Worldview, Practice and Action – Taking Whole – Guest Blogger Jerry Nagel

Authored by Jerry Nagel (originally published at Growing Hosting Artistry on January 12, 2014)

 In Art of Hosting trainings, several of my colleagues and I have been offering a short teaching on worldviews and the importance for each of us to understand what our own worldview is. I often link it to elements in the Art of Hosting workbooks that I feel are an expression of an AoH worldview such as seeing the world as a complex living system and not a machine.

The simple teaching has two components – an explanation of worldview impact using the Ladder of Inference from systems thinking and an explanation of worldviews in The Rules of Victory: How to Transform Chaos and Conflict – Strategies from the “Art of War”. (Gimian & Boyce, 2008) The text known as the Sun Tzu and more popularly as The Art of War offers a framework for action that contains three components – View, Practice and Action. Central to view is the idea that the world is an interconnected whole. Seeing the world this way informs one’s Actions in the world and the Practices used to manifest (act) the View of interconnectedness. In the Sun Tzu this idea is referred to as ‘taking whole’.

The diagrams below show how our worldviews impact the actions we take in the world and, that as we act in the world, our worldviews are impacted and potentially changed; that patterns and practices like those offered by the Art of Hosting are the tools or methods we use to bring our worldviews to action; and that as we act in the world what we learn impacts the methods we choose to manifest our worldview. If the methods we choose to manifest our worldview are not congruent with that worldview, then our actions will not ring true with people. They will see us as not acting in a way that reflects the worldviews we claim to hold. This simple explanation has proved quite thought provoking for AoH participants.

Worldview Influences Action

Our Actions Influence our Worldview

A worldview can also limit us, because it could close us off to new knowledge if we only see the world through our existing knowledge and assumptions. (Jenkins, 1999) Importantly for many of us, our worldview offers us a way to understand the world that gives us “a feeling of being home” and that reassures us that our interpretations of reality are right. (Heibert, 1997)

Ladder of Influence

One tool from systems thinking that helps visualize how easy it is to get trapped in one (world) view and close off the possibility of seeing other perspectives is the Ladder of Inference. The process depicted follows a flow from the bottom of the ladder up to the top. We ‘see’ data in the world and go through a process of sense-making that then informs the actions we take. What the Ladder of Inference shows us is that the beliefs (worldviews) we adopt can influence what data we see. The result is that we begin “seeing only what we want to see.”

If we are in a time in the Western world of co-creating a new narrative of wholeness, then as hosts it becomes important for us to not only clearly know what our worldview is, but to understand that within our own contexts and within other contexts there could be greatly different worldviews. (Shire, 2009) In other words, given the depth of invitation to step into dialogue (discourse) that we are asking of people, we should remember that our worldview could be much different than someone else’s within our community or local cultural context. And, that people we are working with that are from other local contexts may have differing worldviews within that shared construct.

In thinking about our world today it is fair to say that, “The presence of a multitude of alternative worldviews is a defining characteristic of contemporary culture. Ours is, indeed, a multicultural, pluralistic age.” (Naugle, 2002) Thus, as we practice dialogue in our world in order to find ways forward, we must develop the capabilities to work in the multi-varied and rich system of many worldviews. To do so, however, requires skill and practice and the capacity to hold paradoxes or multiple truths all at the same time.

Learning to effectively communicate (host/facilitate) in a different or new cultural milieu is a deep-level process.  It involves connecting at more than an intellectual level with the ‘host’ culture. It involves connecting at a heart and spiritual level. If worldviews are a matter of the heart, then to enter into effective communications within a different or new culture means opening up one’s heart as a host/facilitator to a space/place that connects heart to heart. This involves capacities to be vulnerable, to respect difference, to be curious and to sit in the space of the unknown or unknowing (i.e. nonjudgment), and to be self reflexive regarding one’s own thoughts, reactions, and carried in thinking about another culture. It also involves recognizing the limiting role our language can play when hosting, which will help each of us as hosts to hold our own and invite others to hold their opinions about another’s worldview much more lightly. This is a core part of the artistry of hosting.

References

Hiebert, P. (1997) Conversion and Worldview Transformation. International Journal of Frontier Missions. 14(2)

Jenkins, O.B. (1999) Worldview Perspectiveshttp://orvillejenkins.com

Shire, J. (2009) The Universe Next Door: A Basic Worldview Catalog. Nottingham, UK: Inter-Varsity Press.

Naugle, D. (2002) Worldview: The History of the Concept. Cambridge, UK: Wm. B. Eerdmans Publishing Co.

Explaining Art of Hosting for Beginner’s Wanting to Know What It Is

Every place we go has its own tone, texture and timing.  It is part of what makes Art of Hosting – or in the case of California in August 2012, the Art of Participatory Leadership and Social Innovation – so hard to define. “We” being whatever configuration of hosting and calling team has coalesced around an identified need or opportunity.  Every training is different because every place is different, every group that responds to the call is unique.

People who are just coming across Art of Hosting want to know, what is it?  One way to think of it is, at its core, a set of patterns and practices that help us be successful in complex circumstances.  Developing skill in using these patterns and practices is particularly helpful now at a time when long term strategic planning doesn’t work anymore (if it ever did) because we don’t know and can’t predict what ten, five or even two years down the road will look like.  One thing many of us have a growing awareness of is that what has worked in the past – strategies, practices, principles – doesn’t seem to work anymore – if it ever did.

The world is providing us with increasing complexity – in the environments in which we operate, our communities and in our organizations, especially as things seem to move faster and faster.  Social innovation is a response to this increasing complexity.  Rigid protocols have limited application in complexity.  Complexity calls for a different set of leadership skills – skills that tune in and are responsive to emergent circumstances.  Complex systems share behaviours that cannot be explained by their parts.  This requires a different set of frameworks to see and understand it.  In the Art of Participatory Leadership we draw on world view, chaordic path, divergence/convergence, the 2 loops of systems change, theory U and other frameworks as lenses through which to think about complexity and social innovation.  Social innovation looks for an alignment of circumstances that makes action possible – the relationship among elements.

One of the names we use for this type of experiential learning is the Art of Participatory Leadership because it also calls forth a new set of leadership skills required to deal with complexity and social innovation, quite different from how we think about traditional leadership.  Participatory leadership focuses on participation and engagement strategies, knowing from experience there is wisdom and knowledge that exists within a group, a team, an organization, a system.  When we make it visible in a group, it moves into the realm of collective wisdom, knowledge and understanding leading to a different kind of action and ultimately different results.

Participatory leadership  connects well in high pressure situations. Some of its core characteristics are curiosity or non-judgement, staying in the space of not knowing, generosity or openness, a belief that conversations matter and that good conversation leads to wise action.

It is not a quick fix or a magic bullet for problems that have existed and have been evolving over long periods of time.  However, there are often very immediate results for individuals as they examine and reflect on their own leadership practices.  This is also why we encourage teams to participate so they have a new common language and are more able to hold each other accountable to create a path of behaviour change and organization practices that will be sustainable.

A core element of the Art of Participatory Leadership is for each of us to deepen our own capacity to effect transformation – in ourselves and in a complex world.

Where have these practices and patterns been used? In community, private sector, academia, healthcare, and educational settings as well as social change efforts around the world.  The stories are only just beginning to be documented because many of us have been deep in the work rather than the writing about the work.  Stories are alive in Nova Scotia, Ohio, Minnesota, Europe and Brazil and many, many more places.

Art of Hosting is also a global self-organizing community of practitioners who use these integrated participative change processes, methods, maps, and planning tools (like circle practice, appreciative inquiry, world cafe and open space technology) to engage groups and teams in meaningful conversation, deliberate collaboration, and group-supported action for the common good.

The hosting and calling team for this first Art of Participatory Leadership and Social Innovation in California: myself, Jerry Nagel, Ann Badillo, Sherri CannonDana Pearlman and Mia Pond will weave stories of where this work is alive in the world into these three days of co-created emergent design and process – a little taste of what we do in the world and what is possible.

Innovators and Pioneers in Systems Change

In Utah for Healthier Health Care Systems Now (January 11-13, 2012), we used the 2 Loops Model of Systems Change as one of the framing references for why we were gathered. It is a tool and a framing to understand the work we are individually and collectively in that shifts the shape of health care.  The two loops model looks like this:

 

The first loop represents the old system, the one we often name as the dying system.  The second loop represents the new system, the one we keep claiming we want, the one we think cannot emerge by fiddling with the old, the one we believe is needed to bring our current systems out of crisis.

The problem is, when we begin to think about the complexity of something like health care, where there are so many jurisdictions, so many players, so many interlocking systems,  trying to imagine what this new system or systems could be becomes paralyzing.  The conversation often becomes philosophical and theoretical.  It largely comes from an intellectual and cognitive place focused on all the things that need to shift that are outside our circle of influence.

Some of the frustration in being innovators inside of systems is that the systems begin to push back on the work in small and large ways, leading to the exhaustion, frustration and disillusionment so many leaders in health care experience.  This is all part of the old narrative.  Of course this showed up in our conversations in Utah to greater and lesser degrees depending on the questions, depending on who was in the conversation at any given time.  Any time we were in that conversation, thinking about the new system, it didn’t feel like a new conversation.

So, how could we be in conversation about Healthier Health Care Systems Now without  focusing on the second loop or the new system?  Well, by remembering who we are – pioneers and innovators in health systems – working under the first loop – in the in-between spaces – championing the new or being championed.  We began to focus in on and explore new questions: Where are the edges of my work?  What is the new territory I could begin to walk when I go home?  How can I draw on the resources in the room to expand my thinking, even turn it upside down and on its head – like the person who relies on gift economy in her practice, for her livelihood?  What more becomes possible in generative spaces with other innovators?  This was a different conversation, in tone, texture and energy.  This one did not come from the head. It was embodied in a whole new way – the beginnings of a new narrative of health.

The awareness of the old narrative and of the stuck places infiltrated us in the best of ways at the end of the first day of our three day gathering.   Someone suggested what we needed to do was create a vision of the new.  Ordinarily I might agree.  In this case though, that didn’t feel right.  It felt like it would take us further off track given that our roomful of people were geographically stretched from coast to coast across two countries with countless “systems”?

So, without taking our eye off the intention of shifting the narrative of health, we refocused on innovating and pioneering and guerrilla tactics of  hosting, collaborating and co-creating, engaging those around us in this journey that is health.  We didn’t leave with a specified vision of the new system.  We left heartened in our respective journeys, knowing the way to the future is through new processes, deeper conversations and finding our way with as many of our friends and colleagues as we can attract, engage and embolden along the way.

As we continue to shine the light on the experiments already underway, the successes, the challenges and the “failures”, and tap into the individual and collective resilience that is fighting to emerge, we can remember it is a journey that will shift and change as we go.  We remember life actually wants to help and it wants to heal. If we focus on how to expand our individual systems of influence and share those stories with our friends, our collective system of influence automatically begins to expand.  What seems like isolated work informs pockets of work elsewhere and we grow an energetic field that is part of the new, part of the second loop and is fueled by everyone stepping into innovative, courageous and pioneering ideas and projects.

I still can’t see what that second loop is for health care – other than it is about health and it is healthier.  I’m not sure anyone who showed up for this conversation can see the second loop either.  But I am absolutely sure that the innovators and pioneers are already prototyping what’s possible, what’s new, and in this work more and more of the new and the new narrative will show up.  I am reinvigorated by what’s possible, by the people who continue to explore these questions, who challenge the status quo, despite possible personal risks in doing so and know that there are better and more healthy ways to engage health care.

I and my hosting mates are committed to convening more of these conversations with people compelled to be in them to grow the field.  We envision large gatherings of people convening in new ways, continuing to innovate our way into the new system(s) so that maybe one day we will wake up and see in front of our eyes what we once thought impossible – a new generative system of health resilient enough and healthy enough to be sustainable in unexpected and beautiful ways.   If we take our eyes off the urgent need for something that feels impossible and put it in the places where possibility thrives… well, what more is there to imagine or say?

Steve Ryman, Tenneson Woolf, Kathy Jourdain, Marc Parnes

 

 

2 loops of systems change

Healthier Health Care – Now! A Little Taste of What’s Cooking

We wondered what would happen if we invited friends from across North America to convene in Salt Lake City, Utah around the question of Healthier Health Care Systems Now?  We were amazed.  We began by sharing who we are – the innovator and pioneer in us that  compelled us to come to this conversation.  Then we shared the exciting work we are engaged in.  We talked about the “system” and discovered “it” was never A system and “it” was not about health.  We moved from talking about systemic issues that felt as philosophical as we know they are real and moved into embodying the conversation, coming from a place of deep connection to ourselves, each other and the work that continues to call us in the worlds we work and travel in.  The insights, themes and cool learning are just beginning to percolate for each of us.  More, much more, is cooking.

It was beginning to cook before we even arrived in Salt Lake City.   We discovered healthier health care was such a compelling question people went to great lengths to get there.  Some initially said no and then found a way to come.  Others felt the question so urgently they used vacation days and airmiles to get there.  One person even crowd funded her flight.

Twenty-six of us arrived on January 11, 2012 – physicians, naturopaths, other practitioners, administrators and consultants from heath, public health, dentistry, acute and long term care from Nova Scotia, Ontario, Alberta, Ohio, Minnesota, Winsconsin, Illinois, Texas, Oregan, Washington and Utah.  Everyone an innovator or pioneer already working diligently on shifting the shape of health care within their spheres of influence.  We all brought stories of change and deep and compelling questions. We made instant connections that inspire us to go deeper and to keep at it.

This will continue to simmer and cook for quite some time to come.  I will have more to share here about this conversation at the beginning of 2012, curious to see how it might grow as we convene a community of practice for those who were there, those who wanted to be and couldn’t make it and those who begin to find their way to this particular conversation in their own way.

You can find snippets of harvest on Twitter by searching #HHSUtah.  Thanks to Amanda Fenton, who was with us from afar, for stepping in and compiling our tweets @Storify.

I offer here a little taste of a quick and fun harvest at the end of day 2 as we went around our circle and each of us added a line to the unfolding story of our journey together. I didn’t catch every word, but it will give you some small essence of the experience, recognizing some references are very specific to our experience, and it will have to tide you over til the next post.

“There were a bunch of hooligans in a house by the mountain.  They thought of themselves as pioneers, radically re-engineering, brought together by living systems that taught them how to transfer what they are learning and experiencing into what they are doing now – open to possibility.  In sharing, they saw new connections and unique opportunities.  They described them as opportunities to change and blow shit up.  These hooligans had so much to think about, they sat in circle, played, visualized and created on many levels a new vision of what they were yearning for – simplicity, wellness, with open heart toward the future to bring this new narrative to everyone.  Envisioning systems that bring forth vision and health, letting go of the old to release into timeless universe.  They pondered next action.  In the middle, they went deep into the cellar to share unique fonts and forms of creativity.  They came together to discuss the topic but it was more than the sum of its parts – human nature – own beauty, higher power and purpose run in each of them and each other with gratitude, although we do fear discovering in horror on FB the shaking moments, with brains exploding in chaos, guerrilla gardening and permaculture parties.  But then, a pause for reflection and even more to emerge.  Finished.  No shame.  Amazing thing, working hard to create something different.. but in the end, they were different, a community – and in their differences they found their common humanity from which to go back to the places they came renewed, reinvigorated, inspired to innovate on!”

With gratitude to all who were there, all who held the rim of this gathering from afar and specifically to my fellow hosts Tenneson Woolf, Steve Ryman and Marc Parnes for an experience that will be long remembered, in a gathering where the new narrative of health was activated, the field of innovation in health care where we meet was amplified and shifting the shape of health care in our spheres of influence has been accelerated.

Exceptional is not an Extension of Good

“There is a fundamental discontinuity between good and great,” was one of the assertions Ray Ivany, President and Vice-Chancellor of Acadia University, made during a talk at a recent Knightsbridge Robertson Surrette event.  He was invited to speak on the topic of being the best and his talk was an insightful blend of the human dynamics and structural components necessary for exceptional performance.

“Exceptional is not an extension of good but it’s in a completely different place,” he said as he shared the following diagram with us.  Imagine that organizational effort is represented by a helium balloon that is attached to a stake in the ground by an elastic tether.  It manages to rise to the expectations of good performance without too much effort.  And, with some effort and exertion, it can stretch into the category of great.  However, it takes sustained effort to keep it there and as soon as the pressure is taken off, the elastic tether immediately yanks that balloon back into the category of good.

Great is not on the same continuum as Good

In order to allow it to stay in the zone of great, you actually need to sever the tether that holds it in place.   If you believe that great is discontinuous from good, the organizational and human strategies needed to move to and stay in great or exceptional performance are fundamentally different.

In looking at this diagram, it occurred to me that not only is good the enemy of great, it is probably the enemy of itself as well.  As soon as we think we are onto something good, we want to institutionalize it by creating standards and policies to maintain it.  This standardization means we often prevent the organization from conceptualizing the strategies that lead to great.  On the other side, the more we insist on standardization without the ability to continually adapt, the greater the likelihood we actually unintentionally shift our organization from good to mediocre by insisting on standards that often lose their meaning and relevance over time.

From this place of mediocrity, leaders still try to aim their people for excellence without any hope of getting there and the people are often frustrated in their efforts to shift organizational thinking and performance and no one really understands why.

We only shift the shape of our organizations from good to great, and stay there, when we build in the systems and the capacity to take different risks – one of those risks being failure.

Looking at this diagram and the capacities necessary to shift into a whole new category of performance reminded me of the Chaordic Path where one of the key questions is: “what is the minimum amount of elegant structure required to enable us to act in purposeful ways that lead to wise action and meaningful results?”  This is also the amount of structure that allows an organization to stay nimble and responsive to its environment, creating the conditions for chaos to emerge into its own sense of order and cultivating the adaptive and collaborative leadership that is also a strategy for exceptional performance.

Ray’s comments were entirely consistent with many of the steams of thought that show up in the Art of Hosting community and body of knowledge, providing a beautiful avenue of reflection for me.  The next entry will focus on some of the human dynamics elements that comprised the other main thread of this thought provoking talk.

Prototyping Collaborative Leadership at Capital Health – Citizen Engagement and Accountability

Citizen Engagement and Accountability Portfolio

In May 2009, the creation of a portfolio within Capital Health with the title of “Citizen Engagement & Accountability” presented a rare opportunity to create something that had no precedent.  The portfolio was launched in response to the strategic stream of Citizen Engagement that came out of the Strategic Quest work in 2007.

Lea Bryden was tasked with bringing together three functional areas under this new portfolio: Marketing and Communications, Community Health Boards and Patient Representatives.  In looking across the country, they found themselves virtually alone as there were no models to inform the portfolio development.

In January 2010, Kathy Jourdain and Tony Case, through Shape Shift Strategies Inc., were contracted to assist in shifting the shape of this portfolio.  The intent was to truly create a new portfolio with collective purpose, principles and streams of work and not just perpetuate the three existing functional areas under a new name.  Some of the functional work would be the same and new work would emerge through the process but all of it would be informed by the collective purpose.

This work was given context and framing by the following pre-existing pieces of work:

  • Our Promise
  • Declaration of Health
  • My Leadership: Being, Caring, Doing
  • Citizen Engagement Strategic Stream
  • 2013 Milestones

In addition to wanting to honour CEO Chris Power’s intention in asking the question: “What kind of future could we create if the vision of Our Promise and belief in our Declaration of Health showed up at each of our touch points in the course of our day?”, Lea also wanted to uncover the unique gifts and contribution of each member of the portfolio and understand how they came together as a collective.  And, it was  very much a mechanism to create a cultural shift to even greater transparency and accountability.

This process invited a design team to co-design the process.  There was initially a very specific invitation to a member of each of the three functional areas. As the process unfolded participation in the design process was completely open and transparent and those with the greatest interest and passion continued to participate in the process.  Some people showed up in the beginning because they thought they should and then kept showing up because they saw how their contribution directly influenced the design of each session.

This work took place over a period of four or five months to establish collective purpose, principles, priorities, and strategies.   It took into account other work that was underway in the organization, incorporating things like the budget planning process or the response to Capital Health’s community engagement recommendations right into the process so the portfolio could learn how and when to respond as a portfolio to other moving parts of the organization.

We knew we were making headway when we hit the groan zone.  The collective purpose and principles were articulated and we began to hear, “Oh good.  We have what we need.  Can we be done?  Can we get back to our regular work now?”  This was a signal to push back.  Lea did this by asking a simple question, “Where are we seeing evidence of our collective intention at work?”  The responses were amazing, informative and represented a turning point.

A philosophy of our work as consultants was to transfer collaborative leadership skills into the portfolio so it could flourish once our involvement came to an end.  The portfolio created a transition team to continue to guide the work and this team is also working collaboratively.

A key contributor to the success of this initiative was Lea’s willingness to foster collaborative leadership and her openness to growing her own awareness and skills in the process.

Like all significant culture shift initiatives, there are certainly bumps along the way.  But there is lasting change in the way this portfolio views itself, understands its work and engages with the public.

Prototyping Collaborative Leadership at Capital Health – Infusion

In March 2007 Capital District Health Authority (CDHA) in Halifax, Nova Scotia took on a planning process called Strategic Quest.  A significant component of Strategic Quest included public participation in an unprecedented way, shifting the shape of awareness and thinking at Capital Health.  The results were revealing and the impact continues to reverberate throughout the organization today, strongly influencing ongoing public participation in a number of areas and inviting collaborative leadership as a strategy to accomplish many of its goals.

One initiative I was involved with where Collaborative Leadership was an essential part of the process was Infusion: a gathering in November 2008 of 70 leaders from across North America, in our local community and within Capital Health, convened to inform what bold and unique leadership development within Capital Health could look like.

The planning process for Infusion, championed by Lea Bryden and led by Shape Shift Strategies, invited and modeled collaboration, shared leadership and shared responsibility.  A diverse group of people from across Capital Health were invited into the planning process.  Many identified the planning process itself as a leadership development opportunity as they experienced collaborative leadership in new ways, stretching beyond their original assumptions about how and what they could each contribute to this unusual event.

Achieving clarity of purpose was the first task.  It required a significant investment of time – several meetings.  It was a difficult task because there were multiple overlapping components all alive and unfolding as we were in this planning process.  We stayed in the conversation until sharp clarity was achieved and then rest of the planning process unfolded rapidly because it was guided by this clarity of purpose.  We also actively worked with Theory U in the planning process and for the event itself.

The planning process always had a forward momentum, even when people missed meetings.  As they came back in, they found their place in the process and continued to contribute constructively.  They could step into and out of the flow of the process without having to back track and rehash decisions made when they were not present.

The two day Infusion event drew on the talents of everyone on the planning team.  Invited guests: leaders from a vast array of backgrounds, many of whom were leadership consultants, were asked to bring their knowledge and expertise in a participatory way.  It was at times a challenging field to hold.  The team was able to hold its ground as we went through the fire of chaos, adjusting design in the moment and holding space for some anger and frustration that unexpectedly arose within the group because of the collaborative leadership we had been growing throughout the planning process.

Infusion did not end in a nice tidy wrapped up bundle and Lea Bryden, myself and the team were good to leave it that way while taking away the gems that guided the development of My Leadership – a truly unique leadership development initiative inside of Capital Health with a bold vision and goals that has since had 500 leaders complete and won a number of regional and national awards.

 

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.

New Models of Organization and Work – Are We Ready?

The shape of the world is shifting, pretty dramatically and quickly, right now.  Are we ready?  Are organizations and systems ready? These questions have completely captured my attention fueled by the conversations and places I’ve been in lately.

I’m not sure we are ready and I’m not sure we will ever actually be ready for the shift that is emerging in the world right now.  Systems and organizations are designed to be self perpetuating.  Threat and opportunity are viewed through the lenses and structures of the system or organization – we usually believe that we only have a certain amount of scope within which to bring about change – we can only get certain people’s attention for brief periods of time, we need to work within the system, within the structures, because there are some things you cannot change, some things that will not work.  They may reflect current reality but they are also limiting beliefs and as long as enough people buy into them, radical change will be stalled.  Yet radical change may be what is lurking right around the corner, ready or not.

What gives me hope?  One is the conversations I’ve been in lately around the 2 Loops of Systems Change with my Berkana friends and beyond.  You can read a bit about it here and you can find my own hand drawing of the model here: 2 Loops of System Change

This model shows that in the peak and the beginning of the decline of the mature systems, there are alternatives already beginning to appear.  These alternatives need space to find their way.  Some will grow stronger and some will fail.  The ones that do grow stronger need to begin to connect with each other to grow collective and individual strength and capacity.  There are people in the mature system (stewards or sometimes called “toxic handlers”) who see and understand the importance of this work and who hold the space and clear the way for these alternatives to grow.

The alternatives do tend to fly under the radar and are often not widely known, but they are there.  Maybe they will be ready in the event of collapse of the old systems although it is hard for me to fully imagine what a collapse of the old systems will look like.  Maybe we are already seeing it but just not recognizing it for what it really is.

While existing organizations are entrenched in their structures and processes, newer, usually smaller organizations  have greater flexibility, resourcefulness and resilience and the greater capacity to totally rethink how they are structured, how they deliver their goods or services to the world.  They often can do this at less cost because they don’t have as much “bricks and mortar” in place as larger organizations and it feels less risky because they have “less to lose”, or so it might seem.

What has me excited is the possibility of new business models that can emerge now.  I have found myself sharing stories about networks – the Art of Hosting network, World Cafe, Berkana to name a few – because these networks recognize themselves as networks, organic and emergent.  They trust in the capacity of people to self-organize and are held together and flourish because purpose and principles are clear.  They have a minimum structure and sometimes struggle with how to live models of organization that are outside of traditional structures, particularly because in times of stress people push for what they already know and are comfortable with.    They are open source, openly sharing knowledge and new learning in recognition that this sharing grows the body and field of knowledge.

I share what I know about these ways of organizing with businesses and other organizations I am in conversation with, not because I think they should adopt the specific models, but because I think there is wisdom in these ways of organizing that could inform new business models – especially business models that see the value in operating from a place of openness and open heartedness – which I seem to be running into more often lately.

More than ever, I feel we are on the brink of unprecedented social change around the world and I have a greater awareness of just how connected we all are.  I can’t imagine what exactly it looks like but I continue to grow my comfort and skill working at the edges of my own not knowing – thanks to collaborative relationships with people I am privileged to call friends.

Are we ready?  I don’t think we really are.  Does it matter?  This shift will happen whether we are ready or not.  Our greatest path to readiness is to grow our own capacity for resilience, dealing with chaos, complexity, simplicity and not knowing.

My next posting will look at some of these new models of organization to see what we can learn from them and maybe, just maybe, grow our level of readiness even just a tiny bit.

Can Large Organizations Navigate The Shifting Shape of the World?

Can large organizations (including government) that have an abundance of structure and control actually navigate the shifting shape of the world and survive?  Are they even aware of the degree of shifting that is going on in the world and and the need to dramatically reformat structures, processes and ways of thinking?  I’m not even sure they need to be large or have too much control.  Maybe we are just stuck in old ways of doing things and can’t imagine it might not be possible to simply tweak what we do to survive.

I didn’t realize the intensity with which I have been sitting with this question until now as I find it bursting out of me thanks to the conversations I have been in with people from around the world over the last six months and the reading that I’ve been doing lately.  I don’t think this question was even formulated in my mind but I could feel it working in my being, nudging me this way and that, puckering my brow in moments of concentration, confusion and curiosity contrasted with moments of complete openness and open heartedness – taking it all in, beginning to congeal in the most unexpected ways – for me anyway.

The congealing factors seem to be the book I’m reading by Nick Bilton: I Live in the Future and Here’s How it Works and a video on the younger generations and how they experience life and work: We All Want to Be Young.

Bilton writes that “a universal brand is not enough for today’s consumers”, “people will pay for well-packaged offerings – even in the face of free alternatives” and “it is evident that the smaller start-up companies are innovating and pushing the boundaries… They are listening to their customers and creating content that customers are willing to pay for and delivering it to the devices where they want to enjoy it.”  This is in his first chapter on bunnies, markets and bottom line, porn leads the way.  He does write about other things in this book – texting, video games, how communication is changing, storytelling.

Quite frankly, I was surprised to find myself reading about the porn industry but his points really hit home for me.  Bricks and mortar will have a hard time being responsive to what their customers are looking for. The new economy is open source and crowd sourcing.  Businesses that have made a living off of protected content and protected product development will find themselves hugely challenged as a result of the new economy.   They will — they are — losing their relevance and many are losing their margins on the bottom line.

We have been saying for a long time that our systems – financial, health care, education – are falling apart and/or not serving us well anymore.  But we are stuck.  We don’t know how to shift the systems and, it is really beginning to dawn on me,  maybe they are not shiftable.  Maybe they really will collapse before any real shift can take place.  I don’t know for sure, but when I think about how technology has shifted the marketplace and made information accessible with a few clicks of the mouse, it is hard for me to imagine how large organizations and systems can actually gain the resiliency necessary to navigate the complexities and the simplicities of the shifting shape of this world.

Organic, emergent networks – like social media, the Art of Hosting, the World Cafe, Berkana – are shifting the shape of how we are in relationship with others and with goods and services.  Smaller, innovative organizations know how to tap into these networks in ways that leave larger organizations in the dust.

There is still a big question about how some of these smaller organizations or networks will make money but there are all kinds of conversations going on about money systems, gift economies and finding other ways to recognize or exchange value.  It wasn’t that long ago that the idea of a debit card seemed far fetched to me and now I have a few of them in my wallet.  Just because I can’t see it or imagine how it would work doesn’t mean it isn’t already on its way.

And, we are underestimating our youth.  They represent new language and new behaviours.  The way they think has been influenced by technology in ways that older generations cannot comprehend. Instead of really paying attention to how they will shift the shape of the world, they are discounted as are their values and their work ethic.  But we are trying to fit them into systems designed for a different time (as this video on educational paradigms so beautifully illustrates) and then faulting them for failing to conform.  They gravitate to networks and social innovation.  They are the most plural youth in history with extended social networks.  Traditional career plans and structures are losing strength as the younger generations seek to unite work and pleasure, not in hedonistic ways but in pragmatic and realistic ways, looking to make small dreams possible.    They are already shifting the shape of the world.  How will large organizations navigate these shifts successfully?  Is it even possible?

In my next blog, I will write about the emergent, networked organizations and initiatives that I am either part of or know a bit about because I’m connected to people who are connected to them – like Art of Hosting, Berkana, World Cafe, the Oasis Game, Swaraj University.  All of these networks are modeling new ways of organizing and working in the world.  I’m believing that there are huge lessons in them for new business models and when I tell stories about these networks it is often in this context.  When I even begin to sniff the possibility of new business models I get excited although I’m not yet sure what they will look like but look forward to co-evolving a few of these over the next few years.