For a while, now, my attention has been repeatedly dragged back to a research paper published by the Joint Commission on MBWA.
Its unexpected conclusion was that MBWA (Management by Wandering Around) counter-intuitively reduced the perception of safety and quality in units when compared with 'control' units whose perceptions remained unchanged.
I could see, between the lines, what was going on, although the authors politely refrained from drawing the same conclusion:
Which was: that by making managers more available insitu, clinicians realised that they (the managers) were essentially incapable of fixing the systems gaps that were empathically highlighted to them.
Which is why, subconsciously, I wondered if the 'Below Ten Thousand' team had something to offer.
It turns out we do.
The 'Communities of Practice' (CoP) component of 'High Performance Teams (HPT) seems the perfect solution to this gap in the 'evokability' of systems improvement (ESI).
The most essential step is to turn the thinking around.
Instead of MBWA, we are more interested in 'EBWA'.
Engagement by Wandering Around.
That is: seeking to EMBED the manager back into the team, thus making them available to the people doing the work in a way that ensures they ENGAGE by listening and seeing.
We are not seeking 'management' in this step. We are seeking 'understanding'.
The effect of this is that we are priveliging communication.
And instead of 'commanding' by expecting to have to come up with the answers themselves, alignment of purpose through Communities of Practice allows those doing the work to significantly contribute to the engineering of the solutions for themselves.
Which further adds value to the team by establishing 'trust'.
The second effect is that, by engaging in CoP, we privelige Human Factor Ergonomics (HFE), Systems of Work (SoW) and Flow (Flo?) in the system.
In doing so, we have inadvertantly re-commanded three of the biggest barriers to safety and quality as identified in recent reports.
These reports found that communication, leadership and human factors were by far the three biggest root causes of errors in Healthcare last year.
And by priveliging these behaviours right from the top of the clinical tree, we are ensuring that such behaviour disseminates throughout the clinical workforce.