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A blog by Ryan Quinn, Robert Quinn, Shawn Quinn, and Amy Lemley

Managing Mindfully

By Ryan Quinn

I spent last week at the annual meetings of the Academy of Management in Chicago. While there I caught up with a friend and colleague of mine, Tim Vogus – a professor at Vanderbilt’s Owen School of Management. Tim told me a story I had not heard before. When Tim was a graduate student, preparing to do his dissertation research, his wife gave birth their son. As she was delivering the baby, there was a shift change in the maternity ward. This caught Tim’s attention, because he had decided to study organizational mindfulness as part of his dissertation research, and one of the events that are of most interest to researchers who study mindfulness are “handoffs” – the events in which one or more people pass along the responsibility for an activity to another person or people. Mindful handoffs create smooth transitions, while mindless handoffs can lead to catastrophe.

Mindful Organizing

Handoffs are just one of many events that require mindful behavior. When Tim conducted his dissertation research, he decided to focus his research on nursing units in hospitals. he focused on nursing units, rather than on nurses alone, because nursing managers can run units in ways where each nurse takes care of his or her assigned patients individually, or where nurses help each other with taking care of each other’s assigned patients. This collaboration could make a difference in unit performance.

Tim’s research provided evidence for two simple but powerful arguments. First, he found that nursing units perform better (measured in terms of medical errors and patient falls) when they:

  1. took the time to give each other detailed reports about patients’ history, emotional needs, and what to look out for as well as the usual medical information;
  2. listened to reports attentively and asked detailed questions;
  3. remained on constant alert for any potential failure, even if it was small;
  4. were reluctant to simplify their interpretations of any patients’ situation;
  5. were sensitive to who might need help in operating the unit effectively; and
  6. showed deference to the people who had the most relevant expertise for a given situation rather than just to the person with the most formal authority. [1]

Second, he found that nursing units operate more mindfully when their managers:

  1. Staff their units selectively;
  2. engage in continuous, relevant, informal training;
  3. involve nurses in making decisions about patient assignments; and
  4. give developmental performance appraisals.

As Tim collected data on management practices, mindfulness, and nurse unit performance, he met one nurse manager who blew him away with how collaborative her management practices were. Her name was Gwen, and she had thoughtful deeply about how to create nursing units without medical errors. For example, one of the practices she described to Tim was her practice of assigning the least experienced nurse on any shift to the hardest patient.  This counter-intuitive practice served her unit in many ways. Perhaps most importantly, it ensured that the nurse who was taking care of the hardest patient would be the one who was least likely to feel stupid about asking others for help. It also provided the least experienced nurse with a great opportunity to learn from the more experienced nurses.

Another practice that Gwen used to manage her unit was to have the nurses take reports from the previous shift as a unit, and to have them discuss and critique how the assignments for the next shift should be distributed. When Tim reported this practice to other nurse managers, they often said things like, “We could never do that on our unit – it would be too political.” Gwen’s unit quickly learned, however, that the purpose of discussing how assignments should be made was for the purpose of helping them serve the patients mindfully, not for getting the easiest assignment, the most pleasant patients, or any other self-serving objectives.

Broader Applications

Mindful management and mindful organizing are not concepts that are limited to workplaces focused on safety and reliability. Each workplace can be mindful about whatever values are most appropriate for that workplace, such as efficiency, service, or innovation. Andrew Hargadon and Beth Bechky [2], for example, found that formal and informal work units in design shops like IDEO or Design Continuum are exceedingly mindful about innovation practices. And many of the same management practices can be implemented in other organizations by focusing people’s reports, listening, knowing what to be pre-occupied with, reluctance to simplify, sensitivity to operations, and deference to relevant expertise on the organization’s central values.

Communication

As Tim’s wife was giving birth and Tim listened to the handoff between nurses, he was pleased to hear how effective their handoff was. The outgoing nurse talked about preferences that Tim’s wife had that they had never told to the nurse, about how the story of her delivery had unfolded so far, and about many other details as well. Effective handoffs like these usually include some comination of the following five steps, using the acronym STICC:

  1. Situation: “Here’s what I think we face.”
  2. Task: “Here’s what I think we should do.”
  3. Intent: “Here’s why.”
  4. Concerns: “Here’s what we should keep our eye on.”
  5. Calibration: “Now talk to me.” [3]

Although these five steps were developed in the context of wildland firefighting, they are also useful across contexts. They can be used by nurses, but they can also be used by accountants, lawyers, salespeople, engineers, teachers, and professionals of all kind. In fact, it is just as useful to think about these steps in terms of effective delegation as it is to use them for handoffs. Managers who use steps like these do not need to micromanage because their people know the intention and context as well as what they are supposed to do. They can adapt as needed, and still make thier managers happy.

Tim’s wife gave birth to a beautiful baby boy after a smooth and seamless delivery. The nurses were mindful and the birthing process was executed reliably. And each of us could execute together, and in line with our values, if we make the effort to be mindful of our values as we coordinate our activities with each other.

[1] The first two categories on this list come from Weick, K. E. and Roberts, K. H. 1993. Collective Mind in Organizations: Heedful Interrelating on Flight Decks. Administrative Science Quarterly, 38(3): 357-381. The second two categories on this list come from Weick, K. E.; Sutcliffe, K. M. & Obstfeld, D. O. 1999. Organizing for High Reliability: Processes of Collective Mindfulness. In L. L. Cummings, & B. M. Staw (Eds.), Research in Organizational Behavior, Vol. 21: 81-123. Greenwich, CT: JAI Press.

[2] Hargadon, A. B. & Bechky, B. A. 2006. When Colections of Creatives Become Creative Collectives: A Field Study of Problem Solving at Work. Organization Science, 17(4): 484-500.

[3] Weick, Karl E. 1995. South Canyon revisited: Lessons from high-reliability organizations. Wildfire, 4: 54-68.

2 Responses to “Managing Mindfully”

  1. Mike Peters says:

    Ryan,

    This is an awesome post. Tasha is a Nurse and she never comes home immediately following her shift. When I ask her why she is home an hour later, she always tells me that she have to give a very detailed report on her patient. That transition is so important. From an organizational standpoint, think about how much information is lost in knowledge transfer upon someone’s departure. That severely impacts an organization’s efficiency. Great post Ryan.

  2. [...] I’m going to focus on Hargadon’s in this entry. I have cited him before in this blog, here and here.) One of the things I like about Hargadon’s workis his focus on innovation as a [...]

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