The e-mail sported a red exclamation point! The author pled for immediate attention to a problem that seemed neither urgent nor insurmountable. As I read on, I realized that the problem required better definition, an exploration of options, joint selection of the best of the options, and a commitment to monitor results and regroup if necessary. I immediately responded with the following, "Let's meet. I will come to your office anytime this morning." An hour passed before the response to my offer arrived, "Too busy today-but problem needs to be addressed." I immediately replied, "How about tomorrow morning? I am available from 8 AM to noon-for an in-person meeting or by phone." The response, "Working at home tomorrow, I will catch up with you! "Two days later, the "urgent problem" escalated to a "pending crisis" and was finally resolved when 5 administrators sat at a table and applied the simple process described earlier.
What went wrong in this situation? Why the delay, the mixed message about urgency, the failure to connect, the escalation, and the involvement of many more individuals? Failure to conduct deep problem solving is endemic in organizations. Problem identification is relatively easy but honing in on contributing factors, agreeing in the midst of poor interpersonal chemistry, testing consensus approaches, and reviewing results takes time, discipline, mutual respect, and tongue-biting strategies-scarce commodities in today's practice environment. The origin of the word "problem" is, of course, Greek. It means to "throw something forward," not backward, not out of sight-forward, out in the open, ripe for solving. For some, this takes courage. As nurses we learn early on to "keep our heads low," "avoid negative people," "keep the focus on our patients," and "don't rock the boat"; therefore, once confronted with a complex organizational problem, we are adrift; we retreat or we turf the problem either up, down, or laterally sometimes to avoid or blame and often with disastrous results.
As someone committed to a holistic philosophy, I ask that you fully engage in deep problem solving through a rubric that will enrich your practice and your life. First, never run from a problem; observe it, draw a picture of it, embrace it, and work with others to define it. If others avoid the necessary discussion and negotiation of possible solutions, pursue them, not through e-mail but in person. Start with the phone if you are a timid soul, progress to the "drop in," or, if you are in a position, call a meeting and serve food-a guarantee of attendance. Feel free to discuss all options and stick with it until there are one or two likely approaches. As Einstein once observed, "It's not that I'm so smart, it's just that I stay with problems longer." Keep notes on what works and what does not and get together (with food of course) to review results and tweak.
So what is holistic about this? There is no deep breathing or meditating on the problem, though those can be preliminary strategies. What is holistic about this approach is the promise of respectful engagement with others, a meeting of the minds to make the world, especially the world of practice, a better and safer place and a willingness to problem solve as if it were art.
-Gloria F. Donnelly, PhD, RN, FAAN
Editor-in-Chief