A Complex Way of Connecting with Communities
Creating hope through connections and action

Portions of the Rusch/Zastocki stories from above on community health work told together and with reflections

Told by: Brenda Zimmerman and Curt Lindberg

Illustration of:

• Stacey matrix
• 15% solutions
• chunking
• creating conditions
• emergence
• minimum critical specifications
  
  

Complexity science provided insights for relating hospital work to community health for two nurse executives, Linda Rusch and Deborah Zastocki. They argued that the limitation in most community initiatives is due to high levels of complexity, huge number of variables and a desire to come to consensus before any action occurs. There is this belief that there needs to be "the plan".

A framework presented by Ralph Stacey (1996), showed them consensus was an appropriate approach in situations of relatively high agreement and high certainty. Issues of community health and wellness rarely meet those criteria.

People are "paralyzed with the consensus mode" and "tired of feeling like this is another meeting where we discuss everything and nothing gets accomplished," said Zastocki. Instead both Rusch and Zastocki provided opportunities for hospital and community members to get together and agree to act in areas where they have influence. Rusch described it as "‘chunking’" (Kelly, 1994) or " using their 15% sphere of influence" (Morgan, 1993).

They used notions of minimum critical specifications. As a hospital group, they first decided what they need to hold "sacred" and then engaged in and allowed for lots of actions within that container.

"I give the minimum specifications of where we could think about going or what the world’s going towards as much as we can predict it about partnership and community. The next thing I know, I hear about these nursing units that are collaborating in all these different projects with the outside public." (Rusch)

Rusch argued that a healthy community means everyone takes responsibility. This involves more teaching and more sharing of information. In her hospital, Rusch discovered that the operating room nurses took the initiative to create a community forum to teach the general public about the instruments used in surgery. She didn’t initiate or direct this project. It was another "sprout that emerged."

Zastocki and Rusch said the teams learned from action. They did not try to plan their way through these community initiatives. Feedback loops and reflection are key. "One of the feedback pieces we have had is that the community groups see hope", said Zastocki. The hope resulted from experiencing actions that happened in a thoughtful but not totally planned manner.

Rather than a community plan, "we need to have a Mecca in some sense where people come together, they grow, they act and they learn together - where natural spin-offs will occur that allow more and more people to connect," said Zastocki.

Reflection: Zastocki and Rusch are highly committed to making health care a community concept. One of the differences drawn from their study of complexity science, is that they now see action opportunities to work towards this concept. They don’t believe in the separation of thought and action. If you can move on something that brings it a little closer to the "good enough vision" and "connecting with the greater good" then they go for it.

The work with the natural energy, they do not force their nurses to work with community organizations or the public. Rusch said she is puzzled when she hears colleagues who are struggling to get the nurses into the community. She said at her hospital "it just happens - they do it on their own." They see their jobs as making sure there aren’t barriers to the natural processes that should occur.

Zastocki commented on the need for a diversity of approaches to ensure as leaders they don’t "force people back into those little boxes where they don’t think." She sees this as her job - creating the conditions so they will think and develop their own links to the community. "People are really feeling like they have ownership and are willing to let things evolve... also they see that it doesn’t have to look the same" for every team or project.

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Copyright © 2001, Brenda Jane Zimmerman and Curt Lindberg. Permission
to copy for Educational purposes only. All other rights reserved. Excerpt
from "Stories of the Emergence of Complexity Science in US Health Care" -
paper to be published in a book edited by Eve Mitleton-Kelly of the London
School of Economics.