Loading ...
Sorry, an error occurred while loading the content.

Could a CoP work here?

Expand Messages
  • Denham Grey
    Interesting summary on the problem solving behavior of nurses. This research points to quick fixes and nearest neighbor help as the main way to solve
    Message 1 of 3 , Jul 31, 2001
    • 0 Attachment
      Interesting summary on the problem solving behavior of nurses. This
      research points to quick fixes and 'nearest neighbor' help as the
      main way to solve pressing issues. I'm left wondering if there was a
      CoP AND a practice to reflect, detect and solve root causes within
      that group, this could be a potential solution.

      http://hbsworkingknowledge.hbs.edu/pubitem.jhtml?
      id=2397&sid=2398&t=knowledge

      (apologies for the broken link)

      My next question or hestitation is: how many CoPs do adopt a
      structured approach to root cause analysis?

      Recommendations from the article:
      1) make rootcause analysis an explicit part of the work & allocate
      resorces for this
      2) create opportunities for sharing problems and make providing
      feedback easy
      3) pay proper attention to pobems signals & signs
      4) dedicate a personal or part of a role to collecting & tracking
      problems to final resolution
      5) encourage solution generation, experimenation and a focus on
      longer term issues (make the problems go away)
      6) Sell your stories to help motivate for this 'extra' work.
    • John D. Smith
      Denham, Thanks for that article. An interesting case study and I agree that a community of practice would probably address many of the issues that are raised.
      Message 2 of 3 , Aug 1, 2001
      • 0 Attachment
        Denham,

        Thanks for that article. An interesting case study and I agree that a
        community of practice would probably address many of the issues that
        are raised. I thought the punch-line of the study was in the
        side-bar: "The telltale sign is silence." My question was: "How would
        'company leaders' learn to perceive silence (more skillfully)?"

        I think that one way to talk about the benefits of a supported
        community of practice is that it lengthens attention span (as well as
        broadens it). But there's no guarantee that a community will focus on
        the issues (much less heuristics or structured approaches) that would
        make sense to an outside researcher or consultant. (An attention span
        issue?)

        Just how pathological are the hospitals under observation? How
        pathological are they assumed to be? The author doesn't say anything
        about the organizational context: were doctors, administrators,
        trustees or other organizational leaders concerned about the
        situation? Or were they interviewed? Maybe the error level was just
        right, and the 8 hospitals were ripe for further squeezing of the sort
        that would increase the error rates and reduce attention span.

        The issue of attention caught my eye in the statement that "The first
        author shadowed twenty-two nurses in eight different hospitals for a
        total of 197 hours." On one level that's a lot of time. But I wonder
        whether she bothered to have lunch with these nurses? Etienne Wenger
        wrote an article in Healthcare Forum Journal (that's moved it's web
        location several times already) that suggests that lunch is the time
        when such a community might convene. (EW, "Communities of Practice;
        The Social Fabric of a Learning Organization" in Healthcare Forum
        Journal August 1996 that used to be at
        http://www.trusteemag.com/thfnet/th960401.HTM)

        I think there are good reasons why understanding knowledge at a
        community level is so difficult. Once I asked Etienne about what it
        was like to hang out with claims processors for 6 months. He said
        that he sometimes had real doubts about whether it would be worth
        anything, mentioning that sometimes at the end a week he would find
        that he had produced one note that he thought maybe would be worth
        something.

        John

        --*
        --* John D. Smith, 503.963.8229, 2025 SE Elliott Ave, Portland OR
        97214-5339
        --* http://www.teleport.com/~smithjd ICQ: 72789757 cell: 503-975-7799
        --* "With company you quicken your ascent." -- Rumi

        -----Original Message-----
        From: Denham Grey [mailto:dgrey@...]
        Sent: Tuesday, July 31, 2001 11:06 AM
        To: com-prac@yahoogroups.com
        Subject: [cp] Could a CoP work here?

        <snip>

        http://hbsworkingknowledge.hbs.edu/pubitem.jhtml?
        id=2397&sid=2398&t=knowledge

        <snip>
      • nickols@optonline.net
        Denham points to an article in HBS Working Knowledge (albeit via a broken link -- which is not a big problem to overcome) and wonders if a CoP focusing on root
        Message 3 of 3 , Aug 2, 2001
        • 0 Attachment
          Denham points to an article in HBS Working Knowledge (albeit via a
          broken link -- which is not a big problem to overcome) and wonders if
          a CoP focusing on root causes, etc., might be a solution.

          I was interested enough to fix the link and go read the article. I
          had two basic reactions: (1) from a different perspective (i.e., that
          of human performance technology or "HPT") the nurses' situation is a
          classic HPT problem and is amenable to treatment using that approach
          (see, for example, the www.ispi.org web site for a basic look at
          HPT); and (2) I'd be willing to wager that the nurses already have a
          community of practice and it's probably focused on sharing quick
          fixes because that's what their "practice" is currently all about.

          That takes me to Etienne's study of claims examiners. As it happens,
          I spent several years "hanging around" claims examiners - and other
          folks whose primary work activities belong to the "adjudication"
          class (e.g., insurance underwriters, loan officers and financial aid
          assistants). I didn't study their work from the perspective of a
          cultural anthropologist; instead, I studied it from the point of view
          of someone brought in to make it more productive. In other words, I
          was less concerned with how they did or how they learned to do their
          work as it was currently defined but with how to redefine their work
          to make it more productive (as well as getting them to go along with
          the redefined work).

          The nurses, like most people in the workplace (or so I would
          estimate), are caught up in daily fire-fighting and likely to remain
          there. My guess is that they don't see it as their job, either as
          assigned to them by hospital management (or as accepted by them as
          nursing professionals) to go around fixing all the many dozens or
          hundreds or thousands of "glitches" that plague the many processes
          making up the work of the hospital. Further, I'd be willing to wager
          that any attempt to establish a so-called CoP among the nurses with
          the intent of cleaning up or sprucing up the hospital's processes
          would "come a cropper" to borrow an old phrase.

          What might be viable would be to spend some time identifying what is
          almost certain to be an already existing CoP among the nurses, see
          what it focuses on (almost sure to be the practice of nursing as seen
          by that set of nurses) and, perhaps, seeing if there might be a way
          of getting them to incorporate this larger loyalty to the hospital's
          efficiency as part of their practice. That said, I wouldn't hold out
          much hope for success.

          The time horizon of most employees, not just nurses, is pretty darn
          short. Their scope of interest is comparably narrow. Fighting fires
          and putting on heroic shows is what they do. To be sure, programs
          involving incentives and recognition can be crafted and these can
          produce a great deal of improvement in organizational and process
          efficiency and effectiveness, but to expect employees in general to
          focus on fixing root causes and process glitches seems to me to rank
          right up there with other "holy grails."

          I'm not trying to be cynical or critical here; I'm simply commenting
          on what I see as the reality of the workplace. It all strikes me as
          rather like asking academic researchers to reflect upon and improve
          their project management processes. That's not what they do.

          Regards,

          Fred Nickols
          Distance Consulting
          nickols@...
          http://home.att.net/~nickols/distance.htm
        Your message has been successfully submitted and would be delivered to recipients shortly.