The Breakthrough Formula for Solving Just About Anything Fast
David Benjamin and David Komlos
Nicholas Brealey Publishing, Boston, 2019
Reviewed by Laura Calhoun, MD
Since learning the difference between technical problems and adaptive challenges more than a decade ago, we have known that the traditional command and control structure is not conducive to solving the complex problems of health care. Understanding complexity theory and knowing how to tell when a problem is simple, complicated, or complex was helpful, but no one has come up with a standardized process for solving complex challenges. Until now. This book builds on the work of Argyris1 and Heifetz et al.2 and lays out a process or formula that, if used with fidelity, may be the answer we have all been searching for.
Canadian authors, David Benjamin and David Komlos, show how using the formula can engage and align teams, cross silos, create space for innovation, and solve complex challenges in a consistent and replicative process.
The beginning chapters deal with a review of complicated vs. complex and introduce the reader to three companies that have used the formula successfully. Over the course of the book, the same companies are followed, allowing for “how to” and real-life stories, which help the reader see how the steps in the formula actually work.
Complex challenges are “the confounding head-scratchers with no right answers, only best attempts.” Having a wedding is complicated; having a happy marriage is complex. Rolling out a new EMR to enable transformation is complicated; transformation is complex.
Benjamin and Komlos have invented some metaphors and analogies to help the reader gain understanding quickly. One I liked in particular is called “the Lion in the Office.”
“Imagine you walk into your place of work one morning, open your office door, and see a lion sitting on your desk, licking its chops. In the blink of an eye you are able to sense the lion, absorb the implications of its presence on your desk, think about your options, decide on a good course of action, and act (very likely by turning around, slamming your door and running in the other direction).
“The lion is the metaphorical complex challenge. The sensing, absorbing, thinking, deciding, and acting are the steps needed to overcome a complex challenge. But these steps are distributed among different people or teams in an organization. Even when the challenge is big and scary, or the opportunities highly compelling, people across and around your organization are seeing them in different ways at different times.” The authors use the acronym SATDA as a heuristic which is one of many they have made up to make the reading of this book lively. Top
A graphic representation of their process, much like a graphic representation used to guide the treatment of illnesses, is presented early on in the book. There are 10 steps in the formula and each subsequent chapter is a detailed review of a step with an accompanying story from one of the companies with whom the reader is now familiar.
Step one of the process is “Acknowledge the complexity.” A table lists all the questions a leader can ask to determine if the challenge is complex or complicated. For example:
“Have you solved the problem before and then been able to implement that same solution successfully in a variety of similar situations?” If the answer is “yes” then the problem is complicated. If the answer is “no” then it is complex.” They go on to list a variety of sub-questions along these lines, which are extremely helpful in teasing out the subtleties. Top
Step two is “Construct a really, really good question.” The book acknowledges that this step in itself is not easy. They give some helpful hints, which they call “rules of Q.” One of the rules of Q is: “When jumping into complexity, do that from any part of the deck because it is all one pool.” Here is one of the really, really good questions: “How can healthcare organizations in our state work together in new ways to improve outcomes for patients struggling with mental health issues?”
Rather than list the rest of the steps, here are some of the principles that can be pulled out of the formula. They are the same principles elucidated by Heifetz et al.2 a decade ago.
Solving a complex challenge requires people with different views to come together to listen and learn from each other so that solutions can emerge. The authors call these types of conversations “engineered collisions.” They lay out how to manage these collisions so that everyone learns, everyone listens, and everyone observes. And they emphasize that these collisions can’t just occur once, they need to be iterative and occur three times before solutions emerge. Top
The downside to the formula is that, to be successful, the people who own the problem and the solution need to show up and work together for three straight days. The first half day is spent making the agenda, because only the people who own the solution know what really needs to be talked about. By letting go of control in this way, leaders ensure that any “elephants in the room” surface, which ensures that the emotional aspect of any complex challenge is dealt with as part of the solution.
The engineered conversations take place over the next 2½ days. These are set up in a manner than ensures everyone talks to everyone else three times. This means the number of conversations is n(n − 1). If there are 20 people who own the solution, there will be 20 × 19 = 380 conversations. The formula describes exactly how to do this in a step-by-step manner that leaves the reader quite convinced that, with the right people, they can tackle any complex challenge.
The book goes on to lay out what to do with the solutions that emerge: how to create an action plan with metrics and a time line. Because the people who own the problem have come up with the solutions, they are already engaged and aligned. Because the right people are in the room, the silos have already been breached. People know what they need to do together to solve the challenge, what might get in their way, and how they can mitigate potential obstacles.
This book is a game changer. I highly recommend it for leaders at all levels.
1.Argyris C. Overcoming organizational defenses: facilitating organizing learning. New Jersey: Prentice Hall; 1990.
2.Heifetz R, Grashow A, Linsky M. The practice of adaptive leadership: tools and tactics for changing your organization and the world. Boston: Harvard Business Press; 2009.
Laura L. Calhoun MD, FRCPC, MAL(H), CEC, practises psychiatry and has a role as a physician leader in Alberta Health Services.
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