Tag Archives: Culture

Strategies for Delivering Unpopular News

The mass never comes up to the standard of its best member, but on the contrary degrades itself to a level with the lowest.” – Henry David Thoreau
Recent experiences of Republican congressional members returning to their home districts during recess to explain President Trump’s proposed changes to the Affordable Care Act are instructive for the design of organizational change management (OCM) strategies.
How should you plan to communicate when the news will be unpopular?
We want to surface resistance, and we want to give voice to those closest to the work being affected. Evidence suggests that despite the additional time and cost, it makes sense to plan for small groups, or one-on-one meetings to deliver messages and get feedback from affected stakeholders.
I’ll never forget a meeting I attended many years ago where senior management assembled all the union machinists in an organization to update them on hazardous material safety. About ten minutes into the meeting one outspoken participant broke the ice with an accusation that leadership was concealing the true hazards of one of the materials that they routinely worked with. Within minutes, it became a shouting match, a mob mentality had taken over, meaningful communication stopped, and the meeting had to be abruptly ended. Eventually, one-on-one meetings were scheduled, not only to share the original information, but to repair the damage that occurred during the mob scene.
Excerpts from a recent New York Times editorial that highlights this issue in detail and references some of the research follows.

Can the G.O.P. Turn Back the Tide of Town Hall Anger?
Ralph Waldo Emerson wrote in “The Conduct of Life”: “Masses are rude, lame, unmade, pernicious in their demands and influence, and need not to be flattered, but to be schooled. I wish not to concede anything to them, but to tame, drill, divide, and break them up, and draw individuals out of them.”
Thoreau and Emerson argued that crowds add up to something less than the sum of their parts. The principle behind this is called “deindividuation,” in which an individual’s social constraints are diminished and distorted by being part of a crowd that forms to express a particular point of view. The French psychologist Gustave Le Bon first explained this concept in his magisterial 1895 text “The Crowd: A Study of the Popular Mind.” Le Bon found that crowds were inherently “unanimous, emotional and intellectually weak.”
Lots of research confirms this, showing that deindividuation can lower inhibitions against immoral behavior. In one of my favorite studies, researchers set up a bowl of candy for Halloween trick-or-treaters, told them to take just one piece and then left them alone. Some of the children were in anonymous groups, others were by themselves. When kids were part of a group, 60 percent took more than one piece of candy. When they were by themselves but not asked their names, 20 percent cheated. But when they were alone and asked their names, only 10 percent took more than they were allotted.
Of course, it stands to reason that deindividuation could improve individuals instead of making them worse. We can all think of cases in which we have been swept up in a wave of kindness and compassion in a group, even in spite of our personal feelings. Group polarization, in which individuals are pushed emotionally in the general direction of the crowd, can be either positive or negative.

The common error is when leaders treat the whole group like one individual. Remember Le Bon’s theory that a crowd is stronger, angrier and less ideologically flexible than an individual. Getting irate or defensive will always be counterproductive. Similarly, it is mostly futile to try talking over a protest chant.
The opportunity is to “re-individuate” audience members — to treat people as individuals and not as part of a mass. This is done not by acknowledging questions shouted anonymously but by asking audience members to physically separate from the mass and identify themselves if they wish to speak. When people detach from a group, the research suggests they will become more ethical, rational and intelligent.

A link to the entire article is below

 

Org Change is Missing in Health Care Tech

If you are an Organizational Change Management (OCM) professional you must read this.  If it doesn’t make you angry then you need to read it again.

Robert M. Wachter, professor of medicine at the University of California, San Francisco, and the author of “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age” wrote an op-ed that appeared on Sunday, March 22, 2015, in the New York Times under the headline “Why Health Care Tech Is Still So Bad.”

As Org Change professionals, we are collectively pressured to provide hard data to prove the value of OCM.  We see project teams rigorously measured and rewarded for meeting scope, budget and schedule without any regard for actual adoption or business impact.  We deal with senior leaders who believe that they will realize 100% of a projected benefit on the day a project is completed.  We know that this is crazy, but can’t seem to do anything about it.

My recommendation: Download this article from the NY Times.  Circulate it among your sponsors.  Talk with them about it.  This is what OCM is all about.

Here is the unedited text of the op-ed:

 LAST year, I saw an ad recruiting physicians to a Phoenix-area hospital. It promoted state-of-the-art operating rooms, dazzling radiology equipment and a lovely suburban location. But only one line was printed in bold: “No E.M.R.”

In today’s digital era, a modern hospital deemed the absence of an electronic medical record system to be a premier selling point.

That hospital is not alone. A 2013 RAND survey of physicians found mixed reactions to electronic health record systems, including widespread dissatisfaction. Many respondents cited poor usability, time-consuming data entry, needless alerts and poor work flows.

If the only negative effect of health care computerization were grumpy doctors, we could muddle through. But there’s more. A friend of mine, a physician in his late 60s, recently described a visit to his primary care doctor. “I had seen him a few years ago and I liked him,” he told me. “But this time was different.” A computer had entered the exam room. “He asks me a question, and as soon as I begin to answer, his head is down in his laptop. Tap-tap-tap-tap-tap. He looks up at me to ask another question. As soon as I speak, again it’s tap-tap-tap-tap.”

 “What did you do?” I asked.  “I found another doctor.”

Even in preventing medical mistakes — a central rationale for computerization — technology has let us down. A recent study of more than one million medication errors reported to a national database between 2003 and 2010 found that 6 percent were related to the computerized prescribing system.

At my own hospital, in 2013 we gave a teenager a 39-fold overdose of a common antibiotic. The initial glitch was innocent enough: A doctor failed to recognize that a screen was set on “milligrams per kilogram” rather than just “milligrams.” But the jaw-dropping part of the error involved alerts that were ignored by both physician and pharmacist. The error caused a grand mal seizure that sent the boy to the I.C.U. and nearly killed him.

How could they do such a thing? It’s because providers receive tens of thousands of such alerts each month, a vast majority of them false alarms. In one month, the electronic monitors in our five intensive care units, which track things like heart rate and oxygen level, produced more than 2.5 million alerts. It’s little wonder that health care providers have grown numb to them.

The unanticipated consequences of health information technology are of particular interest today. In the past five years about $30 billion of federal incentive payments have succeeded in rapidly raising the adoption rate of electronic health records. This computerization of health care has been like a car whose spinning tires have finally gained purchase. We were so accustomed to staying still that we were utterly unprepared for that first lurch forward.

Whopping errors and maddening changes in work flow have even led some physicians to argue that we should exhume our three-ring binders and return to a world of pen and paper.

This argument is utterly unpersuasive. Health care, our most information-intensive industry, is plagued by demonstrably spotty quality, millions of errors and backbreaking costs. We will never make fundamental improvements in our system without the thoughtful use of technology. Even today, despite the problems, the evidence shows that care is better and safer with computers than without them.

Moreover, the digitization of health care promises, eventually, to be transformative. Patients who today sit in hospital beds will one day receive telemedicine-enabled care in their homes and workplaces. Big-data techniques will guide the treatment of individual patients, as well as the best ways to organize our systems of care. (Of course, we need to keep such data out of the hands of hackers, a problem that we have clearly not yet licked.) New apps will make it easier for patients to choose the best hospitals and doctors for specific problems — and even help them decide whether they need to see a doctor at all.

Some improvements will come with refinement of the software. Today’s health care technology has that Version 1.0 feel, and it is sure to get better.

But it’s more than the code that needs to improve. In the 1990s, Erik Brynjolfsson, a management professor at M.I.T., described “the productivity paradox” of information technology, the lag between the adoption of technology and the realization of productivity gains. Unleashing the power of computerization depends on two keys, like a safe-deposit box: the technology itself, but also changes in the work force and culture.

In health care, changes in the way we organize our work will most likely be the key to improvement. This means training students and physicians to focus on the patient despite the demands of the computers. It means creating new ways to build teamwork once doctors and nurses are no longer yoked to the nurse’s station by a single paper record. It means federal policies that promote the seamless sharing of data between different systems in different settings.

We also need far better collaboration between academic researchers and software developers to weed out bugs and reimagine how our work can be accomplished in a digital environment.

I interviewed Boeing’s top cockpit designers, who wouldn’t dream of green-lighting a new plane until they had spent thousands of hours watching pilots in simulators and on test flights. This principle of user-centered design is part of aviation’s DNA, yet has been woefully lacking in health care software design.

Our iPhones and their digital brethren have made computerization look easy, which makes our experience with health care technology doubly disappointing. An important step is admitting that there is a problem, toning down the hype, and welcoming thoughtful criticism, rather than branding critics as Luddites.

In my research, I found humility in a surprising place: the headquarters of I.B.M.’s Watson team, the people who built the computer that trounced the “Jeopardy!” champions. I asked the lead engineer of Watson’s health team, Eric Brown, what the equivalent of the “Jeopardy!” victory would be in medicine. I expected him to describe some kind of holographic physician, like the doctor on “Star Trek Voyager,” with Watson serving as the cognitive engine. His answer, however, reflected his deep respect for the unique challenges of health care. “It’ll be when we have a technology that physicians suddenly can’t live without,” he said.

And that was it. Just an essential tool. Nothing more, and nothing less.

Leadership is Dead and our Performance Evaluation Processes Lie

“If your actions inspire others to dream more, learn more, do more and become more – you are a leader.” – John Quincy Adams

Please read the descriptions of “The Five Practices of Exemplary Leadership” below.

If you have people in positions of authority in your organization and they are not consistently demonstrating these behaviors, they should be getting poor performance reviews and you should be putting them on an improvement plan or moving them out.

Done laughing? Unfortunately it’s easier to just look the other way and perpetuate the myth.

You want innovation, engagement, accountability? I contend that the slow death of real leadership is the root cause of most of the problems we experience in our work environments today.

For a multitude of reasons, we have collectively lost sight of what real leadership looks like. Instead we have defaulted to a norm-based evaluation process, i.e., compared to everyone else, this leader is OK. This would not be an issue if your leaders were all true leaders. But what I see across organization after organization is that the whole lot have marginal management skills and absolutely no leadership ability. It’s essentially the same as the social promotion problem we see in public schools. If we were to adopt a criterion-referenced evaluation system and measured leadership against a standard like that described below, we’d have no one left to run the place. We have somehow slipped to the point where we all hold our noses, lie to ourselves, and no one dares explode the myth. The emperor has the finest clothes in the land!

Suppose we evaluated all people-managers against these five competencies?

The Five Practices of Exemplary Leadership

1. Model the Way – Clarify Values, Set the Example
Leaders establish principles concerning the way people (constituents, peers, colleagues, and customers alike) should be treated and the way goals should be pursued. They create standards of excellence and then set an example for others to follow. Because the prospect of complex change can overwhelm people and stifle action, they set interim goals so that people can achieve small wins as they work toward larger objectives. They unravel bureaucracy when it impedes action; they put up signposts when people are unsure of where to go or how to get there; and they create opportunities for victory.

2. Inspire a Shared Vision – Envision the Future, Enlist Others
Leaders passionately believe that they can make a difference. They envision the future, creating an ideal and unique image of what the organization can become. Through their magnetism and quiet persuasion, leaders enlist others in their dreams. They breathe life into their visions and get people to see exciting possibilities for the future.

3. Challenge the Process – Search for Opportunities, Experiment and Take Risks
Leaders search for opportunities to change the status quo. They look for innovative ways to improve the organization. In doing so, they experiment and take risks. And because leaders know that risk taking involves mistakes and failures, they accept the inevitable disappointments as learning opportunities.

4. Enable Others to Act – Foster Collaboration, Strengthen Others
Leaders foster collaboration and build spirited teams. They actively involve others. Leaders understand that mutual respect is what sustains extraordinary efforts; they strive to create an atmosphere of trust and human dignity. They strengthen others, making each person feel capable and powerful.

5. Encourage the Heart – Recognize Contributions, Celebrate the Values and Victories
Accomplishing extraordinary things in organizations is hard work. To keep hope and determination alive, leaders recognize contributions that individuals make. In every winning team, the members need to share in the rewards of their efforts, so leaders celebrate accomplishments. They make people feel like heroes.
These Five Practices of Exemplary Leadership above were codified by Kouzes & Posner in “The Leadership Challenge” first published in 1987 – what I consider to be the gold standard of leadership books (now in its 5th Edition). They are remarkably similar to the leadership traits that Simon Sinek describes in his latest book “Leaders Eat Last.” If you have not seen this TED video yet, please watch it.

Ask yourself this question when you do your next performance review of anyone in a leadership role; who would follow them if they left for another job? If the answer is “no one” then you better re-think how you define leadership and think twice about that “Meets/Exceeds Expectations” rating.

Show your senior leadership team the Simon Sinek video. Show them Five Practices of Exemplary Leadership. Ask them to reflect and self-assess. Start the discussion. Light the fuse. That is the true leadership challenge.

Great Quotes – Organizational Change and Leadership

I’ve accumulated a pretty good collection of quotes over the years.  I’ll be adding to these regularly.  Feel free to send me some of your favorites.

Organizational Change

“It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” – Charles Darwin

“If you don’t like change, you will like irrelevance even less.” – General Eric Shinseki (U.S. Army Chief of Staff, 1999-2003)

“It is not necessary to change. Survival is not mandatory.” –  W. Edwards Deming

“An organization’s ability to learn, and translate that learning into action
rapidly, is the ultimate competitive advantage.” – Jack Welch

“We now accept the fact that learning is a lifelong process of keeping abreast of change.  And the most pressing task is to teach people how to learn.” – Peter Drucker

Leadership

“Leadership is the art of getting someone else to do something you want done because he wants to do it” – Dwight D. Eisenhower

“Example is not the main thing in influencing others, it is the only thing.” – Albert Schweitzer

“When we do what we have to do we are compliant.  When we do what we choose to do we are committed.” – Marshall Goldsmith

“Obstacles are those frightful things you see when you take your eyes off your goal” – Henry Ford

Innovation

“To dare is to lose one’s footing momentarily.  To not dare is to lose oneself”  – Soren Kierkegaard

“Anyone who has never made a mistake has never tried anything new” – Albert Einstein

“The true sign of intelligence is not knowledge, but imagination” – Albert Einstein

“Failure is the foundation of success; success is the lurking place of failure” – Lao Tzu

Culture and Change Management

Over the last year or so, I’ve had to confront organizational culture as the most significant obstacle to several change initiatives.  If you are reading this, then you’ve probably heard the words, “That’s the way we do things here,” or “That’s the way it’s always been.”  You know what I’m talking about.

Then last week I read an article in Business Week by Jonathan Alter (not someone I ordinarily regard as a “change guru”) that triggered a few thoughts.  Particularly this sentence:

“The stove-piping that hampers so many bureaucracies can’t be busted on paper, only in practice. Organization charts only matter in organizations that aren’t nimble and effective in the first place.”  Read the entire article here

In GE’s Change Acceleration Process (CAP) model, both Leadership and Organizational Systems & Structures are established and functioning on the first day of your project.  I’m now thinking that you need to consider that organizational culture is also established and functioning at project inception, and must be considered on day one, as is leadership and systems & structures.  See the graphic below.

Culture goes beyond leadership, and permeates all aspects of organizational behavior.   When you hear, “That’s the way we do things here,” that’s code for: Several levels of existing leadership have been developed and prospered under conditions like these:

• Lack of accountability, poor performance management
• Bureaucracy, decisions by committee, lack of empowerment, lack of urgency
• Lack of fiscal discipline
• Lax ethical or compliance mindset
A “change strategy” within the scope of your project is NOT going to undo the problems listed above.   Referring back to Jonathan Alter’s comment, I always consider organizational design/structure early in any change project.  It is essential to know what Systems & Structures obstacles you are up against as you get started so you can manage expectations effectively.  Traditionally, I’ve worried about culture later in the project, as behavioral changes required by the change initiative emerged, feeling that cultural obstacles could be overcome with an effective organizational change strategy, like typical technical and political obstacles.  After my experiences over the last year, I have a different persepective.   I am now taking a hard look at organizational culture early in a project, and when I see significant obstacles, I am managing expectations differently.