“Ask a good question” emerged from a teleconference I sat in on with Brenda Zimmerman several years back. In this conference, one of her principles (Download file) was to build a good enough vision one that good enough but not so crafted as to overly constrain. So thanks Brenda for the seed. In workshops, I get people to list issues and opportunities, and then get them to convert their problems into good questions. Example: “we nurses have workload issues” becomes “how might we better manage our workload?”

In other words, we spend some time up front developing the questions. These become portals of possibilities whereas listing your problems most often results in a fight or flight response. Good questions – even tough questions – should be proactive, engaging, stimulating. And if they are seen as fundamental and essential to a person or an organization, they should lead to action.

Here’s the guidelines for this phase of the process.

• Don’t take too long. Just get your question close enough to get the ball rolling.
• Test your question: Does this question energize you and your audience, or does it suck the life out of you? Who cares?
• Don’t be surprised if your original question dries up or morphs. If it does, re-craft the emergent question.

Step 2 – Get the right people at the table - needs less explanation. This is all about getting diverse thinking and perspectives to address the question. I often use the example that the winner of an in-house Nike shoe design contest was a member of the janitorial staff. Woody Allen says 80% of success happens just by showing up. This step in the process is a great place to position your good question within the Cynefin framework. Do we need experts at the table? Or representation from the frontlines or the underground? Or both?

Step 3 – Swarm around the question – is all about developing multiple experiments, using ritualized dissent et al, and Step 4 is of course to properly support and monitor those probes. (I plan on talking more about this later.)

On reflection, here’s my perspective on how this process has worked. At our senior table, we now have a one-page discussion template where people writing out their central questions in advance of discussions. Without prodding, this small piece of pre-work has become a standard practice and people feel better grounded in leading discussion they have thought through at this level. I have also watched groups step and re-frame their question when they get lost.

And it has taken a while, but I have actually heard senior leaders in our health care system ask if we have the right people at the table. I have seen them spend literally hours just coming up with the invite list and I have seen them defer meetings where in the past they would simply carry on, come hell or high water.

From my view in the cheap seats, developing a focussed question and laying the groundwork for a diversity of perspectives has been a substantial shift when the pattern for decision making in the past was typically top down and autocratic in nature.
What has been tricky is that old habits seem to die hard. Moving our health care system – be they administrators or front line workers - towards systematic experimentation a push, especially when the urgency is running high.
‘nuff said on this for now.