The outdoors is my preference for a classroom

My job title of "Senior Explorer" might surprise those who expect the more formal Director, or President, or Consultant - but it more accurately explains what I do.  I tend not to direct, preside or consult - but I do explore... Most importantly, I am spending more and more of my time with my clients in the wonderful classroom called the outdoors. It's a marvelous antidote to Powerpoint, fluorescent lighting, stale air and aching backs.

Sometimes a short walk around the grounds of the hospital is enough, or a half hour stroll through the neighbouring streets can get the minds shifting into another gear. Or we can be a bit more ambitious and go for a walk into the Chiltern Hills or around the grounds of a National Trust property where I can lead a small group through some high level and detail of analogies in organisational change. There's a great deal to learn from plants, insects, the weather, trees etc. - and that's before the bodies have loosened up and the brains have been given permission to be a bit more creative.

Appleacre Adventures is a division of my company. If you're feeling really adventurous I can lead you on a two week expedition through the desert in Namibia - or maybe an overnighter on canal boat reflecting on the large scale change theory and practice of the Victorians and the applicability of their principles for the public sector in 21st Britain will suffice for you... Or maybe you'd prefer a few hours of guided personal reflection "on the hoof"?

What I've learnt is that outdoors, the quality of the learning and the radicalness of the thinking is significantly increased.  And it's not just a walk - for those of you who know me - I've invested a great deal in ensuring I understand how to leverage the benefits of outdoor learning.

Business learning from walking: 7. What to do when you reach your goal

Every project needs a plan of what to do when the project reaches its goal.

When I've finished a 14 mile walk I need to know how and where I'm going to rest my feet, dry off or warm up depending on the weather, going to get a meal etc.  The end of the walk is the not the end of the entire process. Just as I'm unlikely to organise a dinner party for the evening of a long walk, I'd like to know when I end a project that there's going to be a time of rest, recuperation and celebration.

Business learning from walking: 6. All time is not equal

You've seen the plans that show a pleasant linear progress of tasks that are planned to be completed as a constant pace over the duration of the project. We know that plans are not the change process itself but we still tend to think of things happening over time in a nice equal and fair sort of way.

To understand how all time is not equal, take a walk up your nearest steep hill. A mile on the flat might take you 20 minutes to walk. Add in a quarter of a mile uphill and you could end up adding ten minutes to your time to walk a mile. Add in a grassy field with no clearly marked path and a broken stile and a mile could end up forty minutes. Alternatively, add a field of nervous cows and you may run through it, matching an Olympic qualifying time for a mile.

Change projects are no different. While the measurement of months stays the same unfortunately the tasks, even if simple, may end up taking far more time than expected.  I good project management adage is to look at the final plan and add in 30-50% extra time. Then go back and check where this time may be needed.

Timing is not the same as pacing. When walking, it's good to know your own pace - how many steps it takes to cover a certain distance. This is an individual measure. In projects, it's useful to agree as a team the pace for certain tasks and then from that build up the overall timescales.

Business learning from walking: 5. Beware Groupthink

groupthink  (ˈɡruːpˌθɪŋk)
— n
	a tendency within organizations or society to promote or establish the view of the predominant group

Collins English Dictionary - Complete & Unabridged 10th Edition
2009 © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins
Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009
Cite This Source

The trouble with groupthink is it's easily understood in theory and spotted in others. It's like a cloak that everyone can see from the outside but from your own perspective it's invisible.

I've been in walking groups where we've all agreed on the route we're taking. We stop and check - and we continue to agree that the mast over the is the mast on the map and therefore the path we take is this one over here... The fact that none of us spotted there were two masts about a quarter of a mile apart is groupthink.  Basically one person suggested the visual markers and pointed them out on the map and we all agreed, enthusiastically. And we ended up retracing our steps about a mile and a steep hill later...  We've also ALL walked past a path closed sign because we didn't want to believe the path was really, really closed, despite a couple of people questioning the route.

Would you fly with an airline where the pilots were subject to groupthink?
Would you like to undergo surgery where there is groupthink in the operating theatre?

Speaking up is not all about whistleblowing and making a drama out of an everyday moment. It's about pointing out the obvious, not allowing yourself to conform, being unafraid to ask a question and to hold out for a considered answer. The responsibility for avoiding groupthink is with the self - not with others.

from restortivepractice.org

Business learning from walking: 4. Teamwork trumps individual heroism

Walking alone is as about much fun as doing a change project on your own. Even if you like your own company, working alongside others will enhance the process in both cases. Sometimes it's enough on a walk to have someone to chat with, to help you put a blister on the heel of your foot or to give you a second opinion on the choice of path to take.

Walking in a group is a bit like working in a project team. You go at the pace of the slowest - there's no point in rushing ahead to a milestone to then sit and wait for someone to catch up. It's far easier to support the slower person as you go along as it may increase their confidence and fitness. Same goes for project teams.

The "hero" who strides ahead and out of sight of the group is no hero at all.

The Isle of Wight Coastal path is a moving feast and as we gathered on a group walk recently, it is collapsing  on a daily basis. Out group was faced with a section of path that had fallen away leaving no clear route forward. Do we retrace our steps (see previous post) or find a way around? One member of te group who has climbing experience assessed the risks and found a way for us to clamber around holding onto a fence while he supported us from underneath! It was not very dignified, but it worked and we were soon continuing down the path, adrenaline leaving us slightly elated.

Change projects will reach those points where it seems impossible to go on. Things happen that could not have been predicted. That's the time to check the skills of the group. If you can help then it's time to step up and take the lead. Assessing the risks is important.

Teamwork means giving up some control, allowing others to take the lead as their skills fit the task, and giving each other the physical, intellectual and emotional support required to reach the agreed goal.

Business learning from walking: 3. Never fear turning back or retracing your steps

I learnt an important lesson last week when walking on the Isle of Wight. Well, I learnt many lessons, but one of them was that sometimes it's easier to turn back and retrace your steps, than to go into unplanned territory.

We'd walked for a hour or so, it was hilly and we'd just headed down a steep hill that was so steep in places there were steps. Popping out between the hedges we realised something was wrong. After much deliberating and map checking, we had two options:( a) take a new, unplanned path that would get us back to where we wanted to be that was longer, less scenic and involved riskier road walking, or (b) hike the half mile back to the last decision point, even if it mean a steep 200ft climb back up the hill. After some whimpering and puffing from me, we got back on our planned track.

All change projects reach dead ends or go off track - often due to enthusiasm for trying new ideas. It's important to keep the goals in  mind and to assess any difficult situations. In my experience we tend not to have the courage to go back a few project steps and start again. Instead we blunder on and end up taking a longer and more tortuous route to get to where we need to be.  In future, I'll be asking more questions and keeping in mind the possibility of going backwards to go forwards.

Part of knowing when to turn back and when to go on is an important skill, and this is covered in the next post in this series.

Business learning from walking: 1. The plan is not the event

Picture from grough.co.uk

Advice is never to leave for a walking adventure without a map and compass – and a sandwich, drink and set of waterproofs is also a good idea.  In business we have our plan as our map. But just as the map we read and mark while sitting in the comfort of our warm and dry home, the plan we create in our offices is never going to be what actually happens.

 A tree may have fallen across the path – a barrier to change is discovered that the plan didn't take into account.  Someone twists an ankle – a key staff member goes off on long term sickness. It snows – a new directive from on high impacts the organisational plan

Never set out without a plan, but never assume that having spent hours (or days, weeks, months) on the plan that the event is now sorted. The plan is prework. No imagining beforehand can take the place of an actual walk under the trees, beside the sea or over a field. Similarly, no amount of planning can predict the actual path and experience that any organisational change will take. 

Redisorganisation in healthcare: the theory and the practice

A good friend, Bill Russell, tweeted a link to "A surrealistic mega-analysis of redisorganization theories" published in the Journal of the Royal Society of Medicine, December 2005.  Yes, it's a Christmas edition spoof, however, there is some unnerving truth underlying the splendidly irreverent - and creative - paper.  I share it nervously, as I wouldn't be surprised to find it turned into a PowerPoint and a half day course being run to teach people the theories.

The paper got me thinking about the tendency of Healthcare Improvement Leaders to grasp at the latest theory that comes their way, further confusing the people they are expected to serve with their "leadership".  Recently I have encountered an exhortation about the need for consistency and a single model for change in the NHS; countered by the push of new ideas and theories, which dilute this message.  As well as new concepts being presented as though they are the next best way to make an improvement / support change; the concept is a concept - it has not been fully tested.

The frivolousness and scattergun approach for supporting healthcare staff and their organisations is unlikely to be a useful one.  My concern is the endless search for the quick fix is confusing people. In addition, when one theory ends up not working in practice, then I'm not seeing the evaluations, reviews and sharing of lessons (as in role modelling learning and improvement). Therefore each new concept is being built on an ever-weakening foundation.

The value of of those who lead improvement and change in healthcare  I believe, should be based on the depth and pervasiveness of change they support, rather than on the number of new concepts of pilot projects they put into the system.

Book Review: Tribes: we need you to lead us; by Seth Godin

All of Seth Godin's books are amongst my favourites - sometimes you just resonate with an author. I like the way he speaks his mind and is unafraid to test out new thoughts and ideas.

He explains a tribe is nothing ore than a group of people connected to an idea, a leader and one another. His point is that with the web as it is developing we have more ways to find people of similar ilk and to join the "tribe". However, not all of these groups are fruitful and they need leaders and facilitation in order for them to be productive and constructive. This leadership angle is important.

Seth Godin's thoughts as I connected to them in this book is that being a leader of a tribe is tough and demanding. Often tribal leaders are accused of being outside the norm - a bit of a heretic. He believes that the leaders who are perceived as such and who stick to their views will win out in the end.

What does the author suggest we do to grow these tribal social movements?
1. Publish a manifesto; state who you are and what you are about
2. Others need to find and connect to you - make this as easy as possible
3. Keep the financial stuff in the background
4. Publicly track your movement's momentum and growth
mmm easy on paper though I wonder just how easy it is to do these things.


As good as his books, I also recommend Seth's Blog http://sethgodin.typepad.com/ and you can find out more about him and his books at http://www.sethgodin.com

An introduction to Activity Theory

I'm finding Activity Theory very useful for thinking about large scale change. Traditional quality improvement, implementation science, dissemination science, organisational development and the like, are all useful. However, every theory has its limitations and although Activity Theory isn't perfect, it does provide some thought-provoking challenges.

There's a good 9 minute introduction, though you do need to be in a quiet place and be concentrating...

Design a 50 minutes lecture that works

Tired of the person who stands up and delivers a repeat of their presentation (they are as bored as you)? Tired to the point of not being able to concentrate for more than the first few minutes of a presentation? Tired of making it through to someone's lecture to discover afterwards you have no idea what you learnt?

John Medina is a scientist who researches ways to avoid problems like these. He also has some very practical advice. I like his Brain Rules website, with videos (nice to see him practising what he preaches), tips and links to a new book. Each of his 12 rules are available with illustrations and videos.

Advice for a 50 minute presentation? Break it down into 10 minute segments. At the end of every segment add a hook / statement that will generate an emotional response in the listener. I'll be trying that for my next presentation.

Literature review for the use of Web 2.0 tools in Education

Whilst education is different from both healthcare and private organisations, there is a lot in this literature review to get you thinking.  I was wowed by the comprehensive coverage of the technologies and the analysis of what might best be used when and where and by whom.  I started reading from the back - with the Appendices!



Introduction
Methodology
Changing
 technologies
The 
emergence 
of
 Web
2.0 
tools
A 
typology 
of 
Web
2.0 
tools
Changing
 learning 
and 
learners
Theories
 of 
learning
New 
forms 
of 
learning
Patterns
 of
 technology 
use
and 
the
 characteristics
 o f
learners
The
 changing
 role
 of
 teaching 
and 
teachers
Strategies 
for 
supporting 
the
 use 
of 
technologies
Barriers
 to 
uptake 
and 
lack 
of 
impact
Digital,
 networked
 and
 multi­literacies
Success
 factors 
and 
strategies 
for 
change
Contextual 
examples
Blogs,
 wikis 
and
 social
 tagging
Twitter.
Social 
networking.
Immersive 
environments 
and
 virtual
 worlds.
Summing
 up.
Conclusions
Appendices

Gagne's nine levels of learning

It;s a while since I visited the theory about learning in a way that fundmaentally changed the way I delivered a workshop or series of lectures. Gagne's work is not new but it is, I think, forgotten by many.

1. gain attention 
2. inform the learners of the objective (expectancy)
3. stimulate recall of prior learning (retrieval)
4. present the stimulus for current learning
5. provide learning guidance
6. elicit performance
7. provide feedback
8. assess performance
9. enhance retention and transfer

to read more about this you can Google "Gagne" or read the short summary at Mindtools.

Getting started with mobile learning

While some organisations are struggling to make the move to video conferencing and webinars, others have moved on even further and are using mobile technology as a key part of their learning and development plans for employees. A recent article in ASTD covered this topic and it is a short and easy read for anyone who is wondering what is meant by mobile learning.

Mobile learning may be more significant than web learning for healthcare

Educational methods have long been one of the key strategies to encourage the adoption of existing good practice and evidence in healthcare. The predominant method is face-to-face sessions though over the last three or four years this has started to be replaced by virtual sessions. The Web has been the technology used ofr the virtual learning, however, the advent of smart phones suggests learning via the mobile may be overtake the web portion of learning and may dig deeper into the face-to-face session.

The chart above comes from Ambient Insight Research who have an excellent article on this topic.

Are your spread plans including the use of mobile learning and technology?.

Learning communication techniques is important for spread and safety

I'm freshly back from a fabulous 2 day masterclass with a group who actively particiapted in developing their own communication skills. This was more than ideas on how to develop a technical communication plan. This was a group of individuals who spend time in front of video cameras and then assessed their own performance - with the aim of giving each other feedback and consequently improving their skills.

So often when communication is mentioned in the context of spreading good practice we default to "how to develop a communication plan". Yet I know from working with this groups, as with other groups I encounter, that it is only when we get to the finer details of communication and behaviour does anything really change.

Communication itself is an important topic. There is oodles of research about which demonstrates the link between communication and performance, communication and financial outcomes, communication and patient outcomes. In the current copy of International Journal for quality in Healthcare there is another excellent research report demonstrating how communication is linked to medical disputes.

My feeling is we can get further in the goal of spreading good practice when we pay attention to the details, like how individuals communicate with one another and resist the temptation to focus only on technical planning.

I also suggest we can stop researching the link between communication and outcomes and focus on making the desired communication changes.

Synchronous learning is important for large scale change

I've always felt that the paradigm of learning, how we learn, the fact we have different styles etc., is a crucial theme for spreading good practice across systems, in large scale transformational change.

Some of us like to learn through theoretical experiences whilst other of us prefer a more interactice and discussive type process. There's an interesting article in "Chief Learning Officer" which I think closely relates to the problems we grapple with in healthcare in scaling up change across lots of people and organisations.

The article looks at the difference between synchronous (do together, discuss, meet, talk) and asynchronous (email, read alone) activities. It looks at how the learning process is effectively part of the outcome of any change.

I'll not repeat the article; have a look here for the whole thing -
http://www.clomedia.com/features/2008/July/2276/index.php?pt=a&aid=2276&start=0&page=1

Learning is part of knowledge management

There's a good article in Harvard Business Review 08/08 Vol.36 No. 8 P.60 by Amy Edmondson, entitled "The competitive imperative of learning".

This article is about the global trend to move away from a product based organisations to those that are more knowledge based - that is where the value is now. A process called EAL - execution-as-learning is introduced as a means to support the organisational learning and knowledge management process.

I like this framework because it is action orientated (good for healthcare) and shows how competitiveness can be managed, challenged and leveraged, though collaborative tools. This sounds a bit like an oxymoron. My view is that competitiveness might be the overarching strategy but it is delivered, at the action level, by collaborative working, including the use of systems and tools to enable this. There is also an emphasis on evaluation and feedback as essential parts of the learning process.

Traditional copyright may limit spread and adoption

I've been inundated with a variety of contractual issues in the last few days, quite a lot of it is Requests For Proposals for programs of work where potential clients have clauses in their agreements specifying that any idea (or derivative) developed will belong to them. The strange thing is, these are the same clients who are often contracting or asking me for support in finding ways to spread their messages and ideas to wider audiences.

The perceived paradox is that we, me included of course, want to hold on to the ideas that we come up with, for many different reasons. However, it may just be that one of the barriers to the idea getting "out there" in the first place, or being adopted and adapted by others, is the tight restrictions of the traditional intellectual copyright - the (c) symbol.

I've personally been tossing about in this sea change of intellectual sharing for some months. Making the personal and then the business strategic shift to an alternative paradigm has taken nearly two years of trial and error and will no doubt continue. I am having to redesign my entire concept of a consulting business, along with all the supporting paraphenalia. Some of these lessons are directly pertinent to the spread of good practice.

As I am not the first to struggle with this concept, there is now a robust framework for dealing with this issue - the Creative Commons Licence. http://www.creativecommons.org/ This organisation has developed licenses specific to many countries that cover may combinations of the following:

Generally you are free to copy, display, distribute and perform the work

a) Attribution: you must give the original author the credit

b) Non-Commercial: you may not use this work for commercial purposes

c) No derivative works: you may not alter, transform or build upon these works

d) Share-alike: if you alter, transform or build upon this work, you may distribute the resulting work only under a license identical to this one

and then there are a few minor details to take note and if you'd like to read all the fine print for each license for the combinations you choose then they are available for you.

On the basis that the spirit of a CC license is to copy, distribute, display and perform a work, then that sounds to me like a good start for spreading good practice. My choice is to add in (a) and when I am providing my ideas, thoughts and materials for free, then I expect them to continue to be made available in the same way so (b) needs to apply. I'll then make a choice regarding (c) and (d) for each idea or product, though I know from the theory and practice of spread and adoption, if I really want something to take off then I will need a balance as (d) is quite often a necessary step in the implementation and adaption process.

What I have learnt is there is no going back.

2008 Sarah Fraser CC:Attribution-Non-Commercial-No Derivative Works

Warning: "holding the gains" means missing the point

For those well versed in the art of Cockney rhyming slang, then you'll know that the "dog and bone" is how a Cockney Londoner refers to the phone and "apples and pairs" the stairs. They might now say "Would you "Adamn & Eve" (believe) it, but we seem to have a new term."
I keep coming across "spread and sustainability" as though these two remarkably different concepts and dynamics were intertwined. They appear in requests for short presentations, in documents, booklets, advice to project leaders and exhortations for improving results in healthcare.

The quickie defintion usually given after "spread and sustainability" or "sustainability and spread" is "sustainability" means we need to hold our gains and then we need to "spread" the gains / results to others in the organisation.

This looks fine on paper. But let's think about this. What exactly is meant by "holding the gain"? In the majority of improvement projects the gain is valued and assessed against a measurement. For example, the reduction in rate of infections on the ward would be measuring an outcome which is helpful and can keep a team focused on the end result. Some measures focus on a process, such as the number of staff who have adopted the use of a checklist for a certain procedure. Here is my concern.

When it comes to working on what it is that needs to be "held" many teams will focus on the the "what's" they have created. This will be the checklists, the new procedures etc. While helpful, it takes a humble team to be able to keep focused on the outcome and continue to adapt their processes and behaviours to continue to maintain and perhaps improve on their results. In many cases this may mean they have to alter their original soultions (thus, of course, impacting what others may want to spread - but that is another issue for another day...).

How many leaders and improvement teams take the time to work out the qualitative aspects of their results? What really enabled them to deliver the improvement? While the attention is so often on the output, the "thing" that was created, by ignoring or avoiding reviewing the human, social and emotional behavioural processes involved in the development of it, they are at risk of losing what they have gained. I believe that it is in this tacit knowledge that the true gain lies. It is here that the learning resides. The checklist is merely the tangible, and temporary, manifestation of their experience.

The discipline of learning organisations and learning teams is well known, though sadly often disconnected from the conscious experience of many improvement project teams. When the concept of learning gains a hold, then we may hold some gains.

(c) 2008, Sarah Fraser