1. Discovery and Action Dialogues

2. Purposes: D&AD Discover practices and behaviors that enable some people to find successful answers to common problems – so positive deviations in everyday activities They do it without anything extra special and work within the same constraints as everyone else Resistance to change evaporates as folks act their way into a new way of thinking/behaving We uncover hidden and untapped solutions with seven progressive questions regarding a shared challenge

3. Tips for Discovery and Action Facilitators Just get started and follow the group with your questions! DO: Start with the purpose, We are here to _______________! “Give” the questions to the group, wait at least 20 seconds for a response (sing Happy Birthday) Encourage quiet people to talk Flip cynical assertions by asking, “If I understand you correctly, no one has ever done this successfully or well” or “What would you do if there was an opportunity for change?” or “ I would like you to reframe what you just said with a question beginning with ‘what’ or ‘how’ that includes the word ‘I’ and contains some kind of ‘action’. Work through all or some of the questions without worrying about the order AND/OR follow the conversation with other questions (catch butterflies) Maintain humility at the feet of the people with the solutions Have a scribe to take notes (also catch butterflies)

4. Tips for Discovery and Action Facilitators DON’T: Answer questions that have not been asked directly to you – and even then, ask the group to provide an answer (they are the wise ones who will have the answers) Miss opportunities to ‘catch butterflies’ (record those ideas that got missed in the conversation) Come away with a ‘to do’ list for yourself Continue the conversation when others need to be present “Nothing about me without me”!! Invite them to the next dialogue. Avoid responding positively or negatively to contributions, invite the group to sift through their own assessments. You might ask “How/What to others think or feel about this suggestion??”

5. DAD 6 key questions 1.What do you know about xxxxxx (the problem)/how do you know when xxxxx (the problem) is present? 2.What do YOU DO about it personally? 3.What are the BARRIERS that prevent you from doing xxxx (or the right thing/process) 100% of the time? 4.Who do you know who is doing the extraordinary or who has overcome these barriers? (positive deviants) 5.WHO ELSE needs to be in on this conversation that isn’t here? (“Don’t decide about me without me”) How do we invite those people to be part of the action? 6.What other ideas do you have? Any volunteers?

6. What do you know about this problem/how do you know when the problem is present? What do YOU DO about it personally? What are the BARRIERS that prevent you from doing the right thing 100% of the time? Who do you know who is doing the right thing or who has overcome these barriers? (positive deviants) WHO ELSE needs to be in on this conversation that isn’t here? (“Don’t decide about me without me”) How do we invite those people to be part of the action? What other ideas do you have? Any volunteers? Affirm the participant’s existing knowledge of the problem Provide opportunities to get questions on the table Focus on personal practices, NOT on what other people don’t do Amplify/confirm the participant’s knowledge of effective process Identify real barriers and constraints to the effective behavior What prevents you? Identifies barriers rather than Why don’t you? Which sounds judgmental Establish that getting around barriers is possible Identify the existing-but-uncommon successful strategies Widen the circle of people involved in discovering solutions, drawing in unusual suspects Identify the supports that will help behavior change Provide an opportunity to generate ideas for change Identify action steps, timelines, and feedback loops Invite volunteers for each action step (Parking Lot?)

7. Examples For eliminating practices that keep doctors from helping patients change unhealthy behaviors For a series of local dialogues to help community members discover solutions to a chronic problem (infection control, disruptive children in a classroom, a cycle of violence that is not solved only by punishing offenders)

8. Examples Harm reduction for patients experiencing safety issues (wrong side surgery, patient falls, medication errors, iatrogenic infections) with cross-functional groups Researching and unleashing action to build professional competencies (medical schools, social service agencies) One-on-one conversations about how to approach a challenge

9. D&AD Keys to Success Hold the dialogue in the participant’s local context Make impromptu invitations as you enter the area Create an “informal climate”, starting with introductions and an anecdote if appropriate Maintain eye contact and sit with the group (not higher or away from the group) Be sure you talk less than participants, encouraging everyone to share stories and “sift” for action opportunities Demonstrate genuine curiosity in everyone’s contributions without answering the questions that arise Practice makes perfect!

10. LiberatingStructures.com Keith McCandless Henri Lipmanowicz