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?

1 comment:

Seth Kahan said...


Thank you for mentioning my Fast Company blog, Leading Change. I am honored. You may also be interested in my personal blog

I love your questions! You write you are pondering " 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."

Thank you for this. It opens a door into a frame-of-mind that is immensely constructive. Indeed, where do our mental models transfer from recollections of an experience to a framework that works as an application? This is so difficult. Yet, so needed to boil everything down to a set of workable principles.

How can we possibly capture all circumstances in a mental model? Yet, all we need is enough to promise the results we are after. This is the nature of the human mind, to build generalizations in the hopes of being able to control our own destiny in some limited way. As a practitioner (not a researcher or academic), I am always on the lookout for models that work, that I can adopt, adapt, and put to work.

I see that you are involved with nurses and healthcare. Are you familiar with the American Nurses Credentialing Center's Magnet hospital program? I have been very impressed by the "Fourteen Forces of Magnetism as a way of predictably transforming hospitals, beginning with nursing excellence and extending through the whole system.

What I know about this program is that these principles are useful in starting interactions, and setting clear expectations about what is involved in transforming a hospital. In application, people must by necessity be involved in adapting the principles to a given hospital's needs and situation.

Look forward to more from you,