Monday, August 31, 2009

Staff Nursing Paradox Addendum

By: Gary J. Salton, Ph.D.
Chief: Research & Development

Professional Communications, Inc.

This addendum consists of material that is relevant to the Staff Nursing Paradox article. It collects the practical information that is true and useful but that does not meet the evidence-based criteria of the Organizational Engineering research blog.

Hospitals benefit from strengths the Logical Processor (LP) brings and sometimes suffer from its vulnerabilities. On the strength side the LP staff nurse is characterized by:
  • High competence in operational execution
  • Precise, comprehensive and thorough
  • Dependable, dedicated and trustworthy
  • Methodical, deliberate and rational
  • Patient, level-headed and self-composed

The vulnerability side is typically the corollary of the strength. Change the corollary and you change the competency. And vice versa. The first thing for hospital management to realize is that they are dealing with a system and not stand-alone qualities.

For example, high execution competence means that “how” something is to be done must be known in detail. Leave out the detailed specification of methods and “high” competence evaporates. This means that flexible adaptability to new methods, processes and procedures comes at a price. That price is a forfeiture of excellence in execution.

The same logic applies to every one of the other qualities listed. Being methodical and deliberate precludes spontaneous improvisation. Patient, levelheaded behavior is inconsistent with charismatic enthusiasm. Improvisation forecloses the ability to be precise, comprehensive and thorough. The trade offs are inevitable. They are built into the structure of human nature.

There is some wiggle room. We all have access to all of the possible strategic styles. Anyone can adopt any strategic style posture in a particular instance. This means that hospitals can successfully implement initiatives that are contrary to a style preference.

The issue is how long it can be sustained. This depends on the degree of commitment to the style. For example, the Reactive Stimulator (RS) style is particularly adept at handling work overloads. If a hospital implements and initiative designed to handle an overload condition, it is likely that the staff nurses will draw on their RS abilities.

Graphic 1 shows the average staff nurses’ degree of commitment to each of the “I Opt” styles. It shows that hospitals should not depend on tapping into the Reactive Stimulator (RS) or Relational Innovator (RI) styles on a sustained basis. The common element of both of these strategies is their input is undisciplined. Anything that looks like it might work is accepted. The consistency, predictability and certainty needs of the LP are certain to be quickly frustrated by this condition.

Graphic 1

Quickly accommodating change, generating new groundbreaking ideas, ready acceptance of contrary opinions, fast reaction to unfamiliar situations and easy forgiveness for past transgressions are some of the behaviors that will be difficult for a staff nurse to sustain. There are many more. Some sense of how an LP views the world can be obtained from Shannon Nelson’s “Secrets of a Logical Processor” article on If you are not an LP yourself, the article is likely to be eye opening.

Specifying the exact management strategy suitable to a particular hospital with specific program needs is beyond the scope of this article. That is best left to someone who is certified in Organizational Engineering and who has the confidence of management. They will be able to take into take the situation, circumstances and specific capacities of the hospital into account.

The above notwithstanding, there are some general observations that are relevant to staff nurse management. The current popularity of “ten things you can do” lists suggests itself as a format for presenting them.

  1. Change is defined as anything that disrupts a normal pattern. For example, you may think that minor alterations of a schedule are inconsequential. The LP may have a different view. Hospitals should recognize that any change is an important one.

  2. LP’s can execute known procedures very fast. But unfamiliar methods and matters will be done slowly and with great care. Hospitals should take care in inferring that the speed in one activity predicts the speed in another. Expectations need to be realistic.

  3. Assimilation of change will take a lot of time. Explaining the “why” is important. Providing the “how” in excruciating detail is vital. Hospitals need to invest heavily in their human capital to effect major changes.

  4. Styles such as RS and RI handle overloads with ease. The LP can be overwhelmed. When this happens they simply freeze up. This happens because they are detail sensitive and enough detail can overwhelm any mind. Hospitals need to carefully monitor the demands they put on the LP.

  5. LP’s are inherently conflict averse. It is a natural outcome of their need for certainty and order. Conflict is inherently turbulent. Do not expect the LP to tell you of their discomfort or anger. LP’s can and do get angry but they seldom show it. Hospitals would do well to test morale using sensitive, indirect or non-threatening means. It is very easy to be misled.

  6. LPs do not forget. This is a corollary of order, consistency and the pursuit of perfection in execution. Evidence of unworthy motives and intentwhether true or not—pile up and harden. Hospitals should recognize that difficulties will not “go away.” Investments to minimize negative issues will pay large dividends into the far future.

  7. The LP is literal. Analogies are irritating. Metaphors are a distraction. Similes are annoying. Hospitals need to be explicit in their communications. Expecting LPs to draw the expected inferences is a formula for disaster.

  8. Avoid superlatives and optimistic scenarios when attempting to enlist the LP. They are born skeptics. Overstating matters simply gives them more aspects to pick apart. Hospitals need to be realistic, honest and complete.

  9. Certainty is highly valued. Predictability is the evidence that the certainty is well founded. LPs hate surprises. Hospitals need to create and maintain as predictable environment as possible even at the cost of some efficiency.

  10. Be honest. The LP style uses “facts” to guide their behavior. If “facts” can be called into question their entire interpretive system is threatened. They will react unfavorably.

The items on this list are merely samples abstracted from a system of behaviors that derive from the LPs way of interpreting the world. They can be used as they stand without any knowledge of “I Opt” technology from which they were drawn. Applied appropriately, they will produce positive results almost instantly.

There are many more corollaries to the LP strategic style. In addition, other styles can interact with the LP to produce emergent behaviors that only show up when styles are combined in a particular way. These multiple qualities can be harnessed to pull in the same direction at the same time. Positive effects are then magnified multi-fold.

These added capacities—knowledge of the range corollaries, emergent behaviors and system level strategies—can only be obtained by investing in learning “I Opt” technology. This sounds like a promotional strategy. It is not. It is simply a statement of fact. “I Opt” is an entirely new paradigm. It is not a spin, derivative or other variant of an existing approach. Like mathematics, once you know it you can apply it to anything you choose in any manner that you choose. But first you have to invest in learning it.

Our research has shown that, in all likelihood, the staff nurses in any hospital probably subscribe to the LP strategic style. Making the assumption that the staff nurses in your institution are dominantly LP in orientation is a relatively safe but not risk-less bet. There are always exceptions to any general rule.

Our websites and research blogs are full of free articles and materials that you can use to gain insights and action options that can be applied to people using this style. It is likely that you will gain from the effort. But you will not see the full power of the technology nor will you enjoy its full benefit without investing in building your knowledge base. We have made knowledge acquisition as easy and inexpensive as possible. If there is a need, it is a worthwhile investment.