The challenge of asking difficult questions

Animate partner Jo is working with leaders, managers and practitioners to help them understand and embrace health and social care integration. Here she tells us of the challenges that creates.

It is hard to keep asking questions – especially when the answers we get clearly show us that we are not getting it right.

We have been attempting to adopt an action inquiry approach to collaboration, which means supporting leaders, managers and practitioners to ask questions of their experience of the implementation of policy change in health and social care. The action inquiry encompasses not only what they are doing but also what we are doing with them.

What we have learned is that the more we stand back, inquire, listen and really try to understand, the more chaotic and complex it becomes. That feels scary for us and really scary for the senior leaders, who bear a lot of the ultimate responsibility.

I found re-reading Margaret Wheatley’s 20-year-old article on Chaos and Complexity (and sharing it with the leaders) reassuring. She states that science shows us that it is in the darkness of chaos that our ‘self-organising processes’ and our creativity come forth. She makes an interesting distinction between control and order:

‘All these years we have confused the search for control with the search for order. So what if we reframed the search? What if we stop looking for control and begin the search for order?’

The search for order starts with looking for simple patterns and recurring themes and it relies on information:

‘The kind of information that does create fundamental shifts in the self-organising system is always information that it doesn’t want to hear. It is information that is new and disconfirming, that is difficult and challenging…’

Otto Scharmer’s U Curve is helpful here too. It shows that when we go beyond ‘downloading’ and really listen with an ‘open mind, an open heart and an open will,’ suspending the ‘voices of judgement, fear and cynicism’, we get to a place of not knowing before we are able to begin to see opportunities emerging.

‘chaos is no longer an abyss – it is filled with information that we cannot yet make sense of…’

Holding this uncertainty and being able to take actions, however small, requires faith not only in ourselves but in each other. At the same time, the reality of the budget cuts is really biting.

The temptation is to skitter away from the despair rather than try to hold it together. Some people are really suffering now, because they can’t get access to the support, which meant that they could get out of their houses every day. Some organisations, which were doing brilliant work are going under. There is nothing good to say about that, and no positive spin we can put on it, but we need to face it together.

For operational leaders and practitioners, it is just downright frustrating a lot of the time. What they see is lack of direction and a refusal to make decisions at a senior level. What they experience is a lack of acknowledgement of the real skills and experience they have. Without clarity and ‘a plan’ they don’t feel able to take up their leadership role.

What gives me energy at the bottom of the U Curve is when I see a GP open enough both to admit how her attitudes are changing – and to tell us what her colleagues will think. Or when I see people being brave enough to challenge one another from their different perspectives. Because they know that they will be listened to without being judged, they can come to questions like: was that really a crisis – or was some of it caused by our inability as individuals and organisations to ask for help?

What inspires me is that when we work in this way, what can emerge makes the radical seem logical. We have to do things completely differently; it becomes the only way that makes sense. For me that heals the split between transformation and improvement science. We stop doing what we used to do, because we know it doesn’t work anymore, we start doing something completely different, because it suddenly begins to make sense, and we keep an eye on it, carrying on learning whether the ‘small tests of change’ which we begin to implement, really do mean that people’s lives improve.

What Margaret Wheatley concludes is that ‘…it is only when we allow organisations to look at troubling information and trust people within them to reorganise around that information that we get truly transforming levels of change, however most organisations do not trust their people to act as adults…’

I hope that we are brave enough to take that risk, and brave enough, too, to ask the really difficult questions which challenge government targets and the expectations of society at large: given what we know, given what we have, what difference can we realistically try to make?