Findings/Spring 2002Healthcare:The Dilemma ofTeamwork, Time,and TurnoverA report on Rival Hypotheses,Options, and Outcomesfrom the CARNEGIE MELLONCOMMUNITY THINK TANKThis Think Tank series explores the decisionsin long term healthcarefacing healthcare workers,administrators, and the communityconcerned with• meeting the need for compassionate caregivers• working changes in the culture of work and healthcare• developing a new paraprofessional workforce• heeding the call for professionalism, recognition, andrespectThe Center for University OutreachCarnegie Mellon UniversityIntercultural Problem Solving for Performancein WorkPlaces and WorkLivesThe Carnegie Mellon Community Think TankCreates an intercultural dialogue among problem solvers—from Pittsburgh’s urbancommunity, from business, regional development, social services, and education.And seeks workable solutions to problems of workplace performance, workforcedevelopment, and worklife success for urban employees.The Think Tank’s structured, solution-oriented process:® Opens an intercultural dialogue in which employees, line managers, andadministrators, human resource developers, educators, and trainers, researchers andcommunity workers meet as collaborators.® Structures this talk into a problem-solvingsearch for diverse perspectives, rivalhypotheses, and collaborative solutions.® Draws out untapped levels of expertise in theurban community and low-wage workers tobuild more comprehensive interculturalunderstandings of problems and to constructcommunity-tested options for action.® Builds a scaffold for Local Action ThinkTanks in individual workplaces.Please visit our web site to see the Findings of other Think Tanks and to explore aguide to developing your own dialogues as educators, human resource developers,or community groups. www.cmu.edu/outreach/thinktank/Carnegie Mellon Center for University OutreachDr. Linda Flower, DirectorCarnegie Mellon University, Pittsburgh PA 15213(412) 268-7801 www.cmu.edu/outreachTable of ContentsWhy We Initiated A Think Tank iSome Highlights From the Findings iiiTHE TRAINING EPISODESThe “Training Episodes” Problem Scenario 1Decision Point 1. Short-Staffed, Again 3The Story Behind the Story 3Options and Outcomes 5Decision Point 2. Orientation 7The Story Behind the Story 7Options and Outcomes 10Decision Point 3. Training and Mentoring 13The Story Behind the Story 13Options and Outcomes 17THE RECOGNITION AND RESPECT EPISODESThe “Recognition and Respect Episodes” Problem Scenario 25Decision Point 4. Conflicting Expectations 27The Story Behind the Story 27Options and Outcomes 29Decision Point 5. Signs of Respect 30The Story Behind the Story 30Options and Outcomes 32Decision Point 6. Forms of Recognition 33The Story Behind the Story 33Options and Outcomes 35Evaluations by Think Tank Participants 40Resources 41iWhy We Initiated A Think TankThe crisis in long term health care—and the acute shortage of qualified caregivers— has been shaped by broad social policies and economic forces in workforcedevelopment and healthcare. But it is also a community problem, played out in carecenters around this region. And in this context, we know that retention is linked torespect, performance often mirrors the culture of work, and the problems of aminimum wage work life become the problems of the workforce.We believed that local, workable options for responding to these problems—to thedilemmas of teamwork, time and turnover—could be constructed.But creating more options for action would require the following:• an intercultural dialogue that draws on the expertise of all stake holders;• and a problem-solving dialogue focused on a collaborative search for solutions.The People at the TableIn this series of the Carnegie Mellon CommunityThink Tank you will hear from the following voices:® Front line caregivers—Certified Nursing Aides,Unit Clerks, Agency staff, and trainees;® LPNs, RNs, Charge Nurses, and Directors ofNursing;® Administrators, human resource developers, business managers, union leaders,and care center directors;® Urban community groups, teachers, researchers and workforce developers;® Reports and conferences organized by regional groups, foundations, academicinstitutes, and government agencies and offices; and® The published conclusions of national and state organizations including PA Intra-Governmental Council on Long Term Care, the PA Economy League, SWPPA,Iowa Caregivers, and the Direct Care Alliance (see the Resources list on page 41).How We Generated these FindingsThe Think Tank process begins with intercultural and cross-level problem finding.We use “critical incident” interviews, published work, and “story-behind-the-story”dialogues to 1) identify the key issues, 2) script prototypical problem scenariosaround them, and 3) collect strong rival hypotheses about what is really happeningand why in these familiar situations. We then compile these diverse readings of theproblem into a Decision Point Briefing Book organized around key decision points.We are especially indebted to the Lemington Center and Grane Healthcare staff inthe development of this Briefing Book.iiThink Tank participants use theBriefing Book to focus dialogueon a series of problematicDecision Points—to exploreinterpretations, consideroutcomes, and develop acollaboratively constructedtoolkit of workable options.The insights in these Findingscome from both “expert” sessions(drawing on people across thecity) and “local action” sessions(working on change withinindividual organizations).We are grateful to the manypeople who have lent their wisdom and experience, their passion for healthcare, andtheir respect for frontline workers to this call for community-grounded, action-oriented understanding.What Can You Do?® We encourage you to use and share the insights of this intercultural dialogue inyour own work—in healthcare, education, human resource development, andcommunity action. This document and supporting materials are available on theOutreach web site at www.cmu.edu/outreach/thinktank/.® Consider initiating a Local Action Think Tank in your community or worksite.Build on the findings from this book, helping managers and staff use thiscollaborative problem-solving process to translate options into site-specificactions. Contact the Community Think Tank team if we could be of help.Linda Flower, Ph.D.Director, Center for University OutreachCarnegie