Large Scale what? Change, outcome, implementation or impact?

I prefer the phrase "large scale outcome" or "Large scale implementation" to the more generic "large scale change". Why? When the words outcome and implementation are included it feels more active, more directive, more specific.

For example, it is possible to have a large scale change that is not resulting in the outcomes you set out to achieve. A huge amount of change can happen and yet only a small scale impact is achieved.

Equally it is possible to have a large scale impact from a a small change that might affect only a small scale (numbers and geography). Using Pareto analysis can provide organisations with hints on where to leverage the smaller changes for the bigger impacts.

By focusing on impacts, by elevating the results we want, we can design organisation and system interventions to deliver targeted outcomes. In my experience, many groups who talk of large scale change are ending up creating busy-work that is not specifically directed at delivering a large scale outcome. For me change does not equal outcome or impact.

I'm reminded of a quote from Thoreau which runs along the lines of "It is not enough to be industrious; what are you industrious about?"

Sharing - Seeking; a necessary dynamic of spread

The concept of large corporate databases capturing and storing "good practice" and "knowledge" was discredited by the late 1980's due to the costs involved and limited impact. It seems a standard approach to problem solving is to "start with what I know" and then if really desperate "find someone who can fix the problem". I frequently find that few managers and teams spend a short time seeking out information from those who have gone before them with regards the same problem.

A corporate database tends to be fairly clinical in approach. Woudl you rather get your ideas from the place where all entries have been approved, or from the hundreds of places on the web where forums are filled with people sharing not only technicalities of solving the problem, but also the emotion. Trust and credibility is importnat. How much do we trust the corporate database and how much do we trust what someone has written on a Forum.

Today I had a nightmare with MS Outlook consuming most of my computing CPU. The compiter temperature was rising along with my frustration and a literal metdown was predicted. A quick internet search revealed this was a common problem. The Microsoft database gace some suggestions but I chose not to follow them. INstead I found suggestions from "real" people, who reported on their tests of change and what worked for them, in their circumstance. Problem was eventually fixed (it was an overlarge normal.dot file if you're interested...)

I am hugely grateful for those who are questioning, providing repsonses and generally sharing their knowledge on internet Fora. Search engines are brilliant at organising this morass of wisdom. I really can't see how closed shop databases can be as effective in helping others solve problems.

The bottom lie though is the use of this wisdomw is dependent on some seeking it. So who will be actively seeking infomration from your database? If they use an internet search engine will they find your knowledge?

Designing for large scale change

The scale of "large" change depends on your perspective and intent. Usually, any change of significance feels large scale if it dominates a large part of your life. At what point does the PDSA cycle method become less than useful in delivering change?

In healthcare improvement work over the last 10 or more years we have been fixed within the domain of PDSA cycles and the Improvement Model. This is a useful technique in (a) testing out ideas where we are unsure whether they will work and (b) in implementing change on a small scale. These methods have a tendency to produce large number of pilot projects, many of which demonstrate good results. The exhortation is then to "scale up" or "spread" the results to others. So far, this has proven very difficult - and not unreasonably so.

The difference between designing for scale and doing Improvement Model/PDSA type projects lies in the intent. If the intent is for all those for whom the topic is applicable to implement changes to demonstrate an improvement, then consider what might be the opportunities if the focus is on large scale design rather than demonstrator projects:

i) a large scale intent most likely has a large scale context; working with the wider system may help to identify areas where smaller changes can have a big impact. Namely, large scale design does not mean everyone has to do a lot of change. It could mean that if a few, cleverly targeted areas changed, then everyone benefits. We can only find these possibilities if we work with intent and the larger system
ii) we consider how the context interrelates to the aims of the project; context is critical in the process of adopting change ideas. Without highlighting and working on the context change is difficult to achieve
iii) with design as a focus and scale as the objective then we are more likely to seek out innovative solutions to age old problems. Sometimes replicating what we perceive to be good practice may in fact be part of what is hold back large scale improvement.

If you find it difficult to spread from pilot projects then maybe it's time to consider a design process for large scale improvement.

For more on why good practice doesn't spread, go to this book

Transformation versus Metamorphosis in Systems & Organisations

Gone are the days where the method of reducing variation and improving quality was focused on the incremental spread of good practice, using mostly communication methodology from the 1960's. The current mantra is "transformation". I am proposing an alternative, "metamorphosis", which may be a more relevant meaning-making metaphor in some circumstances.

We recognise when an organisation has transformed because we perceive a difference. This difference is usually one to stay. Slipping backwards to the old way is not an option. Transformation is something we recognise after the event. Thousands of books and papers have been published describing the experience of others and their own summary, meaning making and production of frameworks and models. However, underlying all the noise of methodology lies the premise that all transformation requires a behavioural change of significance. In addition, to transform usually requires a high degree of emotional commitment, trauma, distress and joy. Transformation is touted by "those at the top" as a process and outcome that is positive. However, for some it is necessarily an unpleasant process.

An alternative concept is "metamorphosis". This focuses on the striking change in appearance, in form and function, of an organisation or system. Individual may transform their behaviour, organisations and structures may morph into new, innovative and maybe even shocking forms. Morphing can happen slowly, the result of an incremental drip by drip process. Then we look back and see it now looks totally different. The changes around Mental Health Care in England from the 1970's to date are an example. Experience a deep depression in the 1970's and you would find yourself in an open ward of a Victorian building, treated (in a rough sense of the word) as a curious, complex and perhaps untreatable patient. Nowadays, you'd be cared for in the home by multi-disciplinary teams who recognise you as an individual with a family and personal set of circumstances. While drugs may be used, talking therapies also abound.

So what is it you are wanting from your quality improvement work? Are you requiring the sorcery of personal transformation or the magic of metamorphosis? Is the aim a behavioural one or a structural version? Of course both overlap and are dependent on each other, though a focus on form is different to a focus on individual behaviour. The resulting process and consequential outcomes will also differ.

One way to use these concepts is to think of transformation as a bottom up behavioural approach and metamorphosis as a top down structural and form based strategy. The two are related, differently.

Using Facebook Pages: A Guide for Governmental Organisations

The Learning Pool is one of my favourite resources for the use of social media in governmental organisations. Their guides are excellent.  I suggest you can download a copy of their latest guide which covers how to use Facebook pages to best effect.

The guide covers the basics like "what is a Facebook page", though to how to get the best use out of one as well as a step by step process to setting one up and marketing it. Huh, wish I'd written this guide myself!

Spread: Luck or Planning?

Duncan Watts is one of my heroes as he has been carrying out excellent research and simulations into how ideas, messages move between groups. In particular, I like the way his work is not dominated by the "diffusion" theories and how he is prepared to speak up when the results are different to those you may expect.

A recent experiment using song downloads from the Internet has come up with some interesting results and ones to make me think a bit more. An easy to read description of this here.

Some key results:
a) Luck plays a large part in what is successful (more than you might like to think about as you make plans for organisational and system success...)
b) If you lie (use false data etc) to your customers/target audience, at first they may go with you and then sensibility appears to win. At first it appears lying work.
c) When you lie, after a while behaviour of adopters/participants tends to revert back or change to what they perceive is the right thing to do. This reminds me of the issues we have with "sustainability" in healthcare change.

Any comments or thoughts about this research then do comment on this blog.