise action rather than focusing on a project “deliverable” helps to dispel past assumptions that limit the creativity and adaptability in the present.
• Looking for surprises can bring important breakthroughs and unexpected insights.
• Sometimes important information comes from focusing on similarities, and sometimes it comes from watching what is different. 
• Massive change can come from minimal investment, when you understand and leverage the potential of the current pattern. 
• Sometimes change is hard, but sometimes it is easy.  You can choose to pursue what is easy and notice what it shifts.
• Difference provides the potential for change. There may be more difference within organization levels and silos than between them.
   

These have not been easy lessons to learn because they challenge deep assumptions about how people and institutions organize themselves to get work done. On the other hand, the AALTs have seen with their own eyes how Adaptive Action can shift wicked problems, even when solutions are out of the question.  This past week, the teams shared their reflections on how patterns shifted for the system, for their teams, and for themselves. They assured us that this will not be the end of their learning adventure, but the beginning of many more Adaptive Action engagements with all the wicked issues to come.  Stay tuned!