Here we are again, with real-life answers to real-life questions, gathered from the stickiest wickets in my work helping organizations learn how to achieve better results. It’s called …
Quandary-Mat: Clean answers for the dirty work of leading change in a complex world.
Our medical group is part of an initiative to improve care for patients with multiple medical conditions and complex care needs. The team of 7 people working on this is motivated, but I worry that they won’t be able to achieve as much as I know we can. The best practices (for patient engagement, home visits, care coordination, etc) are all different than how our organization works now. People here act like we are creating more work for them even though they aren’t involved in the work, and I worry about people getting in our way. What should I do to help the team? Signed, Push-Pull-Stall
This is a classic dilemma. I’m glad you brought it up. I suggest you approach this challenge with a four-prong attack. Hey, just like a dinner fork: a clear executive mandate, education, road-block busting, and making it exciting and fun.
1) Clear executive mandate
Start here. This is the loud and clear message that gives you the time and space to do this challenging work with your brave pilot team of 7. If you will permit a biblical illustration, think about that dramatic story where Moses raises his hand and the Red Sea opens up to make a clear path along its bottom for the people to pass. The message is “This work on improving care for patients with complex care needs is important to us, the executive-level bosses, because it’s important to the organization and the people we serve. It’s a priority. It’s happening. This group of seven people has tasked with learning how to succeed with this work before we take it to scale. Help them if they need you, or watch and learn.” A clear executive mandate says, in a nice way: This bus is leaving the station. Get on or stay out of the way.
If your senior-most executives aren’t able to give your work this clear mandate, if it’s just not true that it’s a top priority right now, then that’s your biggest problem. You should think seriously about how successful you can be without the executive mandate. Adjust accordingly, or decide to stop the work until you are ready as a whole organization to make the commitment to the particular goals of a project.
This is education of your peers across the organization, about what the pilot project means for them. How they can help or how they can stay out of the way. Part of this education is specifics of the project: who is on the pilot team, when the work of your team will start and stop, your plans for using process improvement methods and/or innovation and design thinking to try new things, what they may see in the halls, how you will keep them updated.
Another part of the education should cover the mechanics of improvement work, the methods you are using. If you don’t have an established improvement and learning culture, people will want to know: “Why are you doing that patient visit differently than every other patient visit? Is it fair that one patient gets more attention and services than all the others?” Answer these with education about how your team is trying new ideas in a systematic way, as part of a specific methodology.
And answer the What About Me questions (even if nobody asks): “When will I have to start doing more and different things in my job? Will I get any say-so about what I have to do and how I do it?”
Tell them: “We are doing this extra project work to try out new services and activities of care in a controlled, small-scale way. When we find something that works, we will speak to the bosses of the staff who would be part of the scale-up of the new work, and talk about getting input and how to roll out the changes.” See Signal Key’s Spread Strategy and Spread Aim guide that I use with leaders of change in complex systems.
The education continues with updates. How will you update everyone as the project goes along? Email newsletter? Team members giving updates in regular meetings? Be humble and excited. Share struggles as well as victories. Share patient stories when something works. Show the numbers you use to track progress. Ask for ideas for your team to consider.
3) Road-block busting
Any team that is serious about coming up with new and better ways to do things will run into obstacles. They need your help to be open-minded, optimistic, determined and practical in getting around challenges.
Here are some tools to use in busting roadblocks:
• Small experiments or prototyping, using PDSAs or design approaches. Break down the obstacle or overcome the objection by testing the new thing on a small scale. It’s low risk and teaches you what works and what doesn’t. As I have discussed in past articles, with small experiments, you don’t have to guess and argue.
• Difficult conversations with managers or frontline staff who are getting in the way. Try to turn their concerns into productive feedback for your work, including PDSA tests to see if you can address their concerns with testing.
• Scrappy creative resourcefulness, particularly if the roadblock is financial. In a pilot project, you shouldn’t rely on the ability to buy a whole new electronic records module, for example. Use Excel or project management software or some other available tool to help you know for certain what you need in information technology for the eventual long-term and wide implementation.
• Ask senior executives for help. As a last resort.
4) Making it exciting and fun
You and your team are brave pioneers who are putting in extra effort, making changes in their daily work and to have their progress closely measured and observed. You are the heroes of your organization. Your work is a model for what the organization should be promoting to address many other challenges and priorities. It’s important that people feel like they are doing the right thing and that the work is valuable and fun.
Make sure you conduct team meetings with this in mind, and set up systems for recognition of effort and success both within the team and across the organization. Edwards Deming, the father of modern systems thinking and continuous improvement, used to start his seminars by saying: “We are here to learn, to make a difference and to have fun.” If you need a mantra for yourself and your team, you could do a lot worse.
If you can get specific about your concerns, by identifying with your team the obstacles and potential obstacles to your progress, that should help you decide which approach to use to get started. All of these four approaches are needed to guarantee smooth sailing, a smooth crossing of the Red Sea. They overlap a good bit in practice: You educate senior executives about the change process as you enlist their help to bust roadblocks. You make it exciting and fun for people to get out of your way and align with your team’s work. Good luck! I’m rooting for you guys.