2. Intro Dialogue: The Language of Complex Systems

3. Intro Introductions

4. Intro Learning Outcomes Understand complexity as it relates to healthcare leadership, collaboration, and innovative change Practice systems thinking and inquiry skills to bridge diverse perspectives, strengthen relationships, and collaboration across disciplines Use dialogue to navigate complex, ambiguous and rapidly changing environments with less stress Explore a real challenge with peers, leaving the program with fresh ideas and practical next steps for building partnerships and leveraging change

5. Intro Guiding Principles Appreciative Workshop approach Balance reflection and action Applied and practical

6. Intro Agenda Day 1 Introduction & Context Setting A Systems View of Healthcare Navigating Complex Systems Systems Thinking in Action Change Challenge l Change in Complex Systems Introduction to Dialogue Reflection & Summary Day 2 Opening Reflection Developing Dialogue & Inquiry Skills Using Dialogue in Pivotal Conversations Beyond Expert and Silo’s Thinking Change Challenge ll Project Sharing and Planning Next Steps Summary & Evaluation 6

7. A Systems View of Healthcare

8. Navigating Complex Systems

9. An Increasingly Complex World 2 Danish political scientist Bjorn Lomborg heads the Copenhagen Consensus, which has prioritized the world's greatest problems -- global warming, world poverty, disease -- based on how effective our solutions might be. It's a thought-provoking, even provocative list. A campaign to change the course of history. Really. It’s time to make a choice. We can let present trends continue and risk almost certain breakdown and collapse. Four years is enough time to build that will, to change our direction, even to transform ourselves. And Go because we must start now. 9

10. Organisation is: Structures Roles Processes Balance sheets People are: rational, role-oriented, willing to be a ‘cog’ within a managed system (‘levers’, ‘engagement’, ‘performance maximisation’, ‘human capital’) A paradigm so prevalent it is largely invisible Machines are predictable, controllable and can be reduced to parts – problems can be solved by taking them apart and looking at the ‘pieces’ The machine paradigm

11. The complexity paradigm Organisation is made of : Relationships and feedback loops Power interactions, loyalties and rivalries Influence systems, in groups and out groups Paradigm assumes that reality is complex and that key issues are in relationships, not the parts This requires : a holistic approach (the system cannot be studied by breaking it down into parts) an appreciation of different perspectives (there is no single objective viewpoint)

12. 2 Qualities of Complex Challenges Difficult to frame, not predictable in detail Multiple root causes, non-linear Multiple stakeholders Emergent Novel Difficult to Eliminate Long Term Nature Relational complexity - Relationships are more important than parts Dynamic complexity - feedback loops rather than linear cause and effect

13. The impact of complexity on people These basic characteristics of complex systems lead to: Ambiguity, uncertainty about what is occurring, what others require Rapid change: change in information, in events and context Unpredictability that is inherent in the situation Strong interdependence to other systems that are also complex And for individuals, a sense of being overloaded, not in control.

14. What sort of challenge have you got? Complexity Worldview Far C E R T A I N T Y Chaotic Zone of Complexity Complicated Simple Near AGREEMENT Far Mechanistic Worldview The Stacey Matrix Brenda Zimmerman, Professor of Policy/Strategic Management , Schulich School of Business

15. What sort of challenge have you got ?

16. What can you do about it? 2 Some problems are so complex that you have to be highly intelligent and well informed just to be undecided about them. ~ Laurence J. Peter 16

17. Systems Thinking in Action

18. Systems thinking is an organised way of shifting your way of thinking so as to escape from mental traps generated by the ‘machine’ paradigm: Linear cause and effect thinking Search for ‘objectivity’ ‘Locking in’ of starting assumptions All systems thinking tools provide ways of: stepping back and seeing a bigger picture including multiple perspectives representing complex feedback mechanisms

19. Systems Thinking in Action What kinds of questions do systems thinkers ask? What happens when we don’t think systemically? If you see differently, you think differently. And all your actions start to change. - Peter Senge 19

20. Behavior/Events Increased Leverage & Opportunity for Learning & Change Assumptions/Patterns The "Water Line" Mental Models/Systemic Forces Systems Leverage 20 Society for Organizational Learning

21. Systems Archetypes Quick Fix That Fails Quick Fix or Symptomatic Solution Problem Symptom Side Effect Shifting the Burden Success to the Successful Tragedy of the Commons Accidental Adversaries Fundamental Solution Society for Organizational Learning

22. Tragedy of the Commons

23. Systems Thinking & Dialogue The system needs to be in the room Systems thinking needs a space or container for the “thinking together” The container is conversation, and specifically dialogue Dialogue aligns us through shared inquiry and a common understanding of the system. 23

24. I draw conclusions and take action This becomes a reinforcing loop as we select the same data to focus on over and over. I make assumptions I select data Pool of observable data: Things I could choose to focus on What gets in the way? Ladder of Inference Observed event, interpretation, generalization This is the way it is! Treating initial inferences as facts 24 William Isaacs Dialogue and the Art of Thinking Together

25. Change Challenge l

26. Change in Complex Systems

27. Types of Change

29. Simple, Complicated, & Complex Change Low Transformational CHANGE AGREEMENT Transitional change High Developmental change High Low CERTAINTY

30. Appreciative Inqiury Kotter Senge Heifitz - Adaptive Change

34. Use their knowledge

35. Support their efforts

36. Create the heat

37. Sequence & pace the work

38. Regulate the distress

39. Work avoidance

40. Use conflict positively

43. Low Value Conversations…. …..do not contribute to positive change Telling the history of how we got here Giving explanations and opinions Blaming and complaining Making reports and descriptions Carefully defining terms and conditions Retelling your story again and again Seeking quick action Most of what we want to see changed has been explained, complained about, reported upon, and defined for decades. Peter Block

44. Leadership Conversation Conversation Begins Choice Point: What kind of conversation does this need to be? Dialogue Inquiry Assumption Testing Shared Understanding Discussion Action Problem Solving Finding Best Answer Conviviality Debate 34 Garmston & Wellman, Cognitive Coaching

45. 35 A Balcony View Conversation Begins Choice Point: What kind of conversation does this need to be? Dialogue Inquiry Assumption Testing Shared Understanding Discussion Action Problem Solving Finding Best Answer Leadership Conversation: Creative Conflict, Collaboration, Innovation Effective Action Garmston & Wellman, Cognitive Coaching

46. 36 Dialogue is a way of conversing and thinking together that dissolves barriers, creates collaboration, and builds partnership. The outcomes of dialogue are: Greater view of the system Access diverse perspectives Break down silos Collaboration and partnerships that foster shared responsibility and accountability Team learning Leaders talk about what matters - Trust built that surfaces undiscussibles Get at root of recurring problems New insights leading to innovation Dialogue is a core process in complex systems

47. Developing Dialogue and Inquiry Skills

48. Dialogue Practice Suspend certainty Bring curiosity rather than answers Inquire into your own and other’s reasoning Display assumptions rather than defend them Allow silence for reflection Slow down; Speak from “I” Speak to the centre rather than to the person Welcome diversity in ideas and thinking Move Voicing Follow Listening Bystand Suspending Oppose Respecting 38 William Isaacs Dialogue and the Art of Thinking Together

49. Dialogue Practice What conversations are happening now in healthcare that are shaping our practices and changing our lives?

50. Using Dialogue in Pivotal Conversations

51. What is a pivotal conversation? Potential to change the course of action and consequently the levels of results Crosses boundaries Potential for conflict Power dynamics Outcome matters

52. Left Hand-Right Hand Column Conversation Transcript: 4 x4 Unspoken thoughts & Feelings Mental models as barriers to effective communication Record what you didn’t say but thought, reflect on assumptions and preconceptions - J. Bennecker 42 Chris Argyris, Graduate School of Business, Harvard University

53. Leadership Moves in Pivotal Conversations Framing (abstract) Illustrating (concrete) Inquiring (others) Advocating (self)

54. Trio Check-In: Pivotal ConversationsWhat did you observe about yourself in recent pivotal conversation?Which parts of speech do you most rely on?What will increase your effectiveness?

55. Beyond Expert & Silo’d Thinking

56. Ellinor & Gerard Dialogue: Creating and Sustaining Collaborative Partnerships at Work

58. 1920’s Piaget research on stages of child development, expanded to include stages of adult development (Fowler 1981; Kohlberg 1981; Kegan 1982; Loevinger 1976, Wilber 2000; Torbert, 2004) Progressive levels of meaning-making, cognitive and emotional growth. As adults evolve through these stages, they develop the capacity for more complex thought and find it easier to understand and empathize with different viewpoints. Adults do not automatically progress through these stages as they age. What are the implications for leadership & leadership development?

59. Robert Kegan In Over Our Heads (1995) McGuire & Rhodes Transforming Your Leadership Culture (2009) Joiner & Josephs Leadership Agility (2007) Bill Torbert Action Inquiry The Secret of Timely & Transforming Leadership (2004) We’ve found that the level of personal development of the leader can have a critical impact on the success of organizational change efforts and, in turn, on the company’s ability to thrive in an ever-more complex business environment. ~Torbert & Rooke, Seven Transformations of Leadership (Harvard Business Review, 2005)

61. Expert leaders tend to operate within silos; little emphasis on cross functional teamwork; tend to be overly involved in subordinates work, fighting fires and interacting with direct reports one-on-one; little time to approach their own roles strategically. Organizational improvements are mainly technical and incremental. Achiever leaders articulate strategic objectives; have the right people and processes in place to achieve these objectives; develop effective teams, orchestrating them to achieve important outcomes. This patient/ customer centred culture encourages rewards and customer focused cross-functional teamwork. Change initiatives reflect analysis of the larger environment, and consultation with key stakeholders is a cultural norm. Strategist leaders animate by a compelling vision that includes high levels of participation, empowerment, and teamwork. Collaboration, decisiveness and candid, constructive conversations are the norm. Senior teams become living labs that create this kind of culture and in the organization. Leaders coach their people, solicit informal feedback and change their behaviors in ways that are beneficial to the organization. Developing your capacity to meet complex conditions

62. DevelopmentalTransformations Transcend and Include Adapted from Harthill UK

64. Change Challenge ll

65. Integration of Learning