Monday, 28 April 2008

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

Tuesday, 22 April 2008

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

Friday, 18 April 2008

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

Sunday, 13 April 2008

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. 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

Thursday, 10 April 2008

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

Sunday, 6 April 2008

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