PDIA and Dementia in the Workplace

Guest blog written by Tamsir Cham, Andrea Hayes, Fateme Najafi, Aysha Valery

This is a blog series written by students at the Harvard Kennedy School who completed “PDIA in Action: Development Through Facilitated Emergence” (MLD 103) in March 2020. These are their learning journey stories.

Overall, we learned that the PDIA process is about being patient, digging deep into a problem, continuing to iterate, and engaging both the stakeholders and the authorizers.  We also learned how to dig deep into problems.  Digging deep requires discovering the underlying or root causes of a problem. To discover these causes, we kept asking ourselves: “Why is this a problem?” In PDIA terms, we call this “The Five Whys.”  In our case, our dialogue went somewhat like this:

  • Why is it a problem that the state of Massachusetts is not equipped to handle dementia in the workplace?  
  • Because there is lack of awareness.
  • But why is there lack of awareness? 

Once we dug deeper into the problem, or deconstructed the problem in PDIA language, we drew the bones on our fishbone diagram.  In the words of Tamsir Cham, “Just like all the bones make up the fish, if you don’t have all those bones together, you won’t have a fish.”

Over the course of the next several weeks, we redrew our fishbone diagram at least two more times.  

We discovered that deconstructing the problem had several benefits.  We found new stakeholders or new interests for current stakeholders. For example, we would have never discovered that the state of Massachusetts had an interest in solving this problem because it cannot get tax revenue from people that are not working.  Additionally, every hour of work lost by a caregiver to care for a family member with dementia means potential lost tax revenue for the state.  It also means loss of income to the caregiver, resulting in economic hardship to the caregiver and his/her family.

Deconstructing the problem also allowed us to check our assumptions.  Too often, we rush to solutions.  There was an initiative to give money to caregivers for respite services, or people to relieve them temporarily of the caregiver duties.  However, no one took the money because they did not trust the respite service providers with their loved ones or even in their homes.  This was a quick reminder to spend more time understanding the problem before identifying ideas for intervention. 

Once we identified the root causes of the problem, we found places to intervene. We learned a system for how to do this.  We started by seeing on which part or parts of the bone we have the most authority, ability, and acceptance.  This is also known as the Triple A analysis.  We decided together with our authorizer, Olga Yulikova, that the lack of awareness and the lack of coordination on caregivers’ needs in the workplace were the areas where we had the most authority, ability, and acceptance.  This helped us to identify the small incremental steps that we could take to gain headway into this problem.  Therefore, we no longer had to be paralyzed to intervene in complex challenges for fear of not knowing where to start.  Eventually, if we had more time to act, we would see that these small incremental steps would add up to produce a large change.  

As we continued to work on the problem, we continued to zoom in and zoom out.  We had to hold both the big picture, the context in which the problem was taking place, and the narrow part of the problem that we were working on, which was caregivers’ needs in the workplace.  

Through the PDIA process, we gained a lot of insights into the problem that we were dealing with.  The big insight was: This is a problem that affects all of us or could happen to any of us.

Understanding this helped us to see that changing the narrative around dementia could help people to become more empathetic to people affected by dementia and their caregivers.  In this way, lack of awareness was not only part of the problem, but it was also part of the solution.  

In addition, talking to different stakeholders, helped us to see that different sets of caregivers have different needs.  For example, young caregivers that are working face different challenges from older caregivers that are not working. Older caregivers may need more support because they have less income and less energy to care for someone else. 

We also underestimated the importance of infrastructure in the solutions to this problem.  For example, we never could have guessed the role that website design could have played in making sure that caregivers could access the information that they need easily. 

We also learned a lot about working together as a team.  We each came from completely different backgrounds and countries.  We spoke completely different languages as children.  Nevertheless, this diversity never hindered us.  In fact, it helped us.  It was the catalyst that allowed us to work more productively because we were each able to bring a unique perspective to the problem.  For example, we realized that the lack of support for people facing dementia in the workplaces was a symptom of a culture that values independence and self-sustainability.  We would not have realized this unless we had some people in our group that were from non-Western countries.  

Diversity is a necessary condition to a productive team, but it is not a sufficient one. This unification across differences, both in terms of perspectives and backgrounds, would never have happened without us putting in place certain mechanisms.   We had to create an atmosphere that was conducive to expressing this diversity as well as a way to work together.  We had to be honest with each other when we could not do something that we had promised to do and work with each other’s schedules.  We had to have grace for one another and humility to see each other’s perspective.  We had to understand that we are not always right. 

In addition, we had to be committed both to each other and to the problem.  In the midst of our work, we realized not only that dementia could affect us, but also that each of us, including our authorizer, knew someone experiencing dementia.  This fueled our passion to keep tackling this massive problem and to not give up. Our passion helped us to continue supporting each other to persevere. 

Finally some parting words of wisdom:

  1. Test your assumptions: Do your research, but do not forget that your team is a resource.  Do not be afraid to bounce ideas off of them.  
  2. Set up channels for open communication: You cannot get the benefit of good ideas from your teammates or exploit the benefits of diversity without creating an atmosphere to allow for these ideas to surface.
  3. Be open and accommodating to each others’ schedules

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