reframing for learning

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re-framing for learning

Conducting field research with a positive lens

• Amy C. Edmondson
• Positive Organizational Scholarship Conference
• University of Michigan
• December 12, 2003

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all but forgotten formative experiences

• Bucky Fuller
• Guinea Pig B
• Committing Egocide in 1927
• One too many failures made in the service of
  what others will think
• Committing to work on behalf of all of humanity
  -- a sincere, if desperate, attempt to be more
  effective
• What is it my experience base tells me needs to
  be done? What do my talents and knowledge and
  history allow me to do well?
• AE three years as chief engineer

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reframing architectural possibility
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triangles hold their shape!
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Boston, 1900 What do 5-year olds given
toothpicks and semi-dried peas build?
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what did Bucky build?
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formative experiences

• Larry Wilson, Pecos River Learning Center and
  Playing to Win
• Helping people (whether executives or line
  workers) choose growth over fear at work and in
  life
• Surviving vs. thriving most of us are playing
  not to lose in work and life
• Helping people embrace a new mindset I cannot
  fail I can only learn and grow
• Awakening to meaning You are here to do
  important work
• AE three and a half years as director of
  research

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managing uncertainty learning from a case study
An excellent customer service organization
(Verizon) fails dramatically in a new service
introduction (DSL). Managers, trained by past
success, automatically frame the new situation as
an execution challenge.
Primarily a difference in mindset leading to
different practices and to different conceptions
of the ideal employee
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organizing to execute seeking the
adaptive conformer
make few errors and correct errors made with
minimal fuss
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organizing to learn seeking the observant
nonconformist
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illustrative studies of learning

• The drug error study
• A small success born of a small failure
• The cardiac surgery study Going out on a limb in
  a new context
• Not knowing the answer in advance

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a study of error
team error rates in two hospitals
number of preventable and potential adverse
drug events per 1000 patient-days
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intolerance for human error as a
taken-for-granted attribute in a nursing unit

• Nurse managers view of staff
• The residents are like kids, needing
  discipline...
• Staffs view of nurse manager
• She treats you as guilty if you make a
  mistake... I was called into her office and made
  to feel like a two year old.
• She gives you the silent treatment.
• Staffs view of drug errors
• You get put on trial...
• People get blamed for mistakes... you dont
  want to have made them.

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tolerance for human error as a taken-for-granted
attribute in a nursing unit

• Nurse managers view of staff
• Nurses are too hard on themselves... they are
  harder on themselves than I would ever be.
• Staffs view of nurse manager
• She is a counselor, not a boss.
• Staffs view of drug errors
• Mistakes in this unit are serious, because of
  the toxicity of the drugsso youre never afraid
  to tell the nurse manager.

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drug error rates and nurse manager style
Blind to error data, survey data, and
researchers hypothesis
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psychological safety

• Psychological safety a shared belief that the
  team/organization is a place where expression of
  honest thoughts, observations and questions is
  expected and desired
• I will not be rejected for being or expressing
  myself, for raising a different view, for having
  concerns or questions, for making mistakes, etc.
• What types of interpersonal risks are associated
  with behaviors such as asking for help, admitting
  an error, or expressing a different point of
  view?
• Risk of looking ignorant
• Risk of looking incompetent
• Risk of being seen as intrusive
• Risk of being seen as negative
• How are these risks usually handled?
• With silence
• Psychological safety mitigates those risks to
  enable candid discussion, collaborative
  problem-solving, and learning

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a prospective study

• Operating room teams learning a new technology
  for minimally invasive cardiac surgery (MICS)
• Recent technological innovation
• Offers less painful and shorter recovery for
  patients
• Significant barriers to successful implementation
• Initially longer procedures and simpler cases
• Vastly increased interdependence among individual
  roles
• Unprecedented need for speaking up and teamwork
  -- against profound status differences
• Research Question What would drive successful
  implementation? (more important would there be
  differences???)
• Academic prestige of institution?
• Resources?
• Surgeon skill?
• Surgeon leadership behaviors?
• Psychological safety?

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sample 16 (of 150) teams

• All are from leading academic medical centers and
  well-respected community hospitals
• Highly successful in the old game
• All go through identical training to use radical
  new technology for minimally invasive cardiac
  surgery
• A well designed training program
• All go back and try to successfully implement the
  new technology in their organizations
• Fewer than half succeed (no discernable
  patient-level differences)
• Achieving mastery with the new technology is more
  difficult than any one anticipated in advance.
• It requires collaborative learning -- not just
  persistence and determination to get the job done

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profound change

• "The perception that the surgeon has to know
  everything has to change. ...each person has an
  important job. For minimally invasive surgery
  you cant ever stop talking. For minimally
  invasive surgery, I have to be able to tell the
  surgeon to stop. This is very new. I would
  never had dared to say anything like that before,
  nothing was that important. So you have to
  develop a way to deal with communication in
  advance, such as anesthesia can be telling the
  surgeon what to do. It has got to be legitimate.
  This is really important. Everyone has access
  to key information and communication is
  essential. Anyone on the team can say something
  pertinent that will affect the operation. It is
  a different level of communication.
• (Anesthesiologist, Eastern Medical
  Center)

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for some, its too much change

• If you see an MIS case on the list, its
  like, oh, do we really have to do this... just
  give me a fresh blade and Ill slash my wrists
  right now.
• OR Nurse, Chelsea Hospital

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for others, its a breath of fresh air

• I was so grateful I was picked for the team.
  Every time we are going to do an MIS case Im
  excited. I feel like Ive been enlightened.
  OR Nurse, Janus Hospital

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explaining implementation success

• What does?
• IMPLEMENTATION JOURNEY TRAVELED BY TEAM
• Team preparation
• Work across boundaries
• Team leaders perspective
• how the change is framed by the leader
• creating psychological safety
• structuring the learning process
• includes reflection in action, not just after
  action
• Team stability

• What doesnt matter?
• STRUCTURAL FACTORS
• Institution type
• academic versus community
• High level management support
• Project leader status
• After action reports
• retrospective data analysis

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what matters team preparation

• Team with relatively high rate of learning
• " We had a couple of talks in advance, and the
  night before the first case we walked through
  the process step by step. Took two and a half or
  three hours. (Perfusionist)
• Team with relatively low rate of learning
• To prepare for our first MICS case, we kind
  of more or less looked at the room. (Nurse /
  Physicians assistant)

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what matters psychological safety

• Team with relatively high rate of learning
• "I have no qualms at all about speaking up. In a
  regular case, you can clam up, but in MICS its
  too late." (Nurse)
• Teams with relatively low rate of learning
• Once when we were having trouble with the venous
  return, I mentioned it. The surgeon said, Jack
  is that you? I said yes. He said Are you
  pumping this case? I said, No. Im assisting.
  Well, in the future, if you are not pumping the
  case, I dont want to hear from you. You see,
  its a very structured communication.
  (Perfusionist)

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team leader behaviors that promoted psychological
safety

• Accessibility
• hes very accessible. Hes in his office,
  always just two seconds away. He can always take
  five minutes to explain something, and he never
  makes you feel stupid.
• Inviting Input
• The surgeon gave us a talk about what
  minimally invasive surgery is aboutthe kind of
  communication he wanted in the OR, what results
  he expected, and told us to immediately let him
  knowlet us know if anything is out of place.
• Modeling Fallibility
• The surgeon has created an atmosphere where
  that happens. He models the behavior. Hell say
  I screwed up. My judgment was bad in this case.

n.b., in order of increasing challenge
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what matters boundary spanning

• Team with relatively high rate of learning
• Cardiology and cardiac surgery are a hand in
  hand relationship. Very much a team approach to
  a continuum of care" (Administrator)
• Teams with relatively low rate of learning
• There is a territorial war in this institution
  as to who controls echo" (Nurse)
• There are no inter-area meetings here. Not in
  this institution. (Nurse)

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what matters team leader frame

• Framing the change as a team project not an
  individual project, a learning challenge not a
  technical challenge

Playing to win vs. playing not to lose
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organizing for collaborative learning framing
experience as experimentation

• 1. Selection
• Right team members
• Right context
• Right cases
• Leaders actions
• Define roles and responsibilities
• Set frame of team learning project
• Build consensus to facilitate referrals

• 2. Preparation
• Off-line practice session high fidelity, low
  noise experiments
• Leaders actions
• Lead practice session
• Create psychological safety by
• Signaling openness to feedback
• Mitigating status

3. Trials Trials of new routine in environment
conducive to learning Leaders
actions Psychological safety - Invite input -
Acknowledge need for help - Dont reject new team
behaviors

• 4. Reflection
• Debriefing to learn from trials
• Leaders actions
• Review data
• Initiate discussions
• Listen
• Modify
• Reflection in action (during trial)

Outcome New routine becomes accepted practice
and established routine in the organization.

• Multiple iterations
• Experimental capacity
• Frequent iterations

See Edmondson, A C., Bohmer RMJ, Pisano GP.
"Disrupted Routines Team Learning and New
Technology Adaptation." Administrative Science
Quarterly 46 (2001) 685-716
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features of the research

• Getting it wrong
• ultimately a more interesting story
• Taking (some) risk
• A strong context -- risk of no variance
• A strong context -- risk of not being right
  setting for my stuff
• Collaborative to learn from other disciplines
• Economics, operations, medicine
• Making room for the positive
• From why is organizational learning so unlikely
  
• To what is it like when it happens...

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research as a learning process

• Field research as learning (vs. performance)
• Preparation thinking, reading, and planning
• Plus ongoing action/ reflection
• frequent cycles within projects
• intermittent cycles between projects
• Its a process not a destination
• taking action and reflecting on the results of
  that action
• Requires
• Curiosity, open-mindedness, listening to the
  data,
• Respecting informants
• Relinquishing control

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research as a learning process
Preparation formulate a research problem
Planning develop a research design

• Action
• collect data
• analyze data
• write paper
• revise papers

• Reflection
• assess results against expectations
• seek explanations for gaps
• consider possible changes

Fast Cycle Repeats from 3X to a great many X per
project
Slow Cycle (New project, repeats over years)
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reframing for learning implications

• Framing research as execution (performance)
  versus as experiment (as part of a learning
  process) changes what you see and what you do,
  and the nature of your findings
• You never have it right
• you can either learn or not learn from its
  not-rightness (more importantly, being right is
  not the goal)
• when wrong, embrace the result then, think hard
  about why
• Measurement error vs. an unexpected but
  interesting phenomenon
• You have to engage in a dialogue
• with your colleagues--learning occurs in
  collaboration, especially across boundaries
• with your phenomena
• Listen to informants with genuine curiosity and
  respect
• Their stories can and will trigger new insights,
  often more interesting than what you started with
• Take risks
• Look to study areas where you might not be
  right so you can learn from the not-rightness
• Seek feedback from the field, not just from
  academic colleagues

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contrasting approaches to group decision making
or, perhaps advice for researchers
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framing for (collaborative) learning

• Tell yourself that the new study is different
  from anything you've done before and presents an
  exciting and challenging opportunity to try out
  new approaches and learn from them.
• See yourself as vitally important to a successful
  outcome and, yet, as unable to achieve it alone
  without the willing participation of others.
• Tell yourself that others (who are vitally
  important to a successful outcome) may bring key
  pieces of the puzzle that you dont anticipate in
  advance.
• Communicate with others exactly as you would if
  the above three statements were in fact true
• And, by the way, you can let them know what
  youre up to!

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selected references

• Edmondson, A.C. (1996). Learning from mistakes
  is easier said than done Group and
  organizational influences on the detection and
  correction of human error. Journal of Applied
  Behavioral Science, (32) 1. 5-28.
• Edmondson, A. (1999) Psychological safety and
  learning behavior in work teams. Administrative
  Science Quarterly (44), 350-383
• Edmondson, A.C., Bohmer, R.M. and Pisano, G.P.
  (2001) Disrupted routines Team learning and new
  technology implementation in hospitals.
  Administrative Science Quarterly, 46 685-716
• Edmondson, A. C. (2003). Framing for learning
  Lessons in successful technology implementation.
  California Management Review, 45 2, 34-54
• Edmondson, A.C. (2003). Speaking up in the
  operating room How team leaders promote learning
  in interdisciplinary action teams. Journal of
  Management Studies 406, 1419-1452.