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!
News, views & challenges from Sarah Fraser. Breakthrough results need radical thinking. Words need to be matched by action. Change starts with the self.
Tuesday, 26 January 2010
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.
Thursday, 24 December 2009
The continuum of spread: from outward communication to behavioural change
A few days ago I toyed with the idea of producing an FAQ sheet to cover the top 10 questions I am asked about how to spread good practice. Then I realised the answers are in my books and also in this blog. However, I'll revisit some of these questions over the coming weeks.
The top question is.... "how do I spread good practice"! And this usually sends me into panic mode. My immediate response includes:
What do you want to spread (and really, what, like skills, attitudes, behaviours etc)
How do you know it is good practice and who will recognise it as such?
Who is the target audience? Are you sure you are meaning individuals and not organisations?
What do you need people to do?
Why are you planning to do this? What is your stated and underlying intention?
I could go on...
I realise now that in most cases the big question comes from people in charge of something. Either they have the legitimate authority for a group (like Medical Director, CEO) or they are in a facilitative role (National body, program managers, consultancy). In both cases they want someone else to do something. The word "spread" gets used because either they have little authority over the people they want to change or they believe a softer-bottom-up-gentle approach will help people make the change. They may be right.
As the request to spread is coming from those "in charge" it is not surprising that the underlying question I think they are trying to ask is "How can we best communicate our good practice?". How do we communicate in a way that enables the right people to become aware of and do something about our topic? This is the standard approach to spread.
My experience in the last 10+ years on helping make large scale changes across healthcare systems is communication strategies and plans are not enough. Consider this continuum:
Spread (Communicate/Market/Advertise)--->
Communicate for behaviour change (Social Marketing)--->
Organisational change activities (OD, improvement projects)
Traditional spread programs limit themselves to clever and thoughtful (hopefully) design of outward communication. I say hopefully because in the most cases in healthcare the default button is set to "write an article" or "type up a case study".
As a minimum I feel spread needs to include the behavioural change aspect. Without this the communication is worth-less. The techniques from social marketing are a good place to start. This also means the behaviours required to change need to be identified as part of the "what" of the good practice.
Finally there is the perspective of the organisation. Again, my experience has led me to favour this approach. When the intended changes are part of or as a minimum identified as contribution to the organisation's purpose and objectives, with appropriate leadership support, then imprivement happens. Without this contextual setting the speed of adoption is much slower. Also, the breadth of adoption across the organisation may be limited. And there may be inappropriate adaptation to the good practice to such an extent that the intended benefits are not achieved.
So how do we spread good practice? I suggest the first place to start answering this question is to ask "why do you want to spread this good practice?". The aim here is to answer this in detail to get beyond the "to make things better" answer. This reframing will elicit the underlying motives and will direct an appropriate spread strategy.
The top question is.... "how do I spread good practice"! And this usually sends me into panic mode. My immediate response includes:
What do you want to spread (and really, what, like skills, attitudes, behaviours etc)
How do you know it is good practice and who will recognise it as such?
Who is the target audience? Are you sure you are meaning individuals and not organisations?
What do you need people to do?
Why are you planning to do this? What is your stated and underlying intention?
I could go on...
I realise now that in most cases the big question comes from people in charge of something. Either they have the legitimate authority for a group (like Medical Director, CEO) or they are in a facilitative role (National body, program managers, consultancy). In both cases they want someone else to do something. The word "spread" gets used because either they have little authority over the people they want to change or they believe a softer-bottom-up-gentle approach will help people make the change. They may be right.
As the request to spread is coming from those "in charge" it is not surprising that the underlying question I think they are trying to ask is "How can we best communicate our good practice?". How do we communicate in a way that enables the right people to become aware of and do something about our topic? This is the standard approach to spread.
My experience in the last 10+ years on helping make large scale changes across healthcare systems is communication strategies and plans are not enough. Consider this continuum:
Spread (Communicate/Market/Advertise)--->
Communicate for behaviour change (Social Marketing)--->
Organisational change activities (OD, improvement projects)
Traditional spread programs limit themselves to clever and thoughtful (hopefully) design of outward communication. I say hopefully because in the most cases in healthcare the default button is set to "write an article" or "type up a case study".
As a minimum I feel spread needs to include the behavioural change aspect. Without this the communication is worth-less. The techniques from social marketing are a good place to start. This also means the behaviours required to change need to be identified as part of the "what" of the good practice.
Finally there is the perspective of the organisation. Again, my experience has led me to favour this approach. When the intended changes are part of or as a minimum identified as contribution to the organisation's purpose and objectives, with appropriate leadership support, then imprivement happens. Without this contextual setting the speed of adoption is much slower. Also, the breadth of adoption across the organisation may be limited. And there may be inappropriate adaptation to the good practice to such an extent that the intended benefits are not achieved.
So how do we spread good practice? I suggest the first place to start answering this question is to ask "why do you want to spread this good practice?". The aim here is to answer this in detail to get beyond the "to make things better" answer. This reframing will elicit the underlying motives and will direct an appropriate spread strategy.
Tuesday, 8 December 2009
Resources to understand tragedy of the commons
At the Institute for Healthcare Improvement's National Forum today, Don Berwick used the example of 2tragedy of the commons" in his Opening Plenary. His pitch was to encourage healthcare leaders to cooperate and work for the wider and more common good and to beware of continuing to work on a self-centred and healthcare industry basis.
For those interested in the concept of "tragedy of the commons" I have put some links in here where you can get more information.
The original article by Garrett Hardin in 1968 which introduced the concept can be found here.
A special issue of Science magazine provides not only all the critical papers you need to read but also links to excellent web resources. You can find this here:
Some games you can play to simulate and understand what is meant by ToC (though anyone trying to get onto the conference wifi will know just what it feels like!). You can access these here:
One of my favourite bloggers covered ToC a while back. You can read his post and associated comments here:
I've been a fan of Systems Thinking for years. There are loads of tools and techniques to understand how ToC occurs and how to work with it. I'm looking forward to healthcare improvers adding systems thinking techniques into the regular and perhaps rather technical improvement techniques. You can learn about ToC using causal loop diagrams here, and discover resources at Pegasuscom.
Any more - please add in the comments below.
For those interested in the concept of "tragedy of the commons" I have put some links in here where you can get more information.
The original article by Garrett Hardin in 1968 which introduced the concept can be found here.
A special issue of Science magazine provides not only all the critical papers you need to read but also links to excellent web resources. You can find this here:
Some games you can play to simulate and understand what is meant by ToC (though anyone trying to get onto the conference wifi will know just what it feels like!). You can access these here:
One of my favourite bloggers covered ToC a while back. You can read his post and associated comments here:
I've been a fan of Systems Thinking for years. There are loads of tools and techniques to understand how ToC occurs and how to work with it. I'm looking forward to healthcare improvers adding systems thinking techniques into the regular and perhaps rather technical improvement techniques. You can learn about ToC using causal loop diagrams here, and discover resources at Pegasuscom.
Any more - please add in the comments below.
Monday, 16 November 2009
Improvement Projects: Do no harm
A common issue raised by project managers who are trying to implement existing good practice with individuals and teams is one of resistance to change. I am constantly seeking ways to reframe the term "resistance" as a means of moving away from a potentially obstructive and destructive frame of reference.
I've been wondering whether one of the reasons people appear to "resist" adopting even what is well evidenced as good practice is because of a natural and at times perfectly reasonable conservative attitude towards risk. The medical profession has the theme of "do no harm". My feeling is often we are asking professionals to take on the solutions designed by others and in different contexts without providing the potential adopters with the evidence that the results are both relaible and generalisable. Reliable in the sense they can be repeated int he same context with the same results. Generalisability is what is proved when the intervention (improvement process) can be done in a different context and obtain similar results.
Without this evidence of generalisability in our improvement work I feel professionals will continue to be suspicious of changes.
In additon, do we ever publish the knock on consequences and the adverse effects of improvement work? A quick trawl of improvement projects published in high impact journals in the last 2 months demonstrates the attitude that improvement work is all good. None fo 12 papers that I looked at provided (or even hinted) at any negative consequences. Without honesty abotu improevemnt work and results I suspect we will continue to encounter "resistance" to change - and I will consider this an appropriate response to any solution being touted for implementation where there is no demonstartion of generalisability and no discussion about identified adverse consequences.
I've been wondering whether one of the reasons people appear to "resist" adopting even what is well evidenced as good practice is because of a natural and at times perfectly reasonable conservative attitude towards risk. The medical profession has the theme of "do no harm". My feeling is often we are asking professionals to take on the solutions designed by others and in different contexts without providing the potential adopters with the evidence that the results are both relaible and generalisable. Reliable in the sense they can be repeated int he same context with the same results. Generalisability is what is proved when the intervention (improvement process) can be done in a different context and obtain similar results.
Without this evidence of generalisability in our improvement work I feel professionals will continue to be suspicious of changes.
In additon, do we ever publish the knock on consequences and the adverse effects of improvement work? A quick trawl of improvement projects published in high impact journals in the last 2 months demonstrates the attitude that improvement work is all good. None fo 12 papers that I looked at provided (or even hinted) at any negative consequences. Without honesty abotu improevemnt work and results I suspect we will continue to encounter "resistance" to change - and I will consider this an appropriate response to any solution being touted for implementation where there is no demonstartion of generalisability and no discussion about identified adverse consequences.
Thursday, 29 October 2009
Disseminating guidelines using MBTI Style
One of the eternal difficulties in the dissemination and application of clinical evidence is what I believe to be the " style gap".
Either they are researched and written so generically it is difficult for any individual or team to see how they apply to them. Or they are written so specifically that individuals and teams are so constrained to the detail and working out how they apply to themselves, they don't implement.
Different groups and organisations have developed their own ways round this problems. At a National or Regional level, boards and groups develop guidelines that are generic and then disseminate with a covering letter urging local adaptation of these guidelines. They know there will need to be local differences and contexts taken into account so they acknowledge this. This raises some questions for me:
- to what extent does turning the generic into the specific mean the intended benefits remain?
- are there different bits that can be adapted in different ways? Do the authors suggest how different bits can be adapted?
- what are the systemic links with other pathways, clinical areas etc that need to be taken into account?
- what are the contextual variables that are necessary for the generic guideline to be implemented (things like resources)?
- Where to start? Something practical?
For those guidelines which are so specific as to be overwhelming
- how do all these details scale up into themes and topics?
- what are the patterns and links to systems that will be useful to know about?
- which if the details are most important? Which ones can be left out and the main benefits are still reached?
- is there a specific order to implementation?
- how to the parts integrate with other systems like IT and HR?
I don't know the solution to this. What I do know is that many clinical and process guidelines are written in the MBTI (Myers Briggs Type Indicator) N/Intuitive style. This is the big picture, system and pattern way of seeing things. In contrast many of those required to implement these guidelines are more comfortable working with details (MBTI S/Sensing) and make sense easier of instructions if they are practical and specific. Sometimes the reverse is true - S's develop guidelines for N's to implement.
All the other parts of the MBTI styles could be a factor in the adoption of messages that change personal behaviour.
Perhaps one way round this is to use dissemination processes and content in a way which best suits the style of the potential adopters rather than the comfort of the authors.
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