Business learning from walking: 2. Knowing where you are is more important than knowing where you are going

Picture from simonmainwaring.com

It's a truth that you have to start where you are. Whether it's starting a walk along a trail or a new change initiative to streamline the repeat prescribing process, you begin where you are - not where you think you are.  Anyone who has run a process mapping event will know that participants love to create maps and plans about what they want to happen, where they want to be. Focusing on the reality of what actually happens seems far more difficult. It's fairly boring too. To start your walk you need to be able to place your finger on the map and say "We are here". To start a change program you need to be able to use all the data you have to state your current position.

Would you start walking a linear trail, like the Thames Path or Hadrian's Wall, without knowing where you are starting from and whether you are at the place you expected to be?  I may decide to start walking the Thames path but if my actual start point is 8 miles from the predicted start point, then it's goign to be a very long day and probably one with many disappointments.

After you've started moving, you need to keep track of where you are. In business we do this by measuring our progress. These measurements need to be close in time to the actions and decisions. If I walked a route saying I would check the map at every hour on the hour (monthly reporting?) then I could quite easily waste time and energy by going in the wrong direction.  Every decision point needs a check between plan and actual progress.

I can talk a lot about where I want to end up with my walks, as Many talk a lot about what the results fo their change program will be. But in the end, those results and goals are dependent on a system and practice of knowing where you are, at any point along the way.

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. 

Outsiders cannot change NHS Culture - only NHS staff can do that

The responsibility for a change in behaviour and subsequent culture in NHS organisations, lies with the staff employed in those organisations, not with any external body.

NHS Organisation: the NHS is not an organisation by most definitions  It is not a singular corporate body..

Definition of "Organisation" from Business Dictionary:

A" social unit of people that is structured and managed to meet a need or to pursue collective goals. All organizations have a management structure that determines relationships between the different activities and the members, and subdivides and assigns roles, responsibilities, and authority to carry out different tasks. Organizations are open systems--they affect and are affected by their environment."

The NHS is a system, and one composed of formal organisations (with differing structures) and informal networks and collaborative structures that include other government bodies (social care) as well as NGO's and social enterprises. The Department of Health is not the NHS. Nor are consultancies, improvement bodies (acting as consultancies), regulators etc. These are their own organisations, with their own cultures with underlying behaviours, that also need to change.

It's easy to tell someone else or another organisation that they need to shift their mindsets and behaviours. However, following the Francis Report, the best place for everyone to start is by looking at their own teams and organisations, assessing their own culture, and making the efforts to change their own personal and group behaviours. This needs to happen not only for those organisations who deliver health care services, but also those organisations that are government funded to support the delivery of healthcare.

For these "outsider" organisations, the cultural and behavioural questions need to be reflective of their own internal behaviours and the impact these have had on NHS delivery organisations. They also need to be an honest appraisal of the cultural norms that exist within, and how these may be played out in the way they "support" the NHS Delivery organisations.

No-one needs a consultant or a clever framework to do these reviews, nor an expensive and complicated change programme. Large change initiatives operate as a displacement activity for not facing up to the details of the changes required. Real change starts with two people sitting down, telling their stories to each other, listening, mulling over the behaviours that may need adapting, then committing to have a go at changing their own behaviour, and to including others in their conversations.

Cutting the cloth does not a slimmer NHS make

The NHS in England is undergoing a fundamental change  It's driven by the need to cut the cloth - to cut the expenditure. The trouble is, if the body of the organisation is still fat, then trimming the clothes will neither a pretty picture nor a happy organisation. The body needs some work.

It's a little like telling someone who is used to living a life where they can buy designer clothes  shop for the best cut in steaks and live in the best areas - that they have to buy from Primark and live in a less desirable area.  Obviously this is not an ideal situation. But it is one where the person starts to live within their means. Yes, it means life will never be the same, but if the person doesn't make the shift then they may face bankruptcy and lose everything. Surely it's better to take control and create a new life that is sustainable.

The NHS has a lot of fat in it. There is waste, despite the doomsayers who tell of the end of the NHS due to budget cuts (cloth cutting). This fat often isn't obvious (it is hidden deep within the organs of the organisational body, often in small streaks, but there nonetheless. When I can buy a ream of paper cheaper than an NHS organisation - there is waste. When I or a member of my family has difficulty in getting discharged from outpatients - there is waste.

I'm on my personal mission not to become part of the obesity epidemic. I am pleased to have got through a number of (healthcare...) events without resorting to the biscuits and pastries. Maintaining an exercise regime in the snow is difficult - but not impossible  I know that buying clothes two sizes smaller will not cure what's lying beneath them.  A radical shift in behaviour is required from me.  And so for the NHS - a radical shift in how services are designed to meet the future needs of future patients is necessary. While I commiserate with the pain staff in the NHS are going through, I do hold out hope, as a patient, that eventually the cloth cutting will move on from losing staff to rethinking the way care is delivered.

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

Book Review: Spiritual Capital; wealth we can live by. Zohar, Marshall

You know about IQ. Along came EQ. And now we have SQ - Spiritual Capital.

Published in 2004, this book languished on my bookshelf filed somewhere between management books, self-help and fiction. Having read it I will now file it permanently under management texts. Although it is written for an individual to read and contemplate their own SQ, it is framed for wider thinking covering society and organisations.

The authors provide explanation of the different type of Capital:
IQ: Material Capital, rational intelligence - What I think
EQ: Social Capital, emotional intelligence - What I feel
SQ: Spiritual Capital, spiritual intelligence - What I am

SQ is defined at what a community or organisation exists for, aspires to, takes responsibility for. These combine to provide a moral and motivation framework for existing. "Spiritual" is described as human beings asking why we are doing what we are doing and suggest we seek a better way of doing it. It is not, as the authors state, about shrines in hallways or calling employees to prayer.

SQ links to corporate social responsibility (CSR). When I read this I wondered how much public sector organisations monitored their CSR - being funded byt he taxpayer does not automatically create CSR.

The authors spend a few chapters unpicking various theories of motivation. Nothing new in here if you've covered this before, however, I liked the way they framed their discussion and the use of their motivation scale.

They suggest twelve principles of transformation. These alone are worth the read. So much of the change management and improvement work I am involved in is focused on transformation. These authors provide a thought-provoking, simple yet rich framework for conceiving of and applying transformation.

The book ends with a chapter on corporate spiritualism and asking the question "Is it still capitalism".

If you are trying to figure out your own meaning at work, leading others through change processes or concerned about your organisation's "soul", then this book will provide you with some language and structure to frame your thoughts.

Readiness for Spread. Whose readiness - the adopter or the "pusher"?

One of the most frequently asked questions I get is how program managers can assess whether organisations and teams are ready for spread. For me, the answer is a lot more than a quickie checklist or diagnostic tool - I've tried many, including developing my own, but they have their limitations. The first question to think through is "whose readiness"?

1. ADOPTERS: Mostly I have program managers wanting to know whether organisations and teams they want to adopt something are ready. This is a useful question to ask, and indeed much of the literature focuses on these potential adopters. So yes, it's good to consider their readiness and there are a multitude of tools and techniques for doing this - any good change management assessment will work.
2. "PUSHERS": What most people forget is to assess the readiness of the "pushing" organisation to go through the spread process. For example, a regional organisation may want all physician practices to adopt the use of new diabetes guidelines which includes an information monitoring system. It may sound obvious, but the "pushing" organisation does need to make sure they are ready and geared up for others to adopt the process.They need to have the support and systems in place. Often, great practices and ideas can be adopted so quickly that the "pushing" organisation panics and then becomes part of the "slow-adoption" problem as they put limits on the process.
3. CONTEXT: Finally, the context is crucial. When it comes to large scaling up activities, it's vital to assess the readiness of the context that organisations and teams find themselves in. For example, the context where a pilot program achieved great results may have changed in the year or so since they completed their work: a change of government, the financial crisis, new technology etc.

So, when you are next assessing the readiness for your spread / scaling up program, do take the time to think through the three different angles.

7 Twitter Resources for Healthcare Professionals, NHS

If you're just getting started on Twitter, here are some resources you may be interested in:

1. 140 uses for twitter by healthcare - a blog post and one of my favourites. A bit old but still up there with challenges for you
2. Using Twitter in the classroom or organisation - nice framework
3. Canadian booklet on Twitter for Healthcare Professionals; short, sweet and to the point. Recommended.
4. How using twitter can help increase staff transparency and trust - one of my blog posts from a while back
5. Twitter for Doctors - by a doctor, with his experience
6. Pull vs Push; a twitter case study - this is my personal 90 day project from when I first started using Twitter. The lessons then are relevant to anyone starting up now.
7. Using Twitter as a social movements strategy; one of my blog posts from March 2009. Some actions to consider.

Leadership, Spread, Adoption & Sustainability

Here is a summary of some blog posts I've written with healthcare leadership in mind:

• Do middle managers matter in healthcare? (refers to a peer-reviewed paper)
• Why don't we search for evidence? (Importance of role modelling)
• Is the role of the organisational champion effective? (Refers to peer-reviewed paper)
• Leaders need to be productive (Video)
• Scheming virtuously: A handbook for public servants (links to the handbook)

Staying motivated

Brendan Venter, coach of an English rubgy team, explained at conference I attended, how important it is to keep motivated, especially in difficult times. This sounds a bit trite but I was interested in the way he explained for a team that is losing, when you get together at half time, the pep talk is important., However, what really matters is the culture of the team that will support their ability to survive the difficulty and to work through it so they engineer some from of success.

Will healthcare systems all over the world going through significant change, I was left wondering how important past and current culture is - so often the word on the organisational street is "we must develop a new culture" - but it may be too late. It is the existing culture that will determine much of the success of tomorrow.

Brendan also mentioned that people on the team need to know what the purpose is of it all. They need to know this for themselves. It is not something that can be issued in a memo. What is it that keeps people coming back to work?  Ultimately, he suggests, it is friendship. There is nothing else.

Alignment or attunement for large scale change?

(Photo by Goodshoot Photos)

The term "alignment" is often heard in leadership groups, team meeting and in programme documents. Do we mean alignment when we use it?

I came to this question of alignment vs attunement on reading a review on the book "Enterprise-Wide Change; superior results through systems thinking" http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0787971464.html and the review is here: http://articles.directorym.net/Business_Alignment_and_Attunement-a1128711.html

Most of us working in the Public Sector and in healthcare will recognise that we are working within living systems. The nature of people interacting, interfacing, creating and constantly altering interdependencies - all creates a perpetually shifting culture - with the consequence of perpetually shifting performance.

Dictionaries suggest the meaning of "alignment" is to arrange to in a straight line or in parallel lines. It is a term that comes from a mechanical and industrial age and is an important one in engineering.

In contrast, "attunement" means to bring into a responsive or harmonious relationship. I like this term. For your large scale change or mechanism to spread good practice, are you conducting a quartet, a 12 piece orchestra, a 120 piece orchestra or even a series of large orchestras all required to play the same tune in different places at the same time? Imagine helping each member of this orchestra to perform their best. They are professionals and know how to tune their instruments, the great music will come from arranging their performance in a way that it harmonious.

How do we lead professional individuals and teams so they use their skills and capabilities to their maximum, yet do so in harmony with others around them? I like to think of the attuning process as including:

• future orientation; you may call this a vision, it may be a picture of what the future looks like, it may be taking time to feel what the end results needs to be like. An orchestra may listen to a previously recorded version. A programme team may visit a place where similar results have been achieved. It is about creating a collective sense of possibility
• a high level plan; for the orchestra this is the score. This may look like detail though there will also be a high level interpretation of the score by the conductor. The leader cannot do the playing for someone else, they can only guide their interactions with others, to create the overall result
• using individual excellence and surrendering this to the collective experience. By this I mean that it is essential for individuals to do their best, to work at their optimum, yet do so as a servant to the group. An individual may have a soloist part, though this is a contribution to the whole and is not the result in itself. In my experience we have many soloists playing well and being praised for their individual achievement with little leadership effort placed on containing these performances

When I am working with individuals, teams, organisations and systems in enabling large scale change my focus is not on seeing them in organised rows, neatly lined up. Instead my aim is to help them identify their tune, make conscious their personal capabilities and to discover ways to build responsive relationships and work in a harmonious way.

Are we unleashing people to act?

I has a good discussion with a valued colleague in the week about whether his organisation should be concentrating on encouraging others to adopt solutions (in the form of products, guidelines, known ways of doing things) or whether the focus should be on delivering the outcomes (the results of using the solutions). This is a regular topic for those of us working on the spread of good practice and one of the stock in trade answers is "it depends on the context" and another answer is "do both".

However, last week, I came away with another thought. Unfortunately, it was after I put the phone down so I was unable to chat it through. You see, I wondered whether we weren't being a bit constraining in our thoughts by constanting focusing on "innovation" and "output". It was only after some reflection I wondered about the role the people had in the process of change. Yes, I know that by measuring outcomes we'd be able to measure how much they have changed and whether they are now able to perform to a new standard. But what I am interested in is whether they have learnt new skills and developed their abilities in the process. Are they enjoying themselves? Are they less stressed? Do they feel more able, in the future, to contribute to the organisation's success by coming up with and applying new ideas? Has the way we've worked with them in this change process stimulated them to be part of an ongoing process -or have we done the opposite?

By focusing on transferring specific knowledge round the organisation in very basic ways such as focusing on the implementation of simple guidelines, are we ignoring some basic human needs to be involved in something more meaningful?

Creative Commons 2008 Sarah Fraser Attribute-Non-Commercial-No Derivative

Why do social network analysis?

Revealing who is connected to whom and the strength and power of those connections is about making the invisible visible. But so what? Why would an organisation want to do this when it's overwhelmed with financial reports, performance reports, improvement activities, recruiting staff, production problems, safety issues etc?

We all know instinctively and through personal experience that work gets done in an organisation according to a method, flow and process distinctively different from the formal organisational chart. I suspect one of the reasons why formal organisational structural changes often have little impact is because they pay minimal attention to restructuring the informal connections that operate the business.

What does social network analysis do? It shows people and how they are connected to one another on the basis of their relationships. It can identify groups and can show a variety of patterns such as who is central or peripheral to the network.

Here are my top three reasons for carrying out a social network analysis in an organisation (or subset of an organisation)

1. As part of improving or redesigning a process I would like to assess the underlying relationships that support that process. For instance, if the process we've been working on had some bottlenecks in it and we were looking to eliminate these or find some way of reducing stress at high pressure points, then I would want to assess whether the social network underpinning the process was experiencing a similar pattern. It is quite possible that this analysis would throw up a central person who is acting as an informational or decision making bottle neck. This person may also be overworked and stressed and the organisation may be over-reliant on this person.
2. Some individuals or small groups may have become disconnected from others in the organisation. The causes of this could be no more complex that a move to another floor or it could be more subtle. Disconnected individuals and groups may end up with a lower performance as it may, over time, become more difficult to share ideas and spread good practice with them. So it it important to identify these groups and discover ways to overcome the peripheral social network issues that have evolved.
3. Understanding the structure of social network is key for leaders to find ways to support and continue to enable it. If the analysis has been bounded (framed within the organisation only) it is helpful in discovering ways to match organisational goals with how relationships are evolving. If the analysis links to relationships outside the organisation (important for research and consultancy) then this can be linked to future strategies and plans.

We analyse the finances, the processes, the structures, the products and just about everything else in the organisation - I wonder why we don't do more analysing of the social network?

Creative Commons 2008 Sarah Fraser Attribute-Non-Commercial-No Derivative

Organisation-wide spread plans need vision

With most groups I work spread seems, roughly, to fall into two categories: (a) spreading good practice across large geographic communities, involving multiple organisations, and (b) spread within a single organisation, managed by a single top team.

In the case of the single organisation spread effort, the aim is twofold (i) breath - getting the good practice to the further reaches and corners of the whole organisation, and (ii) depth - helping all the relevant individuals in the organisation through the change process of implementing the new practices.

Most organisations I've been working with recently have been struggling with developing the plans to achieve the breadth and depth they desire. In most cases they are working through what appears to me to be a technical, step by step planning project type mechanism. I feel this is helpful though for me there is a very important missing ingredient which might be best handled right at the start and before detailed plans are written up. Perhaps this is best explained through an analogy.

Imagine weaving a large tapestry; one of those you might have seen hanging on the wall in a museum. Large creations like these are usually participative activities. Now think what it would be like to be stitching part of the tapestry without knowing what the whole picture looked like. Yes, it would be helpful to know your own piece, but far more satisfying to know where you fit into the whole. Imagine now the activity you could undertake as a team in thinking through what your organisation will look and feel like when the whole organisation has adopted the new practices. And then how you might share this picture. This visioning and sharing process is important and there is an entire discipline dedicated to what is called "goal orientated behaviour" - in case you are interested in following this up.

Keeping with the tapestry image, we can extend it a bit further by thinking about the structures we need to put in place for a large and complex activity. How will we watch for the gaps? By answering this sort of question we might develop a different type of spread measurement system for the organisation; a measurement-by-exception attitude rather than a wearing down by a comprehensive performance monitoring system.

And the threads? How do we feel about them? Some may need to be left hanging as they will link to other projects and issues? How will we identify them? Can we "colour-code" them? How can we make sure that they are not the type of threads that when you pull on them the whole tapestry won't just unravel and we're left with nothing to show for our efforts? For me, this is about being aware as a project team. About seeing the spread of the good practice as part of a larger system.

I know project plans are important, however, I am perturbed by the predominance of the step-by-step guides that disconnect individuals and teams from the heart fo their work. The quickie fixit mentality may be leading organisations away from the breadth and depth they so desire.

It takes time to weave a tapestry.

2008 Fraser Creative Commons Attribution-Non-Commercial-No derivative Works

Differentiating the types of good practice matters

In my theoretical and practical travels I find that all good practice (however you'd like to define it) tends to be regarded as similar. What I mean by this, is there is little distinction as to whether the practice is designed to
a) make something happen
b) avoid something happening
This "commission" or "ommision" differentiation may be important. I'm working on it and if you have any ideas please then do put a comment in this post so we can add to the body of knowledge and share it openly. Or email me if you prefer.

Let's look at a couple of healthcare examples. In (a) we might be creating a new healthcare service for patients who have developed diabetes. Part of this might be to design and implement a new form of consultation called a group visit where a number of patients are seen together by a variety of different professionals. This has been successful in a number of places and we may like to copy what they have done. Yes, this may be to avoid something happening, but mostly, it is about adding something new into the system.

In contrast, we may be concerned at our hospital about the high level of MRSA infections. We want to avoid something happening. Yes, this may include something new being created, though the emphasis is on avoiding a situation.

The reason I feel this differentiation may be important is that the change process for the individuals and teams may be quite different. Understanding that they may be going through a different learning process whether they are taking on something more creative and new, or whether they are designing to avoid, may streamline and accelerate the adoption process.

For example, in the (b) avoidance example, the learning process is likely to be enhanced if the emphasis is on understanding the "near misses" so the individual / teams can discover how best to take action before the situation arises. Raising awareness and linking a "near miss" awareness to the ability to make a decision to fix it, may enable the individual to learn and sustain a new behaviour more rapidly. "Near misses" will also allow for the customisation nearly always required for the local context.

In contrast, in the (a) commission example, the learning process may be less organic and it may be possible to apply and use more straight forward project implementation techniques. These are unlikely to reduce the need to pay attention to the people issues, however, there may be as much success in using well known management tools as in using the more esoteric "spread" techniques.

"Making something happen" or "avoiding something happen" - do you think it makes a difference?


(c) 2008, Sarah Fraser

How opinion leaders may be ineffective

The word "Champion" gives me shivers when I hear it as a label given to someone by senior management who then overlays their expectations on this person to lead the change of a topic with their peer group. For example, in healthcare, we get clinical champions for colorectal cancer, or nurse champions for infection control. Often these individuals are identified because they have participated in projects or shown interest and leadership in their work, within their peer group.

So what happens once they get "promoted" to champion?

Before answering this question, some background. I am aware of much research on the topic of opinion leadership. Much of this is contested and conflicting. In fact, come of the recent research questions whether they exist at all and other research points out they may exist, however, the manipulation of them may be impossible, for many reasons I'll not cover here. So or the purposes of this short note I am assuming you're interested in the concept because you like the use of it and wonder whether and how it works for you.

In colloquial terms, I do find there are two types of opinion leaders. The promiscuous type and the powerful ones. The first category are those who have a lot to say. They have strong opinions and will talk to many people, within and without their per group, about those opinions. The extent to which others are influenced by those opinions I feel is rather weak. This may be because of the volume of them, the weakness of targetting or the number of different ideas discussed. In contrast, the more powerful opinion leader is the one who shares a little less and builds more credibility with focus. More of an expert this person is also a bit more interested in ensuring the ideas are successful in the workplace. So the followers will place credibility in the ideas this person speaks about or actions that are taken. Obviously there are some grey areas in between these two steareotypes I have described above.

So what happens to the 'champion' role?

If the person who is placed in this role comes from the more promiscuous type of opinion leadership orientations, I feel they will start with less credibility amongst their peers. From the management perspective they may appear quite (or indeed very) effective, as they may be able to maintain a high degree of communication. The issue is whether this communication transfers into a change of behavior. At best it does. At worst it creates noise in the system and a consequential immunity to further change.

For the more powerful and expert opinion leader, the transfer to 'champion' often ends in the loss of credibility. The individual is seen by their peers as having 'gone over to the other side'. The very factor that gave them their power is then lost. Perhaps they would have been best left in their place and given support to carry out their social leadership role, without interference.

There is theory and research, and there is practice. I read the theory and research and spend time in organisations and working on projects. My difficulty is connecting the theory and the practice when it comes to opinion leadership. I'm starting to realise that the theories are very limited and maybe it is time to do some reframing by looking very closely at what actually happens in practice.

And maybe it's a good idea to work with the social system rather than to mess with it.

(c) 2008, Sarah Fraser