Don’t you just hate advice?  I do!

If I had a nickel for each time I was given advice that I never used, I could retire tomorrow.  This month, I’d like to share with you an alternative to advice giving –something I learned from The Veterans Health System at a learning session.  It is called, “Have you considered?”

But first, some of you may be wondering, “Jane, what the heck does this have to do with quality improvement?”  Most of our improvement work happens with people – with those we work with, with our patients, with key stakeholders, etc.  Dr. W. Edwards Deming, one of the foremost improvement philosophers of the 20th century, identified four components of his “System of Profound Knowledge,” a type of thinking that supports improvement science.  They are:

• Psychology (or how people work together and are motivated to improve);
• Understanding Variation (what data tells us about our improvement);
• Appreciation of a System (more on that in another Blog post); and
• Theory of Knowledge (using PDSA to build knowledge sequentially).

I would like to ground this topic squarely in psychology.  How often have you been given advice on how to solve a problem?  I often get advice when I’m just thinking out loud, or complaining, or even processing a problem with a colleague. The next thing I know, I’m bombarded with advice, most of which I reject because my friend or colleague doesn’t understand the constraints I face, the limitations I have, or the nuances of the problem.

“Have You Considered?”

“Have you considered?” is a powerful tool.  It expands my limited perspective and increases the possibilities for action.  I get ideas I never would have come up with on my own.

Here’s how it works:

• Get a small group together (say, 5 to 7 people).  You’ll need about 45 minutes to an hour to go through this exercise with a group of 7.
• Sit in a circle.
• One person starts off by stating a challenge or problem she or he faces.
• Then, one by one, each person takes a turn by completing the question, “Have you considered . . . ?”  Just one item per person, please, and anyone may “pass” at any time. The person with the challenge or problem does not respond.  He or she just listens.  (The group may select a note taker, or those with challenges may take some notes themselves).
• You may go around again if there are still ideas.
• Repeat this process until each person in the group states a problem or challenge, and listens to a round or so of “Have you considered . . . ?” questions from the group.

Recently, I used this activity in a workshop in Central New York.  During a follow-up webinar, participants said that they had taken the process to their work site and found it to be a valuable problem-solving approach.

Why does it work?

It works because you are not giving me advice. You are just asking me a question.  It works because, as I consider your question, I am introduced to a new perspective or way of seeing my problem and a possible solution.  It works because I get not just one perspective, but at least as many as there are members in the group.  I have to suspend my judgment and habits of mind and action in order to listen and consider.

Try it!  Let me know what you think about it, ok?

Happy Holidays everyone!

Jane Taylor, CHAMP Improvement Advisor