Saturday, 28 February 2009

Role modelling large scale change is tough

Sometimes getting the big stuff done means finding a way to manage the little stuff. I find when I’m trying to work on a big project, designing large scale change programs, developing spreading good practice interventions and other activities which require a complex set of activities, I am easily distracted from my leadership role unless I employ a few tactics.

I have been wondering whether one of the reasons large scale change doesn’t get implemented is because we may project our own disorganisation and unproductiveness onto the systems, processes and people who are intended to be part of that change. Namely, is there a large scale change we need to adopt ourselves before we can scale up any change process to teams, organisations and systems?

It’s all well and good saying the big things are the priority and therefore I should spend most of my time on them. However, no-one has told that to all other small requests, queries and information despatching that usually ends up in my email inbox.

Now I am very cautious about treating the small stuff as not important. It was Dame Anita Roddick who once said that “anyone who ever doubts that small things can have a big impact has never spent the night in a tent with a mosquito”. So I treat the “small stuff” with care. But how does this help with creating, managing and delivering on the big stuff and priority projects?

I employ a few specific tactics to keep me focused and on track. My consultancy role has me working at two polar opposites; virtually, attached to a computer, and face-to-face with clients. (There is a twilight world in between called “travel” but we’ll leave that for now.)

I am in charge of my computer. I am the head that organises how best to use it and I work hard not to let the computer-tail wag my dog.
- I aim to complete one task in the morning before I turn on the computer
- Then I complete one task, such as reviewing a document, before opening my email inbox
When I do open my email, I delete without opening anything where the subject line looks like the message has little to do with me, then I read them. If I can reply in 2 mins then I do so. If not I drag the mail to the tasks or calendar button in Outlook and allocate some other time to handle it.
- Then I get on with the priority tasks, which I may or may not have allocated time for…
- I allocate one hour a week, usually Fridays if I am in the office then, to a swift check around all my online team working systems.
So, before I can work on the big stuff I need to find a way to more productively manage the smaller stuff. This reminds me of the NHS Institute’s Productive Wards system where an investment in getting yourself, your ward, organised means you have more time to care (big stuff).

When face-to-face with other people, at a single or multiple day event, at meetings etc., my singular contribution is that of my presence. I know that physical presence needs to be combined with my emotional and intellectual presence.

- I aim not to take calls, look at or answer emails while I am F2F. (This did take about 6 months to wean myself off the habit as well as enable my email-senders to gain the trust that I do still value what they email and I will respond, fully and care-fully, when I can focus on them.)
- I avoid travelling with other people’s business to do. This means I am not preparing next week’s presentation for another client in the breaks between working with the F2F client. (This is a capacity / demand issue and I have employed the same techniques used in healthcare service delivery. It has been a tough learning curve).

My own experiences leave me with the feeling that practising and implementing some of the changes we require of others provides some salutary lessons. It’s hard to encourage role modelling as part of a change strategy unless you also see yourself as a role model. Maybe that is one of the toughest challenges about spreading good practice and implementing large scale change? Namely, we have to change ourselves before we can ask other to change themselves.

Wednesday, 25 February 2009

When personal communication hinders the spread of messages

I've been on the receiving end of a flurry of emails this week. My curiosity is piqued by what looks like an outbreak of "on behalf of" emails. I'm presuming the individuals concerned are either too important or too busy to send out an email in their own name. Instead, they come from someone else "on behalf" of the other person. Some of these emails have included a call to action, a request for me to do something, a suggestion etc. I am differentiating these from my regular dealings with P.A.'s and other support staff.

I'm only a sample size of one on this topic, however, the impact on me is to view the requests lightly and with little priority. I'm less likely to act on them than on other more personal pleas and requests.

For me, the personal connection has been lost. I know my behaviour is more influenced by the person/s directly, rather than by the person who is acting on their behalf. Much of the opinion leader literature is awash with evidence and ideas on how crucial this personal link is in influencing others, especially when behaviour change or commitment is required.

When the theory of spreading good practice and large scale change meets the practicalities of real life we depend on a communication process designed to connect, compell and commit.

Let's get personal.

Wednesday, 18 February 2009

Surgical Safety Checklist Sprint 10th March 2009

The IHI are leading a "sprint" to have every hospital in the USA test the World Health Organization (WHO) Surgical Safety Checklist at least one time with one operating room team. Sprint Day is 10th March 2009. The version in England is more marathon-like with a target set for February 2010 for all hospitals and teams to be using the checklist. So, we have two different approaches to getting this life-saving tool implemented.

If I had to place a bet as to the effectiveness of each strategy I would go for the sprint. Yes, the aim here is only for one team in each hospital to test it out. This strategy is going for coverage by having every hospital participate. The marathon version is going for both coverage as well as completeness - wanting every team to be using it. I expect the Sprint version will migrate into a marathon so completeness is developed in each of the hospitals that tested the checklist.

I'm placing my bet on the Sprint because I would rather the checklist got tested soon. If a team finds it helps and is not too onerous then they'll gossip about it in the surgeon's coffee lounge. To me that is preferable to planning sessions and meetings about how to implement marathon-style. Better to get on and test it.

As a patient, there is no choice - the sooner the better.

The IHI has all the tools you need to get started So what are you doing? Sprinting, doing a short jog or planning for a marathon?