What is the Temperamenture?

Saturday, March 16, 2013

tweet_birdie_flying_between_phones_150_wht_9168Tweet
The sound heralded the arrival of a tweet so Bob looked up from his book and scanned the message. It was from Leslie, one of the Improvement Science apprentices.

It said “If your organisation is feeling poorly then do not forget to measure the Temperamenture. You may have Cultural Change Fever.

Bob was intrigued. This was a novel word and he suspected it was not a spelling error. He know he was being teased. He tapped a reply on his iPad “Interesting word ‘Temperamenture’ – can you expand?” 

Ring Ring
<Bob> Hello, Bob here.

There was laughing on the other end of the line – it was Leslie.

<Leslie> Ho Ho. Hi Bob – I thought that might prick your curiosity if you were on line. I know you like novel words.

<Bob> Ah! You know my weakness – I am at your mercy now! So, I am consumed with curiosity – as you knew I would be.

<Leslie> OK. No more games. You know that you are always saying that there are three parts to Improvement Science – Processes, People and Systems – and that the three are synergistic so they need to be kept in balance …

<Bob> Yes.

<Leslie> Well, I have discovered a source of antagonism that creates a lot of cultural imbalance and emotional heat in my organisation.

<Bob> OK. So I take from that you mean an imbalance in the People part that then upsets the Process and System parts.

<Leslie> Yes, exactly. In your Improvement Science course you mentioned the theory behind this but did not share any real examples.

<Bob> That is very possible. Hard evidence and explainable examples are easier for the Process component – the People stuff is more difficult to do that way. Can you be more specific? I think I know where you may be going with this.

<Leslie> OK. Where do you feel I am going with it?

<Bob> Ha! The student becomes the teacher. Excellent response! I was thinking something to do with the Four Temperaments.

<Leslie>Yes. And specifically the conflict that can happen between them. I am thinking of the tension between the Idealists and the Guardians.

<Bob> Ah! Yes. The Bile Wars – Yellow and Black. The Cholerics versus the Melancholics. So do you have hard evidence of this happening in reality rather than just my theoretical rhetoric?

<Leslie> Yes! But the facts do not seem to fit the theory. You know that I work in a hospital. Well one of the most important “engines” of a hospital is the surgical operating suite. Conveniently called the SOS.

<Bob> Yes. It seems to be a frequent source of both Nuggets and Niggles.

<Leslie> Well, I am working with the SOS team at my hospital and I have to say that they are a pretty sceptical bunch. Everyone seems to have strong opinions. Strong but different opinions of what should happen and who should do it.  The words someone and should get mentioned a lot.  I have not managed to find this elusive “someone” yet.  The some-one, no-one, every-one, any-one problem. 

<Bob> OK. I have heard this before. I hear that surgeons in particular have strong opinions – and they disagree with each other! I remember watching episodes of “Doctor in the House” many years ago. What was the name of the irascible chief surgeon played by James Robertson Justice? Sir Lancelot Spratt The archetype surgeon. Are they actually like that?

<Leslie> I have not met any as extreme as Sir Lancelot though some do seem to emulate that role model. In reality the surgeons, anaesthetists, nurses, ODPs, and managers all seem to believe there is one way that a theatre should be run, their way, and their separate “one ways” do not line up. Hence the high emotional temperature. 

<Bob> OK, so how does the Temperament dimension relate to this? Is there a temperament mismatch between the different tribes in the operating suite as the MBTI theory would suggest?

<Leslie> That was my hypothesis and I decided that the only way I could test it was by mapping the temperaments using the Temperament Sorter from the FISH toolbox.

<Bob> Excellent, but you would need quite a big sample to draw any statistically valid conclusions. How did you achieve that with a group of disparate sceptics? 

<Leslie>I know. So I posed this challenge as a research question – and they were curious enough to give it a try. Well, the Surgeons and Anaesthetists were anyway. The Nurses, OPDs and Managers chose to sit on the fence and watch the game.

<Bob>Wow! Now I am really interested. What did you find?

<Leslie>Woah there! I need to explain how we did it first. They have a monthly audit meeting where they all get together as separate groups and after I posed the question they decided to do use the Temperament Sorter at one of those meetings. It was done in a light-hearted way and it was really good fun too. I brought some cartoons and descriptions of the sixteen MBTI types and they tried to guess who was which type.

<Bob>Excellent. So what did you find?

<Leslie>We disproved the hypothesis that there was a Temperament mismatch.

<Bob>Really! What did the data show?

<Leslie> It showed that the Temperament profile for both surgeons and anaesthetists was different from the population average …

<Bob>OK, and …?

<Leslie>… and that there was no statistical difference between surgeons and anaesthetists.

<Bob>Really! So what are they both?

<Leslie>Guardians. The majority of both tribes are SJs.

There was a long pause. Bob was digesting this juicy new fact. Leslie knew that if there was one thing that Bob really liked it was having a theory disproved by reality. Eventually he replied.

<Bob> Clarity of hindsight is a wonderful thing. It makes complete sense that they are Guardians. Speaking as a patient, what I want most is Safety and Predictability which is the ideal context for Guardians to deliver their best.  I am sure that neither surgeons nor anaesthetists like “surprises” and I suspect that they both prefer doing things “by the book”. They are sceptical of new ideas by temperament.

<Leslie> And there is more.

<Bob> Excellent! What?

<Leslie> They are tough-minded Guardians. They are STJs.

<Bob> Of course! Having the responsibility of “your life in my hands” requires a degree of tough-mindedness and an ability to not get too emotionally hooked.  Sir Lancelot is a classic extrovert tough-minded Guardian! The Rolls-Royce and the ritual humiliation of ignorant underlings all fits. Wow! Well done Leslie. So what have you done with this new knowledge and deeper understanding?

<Leslie>Ouch! You got me! That is why I sent the Tweet. Now what do I do?

<Bob>Ah! I am not sure. We are both in uncharted water now so I suggest we explore and learn together. Let me ponder and do some exploring of the implications of your findings and I will get back to you. Can you do the same?

<Leslie>Good plan. Shall we share notes in a couple of days?

<Bob>Excellent. I look forward to it.


This is not a completely fictional narrative.

In a recent experiment the Temperament of a group of 66 surgeons and 65 anaesthetists was mapped using a standard Myers-Briggs Type Indicator® tool.  The data showed that the proportion reporting a Guardian (xSxJ) preference was 62% for the surgeons and 59% for the anaesthetists.  The difference was not statistically significant [For the statistically knowledgable the Chi-squared test gave a p-value of 0.84].  The reported proportion of the normal population who have a Guardian temperament is 34% so this is very different from the combined group of operating theatre doctors [Chi-squared test, p<0.0001].  Digging deeper into the data the proportion showing the tough-minded Guardian preference, the xSTJ, was 55% for the Surgeons and 46% for the Anaesthetists whichwas also not significantly different [p=0.34] but compared with a normal population proportion of 24% there are significantly more tough-minded Guardians in the operating theatre [p<0.0001]. 

So what then is the difference between Surgeons and Anaesthetists in their preferred modes of thinking?

The data shows that Surgeons are more likely to prefer Extraversion – the ESTJ profile – compared with Anaesthetists – who lean more towards Introversion – the ISTJ profile (p=0.12). This p-value means that with the data available there is a one in eight chance that this difference is due to chance. We would needs a bigger set of data to get greater certainty.  

The temperament gradient is enough to create a certain degree of tension because although the Guardian temperament is the same, and the tough-mindedness is the same, the dominant function differs between the ESTJ and the ISTJ types. As the Surgeons tend to the ESTJ mode, their dominant function is Thinking Judgement. The Anaesthetists tend to perfer ISTJ so their dominant fuction is Sensed Perceiving. This makes a difference.

And it fits with their chosen roles in the operating theatre. The archetype ESTJ Surgeon is the Supervisor and decides what to do and who does it. The archetype ISTJ Anaesthetist is the Inspector and monitors and maintains safety and stability. This is a sweepig generalisation of course – but a useful one.

The roles are complementary, the minor conflict is inevitable, and the tension is not a “bad” thing – it is healthy – for the patient. But when external forces threaten the safety, predictability and stability the conflict is amplified.

lightning_strike_150_wht_5809Rather like the weather.

Hot wet air looks clear. Cold dry air looks clear too.  When hot-humid air from the tropics meets cold-crisp air from the poles then a band of of fog will be created. We call it a weather front and it generates variation. And if the temperature and humidity difference is excessive then storm clouds will form. The lightning will flash and the thunder will growl as the energy is released.

Clouds obscure clarity of forward vision but clouds also create shade from the sun above; clouds trap warmth beneath; and clouds create rain which is necessary to sustain growth. Clouds are not all bad. 

An Improvement Scientist knows that 100% harmony is not the healthiest ratio. Unchallenged group-think is potentially dangerous. Zero harmony is also unhealthy. Open warfare is destructive.  Everyone loses. A mixture of temperaments, a bit of fog, and a bit of respectful challenge is healthier than All or None.

It is at the chaotic interface between different temperaments that learning and innovation happens so a slight temperamenture gradient is ideal.  The emotometer should not read too cold or too hot.

Understanding this is a big step towards being able to manage the creative tension.  

To explore the Temperamenture Map of your team, department and organisation try the Temperament Sorter tool – one of the Improvement Science cultural diagnostic tests.