Discovery and Action Dialogue

How do we turn resistors into supporters? We include them in the change. It is scientifically proven that when people participate in the change process, they become adopters of change and resistance decreases. The Discovery and Action Dialogue is a Liberating Structure that encourages participation, breaks down resistance to change and achieves ownership of change.

Discovery & Action Dialogue (DAD) Team Activity

Purpose: Discover, Invent, and Unleash Local Solutions to Chronic Problems (25-70 min.)

What is made possible?
DADs make it easy for a group or community to discover practices and behaviors that enable some individuals (without access to special resources and facing the same constraints) to find better solutions than their peers to common problems. These are called positive deviant (PD) behaviors and practices.

DADs make it possible for people in the group, unit, or community to discover by themselves these PD practices.

DADs also create favorable conditions for stimulating participants’ creativity in spaces where they can feel safe to invent new and more effective practices. Resistance to change evaporates as participants are unleashed to choose freely which practices they will adopt or try and which problems they will tackle. DADs make it possible to achieve frontline ownership of solutions.
Structuring the Invitation
Invite people to uncover tacit or latent solutions to a shared challenge that are hidden among people in their working group, unit, or community. Ask anybody interested in solving the problem to join a small group and participate in a DAD. In the group, ask seven progressive questions:

How do you know when problem X is present?

How do you contribute effectively to solving problem X?

What prevents you from doing this or taking these actions all the time?

Do you know anybody who is able to frequently solve problem X and overcome barriers? What behaviors or practices made their success possible?

Do you have any ideas?

What needs to be done to make it happen? Any volunteers?

Who else needs to be involved?
How Space Is Arranged and Materials Needed
DADs take place in a local setting or unit

Groups may be standing or sitting around a table

Paper, flip chart, or software/projection equipment needed to record insights and actions
How Participation Is Distributed
Facilitator introduces the questions

Everyone who is around is invited to join and be included

Everyone in the group has an equal opportunity to contribute
How Groups Are Configured
Facilitator works with a partner to serve as a recorder

Group size can be 5–15 people

Diversity in roles and experience is an important asset
Sequence of Steps and Time Allocation
State the purpose of the initiative being discussed and the DAD and invite brief round-robin introductions. 5 min.

Ask the 7 questions one by one in the order given in the Invitation. Address them to the whole group and give everyone the opportunity to speak to each question. Make sure your recorder captures insights and action ideas as they emerge—big ones may emerge when you least expect it. 15–60 min.

Ask your recorder to recap insights, action ideas, and who else needs to be included. 5 min.
WHY? Purposes
Engage frontline people in finding solutions to thorny challenges

Discover tacit and latent behaviors and practices that are positively deviant from the norm

Spark the emergence of new solutions

Inspire rather than compel behaviors that solve complex problems

Generate changes that are sustained because they are discovered and invented by the people doing the work, rather than imported and imposed

Solve local problems locally and spread momentum across units

Build relationships between people in diverse functions and levels that otherwise don’t work together to solve problems
Tips and Traps
Question #2 often consists of two parts: how the problem affects the individual personally and how it affects others. For instance, “What do you do to keep yourself from infections and what do you do to prevent infection transmissions?” or “What do you do to keep your students engaged and what do you to keep yourself energized and enthusiastic?”

Hold the DADs where the participants work to minimize obstacles for participation

Make impromptu invitations for people to join in as you enter the area

Create an informal “climate,” starting with introductions and an anecdote if appropriate

Maintain eye contact and sit with the group (not higher or away from the group)

Be sure you talk much less than participants, encouraging everyone to share stories and “sift” for action opportunities

Dramatizing Behavior Change to Stop Infections” in Part Three: Stories from the Field

Notice when you form judgments in your head about what is right or wrong, then count to ten and “let it go” before you say anything (you may need to ask for the help of your recorder or a facilitator colleague)

Avoid statements like “that’s a good idea” and leave space for participants to make their own assessments

Demonstrate genuine curiosity in everyone’s contributions without answering the questions yourself: study at the feet of the people who do the work

Do not give or take assignments!

Don’t judge yourself too harshly: it takes practice to develop a high level of skill with this approach to facilitation. Be sure to ask your recorder for direct feedback.
Variations
Use TRIZ-like questions instead of the first three, namely: (1) What can you do to make sure that problem X becomes much worse? (2) Is there anything you are doing that in any way, shape, or form looks like any of the practices you just listed? (3) What is preventing you from stopping these practices?

Use insights and barriers that surface to develop scripts for Improv Prototyping scenes and organize Improv sessions

Use the same sequence and type of questions to guide one-on-one conversations

With virtual groups, use the chat function to share answers to each question, then select powerful stories/behaviors/actions to be vocalized with the whole group
Examples
For reducing harm to patients experiencing safety lapses (e.g., wrong-side surgery, patient falls, medication errors, iatrogenic infections) with cross-functional groups. Video of a DAD in progress to reduce the transmission of infections from UHN in Toronto.

For use as an ethnographic data-collection tool within a multi-site research project

For eliminating practices that keep professionals from helping clients change unproductive behaviors

For a series of local dialogues to help community members discover solutions to a chronic problem (e.g., disruptive children in a classroom, a cycle of violence that is not solved only by punishing offenders)

For researching and unleashing action to build professional competencies (e.g., in medical schools and social-service agencies). See “Developing Competencies for Physician Education” in Part Three: Stories from the Field.

For use in a one-on-one conversation to find approaches to a tough challenge

How do you know when anxiety about returning to work on site is present?

How do you contribute effectively to alleviating anxiety about post-covid return to work?

What prevents you from doing this or taking these actions all the time?

Do you know anybody who is able to help alleviate anxiety and uncertainty and overcome barriers? What behaviors or practices made their success possible?

Do you have any ideas?

What needs to be done to make it happen? Any volunteers?

Who else needs to be involved?

Discovery and Action Dialogue

Discovery & Action Dialogue (DAD) Team Activity

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