Contagious culture change

Editor's note: Once a month, the Strategic Capability Network (SCNetwork) hosts a special seminar on a topic of interest to HR professionals and business leaders. Canadian HR Reporter covers these events for a special feature titled "Executive Series." The feature includes news coverage from one of our editors, plus commentary from SCNetwork's panel of thought leaders on strategic capability, leadership in action and organization effectiveness.

This web post contains all of these elements:

Canadian HR Reporter's news coverage
Employers fear letting go of command-and-control, by Karen Gorsline
Being positively hierarchical, by Michael Clark
The power of positive deviants, by Trish Maguire

Contagious culture change
A positive deviance approach can infect organizations with positive culture
By Liz Bernier

During a major C. difficile outbreak in a Toronto hospital ward, a husband and wife both contracted the infection. The wife became so ill, she ended up in a long-term care facility. The husband died.

“Those stories happen every five minutes in health care — they are constant,” said Michael Gardam, director of Ignite Consulting and an infectious disease specialist in Toronto. “If it’s not C. difficile, it’s someone falling, breaking a hip. It’s someone lying in bed getting a pressure ulcer. It’s someone getting the wrong medication… these things are a dime-a-dozen.”

Just about everyone has some sort of story about a negative health-care experience. And it’s stories like this that demonstrate just how high the stakes are, just how critical it is for health-care workers to get it right.

“This is what motivates me in the work that I do — trying to prevent these terrible stories from happening,” said Gardam.

When he was asked several years ago to lead a group looking at how to prevent the spread of a superbug, Gardam found the experience frustrating.

“It really didn’t work — and the rates of the superbug (infections) kept going up,” he said.

But through that experience, Gardam met a group of American researchers who took an unusual tact: Instead of developing a traditional change management model, they focused on a positive deviance approach.

Most organizations follow a fairly standard script when approaching a problem or implementing change: The leadership team meets behind closed doors, hammers out a strategy and then hands it down to the organization at large.

But when that new “cure-all” change strategy reaches front-line employees, it’s rarely accepted with open arms, said Gardam.

His experience working in the health-care field — and specifically in the area of infection control — has given him a unique insight into why that traditional change management approach usually doesn’t work.

“The sort of traditional approach that we use… is education,” he said during a Strategic Capability Network event in Toronto. “When that doesn’t work, we’ll do it again. And when that doesn’t work, we’ll make the education mandatory. And, at some point, maybe it’ll sink in and people will start doing what they’re supposed to do.”

Best practices, detailed data and an evidence-based approach are the lynchpins of this traditional approach — but they aren’t always the right solutions, he said.

“We love our evidence-based practice… but, of course, for many of the things we’re trying to do, the evidence may not be ideal,” he said.

“We love our information and data, and we always want more information and data. But one of my favourite phrases is ‘You can’t fatten a cow by weighing it.’ We’re very good at collecting stuff but we don’t necessarily do anything with that stuff… We’re not necessarily taking that and saying, ‘So what? What are we going to do about this?’”

Positive deviance presents an entirely different approach. Instead of crunching all the data and developing a sweeping, one-size-fits-all set of best practices, a positive deviance approach focuses only on the outliers — the best outcomes — and examines what is different about them.

“Positive deviance is a social phenomenon where there are some people in a particular population that outperform others,” he said.

“They don’t know they’re special, they don’t know they’re good, they just do their thing and they’re outperforming. It’s been around forever but, in the last 40 years, it’s started to be used as an approach to changing problems.”

When designing a solution, it’s important to consider there are different types of problems, said Gardam: simple, complicated and complex.

“A simple problem is like baking a cake — you follow the recipe, you put it in the oven, there’s going to be a cake in there. It’s not going to be a puppy, it’s not going to be a car; it’s going to be a cake. And if the cake isn’t perfect, you can tweak the recipe and then you can figure it out,” he said.

“A complicated problem, as you might expect, is a little but more involved. (One example) is sending a rocket to the moon — many more steps involved, many more people involved but, ultimately, it’s linear. You can predict what’s going to happen. If nothing goes wrong, you’re going to get there.”

A complex problem, however, is like raising children: Each child is highly individual and there is no one script or solution to follow.

“Much of what we deal with in health care is complex like that — you can’t come up with a script on how to do it,” he said.

“So for simple problems, like baking a cake, one size fits all. You want to standardize. This is the world of problem-solving, of checklists, of best practices — this is the world where education really is going to get you a long way.

“In a complex world, all the rules change. And once we acknowledge that the rules are different, we use different tools to try to bring about change in complex environments.”

A key factor in complex problems is the “social immune response,” said Gardam — people may be quite offended when you try to impose a solution.

“No one’s going to say, ‘Whoa, back off buddy, I don’t want your cake recipe.’ But if I come and tell you how to do something (more complex), you may very well be offended. What if I show up and tell you how to raise your children? It’s probably going to be offensive. Why? Because it’s very complex. I don’t know you, I don’t know your children, I don’t know what’s important to you… in a complex world, one size never fits all,” he said.

Implementing culture change when the problems are complex isn’t about standardized solutions — and it’s also not about a strict, top-down hierarchy, said Gardam.

“We have an incredibly strong hierarchy in health care and we’re all about our top-down leadership — people sitting in a conference room, making a decision (about) what’s going to work, and then developing a program and rolling it out across the organization,” he said.

“In a complex world, relationships matter more than anything else. So how you interact with each other matters greatly in complex problems.”

When those relationships and that communication aren’t there, you’re missing a critical piece of the puzzle, he said.

A hospital in New York, for example, was trying to have doctors do their rounds with the nurses, so there would be more communication with each other and with the patients. But the doctors wouldn’t get onboard because they didn’t want to take more time out of their schedules to talk to the patients, said Gardam.

“That’s toxic culture,” he said.
“We could bring in all the checklists that we want but that is the elephant in the room. And that is what we need to fix in order to make things better.”

So Gardam’s consulting team does social network mapping to see how many people are communicating with each other.

“One of the most amazing maps I’ve ever seen was at a hospital in Toronto, and we asked, ‘Who do you talk to about preventing superbugs?’ And this hospital, which has the best record on multiple levels when it comes to patient safety, you know who was at the centre of the map? The CEO. I’ve never seen that before.”

There wasn’t just one group taking responsibility — everyone from the CEO to the housekeeping staff to the doctors were fully engaged in providing the best patient care.

That type of high-level engagement is called front-line ownership, said Gardam.

“Front-line ownership is exactly what you think it is: When we’re trying to bring about change, we engage the people who are touching the problem. In other words, the very people who are going to be most affected by this change are the ones who lead it.”

So how do we do that? Through the peer-to-peer spread of ideas, rather than top-down, he said.

“You specifically don’t tell people (what) to do; you let them see it for themselves. And that’s where this feels so uncomfortable, because we look at it and say, ‘Well, if that’s working, why don’t we just tell everyone to do it?’ Well, how does it work when you tell your teenagers exactly what to do?

“What we’re looking for is ownership. You change because you want to change, because this is your baby. You’re doing this.”

Employers fear letting go of command-and-control
By Karen Gorsline (Strategic Capability)

Members of organizations at any level will readily agree that attempts to introduce change often have dismal success records. Yet employers continue to follow a traditional change model of attempting to secure commitment by creating a “burning platform” — a compelling fear of not changing. They demonstrate a command-and-control approach to change. Why?

Focus on closing gaps: Organizations often see problem-solving in the simple context of closing gaps as opposed to leveraging capabilities. This mindset is about looking at what is wrong versus looking at what is working. When this mindset is extended to managing behavioural change, it often results in an analytical, education-focused and standardized rollout approach. An opportunity is lost to understand the contributing factors in areas that already have positive, desired results and have the potential to spread change throughout the organization from the ground up.

Not understanding when to let go: Employers don’t differentiate the types of changes they are trying to make. They expect education will ultimately result in the desired change. Where the change is a readily accepted solution to a simple problem, or where no behavioural change is required, knowledge in the form of education or tools such as a checklist may be sufficient and may be a welcome response. However, where change requires acceptance of a behavioural change, education will likely fall short of the goal. Individuals in the organization need to first appreciate and accept the need to change and then have the motivation and discipline to actually implement it.

Not understanding when and how to use best practices: Best practices are developed within specific contexts. What works in one may not be successful in a different context. Best practices are helpful in two regards: Where the problems are simple or rote routines that don’t depend on culture or specific work context and adopting a tool or approach is perceived as useful; or as a thought stimulator where a change in thinking is required to show different ways of approaching a problem. In either instance, looking at best practices cuts through “not invented here” management and expands thinking beyond the confines of normal organizational practices.

Not knowing how to let go: There is a difference between abdication and letting go. Involving the broader membership of the organization in determining the course and type of change still requires the participation of senior leaders. Leader support — not micromanaging — is needed in defining the overall result objective and setting any parameters that are truly not negotiable. Support also includes providing resources to teams, demonstrating trust in teams in accepting various solutions to reach the desired result, and monitoring the overall track record of the various parts of the organization toward meeting the desired result.

Not knowing how to work in a “let go” organization: At all levels, members of an organization may look up the organization for answers to problems. Engagement of the broader organization, along with the freedom and responsibility to find solutions, may be a no-brainer for some — but for others, it may represent a major culture shift. In the latter instance, there may be little experience or expertise to know how to work toward solutions. There will be a learning curve and there may be bumps along the way, requiring ongoing support and encouragement.

Not understanding how to use and reconcile internal best practices: As various teams look for solutions, there will be variation in the resulting practices. Practices can be improved by ongoing sharing among teams on what they are doing: what is working, what is not working. Through sharing, practices can evolve to a better and more common practice overall. A few specific work environments may require specific provisions, but these will still benefit from the experience of sharing and an understanding by others of the special requirements.

Although letting go of a command-and-control management approach to change seems to be risky, scary and demonstrate a lack of leadership, leaders cannot deny that many changes in their organizations fail to stick even though significant expertise and resources are committed to the initiative.

The truth is, organizations cannot effectively force complex behavioural change to occur at the individual and cultural level. Using what appears to be a more risky approach can actually be more effective and sustainable. The only reasonable course of action is often to “let go.”

Being positively hierarchical
By Michael Clark (Organizational Effectiveness)

“What do you mean it took three years to get hand-washing to desired levels?” During Michael Gardam’s engaging presentation on change management and positive deviance, I kept going back to this challenge of getting hospital staff to embrace a new standard. Have we so forgotten that the point of work is to achieve organizational strategy and increase shareholder value (however defined) that we are prepared to tolerate three years of the potential spread of superbugs in hospitals while we get everyone on board? I am a shareholder in Ontario health care and I find that unacceptable.

The means by which Gardam ultimately achieved the reduction of superbug transmissions is fascinating , and it joins a chorus of powerful new ideas about bottom-up, emergent change and complex adaptive systems. But from the perspective of organizational effectiveness, and of the timely achievement of strategy, sometimes leveraging top-down
hierarchical authority is the better call.

After all, it is inevitable that we work in hierarchies — it is in our nature. So let’s take advantage of that and use the mechanisms within “positive hierarchies” that promote change, not hinder it: strategic intent, managerial accountability and effective managerial leadership.

Without strategic intent at the executive level, bottom-up change will peter out or, at best, live on in isolation. Gardam took his orders to reduce the spread of superbugs from the executive level of the University Health Network, not the ward staff. Without that intent, his change efforts would not have even begun.

Without managerial accountability, change is unlikely to stick. Unless all managers at all levels are held to account (by their own managers) to implement change, then change is driven by individuals’ sense of

responsibility, not the strategic will of the organization — and, as such, it will be adopted indiscriminately.

With managerial accountability, any initiative (including transformational change) flows from the C-suite to the shop floor (or ward) like it’s riding a conveyor belt with quality assurance checkpoints. Reciprocally, if all direct reports are held accountable to provide their best advice to their managers who are accountable to listen to that best advice, then tactical, continuous improvement (team change) goes the other way as well.

Finally, by holding managers to account for continuously growing team capability, change is inevitable, encouraged and ongoing.

Current practices in effective managerial leadership already involve much of what Gardam is proposing.

Surely, by now, any manager
understands it is her accountability to provide direction, resources and coaching to her team, not to instruct the team on how to do their work.

Any manager quickly discovers that managing — managing change included — rarely succeeds by diktat. As Gardam mentioned, one size does not fit all and every team and every team member requires a customized solution created in dialogue with those who will experience the change.

In this model, it may well be that managers identify their positive deviants and encourage them as agents of change, but it is the manager’s call to make — not a change expert stalking the wards.

There needs to be a meeting of the minds on top-down pushing and bottom-up pulling (or is it the other way around?).

Gardam proposes that “change spreads in infinite ways,” including emergent change from individuals on the front line. But we should not lose sight of the fact that one of those ways is using the energy and focus provided by hierarchies

The power of positive deviants
By Trish Maguire (Leadership in Action)

I wonder if change and innovation would be easier for many organizations, including those in the health sector, if more leaders adopted the mindset of letting go of what is no longer essential and — most compelling of all — command and control?

In listening to Michael Gardam from the University Heath Network and hearing about his experience with positive deviance, it seems the health sector has the same challenges with change and innovation as the rest of the corporate world. How many of you would agree with Gardam that your leadership team depends on “evidence-based criteria, top-down leadership structures and practices, balanced scorecards and limitless information and data” before making any decisions?

All these leadership practices and operating principles have allegedly worked well for most companies, prior to the recession. There is, however, a growing belief these practices are in fact not working in today’s world, where greater change and innovation is mission-critical.

In searching for an alternative practice, Gardam found inspiration in Pascale, Sternin and Sternin’s The Power of Positive Deviance: How Unlikely Innovators Solve the World’s Toughest Problems. This counter-intuitive approach is intended for leaders in search of alternative solutions to the most complex of challenges.

Their core concept is based on leaders leveraging the abilities of individuals whom they consider to be “positive deviants.” Interestingly, these people are not your leaders or managers; they are typically front-line employees. Positive deviants are as those few individuals who find unique ways to break down and break through problems that others see as being impossible to solve.

Pascale expands this approach even further in Surfing the Edge of Chaos where, as co-author, he shares a number of actual stories. For example, Steve Miller (former managing director at Royal Dutch/Shell) tells how his leadership team learned from employees as to what were and were not effective change management practices. One of the quotes that captures their key learning is “We stopped treating the downstream business like a machine to be driven and began to regard it as a living system that needed to evolve.” Does this sound familiar?

Remember when Meg Wheatley’s Leadership and the New Science advocated that the only way leaders could expect to change organizations effectively and successfully would be to start viewing them as a system? In other words, before commanding what has to change, we need to first examine, think about and value how individuals, work groups and teams work together within the system.

Once completed, the second step is only then to consider how we want to drive change. As a leader , how many times have you experienced the ensuing chaos when a change initiative has been mandated from the top down without any attention being given to Wheatley’s first step?

How many times have you heard leaders express their frustration because “People don’t understand, are unwilling to buy in and are resisting change?” How different do you think the impact of change could be if leaders introduced change as the start of a conversation rather than a fait accompli or directive?

A key learning for me with change initiatives is that the opportunity starts in changing employees’ conversations up, down and across the organization. This is how people learn and only then do you see lasting change and innovation happen. The self-confidence that evolves from a core of committed employees is highly infectious, together with their energy. People begin to think in new ways and fresh, innovative ideas emerge.

It’s fascinating how the smallest of actions in an organization can generate phenomenal results. Has anyone ever asked you how the principle “If a butterfly flaps its wings in Tokyo, it causes a tornado in Texas?” applies to leadership and change management practices? The answer: It enables everyone to appreciate the enormity and consequence of each and every employee’s connection and impact on your organization.

Whether you reflect or choose to act on how you can leverage the influence of your positive deviants, I leave you with a final thought from Harold Geneen: “Leadership is practised not so much in words as in attitude and in actions.”