Large scale change through small interventions

The phrase "large scale change" seems to be flavour of the year. What I am learning is that it means different things to different people, even when they are working in and on changing the same system. Something here about perception and definition I think.

While large scale change is in the press and on the lips, "small scale" changes or tests of changes seem to be dropping out of fashion. For those who have cut their improvement teeth in the realm of the PDSA cycle will know about the limitations and also the value of small scale changes.

So where does small scale and large scale meet?

I am finding it useful to focus on the the words impact and implementation. How can I achieve a large scale impact (maybe it is possible to have a large scale change yet insufficient impact)? How can I implement large scale change? So let's use large scale impact and large scale implementation as a way to define our change intentions.

There are many ways to achieve a large scale impact. My search is for the small scale changes that can have a large scale impact. For me this means getting the most efficiency, productivity, quality, outcome, gain, benefit (whatever your choice of measurement is) from the least amount of effort and disturbance to the system.

This is about paying attention to the what appears to be the small, boring and probably not award-winning changes that can make a difference. Focusing only on the bright and shiny changes can have many adverse consequences. Yes, it's good to talk of transformation, though that does depend on your perspective of the system. From an objective, outsider view that seems a rational task to accomplish. From the insider, subjective perspective this can creative unnecessary disruption. Also, transformation as a rhetoric provides little clue as to the how of transformation (see Weick,2000 for more info on this dynamic). It is possible that accumulated small changes can result in transformation. However, in the present financial situation for most organisations I am seeking large scale impact with small scale effort.

How can we determine whether the small scale change will have a large scale impact?

Looking at Impact (high/low) and Volume (high/low) for a specific proposal can help determine where to start, where more data analysis is required and where to put organisational change resources.

I am specifically nervous about what looks like a high impact yet is over a very small volume. One of the adverse consequences of implementing change here is regular, routine and predictable processes can be disrupted on the pretence of improvement. Pretence because it may be that the reasons for the change, for example a small patient group that needs additional time or never seem to be treated the "best" way, come about because of trying to solve the wrong problem. It could be this patient group needs extra special care. One way to get this is to look for small improvements that can be made over the large more predictable groups. By doing this more resources can be freed up to work with those who, by definition, will always be special cases.

In the current financial context I am hard pressed to agree to work on any change process unless some basic data analysis has taken place which demonstrates it is both high impact and high volume. If not HI/HV then some explanation of the need to change and the knock on consequences of both doing and not doing the change would be helpful.

I have a growing list of examples where small changes can have a big impact. For example, how saving 2 minutes on this procedure here by using resources in a different way can save £500,000+.

If you have any examples like this let me know (respond to this blog or email me).

Weick, K. (2000). Emergent change as a universal in organisations.Breaking the code of change. M. Beer and N. Nohria. Boston, MA, Harvard Business School Press: 223-242