Wednesday, 1 August 2012

Abilene Paradox: Watch out, it could hurt you

Abilene paradox - the importance of managing agreements and agreeable colleagues

Last month I wrote about the Bad Apple theory and argued for a slightly softer approach in understanding and dealing with clinical 'bad apples' in healthcare. In a subjective sense, bad apples (irrespective of whether they are actually right or wrong) are persons who tend to disagree with their group and use negative behaviors to show their disagreement.

The Abilene paradox is some what the opposite phenomenon. This is when we do not voice our concerns, do not speak up, do not disagree. In fact in this paradox we actively do something that we do not fully believe in or want to do, because we felt that is what our boss, our group, our organisation wanted. We agree with our colleagues and peers to please them, we think our agreement will make them happy, will vindicate their opinion. If you are the leader, manager or proposer of ideas you come up with ideas, projects, activities, etc with the intention to please your team; your team in return go with your idea not because they think it is a good idea or want to agree with you, they simply run with your idea as they do not want to displease you or dampen your enthusiasm.. They might agree due to fear of authority, lack of knowledge, loyalty, the desire to play the part of a cooperative team member or perhaps even with the hope of getting something from you in return in the future. Obviously these are all the wrong reasons to play along with an idea if it was bad in the first place.

Watch out. This is something which has the potential to take you well away from your mission and plunge you into problems despite everyone's support and agreement; well actually because of everyone's support and agreement. Some might consider this a version of what we know as 'group think'; perhaps. In my view, group think is when all members of the group are convinced that it is a good idea, whereas the Abiline paradox is when group members may not believe it is a good idea but push the idea along forward and ahead simply because they think it will please other members of the group. This is something you want to avoid at all costs.

The fairly old but very interesting article called the Abilene paradox can be found at .

In summary, the author John Harvey says
‘’Organizations frequently take actions in contradiction to what they really want to do and therefore defeat the very purposes they are trying to achieve.’’

‘’.......a major corollary of the paradox, ... is that the inability to manage agreement is a major source of organization dysfunction.’’

This is the opposite of what many of us often assume that managing conflict is the usual big problem that frustrates us.

He suggests

‘’through the process of active confrontation with reality, we may take respite from pushing our rocks on their endless journeys’’

Abilene paradox is very relevant to healthcare. Just think, at your department level in MDT (multi disciplinary team) meetings and at national/international levels the unanimous decisions, at the consensus groups. Could the paradox be in play or could group think be in play? May be yes, may be no. But has the question been asked and answered if these phenomena could be affecting our decision making? I think we do not consciously explore this; we simply assume sometimes rightly, sometimes wrongly, that such ill effects did not afflict our decision making. In highly technical industries, in highly scientific industries and in highly evidence based industries adverse effects of the Abilene paradox will be negated pre-event by knowledge and post-event by data. In healthcare with its relatively poor evidence levels which results either in large variations in clinical practice or practice without improvement, the problems with group think and managing agreements are undoubtedly huge with its negative impact on patients.

Abilene paradox may turn out to be the bigger problem in recognition and management of healthcare's complexities.

You see the bad apples are easy since they are visible, audible and apparent. They make you uncomfortable or annoyed. You will be able to identify them and deal with them as early as you wish. Since we are all trained on how to deal with 'difficult colleagues' we at least imagine we can deal with people who disagree with us. Abilene paradox does not make you uncomfortable or annoyed till it might be really late. Since the intention of the group, who fall prey to the paradox is to cooperate and please, it will be really difficult to identify early and when identified we will be reluctant to deal with persons who have cooperated with us with good intentions. We have no knowledge or training on how to deal with easy colleagues who might pleasantly mislead. In organisations and teams peoples role is to cooperate appropriately and that can only happen when people support their team by critically questioning and vigorously analysing the issues. Only after a robust process should people offer their cooperation or agreement. 'Yes (wo)men' are probably more harmful to teams than bad apples in the longer run.

In old Jewish writings it is said that in a case subject to capital punishment if a guilty verdict was unanimous then the accused would walk free. This was generally thought to prevent group think, I feel their wisdom probably included concepts of the difficulty of managing agreements as in the Abilene paradox. It is said that good effective leaders surround themselves with a good team. Of course that is very important, but good leaders should make sure that the Abilene paradox does not frustrate them. Good leaders should demand that their team provide a genuine expression of opposing or divergent views so that higher quality decisions are made which would enable longer term success.

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1 comment:

Indian doctor said...

I think I remember reading the same concept in some ancient writings from Sangam Tamil literature and ancient Indian Philosophies and mythologies.