Monday, 28 September 2015

Ever Gone to Abilene?

“It is well known that when like-minded people get together, they tend to end up thinking a more extreme version of what they thought before they started to talk.”
Carl Sunstein, NY Times September 2012

Have you or your team ever gone to Abilene? You probably have. I know I have in my career and the results and fallout can prove disastrous.

The real reason for so many wasted efforts, projects that go nowhere and consultations that miss the mark. The answer lies not with disagreement or dissent but instead with mismanaged agreement, also known as the Abilene Paradox.

A short story will illustrate what happens when you go to Abilene:

It's a hot, dusty afternoon in Texas. A husband and wife have visited her mother and father, they play dominoes on the terrace. After some stilted conversation the father-in-law suggests that they should go to Abilene for a meal, a journey of 53 miles in an old car without air conditioning. The son-in-law wants to protest but when his wife says she would like to go he says he would too. His mother-in-law also says she would like to go, so they all agree.

They drive without air conditioning through over 100 degrees of heat and dusty road to a diner, where they eat poorly prepared food, and everyone secretly feels disgruntled, but no one says anything. Then they drive back home again in stilted silence.

Back home after the silence continues the mother-in-law finally admits that she would have preferred to stay home but that she went along with everyone else. A minor argument then ensues as each says that they didn’t want to go to Abilene either but that they didn’t say anything in case they upset the others. So, they all missed out on staying home and enjoying the afternoon together.

The Abilene Paradox, coined by Professor Jerry B. Harvey, describes a problem found in many groups, teams and organisations, namely the inability to cope with agreement not disagreement. He found that most agreement in groups, teams and organisations gets based on false consensus. It occurs because individuals in the group feel they might get censured or ridiculed if they voice objections.

When this happens groups tasked with a job act on assumed agreement. At best the project lurches forward in a series of revisits to the original plan as disagreement, assumptions and misunderstandings arise, or worse, the wrong decision gets made, or worse still, the project just fails.

When teams blunder into the Abilene Paradox, they agree on actions that contradict what they want to achieve and defeat the very purpose of what they set out to accomplish. The Abilene Paradox represents a symptom of the inability to manage agreement - not the inability to manage conflict.

Harvey says that groups that suffer from the Abilene Paradox often show these characteristics:
  1. They agree individually in private about the nature of the situation or the problem facing the organisation.
  2. They agree individually in private about the steps needed to address the problem.
  3. Individuals fail to communicate their thoughts and feelings about the project to one another.
  4. Failing to communicate, as a group they make decisions that prove counterproductive for their intent.
  5. As a result, frustration, irritation and dissatisfaction arises, with cliques forming that pass the blame.
  6. The inability to manage agreement repeats itself if the process of communication does not get addressed.
You can read more in depth about The Abilene Paradox as described by Harvey here
or find the book by Jerry B. Harvey, The Abilene Paradox and Other Meditations on Management; 1988, here (Not an affiliate link).

The Abilene Paradox explains why groups often come up with a solution no-one wants or cares about.

Effective group, team or organisational communication stems from the recognition that the process ought to have just as much precedence as the outcome. The group leader, facilitator or the chair must make explicit the expectations about the process of expressing respectful disagreement, professional opinions, and personal concerns to create a solution that people care about while delivering the desired outcome.

Here’s some tips for all group leaders, facilitators, and chairs and teams, be they newly formed or well established to avoid an unpleasant trip to Abilene:

As group leader, chair or facilitator ensure you:

Prioritise diversity of knowledge, skills and experience among group members. Avoid a group who share too many similarities. Aim for as many different perspectives as necessary for the task. 

Keep the group size just big enough for the task while maintaining diversity.

Ensure other group members understand your role as a information manager and process coordinator.

Encourage all members to own the process and recognise the dangers of various cognitive or judgemental biases.

Make explicit to the group what each individual brings to the table and why it’s valued.

Make critical thinking and analysis the norm for discussions not finding quick consensus.

Set a tone where people can express their ideas without fear of being mocked or disregarded.

Develop an ethos where everyone respects the necessity for conflict of opinion but not conflict among individuals.

Get differences of opinion and points of view out in the open as soon as possible.

As group leader, chair or facilitator that you not share your opinions first or that your opinions take precedence over the group process.

Reiterate the need for all to maintain and manage the quality of the process over time.

Ask individuals to write down their points before they offer them to the group. The simple task of writing and reflecting on what one would like to say before saying it can help curb inappropriate comments arising.

Have we agreed? Let’s test it. If not then engage in another round of process. If you all do agree don’t waste time and energy on further discussion. Set SMART goals and move on.

Take comprehensive notes - sticky notes, flip chart, white board - it doesn’t matter. Make sure all can see the thought process and that it makes sense. Publish these notes quickly after the meeting. Get individuals to take a record there and then, easily done with an image taken on a smart phone or tablet.

Get good. The more you, as the leader, and the group members practise good group process the easier it becomes and the better it gets.

Wednesday, 16 September 2015

Voices of a Patient - Jonathan Eyre

Jonathan Eyre, spoken word poet and performer, recorded this version of my poem Voices of a Patient at the end of the day's shoot for the film of the same name. Jonathan is a member of the Patient | Carer Community at Leeds Institute of Medical Education where I work.

Jonathan produced two standout readings from which I have produced this version. Sit back and enjoy:

You can visit Jonathan's website to find out more about his poems and performances.

Wednesday, 12 August 2015

Voices of a Patient - Film

Voices of a Patient - A poem by Philip Sheridan

I wrote Voices of a Patient in November 2014. I felt inspired to write the poem from the conversations I had with and heard from my peers in the Patient | Carer Community (PCC) based at Leeds Institute of Medical Education (LIME), University of Leeds. Early on in the new year I suggested the idea of a film to Jools Symons, Patient & Public Involvement Manager at the LIME, who gave her blessing. Thus commenced the production of the film.

I joined the PCC in 2012 after almost two decades as a children's therapist, team leader, practice educator and trainer. In September 2002, almost half way through my career, I survived a near fatal road accident that left me with long term physical disabilities and mental health issues. It didn't take long for this awesome community of people to make a big impression on me. In particular the way they brought all their knowledge, skills, experience, and most of all their passion, to bring the patient and carer voice into the education of Tomorrow’s Doctors.

I dedicate this poem and film to them, and to all those people who work in the health services who see the human being first, not a condition.

I would like to offer my heartfelt thanks to the PCC members who appear in this film:
Jonathan Eyre
Ian Horbury
Robina Mir
Cynthia Rover
Effie-Jane Wallis
Kenneth Watson
Sharron Winn
Special thanks must go to Dr Kate Granger MBE founder of the #hellomynameis campaign. Despite her busy schedule, Kate made time to visit and read the poem when she had so much on. I hope this film will help spread Kate's message about the importance of good introductions for compassionate, high quality care and patient safety.

You can find out more about Kate's campaign at:

Saturday, 8 August 2015

Voices of a Patient - Soundcloud Version

Voices of a Patient

The title of this poem riffs on Pieces of a Man by Gil Scott Heron.

It features Cynthia Rover. I know Cynthia through my work with the Patient Carer Community at the University of Leeds Institute of Medical Education where we work with student doctors.

This poetry project represents a recurring theme raised by patients and carers with regard to their treatment at times from health care professionals. Namely, being treated as a condition not a human being:

A film that features Cynthia along with other members of the Patient Carer Community and special guest Dr Kate Granger MBE - Founder of #hellomynameis - will be released on Tuesday 11th August 2015.

Friday, 31 October 2014

Co-production for Integrated Care

“Medicine's ground state is uncertainty. And wisdom - for both patients and doctors - is defined by how one copes with it.” 1
I think the health discourse has begun to move. Move from the acceptance or expectation that a healthcare professional does something to the patient or for the patient. To one where both the patient and healthcare professional co-produce health in partnership. In other words a move where medicine is done ‘to’ an individual, to a working ‘with’ relationship.

When we talk about co-production it can, at first, seem a complicated idea. In essence it means to make together. It extends upon the idea of professionals working together across work or organisational boundaries, a model I became familiar with in my social care career. It brings into the conversation, in a meaningful way, the individual, group, or community as equal partners in the planning, implementation and evaluation of their health and well-being.

For this to happen will require an examination of our roles as patients and professionals in relation to health, education, culture and politics. It embraces an idea of a more active form of citizenship. It will require us to acknowledge and act together upon the affects of impoverishment on peoples health and well-being as a consequence of economic, social and cultural inequality.

It can seem the most difficult conversation to begin. From a professional point of view the active engagement of patients and carers in the co-production of health would seem the least effective or even wished for way to work. It will require healthcare professionals to examine some of the values and assumptions that underpin their practice. It will prove a challenge, given the inherent status, power and control that comes with the role.

I hear the same repeated themes in my conversations with patients and carers about what they want from healthcare professionals. They want to feel included as far as possible in the important decisions about their healthcare choices. They want to feel the benefits of a team of professionals who work with the patient in the patient's best interest.

As I did when I worked in my various roles for social care and continue to do so now in my work with students and healthcare professionals. One must engage in a ongoing dialogue to answer some simple questions:  ‘Who do you work for?’ and ‘Who's needs do I / we meet when I / we make an important decision about an individual's or a communities health needs?’

No one said that the work of healthcare in the 21st century will be easy. It will require healthcare professionals to explore the difficult discourse of uncertainty with patients, carers and fellow professionals. It will require the learning and practice of complementary skills with the same dedication given to the clinical skills learnt as part of  medical training. Skills such as facilitation, care-coordination, care-planning, and advocacy, among others.

When I worked with the Darzi fellows in 2014 as part of the PCC from Leeds talking about coproduction I left the events buoyed by the passion and energy I witnessed. I felt hopeful that the health professionals and leaders of tomorrow will continue to work, advocate and value the knowledge, skills and experience that patients and carers bring. Not just to manage their own health needs but for the co-design and development of our health services.

1.  Atul Gawande. Complications: A Surgeon's Notes on an Imperfect Science.  2nd ed. London: Profile Books; 2008.

Thursday, 23 October 2014

Message to the Darzi 6 - Gil Scott Heron and Clinical Leadership

I wrote the following message to the Darzi 6 Fellows at the beginning of their PG. Cert. in Clinical Leadership. The theme for the day was an exploration and discussion on:
What helped me to learn to be effective in complex social systems?
I took part as one of a group of ‘wise visitors’ who shared experiences from their respective careers and then discussed with the fellows the ways in which we had managed to negotiate the complex of people, systems and processes one finds in organisations.

On the train journey home I began to reflect on all things I wish I could've said had we had more time. So, to make amends I quickly wrote down those things and sent it to Duncan Ross, one of the facilitators on the day to share with the Fellows. Here's what I wrote: 

‘Things I didn't say but would have liked to.’

I would, first of all, like to say how much I enjoyed meeting you all on Friday. Toward the end Duncan asked if we, the visitors, had any other thoughts that we hadn't had a chance to speak about. It seems to happen all to often that when one leaves an event as stimulating this that many questions and reflections arise afterward but too late to communicate at the time.

I recognised from the questions and discussion I had with the two tables I sat with just how many demands you face day to day. Your passion showed that you will grasp the nettle of these challenges and affect a positive and lasting change.

So, if you will allow, I would like to offer some of my thoughts on the question above. I hope it may prove, if not helpful, a spur for your reflections on the day and this experience.

I ought to add a caveat. I offer these reflections in the spirit of Message to the Messengers by the late great Gil Scott Heron.  Gil Scott Heron (poet, author and musician)  known as the ‘Godfather of Rap’became most active in the 1970's and '80's.

Message To The Messengers speaks to the rappers of the 1990's and rap music in general. In his poem Gil advises the new generation of hip hop artists to remain conscious of the past. To respect the elders that went before and a map to avoid the pitfalls inherent within the music industry.

Diane mentioned the accumulated wisdom present in the visitors when she introduced us. In a similar vein, Gil's message expresses his hard won wisdom and best hopes for the next generation as they make their way in the world.

The following reflections I noted down on my journey home to Yorkshire on the train. I trust that you will examine them in the spirit that I offer them. Or you could just listen to Message to the Messengers:


Thoughts and Reflections


Systems and process's can disguise what happens in health organisations and agencies. Namely, the day to day process of people engaged in complex face to face relationships, interdependent upon reciprocal and mutual benefits.

Often times it seems, we can find ourselves in uncharted territory where we must draw the map as we go along.

Our ability to navigate depends on our interpersonal skills to negotiate and cooperate. To work with knowledgable, skilled and experienced local people on the ground who can help.

Our interpersonal skills need to foster helpful conversations that seek and affirm the good. To find those things that we all share in common.

Know that the process is dynamic and emergent. One must become agile and nimble, embrace the unknown and let go the idea of always having or taking control.

Think about your core values. Examine them. How do they affect your behaviour, your attitude and communication style.

Be generous. With your time, with yourself, with others.

Get comfortable with the unfamiliar. With different people and places, where alternate ideas and ways of being exist. You just might learn something. You will, without a doubt, come away richer for it.

Your role and title, be it manager or leader, describes a series of knowledge, skill, and function sets. As we used to say in our team, ‘Management is a function not a status.’

If you don't know, don't bluff. Ignorance, if embraced can become a strength. That doesn't let you off the hook. Once again, in our team, if you didn't know something then go find someone who does and ask for their help, or find out for yourself.

In other words you either know, or don't know, and if you don't know you engage in finding out. Ignorance gifts you the greatest invitation to learn something. In the process  you will develop yourself, meet unique characters and get to travel to interesting places.

Find and nurture your voice, your way of being. Become adept at using different modes and mediums of communication while you remain true to yourself.

When things go wrong, and they will, respond with integrity. Take ownership and never seek to cast blame because:

People can and do make mistakes, 'to err is human.' You will make mistakes.

Systems and process's can and do fail, 'if it can go wrong it will go wrong.'

Don't confuse the two points above. The first needs support. The second requires attention.

There's a difference between having a plan and planning. Plans become fixed, difficult to adapt and slow to respond. Planning makes room for contingency, builds in flexibility and nimbleness to respond.

As the professional in the relationship don't become the barrier, either to others or yourself. Many of life's barriers start and remain inside people's heads.

Change happens all the time. At the micro level (teams and individuals) and macro level (organisational structure, systems and process's) .

Within teams individuals come and go, have significant life events and mature as characters. Organisations must adapt to local, national and international policy agendas. Both individuals, teams and organisations must respond to crisis and breakdowns.

I wish you all well on your respective journeys. It was a pleasure to meet you. If you go away with anything then I hope at least I may have introduced you to the work of Gil Scott Heron.

Thursday, 13 March 2014

Reflections on Coproduction with the Darzi Fellows

I had a wonderful day in London in 2014 with my colleagues from the Patient Carer Community (PCC), Leeds Institute of Medical Education. We engaged with clinicians on their PG Cert in Clinical Leadership, the Darzi Fellows, facilitated by Becky Malby and Duncan Ross of the Centre of Innovation in Health Management (CIHM), Leeds Business School.

We worked in small groups talking about coproduction and offered our unique experience as patient experts and leaders. Over the course of three half hour round table sessions the groups explored the benefits and barriers of coproduction with patients.

Each one of my conversations revealed the hopes, fears and potentials of coproduction felt by the clinicians. All recognised the desire for engagement and the agenda for change that drives it. Perceptions and expectations of what patients can offer ranged from enthusiastic to pragmatic to critical. All showed a desire to explore what patients could offer their particular service area.

At the end of the round table sessions each of us from the PCC had the opportunity to speak to the whole cohort to give our feedback and reflect on the impression left by our involvement. I recognised that clinicians, clinical leads and their teams often face complex and conflicting demands that challenge the implementation of meaningful patient coproduction initiatives.

In the same way that the clinicians I spoke to empathised with patients who feel overwhelmed when faced with the life changing impact that ill health brings; the physical and emotional challenge to their way of life and personal values; the disruption to established routines and relationships. I could empathise with these clinical leaders of the future and the often overwhelming demands they will face in their endeavours to establish and sustain new ways of working.

I left the event buoyed by the passion and energy I witnessed. I feel hopeful that these health leaders of tomorrow will continue to work, advocate and come to value the considerable input patients can bring to determining the future of our health services.

As a final take away I would ask that clinicians and health leaders see beyond the label of patient and instead meet the human being. To recognise the knowledge, skills and life experience that people as patients bring. Not just to manage their own health needs, but the potential for the co-design and development of our future health services.