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5 Simple Rules for Curious Leaders

Why It Matters

"We are more likely to find solutions closer to the point of care than the executive suite. If we ask questions first, before stating our opinions and thoughts, we will hear ideas and a range of views we might not otherwise receive."

The Institute for Healthcare Improvement (IHI) recently sat down with Derek Feeley, IHI President Emeritus and Senior Fellow. In the following interview, he shares the work of the Health Improvement Alliance Europe (HIAE) workgroup related to curiosity.

Leaders have so many things to focus on. Why is it important for them to be curious?

People are always dealing with multiple issues. and we do not have the luxury of dealing with issues sequentially. I cannot decide to one day focus on safety and the next day on person centeredness. A key skill leaders must develop is a way to make sense of the myriad of competing pressures and complex challenges. There is rarely a straight-line solution to a complex problem. As H.L. Mencken is credited with saying, “For every complex problem there is an answer that is clear, simple, and wrong.”

What inspired you to focus on curiosity with the members of the IHI Health Improvement Alliance Europe?

When leaders face a complex problem, they often go straight into solutions mode, but there is very rarely a quick fix that works for the long-term. Instead of traditional solutions-oriented, easy, and temporary fixes, what is the alternative? In my experience, having the right questions and a curious approach is better. The five simple rules borrow from complexity theory: if you are trying to make sense of a complex situation, create simple, order-generating rules. And that is what we did.

What is the first simple rule for curious leaders?

  • Ask rather than tell. Fundamentally, the job of the leader is to have the right questions. The answers to complex problems are unlikely to lie within the knowledge and ambit of the individual leader. Rather, they are likely to be rooted in the perspectives of multiple people with lived and learned experiences.

    We are more likely to find solutions closer to the point of care than the executive suite. If we ask questions first, before stating our opinions and thoughts, we will hear ideas and a range of views we might not otherwise receive. By asking rather than telling, we value the diversity that exists in our organisations. We’ll get solutions that make sense in the local context, rather than ones imposed from the top.

    The evidence from surveys on staff engagement is clear. Organisations with high rates of employee engagement have fewer patient safety incidents. That is a benefit of asking rather than telling. It’s also a product of an approach that’s based on engaging people and seeking collective wisdom.

    I was once visiting an IHI customer struggling with the sepsis bundle. Despite their best efforts, the teams had trouble with following the proper antibiotic timing of the protocol. Through asking those closest to the point of care for ideas, one of the nurses suggested creating a sepsis clock. She made a paper clock with movable hands to show what time the next step needed to happen. I do not think a CEO could have produced that idea. I know I wouldn’t have. Asking rather than telling often generates a more promising set of solutions through inquiry. It is an essential component of curious leadership, and we have chosen it as number one on our list for a good reason.

What is the second simple rule?

  • Listen to understand rather than to respond. If we accept number one, how we respond once we have asked a question is vitally important. Rules number one and two go hand in hand because it is so important to think about how we present ourselves when we ask questions. Too many leaders go to the point of care to share what they already know and think. That is unlikely to be productive. Too frequently, leaders listen to respond and to demonstrate their knowledge when they should really be deeply listening to understand.

    I have seen many leaders who listen well, and there are concrete behaviours they demonstrate when they are listening to understand. Leaders will say things like “tell me more about that” or “help me understand that better” to show they are curious and open to learning.

    Listening to understand requires what Edgar Shein calls “humble inquiry.” His book by the same title is an excellent resource. People can learn and build these skills over time.

What is the third simple rule?

  • Hear every voice rather than only those easiest to hear. The democratisation of opportunity and knowledge is key to problem solving. I can think of many times when a person who had not spoken up before shared an amazing idea. It is important to take the time to hear multiple voices including staff, clinical colleagues, service users, patients, and carers. Dr. Ruth Gray, Assistant Director in Quality Improvement and Innovation at South Eastern Health and Social Care Trust and HIAE workgroup member put it nicely when she said, “It is important that a leader enable diverse voices and experiences to enter a welcoming arena to be heard.”

    People take different amounts of time to process information, analyse a situation, and form ideas and opinions. Our minds work in diverse ways. Those who take longer will not be the first to speak, and unless you provide time and space, they will not ever get a chance. Leaders need to find time for everyone, especially for the quiet thinker.

    It is also important not to assume that if people have a promising idea or something important to say that they will simply say it. As a leader we must actively invite people to contribute rather than require them force their way in. Leave time and space for people to share, give everybody an opportunity to contribute, listen to multiple perspectives before concluding a conversation, and be sure to allow time for quiet reflection.

What is the fourth simple rule?

  • Prioritise problem framing rather than problem solving. Our emphasis on curiosity and listening to understand must extend all the way through the solving of problems. In practice, this means leaders saying things like “have we considered” or “what if.” Prompting questions lead us to a deeper understanding of the problem rather than jumping straight to solutions. Einstein is often credited with saying, “If I had an hour to solve a problem, I’d spend 55 minutes thinking about the problem and five minutes thinking about solutions.” That’s what we’re asking leaders to do.

    Thinking strategically, when we frame a problem rather than jumping to a solution, we help people connect their work to the mission and vision of our organisation. The connections make work more meaningful, and the ideas generated by people closest to the problem are more likely to be sustainable.

Finally, what is the fifth simple rule?

  • Treat vulnerability as a strength rather than a weakness. This rule goes against the assumption that leaders always need to be tough. Our working group originally framed this simple rule around considering vulnerability as a strength, but after lots of good discussion, we decided to take it a step beyond thinking. We are asking leaders to acknowledge the strength of vulnerability within themselves and their teams. Professor Brené Brown’s TED talk, “The Power of Vulnerability,” about her research on the need for connection helps us think about vulnerability as a strength. Organizational behavioural scientist Amy Edmonson’s approach also highlights the importance of vulnerability in leaders to create the psychological safety essential for any organisation striving to provide high-quality and safe care.

    This simple rule completes the circle that begins with asking questions. Leaders must admit that they do not know everything and see that admission as a prelude to enquiring about people’s ideas. It opens the door to testing changes and learning. Priit Tohver, a workgroup member and Head of Sustainable Development at North Estonia Medical Centre, shared that “it’s really important that we as leaders act vulnerable, but we should also appreciate the vulnerability of others.”

    It can be difficult to say the words “I don’t know.” Instead, we can say things like “I’m not absolutely sure” or “I’ve got some ideas but want to hear what you think first.” But really, it is ok to also say “I don’t know” and “you’ll know better than me.” It is crucial to defer to both lived and learned expertise to help us provide safer care more reliably and generate a virtuous cycle of inquiring, listening, hearing, learning, and working together to solve problems.

Is any one of these rules more important than any of the others?

These rules fit together nicely; they are a set. They are also “all or nothing” because they are mutually reinforcing and enabling and in that lies their simple strength. We invite you to try them out the next time you face a complex problem.

Editor’s note: This interview has been edited for length and clarity.

Angela Zambeaux is an IHI Project Director.

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