In the previous part of this series, Marilyn witnessed progress on the adaptive issue of addressing prescription errors when the IT manager, Harry, agreed to perform his own listening tour to promote resolving the issue of work-arounds. In this article, Marilyn continues meeting with the original listening tour participants and sharing her themes. The listening tour participants not only concur with her themes based on their own experience at the hospital, but also provide stories further validating them.

However, unlike Harry, the other listening tour participants are staff and have no formal authority.  The staff members do not currently view themselves as part of the problem or able to respond with a solution. As someone on the border of staff and management, Marilyn empathizes with their view. At the same time, she considers the staff as not only capable but essential to a lasting resolution of this adaptive challenge.

After completing the listening tour, Marilyn intentionally pauses. She reflects by going to a place of sanctuary – the garden on the hospital roof. From the garden she has a view of the entire town, and watching the town “wake up” causes her think of the interdependence of what she is discovering. The themes she has validated contrast sharply with her stand to do no harm, and she senses the suffering of both patients and the hospital community. In this moment of revelation she moves beyond her role as a nurse and feels responsible for the entire system.

From her garden perspective, Marilyn concludes that the time has come to directly share her work with Nancy, the CEO of the hospital. Her direct supervisor, Tim, has encouraged her to do so since Nancy has been a strong proponent of mobilizing leadership from everyone. Marilyn meets with Nancy and shares her listening tour results. In contrast to the previous CEO, Nancy’s reaction to what could be considered “bad news” is one of curiosity and openness. Nancy asks what support Marilyn needs. Marilyn thinks of her stand and makes an unreasonable request. She asks Nancy to privately begin noticing where her conversations and actions inadvertently contribute to a system that makes prescription errors. Nancy agrees to do so for the next workweek and to let Marilyn know what she learns.

The Fatigue Issue

Marilyn decides to pursue another theme. She will test the readiness of the listening tour participants to work with her on a voluntary basis. She speculates that the theme regarding prescription errors resulting from fatigue will be the most personally relevant and important to staff. Marilyn meets with her listening tour participants and asks if they would be willing to assist her in diagnosing the fatigue issue. After discussing the commitment required and what would be expected of them, ten of the original group agrees to work with her. Marilyn asks that each person design a compelling open-ended question relevant to the fatigue issue for an individual listening tour.

While for Marilyn this seems a straightforward request, several individuals within the group begin expressing objections to conducting a tour. In a group conversation, a variety of reasons are proposed for the tour’s difficulty. One person even proposes that doing the tour will foster the very fatigue they are intent on resolving. Marilyn surmises that this may be an example of people avoiding the responsibility needed to make progress.

Marilyn holds the conversation together, acknowledging the validity of the views expressed while suspending the assumptions underlying them. Ultimately, the entire group acknowledges their fundamental concern: their fear of standing out as management pawns. They are concerned that the work they are about to undertake would be seen as violating their loyalty to those they work with.

Marilyn opens up the possibility that they too can have their colleagues see the value of what is being done, not only in service of their patients but also in service of their own wellness at work. In order to reduce their distress, Marilyn proposes that she coach anyone concerned about doing the tour.   Marilyn provides an opportunity for people to choose moving forward with the group. One person does leave by thanking the group for the opportunity and for allowing him to make the decision best for his situation.

In the final part of the series we learn about Marilyn’s work with her group as well as how the group’s work is acknowledged. We invite you to pause and adopt a systemic view of your organization, and in a mood of speculation reflect on the capacity to respond to adaptive challenges of both management and staff.

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