Recently, I observed an A3 training session comprised of front line managers from several ambulatory clinics. The participants were asked to break into small groups and identify an issue they were having in preparation for practicing A3 problem solving.  As each group shared their issue it became apparent that the entire group had an “issue” with the IT department.  With the sharing of each “issue” the large group became more animated and pointed with comments regarding IT, “They don’t understand what we do,” “They don’t realize how difficult it is for us,” “They seem intent on making our day miserable,” and so on.  By the end of the sharing the entire group was sufficiently worked up.  The simple exercise of identifying an issue applicable to A3 problem solving had become a considerable gripe session.  What had just happened?

The group unknowingly chose to entire the Drama Triangle, a phenomenon identified by Stephen Karpman.  The Drama Triangle is a place where individuals and/or groups choose to relinquish their ability to solve a problem by blaming someone else for their “misfortune.”  The following diagram depicts the roles played within the Triangle:

Lean Healthcare Drama Triangle

This group, all deemed by others as effective managers, chose to play victims and considered the IT department, either intentionally or not, to be persecuting them.   As the discussion went on, the group sounded more and more helpless in the face of IT.  And then the third character in this drama was introduced: the rescuer. “Administration needs to do something about IT.”  “Yes, administration can solve this by ‘fixing’ IT so they won’t make our daily work so difficult.”

As the group became more entrenched in its victimhood, sounding more and more helpless, a manager spoke up. He shared that he had a similar IT issue with registering patients after listening to his staff and analyzing the registration performance metrics.  He was initially convinced that IT was in some way deliberately sabotaging his staff’s daily work.  As he too began to enter the triangle, he stopped himself, asked what he and his group could do about this and proceeded to engage in A3 problem solving (though he didn’t realize he was using A3 problem solving at the time).

He gathered his staff and asked them to explain the issues they were having with completing their work activities.  Based upon this input and observations he conducted, he reached out to his counterpart in IT. Together, the two managers identified a small group of front-line staff from both departments to map the current state. The group then identified broken pathways, selecting two that were occurring most frequently and causing the most work stoppage and rework.  From here, the group began to ask why these pathways were breaking down.  Once this team identified the root cause of the breakdowns, they defined the target condition for the registration process.  Based upon their analysis and desired future state, they jointly identified the action plan necessary for success:  what changes needed to be made, who was responsible, when the changes were to be completed and how they would measure the effectiveness of their plan.

The ambulatory manager shared that they had to return to the plan more than once given that some of the changes did not achieve the desired results.  But, the willingness of this team to do so was something he had not experienced before.  More so, he noticed more of his staff engaging in similar activity with IT and other groups.  His staff, as well as those in IT, had shifted from being victims to active problem solvers and partners.  As my colleague David Emerald[i] explains, they chose no longer to be victims, but creators, in improving their work.  The manager’s staff began to challenge long-standing work practices seeking to improve how the work was done.  Finally, he began to see his work role more so as a coach and not a rescuer.

This manager, as have countless others, identified an effective antidote to the Drama Triangle – A3 problem solving.

i David Emerald, The Power of TED

Today’s post was written by Bill Kirkwood, Ph.D., director at HPP.

Bill has 30 years of healthcare leadership experience in both system and individual hospital settings in the Midwest and Northeast. He has overseen change management activities and Lean transformation engagements.  His experience includes serving in an executive capacity in quality, operations and human resources. 

He holds a Masters in Health Administration from Xavier University and a Doctorate of Philosophy in Organizational Behavior from the Union Institute and University. 


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