Blog from August, 2023

Six Methods for Sustained Collaboration

Reading Time 8 mins

Wondering about the real importance of collaboration in organizations? Just ask any leader, and you'll receive an enthusiastic confirmation. Yet, when it comes to the actual outcomes of their collaboration strategies, the answers might differ. A high-ranking executive from a major pharmaceutical company recently revealed, “We've tried various changes, but nothing sticks or brings the results we anticipated.” This sentiment resonates widely—many leaders share the same frustration, investing substantial effort with disappointingly little to show. 

The challenge often stems from how collaboration is perceived—as a value to uphold, rather than a skill to cultivate. Companies have experimented with methods like open offices and official collaboration goals, yielding progress by creating opportunities or demonstrating support, but relying on superficial or forceful means. Surprisingly, these tactics rarely yield consistently effective collaboration. A psychological shift is needed. Successful collaborations in various industries share a mindset characterized by respect for colleagues' contributions, a willingness to explore diverse ideas, and a keen awareness of how actions impact both peers and the mission at large. Unfortunately, these attitudes are scarce. Most individuals lean towards skepticism and self-focused biases. The task for leaders is to transform this self-centric outlook into a genuine interest in learning from others. Refer to our blog article 7 Sneaky Cognitive Biases that Wreak Havoc on Innovation. 

Though it may seem like a daunting task, some organizations have cracked the code. Recent research has identified six interactive training techniques that empower leaders and employees to collaborate seamlessly, learn from each other, and overcome psychological barriers. These methods facilitate deeper and more consistent connections by emphasizing distinct phases—listening, expressing ideas, critiquing concepts, and selecting the best ones to pursue. By clarifying these stages and preventing overlap, these techniques lay the groundwork for genuine collaboration to thrive. Practical examples are provided to offer context and adaptable solutions.  

1) Teach People to Listen, Not Talk: In the competitive business world, the art of self-presentation takes center stage. Employees invest significant effort in making persuasive arguments, impressing bosses, and ensuring their viewpoints are heard. However, this obsession with self-presentation can hinder effective collaboration. Research indicates that instead of truly listening when others speak, people often gear up to respond. This inclination grows more pronounced as individuals ascend the corporate hierarchy. Anxiety about personal performance and the belief in one's superior ideas are among the reasons for this. This lack of attentive listening leads to conflicts that could be avoided, missed opportunities for progress, alienation of unheard colleagues, and reduced team efficiency. 

Four actionable listening examples of how to: 

• Ask expansive questions: Pixar encourages this behavior by incorporating a 90-minute lunchtime class on listening skills. The class is adorned with posters urging participants to "Stay curious" and "Build on others’ ideas." Open-ended "what" and "how" questions are emphasized over yes-or-no queries. This encourages more comprehensive information sharing and reflection. 
• Focus on the listener, not on yourself: Demonstrated through exercises, active listening involves empathetic responses rather than self-centered reactions. Coaches simulate conversations, showing how active listening involves understanding the speaker's emotions and experiences, as opposed to turning the conversation towards oneself. 
• Engage in "self-checks": Webasto's North American roofing-systems business unit implements the Listen Like a Leader course, which incorporates self-checks. Participants analyze their past listening failures and identify common patterns. This raises awareness of their own tendencies, fostering improvement. 
• Become comfortable with silence: At Webasto, they initiated another exercise involving silent participation in a conversation while maintaining positive body language. This approach promotes an atmosphere of attentiveness and respect, providing less vocal individuals with an equal opportunity to contribute.

2) Train People to Practice Empathy: Recall your last conflict with a colleague – often, we tend to perceive the other person as either uncaring or lacking intelligence in such situations. However, my research suggests that fostering receptiveness to differing viewpoints can lead to better outcomes. In successful collaborations, a key assumption is that everyone involved, regardless of background or position, is intelligent, caring, and fully engaged. This outlook fosters a desire to comprehend diverse perspectives, enabling constructive conversations to take place. Instead of judgment, curiosity takes the forefront, allowing the recognition of the value of other viewpoints. Two valuable approaches can facilitate this. 

Two examples of how to think: 

• Expand others' thinking: Pixar utilizes an exercise called "leading from the inside out," where collaborators present a challenge and teammates ask questions without pushing their own ideas. The aim is to aid the presenter in rethinking the problem from various angles. The questions delve into the presenter's and others' perspectives. This technique encourages active listening and generates creative solutions, contributing to a sense of being genuinely heard. 
• Look for the unspoken: A marketing firm employs a similar approach and trains participants to pay attention to unspoken cues. When someone presents an idea, colleagues focus not just on the words, but on the presenter's tone, body language, and underlying emotions. By addressing these subtleties, team members create a more empathetic atmosphere, enhancing satisfaction with discussions and promoting smoother collaboration. 

In addition to listening and empathizing, engaging in candid conversations and expressing views courageously is crucial in effective collaboration. The next three techniques concentrate on achieving these goals. 

3) Make People More Comfortable with Feedback: Effective collaboration hinges on giving and receiving feedback adeptly, rooted in influence rather than authority. Here's how you can cultivate this practice. Implementing these strategies can be challenging, but the transformative impact on collaboration and personal growth is well worth the effort. 

Five examples of how to attain feedback: 

• Discuss feedback aversion openly: Pixar’s new managers are trained to provide and receive feedback more effectively. By acknowledging that many of us shy away from feedback – as givers, we fear hurting others; as receivers, we juggle the desire for improvement with the desire for acceptance. This open discussion normalizes these concerns and fosters a sense of shared experience. Consider using the Design Critique method. 
• Make feedback about others’ behavior direct, specific, and applicable: Organizations like Pixar use three principles for impactful feedback: Be straightforward in your communication; specify the particular behavior you're addressing; and elucidate the impact on you and others. An exercise challenges participants to provide feedback using these principles and reflect on the experience. This addresses the tendency for vague feedback and empowers clearer communication. 
• Give feedback on feedback: Volunteers share drafted feedback, while others contribute suggestions for improvement. This practice counters the common challenge of offering vague or indirect feedback. The process, often aided by rehearsing, equips leaders with the confidence to articulate their thoughts succinctly and effectively.  
• Add a “plus” to others’ ideas: At Pixar, commenting on a colleague's idea entails offering a constructive "plus" – a suggestion for improvement. This method draws from improv comedy's principles: accept all ideas, build on them with a "Yes, and..." approach, and elevate your teammate’s contributions. Consider  
• Provide live coaching: Coaches participate in brainstorming sessions to reinforce constructive feedback methods. They intervene when comments lack a collaborative spirit, encouraging reframing. While these interventions might initially be met with resistance, they're ultimately seen as invaluable gifts for personal development. 

4) Teach People to Lead and Follow: While the qualities of effective leadership are widely studied, the importance of adeptly following hasn't received as much attention. Successful collaborators master both roles, fluidly transitioning between leading and following—a skill known as "flexing." Cultivating flexing skills ensures individuals can seamlessly switch between leadership and follower roles, enhancing collaborative dynamics. 

Three examples of collaborative leadership: 

• Flexing in Crisis: During the Thai cave rescue in 2018, diverse experts collaborated to rescue a trapped soccer team. Flexing between leading and following allowed them to combine their expertise effectively. When an inexperienced engineer suggested an unconventional plan to divert rainwater using tubes, senior engineers flexed by considering the idea, which ultimately proved successful. Flexing involves relinquishing control, a challenge for many. Boosting flexing skills can be accomplished through straightforward exercises: 

• • Increase self-awareness: By having individuals rate themselves relative to peers in areas like decision-making, interpersonal skills, and honesty, their inflated self-perceptions become evident. Recognizing this disparity helps build self-awareness, crucial for successful flexing. 
  • Learn to delegate: Effective delegation isn't solely crucial for leaders; it's equally vital for collaborative efforts. Pixar's training on delegation explores common reasons for micromanagement, emphasizing trust-building and adopting a tailored approach based on the skills and motivation of those taking control. 

5) Speak Clearly and Avoid Abstractions: In collaborations, the ability to navigate discussions effectively between sharing ideas and providing clear directions is vital. Psychological research reveals that our communication often becomes overly indirect and abstract. Precision and vivid imagery in communication are shown to increase impact and perceived truthfulness. For instance, communication exercises in organizations like Pixar and a pharmaceutical company involve role-playing to practice conveying messages with clarity and purpose, reframing abstract statements into concrete, specific directives, and enhancing collaboration dynamics. Consider using improvise role-play method to dry-run conversations.

6) Teach Win-Win Interactions: In a classic exercise, students are paired to divide an orange, each secretly assigned a unique purpose: one for juice, the other for the peel. Often, without discussing interests, they either argue or settle for equal, but less beneficial, shares. This demonstrates the importance of exploring both sides' needs for mutually beneficial outcomes. 

Effective communication often falls short due to indirectness and abstraction. Only a few excel at optimal win-win outcomes by genuinely investigating each other's needs, a key aspect of successful collaborations. In such projects, transparency about personal interests and contributions leads to more favorable results, allowing participants to explore various winning scenarios. Many organizations teach team leaders and employees to discover mutual interests through exercises simulating real-world collaborations, emphasizing techniques like questioning, attentive listening, and understanding each other's perspectives. Balancing self-expression with inquiries and comprehension fosters solutions that add value, unlocking opportunities in differences with a win-win mindset. 

Conclusion:

The six techniques work in harmony and complement each other, making it optimal for employees to incorporate them all regularly. Balancing talking and listening, empathy and self-expression, they foster a positive cycle of respect, enthusiasm, and openness. This cycle, however, hinges on leaders and teams initiating it. Encouraging collaboration involves consistently owning mistakes, actively listening, respecting diverse viewpoints, and fostering direct yet respectful communication. By training individuals in these techniques, teams and leaders can establish a culture of sustained, productive teamwork. 

Resources:

Harvard Education - Win Win Negotiation: Managing Your Counterpart’s Satisfaction: https://www.pon.harvard.edu/daily/win-win-daily/win-win-negotiations-managing-your-counterparts-satisfaction/

Forbes - Leadership From The Inside Out: Eight Pathways To Mastery: https://www.forbes.com/sites/kevincashman/2017/10/08/leadership-from-the-inside-out-eight-pathways-to-mastery/?sh=30b0492f549c

The Royal Society Publishing - The impact of the ‘open’ workspace on human collaboration; https://royalsocietypublishing.org/doi/full/10.1098/rstb.2017.0239

Research Gate - Truth From Language and Truth From Fit: The Impact of Linguistic Concreteness and Level of Construal on Subjective Truth: https://www.researchgate.net/publication/47429344_Truth_From_Language_and_Truth_From_Fit_The_Impact_of_Linguistic_Concreteness_and_Level_of_Construal_on_Subjective_Truth

NNG - Design Critiques: Encourage a Positive Culture to Improve Products: https://www.nngroup.com/articles/design-critiques/

United States Peace Institute - What is Active Listening? https://www.usip.org/public-education-new/what-active-listening

MindTools - Active Listening: https://www.mindtools.com/az4wxv7/active-listening

Harvard Business Review - Cracking the Code of Sustained Collaboration: https://hbr.org/2019/11/cracking-the-code-of-sustained-collaboration 

HCD COE - 7 Sneaky Cognitive Biases that Wreak Havoc on Innovation: 7 Sneaky Cognitive Biases that Wreak Havoc on Innovation

Improv: Building Ideas With the Yes, and Principle : Improv: "Yes, and" Marketing Brainstorm Exercise: https://www.youtube.com/watch?v=eicyG2hPoIE

5 Ways to use Role-Playing in eLearning: https://www.youtube.com/watch?v=kF4qKbVFR0s

HCD COE - Critique: Design Critique Workshop: Design Critique Workshop

Why all the Healthcare Supply Chain Shortages? 

Reading Time 6 mins 

The COVID-19 pandemic exposed vulnerabilities in the US health system supply chains, leading to persistent and elevated supply shortages, economic uncertainty, and growing inflation. Between 2021 and 2022, new medication shortages spiked by close to 30 percent, and according to the American Society of Health-System Pharmacists (ASHP), health systems now recognize the need to improve supply chain resilience to face future challenges. During the pandemic, health systems struggled with shortages of personal protective equipment (PPE) and resorted to unconventional procurement practices, sometimes resulting in overstocking or receiving subpar supplies. As the pandemic abates, health systems are focusing on creating more resilient, efficient, and economically viable procurement approaches for the long term. 

Health systems are facing severe shortages in the generic drug market, drawing attention from the White House and Congress. This has been brought to front-page attention with two glaring cases. Firstly, the recent case of Intas Pharmaceuticals, a company in India with critical chemotherapy drugs in short supply, highlights quality control issues in overseas manufacturing. The shortage of essential chemotherapy drugs, including cisplatin and carboplatin, is a significant concern for patients. These drugs are the best shot at a cure for patients with testicular, ovarian and other cancers and shrinking tumors. The limited supply due to the complexity and cost of manufacturing makes them challenging to produce for a few companies. This scarcity, along with shortages of other cancer drugs and medications, such as antibiotics and injectable fluids, poses potential risks to patient health. 

To address the disruptions, there are calls for creating an exchange to allocate drugs where needed most and increasing production of small-batch medicines. The influence of intermediary companies in contracting with generic drug makers is also under scrutiny, as they often demand rock-bottom prices without accountability for shortages. Market-level solutions and expanded government contracting with organizations like Civica Rx, a nonprofit generic drug company founded in 2018 by national philanthropies, may help stabilize the industry and mitigate shortages in the long run. Leaders in the generic drug industry and other experts cite the pressure from intermediary companies that award the lowest-price bidder with access to millions of customers. The “race to the bottom” in prices, they say, destabilizes the industry and rewards those who might cut corners or operate overseas, often in India, where labor costs are lowest. 

The other major case, the natural disaster on July 19th by a 150-mph tornado ripped apart the vast Pfizer drug warehouse in Rock Mount, North Carolina will probably lead to disrupted supplies of crucial drugs. Pfizer released a list of drugs that could go into shortage — or in some cases, a deeper state of shortage. These include common I.V. pain relievers like fentanyl and morphine used in surgery and critical care, as well as lidocaine, used in local anesthesia, and heparin, used to treat or prevent blood clots. The U.S. Pharmacopeia (USP) examined the impact of tornado damage on drug supply chains, assigning "vulnerability scores" to medications based on factors linked to shortages. Painkiller infusions and I.V. electrolytes were identified with a Vulnerability Score of 92% before the disaster. However, one positive aspect is that under federal rules, specialized pharmacies can make these drugs on an emergency basis, helping mitigate the impact of the unexpected shock to the system caused by the shortages.  

Actions at Hand 

Here are just some actions that are at hand to extend the visibility of the supply chain. The Biden administration is assembling a team to address the vulnerabilities in the pharmaceutical supply chain and improve its resilience. The scarcity of generic chemotherapy for cancer treatments is particularly concerning, with potential negative impacts on patient outcomes. Possible long-term solutions include extending supply chain visibility, exploring product-specific strategies, developing relevant protocols, and optimizing costs. The Food and Drug Administration (FDA) is seeking authority from Congress to access additional information about drug manufacturing and supply chains. However, the agency has expressed concerns about the financial strain on the generic drug industry and emphasizes the need to address the core economics of the system. Bipartisan Senate bills aim to speed up the availability of generic drugs, and addressing tactics causing delays can play a crucial role in easing shortages. This has come in the form of the bipartisan bill for Mapping America’s Pharmaceutical Supply (MAPS) Act (S. 2364) to use data analytics to identify supply chain vulnerabilities and other national security threats.  

In June of this year, the administration announced a new lower-cost prescription drug law—the Inflation Reduction Act. The Inflation Reduction Act is already lowering out-of-pocket Part B drug costs. As part of the new law, manufacturers are required to pay a rebate to Medicare if a drug’s price increase exceeds the rate of inflation. CMS intends to send the first invoices in 2025 to manufacturers for the rebates owed to Medicare in 2023 and 2024. Some people with Medicare Part B, which generally covers drugs provided in doctors’ offices and hospital outpatient departments, may pay lower coinsurance on 43 drugs, whose prices rose faster than the rate of inflation in a benchmark quarter. People who take these drugs may save between $1 and $449 per average dose between July 1 – September 30, 2023, depending on their individual coverage.  

Medicare has initiated a new proposal, the 2024 Outpatient Prospective Payment System (OPPS) rule, aimed at incentivizing hospital payments to maintain essential drug stockpiles, addressing ongoing drug shortages through price transparency, prior authorization process, rural hospital provisions and new payment options. However, some experts warn that this policy may inadvertently lead to the very shortages it seeks to prevent. Traditionally, efforts to tackle drug shortages involved empowering the FDA, granting it authority to require backup plans for manufacturing disruptions and gathering information on ingredient sources. The FDA can also prioritize reviews and inspections for drugs in short supply. 

Four Supply Strategies

Health systems have a chance to strengthen their response to future shocks beyond the COVID-19 pandemic. Health system leaders can consider four initiatives to improve supply chain resilience.

• Firstly, extending visibility into an opaque and sometimes interrupted supply chain internally and externally can help detect potential shocks earlier and track inventory accurately. Although implementing sophisticated inventory-tracking systems may be costly, developing tools like RFID bar-coding for critical supplies can increase visibility.
• Secondly, exploring product-specific strategies can identify key items requiring special attention and proactive management.
• Thirdly, developing relevant protocols, capabilities, and governance can enhance decision-making and coordination during supply chain disruptions.
• Finally, optimizing costs can involve strategic sourcing, collaboration with suppliers, and managing excess inventory. These initiatives can help health systems be better prepared for future challenges and ensure smoother operations in times of crisis. 

Resources

NY Times: How the Shortage of a $15 Cancer Drug is Upending treatment - https://www.nytimes.com/2023/06/26/health/cancer-drugs-shortage.html 

NY Times: Drug Shortages Near an All-Time High, Leading to Rationing - https://www.nytimes.com/2023/05/17/health/drug-shortages-cancer.html 

NY Times: Tornado at Pfizer Warehouse Likely to Worsen Shortage of Surgical Drugs https://www.nytimes.com/2023/07/25/health/pfizer-warehouse-tornado-drug-shortages.html 

Pfizer Announces Post-Tornado Relief Plans for Rocky Mount Community and Manufacturing Facility https://www.pfizer.com/news/press-release/press-release-detail/pfizer-announces-post-tornado-relief-plans-rocky-mount?cid=em_PfizerNewsroomAlert&ttype=em 

United States Pharmacopeia:  U.S. Pharmacopeia statement on supply chain impact of tornado damage to Pfizer Inc. Rocky Mount facility https://www.usp.org/news/us-pharmacopeia-statement-on-supply-chain-impact-of-tornado-damage-to-pfizer-inc-rocky-mount-facility 

United States Pharmacopeia: Visibility to build a stronger supply chain. https://www.usp.org/supply-chain/medicine-supply-map 

Congress.Gov: A bill to map the United States pharmaceutical supply chain and use data analytics to identify supply chain vulnerabilities and other national security threats. https://www.congress.gov/bill/118th-congress/senate-bill/2364/all-info#subjects-content 

Medicare has a new plan to address drug shortages — but it could backfire https://www.statnews.com/2023/07/18/medicare-cancer-drug-shortages/ 

Drug Shortage RFI - https://www.finance.senate.gov/imo/media/doc/drug_shortage_rfi.pdf