Earlier this month I facilitated a meeting for a group of physicians who are members of a state medical society. The Governor of the state established a consortium for the prevention of prescription drug abuse in response to the national opioid crisis. The consortium in turn, reached out to the medical society to convene members for the purpose of establishing protocols, exchanging best practices, and aligning on a point-of-view to share with legislators that would ensure meaningful regulation.
My blood pressure goes up when I’m in a room with one doctor, so you can imagine how I felt about facilitating a meeting with 20 doctors. Nevertheless, I had agreed to help them tackle an important topic. We needed to make the most of a day-long meeting of professionals volunteering their valuable time. The expertise in the room wasn’t going to do anyone any good without a process that ensured shared understanding and produced actionable alignment.
Working with problem-solving groups is itself an exercise in problem solving.
Smart, highly skilled people who generally solve problems by themselves don’t automatically adapt to the challenges of collaboration. One of the challenges of collaborating during a problem solving exercise is slowing the group down enough to confirm that they agree on the problem before they start generating solutions. Doctors in particular, think fast and have been trained in a diagnostic methodology; they move from symptoms to causes and then prescribe or operate.
A challenge like the opioid crisis doesn’t present itself in the way a patient might show up with symptoms. A public health emergency is not just a more complicated set of symptoms requiring a differential diagnosis. Complex social problems can’t be outsmarted. Chasing down causes might help us feel more in control, but the causes are not static conditions waiting to be discovered. Asking what’s causing the opioid crisis is like asking what causes religion (no Marxist pun intended).
Upon reflection, I’ve come to realize that a tension between competing research methodologies hid below the surface of our work together that day. The doctors had been trained as scientists. Science presumes that objective observation and analysis can lead to universal causal laws. I had suggested a collaborative process based on a social theory approach called, participatory action research. Participatory action research presumes a dynamic relationship between understanding something and changing it. By contrast, science presumes we need to understand something before we try to change it.
While we made respectable progress and agreed to a few clear action steps, I am only now coming to realize the mistake I made in designing a process for the meeting. Because of my anxiety about showing up as an authority, I inadvertently acted like a doctor. I treated the group as a patient. I diagnosed their group dynamics and prescribed process fixes. Alternatively, I could have recognized that together we represented our own complex social network. I might have been more open to the way our challenges and shared understanding emerged through our dialogue. Had I been more attentive to and less judgmental about the group’s natural tendencies, we may have made even more progress.
The right-hand side of the framework describes contexts that are either “simple” or “complicated.” In both cases, cause-and-effect relationships exist. In simple contexts, cause and effect are apparent to everyone. In complicated contexts, there may be more than one right answer and it requires expertise to analyze the situation and determine an appropriate response. A simple business problem is collecting a late payment from a customer. A complicated business problem is improving the company’s cash flow.