Henrik Sjövall was recently appointed full member of the management team at Sahlgrenska University Hospital, as representative for the Sahlgrenska Academy. Here, he gives us a taste of his experiences during an intense two-day meeting in the form of a “deep dive”.
SU is Sahlgrenska Academy’s best friend (with all due respect to GU)
“We’re sitting in a ring, expected to reflect on a day spent dissecting a major problem in medical care. We’re using a technique known as ‘deep dive’, which is based on a deep analysis of an important and problematical topic. A sort of ‘sourdough’ baking, where you bake a tasty cake from an old sourdough. The folk in the ring are the hospital management and key personnel in the hospital staff, around 20 extremely capable individuals. Sector managers with never-ending budget problems. A newly appointed IT manager with the transition to a common Melior domain to keep her awake in the small hours. A Press Officer with the friendly newspaper Göteborgs-Posten eagerly chasing news. A Human Resources Manager with Norwegian wages to compare with Swedish ones. And the new Hospital Director, just another member of the ring, but holding responsibility for everything. Two consultants, Anders and Gunilla, keeping themselves in the background, ready to give a nudge in the right direction if we get stuck or wander off topic. And then little me, newly elected sole representative for Sahlgrenska Academy, now with full voting rights rather than the observer status previously held. A member of the team, you see.
Actually, it had started pretty badly. I arrived nearly two hours late to the first ‘ring’ session, having had to teach a course in evidence-based medicine earlier that morning. Straight into the thick of it – it seems that they had already discussed my ‘promotion’, and now were expecting to hear what I thought of it. I must have managed this pretty well, despite being mildly panicked after a hour driving here at illegal speeds, since one of the consultants congratulated me afterwards. So what did I say? I told them what I thought – namely that SU is Sahlgrenska Academy’s best friend (with all due respect to GU); that I was honoured by the full membership that I had been given; that I have a reasonably good idea of the management system on both sides of the divide and I can see that we have a great deal to learn from each other. And that what was probably my most important task is to help to build a strong common trademark – the general public often has no idea what the difference between Sahlgrenska University Hospital and Sahlgrenska Academy is!
I have a file on my desk at work called “Important and Thorny”. It contains matters for which there is no easy solution, but that will have to be dealt with eventually. Sometimes, external events force me to open that file, and that is exactly what had led to this particular ‘deep dive’. Unfortunately, I can’t go into the details of what we discussed, but will describe the process.
The technique we used was ‘beehiving’, which involves intense discussion in small groups, which are constantly being reformed in order to avoid getting stuck. An important principle was that we should always come up with a clear suggestion. Phrases such as: ‘Wouldn’t it be a good idea if…’ were simply not good enough. Only a clear suggested measure with a credible plan of execution was accepted. The discussions were lively, the consultants circulated and listened in, and they intervened with a few well-weighed observations if we ended up in general chat. A break for lunch, to be followed by further discussions. Partial issues were identified by representatives for the groups holding separate discussions, and then a new round of beehiving until we hammered out a message that everyone could get behind. Then a new partial issue, further discussions, more beehiving. And so on.
It’s probably the only place that a member of the university staff is a full member of the hospital management
Of course, we became more and more tired, but were not conscious of this since we were so focussed on the tasks. It struck me that the whole process was being carried out in an extremely open atmosphere without folk caring about prestige. Normally I don’t like it when folk ignore what I say, but there were so many suggestions and so many objections on the go that it was not possible to keep track of who managed to get their particular darling accepted. The final proposal from the beehive usually contained elements from many different ideas, without being identical to any of them. And then our queen bee was off to meet the other queen bees, and sometimes came back with something different, where our proposal was included as a small unobtrusive part. But no-one got upset about that!
When everyone was starting to feel exhausted and the discussions were starting to meander, we took a break for dinner. But we were encouraged to resist the temptation to retreat to our rooms and read our e-mail. Instead, we were to find someone we didn’t know, and take a long walk with them to reflect over the day we had passed. And that’s what happened – I first got hold of the Press Officer and then the HR Manager and we wandered through the sleepy spring countryside, philosophising about life in general (and not so much about the day’s events). It felt as if we were leaving the cake mix to mature, and rise under a teatowel.
Discussions then continued during dinner. The question of horizon scanning came up, why we so seldom investigate the decisions others have taken when dealing with similar matters, differences between leadership in the business world and the public sector, the society that our children who grew up with the internet will create, why teamwork is so bloody difficult, sport and its usefulness in learning how to work in a team, etc., etc., until folk started dropping off. Fell asleep on the way to bed.
A new day, with new energy. New questions, a new focus, but the same main issue. What had appeared obvious yesterday sometimes turned out not to hold water after a night’s sleep. Condensation, uncompromised demands for clear measures to take. Get rid of all the chat – we can put all that into an appendix. Why-what-how? Who is responsible? When is it to be complete? How is it to be financed? Who is to pay? Don’t get into details, keep to clear principles. The result: two lines on the whiteboard that everyone agreed on. Everyone!
Lunchtime, time to gently come down to earth. Folk started to reach for their mobiles. Conversation, normal life starting to make itself felt. One or two started to leave, feeling guilty since everyone could feel we were in the zone, and no-one wanted to break the flow. Uncertainty about what to do after lunch. It turned out we were to be paired with a ‘learning partner’. The Hospital Director had decided who was to work with whom, form pairs to coach each other. She had given me one of the consultants as learning partner; she probably thought I needed to learn some manners… Later on I was called to the front for a conversation about how I see my leadership and my role in the hospital management. Again – I told then what I thought, namely that I am extremely happy that the hospital has taken this large step (it’s probably the only place that a member of the university staff is a full member of the hospital management); that I feel honoured to be the first person to take on this role; and that I will do my utmost to further improve the collaboration between the medical care system and the university.
So now here we are – sitting in a ring, winding up, and we are each given 30 seconds to summarise these two days. And it’s now that the quotation flashes across my mind. I think I found it in a book by Bruce Chatwin, ‘The Songlines’, about the aborigines of Australia. They lived a dangerous life, often trekked long distances, and they noticed a pattern: Those who departed alone and started at high sped seldom came back, while those who travelled in a group most often did.
‘If you want to go fast, go alone. If you want to go far, go together.’ So what I said was that I look forward to setting out on a long journey together with this group.”
End of story.
PS: A final thought: Would the Sahlgrenska Academy be able to work in this way, towards a common goal without caring about prestige? Or are we too strongly individualistic, everyone looking after their own interests? I suppose there’s only one way to find out…
