The Surprising Power of Liberating Structures: Simple Rules to Unleash A Culture of Innovation (23 page)

An executive from the Army Knowledge Management function who had participated in the Starfish program decided to experiment with
Users Experience Fishbowl
in conducting AARs. Several officers who had returned from the war were asked to simply talk to each other in a fishbowl about their experience of developing trusting relationships with community members, including local women, in Afghan villages. The other participants—both the officers being deployed to the war zone and the members of the knowledge management group responsible for harvesting field intelligence—sat around the outside listening.

The executive-facilitator of the fishbowl told Lisa:

Everyone was sitting on the edge of their chairs because they felt they were getting important firsthand, unfiltered information. Every word was important. Moreover, participants got the information plus a sense of how the officers worked together and made sense of confusing signals. The experience AND the information came through
.

For the people who had been interviewers in the traditional AAR process, it was a revelatory experience. They had a chance to see and feel what was conveyed between officers leaving the war zone and those entering it. Some of the questions asked were different and richer than any the interviewers could have imagined. The officers in the fishbowl took the questions very seriously and took notes so that they could be sure to answer all the questions as candidly as possible—if not then, at a later time.

For the officers returning from Afghanistan, the fishbowl was a refreshing and satisfying experience compared to the usual AAR. The traditional AAR interview process was often mind-numbing, producing repetitive answers to questions that had little local flavor. In contrast, the fishbowl conversation evoked many more memories and details. One story sparked another.

Equally important, the returning soldiers were able to make sense of their messy experience together in a way that communicated more detail and nuance to the departing troops. They felt able to share their on-the-ground experience in a way that would truly help their colleagues be safe and effective. The young soldiers who had never deployed were all ears listening to their leaders have a wide-ranging and candid discussion about their concerns. “In the space of a couple hours,” the executive facilitating the experiment said, “there was a huge amount of understanding and progress made. The interaction among the participants told more of the story.”

Inventing Future Health-Care Practice:
Chris McCarthy

How do you start inventing the future? How do hard work, hope and history rhyme in a way that something really new comes into being? Members of the Innovation Learning Network (ILN) are turning to Liberating Structures to discover the answers.

Chris McCarthy has a dual role in inventing the future of health care: he is a lead at Kaiser Permanente’s Innovation Consultancy, where he serves as an innovation consultant, and also leads the ILN. In both roles, Chris’s goal is akin to Dick Fosbury’s breaking the Olympic high-jump record by an unimaginable three inches in the 1968 Olympics, where he reinvented high jumping
.

The “Fosbury Flop” involved a straight approach, jumping with both feet, and twisting the body 180 degrees looking away from the bar. Before Fosbury’s revolutionary invention, all jumpers faced the bar and launched off one foot
.

The ILN network was launched in 2006 with the support of the VHA Health Foundation and Kaiser Permanente (KP), the largest health plan in the United States, as a unique way to share methods, transfer ideas, and generate opportunities for interorganizational collaboration. ILN members realized from the outset that they would need fresh approaches to deepen their understanding of patient needs and learn how to break away from current reality. A synergistic mash-up of Design Thinking and Liberating Structures was put into play. Particularly useful Liberating Structures for the task include
Open Space
and
Social Network Webbing
.

Open Space

Every year since the ILN’s 2006 inception, the group has used
Open Space
during one of its face-to-face meetings.
Open Space
is especially well suited to the action-orientation and “we fail forward” spirit of innovators, Chris
says. “I believe playful curiosity is the best way to attract people into this messy work.
Open Space
gives permission to explore what we know and more importantly what we don’t know. Without exploring unfamiliar territory, most innovations fall short.”

In
Open Space
sessions, innovators from different organizations have found others who share their curiosity about venturing into unfamiliar territory. Big questions have fueled expansive action-research themes. Some examples:

This question cracked open a door to real-world applications: localizing disaster planning with real-time Google weather and traffic data; reducing the spread of infection by incorporating special virtual-reality segments into training sessions; enriching rehab for injured veterans by stimulating movement with Wii technology; and spreading hospital shift-change innovations across the country. Directly and indirectly, ILN members have been urging each other on to discover more.

      
Over the course of just two months, KP, Partners HealthCare, Alegent, and Ascension shared proprietary facts and figures on their current state, practices, improvements, and innovations. All four systems became immediately smarter. KP went on to innovate in the medication-administration process, inventing a system that became known as KP MedRite, and then shared the system back with its ILN partners.

      
This question led to an expansive research and application agenda. Radical inventiveness started to unfold in tangible approaches like hospital-at-home, care at the shopping mall, and home visits, as well as less tangible care methods like e-ICU, Twitter, and Virtual Practice. Eyes opened. Approaches that seemed like science fiction (robo-doc) or retro methods (home visits) started to make practical sense.

      
The games are designed to be used by individuals, and players also can often be connected to peers or a community with the same challenges. Skeptics walked away inspired by a wide range of serious applications in hand as the game designers had demonstrated how technical, clinical, and social motivations can be combined in powerful ways.

      
Like other seemingly questionable ILN experiments, exploring games turned out to be both serious and seriously fun. Many of the ILN discoveries are “game changing,” and each success rose from humble beginnings. The first Open Space sessions had offered only shadowy hints of what was to come. “When we first started the ILN,” says Chris, “we weren’t sure what it was, where it was going, or how it would last. Five years later, we know it’s the sweet spot of content, technique, and friendship that drives us to return year after year.”

Social Network Webbing

Part of the hidden capability in the ILN is well-developed
Social Network Webbing
via informal networks and relationships. Each member organization has a designated “network weaver,” responsible for matching people to people and people to specific projects. This was one result of detailed social network mapping efforts conducted in 2006 and 2007.

Another result is that many members now have local-internal networks to match the global-external ILN. Chris notes, “A year after we started the ILN, we realized that we didn’t even know who the internal innovators were at KP, let alone from the outside world.” As of this writing, Kaiser Permanente’s internal network (dubbed the Garfield Innovation Network, or GIN) has grown to more than four hundred members from five. ILN members also realized that
the members with more robust internal innovation networks were making more practical use of the global network.

Reflections on Results

“
Open Space
is one of those amazing ahas of when you realize that simple is truly better,” Chris says. “Who would have thought a group of people on the fly could construct their own agenda and self-facilitate
? Open Space
works because so rarely are people who gather at meetings ever given the chance to own it, run it, and decide it. Of course with ownership comes responsibility!”

Open Space
and
Social Network Webbing
are the main ways ILN members collectively are inventing the future of health care. A fresh look at fundamental health-care needs, a creative mix of new technologies, and a strong social network are combining to bring the future into focus.

Creating More Substance, Connections, and Ideas in the Classroom
By Arvind Singhal