Grand vision or roadmap, our only choices?

Our bosses come to us and ask for a program that ensures safety, reliability, and productivity. Do they want a grand vision we can discuss philosophically or are they asking for a practical roadmap that details how we move from where we are to where we want to be?

Grand visions sell and make people feel good. Great advertising. On the bad side you are telling them what they are not. Roadmaps are reassuring, we know where we have been, where we are, and can pick a route where to go. Part of my decision making lecture in the PICU was just that - if I tell you to go from your house to the store, how would you go? Trick question as I then give them obstructions and problems. Roadmaps don't work then. Have several ways (routes and mechanisms and others) to go to the same place, and then you do something in an emergency because you choose to, not because you have to. Jim Denney, EMS Captain, LAFD [person], a friend of mine, had two tours in Viet Nam and worked in South LA as a medic with me. He would say, "When faced with a void, move forward.” 

Choose the void.

In thinking about it, if it is all a grand non-specific vision, from 60,000 feet, it ends up going nowhere with a group of people who are seeing patients every day. Ahh, the 60,000 ft or 30,000 ft view. Remind people (this is why I do not use clichés) that you are traveling at that level to go from one point to your destination. Everything below you is incidental to your travel and you are not involved. What frustrates you, if I could be that bold, is that they move to a new destination bypassing the work and problems, if you can even see them. Nothing changes as you choose passive observation, easy to criticize. The bosses are passing overhead while you want them engaged.

Choose engagement.

If it is too granular, then everyone only sees their own few feet of space. Then we have territoriality - get off my space! Granular, reductionism, how can we break things into parts we can discuss? Super, either we have our own space, which we believe we understand, or we have a great set of intricately laced nodes and linkages that only we can understand, and which frustrate us when others do not see what we see. Or, we believe quality comes through interactions and interactions produce complexity to the point of looking smooth, no edges. The first, granularity, the one you fear, is an object, a noun. The second, interaction, is a verb and produces smoothness without edges or borders ... and it is scary. Our anxiety makes us see structure where none exists; our anxiety drives us to choose structure.

Choose the verb.

So, we enact our program. There is failure from not acting and failure from acting. The first one stagnates us but the second one we can correct.

We go for small wins. We do better each time. Everyone can do better. That is the coach's mantra and the athlete's goal. Make better decisions. We prepare for failure. We identify where can we fail and we bolster those areas. Our goals will be verbs. We are actively engaged to achieve our goals. Quality is to do it better. We search for how to do it better.

Communication is information flow. Failure comes from impeded information, we search for and identify anything that interferes with information flow ... starting with our own behavior and attitudes. 

Ask people where they are. If we are a best-kept secret (or well-kept) then ask what makes it so secret? Then, ask where they want to be if they only had one small win. One small change, what would it be? Think of something that would initiate an action rather than a result.

Not a vision or a road map, attitudes are a means to the action, or verbs, we want.



I choose attitudes.