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

How do we know that what gets spread is of value?

I thought I was being radical in my last book, "Undressing the elephant; why good practice doesn't spread in healthcare" (2007) www.undressingtheelephant.co.uk when I wrote about the problem of the idea bias. Of course Everett Rogers and others have researched the issue over many years. I tried to be a bit more in your face when I wrote my chapter, challenging how egos, organisational politics and indeed, governmental Politics all let to inappropriate and questoionably poor value practices being implemented.

I'm still worrying.

I came across an organisation where a team leader proudly shared that his teams "best" practice in a safety issue had spread "virally" to all wards round his hospital. So I asked him some questions. I leave you to imagine some of the conversation we had.

How do you know it was "best" practice?
If it was proven as best for you, how did others who adopted it, know it was best for them?
How will they continue to know it is the best practice?
If it is not the best practice for some wards, then what should they be doing?
How can you use the dynamics of how this spread, to spread what you would prefer to have spread?
What really matters - the spread of the practice, or the improvement of results?

We retired for top up of coffee and both agreed that there is something very scary about self-organising systems, though perhaps not quite as scary as when one person tries to impose their value laden idea on a system that opposes it.

(c) 2008, Sarah Fraser