How Switching Perspectives Helped 15 Doctors and 14 Nurses Save Their Fragile Merger

I’ve designed, organized and led Compression Planning retreats continuously since I was 26 years old.

Periodically I’ll share the essence of some of those Retreats. For many I’ll disguise the clients so their confidentiality is protected. Even change the industry in some cases.

What I’m really after is the story and what I learned. Hopefully you’ll learn something useful for your Compression Planning facilitation.

What is the absolute, “no-holds barred” toughest Business Planning Retreat I ever led?

The answer is easy.

Two southwestern healthcare systems merged. Their composite OBGYN function was about to blow apart because their two pre-merger teams were at each other’s throats.

The VP over that function, Judy, was my client.

She recruited 30 people for a retreat in the mountains – 14 from each pre-merger OBGYN department, herself and the Chief of Staff (COS) Scott.

Dealing with a participant who wanted his attorney by his side

The night before flying to the retreat, I received a phone call from one of the doctors/participants who said he wasn’t going without being represented by his personal attorney. He said if the retreat failed he could personally lose more than $800,000 the first year and more in subsequent years.

After talking for an hour, he agreed to come to the retreat and leave his attorney at home.

The group gathers and starts working

Tension was tangible…as thick as gutter mud…as thick as pea soup…as thick as a London fog (you get the point) when people came into the conference room. I don’t think anyone wanted to be there and I was beginning to question the sanity of taking on the assignment.

The participants were armed with their verbal machetes. Ready to hurl verbal hand grenades at the other side. And they did.

One side said the other was so high tech they didn’t care for their patients as people. Loving their “techy toys” was their charge.

The other side said their opponents were “touchy-feely” – and didn’t apply the latest technology.

High tech-low touch versus low-tech-high touch. A classic battleground.

For about the first 2½ hours nothing productive happened. Just lots of posturing, lots of “chest thumping” and putting down the other side.

I went through everything we teach and had done hundreds of times.

No matter what I tried, it bombed. Talk about feeling lonely.

A basic lesson from a long ago mentor

I remembered the “Arc concept” one of my mentors Mike Vance taught. The essence of this concept is people on both sides of an issue see it differently.

From the perspective of point A, people see the arc as concave. Point B sees the arc as convex.

Also I was pretty much out of “facilitation arrows in my quiver” by then so I said…

“Not much seems to be working right now. I’m asking you to go along with me.”

I told them “the leaders of your major competitor, St. Mary’s Medical Center, are meeting right now 18 miles down the road (this moved them from point A to point B on the Arc).

Their leaders know you “merged groups” are meeting. They also know how much infighting and squabbling is going on between the two factions at this retreat.

They are out to bury you with all your animosity and disgust towards each other. They smell a huge opportunity if your merger collapses so here’s what I propose…”

Putting the Arc concept to work

I asked the head nurse “who is your counterpart at St Mary’s?” Of course she knew so I said “make a nametag and a table tent with that persons’ name.”

I don’t know why they cooperated…probably out of pity for a guy who flew that far or they felt sorry for me because I am a Minnesotan by birth. Whatever their reasons, all the doctors, nurses, the VP and Chief of Staff put on nametags and made table tents with the names of leaders at St. Mary’s.

Even ‘Dr. Hi-Trust’ went along (the man without his attorney).

Then I set the stage. “The group in front of me isn’t from your merged medical center but from St Mary’s. They know how much trouble you’re causing for each other so we’re going to do a planning session from their point of view. From your major competitor’s point of view. You are the St. Mary’s leaders.”

“What questions do you think St. Mary’s leaders are going to be asking right now? Identify questions about YOU and YOUR situation.”

It took a while to get started. After people offered a few thoughts, it was like lancing a boil. Questions flew so fast we could hardly get them on 4 x 6 inch header sized cards.

  • How can we steal their best nurses?
  • How can we steal their best doctors?
  • How can we blow this fight into the press?
  • How can we use their fighting to screw up their reaccreditation?
  • How can we…
  • Ways we can…
  • What about the situation can we capitalize on…

And on and on and on. It was like an erupting volcano. They filled up storyboard after storyboard with questions. Not answers…just questions. Well over a hundred questions.

Then when the questions slowed down, and 6 storyboards were packed with 4 x 6 inch cards, I did something different than we normally do or teach.

We gave them dots. Not a limited number of dots but as many as they wanted. A full sheet of RED dots. If they wanted a second sheet of DOTS, they got it.

They were directed to “go up and put one dot per person on any card you think the leaders of St. Mary’s will answer to capitalize on your lack of cooperation.”

“You are the leaders of St. Mary’s. Your competition is giving you a huge competitive advantage. They’re presenting it on a diamond-encrusted platter.”

“Put your dots on the questions you want to address to BURY them.”

“Don’t talk to each other while you dot. Take as much time as you want and use as many dots as you want.”

It was so quiet. People were stunned as they read the storyboards.

Then they started to dot. Those dots were “RED” and the cards of questions on storyboards started to look like a wall full of measles. Many of the cards had 30 dots on them.

When doting was done, people silently and nervously sat staring at them. They were waiting for me to say something.

Moving from the exploration/focus phase to action

Frequently a line pops into my mind and I have no idea where it comes from but I’m thankful it does. That afternoon I stood in front of the group of 30 and just looked at them for what seemed like minutes then said…

“Are you ready to get serious?”

Almost as one person they said openly or nodded “yes.”

So we went back to the original design and started to work it.

Over a break my teammate Pam took me aside and said “Let’s not work the group in the evening. Get them away from the formal work.”

She made a brilliant call. A barbecue was set up and no one minded not working that evening.

How a “break” from the work brought a group together

After eating, I walked by a group of five people sitting in a huddle when they exploded in laughter.

Someone said “Jerry you’ve got to hear this.” The COS, Scott, told the same joke again and all of us burst into laughter.

Then a strange dynamic happened. Gradually the cluster of people around Scott kept growing in size and he repeated the same joke. Eventually 32 people were sitting in a circle and he told the same joke for the last time.

Then more jokes started to fly. If you know medical people at times their humor can be quite “basic.”

Doctors told jokes. Nurses told jokes. Scott told more jokes. Many jokes were quite raunchy. Some were in-house to their discipline and they used medical language I didn’t understand.

What I did understand was they were becoming a team. Sitting around telling some hilarious jokes. Much of the humor was risqué and it was like people respected others for being willing to be bold.

Strange dynamic. You could never stage it. We stayed in that circle until the bugs drove us inside.

By noon the next day they had a five-year plan in place for how they would build the best OBGYN service in their region.

One doctor was on the board of directors of one of the pre-merged hospitals. He admitted “he went to the retreat with the purpose of sabotaging the merger.”

He ended up being the spokesperson for the new “team” when they presented their report to the Board of Directors.

In following up periodically to see how their five year plan was progressing they were functioning well. They talked about each other mostly and it was respectful and heartfelt.

Two and a half years before they expected to open their new combined service center, Pam and I received invitations to their open house. The COF, Scott, invited us to stay with him and his wife in their home.

Observations and lessons I gained from facilitating their retreat

  • I gained so much respect for their VP Judy who observed and listened during the first day. She let the people “be” as they wrestled with their issues.
  • The COF, Scott, would sit quietly doing crossword puzzles. It was disconcerting until he told me he spent 40 years doing crossword puzzles as a way of relaxing between performing surgeries.  He also led by a great deal of listening.
  • Once people stopped throwing accusations at each other, they were able to do highly effective planning. They all wanted the same thing – to take care of their patients in the healthiest means possible.
  • I doubt that group would have ever functioned effectively outside of a “retreat setting.”
  • You never know where your key ally is. In their case, Scott, the Chief of Staff, was so helpful by just being himself.
  • Try things and tell people you are trying something new when you are. Not necessary to look like you’re always 100% control when you aren’t.
  • Don’t be afraid to break out of your “design.”  Pam was so correct to interrupt our plan with “a barbeque dinner and an evening free from CP.”
  • Trust process.  You’ll never know what will help you crack a tough issue.
  • Get movement.  Sometimes do something different just for the sake of doing something to cause movement.
  • Ultimately, the high tech group saw the others also had high tech and the high touch people realized the others were also high touch. It took several hours to get clarity; however once it came, the plan fell into place in 3 hours.

Final Comments and a Request:

First:  I’ve carried many stories in me for decades. In private moments I’ve shared them with people, normally in the evenings at our Institutes. This is my first pass at capturing the essence of a peak experience in my career as a Compression Planning facilitator.

Second: If you read this far, please send me an e-mail (jerry (at) compressionplanning (dot) com)  just to let me know you read the complete article.  If you have any comments they will be appreciated.

5 Responses to How Switching Perspectives Helped 15 Doctors and 14 Nurses Save Their Fragile Merger

  1. Beth Kohler May 24, 2012 at 2:22 pm #


    Wow, I would love to have seen that!


  2. Jim McNellis May 24, 2012 at 5:03 pm #

    An inspiring story. I’d like to have these medical people practicing near me.

  3. David May 25, 2012 at 10:54 am #


    This is totally on-point with the tension and polarization that exists in many corners of the workplace today.

    Thank you!

  4. Nancy Jones May 25, 2012 at 1:25 pm #

    Jerry, As always, your understanding of the process and your creativity are masterful and inspiring! Thank you for sharing this tale of insights with a broader audience. Nancy

  5. Marc Richardson August 5, 2012 at 9:49 pm #

    Jerry, I have been following your work for years, although I have never been fortunate enough to attend one of your institutes. I received the Brain Train years and two employers ago.
    Thanks so much for sharing this with us. It is inspiring beyond the business case study it presents. It inspires me to know that even in the bitterest of our strugles, their is so much decency in our fellows that we can communicate and cooperate if we will just have patience, trust the process and help them to see the other side’s point of view. Thanks again!

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