BSOM Scenario #3: The Land That Time Forgot

A view from 2015.........a world where government regulates healthcare but does not financially support compliance. As healthcare becomes rationed, physicians and other caregivers who choose to continue their practices give up the traditional hierarchies, strict segregation of roles and predictable work circumstances. Those tough enough to endure do so by way of new forms of collaboration and innovation that embrace communities as well as medicine.

This is one of 4 scenarios conceived as part of the Strategic Conversations Project at the Brody School of Medicine. To read a text version, click here.

BSOM Scenario #2: The Magic Kingdom

A world where the private sector capitalizes on a booming economy to lead healthcare innovations that serve bottom lines. Government is just a spectator, and the universities are little more than that. A two-tiered healthcare system meanders along, with the affluent pleased and well-cared for, and everyone else settling for barely getting by.

This is one of 4 scenarios conceived as part of the Strategic Conversations Project at the Brody School of Medicine. To read a text version, click here.

BSOM Scenario #1: Life After Floyd

The view from 2015, of a world of deteriorating national status where larger concerns relegate healthcare reform to the back burner. People are angry and moved to action, sometimes doing more harm than good. A sense of urgency in healthcare spurs a climate of innovation and radical shifts in the roles of the major players.

This is one of 4 scenarios conceived as part of the Strategic Conversations Project at the Brody School of Medicine. To read a text version, click here.

Making Voices Visible at ArchEX 2011

After making two presentations on visual practice at last year's conference of architects in North Carolina, the Virginia conference accepted my proposal to make a similar presentation as one of their many offerings this year. The Prezi file can be viewed below although it will be difficult to follow without the narrative.

An outline of the content:

• A bit about my role with visual practice in a medical school;
• A sampling of the work of others in the field;
• The roots of the practice;
• The various forms that visual practice takes and the functions it serves;
• Some of my own observations and findings (presented as "my humble but correct opinion");
• What this could mean for practicing architects;
• What it has enabled me to do.

I made the case that these are skills and insights that architects are uniquely poised to take advantage of. In particular I stressed the differences they could make outside their field, while also improving their own professional practice environment. They were shown shots of Brandy Agerbeck working on with a green economy, told the story of Dan Roam going to the White House and shown shots from a 250-person World Cafe; after each I said "This could be you."

They also "tasted" the work. After the first third of the session they went through a 4-word graphic jam, and later they used Leadership Metaphor Explorer to interview each other one on one. Rather than immediately taking questions at the end I told them I would be the one asking the questions, and I walked them through a POINt conversation about what they had just seen and heard. They were a really good group - and on a Friday afternoon at that!

ArchEx 2011 on Prezi

A Little Bit Goes A Very Long Way

Sometimes it seems like my entire inventory of wisdom is a collection of one-liners from old movies. In this case, there was the scene in Gunga Din where Victor McLaglen's elephant, Annie, was not feeling well. As he began to give her medicine, the attendant interceded, cautioning "No, Sahib, little bit go very long way."

During the NACUFS workshop described in the post below, we reached the point when each team was charged with developing and articulating its Idealized Design. As opposed to creating a vision in the way of many practices, the Idealized Design uses the systems knowledge acquired in previous steps to articulate a future and to explain how it works. In this instance, one group asked for additional instruction and clarification as they began.

I offered a quick sketch on an easel, suggesting that they imagine students interacting with their ideal food service. As they visualized the points of contact, they could also look for the next point of contact beyond, and then beyond again, etc. Eventually a fully interactive system would emerge. The explanation only took 2 or 3 minutes.

A little while later this incredible assemblage was on the wall. Many of the post-it notes had been accumulating earlier, so they began to organize them in relationships. The rings were pretty straight forward, but the dowels were a fascinating addition. They were left over from an experience we used a couple of nights before to show the importance of focusing on what it is you want. Afterwards, everyone had been bringing their dowels to the sessions. This group realized a new use for them and made the most of it.

Leadership Metaphors Guide Food Service Design

In June I conducted the week-long Planning Institute for the National Association of College and University Food Service for the third time. As a framework for understanding planning processes we use Russell Ackoff's Idealized Design. This year, I decided to experiment with a reflexive activity on leadership.

Idealized Design begins with a systems analysis of the current situation, in this instance provided by a fictional case study representing a campus with an assortment of issues. Once their analyses were complete, we asked them to consider the current leadership culture. To do this we used Leadership Metaphor Explorer, a tool developed by the Center for Creative Leadership with a little help from yours truly. All of the cards were spread out on a table, and we asked the 18 participants to review each. They then picked the one that seemed most like their situation or, if none seemed to work, they picked the card that spoke to them in some way.

As they were working in three groups of six, we asked them to return to their groups and then share their cards and their thinking in turn. Each group was then asked to agree on two cards from their six that seemed to best represent the leadership culture in place on this fictional campus. We then took the two cards from each group and set them aside without discussion.

As the week went by they developed their Idealized Designs. Rather than beginning with the usual mission statement, we worked with Steve Haeckel's Reason for Being. Pretty quickly, they produced this statement: "Walnut College Food Service exists to provide students with healthy and sustainable food options in an environment that enables them to become successful individuals." Once each group had drafted its Idealized Design, we borrowed from Appreciative Inquiry and crafted Provocative Propositions to guide the subsequent work as opposed to the traditional gap analysis.

Once they had worked their way through the additional details, we asked them to return to a question of leadership: "What is the leadership culture that will give life to the Idealized Design and its Provocative Propositions?" We repeated the selection of metaphor cards, and then posted both sets for comparison.

The original six, as they described them, depicted a conservative and insular environment. "A Confluence of Agendas" to them represented people each getting something for themselves while the larger whole slowly deteriorated. A "Leaderless Orchestra" to them was an indication of a poorly functioning entity. With the new set, they were quick to see a distinct shift toward an interdependent leadership culture. Even metaphors not normally associated with interdependency had a role in creating it: "Nurturing Parents" reflected the fact that someone would have to teach these new skills and behaviors; "High Performance Engines" described how the college's senior leadership was going to have to step up its game in order to keep up with the dining services group.
I often describe the use of these cards and their companion, Visual Explorer, as greasing the wheels of conversation, and this was no exception. In fact, in their closing reflections one participant described how his usual difficulty with verbalizing concepts was completely overcome by having an image to work from.

Visualizing Information with VUE

Over the last several months I have been experimenting with VUE, free software from Tufts University. Generally, it has been used when we needed a group to identify all the pieces and parts of complex projects. For that kind of work it’s much more versatile than scribing on the wall, and it’s easier to clean up and share than sticky notes. The resolution seems to be really good, although I am getting spoiled to using it on a Smart Board.

Most striking, however, has been the way people engage with it: as the information begins to accumulate and breed more information, attentiveness to the screen builds. There’s no other practice I’ve used that seems to create that kind of rapt attention and mental processing. Having recently used it on an especially complex and important initiative here in our medical school, I asked two senior leaders who were involved to share their thoughts via a POINt inquiry:

• The most positive aspects? Could get ideas out quickly, and begin to see myriad interactions and decision issues; “It was kind of fun, too;”

• Opportunities? Good for early stage planning, especially on projects that are at all dynamic in time, or have significant complexities;

• What issues are there? Not linear enough to assure completeness, and too informal to be completely comfortable with its reliability; sometimes ideas flowed faster than the keyboard operator could capture them;

• What new thinking might address the issues? Add another layer of organization - develop a map with the group when it is brainstorming and then ask someone to put the information into a more traditional format with chronological tracking of some kind.

(Note: this last image is deliberately low resolution as the content does not lend itself to broadcasting.)

Positive Image, Positive Action

After many, many miles of running I decided to completely change how I was doing it. I couldn't quite pull it off until I observed how my dog does it, and then carried that image in my head.

In late 2009 I read Christoper McDougall's book "Born to Run," a first-class yarn whether one runs or not. He argues convincingly that homo sapiens became dominant because they could run, but not on their heels as most of us do these days.

It was almost a year later before I began to explore it for myself with any diligence, and I'm still into my 6th month of learning how to run all over again. The ah-ha came when I watched my dog one morning - dogs get it. The photo here (Kevin Moloney for The New York Times) shows the contrast perfectly: you can see the dog is on his forefoot, but the "advanced" species behind him is on its heels.

Progress is made anytime I can "see" the dog's feet in my mind and simultaneously feel what's happening on the ground. It becomes more stroke than stride, more pull than push, more caress than impact. I can't think of a better example of positive image leading to positive action.

Visualizing Scenario Thinking

In April I'll make a presentation to the Joint Meeting of the Groups on Business Affairs and Institutional Planning in Philadelphia. The topic will be the progress to date on three-pronged project at the Brody School of Medicine that we are calling "Strategic Conversations." The portion posted below is on the work we've done with scenario thinking.

In late 2009 the Dean sent me a review of Scenarios: The Art of Strategic Conversation by Kees van der Heijden. His note said simply “A different form of visioning?” I was still relatively new, and I wondered what his intent was, but I decided I better get a copy and read it.

The approach advocated was stunning, in part because the rationale merged many things I had learned in other disciplines. The principles of systems thinking, visual language and Appreciative Inquiry were coming together although not necessarily explicitly. Overall, the strong argument for emergent practice and participative approach resonated.

“The formal planning process cannot in itself produce change. More is required……..most of the decision making takes place through informal contacts in which most of the strategic conversation takes place.”

“The main purpose of creating a planning system in the organization is to create a conversational process around these issues, mobilizing the totality of the organizational knowledge toward an emerging solution to this complex optimization problem.”

While reading Strategic Conversations, I was aware that BSOM “had a strategic plan,” but I was also aware that the Dean, having been here just two years, was already thinking differently. In many ways he was in a mindset of Ackoff’s Idealized Design. Wouldn’t it be great if we had a few more people to think along with him? Engaging with Scenarios would allow us to map the current system and the trends in the external context. One thought led to another until a white board was filled; a snapshot is shown here.

The vice-dean and I brought the dean in to present this as planning approach. Characteristically, he asked to just study it on his own for a few minutes. He then turned to us and said “What do you need from me?"

To assure relevancy in the scenarios we began with one-on-one interviews of 26 of the leaders in our BSOM community –faculty, chairs, administrators, board members and hospital executives. The protocol was designed to elicit what they were thinking about and paying attention to. Handwritten interview notes were then transcribed into mindmaps, and these were then separated into external and internal subject matter, with the internal being those over which we can exercise some control. The external issues were organized by the themes that seemed to emerge from the interviews. This was done by a qualitative analysis using the mind maps to explore relevancies. After informally testing these for reasonableness with a few individuals, a report was compiled for distribution to the scenario team.

To assemble the team, the Dean emailed a vague invitation to 25 people who were good thinkers and who collectively represented a cross-section of the school. Using the “Hidden Gorilla” video to set the tone, these individuals were asked to notify us if they chose to participate.

Another component of van der Heijden's process is The Business Idea, typically a visual depiction of a positive reinforcing loop that describes what we believe is actually happening when we perform well; it also translates into a simple narrative. Transcending static statements of values and vision, it portrays a living “engine of success” as we see it. One way of testing the accuracy of a Business Idea is to ask “Is it reflective of how we think and act as an organization?” An accurate depiction is useful in that it can be compared to the scenarios and adjustments made accordingly. It’s highest and best use, however, is in stimulating conversations about the relationship between thinking and acting.

The Business Idea here was shared in a short workshop with the department chairs. In small teams we had them converse about the depiction and the questions it raises.
At the end we asked for a “fist vote” of how well it represents our thinking. Although there was confusion about the Business Idea versus a business model (and even a vision) we seemed to be fairly well on target.

Until this point all of the analysis, preparation and distribution had been done by just me; now it was time to turn it over to the Scenario Team. Contrary to the norm, the first workshop did not begin with presentation and debate about the findings to date. We stipulated in advance that the material must be read before the workshop, and we began processing it with a focused conversation designed to see what people were thinking without the need to get to any kind of agreement.

Working in small groups, the team was tasked with a process of working with the 11 themes in the report and deriving the Critical Uncertainties that should be considered in our stories. These then were the material for a second workshop in which we invited John Prescott to come in as our “outsider” and comment on the Critical Uncertainties. John stayed and worked with us as we identifies important drivers of the future, their polar outcomes and ultimately the two dimension around which we would develop four scenarios.

As we reached this point close to the holidays, writing the scenarios took three separate workshops. Our first was a “beta” with just a few of us to test the methodology. One of the things we discovered was that visual tools helped the necessary conversations take off really fast.

The next two scenarios were written in a Monday morning workshop just a few days before Christmas. We helped two small groups through a process wherein they first developed an end state, and then they crafted a narrative around how it would come about. To capture their narratives without bogging down over writing, we had a videographer come in at the end of the meeting to capture the stories as they were verbally presented using the graphic material on the tables.

The last scenario was written in a bar. In an effort to get people together quickly after Christmas, I offered to buy the beer; I was also curious about the interaction of alcohol and creativity. In some ways, this evening produced an especially crisp view of the future.

This work grabs some but not others. The interviews with the leadership were almost all lengthy and intense, with the leaders energetically engaged. The initial workshop with the scenario team was also a high engagement event; however, only two thirds of that team stayed with us for the duration.

The energy in these conversations about the outside world suggest that although it’s not the school’s usual subject matter we are constantly thinking about it. Naming the four scenarios seemed to help have more presence in our interactions.

The workshops themselves were carefully scripted, but the actual work was carried out by self-organizing teams. They were quick to grasp the intent, and willing to work hard. We found that we really can interact in forms other than debate, and that there is a higher than expected tolerance for ambiguity.

Doing this work as visually as possible seemed to be a real help. Graphic templates made the more complicated components easily manageable by the teams. Visual tools like Visual Explorer and Leadership Metaphor Explorer seemed to actually productively jump-start conversations.

The final narratives were posted on a website along with details of the process. Attention is being called to them in arenas such as the full faculty meeting and the Dean’s Blog.

Since their completion, they have served as the launch point for a strategy initiative that will focus initially on the creation of Premium Partnerships for the School. It is anticipated that the Business Idea will resurface as a framework for new directions.

Confessions of a Bibliophile

I wonder sometimes just what so much reading has to do with visual practice. The two are inadvertently contrasted in one of the works I came back with: two brothers, both of whom go into medicine, one notes that medicine is a verbal curriculum while the other from an early age carries around a copy of Gray’s Anatomy and draws incessantly. You’ll have to read the book to see which one emerges as “special.”

The purpose of the trip was to sit in on a Systems Thinking workshop conducted by my friend and mentor Jean Tully. We've been talking about how we might make her approach more visual without reverting to a dependency on causal loop diagrams. I left home with:

• Thinking in Systems, by Donella Meadows
• Inviting Everyone: Healing Healthcare through Positive Deviance by the Plexus Institute
• The First Captain: The Story of John Paul Jones, by Gerald W. Johnson

In RDU there is a used book store called 2nd Edition that I always visit if I can. Sometimes I take one away, but this time there were three:

• Nelson in the Caribbean, by Joseph Callo (His Lordship is a hobby of mine)
• Billy Ruffian: The Bellerophon and the Downfall of Napoleon, by David Cordingly
• The Universe and the Teacup: The Mathematics of Truth and Beauty, by K. C. Cole

In the Rock Ridge area I was pointed toward Pegasus New and Used Books. I like serendipity: in Greek mythology Pegasus was tamed by Bellerophon. Three more books went into the stack:

• Shamans of the World, by Connor Kelly
• Six Thinking Hats, by Edward De Bono
• Magical Fabric Art, by Sandra McCraw Scarpa (for my quiltmaking spouse)

Jean and I stayed at the home of her friends Phil and Wendy where we talked about our reading. To my surprise and delight Wendy went out and bought me a copy of a book she had just read, Cutting for Stone by Abraham Verghesse. That one was fascinating enough to be the only one opened on the trip back. "But then you also get...," as they say on TV, Wendy shared a stack of titles with me that she thought would help with things I'm working on:

• Awareness to Action, by Geoge Tallon and Maria Sikora
• Mastery, by George Leonard
• Coaching: Evoking excellence in Others, by James Flaherty
• Fierce Conversations, by Susan Scott

Over the last 6 or 7 years my reading has been growing and growing. I can thank my friend Bob Thompson for that, and he's probably aware of the Edward Morgan quote on the card that Wendy gave me with the book: Reading is one of the few havens where your mind can get both provocation and privacy.

Expanding Visual Practice with Architects

While working at the TJCOG event described below, the Executive Director of AIANC, David Crawford, introduced himself and asked about my background. The encounter resulted in an invitation to make a presentation about my work at this year’s state conference, held last week in Asheville. As a few years have passed since the practice of architecture was my chosen modality for design I felt initially like the prodigal son. The warm reception I received helped me get over that pretty quickly.

To see the presentation's images, click on the Vimeo screen here.

Using this blog’s name as the title, my content went through a progression:
• Some history on how I came to be there
• Examples of work by others in our field
• A synopsis of the history of graphic recording and graphic facilitating, beginning with the work of architects
• An overview of its applications
• My own thoughts about what I’m learning
• Potential applications that would be useful to architects

There were three things that happened that were particularly enjoyable for me:
1. They agreed to participate in a short “Graphic Jam” like what we do at IFVP. They were given one minute to draw a metaphor for each word, and a few of their images are shown below.

All of their drawings can be seen by clicking on these links:
a. Analysis
b. Bio-Diversity
c. Intrusive
d. Clean Air
e. Combos
2. They used Leadership Metaphor Explorer as a way to have images inspire conversations
3. Most of the questions asked were about finding ways to have creative conversations at a deeper level, with clients in particular. Yes, they commented on the visual tools, but their real interest seemed to be relational.

There were a couple of things heard in other sessions that got my attention, and one was from Matthew Frederick, author of 101 Things I Learned in Architecture School. He quoted Marshall Berman: “The crumbling of social relationships, not materials, turns structures into ruins.”

Most throttling of all was a conversation I had with Harry Harrison and Darin Waters about the Young Men’s Institute in Asheville. Initially conceived as an African-American YMCA during the time of the Vanderbilts, it was the resourcefulness of the almost invisible African-American communityin Asheville that made it a success. Darin described finding three letters written by his grandfather in the Vanderbilt archives, and commented that “History is about identity.” That made me twitch a bit, considering that sometimes we do not want to be constrained or pigeon-holed by the past.

Later in the talk they quoted one of the early leaders’ confidence in the face of doubts about the viability of the center: “The verdict has not been written.” That’s more the way I like to think, but I asked about the seeming conflict between the two statements. What we ultimately determined is that our histories are never final, but always works in progress.

M1's Can Draw!

This past week the Brody School of Medicine's Class of 2014 arrived for orientation. Dr. Randy Renegar and I hosted a World Cafe in which these budding physicians thought through "Aspirations of Professionalism." The slideset above is a collection of their table graphics - I hope they're still drawing like that ten years from now! The Harvest graphic is below.

A Cool Tool: Prezi

Last week I gave a 10-minute presentation on what I've been doing at the Brody School of Medicine. Rather than the usual ppt slides, I used Prezi, an online tool.

BSOM Story on Prezi

IFVP 2010 - Day 2

IFVP Conference 2010 - Day 1

Scribing The Practical Futurist

In May I served as the graphic recorder for the 50th Anniversary Forum of the Triangle J Council of Governments, titled "Creative Possibilities: Regional Solutions." One of the featured speakers was Michael Rogers, aka The Practical Futurist. I had the privilege of getting to know him over dinner the night before, which is a real plus in terms of getting mentally ready to graphically record a presentation. As I'm now working on campus with a scenarios project, I was struck by one of his statements in particular: "The future might surprise us, but it should never dumbfound us."

CPSI 2010

Buffalo.
Innovation = implementing something new. Creativity = novelty that is useful. Creative thinking = connecting previously unconnected thoughts.
The more different kinds of things you put into one (side of the) brain, the more connections the other brain will make.
Entrepreneurial ventures for non-profits.
Nothing works without a focus on person-team-organizational enterprise.
Make companies better by making people better.
Those getting traction are those who explore how to improve their processes to benefit people, and how to really develop their own people.
Integrinators.
For creativity to happen we must search for the value in new ideas.
POINt:

• Pluses
• Opportunities, positive potential
• Issues (they come out best as questions)
• New thinking

The rite of passage for innovation teams.
The importance of being 12.
Fear - death = thrill.
Stay hungry, stay foolish.
Deliver more than what was paid for.
Simple questions are the most powerful.
Applied creativity is a process, and CPS is a model.
Creativity = knowledge x ideas x selection.
Rocks can hear.
Innovation: the implementation of an idea that improves someone's life and brings meaning to someone's life.
Find a way and train everyone.
Inspiration and possibility thinking are absolute musts.
Innovation relies on varied talent.
Stale ideas = stale group.
Resonance; it flows when there is consistency with values.
Explore your vision and use it to guide your way.

Thoughts on Sustainable Change

The leadership in a distinguished organization seeks to advance a large-scale change initiative. Among the foods for thought presented is John Kotter’s “The Eight Step Process for Successful Change.” The first step: “Create a sense of urgency. Help others see the need for change and the importance of acting immediately.”

For a couple of years I co-led the Step III workshop of the Planning Institute of the Society for College and University Planning, and Kotter’s book Leading Change was part of our framework. We occasionally debated the nature of the sense of urgency – does it stem from threats or from aspirations? My own reading of Kotter was that he saw a need to represent a negative force and stimulate our survival instincts.

My path subsequently wound through Peter Senge’s Fifth Discipline and the Society for Organizational Learning. Systems thinking would show that using a negative urgency to stimulate change will make that change unsustainable. If the idea is to engender preferred behavior to eliminate a threat – perceived or otherwise - the lifespan of that behavior is in doubt once the threat is eliminated. The best examples are in colleges and universities. There the preferred stimulus for change is a deficit-orientation, generally arising from assessment. In spite of growing attention to the process, things remain as described by a friend in the Center for Creative Leadership: “It’s easier to move a cemetery than to change a university.”

In the Step III workshop we also used Malcolm Gladwell’s Blink. One of the stories we did not discuss was a tragic example of how our focus narrows in the face of a threat. It can be argued that if the change needed is adaptive as opposed to merely technical – changing the way we think as opposed to just changing what we do – it is imperative that we widen our focus. According to Barbara Fredrickson’s work our focus widens and narrows as the positivity of our situation varies. A widening of focus is not only critical to our receptiveness toward new ideas, but it also drives an essential component of long term success: our creativity.

So, in what ways might a positive sense of urgency arise? It can begin with a question as simple as “What do we want more of?” It’s a simple phrase that holds the past, the present and the future together interactively, and it sets up a series of dialogues that engage the entire system. Once the usual conversations begin to change, the leadership can breathe normally in the confidence that things are on their way.

Thinking Through Positivity

I’m fully invested now in Appreciative Inquiry and the broader spectrum of strengths-based and positive approaches. Still, sometimes it’s a challenge for me to explain the rationale to others without that song coming up way in the back of my mind: Keep on the sunny side, always on the….. There’s far more to it than that. I’m also beginning to think that the power of a positive orientation is not as much of a secret as it sometimes seems.

The fundamental example for me is the artist. Michelangelo was not problem-solving when he made the Pieta; there was a lot more going on. When Picasso painted Les Desmoiselles d’Avignon, I doubt that it was because an accreditation agency identified a deficit of Cubism in the art world.

I see other signs. Recently a finance manager noted that if a company has numerous business units, and some are making money and others are losing money, you should not immediately invest in the weak ones. Invest in the strong ones and raise the worth of the whole much faster. In a recent New York Times article Dr. Tachi Yamada talked about the value in finding the positive attributes in analyses and people, and spending your time on those as opposed to just the shortfalls. In the book Born to Run, they point out that species evolve according to what they’re good at. In Scenarios: The Art of Strategic Conversation Kees Van Der Heijden points out that tomorrow’s core competencies come from today’s.

Sometimes when I feel like flying really low, I’ll claim that “No organization ever advanced itself by focusing on its deficiencies.” I have not a shred of evidence for such bombast, but I really do believe it. At the same time, one mustn’t paint with too wide a brush. As pointed out in Metaphors in Mind there are times when it’s appropriate to pull a few weeds.

I also believe that a positive approach ultimately entails really hard work. It’s really easy to call out what we don’t want, but have you ever found it hard to say what you do want? It can be a little tougher. And when we find our strengths, our abilities when at our best, that knowledge brings with it an obligation to always strive for that level. It’s not work for weenies, but our future depends on it.