Monday, January 04, 2016

Queensland exploration of the prophetical approach to leadership training

Queensland Health was an organization under a great deal of pressure several years ago because of safety and quality issues.  In fact, in 2005, the Queensland Government announced an independent review of QH’s administrative, workforce and performance management systems, with focus on issues of bullying and intimidatory behavior in the workplace.  Among other things, what developed was an interesting approach to leadership training employed during the remediation of those issues. I had not heard about this method and was curious to learn more.  What I discovered is that the approach is qualitatively equivalent to the kind of simulation used to teach clinicians how to deal with unexpected situations.  Here, though, the vehicle is a drama-based interactive case study, a "prophetical."  Here are some excerpts from the article (sorry, payment required):

The prophetical is a form of applied theatre which draws inspiration from two words. In the prophetical, the players create a prophecy (which foretells of possible future events) which is also a hypothetical proposition.... The prophetica then blends truth and fiction to present dramatic scenarios which are reasoned speculations on the future. From the prophetical it is possible for participants to see versions of the future, especially flawed futures which can be corrected or transformed through their interventions and actions.

The power of the prophetical as a method of transformatory learning arises from the playing out of a dramatic scenario which has been carefully constructed for the participants. The scenario results from a rigorous research process so that it is grounded in the lived experience of the participants who can recognise and critique what they see playing out before them. Participant interest is also heightened when the chronology of events played out in the prophetical are treated in a highly elastic way; with flashbacks and jumps in time to move the action (and the participants backwards and forwards across time. The manipulation of the sequence of events, and the way the participants engage with them, is in the hands of a facilitator (known as a midwife — “the person who brings about change”) who uses the scenario and its reality as raw material to be adapted and extended to deepen learning for participants. The midwife’s interventions arise from assessing the impact of the action in the moment and quickly judging what would be most beneficial for participants.

What resulted was a scenario which could be played out in 12 scenes by five fictional characters. As workshop participants followed the scenario they could identify the highly ambitious and youthful Area Manager intent on self-promotion through his political connections and his advocacy of the NSI (nursing-sensitive indicators). They could empathise strongly with young Chloe, the well-meaning but not always politically astute Acting District Manager, who failed to project manage the NSI into service. They were quite taken by the cynical and hard-nosed clinical staff, the Director of Nursing and the Medical Superintendent, who had little faith in the system (or Chloe) to deliver on its promises. And they had very little sympathy for the overworked senior bureaucrat, more concerned about the Minister and press reporting than patients.

Together these characters played out a scenario characterised by poor planning, high egocentricity, bullying and the failure to accept responsibility. As the scenes were played out, discussed, replayed and reviewed, participants drew on the Queensland Health Leadership Qualities Framework to critique the behaviour they saw, model alternative leadership approaches for the group and then compare these approaches.

Responses of participants to the prophetical were overwhelmingly positive, with 70% rating it as “successfully opening up the key issues of the workshop.” Similarly, 71% of participants felt that the issues raised in the prophetical were effectively integrated throughout the workshop.

The final recurring comment from participants centred on their responses to the characters in the prophetical. Strong empathy, support and sympathy were felt towards Chloe, the well-meaning but poorly skilled middle manager who finally was held responsible for the unravelling debacle. On the other hand, open hostility and anger were expressed towards the superficial, politically manipulative and well connected bureaucrat whose style-over-substance actually orchestrated the events. The emotional engagement of participants with these characters was palpable and stimulated energetic discussion about their leadership and integrity, caused many to leap to their feet to demonstrate alternative behaviours, and sharpened insights into their strengths and weaknesses as leaders.


Brad said...

Here's a similar program:

Simul Healthc. 2015 Dec;10(6):372-377.
Simulation in the Executive Suite: Lessons Learned for Building Patient Safety Leadership.
Rosen MA1, Goeschel CA, Che XX, Fawole JO, Rees D, Curran R, Gelinas L, Martin JN, Kosel KC, Pronovost PJ, Weaver SJ.
Author information

Simulation is a powerful learning tool for building individual and team competencies of frontline health care providers with demonstrable impact on performance. This article examines the impact of simulation in building strategic leadership competencies for patient safety and quality among executive leaders in health care organizations.

We designed, implemented, and evaluated a simulation as part of a larger safety leadership network meeting for executive leaders. This simulation targeted knowledge competencies of governance priority, culture of continuous improvement, and internal transparency and feedback. Eight teams of leaders in health care organizations-a total of 55 participants-participated in a 4-hour session. Each team performed collectively as a new chief executive officer (CEO) tasked with a goal of rescuing a hospital with a failing safety record. Teams worked on a modifiable simulation board reflecting the current dysfunctional organizational structure of the simulated hospital. They assessed and redesigned accountability structures based on information acquired in encounter sessions with confederates playing the role of internal staff and external consultants.

Data were analyzed, and results are presented as qualitative themes arising from the simulation exercise, participant reaction data, and performance during the simulation. Key findings include high degrees of variability in solutions developed for the dysfunctional hospital system and generally positive learner reactions to the simulation experience.

This study illustrates the potential value of simulation as a mechanism for learning and strategy development for executive leaders grappling with patient safety issues. Future research should explore the cognitive or functional fidelity of organizational simulations and the use of custom scenarios for strategic planning.

ThomasMaloney said...

Why make something like leadership so complicated? I don't think all industries and certainly not anyone from the storage industry, would be able to appreciate this approach.

Paul Levy said...

The sociology of hospitals is complicated. Highly tribal.