Constructive dissatisfaction

Post date: November 08, 2018 by Grace Bourke

As we walked down the hall together, the chief nurse executive at the hospital I was visiting commented that the nurses had been complaining. In fact, they had a long list of complaints, and they were right; a lot of processes weren’t working well and were creating problems for them. Understanding how she felt, I shared that I’d been thinking about “constructive dissatisfaction.” I believe it’s okay to be dissatisfied if we also commit to improvement. This is how we build a bridge from where we are to where we want to be. Isn’t this the heart of lean?

We didn’t have time to discuss further. However, when dissatisfaction was expressed in a meeting later that week, she encouraged the team to be constructive by saying, “We are going to actively listen, use humble inquiry, and learn together.” This seems like a good approach!

Actively listening: Giving the person our undivided attention to really hear the concern. This includes not being distracted by trying to find the solution. It’s focused listening.

Humble inquiry: Asking gentle questions to help the learner clarify their understanding, and avoiding pushing our solutions forward.

Learning together: Encouraging the team to accept the risk of learning and to experiment with an improvement.

This nurse leader was building on the organization’s twin foundations of (1) organization-wide commitment to quality, and (2) leadership commitment to removing barriers and to coaching toward ownership with accountability. In the short time since that meeting, more people seem to be speaking up and taking ownership for fixing situations they are frustrated with. That’s constructive dissatisfaction. They are willing to identify when things aren’t working and to start making improvements. The mindset and pattern of behavior isn’t going to change overnight, but they are on the path.

Here are some examples of constructive dissatisfaction:

  • The doctor who accidently gave an adult vaccine to a child and worked with the team to store the vaccines in separate refrigerators to prevent the mistake from occurring to someone else.
  • The knowledge worker who asked if she was entering the correct information into the new software, researched the answer, and shared the correct way with the team.
  • The nurse who was frustrated with not being able to reach the on-call provider and created a reference list with every phone number verified as correct.
  • The research scientist who identified a more accurate and reliable way to monitor the stability of reagents.
  • The regulatory specialist who identified a quicker, more accurate, and easier way to configure the phone tree so that callers would be directed to the correct department, saving the organization time and money.

Healthcare delivery, research, and manufacturing are all complex, with many opportunities for improvement. You probably can identify a time when you experienced or observed constructive dissatisfaction. Did the above philosophies apply? What approaches have you seen that could be helpful in moving yourself or someone else to be a bridge builder, spanning the gap from where we are to where we want to be?