3 Questions to Improve Service Delivery

23 Oct

The last two articles I wrote covered the role of collecting and analysing tacit knowledge as a method of improving health and well-being. If experience based knowledge (as opposed to only formal knowledge) is collected and shared, then people are exposed to the hints, tips, rules of thumb which are used to overcome challenges, avoid and recover from mistakes. These hints and tips do not appear in formalised aims and objectives, procedures and processes or most structured training (Klein, 2009). These hints and tips are developed when routine is tested to and beyond its limits. It is at these intersections that people improvise and innovate. These non-routine cases frequently happen fast and need solving fast, so what emerges are simple solutions to seemingly complex problems. They play a daily role in health care, as experienced professionals apply expertise and experience to work quickly and effectively. They work daily in communities as members demonstrate resilience and behaviours which improve and maintain their health and well-being. In other words, they are worth examining.

Formal training, procedures and processes frequently do not collect and share tacit knowledge. Strategies and plans outline formal intent but frequently close the feedback loop between aims and objectives and the customisation of these aims and objectives on the ground. The effect of closed feedback loops creates a wall between a strategy and a role in theory, and a strategy and role in practice. When applied to a role, this wall can lead to someone who has been exposed only to formal training being “shocked” by a non-routine event. This person may struggle to recover from this interruption, keep applying routine even when it’s not working, explain the situation away, or in worst cases, cover the situation up. On a strategic level, if the lessons of improvisation, the results of tacit knowledge, are not fed back between planners and implementers then no one is aware if and how the strategy should be adapted. The results of these circumstances can lead to the strategy slowly drifting off course, no one at the helm aware of the situation, until it suddenly hits an ice berg and there is a catastrophe to deal with. In summary, creating feedback between the formal and tacit, and fluidly adapting as a result, is a vital component of service and strategic success.

All of the above might sound like another layer of complexity in an already complex environment. However, establishing tacit\formal feedback loops between planners and implementers, and between peers and partners, can be achieved relatively simply, with three questions. I used the following three questions as a method of recording experienced based progress (tacit skills) for a newly qualified health professional who had just entered practice. The questions not only revealed the limits of formal training and how soon and in what situations these limits were met, but also recorded if and how the health professional improvised, how often they asked for help, and the feedback they were given. Over the space of a few months a reflective record of tacit progress was created and then fed back to the training provider. These are generalised version of the three questions

What parts of the role have been most difficult?

What makes these situations so difficult?

What would you do differently if you could experience these situations again?

The questions are drawn from the research of both Weick and Sutcliffe (2007) and Klein (2006) who have both produced and identified rapid assessments of complex and challenging situations. The focus on difficulty takes the respondent (answering the questions) to non-routine events, where their experience and skills were tested. The questions ask the respondent to reflect on why these events are so challenging, and then use hind sight to outline what they have learned-if you could do it again, what would you do?

You could adapt the questions for partnership and community work. If you are evaluating a specific project-

What aspects of the project have been most difficult?

Why were these aspects so difficult?

If you had to tackle these difficulties again, what would you do?

And if you were looking to examine a particular community issue-

What are your toughest challenges?

What makes these challenges so tough?

How would someone tackle these challenges effectively? What would they need?

The above questions provide a fast and effective way to insert a feedback loop which examines how formal aims, objectives, procedures and also training play out in “live” situations. Applying this method on a frequent basis will move focus away from implementing rigid linear plans, to adaptable, more resilient strategies.


Weick, K. E., & Sutcliffe, K. M. (2007). Managing the Unexpected: Resilient Performance in and Age of Uncertainty, Second Edition. San Francisco, CA: Jossey-Bass

Klein, G. (2007) The Power of Intuition: How to Use Your Gut Feelings to Make Better Decisions at Work. Currency

Klein, G (2009) Streetlights and Shadows. Bradford Books.

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