The Circle Way in Practice in Medical Teams: Health Care in Slovenia
by Natalija Vrhunc
Slovenia, a tiny country in central Europe, has a relatively good standard of health care, accessible to all citizens. Yet, within the hugely hierarchical system that deals with a lot of intensity and pressure, there is an enormous need to re-humanise the structures and processes. In its essence, there is a huge need to talk, be heard, and share burdens.
Traditional hierarchical structures, stressful and demanding work, down-line transfer of pain and frustration, enormous time pressure and urge for high efficiency, strong silos and a vast need to collaborate across disciplines and levels – these are some crucial challenges faced by today’s medical workers. To do the work well, the personnel need to be present with their whole bodies and minds – to the needs of their patients, their colleagues, and the health care units as wholes.
Shifting the System with The Circle Way
When I was invited to provide a ‘training in communication’ workshop for people working in the medical profession, my immediate internal response was to invite them to experience circle. Initiated by the Faculty of Health within the Ljubljana University, as part of life-long learning and capacity building programmes for the medical staff of all profiles across the entire country, this workshop actually turned out to be a bestseller among the faculty's programmes that year, with 7 half-day workshops selling out in record time.
The average number of participants was 16, and altogether more than 100 medical staff met in The Circle Way format, including nurses from a wide variety of working backgrounds (university central hospital, community health care centers, elderly care centres, paediatric departments, psychiatric clinics, trauma centers), midwives, occupational therapists, and even a few physicians. Most participants came from highly dynamic working environments, engaged intensely either with patients or within multi-disciplinary teams. Most were women, reflecting the predominantly female work force in care professions.
Large and substantial system changes are needed to change the communication culture at work within the healthcare system. In such highly hierarchical structures, where inherent pain is mostly suppressed and unspoken, circles can help us to make the system more human for employees and users. One of the powerful realizations of the workshop participants was that it is possible to communicate in more life-serving ways.
When they came to sit in circle, they experienced it as a safe space wherein they could deeply share personal burdens related to their work. They honoured the community they found in circle, mirroring each other through conversations. Not rarely, they cried, as their hearts broke open: it was the first time they felt truly heard by their colleagues.
Workshop Design
Inspired by The Circle Way, the overall workshop design was three-fold, with dialogue occurring:
within the whole group,
among pairs, and
with oneself.
Participants would experience the three principles of The Circle Way: leadership rotates, responsibility is shared, and reliance is on wholeness, and practice the three practices: speak with intention, listen with attention and rely on wholeness, in terms of what emerged from the group.
Dialogue Within the Whole Group
As the host, I “activated” the circle’s center by placing a written intention of the workshop, the guidelines for communication, a few objects for talking pieces, post-its, and markers. After introducing the center, we began with a strong check-in circle, answering the question: “What has called me to join this event?”
A short lecture followed, based on my experiences working with different teams as a facilitator and host wherein I shared key principles for efficient group interaction:
clear intention and invitation to team meetings,
clear objectives
transparent process and time structure of the meeting,
guidelines for creating safe communicative space,
basic circle infrastructure - the importance of slowing down, power of talking piece, transparent writing etc.
I also mentioned that it is not so necessary that a team sits in a circle form for a meeting: it is even more important that they all keep circle infrastructure in their minds, intending and practicing real cooperation.
After this I invited the sharing of their peak experiences in team dialogue and co-operation, using a talking piece to mark intentional listening and speaking.
Dialogue Among Pairs
In the second part of the workshop I invited deep listening and witnessing in pairs: “What would make my/our work truly meaningful? What is the experience of co-operation I am longing for in my team? What is my pain felt when I cooperate in my/our team?” We then regathered in whole circle, and shared key insights.
Dialogue With Oneself
In the third part of the workshop I guided a short, embodied presence meditation dedicated to experiencing one’s personal space. Participants were invited to share to the circle: Where in my life might I release tension? Where do I keep insisting to tensions, any why? Against what are the tensions protecting me? Where are my limits?
The workshop concluded with a check-out in a circle: “What is the most precious insight I am taking with me, and what am I grateful for?”
Afterthoughts
Though none of the participants had been acquainted with such a workshop approach, nor had they ever sat in circle form, they were very comfortable following The Circle Way guidelines and structure, which I found very interesting. To me this is a sign that the people who represent the ‘medical system’ are aware how the strength of their connections can build or break the entire system.
At the same time, the de-humanised structures and processes embedded within the system do not allow for the importance of these human-to-human connections to be made explicit, acknowledged and strengthened. Typically, medical staff - differentiated by age, experiences, education, occupational status, and position – work in siloes, full of fears, biases and unproven assumptions towards each other. What I saw, what the workshop participants experienced is that sitting in circle, they naturally aligned, meeting as humans, regardless of their vertical or horizontal divides.
Natalija Vrhunc, M.Sc. ~ Slovenia, Europe As group process facilitator, host and coach, I work with different clients within the public administration sector. Facilitation and hosting offer me life opportunities to learn and work enabling people to co-create and live in joyful learning together, feeling free in their expression and safe in all kinds of diversities, to listen to and respect each other.