National Alliance for Physician Competence Discovery Workshop


  • The morning began with a round of work focused on providing the participants with an introduction to some concepts from complex adaptive systems.
  • Assignment: Participants were asked to gather two concepts from the Concepts Cards posted around the room. The concepts participants chose were to be the ones that seemed to peak their interest or to be intriguing relative to the forming of a National Alliance.
  • Short Cuts: Use these links to jump to the discussion about the Concept Cards chosen, to see the visual scribing about the conversation and to see which concept cards the participants chose.
  • Download all 42 Concept Cards in one PDF file.

Concept Cart Hunt


Context: Part of what we want to accomplish during this workshop is a shift in how we think about systems and organizations. From a new mental perspective we can possibly create new, transcendent models (structure, process, behavioral) for our organizations. The perspective helps us “get out of the box” by expanding the boundaries of the box.

Objective: Find two concepts that either challenge or intrigue you when it comes to thinking about the National Alliance: its purpose, structure, and processes.

Process: Organize yourselves into small groups of 3 or 4. Around the room you’ll find a number of concept cards printed on 11x17 sheets of paper. Look through them, discuss them and choose the two that meet the objective, stated above. Once you have selected your 2 or 3, please take them with you and find a seat in the plenary. You have about 20 minutes to find your concept cards and get seated.

Exchange: After everyone is seated, you’ll have an opportunity to share your concept cards and why you chose them with the rest of the group.

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OK - Please come have a seat in the large group. There should be a type of chair for everyone. Good morning everyone. We wanted to start off with a tradition that has emerged (or is emerging) with a reading of something. David has something he wanted to share.


I ran across a couple of quotes that I thought was appropriate to this group and this gathering. The first one is from George Bernard Shaw which goes something like this: the responsible man attempts to change himself to fit the world. The irresponsible man tries to change the world to fit himself. Therefore all progress is made by the irresponsible man.

Serious-minded people have few ideas. People with ideas are never serious.

The second quote is from a French writer and poet. I was encouraged by this because this man was a secretary until he was 50 years old.

Every beginning is a consequence - every beginning ends something.

Serious-minded people have few ideas. People with ideas are never serious.


Let's talk about the concept cards. What did you find interesting about the conversations you have had?

Where did these come from?

Our company often gets the opportunity to draw pictures at conferences. Some times we break them down and create concepts from these and develop these concept cards.

We can start a market for these. They all seem to have relevance.

How did you choose? Randomly.

Did you have a criteria or a choosing process?

I was attracted to things I already believed.

If we did a systematic study and threw the ones we picked away, and then used the ones we didn't pick, we would have real change.

If we did a systematic study and threw the ones we picked away, and then used the ones we didn't pick, we would have real change.

Our group didn't have a lot of time to scan the entire room but we chose things that might be related to the challenges we have and these ideas might be useful in solving them.

The cards we chose were: Diversity improves performance. We compete against psychology.

The one thing that strikes us is that we won't be right in the next few days and that any predictions we make won't be right. There is no way to predict the unknown and perfection is not able to be achieved.

Keeping our mind on the Alliance was hard because I was thinking about other things. Each of us picked one and we didn't think about how it related to the others.

What were some of the cards you selected?

Experience and expectation drive decision making. Applying that to the Alliance is interesting. Why did we try to get together in the first place? We are trying to have some control over an entity we are involved in rather than having controls put upon us.

Time has a role in change. Customers act very quickly.

We picked a card that says that strategic planning is a failed concept. What this card says is to develop processes that are adaptable rather than specific products.

Improvisational jazz was our analogy. Beyond the structure you have to interact with other people.

We picked one that talked about building blocks - rather than just rearranging the existing blocks.

It's like the QWERTY keyboard that was developed in order to slow down typewriters. The Dvorak keyboard is a lot faster but we use the QWERTY because we are used to using it.

Survival of the adequate is one of the cards.

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How do you get out of the rut? Getting out of the rut is challenging. Becoming aware of how the mind works is challenging.

I researched something about observing outliers and training people on what they are doing. How do you reconcile that with the idea of survival of the adequate? How do you define what is best? Survival is something but you have to define success. What about when best quickly evolves and changes?

Number two is always best. Whenn you benchmark you are often looking at number two. If you are benchmarking number two you will be number three so it's better to have other things going on at the same time.

Systems thinking is challenging. Linear thinking is a big challenge to get out of. It will be challenging to give up that pattern of thinking.

It will be challenging to give up that pattern of linear thinking.

There is a good book called Turtles, Termites and Traffic Jams. It's about a program with middle school students about how things emerge. Some species of Ants create cemeteries. How does that occur? They could not imagine a way for the emergence of that behavior.

Technology has allowed changing ways of looking at things. Should the Wiki be owned by the physicians and patients and having no blessing from on high? We are in this time continuum of whether we push the envelop and step into the unknown where society will define competence and then we have to give up some authority that we've had. Milton Freedman says that anyone can call themselves a doctor and the public will decide.

We're struggling with this in our model - there are things that we are concerned about and we should think about whether we should push the envelope.

This way of thinking has become part of who we are and looking at these ideas could create a lot of anxiety in us.

This way of thinking has become part of who we are and looking at these ideas could create a lot of anxiety in us. How we help each other in the uncertainty and the anxiety of doing something new is important.

My immediate reaction is to reject it and not give it another thought.

Over the next few days we have to watch that tendency.

One of the cards we picked up was about how things develop in stages and are incubated. You have to protect your risk in order to build psychological safety. The people that developed the B-52 Bomber had the wrong idea at first but because they were incubated they discovered something new. In a lot of the ideas you have to get across the chasm (from Geoffrey Moore).

When we started this process I felt I was in a candy shop and it was really hard to get my hands around what is here and to digest what is here. Finally I decided to look for things that resonated with my past experience and I picked those.

You talk about anxiety - we are looking at how we can develop our thinking but we have to sell this to our constituencies so we might have to identify incremental improvements first. Fortunately we will be working with some ideas that masses are sold to every day. There will be new ideas that take off like wild fire and others that don't take off at all. We might be able to nudge things in a direction. It's probably some combination of engineering and evolution.

Baboons are sneaky. You always hear that the dominant male gets the female. There is another strategy that the sneaky baboon uses to wait until the dominant males are all worn out from fighting each other and then go and propositions the females. That strategy has been shown to really work.

Are there any processes that hold constant or does everything change?

Speaking about the point about going back to our organizations, there are a few things that are more linear than parlimentary procedure. Consensus is the work of people that care and the indifference of those that don't. Parlimentary procedure allows for the indifferent to vote and to sell their vote.

If you care, participate but if you don't care just don't vote.

Some people shouldn't participate in certain things so they should deligate their vote.

Let's do a quick orientation to the Catalyst Ranch. There are drinks in the refrigerator and the bathrooms are down the hall. There is a room out there called the Sausage Room if you need to take a call. We are going to 6PM tonight and tomorrow is the same as today. You will be exposed to some new thinking and then you will be asked to go into small groups and work with these ideas. You will document your work and share it in some way. There is iteration involved but there is new information presented. We will be working with some form of self-organization most of the time. There will be a temptation to get into grooves like sitting in the same place. When we ask you to self select teams please try to work with different people. We aren't going to inforce that. e typically don't have breaks however if you need to take a break please do that. There is a working lunch. If you are working with a small group please conscious of re-entering the group. Take a few minutes to listen and re-engage.

Be present as much as possible. The ruts are these little tapes that play over and over. Stop the tapes and listen - so practice that. Many years ago we worked with a native American group. After someone talks there is silence. While someone is talking they listen and then when someone is finished that is the time to think about it.

We are documenting everything that happens in large group. We don't keep track of what each person says. We will publish this to a web site that you will have access to. We are video taping for back-up.

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