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