The Surprising Power of Liberating Structures: Simple Rules to Unleash A Culture of Innovation (27 page)

Diane Magrane was asked to facilitate a national conference to develop uncommon competencies and learning objectives for medical-student education. She agreed to the project on the condition that the group approach the task collaboratively, with an open mind for new insights from exploring how physicians might better attend to the spiritual needs of patients.

The people selected to work on the project were exceptionally diverse: the teams of participants represented eight different medical schools and included professors, palliative-care specialists, pastoral-care professionals, and a handful of students. So Diane chose a variety of Liberating Structures for the competency-development process, beginning with
Discovery & Action Dialogues
(
DAD
) weeks before the conference. She explains:

I had previously guided different groups through a process of designed competencies for medical-student training. We always used creative methods and interdisciplinary small-group discussions. As the facilitator, I ended up doing a lot of cataloguing and using my formal authority to move the project forward. Too often, participants advocated and jockeyed to protect their discipline. The process required a powerful mediator
.

I wanted this project to be different!

Diane introduced the
DADs
first with the project organizers and then with each team in a telephone conference. Each group conducted three or more
DADs
in academic and clinical settings and then contributed reports of their findings as source materials for the summit (
see box
).

“It was fascinating watching them learn how to suspend their assumptions about how spirituality shows up in clinical care and watching them discover how much they could discover by using their natural curiosity,” Diane says.

The premeeting work took them to a different place than they would have been without those explorations. By using
DADs
, they discovered a much
deeper and richer perspective on how spiritual needs were tended to under a wide range of situations and extreme conditions.

A surprise came when an unusual group of suspects emerged, Diane told us.

Medical students were a major source of insight. Whereas many of the clinicians felt encumbered by the crunch of time in clinical encounters, grousing that they did not have time to tend to spiritual needs in addition to the medical needs of patients, students on clinical rotations observed physicians doing just that—sharing difficult diagnoses with patients in a manner that respected spiritual needs. They could tell us how busy doctors were able to compassionately attend to spiritual needs while completing the rest of their technical duties
.

The work was extremely collaborative and open—and continued to produce unforeseen insights. For example, in the course of analyzing the
DADs
conversations, one unexpected competency the participants identified was tending not only to the spiritual needs of patients but also to those of practitioners and students.

What’s more, Diane says, “they surprised themselves by integrating spirituality into their work at the conference.” A striking example occurred in the final moments of the gathering:

“In the closing circle, when we read out loud the top ten ideas from
25/10 Crowd Sourcing
, a deep silence followed. I recall discomfort until one of the members asked, “Can we read the others?” We proceeded to read and acknowledge every single idea. A deep respect for each individual had emerged. A community of belonging had formed.”

By the end of the conference, participants had developed medical-school competencies as well as methods of assessment and evaluation in six areas:

Knowledge
: Acquire the foundational knowledge necessary in integrating spirituality in the care of patients.

Patient Care
: Integrate spirituality into daily clinical practice.

Communication
: Communicate with patients, family, and health-care team about spiritual issues.

Compassionate Presence
: Establish a compassionate presence with patients, family, and colleagues.

Professional Development
: Incorporate spirituality into professional development.

Health Systems
: Apply knowledge of health-care systems to advocate for spirituality in patient care.

Using more
DADs
, participants had identified the behaviors that would enable effective practice of each of the competencies. The behaviors, in turn, helped to generate evaluation of teaching and learning methods.

Reflecting on Learning and Leadership

Diane’s goal is to help leaders feel confident in messy situations, believing more in themselves when the path forward is challenging. She is keenly aware that she does not solve problems for people. Rather, she helps them discover their own solutions: “I am there to catch them if they fall back.”

Diane genuinely believes that if we dig deeply enough, we all can find more courage to lead, and teach. “I push people and myself to cognitive, spiritual, and emotional deepening,” she says. “This is not a rule-driven process familiar to academics but rather something that emerges. Leaders see themselves in a new way. Emergence is not in their vocabulary.”

In the case of Diane’s competency-development conference, Liberating Structures helped to construct a research project that included many voices not often heard. The structure made it possible to integrate insights from unusual suspects (e.g., students, clergy) and on-the-ground experience in extreme settings. The group experienced powerful learning and generated very practical results for medical-student education.

Passing Montana Senate Bill 29:
Senator Lynda Bourque Moss

A legislative session seems an unlikely setting for giving away power to gain widespread support. That didn’t stop senator Lynda Bourque Moss, who had inherited a very complicated bill to address driving under the influence of alcohol in her state. She chalks up her success in getting SB 29 passed to her use of Liberating Structures.

Montana state senator Lynda Bourque Moss is an artist with a master of fine arts degree. She brings an intuitive sensibility to her work in the legislature and in heading up a regional foundation. The community is her “palette.” She believes that Liberating Structures give more shape and depth to how we relate, and she attributes the passage of SB 29 to the way Liberating Structures enabled including and engaging traditionally opposing voices in the DUI conversation
.

It is exceptionally difficult to pass a bill that mandates new behavior, much less a bill that ignites the passions of industry and advocacy groups. Key constituent groups see the challenge from different perspectives, typically opposing ones. “Mandatory bills are seen as negative and can be killed by invoking ‘too much government,’” Linda told us. “Plus, the liquor industry is very powerful. They can make or break legislation like this.”

To get the process going on Montana Senate Bill 29: Responsible Alcohol Sales and Service Act, Lynda engaged the whole spectrum of concerned citizens and special-interest groups. She convened conversations with MADD (Mothers Against Drunk Driving), the gambling association, the taverns association, the restaurant association, convenience store owners, the Montana Highway Patrol, and the Department of Revenue, which oversees taxing and distribution of alcohol in Montana. Two Liberating Structures helped guide Lynda along the way to passage:
Appreciative Interviews
and
Min Specs
.

Lynda started with
Appreciative Interviews
. “Most legislation is grounded in existing law,” she told us. “You amend by adding or deleting. For SB 29, nothing in the law was used as reference. Rather, I asked ‘What do we need to do?’ and ‘What works now?’”

This line of questioning sparked engagement and unleashed a set of fresh perspectives.

Let It Happen, Don’t Make It Happen

Each constituent group knew the DUI challenge inside out. Novel ideas on
what worked
to prevent alcohol-related tragedies came from their unique perspectives. The organizations selling alcohol were held liable for accidents. The people serving and selling alcohol lost needed jobs. MADD parents lost children and family members. State agencies picked up the pieces. Lynda tapped the experience and imagination of everyone at the table. She recalls, “Unlikely parties came together: all the amendments came from them, not me. I was more a facilitator than a law-MAKER.”

The stories from the
Appreciative Interviews
also revealed
Min Specs
to Lynda: the must dos and must not dos for everyone to share responsibility for preventing DUIs.

First, she learned that training for servers and sellers must be mandatory, as should be personal fines and the threat of license revocation for the employer. This would reduce liability premiums and give the legislation teeth. Second, the requirements for servers must be reasonable, respectful, and flexible. For example, part-time workers needed their training certificates to be transferable as they changed jobs. Third, servers and sellers needed to learn how to truly say “no.” Clearly, the core behaviors and social skills needed to do their job were not trivial, nor widely practiced.