Navigating innovations in U.S. emergency services with PDIA

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Guest blog by Ken Bailey

I have been privy to the legislative and public policy process for well over 10 years, mostly with an amateurish understanding and certainly lacking the tools to be consistently effective. Having muddled in this space for a number of years, I have been successful on many fronts, again more through tenacity than with clarity of purpose. I have authored and pushed through several pieces of legislation, most of which have become part law in my State. Additionally, I have played the politics at the regional level, attempting to shape policy positions, largely with mixed results. As to be expected, my overall results have more losses than wins. Though it was not this loss / win ratio that bothered me. What concerned me the most was the idea that there was a better way of doing things that I was not aware of, thus I looked in to the Implementing Public Policy course at the Kennedy School.

As a dedicated public servant, I feel duty bound to be as effective as possible and believe that this course might provide me with a more meaningful way to shaping public policy for the next 7 to 10 years before I retirement. Here are some take away points I learned over the last several months:

Focus: For most of my career, I have been a problem solver. The issue was not about understanding the problem, but rather applying a solution. This course taught me to focus on the problem. To understand it, to dig deep and establish some degree of truth in how other people saw the issue. Solutions come after understanding and people are much more willing to work on solutions to problems they understand and find important.

People: Nothing gets done without other people. This course made it perfectly clear that building a network of people that care about a problem is absolutely necessary for lasting change. This also minimizes risk and provides diverse learning opportunities. For my part, I realized that in my previous efforts I was in a hurry to implement a solution and thus lacked the time to build relations that can make me more effective. The ability to listen, understand and empathize with people takes time and can’t be done overnight.

What’s more, these networks become more crucial over time, as they will provide new opportunities if they are cultivated for mutual benefit.

Hard Work: Hard work and dedication are still required of any effort. While this class will help on better understanding the landscape of public policy, it will not reduce the necessity to work hard to push our efforts towards success. That said, this class helped me in making my work more meaningful and certainly more effective by having a process and the ability to prioritize our efforts.

Communications: One of the most notable things I learned from this course was the need to be a better communicator. It is vital that we have the ability to tell our problem story in a short and concise way that will move people to action. This is not something that happens naturally and it is something that requires constant attention and modification.

One of the best parts about this class was the length and ability to focus on our individual projects. In my case, that project was standing up a family clinic in a fire station that would be available for local residents rather than transporting all 911 calls to the hospital emergency room. ER hospital diversion issues are not new, but a collaborative effort between the fire department and the University of Texas School of Nursing was certainly not the status quo. Our end goal was to have a seamless approach to healthcare where the public would not see any difference between their primary care provider and the fire department. In fact, we wanted them to have the sense that the fire department was an extension of their primary care provider.

I was fortunate to have been working on this concepts for about a year prior to having taken the IPP course. What I did not have was authorization, a deep understanding of the problem and little to no clue about how other people saw this issue. My plan was simply to push forward and hope I was successful. Being in the IPP course allowed me to put things on pause, dig deeper into understanding the problem, identify some potential risks and build a narrative about this project that was strong enough to withstand most counter attacks. It was this narrative and understanding that allowed me to obtain the necessary support and authorization to move this project forward.

Figure 1. Original Fishbone
Figure 2. Final Fishbone

The approach that the IPP program used is sound and repeatable. However, it takes some patience and the willingness to learn and take a journey to explore future possibilities. Most importantly it requires us to accept that we don’t have all the answers and work with others to explore those possibilities. For my part, I was used to being the person with the answers, more a constraint of my position that any real wisdom or understanding. I strongly believe that this course has helped move our organization towards a culture of learning.

For me, the lasting impact of this course is embedded in the map of the United Station in 1804. What was west of St. Louis was unknown, much like the solutions to our future problems. The PDIA process requires a commitment to learn, explore and try new things. It also frees us from assuming that our previous success provides the understanding of our known and unknown problems. Further, it allows us to make thoughtful and lasting changes to other people – perhaps even to be slightly more functional than legitimate.

This is a blog series written by the alumni of the Implementing Public Policy Executive Education Program at the Harvard Kennedy School. Participants successfully completed this 6-month online learning course in December 2020. These are their learning journey stories.

Learn more about the Implementing Public Policy (IPP) Community of Practice and visit the course website to apply.

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