Steven Rotkoff’s scientific contributions

Hierarchies in academic and clinical settings often preclude decision-making that results in the best idea. Schools of nursing have inherent hierarchies in both faculty rank and position. Higher ranking, tenured faculty influence promotion and tenure decisions. Junior faculty are frequently silent in fear of retribution. Similarly, new nurses and junior staff in clinical settings may be reluctant to speak up for the same reason. This chapter describes a case that shares both the internal and external dialogues typical among junior and senior faculty. The case illustrates how personal motives and faculty rank can influence participation in decision-making. The case begins with a description of how the situation might unfold without Red Teaming and continues with the same scenario using Red Team methods.

New graduate nurses tend to have little power and influence over how things are done. Despite an increased emphasis on evidence-based practice, frequently, things are done in certain ways because they have always been done that way. New nurses, fresh out of school, excited, motivated, and objective, rarely have any voice. They are expected to know their place and earn their voice. Experienced nurses are less likely to listen to new graduates who have no experience and are, as yet, unable to pull their own weight. This disparity engenders conflict. Red Teaming can assist nurse leaders to better understand the problem and work toward a resolution that satisfies both groups. This chapter presents a case of horizontal violence and the perspectives of new nurses and the experienced nurses who are reluctant to accept them.

Futuristic thinking and planning are challenging in both academic and clinical settings. Multiple perspectives are vital because ultimately, the people who implement the plans must believe in the plans. Managers and supervisors may be unaware of why a particular strategic priority is unrealistic or an action step is inoperable. Employees may wonder why certain steps were not undertaken before and not understand how largely invisible organizational units, such as finance and human resources, play significant roles in implementing strategy. This chapter presents a case of strategic planning within a school of nursing.

Outpatient clinics have their own challenges. Community clinics that serve the underserved may have even more challenges because these clinics endeavor to provide quality care equal to any other clinic but without the same resources. Staff may be inadequate to manage the number of patients seeking care and reliance on volunteer clinicians to augment the staff may be necessary. Front- and back-office staff, while dedicated to care of the patients, may have different priorities and strategies for how to ensure quality care. This chapter describes a hypothetical case and how Red Teaming helped reach resolution on two issues.

Some departments of nursing are housed within a school or college led by a non-nurse. Other schools of nursing are embedded within colleges led by non-nurses. Clinical areas run by nurses and consisting mostly of nurses, may have to answer to non-nurses. These are difficult organizational structures and pose unique challenges to the nurses who lead the nursing unit. Nursing has its own culture, licensing regulations, and accreditation requirements. Even the most collaborative and supportive non-nurse leader may have difficulty understanding why nurses do things in certain ways. Non-nurse leaders who are more focused on their own visibility and reputation than on the success of the nursing unit can be toxic leaders. Red Teaming cannot fix toxic leaders, but it can provide tools for functioning within a toxic environment. This chapter presents a case in which a school of nursing led by a nursing dean worked through how to manage within an environment led by a toxic non-nurse leader.

Humans, by nature, tend to act like pack animals and participate in groupthink. We are also reluctant to disagree with our supervisors for fear of retribution or being criticized for not being a team player. Further, if we become invested in a plan, we are loath to let go of it because we view our time and effort as having been wasted. We tend to engage in satisficing when all our presumed criteria for action have been met. Red Teaming teaches us to diverge before we converge. It permits us to remain agile so we can change quickly when the anticipated future changes.

Fundraising is always challenging. Academic and clinical settings must carefully consider from whom to raise the money and for what it will be used. In-depth analysis and multiple perspectives are necessary to reach the best outcome. This chapter describes a case in which a school of nursing must make an important decision that will require fundraising. There are several possibilities and the decision will have long-term consequences. Red Teaming methods assisted in the final resolution.

Improving the conversation through liberating structures

It is critical to understand that one is not likely to use Red Team tools as smoothly as one would like initially. Learning Red Teaming is like studying a new language regarding how to plan and make better decisions. Like any new language, it is awkward and halting at first. Similarly, the more one uses the language and fights through the early missteps, the more fluent one will become. People describe fluency in a new language as the ability to tell jokes in that language because jokes require a deep understanding of culture that is greater than simply the mechanics of communicating information. In Red Teaming, achieving that fluency of thought is evident when one can begin creating one’s own Red Teaming tools that reflect the underlying principles of Red Teaming but are specifically tailored to the needs of the unique problem.

Chapter 3 explored how to improve our conversations in general. This chapter (Fig. 4.1) makes an in-depth examination of the tools designed to better understand the problem, get to the root cause, and anticipate how the future around the problem may emerge. Unlike the tools mentioned in Chap. 3, these tools are planning specific. In planning situations, a combination of each of the categories of tools in both Chaps. 3 and in this chapter are used. As in Chap. 3, please pay attention to the structure of the methods described as they are critical to enabling divergent conversation and agile planning.