Friday, 20 March 2009

Blogging policies and blogging in healthcare

Over the last few months I have been meeting up with groups and organisations who want to dip their toe into the social media soup yet are concerned they have need a policy and/or are worried about what is /isn't kosher when it comes to blogging and twitter etc. I acknowledge the need to develop some guidelines that both enable the best of blogging yet manage corporate requirements.

This reminds me of the early days of email when some organisations felt email was very risky and clamped down on it with many rules and regulations. As time went on, the wisdom of the crowd took over and a "norm" was established. The book "Groundswell" - see my book review blog for a review if you're interested - has a page listing Blogger Code of ethics which I like.

There are also some links in there to publically available corporate blogging policies, like Harvard University, Sun Microsystems.

The BBC has a simple page that makes sense to me as being sufficiently practical without being onerous

Working in healthcare and think that blogging isn't relevant? Check out 100 Best Health Care Policy blogs and see what is on offer and the potential impact they are having

Or if you need a more research based approach then have a look here

If email is your only means of electronic communication then maybe now is the time to test something new to add to your skill base.

Tuesday, 17 March 2009

Large scale change or spreading good practice?

As a Rotarian I have recently been involved in a project to help the Masai Mara community in Tanzania get clean water near their homes. We're working with an inspirational fledgling charity called Weston Turville Wells for Tanzania. They have already enabled the installation of wells, are looking for more as well as more ambitious projects.

My link to this work has helped me understand more about some of the differences between "spreading good practice" and "large scale transformation". Well, it has sort of helped - it also raises more questions for me...

Think of community of 4,000 people which is made up of smaller communities (think small town and suburbs). It costs around £3,000 to install a well that will support a small sub-set of a suburb. One way to help the whole 4,000 community is to take the "good practice/good idea" of the single well and replicate this across the community, say building 15 or 20 wells. Twenty wells will cost around £60,000. There is no doubt that this will transform the lives of the whole community.

Another option, is to spend £60,000 and build a pipeline from a source of water in a mountainous area not far away. The impact of doing this is also a large scale transformation for the community. It is ambitious in scale, impact and ingenuity is required to implement a reliable solution.

So which would be your choice? Option 2 sounds great and at first glance looks sustainable. However, it will take many months, possibly a year or so, to raise the funds, get the permissions and then build. During this time the community is without a viable water supply within any close distance of their homes. Option 1 feels suspiciously like a quick fix with the added difficult dynamic of the spread of the wells not feeling (my feeling) democratically spread. However, money can be found "per well" and work can start in a very short time. The individual well is a solution is tried and tested. In addition the charity has ensured there is local support from within the community to help maintain them.

I can see that both options are transformative for the community. The outcome will make a difference to daily life and health. The process may also be transformative and everyone gets involved with the well / pipeline building process. Option 1 is more emergent, flexible and bottom up type approach. Option 2 is more planned, organised and top down approach. The both/and would be to have a pipeline and some wells - but then I'm torn between the extra cost of doing this where more wells can be provided for another community...

For the record, we've gone for supporting the provision of a well - right now. The essence being that in some cases a quick fix is a good one and when it comes to water, every day without it is a trial.

What would you do?

Saturday, 14 March 2009

Social Movements 2.0; summary and links

I’ve been spending time mulling over the intersection of offline and online when it comes to social movements. Here are a few of my favourite online references to the online perspective.

Vanessa Mason explains how social media is changing the way we think about social movements. She suggests we are moving away from the emerge->coalesce->bureaucratise->outcome->decline process. She lists and describes some defining characteristics of social media’s effect on social movements:
1. linkages between offline and online activity are essential
2. technology facilitates change by reducing costs of resource mobilisations
3. supporters have the ability to tell and publicise their cause’s stories, needs and goals
4. social media enables greater transparency into the political process
read more about this view here:

After a brief description of the world’s first virtual strike in 2007, “The Nation” provides a detailed view on what Social Movements 2.0 is about. They refer to Clay Shirky’s brilliant book “Here comes everybody; the power of organising without organisations” and explain the five reasons why electronic social space is revolutionising the concept of social movements.
1. group formation
2. scale and amplification
3. interactivity
4. destruction of hierarchies
5. cheapness and ease of tools
To read more about this go to

For examples of social movements on the web and an interesting perspective on a new role – the social internepreneur, then read Alberto Masetti-Zannini’s post

Add a comment here if you know of other key Social Movements 2.0 resources, post and links.

Using Twitter as a social movement strategy

It was Stephen Fry, on Twitter, who, in response to a criticism that eReaders would be the death of books, that said:
"I collect books. Have done for years. I will no more throw out "real" books cos I have a Kindle than I'll jettison pens cos I have a Mac" (11.03.09 8:55)
"This is the point. One technology doesn't replace another, it complements. Books are no more threatened by Kindle than stairs by elevators" (11.03.09 9:07)
"I've thousands of books and will continue buying them till I die. Smell and feel, yes. Maybe. But that was true of horses" (11.03.09 9:10)

As Stephen Fry so eloquently pointed out, there is room for a both / and when it comes to integrating new technology with older methods and habits. This post covers only Twitter and my own view. I know there are other methods for enabling social movements.

Much of what we know about social movements is from evaluations and post-hoc descriptive research. This is a good way to find analyse and identify some of the key features of a social movement, with the intent thereafter of trying to replicate some of these so as to accelerate the implementation of organisation and system change. For me the jury is out as to how much a social movement can be engineered, though this doesn't detract from some very important components which seem to work well when implemented.

So where does Twitter fit in to the concept of a social movement?
I feel it is a complementary communication method and perhaps one which can accelerate the process. However, it will probably never take away from the more traditional methods of face-to-face (F2F) influencing. It is a both / and.

1. Tweetups: Twitter can be used to facilitate the gatehring of people both virtually and F2F; called a tweetup! For an example of how viral Twitter can be in organising action then go to
for an example. The charity event, Twestival, took only 24 hours to get 40 cities involved and after that a further 60 joined up.

2. Getting the word out; hierarchical, planned and controlled media (if that's not an oxymoron...) tends to attract the attention of a "target" audience. Twitter works through its transparency, openness and democracy where anyone can follow anyone. There are no rules about who gets what information. Of course, the Twitter system uses its group wisdom to weed out individuals and organisations who behave badly - they get "unfollowed" and "blocked" and then wither on the digital vine. You know your message is hitting the right note when it starts to be retweeted (others copy and send to their own networks). This is energy for a social movement.

3. Jumping networks; targetted communication campaigns are limited in their effectiveness usually because they are just that - targetted. Twitter enables the jumping of an idea from one person's network to another which may seem unrelated though could potentially be the breakthrough in attracting the attention of peopel who really care about the topic. The jump can be from one group of people to another or from one techology to another, for instance when a tweet gets posted onto Facebook

4. Social movement becomes social and has movement; Twitter is informal, casual and to the unitiated often chaotic. When an idea takes off, it flows rapidly through the system. Getting it to this point is difficult, however, and requires patience and practice. In true social movement style, you cannnot make a message viral. It becomes viral when followers deem it of value. They drive it, not you who wishes it to spread. A point to remember is that the enegry comes from the social interaction combined with the power of the idea.

Twitter is one part of what is becoming known as mobile social movement enablers. One of the difficulties of assessing its value is it is developing fast, changing over time in terms of both technology and use, that it is difficult to evaluate. This reminds me of what a social movement is like. Namely something we can analyse after it has happened but durign the process it is all a bit messy, unclear, possibly exciting and almost impossible to evaluate. follow me there
If you're interested in patient safety then follow
or if large scale change is your thing then

Tips for making decisions in change programs

In Everett Rogers’ seminal work, “The Diffusion of Innovations” there is some very interesting suggestions on the importance on the decision making process as part of the innovation adoption dynamic. This decision-making focus is often left out of references to his work though I have always found it helpful when I am working with others to implement large scale changes in complex systems as well as the adoption of known best practices into more simple structures.

Rogers points out that the action of decision-making is the point of action in adopting a new idea. Others may try to persuade me, though nothing will matter until I have made a decision to adopt. You cannot make that decision for me. With this in mind, one of the most helpful questions I know to ask when encouraging the adoption of a new idea is “How can I help you make the decision?” This is starting with the premise that they are not forced into adopting the solution and I am open to helping in whatever way might be useful.

Rogers never got into the complexity of the decision-making process. One of the texts I find useful is “Crucial Conversations; Tools for Talking when the stakes are high” by Kett Patterson, Joseph Grenny, Ron McMillan and Al Swtitzler. They highlight four of the most common methods for making decisions and give ideas on how best to work with each.

Command; defined as a process where there is no involvement of others. This may also be a preference of some people who would prefer not to have to make a decision (or be responsible / accountable for making it).

Consult: is when you ask for input before making your choice. The essence is leaders still make the final decision, though with the ideas, opinions and views of others in mind.

Vote: work when everyone involved agrees to continue to support the final decision, even if they voted the other way. This works when there are a number of options.

Consensus; can be frustrating and time wasting unless carried out properly and with a focused intent. The authors suggest this option should only be used where the issue is high stake, complex and where everyone must absolutely support the choice.

So what has decision-making got to do with the spread of good practice and other large scale improvements?

In my experience, complex change programmes can feel very overwhelming. We spend a huge amount of time planning, working out what we want to get out of it and then how we might go about it. All programmes and especially the complex ones need a whole heap of decisions to be made before we even get to action, and then all those impacted by the change have their own decision making process to go through when the implementation starts. The problem for changes that are large in scale is the amount of detail, levels and complexity involved. The decision-making tactics need to reflect this.

So I use the following list as a diagnostic for the decision-making processes in a spread and large scale change programme. These can be used at the programme team level or the adopting team level.

1. For the programme itself, so we know what the meta decision-making process is (vote, consensus etc)? Have we agreed which issues need what type of decision process?

2. What is the key decision that needs to be taken in order for this new idea / change to be implemented in the workplace? Is this decision different for different people?

3. Who cares about the decision? If anyone cares about it yet they do not have to change their behaviour as part of the implementation process, how might we have a decision-making process that reflects this?

4. Who has to agree to the decision in order for us to gain benefits from the implementation? How does this affect our choice of the type of decision-making process we use as part of getting our work implemented.

How will you make your next decision?

Thursday, 12 March 2009

Managing Large Scale Transitions

Whether spreading good practice from one team to the whole organisation or leading a more ambitious large scale change, managing the transition from one state, today, to a desired future state, is worth some thought. I am not sure that I, the leader, can "manage" the transition as any behavioural change required is very personal to the people impacted by it. The process is something they need to go through and make meaning of, themselves. However, as the leader of any large scale intervention there are a few things I can do to help.

The work of William Bridges where he provides a model of managing transitions, I believe is useful for our behavioural type interventions. His work is primarily focused on the individual and also on the organisation. The nub of the model is that we go through three phases as part of coming to terms with a new situation: endings, the whitewater and then a new beginning. I find this a helpful way to think of the change process.

  1. Endings; what will individuals, teams and organisations be losing as part of this change? How can I help this be made explicit? Has this been taken into account in the planning? How can I as leader help people mark and celebrate their endings?
  2. The whitewater; this is an analogy that Bridges uses to describe the stage between ending and beginning. It is messy, uncertain, unclear, scary and nearly always feels faster than we can cope with. It is also a time of great creativity and innovation. As a leader, what am I doing to support people through this stage? What temporary structures and processes would be helpful? What mechanisms do I have in place to harness the ideas that will arise? How can I support these suggestions?
  3. Beginnings; so much of our planning work is in designing the future. The expectation is the beginning is the start, rather than the two phases listed above. To what extent am I so focused on the beginning that I am disabling the transition process? How will I know when a new beginning is emerging.

While the model is designed for individuals and teams, it has relevance for large scale interventions across systems. For example, I can use it to help me discover the meaning of the change for different groups of people in different organisations. Especially by seeking to understand the endings. Sometimes one team's loss is another organisation's proposed new beginning (though they will also have some endings). By looking at these dynamics across the system I will gain insight into what may be the scale of transition and thus also the pacing of it.

Sunday, 8 March 2009

Large Scale Change: Theory & Practice - March news

I try to keep a close eye and ear on what gets published on the topic of large scale change. It seems the last few weeks have thrown up a peak in activity. My interest is LSC is a variety of contexts and while the majority used to be climate change related, I am seeing more and more comments and publications on issues touching organisations and wider systems, including healthcare.

Sir John Oldham, who calls himself a jobbing GP yet his impact on the healthcare systems is much more than that, published a Commentary in JAMA (4th March 2009 Vol 301, No.9 p965) on "Achieving large scale change in healthcare". The healdines are:
  • Status quo is not an option
  • Optimism is necessary to overcome obstacles
  • Everyone can make a difference
  • Take calculated risks

Kate Goonan and colleagues published in ASQ in January "Journey to Excellence: Healthcare Baldridge Leaders Speak Out". They've done some excellent case study work on how organisations taking on the quality mantle can be successful. I like their 5 step model of transformation (Status Quo, False Starts, Traction, Integration and Sustaining). Which, after getting over the shock of this sort of deep and broad large scale change taking 3 to 8 years, is reassuring common sense. This paper is a precursor to a book on the topic The context for this paper is the US and it is also quite organisational specific. Much of the large scale change I know people are working on is perhaps a little more systems based.

From the e-Government 2009 Awards we have a case study from Avon, Gloucestershire & Wiltshire Communities on how they have improved a child health system across a geographic region. For me this is large scale because it involved multiple types of organisations, with different perspectives, implementing changes with far reaching impact on an identified population.

I'm watching a large scale change in process by following, and where I can also supporting, the IHI Surgical Safety Checklist "Sprint". With an aim of encouraging 4000 hospitals to test out the checklist wihtin a short period of time, this is large in geographic scale and in the numbers of teams and organisations involved. You can join in too: I love the map mashup on the IHI website which puts your commitment on the map - literally.

"The Science of Large Scale Change in Global Health" is an other JAMA paper, this time published in Feb 2009 by Joe McCannon, Don Berwick and Rashad Massoud. There are some great internationally focused examples in there. It is good to know large scale change can happen and is happening. though I have a few queries on some of the Roger's based theories as to whether they are the best lens through which to view what they are writing up. It's interesting work and their piece on how leaders can support large scale change is pertinent. I would like to see more from the leaders themselves on how they are doing it.

If leadership is your thing then a good blog post touching on leadership for large scale change can be found here: "Creating authentic engagement for change" cover hints and tips that seem obvious on the page yet in practice are often much more difficult. It seems that what I'm finding about leadership is there are two camps about leadership for LSC (a) the hierarchical, structural approach, (b) the personal, emotional connection type approach. I suspect there is a continuum.

A new page on Wiki Answers looks at the topic "How can the process of small scale change differ from that of large scale change". The advantage of a Wiki is you can get in there and improve the answer! So feel free:

One thought I am left with after doing this month's catch up is how easy it is to describe what has happened and to make inferences from that as to how we can make something happen in the future. Much research and management consultancy wealth is based on the development of frameworks and models using this descriptive approach. These are, of course, very helpful. However, I am wondering where the research and practice is on developing and using more predictive models? For instance, I know and have used some of the predictive diffusion models which in my mind are more helpful than the Roger's work, though less easy to get to grips with. Similarly perhaps the shift to a more personal and behavioural approach to leading LSC is on the "predictive" side of the coin.

Maybe the seduction of the easy-to-understand model is getting in the way of the really tough work. Namely, finding our own meaning in our own piece of large scale change.

Your thoughts?

Wednesday, 4 March 2009

Lessons in how online communities work

A few months ago I set up a Facilitating Change Forum using the social networking system Ning This was in part to provide people who may be a bit afraid of social networking with a sandpit where they can test and play. Then it was also as a means for connecting those with an interest in Facilitating Change.

Separate to this I have been building my online presence using Twitter

What have I learnt so far:

  1. The adage of giving stuff away to get something back is true virtually as well generally in life. The more I post "useful" stuff on Twitter, the more the followers grow. And the more I get back. I needed a solution to a problem, posed the question on Twitter and someone (who I didn't know) replied in minutes with a fabulous answer.
  2. Letting go, going with the flow - or whatever aphorism works for you - really is necessary. I have just spent 20 minutes actual time and 8 hours elapsed time signing up to a NHS system where I now have to ask permission to join a community. I've lost the will to communicate by now. Access needs to be easy and without significant restriction. I feel for communities to work online they need to be fresh, flexible and open rather than hindden behind walls and barriers.
  3. There is not only widsom in the crowd but also leadership. Having neglected the Forum for a few weeks I feel proud to see a number of people (some of whom I have no idea who they are - and this really doesn't matter) take a leadership role in welcoming new joiners and in stimulating discussion. Wow, this is truly distributed leadership in action.
  4. Like all natural systems, getting started is like pushing a snowball uphill. Then all of sudden it takes off. With Twitter I nearly gave up, persisted another week, and hey presto I reached a criticial mass of usefulness. Same goes for a number of virtual ways of working like using team spaces. It is so easy to have a go, hit a huddle and then drop out the race.

What have these online communities got to do with the spread of good practice and large scale change? They are a great way of sharing messages, asking questions, discovering new ideas, keeping up to date, reducing isolation etc.

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