Visualising data to engage others

So I feel like I just died and went to heaven. The data nerdy part of me likes to find ways to capture and then show information in a way that makes sense and meaning. Too often I see the basic excel chart (not even bothering to change the colours) which does little to inspire me. We know from evidence and experience that capturing the imagination and interest of those we are influencing to change is key.

I clicked on a button and found Google's Visualization API gallery. These are the applications written by Google or 3rd parties. So if you want to put your values on a map, create annotated time series graphs, generate bar graphs with humour, trnslate a table of data into something visual, create an interactive map, show several indicators over time - I could go on. Seeing is believing. There are sections on maps, google, charts, fun, tables, analytics, project, text and other - enough to keep you amused for hours.

http://code.google.com/apis/visualization/documentation/gallery.html Go here only if you have at least an hour to spare to play and be inspired...

Monitter (spelling correct!) who is saying what about you on Twitter

So there are many conversations going on in Twitter-world - how can you find out who is saying what about you, your project, your organisation?

http://www.monitter.com/ is a free tool which requires no login process. Just enter up to three keywords and then sit back and watch the details unfold on your screen. Like eavesdropping with no sound.

All marketing and communications departments need to check out these conversations.

Positive Deviance recognised for MRSA reduction work

I blogged about Positive Deviance as a change and spread methodology a few months back. It is rewarding to see that the concept is listed in the 8th Annual Year in Ideas Issue of the New York Times Magazine http://www.nytimes.com/interactive/2008/12/14/magazine/2008_IDEAS.html

What I like about PD is it provides a different, yet proven, methodlogy for large scale change that is less "problem" focused. It works on the positive rather than the negative and in my experience is a less stressful and more rewarding improvement process in which to participate.

One of the most famous uses of Positive Deviance is in the reduction of rates of MRSA in a network of hospitals in the USA. Details about this work can be found on the PD website (see below) or for a different perspective you can go to http://www.plexusinstitute.org/complexity/index.cfm?id=3

For more information about PD go to www.positivedeviance.org

Examples of social media to spread good practice in healthcare

I often get asked for real examples of what some people feel is theory only - basically, how are healthcare organisations using the variety fo social media possibilities to help creat/capture knowledge as well as transfer it / enable change. There are many of these - you can do your own searches and find things specific to you. I have listed below a few interesting ones:

a) Facebook: South Central Health Authority in England has an organisational profile on Facebook. Anyone can become a fan of the organisation (a novel thought in itself!) and then through Facebook - as a fan - I receive details of its public health campaigns (photos etc) and I have also been targetted through Facebook to answer a survey (which I then passed on to some of my Facebook friends).

b) at http://www.trainingpod.co.uk/ is an example of a hospital using audio podcasts to reduce training costs

c) Derby hospital in the England is handing out iPods preloaded with video instructions to their Radiology students as a means of enhancing the textbooks and the learning process http://news.bbc.co.uk/2/hi/science/nature/7780647.stm

d) A good example of a wiki is one supported by the National Library for Health (UK) which is focused on developing support materials for the commissioning process http://news.bbc.co.uk/2/hi/science/nature/7780647.stm ANyone can log in and add their twopennyworth and experience.

Social media is a practice not a theory...

Breaking free of the IT Dept; Creating your own website

Finding ways to communicate over the internet is often seen as complicated if it involves more than an email. The traditional setting up of a website process was one not for the faint of heart and required some expertise. Now, if you have a message to share then you can do so by building your own website using facilities available on the web. I like the look, feel and ease of use of www.rombla.com

If you have something to say, something to share, then there is really no reason not to get started. I'd like to see patient groups, consumer groups, clients etc starting their onw websites and fora. This would be a good way to mobilise people into action for the improvement of health and social care services.

Learning communication techniques is important for spread and safety

I'm freshly back from a fabulous 2 day masterclass with a group who actively particiapted in developing their own communication skills. This was more than ideas on how to develop a technical communication plan. This was a group of individuals who spend time in front of video cameras and then assessed their own performance - with the aim of giving each other feedback and consequently improving their skills.

So often when communication is mentioned in the context of spreading good practice we default to "how to develop a communication plan". Yet I know from working with this groups, as with other groups I encounter, that it is only when we get to the finer details of communication and behaviour does anything really change.

Communication itself is an important topic. There is oodles of research about which demonstrates the link between communication and performance, communication and financial outcomes, communication and patient outcomes. In the current copy of International Journal for quality in Healthcare there is another excellent research report demonstrating how communication is linked to medical disputes.

My feeling is we can get further in the goal of spreading good practice when we pay attention to the details, like how individuals communicate with one another and resist the temptation to focus only on technical planning.

I also suggest we can stop researching the link between communication and outcomes and focus on making the desired communication changes.

Turn any URL into an RSS Feed using Feedbeater

I use RSS Feeds as a way to receive information as it is updated on websites and without having to resort to filling my email inbox with more messages. They go directly to my Reader (I use Google) and when I am ready I browse through what I have received.

One of the annoyances I have is how many websites seem not to have RSS Feeds. Many of these are in healthcare and the quality improvement world where there is interesting content but the site hasn't been updated to provide feeds.

I use http://www.feedbeater.com to create my own feed for the site and then register it directly into my Reader. It is simple, takes less than 15 seconds and then I am receiving updates when they happen and I'm not reliant of having to remember to go back to the website to check.

Why are RSS Feeds important for the spread of good practice? One main reason is they spread your information to those who want to receive it without you sending out newsletters. I can then forward info etc. If you're not providing an RSS Feed then those of us who want info need to take this extra step by using something like Feedbeater.

Mapping the spread of good practice by geocoding

One of the dimensions often forgotten when we're measuring the spread of good practice is place / geography. There is much theory about how messages spread location by location. If you're curious to provide visual mapping techniques to go along with your results charts, then geocoding is useful.

There are many websites that provide the ability to turn an address into its longitude and latitude reference, and then place a pin on a map to show where it is (geocoding). A new website is now available where you can map multiple places (show in groups to distinguish between the timing of an adoption of a good practice).

http://www.batchgeocode.com/ is where you can upload your addresses (a fun thing to do is to take your Outlook address book, file as they suggest and then upload - you get to see where in the world your contacts are!). A map is produced and you can then file this so you can embed it in a website or even create google earth files.

It is a one page process that is not difficult to do if you follow the directions carefully.

If you come up with ideas on how to use this in your improvement work then I'd love to hear about.

The fallacy of the tipping point

A few years ago I had my own epiphany when debating with someone the value of the concept of the "tipping point" when applied to social change processes.

Most of the research literature as well as the populist books subscribe to the notion that when you get the write idea and it tweaks opinion leaders and the target population, then it will spread automatically once it has reached its tipping point which can be anywhere from 15 - 30% of the total population.

All well and good though this research is descriptive; namely it describes something that has happened. It is not inherently predictive. Many people have written books and articles with their ideas on how to take the descriptive lessons and apply then predictively. However, there are very few longitudinal studies which chekc these implemented efforts with what actually happens.

If you do want a predictive method then there have been a number of formula around for 70 or so years all of which can be used to guide you in your implementation efforts.

Another fundamental issue is the tipping point usually refers to transformational innovation. It is when something quite new and novel gets adopted by others. It has little or no relevance for communities where incremental improvement is underway. Some studies make a point of assuming that innovation is the same as improvement, and they can thus include all innovation spread and adoption research into their models and theories. However, I beg to differ. Anyone who has a strategy of incremental improvement I suggests avoids using the tipping point as a planning tool.

I've written before about the concept of opinion leadership and my ambivalence about it (see earlier blog posts). The tipping point is fairly well predicated on the theory of opinion leaders yet there is much research to demonstrate the wekness in this model.

Yes, you may see many charts showing what looks like an S-curve in the adoption of an idea. However, my first question is to ask what was the total population, namely to how many peopel did you intend this idea to spread? ONce you have the total population you will most likely notice that what you are seeing as an S-curve may not be much mroe than the variation you might get in the early phases of adoption.

Next time I read a strategy and implementation plan that says something like "Once 25% of the population has adopted the change the rest will pick it up" I will continue to be sceptical.

Use blogs to develop communities of practice

Use blogs to help knowledge flow and communities of practice to develop One of the great ways to reduce email is to use collaborative systems that enable project teams to work together, to share all their files and choose how they wish to remain in contact.

Dave Snowden has written an article in KMWorld about how blogging can help communities of practice as well as this use of virtual teaming. His perspective is how these methods can help knowledge flow around an organisation and how communities of practice can develop, thus embedding knowledge and helping sharing.He has a number of tips of how blogging can be used http://www.kmworld.com/Articles/News/News-Analysis/%3CI%3EEverything-is-fragmented%3C-I%3E%E2%80%94Building-CoPs-for-knowledge-flow--49849.aspx

Synchronous learning is important for large scale change

I've always felt that the paradigm of learning, how we learn, the fact we have different styles etc., is a crucial theme for spreading good practice across systems, in large scale transformational change.

Some of us like to learn through theoretical experiences whilst other of us prefer a more interactice and discussive type process. There's an interesting article in "Chief Learning Officer" which I think closely relates to the problems we grapple with in healthcare in scaling up change across lots of people and organisations.

The article looks at the difference between synchronous (do together, discuss, meet, talk) and asynchronous (email, read alone) activities. It looks at how the learning process is effectively part of the outcome of any change.

I'll not repeat the article; have a look here for the whole thing -
http://www.clomedia.com/features/2008/July/2276/index.php?pt=a&aid=2276&start=0&page=1

Learning is part of knowledge management

There's a good article in Harvard Business Review 08/08 Vol.36 No. 8 P.60 by Amy Edmondson, entitled "The competitive imperative of learning".

This article is about the global trend to move away from a product based organisations to those that are more knowledge based - that is where the value is now. A process called EAL - execution-as-learning is introduced as a means to support the organisational learning and knowledge management process.

I like this framework because it is action orientated (good for healthcare) and shows how competitiveness can be managed, challenged and leveraged, though collaborative tools. This sounds a bit like an oxymoron. My view is that competitiveness might be the overarching strategy but it is delivered, at the action level, by collaborative working, including the use of systems and tools to enable this. There is also an emphasis on evaluation and feedback as essential parts of the learning process.

Mapping spread / adoption across geography

A key part of any spread and adoption sptrategy is the ability to map who is adopting the good idea or better practice. Location is a major factor. Are these people close to one another or separated? What might be the factors meaning there is significant adoption on one part of the Region or Country and not in another? How can we visually note the patterns?

I use http://www.mapbuilder.net/ as a tool for mapping adoption. It is flexible and helps me see who is where and what the patterns might be. It is based on Google Maps (check out the terms and conditions so you understand how it can best be used).

Groundswell; social media works

I couldn't help but do some cross pollinating for once (or is it cross blogginating). I've just read and reviewed "Groundswell" by Li & Bernoff.

The book is about how people use social media to buck the trend of how they get information - namely using technology rather than the traditional methods from traditional instititions. This has significant implications for how we go about encouraging the spread of good practice.

Read the book review and get more infomration at www.mybookblurb.blogspot.com

Building awareness is key

Most people keep their focus on the amount and extent of implementation; how many people have adopted the new practice or what benefits have been gained. This is important. However, I maintain that the amount of ultimate benefit you end up with, the number of people who end up adopting a change, comes from the pool of the people who decided to make a change. And not everyone goes through with the chnage process. Then the number of people who decide to make a change, comes from the pool of people who are aware - of two things. Firstly there is a problem they need to resolve, or maybe they just need to know there is a solution worth implementing - or maybe a bit or both. Regardless, they need to have awareness.

So when you next design your programme to rollout the benefits of a set of changes or want to get a large group of people to adopt some changes, my recommendation is to concentrate on the awareness phase. It helps to measure this as you then begin to have an idea of the slope of your adoption curve.

I could go on about this in some detail, but all I really wanted was to make you aware of the issue...

Sharing knowledge through social networking

There are hundreds of social networking sites around but this new one looks interesting and if it works it could reshape how we share knowledge and learn from, with and among our online friends.

www.ileonardo.com is where social networking meets a social form of knowledge management. You can upload content and create notebooks where you can collaborate with other users. You can see the information that your friends are working on. In this new era of open source knowledge and rapid dissemination, this feature has some significant advantages. It could rewrite the concept and dynamics of what is traditionally known as the opinion leader.

What I like about this site is how it moves on the concept of spreading good practice. It forces us all to think about how much we want to to share and with whom.

Methods for involving people in large scale change

Every now and then I come across a really useful website with content that presses all the right buttons. If you're interested in the topic of large scale change or spreading good practice and are looking for participative methods that involve the users, consumers, clients and population base - then have a look here:

http://www.peopleandparticipation.net/display/Methods/Browse+Methods

This is a UK government funded site called peopleandparticipation.net and needs to be congratulated for its simplicity and focus.

Building communities for scaling up requires skill & training

Although all of us can hold conversations, network to varying degrees, can manage a meeting and send an email, I am not sure these generic skills are enough to build both the face-to-face and online communities that we'll be needing for the large scale changes that many organisations I am working with have planned.

A few years ago there was a big push on ensuring that the leaders of improvement projects had the basic project management skills to help them on their way. Likewise we train facilitators of groups in how to perform their role. Building communities and understanding the fundamentals of how they work and what techniques you can employ, when, is part of a set of skills that can be developed by building on what you already know. To despatch an untrained and unsupported person to facilitate a program of large scale change, scaling up or spread (whatever you'd like to callit) without some appropriate social and technical input is most likely to doom them and their program to a lesser set of outcomes.

Is it because we think we know how to have a conversation and have a relationship that we are too afraid to learn any more or to reach our for help when we are taking on large and important change programs?

Managing email: 51 hints and tips

Some individuals and organisations use email as a marketing method. The same people then complain about being overwhelmed by their email. As part of some work I'm doing on helping individuals live and work in their virtual world I've compiled a non-prioritised list of hints and tips on dealing with email.

1. You get back about as much as you send (think about it…)
2. Make sure your signature is set up and includes your contact details. If you are a company you may need to include other details for legal reasons
3. Know how to use the advanced features of your email software, they are there to make your more productive and efficient
4. In Outlook, use the Rules option to send types of messages to folders e.g. messages from distribution groups can go directly to certain folders.
5. Ensure the subject line is pertinent (alter it if replying and changing the topic)
6. Use the subject line as a summary for the whole email; think what it will look like in the recipient’s inbox
7. When scheduling a mtg or a call put all the details into the subject line including the reason for the meeting
8. Cover only one subject per email and make your point succinctly
9. Read the email more than once before responding to make sure you comprehend it
10. Make action requests clear
11. When you copy someone, make it clear in the email what action you wish each person copied is expected to do (else don’t copy them)
12. Provide a context in every email; don’t assume forwarded or replied messages can be understood without this
13. Proofread your reply
14. If your email is printed make sure it will be one page or less and well formatted
15. If you know your recipient is using wireless technology to receive emails, like a Blackberry, then keep your emails very short
16. It is difficult to express your emotions in writing and remember the reader may not understand or “hear” what you mean
17. Praise in public, criticise in private
18. Show respect and restraint
19. Remember email is never confidential and can be forwarded on to anyone
20. Distinguish between formal and informal situations and adjust your language and use of abbreviations and icons accordingly
21. Long emails do not necessarily need long replies
22. Not all email needs to be responded to immediately. Use the “do not deliver before” function or reply when most appropriate
23. Avoid attachments. Better to put attachments on a webspace and link to them in your email
24. Better still, ask before you send an attachment or a large number of attachments. In some cases, good old fashioned print at your end and put in the post might really be appreciated as a time saver for the recipient
25. Be careful opening attachments from people you do not know or where the attachment looks strange, especially if it is an executable file
26. If you end up with a group of individuals regularly discussing a number of topics under a heading then start an online threaded group to manage the process
27. Get on the phone if you start a get-and-forth process; email is not an instant messenger product. A string of max 4 messages = a phone call.
28. If an email angers you, pick up the phone. Chances are you are misinterpreting it.
29. If you keep answering the same sort of questions from different people, consider starting a blog or using an FAQ sheet on the intra/extranet
30. To cut down on repeated distribution of the same document, such as agenda generation, use shared document and collaboration sites
31. For generating complex sets of information in collaborative ways that avoid endless attachments and update emails, use wikis.
32. Delete what you’re not going to deal with or delegate. (If nervous then file in a “delegated” folder). Get it out of your inbox.
33. Avoid being a “grey spammer” by copying irrelevant people
34. Send personal emails rather than sending “to” a 1000 and expecting a response (this is also akin to spam)
35. Send along the jokes and photos only in very exceptional circumstances and to people you know incredibly well.
36. If someone sends you jokes and things you don’t want to receive then ask them to stop
37. Stop sending emails that just say “thank you” or “responses that say “you’re welcome”, and ask others to leave you off the “thank you list”
38. Never forward on a “this is the latest virus” message” as it is nearly always a hoax and will often suggest the recipient take action that may cause damage to their system
39. Check your spam folder and junk e-mail daily to ensure you’re not getting proper email diverted there. If so, add the email address to your safe senders list.
40. Don’t forward mail to someone else unless you feel you have permission to do so
41. If you get email you don’t want in your in-box, use the blocking functions and other functions to have it automatically removed. Don’t allow it to continually waste your time
42. Get off as many email lists as you can, or have the newsletters you’ve signed up to be directed to a specific folder (use the email software rules function) and read them once a month.
43. Use the unsubscribe button to get yourself off the email lists you no longer want to be on (except never do this for spam)
44. DON’T TYPE IN CAPITALS! IT LOOKS LIKE YOU’RE YELLING.
45. don’t type all in lower case or use txtspk in emails.
46. There is no rule that everything needs to look like it is filed in a filing cabinet with folders. Use your computer and email software search function and file everything in one folder.
47. Move messages out of your inbox as fast as you can. Avoid using your inbox as your to-do list (in Outlook, use the Tasks option as your to-do list)
48. Process your email in batches and certain times of the day
49. Know how to turn the email function off and on on your Blackberry so you can receive email when you want it (also useful for not incurring large roaming charges when out of country)
50. When you read it – answer it (or delegate it), then delete it, or file it – remove it from the inbox
51. Archive your inbox or your main filing cabinet regularly so you have a backup if that is important to you if you lose your data

Influencers proven to be less important than we thought

One of the basic tenets of diffusion theory for the last 50 years has been the premise that opinion leaders are key to the dissemination of ideas and the rate of the adoption process. All this has been called into question by the research carried out by Duncan Watts at Coumbia University (and interestingly I instinctively wrote about my issues with opinion leaders not working well in my book "Undressing the elephant; why good practice doesn't spread in healthcare).

Duncan's work suggests that although the influencer hypothesis has some merit under most of the conditions tested the influencers had less influence than expected. In fact what he found was that it appeared adoption was helped by a critical mass of easily influenced individuals - turning the perspective around.

I did a brief and incomplete literature search of publications with "opinion leader" in the context of healthcare for the last 2 years. I found 18. Interesting to note that of these half suggested their experiment of using what they called opinion leaders worked in disseminating information and half said it didn't work.

So I guess the jury is still out. Though after 50 years it is good to see some new thinking.

No time to chat? How will you influence others?

The irony of middle and senior managers sitting alone in their offices and quietly developing communication plans on how messages and information was going to be spread around their organisation was not lost on me when I visited an organisation recently. It seemed everyone worked in isolation and apart from a few meetings where no-one really listened to each other and true dialogue was missing, the organisation appeared to have a dearth of conversation.

Yes, there was a lot of open plan office space, yet this was lunch time and most people sat at their desks, on their own, eating their sandwiches while pressing keys and watching screens. It was very quiet. The kitchens where you can make a coffee are stand around places with no seats, nowhere for sitting down and talking over a coffee. This is an organisation where chat, conversation and informal discussions seem not to happen very much. So I'm not really that hopeful about their "spread" plans. We know from the evidence in researching the impact of planning methods versus informal conversatioons and we know that the informal conversations and peer to peer discussions have a high degree of influence over another's behaviour.

In contrast, I have a client in the Netherlnads that when they redesigned their offices and moved from the rabbit hutch corridors of offices to open plan did so with conversation in mind. Their kitchen areas have seating arrangements and tables around them to encourage eating and talking together. They report that this works well and keeps the flow of information informally moving around the various teams in the organisation.

Design can play a large part but so can culture. If your office is a "no-speak-lunchtime" one, then try sharing your lunchtime with someone else in the coming week. You may even like the break it gives you.

We need system stars not individual stars

I thought I'd come up with a new idea only to discover that more than 80 years ago an article was written in The American Magazine about how perhaps the worst employee to have was the "brilliant" one because this was the person who would have lots of ideas, start them off and most likely never complete the work. You can read more about this orgininal article, called "Why I never hire brilliant men" here http://www.taoyue.com/stacks/articles/brilliant-men.html.

I'm interested in this topic because when it comes to the spread of good practice and scaling up good ideas across organisations and communities we so often focus on individuals. We point out the "champions", the so-called innovators, yet in my practical experience I am finding they really seem to be a turn-off at influencing others. I have written about this before.

What I am thinking about is that we focus on individuals because we are individuals. However, if we want system change we need to think about systems. And systems are not like individuals. They operate differently, to different rules, with different dynamics. We need to think decision-making processes, co-ordination, co-operation, collaboration and competition. Systems Thinking principles (from Senge's work) would be most appropriate here (more to come on this topic in future blogs).

So what we need are system stars for other systems to copy. We need to demonstrate that systems can operate the good ideas that we have. In healthcare we need to move away form the individualised models that we have and move away form the individualised model of scaling up to one which is more system focused - from its development through to its scaling up.

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-No Derviative

Social marketing for health: new resources

The "how" of spreading good practice is what is so difficult. One of the methodologies suggested is that of social marketing. I was pleased to see the English Department of Health using this strategy and openly promoting it. In some new documentation mostly around supporting public health initiatives, this strategy is made obvious. At the same time they have published a leaflet on "What is Social Marketing" and I commend this to general readership. I know they have worked jointly with the National Social Marketing Centre http://www.nsms.org.uk/public/default.aspx on producing it and it does make a great deal of sense. Succinctly written it sets out how social marketing is different from commercial marketing. I also like the way it still sets the expectations for measurement - something that tends to be forgotten in some social marketing programmes.

You can download the social marketing document and associates policy documents at: http://www.dh.gov.uk/en/Publichealth/Choosinghealth/DH_086106

I also find the National Social Marketing Centre website very useful as they make available many presentations on social marketing and a variety of other resources.

Do opinion leaders influence?

Well the answer is yes, though I suggest not enough for what we always need them to do in a planned way. I have written about this before from a slightly different angle though was struck again in a conversation with a client who wanted to create a change strategy based mostly around identifying a range of key influencers and then feeding information through them and wanting them to then infleunce the change process. By influence the change process I am assuming he meant create the action necessary to have the changes implemented by others in the workplace.

On paper and in the cold light of day this looks like a credible theory. In practice it wobbles slightly. Who exactly are the right infleuncers? Will they retain their credibility and influencing power once it becomes known they are working in this way? I suspect not. Also, most true influencers have this power over a discrete set of individuals, most of whom are their peers. In our organisational settings we would thus need to create a multi-disciplinary and multi-dimensional team of influencers to reflect these patterns and this is not what I generally come across when organisations talk of influencers. Mostly they refer to senior members of the team who they then label as champions of an idea.

I think opinion leaders do influence. I believe it is important not to confuse our organisational change and development implementation plans with this complex theory which is easier to see as a descriptive peice of research than it is to use as a predictive planning tool.

How to create an RSS Feed

A few people have asked me whether it is difficult to create an RSS feed since I posted it is one of the easiest ways to help people gather information from your website, and thus help share and spread information.

First you need to get a feed for your site then you need to embed it.

To get a feed there is a natty website to help you. http://www.feed43.com/ has easy to follow instructions and will provide you with the code you need to then instal on your relevant webpage where you want to instal the feed. It's as easy as that. Feed43 even supplies you feeds for pages that don't have feeds so you can keep up to date - perfect if you are waiting for someone to instal feeds...

Remember, a feed allows someone to subscribe to your webpage so that every time you make a change they will then get the changes, the update etc sent to them in the form they asked for it to be sent to them - usually in a reader though someotimes by email. This is much easier than them remembering to come back to visit you or you having to send out newsletters.

Dirtie Bertie; good practice communication

It's cute, it's simple and it works. The UK Department of Health is running a campaign "Catch it, Bin it, Kill it." to reduce infections spread by coughs and colds. I remember the "coughs and sneezes spread diseases" poster of my childhood". Well this is the latest version.

It is a wonderful good example of targetted communication. The Dirtie Bertie comic strip tells a relevant story and you can download the strip in classroom sized handout. On the website there is also a nursery rhyme mp3 to download for a singalong and you can get a transcript of the words.

While the germs don't need to be spread, this communication package certainly does deserve so.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085121

Tips for sharing information via the web

I'm always looking for quick and efficient ways to share information. Here are three that I use and find really helpful. There is some crafty webware available to help the process and it's changing all the time.

1. Social Bookmarking. I use http://www.del.icio.us.com/. If you're still bookmarking to your browser then consider using social bookmarking. Want to know what I am bookmarking then find me on this site - my username is sfraser881. You can find others who might be bookmarking thinsg like you - it is a whole new world of search, discovery, annotation and sharing.

2. Highlighting. Ever found a great paragraph in a website and wnated to point that out to someone? You end up sending an email to a friend with a long winded note explaining what it is all about. No more - use the tool from http://www.awesomehighlighter.com/. Easy to use, you go to the web page you want, use the highighter and it then prompts you to either email the link or share. Here is an example from my book reviews blog http://awurl.com/cpmju0106113

3. Google notebook. If I'm collecting a variety of resources from the web on a specific topic and then want to share those resources often I'm stuck. I now use Google notebook (sign up on iGoogle). You find the web page, right click, add to notebook and it then saves to the notebook you want. When you're ready you can then share that notebook with anyone else. They can then see your web research as well as any comments you may have in there.

Benefits are in the behaviour not the software

For every problem you have there are probably at least three technology solutions out there that can help you. Though is a technology solution always the right answer? Sometimes, yes. However, the first step might be to check out what you're using.

For example, many people I come across at the moment are looking for ways to keep track of their relationships with their customers and clients. So they are tempted to buy in complex customer relationship management (CRM) software. These additonal programs mean they need to record their transactions with each customer. Yet what they may not realise is that for many of them, a solution may already exist that meets their modest needs. If they use Microsoft Outlook then already every email is tracked by contact (check the Activities tab under the contact name) and if you set up your Journal preferences you can do a heap more. If you have the business contact manager add in then this has an almost full relationaship system and it integrates with much of what you use at your desktop - and does so without you doing any additional tasks. Whatever you use, what I have worked out is that if you end up having to do extra tasks, then you are unlikely to use it. So get something that integrates and works in the background. Not may software programs have that sort of ego.

Other software that causing angst is where we want to collaborate. Some use Sharepoint, other Windows Office Live, others Google groups etc. I personally prefer Windows Office Live as it integrates well and is less clunky than other programs. I can save directly from my desktop - no additional steps and it also comes with Shareview where we can share screens, all very quickly if we are on a telephone call and want to share and talk about a document together.

All the software comes with bells and whistles but they are irrelevant if they are not used. Think about your washing machine. How many of the fancy programs do you really use? In our house it is just the two. A quick wash and a regular wash. Heaven knows what all the other options are for.

If we're needing others to adopt the use of some technology as part of our better practice implementation then a good idea is to find ways to integrate it as much as possible into existing systems and to minimise the bells and whistles.

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-No Derviative

Knowledge is in the network not the innovation

At many of the courses I run on the topic of spreading good practice we often have the debate on how to define the "what" of good practice. The issue being what it is you want to spread to others - is it a thing, a behaviour, an attitude, or what? This debate is so "Knowledge Management 1.0" as most often participants on the courses focus on the things like guidelines, manuals, products etc.

A few years ago we hit "Knowledge Management 2.0" which considered the issue that knowledge lay in the person and then frameworks were developed around understanding how the tacit knowledge in individuals gets made explicit, and then becomes tacit again as part fo the knowledge capture and transfer process. All interesting stuff.

Nowadays we are in the "Knowledge Management 3.0" stage where the essense of knowledge is deemed to lie in the networks between people. Then sentient processes are felt to have properties of value. The network is greater than the sum of its parts.

There are some advanced thinkers about the world on this topic so if you're curious then start doing your own searches and see what you can find of value in the the networks.

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-No Derivative

Contributors, consumers and conduits of information

In the past few weeks I have been involved in a number of different virtual, web teaming activities most of which involve one or more of the following activities: the use of chat groups, uploading of documents to share, editing of a shared document using collaborative software, creation and editing of a wiki, telephone conference calling and webinars. It struck me through this process that the virtual world is no different to the face-to-face world. Some people are contributors, some are consumers and some are conduits.

There is a rule of thumb (rough, as I haven't found any research evidence to prove it) that for online chat groups you can expect around 1% of the signups to be active contributors in the sense they provide information, resources and editing effort, 10% to be participants in that they will discuss and use what is made available to them, while the rest, if they engage at all, will be passive. A small number of those who engage may also act as conduits of information for those outside of the participating system.

For online groups there are a number of techniques to improve and increase the rates of participation and good virtual facilitators and moderators will use these. Similarly in conference calls and other virtual web teaming tools there needs to be guidance and leadership to help those who may be unfamiliar with the techniques.

However, let's look at regular communication.

To spread good practice we need people who will contribute to the generation of new ideas, who will help adapt existing practices to new contexts. This takes effort. We also need conduits who pass information along. Then there needs to be willing consumers of the messages sent out. I'm not sure what to call those who are not contributors, conduits or comsumers - I know some people will fall into that category!

For the next project I'm working on in spreading good practice and encouraging others to adopt better ideas I'll do some analysis on how many and who we think in the specific system are contributors, conduits and consumers of the ideas. And then develop communication and action plans accordingly.

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-No Derviative

Energisers enable social movements

I'm in the fortunate position that I can usually choose who I work with which means when I encounter someone who starts to sap my energy, someone who manages to de-energise a group, then I choose to walk away. These are the people who go through working life discovering the problems, the roadblocks, pointing out the pitfalls, relishing in the cloudy skies - well, they don't encourage me to take on new behaviours - unless it's the one to walk away.

On the other hand, you may also have experienced what it's like to be in the same room as someone with a sunny disposition. I'm not referring to the eternal optimist as this person can be a bit tiring. I'm remembering those individuals who make time to be with people, who will be present at the meeting in more than body. They put their Blackberry's to one side and listen in, engaging with the conversation and finding positive and helpful ways to facilitate the discussion.

These same individuals often seem quite purposeful. They are task focused yet approach these activities with a care and compassion for others. If they disagree, they keep focused on disagreeing with the topic in hand and not attacking the person behind it. They keep communicating, even when the chips are down, addressing tough issues with integrity and sincerity. When I work with these individuals they help me gain meaning about the issues we're grappling with, while directing me, and others, towards an goal.

I hear a lot about the need for social movements in healthcare. There are some complicated frameworks and messages about hwo they get implemented. For me, it's all about the positive energy of those involved.

Are you energising or de-energising those around you?

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-No Derivative

There's no such thing as resistance to change

It took me a while to work it out but after I did I was more able to help the process of implementing changes within teams and in enabling individuals to find new ways of working. What I discovered was it was not the other person who was resistant to change, but rather it was me who was labelling them as resistant. This revelation occurred one day during a debate about sustaining changes and "the resistant person" explained that he was actually sustaining what he thought was a better practice than the one being proposed. Then it dawned on me. Of course, he doesn't think he is resistant to change - it is me that thinks he is. (The whole paradox about sustainability we'll leave or another blog post!)

In my experience I encounter more of what I perceive to be resistance when I am proposing that someone take on an existing idea. It is less of an issue when they have the opportunity to be innovative and creative and can come up with something that is their own idea. There is something about buy in and commitment in the process. So I've been working for some time to come up with some of the "how" for this connection, commitment, buy in, communication - whatever you want to call it, process. So often I find high level management type language is used to explain what is happening but little is said about how to then fix the problem.

What I find helps for me is to use the concept of learning styles or personal preferences. The more I understand about the individual's personal preferences and the way they prefer to take on new behaviours, then more I am able to find a way to assist them in adopting this proposed new change. There are many different learning style frameworks. I use Honey & Muford's LSI Instrument and also the Myers Briggs Type Indicator and methods to help me understand the person I am working with.

Not only do these instruments help me understand, they also provide ideas on how communication materials need to be different for different styles. For instance, a more theorist style will require detailed materials providing the facts behind the business case and what may be useful is an electronic copy of the document with hyperlinks to other sites which can provide background infomration. In contrast, a pragmatist may require a single sheet of paper, folded in a clever way so that it is designed like a small book and in this booklet is all the information required, in bullet point form, including some space for them to make a few notes as they go. They should also be able to open up the booklet, photocopy it for someone else and then fold it up again.

It sounds like a mission to have to find out the types of people you're working with, their styles and preferences and then to design materials to and interventions to suit them. In my experience, I know of no other way to appropriately help them take on existing knowledge in a helpful and meaningful way.

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-No Derviative

Transferring knowledge alters meaning

Most knowledge management and knowledge transfer schemes or frameworks that I frequently encounter fit into one of two categories
(a) large scale frameworks that suggest how good practice can be moved from one place to another, with the focus on structure, architecture, policies, procedures and processes to make it happen, and
(b) the detail of how knowledge itself is a combination of something intangible and tangible - and all the complexities of working with something so nefarious as it moves between two individuals

Remember the game we played as children, called "consequences", "chineses whispers" or "telephone", where you passed along a message between people and then found out how it got "corrupted" the further it got away from the original source? Well, I've been wondering what goes on in that game, for the dynamics are true in the transfer of information down most verbal and even written communication lines. What one person intends in their message, another will read differently, and then this other will pass on the message in a subtley different form, and so on.

What does this mean for real life better practices? An example in healthcare that I've been watching closely is one where there is an excellent improved way of working that is described and supported by a number of manuals, or modules. For me it is interesting to watch how in a short period of time these are being streamlined by the adopting population into a slimline set of guidlines, a pragmatic set of notes rather than a comprehensive reference kit. I am sure some of the detail will be lost in translation. However, maybe even more value has been added by the new developments. Will we ever know unless there is some form of evaluation to assess this?

It reminds me of a river system where the flow starts out swift and strong and over time it fans out to form a delta with tributaries. The question is; if you've got a delta forming in your organisation, is this what you expected and what you need for that piece of knowledge transfer?

Creative Commons 2008 Sarah Fraser Attribute-Non-Commercial-No Derviative

Are we unleashing people to act?

I has a good discussion with a valued colleague in the week about whether his organisation should be concentrating on encouraging others to adopt solutions (in the form of products, guidelines, known ways of doing things) or whether the focus should be on delivering the outcomes (the results of using the solutions). This is a regular topic for those of us working on the spread of good practice and one of the stock in trade answers is "it depends on the context" and another answer is "do both".

However, last week, I came away with another thought. Unfortunately, it was after I put the phone down so I was unable to chat it through. You see, I wondered whether we weren't being a bit constraining in our thoughts by constanting focusing on "innovation" and "output". It was only after some reflection I wondered about the role the people had in the process of change. Yes, I know that by measuring outcomes we'd be able to measure how much they have changed and whether they are now able to perform to a new standard. But what I am interested in is whether they have learnt new skills and developed their abilities in the process. Are they enjoying themselves? Are they less stressed? Do they feel more able, in the future, to contribute to the organisation's success by coming up with and applying new ideas? Has the way we've worked with them in this change process stimulated them to be part of an ongoing process -or have we done the opposite?

By focusing on transferring specific knowledge round the organisation in very basic ways such as focusing on the implementation of simple guidelines, are we ignoring some basic human needs to be involved in something more meaningful?

Creative Commons 2008 Sarah Fraser Attribute-Non-Commercial-No Derivative

Why do social network analysis?

Revealing who is connected to whom and the strength and power of those connections is about making the invisible visible. But so what? Why would an organisation want to do this when it's overwhelmed with financial reports, performance reports, improvement activities, recruiting staff, production problems, safety issues etc?

We all know instinctively and through personal experience that work gets done in an organisation according to a method, flow and process distinctively different from the formal organisational chart. I suspect one of the reasons why formal organisational structural changes often have little impact is because they pay minimal attention to restructuring the informal connections that operate the business.

What does social network analysis do? It shows people and how they are connected to one another on the basis of their relationships. It can identify groups and can show a variety of patterns such as who is central or peripheral to the network.

Here are my top three reasons for carrying out a social network analysis in an organisation (or subset of an organisation)

1. As part of improving or redesigning a process I would like to assess the underlying relationships that support that process. For instance, if the process we've been working on had some bottlenecks in it and we were looking to eliminate these or find some way of reducing stress at high pressure points, then I would want to assess whether the social network underpinning the process was experiencing a similar pattern. It is quite possible that this analysis would throw up a central person who is acting as an informational or decision making bottle neck. This person may also be overworked and stressed and the organisation may be over-reliant on this person.
2. Some individuals or small groups may have become disconnected from others in the organisation. The causes of this could be no more complex that a move to another floor or it could be more subtle. Disconnected individuals and groups may end up with a lower performance as it may, over time, become more difficult to share ideas and spread good practice with them. So it it important to identify these groups and discover ways to overcome the peripheral social network issues that have evolved.
3. Understanding the structure of social network is key for leaders to find ways to support and continue to enable it. If the analysis has been bounded (framed within the organisation only) it is helpful in discovering ways to match organisational goals with how relationships are evolving. If the analysis links to relationships outside the organisation (important for research and consultancy) then this can be linked to future strategies and plans.

We analyse the finances, the processes, the structures, the products and just about everything else in the organisation - I wonder why we don't do more analysing of the social network?

Creative Commons 2008 Sarah Fraser Attribute-Non-Commercial-No Derivative

Spreading or sharing? Chicken or Egg?

If you share something with someone, then the idea will have a greater likelihood of being passed on to someone else than if you didn't. This must be a basic premise. Then is the dynamic of sharing the same as basic communication? Let's assume for now that it is. Sharing also encourages new discussion, new ideas, feedback, creativity etc. This can provide a fertile context for the growth and dissemination of ideas.

The language used for spreading changes, scaling up improvement, making large scale impact - whatever you want to call it - comes across as an all powerful notion, with someone in charge, coordinating activity. Yes, if you're responsible for a large organisation and there are benefits to be had from having all departments operating at the industry benchmark, then you may have a right to sound like you want to start coordinating some improvement activity.

It feels a bit like the second example is the chicken (no jokes about headless ones, please...) and the first, sharing example, is the egg. Sharing requiring giving something of yourself, revealing an inner centre. It also works well when true collaboration takes place - to get lost in the analogy, I'm thinking omelettes now.

However, what puzzles me most is if I want good practice and ideas to spread around my organisation then which of the chicken or the egg do I want to encourage the most, and which would I start with?

Without sharing, without breaking eggs, there's unlikely to be any impact whatsoever. Without structure and some force, chicken processing, the impact will most probably be limited to small areas and marginal, at best.

So thinking this through, I'm going to want to draw up plans for scaling up of ideas that take both perspectives into account. And I need to find a way to figure out which one comes first.

What do you think? Chicken or egg? Spread or share?

Creative Commons 2008 Sarah Fraser Attribute-Non-Commercial-No Derivative

The power of impossible thinking

The title of this blog isn't my own - it comes from a brilliant book by Jerry Wind. So what is impossible thinking and what does it mean to business, healthcare and the spread of good practice? To use one of the most famous examples - let's review the breaking over the four minute mile by Roger Bannister in 1954. At that time the perceived wisdom was that to break the barrier required a specific set of circumstances, like a certain temperature, no wind and a track of hard clay. And a large home crowd cheering on the runner would also help. What did Bannister do? He set out on a cold English day, on a wet track in front of a small crowd - and broke the record.

It's what happened next that is interesting. The four minute barrier had stood for decades. As soon as Banister broke it, everyone else started beating his times, and they continue to do so. It was as though the mental barrier was broken and to do that it meant breaking through a significant amount of "perceived wisdom".

So I wonder what "perceived wisdom" we have that is holding up the rapid spread of ideas and good practice across our organisations? What barriers do we have to implementation? One that bother me is the constant lowering of expectations and improvement targets on the basis they could never be reached. As these are then accumulated across the organisation they then accumulate their weaknesses.

Some mental spring cleaning perhaps? Questions to provoke:

• What significant barrier to improvement needs to be broken?
• What is the pereceived wisdom and how can it be reframed and challenged?
• If the barrier is broken, what might be the size of the prize?

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-Non-Derivative

Adopting existing ideas is boring

This really energised senior nurse asked me, after I told a story about working in the oil industry, whether I felt challenged in the job I'd been describing. She went on to refer to her own role as exciting and fulfilling. She was brimming with enthusiasm and delight as she described it. Later on in the day, as a group, we discussed power, motivation and trust.

While not a topic for discussion on the day, it dawned on me at the time that one of reasons for the slow transfer of existing knowledge from one place to another, from one team to another, might be because it just isn't interesting, exciting or motivating enough.

I often hear good practice, ideas and innovation all rolled into one. The same words and phrases are used and assumed to be the same. For the individuals and teams involved in the initial work, it may be an innovation - in the sense it was something new and exciting. It was part of it being meaningful to them. It may have enabled them to gain reward in the sense of recognition for their efforts. We know that these types of factors are very important in determining job satisfaction.

What happens to many of these early innovations is they reach the stage where someone else then decides they need to be spread wider in the system and adopted by others. What I'm wondering about is how we can make this adoption process meet the job satisfaction needs of the second line adopters. Because when they get given a list of what are now routinised tasks to integrate into their work, I am sensing they see this as extra work and this is landing on the dissatisfaction side of the motivation curve. Doing small cycles of change to integrate into their own context appears, in many cases, to be insufficient to stretch these individuals and teams to meet their needs for making this meaningful, challenging and reward based.

How can we take existing ideas and help others see these as novel in their own circumstances?

I have some provocations to reflect on:

a) Instead of continually using the phrase "Let's not reinvent the wheel" - how about encouraging a reinvention of the wheel. Instead, encourage a curiosity. Direct and focus the interest. Provide support and information where it may help. Avoid providing solutions unless asked. Insist on goal orientated outcomes and measure these.

b) Think of everyone, at every stage in the adoption process, as an innovator. In order to have the best job satisfaction, they just innovate in different ways. So how best can I find out for my system who like to innovate in which way? How best can I use this to get the result I need?

c) Instead of implementing tasks and going for outcomes, how can I deliver increased meaningful work and increased job satisfaction. Working on the basis that almost everyone wants to do a good job, my suspicion this may end up int he same place though from a different starting position.

What I'll be doing from now on is checking communication and materials designed for spread and will assess and ask how these are designed to motivate those receiving them. How will they provide meaning to their work? What reward and recognition systems are in place?

I'm not motivated to change my behaviour when bored, so it's hard to think who else might be.

CC 2008 Sarah Fraser Creative Commons Attribution-Non-Commercial-No Derivative

Solution seekers or problem solvers?

Maybe you've had this experience too? You've come across one of those people in a team or organisation who just seem to have things around them so, well, sorted. I've come across another one of these great folk again so I spent some time investigating what it was that contributed to their success. Of course, this also meant I had to rearrange a few of my own mental models in the process.

Yes, they met all the usual requirements of good interpersonal skills, they had good time keeping and you could rate them as productive and efficient leaders. But there was something else. They were working in a fast-paced operational environment where quality improvement was required and the technical skills associated with improvement and change management were highly prized by their peers and senior managers. I anticipated seeing a high achieving improvement manager at work, putting their skills into action and solving problems.

I was wrong. What I encountered was almost the opposite. This person had few if any technical improvement skills. They knew enough to hold a conversation. Their focus was on the business and on diagnosing the context and the wider issues at stake. So how did problems get resolved and improvement take place? And how did this leader stay remarkably unstressed while also delivering a newly streamlined operation?

Their approach was one of a solution seeker? All their language was about solutions. This was more than internal organisational debates and discussions. This person was a vast networker. At the first sign of an issue, feelers were put out on their web of networks, asking questions of their contacts, "anyone seen this issue?", "who has solved this and how", "who has a guideline or policy for this?". If this person didn't get a response within a couple of days the questioning moved on to "does anyone know someone who has solved this problem, can you introduce me to someone?". Very soon, phone calls were set up and discussions held. As quickly as possible they linked up members of the team with teams in other places that had solved the problem and they shared experiences.

Coldy written here in the blog, this looks like any old description of a way to share good practice through a social system. Thing is, it seldom happens this way for real when leaders are up against the hot pipes and working in organisations where the culture is silo'd and boundaries are firm.

This leader is different. They have a fundamentally alternative view of their role. They look outwards. They know they cannot have all the skills necessary to solve all the problems. They know one of the most effective competencies they can bring to the role is their ability to network. They also know the capital their network brings and they use it.

This is the solution seeker mentality and it is focused on speeding up the adoption and implementation of better practices.

CC 2008 Sarah Fraser Creative Commons-Attribution-Non-Commercial-No Derivative

Groupthink hinders the spread of good practice

This topic takes me back to one of my early posts in March 2008 when I worried about how we know whether what is being spread is a good idea in the first place. My experience of the last few weeks leaves me even more perplexed as the reality of large scale change (spread of good practice) initiatives across different continents seems to experience similar, dis-spiriting, effects. On the one hand there is a group, mostly senior leaders, who speak of success in the programs, and on the other hand, there are others, mostly those involved in the direct implementation of the changes, who want to speak of success yet talk quietly of the hurdles and challenges they face.

When I step back and look at many of these large scale initiatives they are all using similar frameworks, tools and techniques, and they are all experiencing the same sorts of problems in their implementation. Roughly, they get around a third of teams involved delivering some improvement, another third demonstrating engagement to some or another extent and the final third inactive despite a variety of tactics. These are very rough figures but the pattern is fairly consistent in a number of large programs.

So the question I ask myself is why do we accept this level of performance? There seems to be a quality improvement / spread of good practice "virus" which goes round and infects all groups to the extent everyone does copy each other with little investigation to seek out new and alternative large scale change methods. The dynamic reminds me of "groupthink" so I checked out what characterises groupthink; according to McCauley we'll see it when we have directive leadership and homogenous groups that are isolated from outside sources of information and analysis. That sounds like many of the healthcare teams and organisations I encounter along with their quality improvement consultancies they work with.

So I've started challenging the groupthink and speaking up a bit more than I usually do. In a small way this means providing information, directing teams and organisations to look outside their usual frames of reference, suggesting alternative sources of challenge (even other than myself). It also means saying no thank you to requests for support where it feels it is encouraging groupthink.

So my challenge now is to think about topics like patient safety. There's a proliferation of programs and initiatives either underway or planned around the western world. The more I think about them and talk with others who are working on the programs, the more groupthink appears to be at work. I am not convinced on the progress so far that the current large scale initiatives are sufficiently breaking free of the mindsets that got us in the mess in the first place. It feels like we're implementing workarounds. Many colleagues agree though few are ready to speak out.

If you are willing to rethink your strategy and tactics on large scale patient safety intiatives, and do so in an innovative and challenging way, involving people from different disciplines, industries and countries, then let me know. There has to be a better way.

2008 Sarah Fraser, Creative Commons: Attribution-Non-Commerical-No Derivative

Organisation-wide spread plans need vision

With most groups I work spread seems, roughly, to fall into two categories: (a) spreading good practice across large geographic communities, involving multiple organisations, and (b) spread within a single organisation, managed by a single top team.

In the case of the single organisation spread effort, the aim is twofold (i) breath - getting the good practice to the further reaches and corners of the whole organisation, and (ii) depth - helping all the relevant individuals in the organisation through the change process of implementing the new practices.

Most organisations I've been working with recently have been struggling with developing the plans to achieve the breadth and depth they desire. In most cases they are working through what appears to me to be a technical, step by step planning project type mechanism. I feel this is helpful though for me there is a very important missing ingredient which might be best handled right at the start and before detailed plans are written up. Perhaps this is best explained through an analogy.

Imagine weaving a large tapestry; one of those you might have seen hanging on the wall in a museum. Large creations like these are usually participative activities. Now think what it would be like to be stitching part of the tapestry without knowing what the whole picture looked like. Yes, it would be helpful to know your own piece, but far more satisfying to know where you fit into the whole. Imagine now the activity you could undertake as a team in thinking through what your organisation will look and feel like when the whole organisation has adopted the new practices. And then how you might share this picture. This visioning and sharing process is important and there is an entire discipline dedicated to what is called "goal orientated behaviour" - in case you are interested in following this up.

Keeping with the tapestry image, we can extend it a bit further by thinking about the structures we need to put in place for a large and complex activity. How will we watch for the gaps? By answering this sort of question we might develop a different type of spread measurement system for the organisation; a measurement-by-exception attitude rather than a wearing down by a comprehensive performance monitoring system.

And the threads? How do we feel about them? Some may need to be left hanging as they will link to other projects and issues? How will we identify them? Can we "colour-code" them? How can we make sure that they are not the type of threads that when you pull on them the whole tapestry won't just unravel and we're left with nothing to show for our efforts? For me, this is about being aware as a project team. About seeing the spread of the good practice as part of a larger system.

I know project plans are important, however, I am perturbed by the predominance of the step-by-step guides that disconnect individuals and teams from the heart fo their work. The quickie fixit mentality may be leading organisations away from the breadth and depth they so desire.

It takes time to weave a tapestry.

2008 Fraser Creative Commons Attribution-Non-Commercial-No derivative Works

Traditional copyright may limit spread and adoption

I've been inundated with a variety of contractual issues in the last few days, quite a lot of it is Requests For Proposals for programs of work where potential clients have clauses in their agreements specifying that any idea (or derivative) developed will belong to them. The strange thing is, these are the same clients who are often contracting or asking me for support in finding ways to spread their messages and ideas to wider audiences.

The perceived paradox is that we, me included of course, want to hold on to the ideas that we come up with, for many different reasons. However, it may just be that one of the barriers to the idea getting "out there" in the first place, or being adopted and adapted by others, is the tight restrictions of the traditional intellectual copyright - the (c) symbol.

I've personally been tossing about in this sea change of intellectual sharing for some months. Making the personal and then the business strategic shift to an alternative paradigm has taken nearly two years of trial and error and will no doubt continue. I am having to redesign my entire concept of a consulting business, along with all the supporting paraphenalia. Some of these lessons are directly pertinent to the spread of good practice.

As I am not the first to struggle with this concept, there is now a robust framework for dealing with this issue - the Creative Commons Licence. http://www.creativecommons.org/ This organisation has developed licenses specific to many countries that cover may combinations of the following:

Generally you are free to copy, display, distribute and perform the work

a) Attribution: you must give the original author the credit

b) Non-Commercial: you may not use this work for commercial purposes

c) No derivative works: you may not alter, transform or build upon these works

d) Share-alike: if you alter, transform or build upon this work, you may distribute the resulting work only under a license identical to this one

and then there are a few minor details to take note and if you'd like to read all the fine print for each license for the combinations you choose then they are available for you.

On the basis that the spirit of a CC license is to copy, distribute, display and perform a work, then that sounds to me like a good start for spreading good practice. My choice is to add in (a) and when I am providing my ideas, thoughts and materials for free, then I expect them to continue to be made available in the same way so (b) needs to apply. I'll then make a choice regarding (c) and (d) for each idea or product, though I know from the theory and practice of spread and adoption, if I really want something to take off then I will need a balance as (d) is quite often a necessary step in the implementation and adaption process.

What I have learnt is there is no going back.

2008 Sarah Fraser CC:Attribution-Non-Commercial-No Derivative Works

Web 2.0 is an important spread medium; it is not just for geeks!

The real "geeks" are talking about Web 3.0 so let's just stick now to Web 2.0. The term loosely refers to a category of internet tools that enable users to actively participate with content on the web. This is so much more than just participating in a chat group. It is about being able to customise your interactions, join up two different programs, make the web a very personal space for yourself right from how it looks through to how it performs for you. Web 2.0 users operate from a personal and community perspective and use the technologies available to them to bypass organisational and social walls.

Both formal and informal organisations that remain stuck in the Web 1.0 world of passive web systems, of the "come and get our information" or "network only within our boundaries" will soon find themselves with a generation of deskilled staff and a customer / client base who drop out sight. If the organisation holds a monopoly for their service, like many public services, then the incentive to invest in Web 2.0 is often limited as the customer has no option. The loss here is the reduction in staff skills and the inability for the gains in knowledge sharing, community building and the sharing of good practice that Web 2.0 can bring with it.

So what can Web 2.0 are some of the benefits of Web 2.0 for spreading good practice, or just sharing good ideas round communities - how can it help?

Publishing and sharing information widely over the internet
a) Use blogs (this is a blog..); personal information is important and can have an impact. If you're really scared then anonymous blogs are possible and could even spark a bit of fun
b) Tag; basically this is booking your favourite sites and then sharing your favourites with others in your social or work circle. Think about the possibilities.
b) RSS Feeds; these allow you to subscribe to places on the web so the infomration is delivered to you when the site / page is updated. Incredibly useful as you don't have to remember to go looking. It shocks me how many important healthcare websites do not have an RSS Feed facility.

Networking and collaborating with others
a) Social networking sites are ten-a-penny. Each has its own flavour. Check out which ones your staff are using now and why. By limiting your organisation to only organisation-wide ones you may be limiting their network and community. My favourite is Linkedin.
b) Whenere does the real news come from? To spread good ideas do we send out newsletters or allow the citizen journalists to use the architecture of participation we have put in place to share their videos and stories?
c) Wikis are ways to allow the we-think teams to create and work together and produce output. This is about dissemination through to adoption (in our spread terms) all in one go and not as a linear process.

Sharing and showing messages and information
a) Photos; there are many different websites with a variety of functions to allow sharing with comunity functions.
b) Podcasts; not just to deliver information, but also to provide ways to manage the downloads and streamline the way that the receivers then use their time more effectively (no more email and paperwork)
c) Videos; U-tube has stolen the market maybe, though this is one of the most succesful methods to get a message across and is almost compulsory. Think citizen journalism though. In web 2.0 the citizen create and share the content.
d) Mashups; this is where information from different places is combined, like putting submitted videos onto a Google map so you can see the location of where entries for a competition are coming from.

I think using Web 2.0 is not so much as using a set of technology tools as engaging with a different mindset about how we do business. It's like not "how do I use MS Outlook", it's "how do I best use the concept of email to carry out my tasks and build relationships", or not "how do I use the @stdev function in MS Excel" but rather "are there some useful functions in MS Excel that may help me in my role as a quality improver"? So Web 2.0 is not "how do I blog" but rather "what can we get from the concept"? or ""how can we mash-up" but "what mash-ups will add to our business value and further spread good practice?"

The technical boffins will always be around to help us do the techie stuff. The strategic and tactical business thoughts and discussions around Web 2.0 need to take place for them to be able to implement and reveal their talents.

(c) 2008, Sarah Fraser

Differentiating the types of good practice matters

In my theoretical and practical travels I find that all good practice (however you'd like to define it) tends to be regarded as similar. What I mean by this, is there is little distinction as to whether the practice is designed to
a) make something happen
b) avoid something happening
This "commission" or "ommision" differentiation may be important. I'm working on it and if you have any ideas please then do put a comment in this post so we can add to the body of knowledge and share it openly. Or email me if you prefer.

Let's look at a couple of healthcare examples. In (a) we might be creating a new healthcare service for patients who have developed diabetes. Part of this might be to design and implement a new form of consultation called a group visit where a number of patients are seen together by a variety of different professionals. This has been successful in a number of places and we may like to copy what they have done. Yes, this may be to avoid something happening, but mostly, it is about adding something new into the system.

In contrast, we may be concerned at our hospital about the high level of MRSA infections. We want to avoid something happening. Yes, this may include something new being created, though the emphasis is on avoiding a situation.

The reason I feel this differentiation may be important is that the change process for the individuals and teams may be quite different. Understanding that they may be going through a different learning process whether they are taking on something more creative and new, or whether they are designing to avoid, may streamline and accelerate the adoption process.

For example, in the (b) avoidance example, the learning process is likely to be enhanced if the emphasis is on understanding the "near misses" so the individual / teams can discover how best to take action before the situation arises. Raising awareness and linking a "near miss" awareness to the ability to make a decision to fix it, may enable the individual to learn and sustain a new behaviour more rapidly. "Near misses" will also allow for the customisation nearly always required for the local context.

In contrast, in the (a) commission example, the learning process may be less organic and it may be possible to apply and use more straight forward project implementation techniques. These are unlikely to reduce the need to pay attention to the people issues, however, there may be as much success in using well known management tools as in using the more esoteric "spread" techniques.

"Making something happen" or "avoiding something happen" - do you think it makes a difference?


(c) 2008, Sarah Fraser

How opinion leaders may be ineffective

The word "Champion" gives me shivers when I hear it as a label given to someone by senior management who then overlays their expectations on this person to lead the change of a topic with their peer group. For example, in healthcare, we get clinical champions for colorectal cancer, or nurse champions for infection control. Often these individuals are identified because they have participated in projects or shown interest and leadership in their work, within their peer group.

So what happens once they get "promoted" to champion?

Before answering this question, some background. I am aware of much research on the topic of opinion leadership. Much of this is contested and conflicting. In fact, come of the recent research questions whether they exist at all and other research points out they may exist, however, the manipulation of them may be impossible, for many reasons I'll not cover here. So or the purposes of this short note I am assuming you're interested in the concept because you like the use of it and wonder whether and how it works for you.

In colloquial terms, I do find there are two types of opinion leaders. The promiscuous type and the powerful ones. The first category are those who have a lot to say. They have strong opinions and will talk to many people, within and without their per group, about those opinions. The extent to which others are influenced by those opinions I feel is rather weak. This may be because of the volume of them, the weakness of targetting or the number of different ideas discussed. In contrast, the more powerful opinion leader is the one who shares a little less and builds more credibility with focus. More of an expert this person is also a bit more interested in ensuring the ideas are successful in the workplace. So the followers will place credibility in the ideas this person speaks about or actions that are taken. Obviously there are some grey areas in between these two steareotypes I have described above.

So what happens to the 'champion' role?

If the person who is placed in this role comes from the more promiscuous type of opinion leadership orientations, I feel they will start with less credibility amongst their peers. From the management perspective they may appear quite (or indeed very) effective, as they may be able to maintain a high degree of communication. The issue is whether this communication transfers into a change of behavior. At best it does. At worst it creates noise in the system and a consequential immunity to further change.

For the more powerful and expert opinion leader, the transfer to 'champion' often ends in the loss of credibility. The individual is seen by their peers as having 'gone over to the other side'. The very factor that gave them their power is then lost. Perhaps they would have been best left in their place and given support to carry out their social leadership role, without interference.

There is theory and research, and there is practice. I read the theory and research and spend time in organisations and working on projects. My difficulty is connecting the theory and the practice when it comes to opinion leadership. I'm starting to realise that the theories are very limited and maybe it is time to do some reframing by looking very closely at what actually happens in practice.

And maybe it's a good idea to work with the social system rather than to mess with it.

(c) 2008, Sarah Fraser

3 tips for measuring the spread of good practice

1. The most basic spread / adoption chart is one which measures the number of people adopting a good practice over time; that is, people on the vertical axis, time on the horizontal axis. If you're not prepared to do this check then do comment in this blog and let me know how else you keep track of progress.

2. Calculate your total population who you would like to adopt the good practice. Work out how long this might take. Then pick yourself up off the floor.... Now work out that from this total amount, what might be a realistic target for the timescale and resources that you have for the project.

Why does this matter? Look at the picture above. Without having thought about the total intent of the spread programme, it is quite possible for a shorter period to show results like those under the red lines. When the project then ends, and measurement continues, then the results look like they take a nosedive. This is when measurement usually stops.

One of the reasons for working out the total intent before starting the spread programme, is to provide for some creative thinking. You may just go about the process in a different way if you knew that eventually there were going to be 25,000 staff using the new method, across 14 locations and it was likely to take seven years.

3. Einstein was on to something with his work on time and space. We've no need to get that deep into the mathematics when working on spreading good practice. However, the issue of space is an important one; or maybe you think of it easier as geography. I've seen some teams use excellent maps and nowadays there are interactive electronic maps on which data can be tagged. Think and get creative. Learn about how and why different practices spread in different ways, not just because of the peopel involved but also because of the space and geography.

Three basics to remember for spread measurement.

People.

Time.

Space.

(c) 2008, Sarah Fraser

Warning: "holding the gains" means missing the point

For those well versed in the art of Cockney rhyming slang, then you'll know that the "dog and bone" is how a Cockney Londoner refers to the phone and "apples and pairs" the stairs. They might now say "Would you "Adamn & Eve" (believe) it, but we seem to have a new term."
I keep coming across "spread and sustainability" as though these two remarkably different concepts and dynamics were intertwined. They appear in requests for short presentations, in documents, booklets, advice to project leaders and exhortations for improving results in healthcare.

The quickie defintion usually given after "spread and sustainability" or "sustainability and spread" is "sustainability" means we need to hold our gains and then we need to "spread" the gains / results to others in the organisation.

This looks fine on paper. But let's think about this. What exactly is meant by "holding the gain"? In the majority of improvement projects the gain is valued and assessed against a measurement. For example, the reduction in rate of infections on the ward would be measuring an outcome which is helpful and can keep a team focused on the end result. Some measures focus on a process, such as the number of staff who have adopted the use of a checklist for a certain procedure. Here is my concern.

When it comes to working on what it is that needs to be "held" many teams will focus on the the "what's" they have created. This will be the checklists, the new procedures etc. While helpful, it takes a humble team to be able to keep focused on the outcome and continue to adapt their processes and behaviours to continue to maintain and perhaps improve on their results. In many cases this may mean they have to alter their original soultions (thus, of course, impacting what others may want to spread - but that is another issue for another day...).

How many leaders and improvement teams take the time to work out the qualitative aspects of their results? What really enabled them to deliver the improvement? While the attention is so often on the output, the "thing" that was created, by ignoring or avoiding reviewing the human, social and emotional behavioural processes involved in the development of it, they are at risk of losing what they have gained. I believe that it is in this tacit knowledge that the true gain lies. It is here that the learning resides. The checklist is merely the tangible, and temporary, manifestation of their experience.

The discipline of learning organisations and learning teams is well known, though sadly often disconnected from the conscious experience of many improvement project teams. When the concept of learning gains a hold, then we may hold some gains.

(c) 2008, Sarah Fraser

Being positively deviant is a way to spread good practice

I've found the term "positive deviance" triggers a diverse range of concepts, prejudices and assumptions from colleagues when I introduce it. Which is probably why most practitioners involved in it refer to the practice as "PD"; it arrives with less emotional baggage.

In essence PD is about individuals and communities discovering their own ways to solve their own problems, using their own resources. They are able to do this because there are individuals and groups within their community who have already found a way to resolve the problem, or least whose practices or behaviours are more effective than others in their community. It is these folk who have resolved the issues who are the positive deviants...

So far so good. We all recognise the PD's in our communities. The bit that fascinates me is what usually happens next.

The leaders in many communities and organisations then design a process to extract the knowledge from the PD and to "spread" it across the others, usually linking the activity to an externally driven needs related exercise. The literature of knowledge management and the science of innovation diffusion is littered with reviews on the consequence of what and does not then spread.

Instead, what the practice of PD offers is the process of helping and supporting communities to investigate what might work for them, in their own context, culturally and specifically. By embarking on their own learning adventure and sharing experiences with their local positive deviant, the community develops solutions that work for them. This process may feel like it takes longer than a more directly controlled "spread" approach, however, I suspect that is an allusion. If a randomised control trial was possible (of course it isn't) we may find that the PD version takes longer to start and has conversations that are more difficult to track (though much of the process can be documented, especially using multimedia techniques). PD may be more sustainable in the longer term due its specificity and the depth of relationships built.

So why don't organisations use PD as a technique to achieve their objectives?

Well, some clearly do and achieve great results in doing so. There are some examples, along with excellent resources on http://www.positivedeviance.org/

There is a video posted of a positively deviant nurse (isn't that a wonderful phrase!) demonstrating techniques as part of reducing MRSA in hospitals. However, many organisations I feel are afraid to use the techniques because they fear a loss of control or that the method doesn't conform to their perceived management model of project planning.

That's a shame as this might very well be a technique that suits some communities as it is not only a process of change, it can also leave individuals and groups with a satisfying feeling of progress, support and enhanced self esteem.

Are you ready to be positively deviant?

(c) 2008, Sarah Fraser

Charismatic leaders may hinder sustainability of improvement

Of course we know that the skill of the truly great leader is to leave behind a team and a succession plan that not only maintains the knowledge and practices that have generated their success so far, but also supports their ongoing learning and development.

Fine words. How often do you see that in practice where the person leading the team can be described as "charismatic"? I could blog for weeks on the definition of charisma at work, so have settled for now on it being a combination of personal traits that enable an individual to reach out to other's emotions in a way that taps their motivation to do things. Usually charming and persuasive these individuals get their own way amongst their systems, for better or worse. As far as public figures go, I'm thinking of people like Mother Teresa, Adolf Hitler, Winston Churchill, Martin Luther King etc.

So how does charisma affect the sustainability of results in improvement projects?

Here are some questions for you to think about when you next choose the person to lead a key project or programme in your organisation where the sustainability of results will be important.

Are you choosing the person because of their charisma? Maybe you feel the need to have someone with the energy and passion to start the project and to motivate others.

To what extent could the project become so identified with the individual that there is a risk that

• team members eventually become demotivated because they get less recognition / air time
• when (and it is most likely a when rather than an if) the leader moves on, the majority of the knowledge and PR moves on with them
• no-one is prepared to "tell the emperor he has no clothes", to provide feedback, thus diminishing the learning opportunities
• succession planning becomes impossible and the person is deemed irreplacable

So you're thinking, none of our project leaders are ever that charistmatic! Well, according to the theory, we are most likely to find many of these traits amongst the more innovative and early adopters of new practices (though not exclusively as some laggards can be highly and effectively persuasive...). It is likely that many pilot projects and early innovations are led by leaders who demonstrate the ability to capture the imaginations and hearts of their followers. These same individuals will later leave to follow other interests, for the similar reasons they got involved with the first pilot.

Take a close look around you. What patterns do you see linking the leaders of your improvement projects and the sustainability of the reults of those projects?

Now that's a research project worth doing. Anyone want to collaborate?

(c) 2008, Sarah Fraser

Knowledge management has lost its bark

I'm reminded of the old saying "It's not what you know but who you know". This struck me when reviewing a large and beautifully presented collection of "good practices" collated onto a website by an organisation. This is one of many I see and the teams involved assure me this is part of their knowledge management strategy and one of the mechanisms they are using to share the good practices amongst their constituents.

So I've been wondering for whom these databases have been designed. The measures applied are mostly about counting the number of entries and the number of "hits". This no doubt gives the owner of the system some satistfaction that the extracted knowledge (and I use that term cautiously) is being tapped into. Personally, I am a great deal more sceptical about the whole business.

There is an industry of "knowledge management" and a quick search through the academic publishing databases through up some interesting omissions. I could find little researched and/or published about how individuals or teams successfully used databases and turned them into practical changes that delivered improved results in their organisations - as this is the expressed intent of those who are creating these systems. It is as though the databases have become their own self-sustaining life form, with a purpose now disconnected from their original objective. At what cost?

The databases hold the "what" of information. Some individuals may remember the database exists, find the time to search it, reach the case study, work out how it fits in their circumstance etc. In my experience, most people will either start to solve the problem they have on their own or at best, will find someone in their personal network who can give them some advice. So, how can we find ways to help people extend their personal networks so they can connect to people who can help them answer the questions they want?

Part of the answer to this is a technology literacy - being able to access and use some of the Web 2.0 function including networking sites like LinkedIn http://www.linkedin.com/, chatrooms, wikizines, collaborative documenting etc. Part is an emotional literacy - having the conversational and interpersonal skills to connect with others.

By over-emphasising the "what" are organisations deskilling the "who"?




For an example of a wikizine go to
http://www.zimbio.com/Quality+Improvement+for+Healthcare+Services
and please post some content!

(c) 2008, Sarah Fraser