Failure to Achieve a Desired Solution: Knowing Your Audience
Collaborations do not succeed when participants do not come to conceive of the issues in the same way
A group of highly-trained and well-intentioned doctors embarked on an international collaboration designed to teach new life-saving techniques to medical professionals in Angola. Unfortunately, the solution-driven approach failed to exert the desired influence on the doctors and nurses who participated in the program.
Dr. Rebecca Miller, a seasoned American surgeon, travelled to Angola as part of a humanitarian mission. The goal of the trip had been for surgeons to learn about the challenges faced by doctors in Angola and to share some of their own expertise. Observing treatment from the sidelines, the American doctors became increasingly concerned about the lack of modern life-saving techniques that had become commonplace in the United States. Dr. Miller was shocked when she repeatedly discerned death from preventable conditions (and in one case an unnecessary amputation) where inexpensive, alternative newer techniques could have been employed. When Dr. Miller returned home, she spoke about her concerns with doctors at her own hospital.
A fellow surgeon suggested that Dr. Miller apply for a small grant to return to one of the hospitals in Angola and to train the doctors in the needed modern techniques. Inspired by this idea, she secured funding and assembled a team of 4 other doctors and 2 nurses who were willing to devote their time to the project. This newly assembled team reached out to a large hospital in Angola that Dr. Miller had visited, and made arrangements for a 4-week training program. The team had a clear goal in mind: to teach the staff in a regular hospital specific techniques that did not require expensive equipment or supplies that might be unavailable. The American physicians wanted to give their Angolan colleagues tools to work more effectively in their environment.
The team spent four months in advance of their trip working with training-simulation dummies to develop “best practices.” With the use of these dummies, the hope was the Angolan doctors could eventually teach others—a “train-the trainers” model. The team tested their program in the United States, with doctors in their own hospital and then with students from the nearby university. They learned key phrases in Portuguese, the language spoken in the Angolan hospital, so that they would not have to rely solely on translators. The team raised additional funds to purchase a training-simulation dummy that could be donated to the Angolan hospital where it could be used to train others in the region. Members compiled a manual and had it translated into Portuguese as well as Bantu, the second most popular language in the country.
The team arrived in Angola loaded with medical supplies, 100 copies of their multi-lingual training manual, and an expensive high-tech training dummy that they had purchased for the host hospital. On the first day, they assembled the team of local doctors and nurses in a small classroom to demonstrate what the training dummy could do and how they would use it as a teaching tool. However, it did not seem that the audience shared the Americans’ enthusiasm. Hands went up immediately, “Why are we working on a pretend patient? We have more patients than we can treat here already!” one doctor said through a translator. “I don’t have an extra bed for him,” joked one of the nurses. As Dr. Miller continued to explain how they would use the medical dummy, she watched the assembled group lose interest. She hoped that the actual simulation, planned for the next day, would elicit a more positive reception.
Alas, the next day, the idea of ‘treating’ the dummy continued to elicit laughter. Dr. Miller asked the Angolan doctors to watch a simulation so that they could see how this teaching tool was used. After handing out manuals, her team launched into a choreographed routine, making a series of deliberate mistakes to ensure that the dummy’s alarms would sound and the audience could see how these alerts proved useful.
By the end of the second day of training, Dr. Miller and her colleagues realized their error. They had simply assumed that their high-tech training dummies and train-the-trainer materials would clearly address an important need—speak for itself, as it were. To come up with a solution to a challenge that seemed so apparent, the American team had devised a comprehensive approach that others did not feel was appropriate for their circumstances. The Angolan doctors didn’t see value in the use of a “pretend man,” as they called him. They felt uncomfortable with the fake skin and the alarm sounds. The shrill alert when someone made a mistake was a source of shame for doctors practicing in front of subordinates. In short, the medical dummy was simply not effective in this context.
Dr. Miller and her team spent 4 weeks in the hospital, but the dummy rarely came out of his bag. The training they did offer by working alongside the Angolan doctors was seemingly effective. However, it was nothing like what they had planned, and the training did not prove sustainable in the long-term. When the team left Angola, they packed up the dummy and all 100 carefully translated multi-lingual manuals and brought them home.
In retrospect, Dr. Miller realized something that she had been unable to anticipate: the tools and materials she had developed in good faith with members of her team to solve a need might not be welcome by colleagues in a different context. After painfully experiencing the reaction of these colleagues, she came to grips with the fact that her design was flawed from the outset. Her solution-driven initiative was unable to help solve the very real problem(s) that she had identified.