Disruption at the starting line

Horizon Fellow Kimberley Forbes is Consultant Sexual Health/HIV at John Hunter Clinic and Kobler Clinic and Service Lead for Contraception at Chelsea and Westminster Hospital. In this blog she shares how she has adopted a solutions-based approach to her work in healthcare and some of the models and ideas she’s used to bring her closer to her goals.

I’m Kimberley, a physician, mother, coach and educator. I work in an integrated centre that provides specialist sexual and reproductive healthcare and care for people living with HIV. I’m also the Faculty of Sexual & Reproductive Healthcare (FSRH) Training Programme Director, delivering clinical training and regular FSRH half day assessments. I’m interested in service redesign in the development of integrated sexual and reproductive healthcare and digital technology to support services.

Adopting a solution-focussed approach has improved my ability to manage the changing demands in my professional and personal life. What is possible? What can I focus on to take me towards that future?

Taking a new approach

But why have I adopted this approach now? A few years back I was introduced to positive psychology when I attended a short course for coaches. Positive psychology is about the strengths and virtues that enable individuals, communities, and organisations to thrive. Fast forward a year and I read about the solution focussed approach in the coaching and therapeutic context. This is about helping people move towards the future that they want and to learn what can be done differently by using their existing skills, strategies and ideas – rather than focusing on the problem. I felt there were many similarities between the two. Both show that the person can be an architect of their future using their unique strengths, resources and past successes. Having solution building conversations can be associated with both increase in positive emotion and self-efficacy This is liberating particularly when life is full of extraneous change, uncertainty and negativity!

The change process

Another way I have reframed my approach with projects is when thinking about the change process and what this can mean to people. Let’s start with disruption. This is mostly thought of as negative or a problem – think rail strikes, airport cancellations, plans changed, time lost. But what if disruption could come with good things? Disruption Innovation Theory coined by Clayton Christensen describes a specific type of innovation where existing structures are “disrupted” by emerging entrants, new companies, technology, business models etc. The COVID-19 pandemic has meant many of us have had to find new ways of working and achieve service reconfiguration to maintain optimal safe access during the pandemic. Currently I am working on a project optimising patient facing technologies to engage and improve access for those who could benefit from using our services. When considering what this looks like I find using a future-orientated approach useful, how can we as an organisation adapt our processes and business model over time?

Focusing on specific goals

Where to start with these changes? Do-Re-Mi will tell us to “start at the very beginning” but I have found visualising a mental image of the desired future state a useful technique to bring clarity to my thoughts and goals. How will it feel? What will it look like? What is the end point I am trying to achieve? Then think about what needs to happen along the way to achieve the end goal, incorporating aspects of design thinking when considering service design and patient experience.

Latham & Locke, 19911 describe aspects of goals in relation to content specificity and how this affects variability of performance More explicit goals lead to less variance in performance. Committing to choosing a goal that is significant to the individual is related to the determination they shall invest to reach it. I think this is particularly important to keep us energized during a change process particularly for teams where the collected imagery, thoughts and ideas provide fuel to keep moving forward in challenging times. With Postit notes and highlighters at the ready, I’ve found doing this as an exercise collectively with my team particularly empowering, helpful to clarify vision and purpose, and great way to connect as a team.

What gets in the way of strategic innovation?

So if we are adopting a solution focussed mindset, what gets in our way? We all have a unique individual filter on reality” – our Frame of Reference. This consists of associated responses which provide the individual with an overall perceptual, conceptual, affective and action set which is used to define the self, other people and the world.2 Our experiences influence the strategies and shortcuts we employ and may be impacted upon by many things our mental health, achievements, relationships, cultural influences, chronic illness, disability, education and socio-economic situation amongst others.  

Various cognitive biases are common and can hamper innovation, for example relying too heavily on one piece of information (anchoring bias) when making a decision, over-reliance on recent experiences (availability bias) or reacting differently to the same situation depending on how they are presented (framing bias). I find that focussing on the facts, processes and opportunities available and letting go of pre-conceived ideas enable us to consider solutions that we may have discounted. Most importantly we need to develop awareness of our automatic responses.

So, what now?

Employing just a few of these ideas in your everyday life can have a huge impact. What are your hopes are for a current project? What will you do differently this week to bring you closer to your goal? How can you become more comfortable with this change? What predictions or assumptions are you making?  
Following a superfluity of rainbow-coloured process diagrams detailing the “as now” and “future” state, stakeholder feedback and meetings  with innovation partners, I feel more at ease on my project journey. More comfortable with the starting line where volatility, uncertainty, complexity and ambiguity (VUCA) are omnipresent.  With optimism of the future and a mission to banish cognitive biases creep I embrace the journey itself. When will you start yours?

[1] Self-Regulation through Goal Setting, GARY P. LATHAM and EDWIN A. LOCKE, ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 50, 212-247 (1991)  
[2] Jacqui Lee Schiff & Aaron Schiff (1975) Frames of Reference, Transactional Analysis Journal, 5:3, 290-294

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