Organisations as thought leaders; some healthcare examples

Thought leadership is not just about individuals. For many organisations, their mission is to be the thought leader in their sector.  I’ve listed below the healthcare related organisations that I believe to be thought leaders.

·     The Health Foundation  in London practices a pragmatic and sensible thought leadership. They base their knowledge around programs of work, linked the more academic reviews. They share knowledge very well and a great example is their work on Self Managements where all the materials can be accessed, free of charge, including train the trainer packs.  They take on new ideas and put them to work in programs. They are prepared to take risks and their work is subject to evaluation – which is also shared.  They are a charity so have no need to sell – and this shows.

·     The Kings Fund, London,  is a traditional thought leader for healthcare. They’ve moved into blogs and videos, and other social media platforms such as Twitter, Facebook and LinkedIn, as a means to share their news and views – and to help others connect. They are best loved for the discussions they hold. These are tough questions with a wide range of people taking part. They empower thought leadership in others, which is very magnanimous of them.

·     The Nuffield Trust is another UK based organisation which is a thought leader, in a fairly tightly packed thought leadership arena. They are probably best known for their sharp and necessary evaluations and reviews of policies and programs. They are trusted because they are independent and not in anyone’s funding pocket. They do blogs, publications, videos and some excellent charts.

·    The Institute for Healthcare Improvement  in Boston.  This is a well-known organisation for its work in developing strategies for improvement and in bringing together groups of interested people to share. Like any organisation, they have something to sell. However, they are quick to share new ideas in white papers and make many of their materials available to anyone, free of charge. (excepting their conferences which are notoriously expensive).

i    The other articles in this series are:

1. What or who is a thought leader
2. Being a thought leader

Being a thought leader

This is the second article in the series. The first article was "What or who is a thought leader".

Gandi had a saying that you need to "Be the change you want to be". So if you want to be a thought leader, you need to be one. Obvious, yes? No, it isn't. I know some people who call themselves a fisherman but fish only once a decade, or they say they are a writer of novels, but they've yet to do more than the first chapter. To be a thought leader takes effort and invest in being one.

Leadersdirect  point out the need to invest in your own knowledge if you want to have followers and be considered as a thought leader:

"To be a thought leader, you need to immerse yourself in your professional domain and search for new things to say that add value to your organization's objectives."

Fastcompany  has an excellent article on the golden rules for being a thought leader from an organisational perspective:

1.       Don’t sell anything except ideas

2.       Always give it away

3.       Have a unique perspective

4.       Focus on one thing at a time

5.       Address a specific audience

6.       Admit what you don’t know

7.       Make your audience feel smarter

8.       Hire thought leaders

The same article also covers the need to thought leaders to be thoughtful, and patient, leaders.

Thought leaders are not people who lie on the sofa dreaming up new ideas (well, not all of the time, anyway).

TheCEOOnline  has a great article on the 9 essential skills for thought leadership, and the graphic below is from them. I recommend you read the whole article and use it to assess your own position as a thought leader.

Who or what is a thought leader?

This is the first in a series of posts about thought leadership.  I started by thinking about the "what" of thought leadership. It's a concept - what does it mean?

Wikipedia suggests that

"The term was coined in 1994 by Joel Kurtzman, editor-in-chief of the Booz Allen Hamilton magazine, Strategy & Business. "Thought leader" was used to designate interview subjects for that magazine who had business ideas that merited attention."

Forbes has an excellent blogpost on the topic and helpfully distinguish between what a thought leader is, and isn't. They have parts to the definition of a thought leader:

“Definition—Part One

A thought leader is an individual or firm that prospects, clients, referral sources, intermediaries and even competitors recognize as one of the foremost authorities in selected areas of specialization, resulting in its being the go-to individual or organization for said expertise.”

To me, this suggests a thought leader is someone who is recognised as such by their followers. Obvious when you think about it.

“Definition—Part Two

A thought leader is an individual or firm that significantly profits from being recognized as such.”

Ouch, this wasn’t quite so obvious, but it makes sense. Behind every thought leader is an intention, a purpose and a bias.

Leadertoday.org suggests that 

"Thought leaders are people who have an influence on how people think about an issue or situation. Through their development of models, theories or ideas, they end up with a following that stems largely from the apparent truth and/or usefulness of their ideas."

That makes sense and I like the bit about influence, and specifically that this influence is balanced with “truth” and usefulness of ideas. Though I suspect truth and usefulness are dependent on a point of view which means some people will not agree with a thought leader’s ideas. So a thought leader can be a leader for some and a non-leader for others; it all depends on the followership’s point of view.

Leadersdirect  have a good description of what a thought leader is. They mention

“Kouzes and Posner base their view of leadership on the metaphor of a journey. Their leaders sell the tickets for the journey AND help followers reach the destination. By contrast, thought leadership merely sells the tickets for the journey, leaving it to others to get to the destination on their own or with the help of managers, coaches, facilitators and catalysts.”

I like the way this separates thought leadership from organisational leadership, though I do wonder whether “regular” leaders can also be thought leaders, and vice versa.  I also wonder how many “tickets” are sold to journeys that are never taken.

The next quote from Leadersdirect I really like as it democratises thought leadership. You don’t have to be in a specific position to be a thought leader. It is about “distributed thought leadership”.

"Whenever you advocate a new idea to your colleagues or boss, you show thought leadership. It isn't necessary to have inspirational influencing skills, which is necessary for senior executives because they need to win over the entire organization and beat off their internal competitors for top jobs. Also, to initiate organization-wide change, it helps to be inspirational. But a thought leader can focus on smaller scale changes - ideas for a new product or changes to an existing one. Thought leaders can persuade others using logic, evidence or an actual demonstration of a prototype to win support."

In summary, a thought leader is:

• anyone who chooses to influence on a specific topic
• who doesn't have the responsibility to implement the ideas
• who is recognised by others as having influence on a specific topic
• who has something to gain from hereir influence

Do you agree? Anything to add?

#thtldr

Is the role of an organisational champion effective?

The label "champion" is a complex one to wear and one which I've been a bit cautious about recommending anyone use.  In the UK, it's been common to identify that enthusiastic doctor or nurse, label them the champion for the work and then expect them to get on and lead the changes.  Sometimes this works, and sometimes it doesn't.

There's a really interesting paper published (by Hendy & Barlow, Imperial College, London) which examines the role of the champion and their effectiveness in one program in the UK. I like this research because it is lengthy (three years is a long time) and ethnographic. Their bottom line, it seems, is that it's good to be a champion in your own patch, but as soon as you're expected to deliver your champion role outside your regular context, then the effectiveness drops off. This is instinctively logical but all the same it's good to see some research on the topic.

Soc Sci Med. 2012 Feb;74(3):348-55. Epub 2011 Mar 1.
The role of the organizational champion in achieving health system change.

Does opinion leadership change over time? New Research

I'm pleased to see useful research is being done to clarify further what we mean by opinion leadership. Too often I hear people reducing what is a very complex topic to a simple slide of Roger's characteristics. Roger's initial work on the Diffusion of Innovations was researched and published before the age fo the Internet and before many staff were born. We need updates and we need to grasp a deeper understanding of the complexities.

There's a new paper out.
Implement Sci. 2011 Oct 11;6(1):117. [Epub ahead of print]
Opinion leaders and changes over time: a survey.
Doumit G, Wright FC, Graham ID, Smith A, Grimshaw J.


I've posted the conclusions to this paper below - and recommend you read the original.


"CONCLUSIONS:
Opinion leaders identified in this study were not stable over a two-year time period and generally appear to be monomorphic with clearly demarcated areas of expertise and limited spheres of influence. These findings may limit the practicability of routinely using opinion leaders to influence practice."

Stories and Examples are different

We know that stories engage hearts and minds more than bullet points on a PowerPoint or a three page proposal. I believe there is a very important difference between stories and examples.

Stories are personal. I know a story when the person telling it comes alive with the emotions attached to the story. I can feel their passion, enthusiasm, sadness, delight - whatever. I am drawn into their personal experience. It is stories like this that engage me.

When someone stands on a stage and tells someone else's story - then for me that is an example. No matter how much we resonate with the other person's story their passion, enthusiasm, sadness, delight - whatever - is unlikely to be captured by the example-teller. Examples are helpful, though I suggest they are no different from the paragraphs in papers. They are second-hand and no longer associated with the context and emotions that go with them.

I am sometimes asked if a story I have used can be used by someone else. I usually recommend they find a way of developing their own reservoir of stories. This is sometimes difficult. Those who develop and advance theories may find their work disconnected from the reality of practice. The best way to both test the theories and develop your own stories is to test them out on a small scale. Not only will this provide self-confidence, it will also demonstrate the practicalities of your theory or suggestion and increase your personal credibility as you have a personal story to tell.

In the event you are unable to experience your own story, then I suggest capturing someone else's using a short video. Then allow their story to be told as they wish.

In the next week, try to focus on gathering, maintaining, treasuring your own stories. If you find yourself giving an example - telling someone else's story - then take a breather and see how you might do something differently to get the outcomes you desire from your listeners.

Photo from www.freephoto.com

Using Twitter in Healthcare

If you need to get a message out quickly and provide receivers with the mechanism to comment and to spread the message onwards, then www.twitter.com may be useful for you. Maybe you want fresh links to medical journal highlights, healthcare policy changes, knowledge management, patient opinion - whatever - there is a raft of formal organisations on Twitter as well as 3 million+ other users. Twitter is a free micro-blogging system that allows its users to send and read other users' updates (otherwise known as tweets), which are text-based messages of up to 140 characters in length.

Another blogger has created an excellent list of 140 things to do with Twitter in healthcare. To see Phil Baumann's list go to http://tinyurl.com/8tzwvz

If you have an example of Twitter in Healthcare then please leave a comment in this blog.

The fallacy of the tipping point

A few years ago I had my own epiphany when debating with someone the value of the concept of the "tipping point" when applied to social change processes.

Most of the research literature as well as the populist books subscribe to the notion that when you get the write idea and it tweaks opinion leaders and the target population, then it will spread automatically once it has reached its tipping point which can be anywhere from 15 - 30% of the total population.

All well and good though this research is descriptive; namely it describes something that has happened. It is not inherently predictive. Many people have written books and articles with their ideas on how to take the descriptive lessons and apply then predictively. However, there are very few longitudinal studies which chekc these implemented efforts with what actually happens.

If you do want a predictive method then there have been a number of formula around for 70 or so years all of which can be used to guide you in your implementation efforts.

Another fundamental issue is the tipping point usually refers to transformational innovation. It is when something quite new and novel gets adopted by others. It has little or no relevance for communities where incremental improvement is underway. Some studies make a point of assuming that innovation is the same as improvement, and they can thus include all innovation spread and adoption research into their models and theories. However, I beg to differ. Anyone who has a strategy of incremental improvement I suggests avoids using the tipping point as a planning tool.

I've written before about the concept of opinion leadership and my ambivalence about it (see earlier blog posts). The tipping point is fairly well predicated on the theory of opinion leaders yet there is much research to demonstrate the wekness in this model.

Yes, you may see many charts showing what looks like an S-curve in the adoption of an idea. However, my first question is to ask what was the total population, namely to how many peopel did you intend this idea to spread? ONce you have the total population you will most likely notice that what you are seeing as an S-curve may not be much mroe than the variation you might get in the early phases of adoption.

Next time I read a strategy and implementation plan that says something like "Once 25% of the population has adopted the change the rest will pick it up" I will continue to be sceptical.

Sharing knowledge through social networking

There are hundreds of social networking sites around but this new one looks interesting and if it works it could reshape how we share knowledge and learn from, with and among our online friends.

www.ileonardo.com is where social networking meets a social form of knowledge management. You can upload content and create notebooks where you can collaborate with other users. You can see the information that your friends are working on. In this new era of open source knowledge and rapid dissemination, this feature has some significant advantages. It could rewrite the concept and dynamics of what is traditionally known as the opinion leader.

What I like about this site is how it moves on the concept of spreading good practice. It forces us all to think about how much we want to to share and with whom.

Influencers proven to be less important than we thought

One of the basic tenets of diffusion theory for the last 50 years has been the premise that opinion leaders are key to the dissemination of ideas and the rate of the adoption process. All this has been called into question by the research carried out by Duncan Watts at Coumbia University (and interestingly I instinctively wrote about my issues with opinion leaders not working well in my book "Undressing the elephant; why good practice doesn't spread in healthcare).

Duncan's work suggests that although the influencer hypothesis has some merit under most of the conditions tested the influencers had less influence than expected. In fact what he found was that it appeared adoption was helped by a critical mass of easily influenced individuals - turning the perspective around.

I did a brief and incomplete literature search of publications with "opinion leader" in the context of healthcare for the last 2 years. I found 18. Interesting to note that of these half suggested their experiment of using what they called opinion leaders worked in disseminating information and half said it didn't work.

So I guess the jury is still out. Though after 50 years it is good to see some new thinking.

We need system stars not individual stars

I thought I'd come up with a new idea only to discover that more than 80 years ago an article was written in The American Magazine about how perhaps the worst employee to have was the "brilliant" one because this was the person who would have lots of ideas, start them off and most likely never complete the work. You can read more about this orgininal article, called "Why I never hire brilliant men" here http://www.taoyue.com/stacks/articles/brilliant-men.html.

I'm interested in this topic because when it comes to the spread of good practice and scaling up good ideas across organisations and communities we so often focus on individuals. We point out the "champions", the so-called innovators, yet in my practical experience I am finding they really seem to be a turn-off at influencing others. I have written about this before.

What I am thinking about is that we focus on individuals because we are individuals. However, if we want system change we need to think about systems. And systems are not like individuals. They operate differently, to different rules, with different dynamics. We need to think decision-making processes, co-ordination, co-operation, collaboration and competition. Systems Thinking principles (from Senge's work) would be most appropriate here (more to come on this topic in future blogs).

So what we need are system stars for other systems to copy. We need to demonstrate that systems can operate the good ideas that we have. In healthcare we need to move away form the individualised models that we have and move away form the individualised model of scaling up to one which is more system focused - from its development through to its scaling up.

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-No Derviative

Do opinion leaders influence?

Well the answer is yes, though I suggest not enough for what we always need them to do in a planned way. I have written about this before from a slightly different angle though was struck again in a conversation with a client who wanted to create a change strategy based mostly around identifying a range of key influencers and then feeding information through them and wanting them to then infleunce the change process. By influence the change process I am assuming he meant create the action necessary to have the changes implemented by others in the workplace.

On paper and in the cold light of day this looks like a credible theory. In practice it wobbles slightly. Who exactly are the right infleuncers? Will they retain their credibility and influencing power once it becomes known they are working in this way? I suspect not. Also, most true influencers have this power over a discrete set of individuals, most of whom are their peers. In our organisational settings we would thus need to create a multi-disciplinary and multi-dimensional team of influencers to reflect these patterns and this is not what I generally come across when organisations talk of influencers. Mostly they refer to senior members of the team who they then label as champions of an idea.

I think opinion leaders do influence. I believe it is important not to confuse our organisational change and development implementation plans with this complex theory which is easier to see as a descriptive peice of research than it is to use as a predictive planning tool.