Key Words: Inquiry/Curiosity, Relationship/Mutuality, Humility/Vulnerability

To explore the meaning of these words, allow me to share a personal career story that had me looking down the barrel of a 12 gauge shotgun. My first job out of college was as a Black Lung clinic outreach worker. My job was to serve as a lay advocate for retired coal miners on their Department of Labor Black Lung claims. Working in the poorest section of Cincinnati, it was not unusual to find myself in run-down apartment buildings. I was told about a retired miner who may be interested in my services and given one of my performance metrics was to increase my case load by a number of cases per month, off I went to meet with this potential client. I knocked on the third floor apartment door which I had to feel my way towards given there was no light. A gruff “come-in” was shouted out. Upon opening the door I focused on a shotgun six feet away pointing right at me. In response to “what do you want”, I stumbled through my name and why I was there. No response and no lowering of the rifle. Do I turn and run, do I tell him what I can do for him or do I ask him why he has the gun and why is it pointed at me? I chose the third option. The rifle was lowered and I heard the story about a man who was disabled and repeatedly robbed in that very apartment. I learned a great deal not only about this once hardworking proud man but also a few lessons about Humble Inquiry and Here and Now Humility.


“If a goal of a conversation is to improve communication and build a relationship, then telling is more risky than asking.

Asking temporarily empowers the other person and temporarily makes me vulnerable.”

Humble Inquiry, Edgar Schein


We know a critical element of effective healthcare leadership is building the relationships with our managers and front-line workers. A positive relationship is built upon mutual trust. We also experience the pressure of goals to be achieved, tasks to be checked, and performance metrics that shape how we frame our work. And, as leaders, we have a natural tendency to tell, to share our brilliance. Yes, we are human.

A very real challenge, indeed. Edgar Schein’s Humble Inquiry: the Gentle Art of Asking Instead of Telling, offers a framework that can assist us in this challenge. The complexity of our times and the organizations we work with makes us less than effective if we do not know the “art of the question”; to ask questions that build positive, mutually trusting relationships. These relationships are foundational to a successful change process and long-term partnerships. If we enter the relationship without a willingness to “access our ignorance” then we default to telling, our comfortable home-base. To access our ignorance puts us in a vulnerable place. The vulnerability pulls us away from the practice of Humble Inquiry. Hence, a real challenge and need for continual practice and feedback on how we ask questions.

There is a type of humility that Schein shares that is applicable to all of us in our leadership roles: Here and Now Humility. Here and Now Humility is a stance one takes at the beginning of the relationship or when the relationship shifts due to unexpected events. It requires us to let go of our all-knowing stance; thereby, acknowledging that we know less than the manager or front-line worker in this initial relationship building phase. It requires us to ask the internal question: What am I focusing on in this situation/relationship? Am I being ego-centric/self-serving or truly wanting to create mutually positive outcomes? Humble Inquiry questions are designed to help increase our curiosity. This requires a willingness to be mindful of our intent and practice. This Inquiry type is part of a larger typology articulated by Schein.

Schein’s Forms of Inquiry

  • Humble Inquiry: This type of Inquiry begins with a high level of curiosity about the other person and the situation. This Inquiry is a form of question that seeks to make us less ignorant and better understand the situation. The questions come from a stance of sincerity and curiosity. It helps build a respectful relationship wherein the leader truly wants to learn and understand.
    • “What is the situation?”
  • Diagnostic Inquiry: This form of Inquiry strives to further explore the problem at hand. Again out of honest curiosity with seeking to learn while resisting the desire to tell even if in the form of a question. Diagnostic Inquiry guides the inquiry path to learn more about the problem facing the leader.
    • “What may have caused this?”
  • Confrontational Inquiry: In this type of Inquiry the leader’s ideas begin to be inserted in the form of questions. The leader is taking over both the process as well content of the conversation through more closed-ended questions. Through these questions the leader is guiding towards giving advice. This form of Inquiry is challenging. It can be offered with an “all-knowing” attitude or with humility. Without humility we may increase the potential for resistance to the change idea.
    • “What did you do?” vs “Why didn’t you do something?”
  • Process-Oriented Inquiry: This form of Inquiry focuses on the conversation itself. If the conversation goes in an unintended direction then it is helpful to ask questions to clarify the current status of the conversation/relationship. The focus is on the relationship. It is not uncommon in the course of these complex relationships that one party or the other misconstrues or misinterprets the situation; thereby creating tension.
    • What is going on in this conversation?”

Diagnostic, Confrontational and Process-Oriented Inquiry can take on the form of Humble Inquiry if our motives are to be helpful and further develop the relationship. Without a foundation of humility we risk the relationship by reverting to our telling even if the tell is in the form of a question. A key is to be as certain as possible that we have, through our inquiry, built the relationship before we start to tell.

Though I did not know anything about Humble Inquiry or Schein when confronted by the retired coal miner and his shotgun, in reflection, my use of a question came out of both fear and curiosity. It shifted the dynamic by my assuming a Here and Now Humility. It opened the door to a relationship built upon mutual respect and honor. It shifted my immediate stance in working with potential or existing clients to one of deeper understanding, not solely for the purpose of my “performance metrics.” Though this gentleman did not qualify for Black Lung benefits, I was able to help him with Supplemental Security Income as well as securing a safe place to live. In return, he opened doors to friends and former co-workers that I am not sure I would have learned about. In retrospect, we both gained something valuable through the relationship.

Have we not all faced a shotgun pointing at us as leaders in our organizations?

 

Edgar H. Schein, Humble Inquiry: The Gentle Art of Asking Instead of Telling; HarperCollins Publishers, 2013.


Bill Kirkwood, Director for Lean Healthcare and Process Improvement at HPPToday’s blog was written by Bill Kirkwood, Senior Consulting Director.

Bill brings more than 30 years of leadership experience in the healthcare industry. Prior to joining Vizient, Bill worked in both system and individual hospital settings in the Midwest and Northeast United States, leading transformational change management initiatives. This experience includes leading service line re-design initiatives [e.g. perinatal services, case management and care model design] as well as serving in an executive capacity in quality, operations and human resources. Bill’s areas of expertise and professional skills include facilitating change management strategies. He has worked with leadership teams in developing and implementing Lean Management Systems and Organizational Design efforts. He serves as Adjunct Faculty in the University of Cincinnati’s Masters in Health Administration in addition to being a certified Executive Coach. He has presented at several national conferences including Institute for Healthcare Improvement, the Organizational Development Network and American Society for Quality as well as being inducted into the Union Institute and University’s Circle of Scholars for his dissertation “The Current State of the Patient Care Nurse’s Vocational Calling”. Bill holds a Master’s degree in Health Administration from Xavier University and a Doctorate in Organizational Behavior from the Union Institute and University in Cincinnati, Ohio.

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