Collaborative Diagnosis in Organization Design & Development

The emergency room doctor watched my Jessica struggle toward the exam room. She couldn’t catch her breath. Every step of the ten meters made it worse. Jessica collapsed on the gurney and answered the doctor’s questions as best she could. There would be tests. Blood drawn, nostrils swabbed, an EKG and an X-ray.

All the tests came back normal. It seemed like just another holiday bronchial infection. An inhaler and antibiotics would do the trick.

But the doctor was puzzled. She had seen plenty of bronchial infections in her 30 years on the job. And they all had something Jessica didn’t: a wheeze. She ordered one more test because a symptom was missing. And when the test came back, there it was: the unpredictable, and thankfully treatable, cause.

Julian Chender and Jessica Phillips in the Emergency Room, December 2023

The Case for Diagnosis

After spending seven hours in the emergency room, I am reflecting on the similarities between doctors and the consultants. Despite the number of times graduate professors in my Organization Design and Development program told our class to avoid falling into the “Doctor-Patient” consulting model, there is much these two professions have in common. Both are helping professions that rely on external intervention in complex systems where accurate diagnosis of system behavior leads to measurable improvement. More so, both use shared participation and accountability. Most medical interventions – and all organizational ones – require the engagement of the client system, be that human being or an organization. The difference is that medical diagnosis falls more heavily on the doctor, while organizational diagnosis is shared between the consultant and the client.

Collaborative Diagnosis in Action

Collaborative diagnosis in Organization Design and Development is a delicate dance between the consultant and client. We work together to understand the current situation. The more we understand and allow the current situation, the more we release energy for action. (See the Paradoxical Theory of Change.) With this energy, we co-create the desired future state for the organization through Design and Development work.

The diagnostic process is ongoing throughout the entirety of any client engagement and has four phases:

1. Client Intake

2. Formal Diagnostic

3. Data Feedback

4. Ongoing Observation

During Phase 1, we make contact with the client and come to understand it as it understands itself. This is where we learn about the presenting problems, those initial symptoms that led the client to seek consultation.

In Phase 2, we take an external view of the client system and conduct a formal diagnostic by interviewing a cross-section of the organization to learn what underlies the presenting problem. We then use pattern recognition based on the theory of Organization Design and Development and our professional experience to discover new insights into the behavior of the organization. This is most similar to what the emergency room doctor did. She understood the disease pattern of a bronchial infection and looked for disconfirming evidence. It was the combination of medical training and years of experience that helped her find the unique underlying cause of Jessica's ailments. In the same way, consultants help their clients discover what the client system cannot always see in itself.

This becomes a collaboration again in Phase 3, which involves feeding the formal diagnostic back to the client system. This puts the organization in a conversation with itself, allowing it to make new meaning of its current situation. We share what we learned and engage with the client as it makes sense of, takes in, debates, and rejects the varying parts of the feedback. It is through this dialogue that the client system adjusts its self-concept, envisions a potential new reality, and unleashes energy for action. Client and consultant then co-create and implement the Design and Development interventions that will help the client achieve its newfound goals.

In Phase 4, we watch the client as they progress through the interventions and solve their underlying issues by integrating new learnings and changing behaviors. Ongoing diagnosis allows us to keep pace with the client’s growth, stay attuned to changes in system behaviors, and continue to meet them where they are. It also provides both client and consultant with a chance to continue to engage and make meaning of the client system as it changes, thus shaping its future.

Conclusion

In Organization Design and Development, diagnosis is a shared undertaking and continues throughout the change. Ultimately, the client and consultant collaboratively diagnose the client system into its new future reality. A good diagnostician, like the doctor in the emergency room, relies on theory and experience to understand the system’s patterns of behavior and draw insights for a way forward. The collaborative process then empowers clients to engage directly and become the engine of growth for their own future.