Case Studies

Case Studies: Transformational Moments

Hesitation Blues

Situation: A weekly staff meeting where a group of 7 intrepid survivors of a recent organizational bloodletting struggle to find a new purpose that will attract funding and clients.  Conversations lurch from team member to leader, starting out engaged and lively then withering.  The leader is showing signs of agitation: If the furrow in her brow gets any deeper, there’ll be a place to put the pet hamster team member Auz has been trying to unload.

Action Taken:  A tight agenda with clear work products and a list of ground rules that are followed have combined to bring the team to this impasse.  This is often the case, that a tight, well-designed agenda and custom list of ground rules takes a team right to its stuck place.  Team members have been practicing saying what is so for them without blame or judgment for the last few meetings, then allowing silences between utterances.  The frustrated leader goes first:

“Why is it that every time I speak the rest of you stop talking?” Out of the arctic silence, a single voice quavers: “Because I assume you’ve made a decision, and further discussion is pointless.” Zombie-like, everyone nods.

“But, that’s not…I don’t always…” As the realization breaks over her face like the yolk of a 3-minute egg and she grabs 2 of the paper plates that are always on hand for snacks. She writes “D” on one and “O” on anther. “I’ll hold up D when I’ve decided and O when I’m adding my opinion to the conversation.” Which she did from then on. In that one tiny moment, the hamster lost her new home, and that team lost its hesitation.

The Saboteur

Situation:  I’m facilitating a weekly work group meeting to design a structure that will give nurses a voice in decision affecting them. The team is mostly staff nurses and I am mostly being thwarted by the group’s excess powerlessness (complaining, blaming) in the face of one group member who seems to snooze through most discussions, waking up just in time to veto decisions.  Even though his sabotage of the group’s work was obvious, my interventions about it were not bearing fruit.

Word has gotten back to the executive sponsor, the CNO, that this group member has been overheard telling the board of the nurses union that “we all know this is just an exercise management is taking us through.”

ActionTaken:  Before the next meeting, I coached the CNO to speak authentically, one human to another, rather than from on high as one role to another. Watching the CNO confront him and talk about feeling betrayed by him, and what her intentions for this structure really were, and seeing him admit to speaking those words and promise to stop it, was wonderful, but seeing each nurse look at him and say in turn “you don’t speak for me” was soul-stirring.  The meetings became a microcosm of the self-governance structure were were designing, with team members becoming responsible for various aspects of the meetings.  The Nursing Shared Leadership structure was successfully implemented and has been in place for years.

“You Can Say That?”

Situation:  An annual care-planning meeting at an eldercare facility. The team is multi-disciplinary, the participation lop-sided. The doctor gives a not-very-inspiring recitation of the treatment plan (meds, vitals, symptoms) and the others, who have much more contact with the patient, say nothing. The meeting feels like the moment before a thunderstorm, when the skies want to erupt, but can’t.

Action Taken:  With Care Planning meetings and medical rounds, I act as a role as team coach working right in the meeting.  I say: “So far Dr. X has been doing most of the talking. I wondering how such a one-sided conversation can add up to a care plan, especially when the rest of you have more contact with the patient.” In the stunned silence that follows, the social worker turns to me and says: “You can say that?” Before I can answer, Dr.X says “YES.  How else can I know whether or not to make changes?  You are my eyes, ears and hands.” Now everyone is talking, and leaning forward, their faces alive: The social worker, the nurses aide, the housekeeper. The new aide mentions a chance observation, nothing much she says, but the room goes silent and the doctor is looking at the aide like a compass tuned to true north. Two focused questions later and Dr. X has changed the treatment plan.  The care plan is quickly changed by the team, and there is an  electric feeling in the room and a new light in the aide’s eyes as they move to the next case.  Everyone is on the edge of their chairs, like thoroughbreds in a starting gate, straining to run.

Case Studies: Big Projects and Programs

Nursing Excellence in Action

Situation: Involving 1000+ highly-skilled, in-demand nurses in designing their own shared governance structure and new care model was more complicated than filming Ben-Hur. The results had to satisfy everybody: Patients, families, nurses, executive and middle management, and the bottom line.

Action Taken: An internal/external consulting partnership that relied on each of our strengths: My knowledge of group dynamics, change management and ability to turn anything to a team’s advantage, and my internal partner’s connections in the organization, persistence, and ability to organize the second coming.  I started each phase at the center of things, then shifted to the side as the project matured.  In both projects, my internal partners led the project, first with my help, then on their own.  I love these kinds of internal-external partnerships because I get to make a difference while supporting new learning and independence in my clients.

Result: The shared governance structure is in it’s 6th year and just gets better. The care model is fully implemented, and has many passionate supporters and success stories, with more to come.

How to Become a Consultant

Situation: 100 consultants and project managers need to become valued business partners to their internal clients. Showcasing their expertise meant showing up in politically-charged meetings with the full complement of consulting skills rather than simply taking orders, not an easy transition.

Acton Taken: A needs assessment yielded the information for a customized case study which we use in a 2-day Consulting Skills training on-site. The course is co-taught to 30 participants. Each trainer conducts 3 extended practices in fishbowl format so more skilled participants model new behaviors for the rest. The practices are heavily coached, so that everyone improves on the spot. By the second fishbowl practice, participants are encouraging and supporting each other to be their authentic selves.  It’s moving to watch and transformational for the consultants.  All participants work in in trios during class and are coached in those trios afterwards using a structured case consultation form to focus the conversation.

Result:  There is a day-long follow a few months later and I see remarkable progress in the consultants with several stand-outs.  The next year, 13 consultants enroll in my 52-week online follow-up program, Honing Your Consulting Skills, which is designed to take consultants all the way to trusted advisor status.  Our monthly conversations make it obvious that they are successfully making that identity shift.

The True Consensus Meeting

Situation: An ad hoc team of 12 needs to meet to make an expensive, important, highly visible decision: Which 20 people will receive the company’s top honor for the year. The CEO has agreed to abide by the groups decision and refused to offer guidance, saying, “either we know our values because we live them or we don’t: you shouldn’t need my guidance to decide who to reward.” 5 days before the meeting, the planners are struggling to figure out how to whittle 368 nominations down to 30 (top 20 and 10 alternates) in the 2-day meeting they have planned. Their idea: have everyone bring laptops and browse through the records online. No one can see how this meeting will ever end, much less result in an agreement. I agree to plan and facilitate the meeting in collaboration with their Director of OD.

Action Taken: We print out the nominations and overnight the 2-1/2 inch thick document to all participants with a single instruction: Come to the meeting with your top 5 picks. All 12 arrive prepared and, after opening the meeting, (including introductions and ground rules), we list everyone’s top 5 picks on a whiteboard and start the highly structured process of consensus. Because we’ve been given no criteria, our first step is to surface the criteria each of the 12 used for their picks. That’s the criteria we use to start narrowing our list of 60. After several rounds of multi-voting, rank ordering, structured discussion and negative voting, the list numbers 32 and there is agreement on who is in the top and bottom 10. Because all nominations are anonymous, this group of strangers has evolved a language to identify each record: “HR guy” and “back office drone,” “leader of the pack.”

Day two starts with an acknowledgment that this is the day for the hard decisions: the top 20, the alternate 10 and the 338 that will not be included, even though each of them has made a valuable contribution. What happens next still brings tears to my eyes: This group of 12 strangers take their conversation deeper, challenging each other, making the criteria tighter, melding into one unit with a single mission: To acknowledge the top contributors in a way that is fair and highlights what the company stands for. By 11:30, they’re so in the zone they’ve forgotten I’m in the room. By 3:30, they’ve done it. Their agreement is unassailable.

Result: Executive management accepts their recommendation without reservation; my OD colleague is thrilled.

The High-Performing Team Needing Renewal

Situation: A staff of 10 has created a department from scratch in a large organization. After 2 years, they are wearing down and are beginning to get irritated with each other. In addition, 2 people have recently been fired and the leader is concerned that this is bothering the team.

Action Taken: We started a with team assessment, the Myers-Briggs Type Indicator (MBTI), and a day-long team-building session where we reviewed the results of both assessments and formulated the team’s goals and a plan for achieving them.
We met each month to hammer out actual work, working agreements and learn more about how Type was playing out on the team. I coached each team member individually, once a month.

Result: Morale increased, and friction dropped away. The team began to focus on real work issues, rather than on each other. The department became an accepted, relied on part of the company; it was already nationally known for it’s excellent work. Several staff members advanced their careers and were replaced by high-quality candidates.

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