Collaborative Sensemaking: Post 74

I spent a small part of my recent vacation meeting with thought leaders in New England to discuss trends and implications for the coming year.  One of my most pleasurable meetings took place at a winery and restaurant in the Nashoba Valley, where I talked with Dr. Kate Goonan about her new book, Journey to Excellence: How Baldrige Healthcare Leaders Succeed. 

The premise of the book, as stated in the foreword, is that although there may be no magic bullets, there are rational approaches that achieve results.  The Baldrige approach that Dr. Goonan and her co-authors elucidate provides guidance and checklists to embark and persist on the iterative journey of improvement based on the LASER framework:

• Leadership consists of 3 steps: recognizing that fundamental change is necessary to achieve one’s vision, welcoming objective evaluation and “brutal facts” feedback, and commiting to build a culture based on organizational learning and improvement
• Assessment reflects the decision to systematically evaluate processes and practices to view the organization from the perspective of patients and families
• Sensemaking describes the critical role leaders play in interpreting and explaining disruptive marketplace changes and framing what is required for successful healthcare delivery (discussed in greater detail below)
• Execution refers to the focused action necessary to achieve results, which includes: formalizing informal processes, setting priorities, discontinuing unproductive activities, establishing accountability with action plans, and integrating the Baldrige process into strategic and operational planning
• Results includes strong performance on a comprehensive set of measures important to patients, stakeholders, and markets; beneficial trends over time relating to the organization’s mission; key results that show good-to- excellent relative performance on benchmarks; alignment with organizational strategies

Sensemaking

On page 102, the authors quote Karl Weick, who introduced the concept by writing, “What is good for sensemaking is a good story.”  I like this concept because it underscores the cyclical journey of improvement including assessment, interpreting feedback, learning, and implementing improvements.  In Collaborative Workout, I mentioned that the discipline of being committed to a continuous process allows an organization’s members to dive deeper into making sense of disruptive changes, using candid feedback to improve clinical and financial processes and outcomes. 

Sensemaking leads people to go beyond narrow silos to focus on processes that they need to perform well to achieve desired outcomes.  It begins with answering questions and addressing inconsistencies.  The authors cited an example of Sister Mary Jean Ryan, CEO of SSM Health Care,  regarding a disconnect evaluators noted: “You say that human resources are your most important asset, but you don’t cover them in your strategic plan.”

Once she became aware of her organization’s failure to link its vision and values with strategy development and human resource management, she was able to lead her team to breakthrough performance.  In short, sensemaking drives organizational maturity because it fosters system thinking (rather than finger-pointing and blamestorming) and facilitates team learning and collaboration.

As I mentioned in  “Embracing Complexity,” in Better Communication For Better Care: Mastering Physician-Administrator Collaboration, face-face conversations are the only sustainable way that people can deal with complex situations  in which predictability is diminished, experience does not guarantee success, and relationships are key.  Sensemaking gives us a way to understand and frame healthcare complexity, view our organizations as part of a holistic system of care,  and provide potential and hope for sustainable improvement.

 What do you think:

• Have you participated in the Baldrige process
• Are you considering being part of a structured improvement process
• What roadblocks and advantages do you see in such a long-term improvement effort

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

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