To illustrate how the Ascent Process works in real life, I will describe the case of a hospital emergency room. Daily crises are the norm. Work is often a matter of life or death. Patients wait to be treated—some with serious conditions; others with minor trauma. The area is overcrowded, especially during peak hours.
Nurses buzz around busily triaging patients, sometimes even in the hallways. Doctors pace from patient to patient checking their vital signs, while making small talk and deciding the best diagnosis. Overall, things are a bit hectic at the ER. Invisible to the patients, however, is the frustration the staff feels as they face budget cuts that result in lower staffing levels, cause longer patient waiting times, and add stress.
Nurses say they were in a scramble before the economy hit, and now they are in a mad scramble. A resident physician in the ER agrees, saying that there is no time to communicate with other departments. They feel locked down in survival mode, just doing their jobs, not realizing how they are affecting everybody else. The sad consequence is that some patients linger in pain longer while others may be misdiagnosed.
The Ascent Process facilitated a shared vision, based on values and focused on collaborative results.
One nurse, Joanne, interned at the emergency room while she was an undergraduate nursing student. She decided then to make emergency medicine her career. After graduation, Joanne took a staff nursing position at the same hospital’s ER. Soon, Joanne began taking additional responsibilities as the staff began turning to her for help thinning overcrowded situations.
Her sharp organization and decision-making skills proved indispensable in making sure they had beds for incoming patients. “I felt it was my duty to do something to help the situation,” Joanne said.
The ER Director position had been vacant for several months, and previous directors had lasted less than a year. With no one in charge, the ER was in constant chaos. “Why don’t you apply for the position?” one of her colleagues questioned. “We need a leader and you understand us.” Joanne decided to take a few days off to think things through.
The Ascent Process provided Joanne a framework to decide what she really wanted and how to obtain it. “What is the story of success?” Joanne wondered. Joanne drew up a plan with specific goals and a timeline.
Joanne was formally offered the position as Interim Director of the ER. She accepted and began to address the department’s chronic troubles. Following the steps of the Ascent Process, Joanne initiated staff meetings to address root problems, focusing on delivering quality care to an increasing patient volume with fewer staff.
The group came up with a vision. Surprisingly, the vision had little to do with improving processes or increasing staff levels. Instead, the vision focused on improving relationships between workers.
They envisioned an environment where everyone would treat each other with civility and respect.
The staff began taking ownership of the story and adopting new behaviors. Following the steps of the Ascent Process, Joanne turned the vision into an action plan. They identified the key players and clarified who was responsible for doing what.
The staff gained a renewed positive, and in-charge feeling that led to doubling the number of patients they could treat during peak hours.
The landmark event occurred during the engagement workshop. The group finally broached the un-discussable subject. Over the years, the older nurses had formed a strong clique. The informal power of this group left the younger nurses feeling disempowered. The silent group finally spoke up and as a group they drafted standards for the ER to work as one team.
Working more unitedly under a code of conduct they created, the doctors began noticing the change in the staff and began acting more respectfully toward the nurses. This led to a collaborative triage process that doubled the number of patients they could treat during peak hours. The ER changes caught the attention of the hospital administration who asked for report.
The situation at the ER was far from solved, Joanne pointed out, but there was a positive, in-charge feeling among the staff. Through a series of steps the overall condition of the ER was vastly improved. The Ascent Process facilitated a shared vision, based on values and focused on delivering results.