How often do we react to problems and not take the time to think about the bigger issue at play? The urgent things that really matter?
Let’s take the example of nurses. Every day, they deal with missing or incorrect information and contend with missing or broken equipment. In one particular case, a nurse on duty was preparing to discharge a new mother from the hospital and noticed that the woman’s newborn wasn’t wearing a security tag. After a quick search, the nurse found the tag in the baby’s bassinet. Then, three hours later, the same thing happened again. This time, a hunt by multiple people came up empty, so the nurse let her manager know that the tag was lost. Because of her quick actions, both mothers were discharged with only a brief delay.
To overcome problems like this requires a nurse to be creative, persistent, and resourceful. They can’t go running to their boss every time something goes wrong. They do what they need to do to keep serving their patients. We think to ourselves that this is what it takes to be a good nurse. But the real problem is that the system never learns. The nurse, who dealt with the two missing security tags didn’t think to ask, Why does this keep happening?
In his recent book, Upsteam, The Quest To Solve Problems Before They Happen, Dan Heath calls this phenomenon, tunneling, i.e., when people are juggling a lot of problems, they give up trying to solve them all. They adopt tunnel vision. There’s no planning, no prioritization of issues. Tunneling confines us to short-term, reactive thinking. In the tunnel, there are no systems thinking, there’s only forward.
Escaping the tunnel is not easy, because organizational structure resists it. When the organization asks us to focus we tend to put our blinders and do what we’re told. When the emphasis is always forward, forward, forward, you never stop to ask whether you’re going in the right direction.
Heath goes on to say that in order to escape the tunnel you need slack. Slack means a reserve of time or resources that be spent on problem-solving. Some hospitals create slack with a morning “huddle” where staffers meet to review any safety “near misses” from the previous day and preview any complexities in the day ahead. A forum like that would be the perfect place for a nurse to mention, “The security ankle tags keep falling off the newborn babies!”
The morning huddle gives staffers a guaranteed block of time when they can emerge from the tunnel and think about systems-level issues. Think of it as space that has been created to cultivate upstream work and think about the bigger issues rather than reacting to the everyday problems that occur.