Video Transcript: Divergent & Convergent Thinking (Part 2)

Bob Lloyd, PhD, Executive Director Performance Improvement, Institute for Healthcare Improvement

In the first part of our discussion on divergent and convergent thinking, we laid out the various steps that one goes through to start from a few ideas, use some tools, and then engage in convergent thinking to bring those ideas back together. So, it’s this notion of engaging in divergent and convergent thinking.

Now I want to talk about how we do each of these different tools and methods a little bit. You can look these up, they’re very well known, it’s easy to follow the steps, but there are different ways to go about it. So, let me first talk about brainstorming. Brainstorming is when you sit around a table and you have all the people on your team, and you’re going to generate ideas about some issue, let’s say that you’re trying to reduce medication errors, or improve wait time in the emergency room. Now, if we go around with brainstorming, we go to each person and we say, give me an idea, give me an idea, give me an idea, and we use a flipchart and we would record, idea one, two, three, etc. But the challenge with brainstorming is that you just go around the circle of the table and everybody - idea, idea, idea, and what happens is at some point, somebody goes I don’t have an idea, and they end up passing. You can pass when you are engaged in a brainstorming activity, but you go around again and you come to this person and they pass. There’s a lot of pressure when you’re doing brainstorming because you want idea, idea, idea, nonstop, right around the table, and unless it’s a high functioning team that knows one another, brainstorming can sometimes be a little intimidating because people aren’t prepared to give you an idea on the spot. That’s where you go to nominal group technique; the different between these two is that with nominal group technique you’ll use sticky notes. Everybody gets a pile of sticky notes, and they put an idea on each sticky note, one idea per sticky note, but they do it in the privacy of their own thoughts. You give everybody say two minutes, so that you can now generate as many ideas as you want in those two minutes, one idea on each Post-it note, then you take those and you stick them on a flipchart. So the difference, the primary difference, between brainstorming and nominal group technique, is giving people this private, quiet time, to think, as opposed to putting them on the spot right away, idea, idea, idea. They both end up with the same notions, but you get there by a little different path. The other thing that you do is once you have all these ideas on your flipchart, you’re going to work to eliminate duplicates, and you can ask people to do that as you go around, if one of your ideas has already been taken don’t even bother talking about it because it’s already been out there on the board, and the second thing that you do is you clarify. You don’t justify, you clarify. You have an idea and somebody goes, “I don’t know what you mean by that”, and the person who presented that idea says, “What I meant was…”, and then you fill in the blank. But rationalizing, justifying, is not done during this period and that’s another thing that often times is a challenge for people because they want to try to explain why they had the idea as opposed to just clarifying it.

Now, once you have all these ideas, you engage in affinity diagram activity. Now, this is interesting because the main challenge here is that you do this quietly. You take all the ideas, let’s say that you had twenty to thirty ideas, each one on a sticky note. We take all the sticky notes, we put them up on a wall or a window or something that will hold them, and then in silence people start taking all these ideas, and let’s say that you have all these sticky notes on a wall, somebody might say, “I think this one”, in their own brain, “relates to this one”. And they take them and now stick those together in a little grouping. Somebody else says, “Oh, I think this idea also fits with that”, and they take it and move it over here. But again, this is all done in silence. Exactly. You want to have quiet, and what happens again is people often times want to start talking about why they think this is an idea, the facilitator needs to nip that in the bud, and engage in silence so that people are doing this, and moving the Post-it notes around, but they’re not giving justification. It’s a big challenge actually, and so a facilitator is highly desirable in doing affinity diagraming so that people do maintain that silence and people will put a Post-it note and other people will move it around and then somebody will take them and separate them and put them back together and until that process runs its course, you let it flow. What you finally do is, after you have each of these little groupings, you give them a name. Maybe this one is registration, and this one is assessment, so you need to finally look at what the ideas are in each little group and then give them a name, a title, for that category. Now, we have all these ideas, we’ve grouped them a bit, now it’s time to think about multivoting, rank ordering, and structured discussion.

What you do at the multivoting, and again this is when you have more than about ten ideas, if you have less than ten ideas, you can go right to rank ordering, because people can rank order up to about ten things before it gets too confusing, but if you’ve got more than ten items you need to go through multivoting. That’s when you give everybody little sticky dots, colored dots, and you ask them to put a dot by each idea. So, what you would do is you would make a matrix where you have the ideas here, and you put all of the Post-it notes, then you give everybody their sticky dots, and let’s say that you have thirty-five ideas, and so each person will have, let’s say, eight dots, and they can distribute those according to the thirty-five things. We’ve got one through thirty-five. And you need to decide if you are going to allow people to put all their sticky dots on one item, or one dot per item. Just a decision criteria you can make with your team. What you do then is let everybody vote, put their stickies one, and then all of a sudden you see that this one has this many, and this one had that many, and so on and so forth. Finally, what you do is you say, “Here are, say, the top six ideas”. Then what you do is you go to rank ordering. Now what we do is we put the initials of everybody as the column headings. So, we have Tom, and Mary, Bob, Matt, Mike, and every one of the people are then asked to provide a rank ordering on the final one, two, three, four, five, ideas. So, Tom says he gives the first idea, he thought that was five, this one’s a four, a one, a two, a three. Then, Mike says, “I think that one is a four, this one is a three, that one is also a one, this one is a five, and this one is a two”, and so on. Then what you do, after every one has voted, you sum them, and you get a total, over here. The only thing you need to be able to do is decide, is one the highest, or is five the highest. So, it doesn’t really matter, just make sure that the team is clear on that. Then, the item that gets the most votes, based on your scoring of one to five, that item is the number one choice that the team thinks will make the most effect on its outcome. So, finally what you do, is you take that item, down to structured discussion.

And now what you do is you have everyone again, sitting around your table, and everybody gets, say, one minute to say whatever they want to, positive or negative, about that final idea that you all multivoted on, and then rank ordered. And that idea, through dialogue, will help you make sure that everybody is buying into the idea that you’re going to take to the final round of work, and then finally take to the final round of starting PDSA cycles. So this whole notion of divergent and convergent thinking, incorporates a number of the tools, brainstorming, nominal group, affinity diagraming, multivoting, rank ordering, and structured discussion, and it’s a way to again, help the team go from a few ideas that individuals have, to building again, a few ideas that the team has.

Good luck with your divergent and convergent thinking!