Blind People Having a Conversation that Goes Nowhere

Can you have an meaningful dialogue without understanding systems thinking?

"The lack of system's wisdom will always be punished."

Gregory Bateson -- The Ecology of the Mind

This morning I participated in a day-long meeting using dialogue to create solutions to the US healthcare system. The morning session was designed to stimulate improvement ideas by listening to six 15-minute though start starters by "expert" types and than dialoguing in small groups for about thirty minutes to create suggestions. 

The groups consisted of a mix of highly-credentialed, experienced and motivated stakeholders: Commissioners of Health, senior government officials of the English National Healthcare System (NHS) (one person was responsible for a £100-billion budget), Mayo physician leader proposing a revolution in healthcare , previous president of a major Institute for Healthcare Innovation, a retired teacher, a retired professor, owner of a small business, plus some peons like me to round out the mix. Excellent ideas and minds engaged in a stated context of "Dialogue" in the David Bohm definition.

A variety of solutions were proposed: articulate a vision, use virtual technologies, make the patient more of a customer or consumer with choices, change the payment system, etc.

All the ideas were good or, at least, focused on an aspect of the healthcare SYSTEM that is important. My concern is that putting a group of people together and asking them to solve a problem like healthcare in the US using a set of 15-minute thought starters isn't a very effective group process.

Healthcare is obviously complex. Creating a shared context for how to consider a complex challenge is important in being able to arrive at some sort of shared understanding. As with many seemingly intractable problems, an understanding of a system is important. Are we focusing on the individual patients, the providers, the organizations in which the providers operate, the governmental factors, or broader societal dimensions? 

What part of the elephant are we talking about? How many parts of the elephant can we coordinate in our conversation? Or are we limited to just the part you are talking about?

If we choose to have the conversation without an understanding of the elephant (system), are we not just a group of blind people comparing perspectives that we each think are the truth?

Dialogue is the ability to create a "stream of shared meaning" with each other. Meaningful dialogues about complex topics create a "stream of shared meaning" with a shared understanding of systems thinking. Meaningful dialogues examine the underlying assumptions and clarify the mental map of each speaker to get at shared understanding.

The organizer in this group was the "call to action" from the thought leaders. A better organizer would be an introduction to systems thinking!

• How do you look at a system? (i.e., individual, process, organization, and society)
• What works in changing a system?
  • Changing only one part of system often don't work (the system is stronger than any individual). 
  • One change can create unintentional outcomes in another part of the system.
  • etc.

I shared my perspective. Others shared their perspectives. Nothing changed. Nothing happened.

I was pretty frustrated: mostly with myself for not making this point about it being a system. Can any complex challenge be talked about intelligently if there's no understanding it as a systems issue? Do we have to continue our conversations as if we were a group of blind people discussing some part of an unseen on unknown elephant, as if it was the most important idea?

What is the real purpose of a meeting like this?