How a £300 telescope made a big difference in helping patients with insomnia.
One of the most touching organisational changes that I was a part of occurred through the work I was doing with a consulting team, helping to turn around a failing mental health service that had a long-standing history of patient bullying.
One of the many signs of trouble in the organisation, was that the ward staff reported a severe problem with “patient insomnia”. They blamed sleepless patients for causing terrible problems with safety, sanitation and building security. Staff moaned about their endless battles to “force patients to go to bed at the designated time”, and they carried out harsh interventions on the wards. There was also bitter conflict between staff and managers as they fought with each other about the most effective ways to control patients’ sleep patterns.
The consulting team worked intensively with the whole mental health staff group to create an environment where people could be more curious and collaborative in thinking about their work. We pressed staff with key questions: Who is this service for? What is its purpose? What core values should guide what you do? What are your individual roles in delivering these?
A symbolic turning point came when one of the ward nurses requested £300 to buy a night telescope, and started a Stargazing Club for patients. This broke the deadlock: patients and staff no longer had to battle over the night schedule. instead there was an initial rush of patients joining the club, and then gradually as the weeks passed an increasing number skipped stargazing to catch up on their sleep. A few patients with enduring insomnia continued to make use of the club to relax and make the most of their waking hours.
What’s great about the Stargazing story is that it is a perfect illustration of systems thinking:
- When we tackle complex organisational problems, we often tie ourselves in knots by formulating the problem incorrectly. We tend to mix up the symptoms, the diagnosis, and the solution we want to achieve. So staff diagnosed their problem inappropriately as “disobedient patients refusing to go to sleep”.
- The “solution” we pursue is often part of the problem – it often makes matters worse. The nurses’ ward regime just hacked off patients and kept them awake.
- There is often a paradox built into the core of our “solution”. Anyone who has experienced insomnia knows it is impossible to force people to go to sleep!
- The intervention often produces the effects that we are looking for. The ward regime set rules that were impossible for patients to stick to – it provoked patients to break the rules.
- If our solution doesn’t work, we tend to slog away doing the same thing even harder. Staff failed to get patients to go to sleep, but they kept up their crusade anyway.
- If a solution isn’t working it is far more helpful to stop and try something different. Past failures should give us a clue about what not to do.
- We need to go back to basics to check that we have formulated the dilemma correctly. Have we differentiated the symptoms and tested our diagnosis before identifying a viable solution?
- The solution comes from letting go of what we think “should” happen. The nurse stopped treating patients as the problem – as disobedient people who “ought” to go to sleep.
- We need to examine how things currently are, by asking more “what” questions. What would support patients to make good use of their waking hours? What would relax people so they can fall asleep when they are tired?
- We need to break the cycle, not go head-to-head with a problem. Ask contradictory questions: “What’s so important about patients going to bed at the designated time? What about giving patients the opportunity to stay awake?”
- Solutions often appear to be illogical: keeping people awake to manage insomnia!
The Stargazing Club is that it’s a classic example of how clients are able to find much more effective solutions to their problems than anything that we consultants could come up with. What we can do best is create a safe context where clients can think together, and a clear framework that enables clients to see their organisations in an entirely different light.
The best advocate of systems thinking was Paul Watzlawick. He wrote umpteen books, but my favourite introduction to his ideas is: The Situation is Hopeless but not Serious – the pursuit of unhappiness. Norton books, London (1983)