‘Bibbidi-Bobbidi-Boo’ Problem Solving

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I was recently reminded that often the simplest techniques are often the most powerful.  I was facilitating a problem-solving session which began to get into trouble when the group began to have trouble choosing between many different options.  My simple technique I used was the ‘Magic Wand’.

I was facilitating a group of  trained healthcare professionals who needed to decide how to simplify a cross-regional call-answering service.  This service needed  to route online video calls from Emergency Room physicians, to the most appropriate on-call specialists. Because it was in an emergency-room setting, a premium was placed on the speed that the physician and specialist were connected to each other was a key consideration.  All the participants – trained nurses from different regions – each had different experiences, as each regional service was quite different.  The session started with a review of comparative services that were currently in use in various hospitals.  It turned out that these services did more than simple call-routing – some of them also assisted the doctors with registering the patients with the consulting specialist, others captured information about the call, such as time and nature, and also assisted with the process of setting up in-patient transfers to another hospital.

The group were stymied.  Deciding what the simplified system should do was complex problem, and for every suggestion of how to improve it, there were three good reasons why it wouldn’t work, or why another way was better.  There was also wide disagreement over what the call service should really be doing.  The existing systems had emerged mostly organically from other services, and evolved over time.  It all seemed intractable, and the meeting was becoming bogged down and was losing focus.

Time to get out my magic wand.  Except that because the video calls were being initiated from a laptop, they were magic buttons, and not a wand.  “What’s the first issue that the call center needs to solve when it receives a call?” I ask.

“Connecting the specialist in the right area of practice, who is on call, and has the strongest relationship with the calling physician.”

“OK, there is a magic button which does that.  So the ER physician is now connected to the specialist.  What next?”  This is going well, I thought.

“But we don’t want an automated response system.  The doctor wants to hear person on the other end.  How do we know which specialist to connect to?”

Whoops – looks like I spoke to soon.  “It’s not an automated response system.  It’s magic.” I said”.  That’s why it is called a ‘magic button'”.

“But if the onset of the condition was less than two hours ago, then we would have different criteria – it would be more urgent, and we would want to connect with the first available, not necessarily the most appropriate.  How can we possibly do that?”

“I told you.  It’s magic.  We’re not going to discuss how the magic works right now. ” I repeated.  “For now, we just are trying to figure out what the magic actually needs to do.  Let’s just hold our disbelief on how it is going to do it, for a second.  It’s just…well, magic!  So, what’s the next magic button that we need?”   The group decided that another task the call service does is to arrange a transfer to another hospital if the condition is so serious that it can’t be treated at the ER facility.  Depending on where the ER physician is calling from, and

“OK, so we need another button to do that.  What does that button do?  What is the end result we are looking for when we push that button? ”

“It connects the ER physician with the hospital bed-scheduling facility, so that they can find a receiving hospital” said someone.   Someone else immediately chimed in with an objection.  “But it can’t.  Different regions have different ways of doing that.  Currently the call service knows where to call for any particular condition.  Also, he intake physician at the receiving hospital will need to phone the ER physician to go over details of the case.  They will also want to speak to the specialist.  They need to ensure they understand the needs of the patient before accepting them, and they won’t want to read the medical record to get that information.”

“”Well”, I said “Is that really the end result that we are looking for here.   I don’t know what your magic button does, but my magic button will auto-magically join an intake physician of the most suitable receiving hospital directly into the video call so that they can have that conversation.  In fact, it could be so magic that the intake physician just knows what he needs to know without having to ask, but that’s not important for now – after all, this is magic we are talking about.  Let’s assume we can do that.  So the patient now has a transfer arranged to a suitable hospital.  Great!  So what other magic buttons do we need?”

Things sped up after that point.  Eventually, it transpired that we would need six magic buttons to complete all the essential tasks that the call service performed.   Moreover, the group came to the conclusion that if the magic worked, then there actually was no real need for the call service to exist at all.  The service was just there to make the magic work.  If we could figure out other ways to perform the miracles, then we could save the overhead.  Take the first button, for instance “connecting the physician to the specialist”.  Having to talk to the call service operator was in a fact a disservice.  Initially the group had been debating the need for a person to answer the call, rather than leave a voice message.  However, once we realized that our customer, the physician, really didn’t want to do either, we could concentrate on figuring out other solutions.

Who needs magic” I hear you say.  “This is extremely  simple system analysis.  Why would you need a fairy godmother for this stuff?  Why wouldn’t you just right down directly what you wanted the system to do?”

To understand why this simple technique works, it is necessary to understand that, by, using magic in this way allowed the group to ‘get out of their heads, to step away from discussing competing solutions, and to really look at what problem they were trying to solve.  As nurses, they are trained to handle life-and-death emergencies on the hospital floor.  They are trained to think of practical solutions, and act decisively.  However, introducing magic forced the group to NOT think about solutions for once.  For a problem-solving exercise, this might seem a counter-intuitive approach to some!  However, as I’ve observed elsewhere, I have repeatedly found that solving problems is not nearly as much as about the solution, as it is about the problem. As humans, we don’t like the uncertainty that problems create.  So we like to rush to solutions, which are much more comforting. Magic, however, robs us of  the solutions, and forces us to really look at the problem.

Moreover, as soon the big hairy problems can be instantly magicked away, the analysis can proceed quickly.  Practicalities and details that might otherwise derail the conversation are glossed over and ignored.  As the bigger problems are magicked away, other, less dominant problems come apparent,and so it goes on.  The whole problem-space can be understood very quickly.

Finally, and only after the problem-space is properly understood should the question be asked “So how does the ‘magic’ actually work?”  Only then can the solutioning actually begin.

 


Paul Osborn

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