Tag: transformation

Everyday habits for Transforming Australian HealthCare

Posted on by simongterry in Future of Work 
        waking themselves up to

habits which collapse
                                    on every block
like a tidal wave
of Hokusai’s sketches
Forest Gander, Kata: Bus Stop

Life is full of curious coincidences. Late last week, I discovered that I had missed publication last November of the report by AIDH and Oracle on drivers of change in the Future of Digital Health. That report was the outcome of facilitation work I did with my colleague Mirinda O’Gorman in mid 2024. This week, I was lucky to be able to participate in a discussion with Adam Kahane on his new book, Everyday Habits For Transforming Systems. Two deep conversations about the drivers of transformational change resonated deeply. I wish now I had Adam Kahane’s book as we summarised the discussions in the report, but I thought in this blog with 20/20 hindsight I would draw out the connections and how Kahane’s work might contribute to Australian digital health practices.

Everyday Habits

And they call again, "It's simple," they say,
 
"and you too have come

into the world to do this, to go easy, to be filled

with light, and to shine."
Mary Oliver - When I am among the trees

I read Every Day Habits for Transforming Systems over the last month since its publication. My initial reaction was one of validation. The Every Day Habits felt like old friends that I have worked with often. It was powerful to have them called out explicitly and drawn together in conversation. Like many longstanding relationships, the discussion in the book also prompted me to reconsider the application and use of each. I realised my practice of the habits can improve if I take each at greater depth and also consider them more as a system of practice.

With a long discussion of transforming the Australian healthcare system at the forefront of my mind I realised I had a case study with which to review the book in practice. The book describes seven habits that facilitate transformation in systems. I will look at the relationships of the seven habits in the context of the ongoing transformations described in the Future of Digital Health work. Adam Kahane’s habits are:

  • Habit 1: Acting Responsibly
  • Habit 2: Relating in 3-Dimensions
  • Habit 3: Looking for What is Unseen
  • Habit 4: Working with Cracks
  • Habit 5: Experimenting a way forward
  • Habit 6: Collaborating with Unlike Others
  • Habit 7: Persevering and Resting

The workshops in 2024 were interactive thought leadership discussions with a wide range of practitioners and participants across the Australian healthcare systems. Habit 1 of understanding and leveraging your role in systems was at the forefront of the participants in the workshop as they were all chosen for their active engagement and contributions in digital health. The rooms of high powered system-oriented change-makers represented healthcare practitioners, institutions, government, vendors, academics and more and put that representation into their work driving change.

Many people in the room naturally understood and practised elements of Habit 2, particularly balancing the system as a whole and self-interest in relationships. Extensive discussion of the importance of user-centred design, consumer preferences, capability and social equity began to draw in the other elements of Habit 2, in the capability to understand wider and more nuanced relationships across the system, those that Kahane refers to as relations of kin, drawing on First Nations perspectives.

Habits 3, 4 & 5 were the bread and butter practices that had much of the discussion in the rooms through the facilitation. As learning oriented leaders, the AIDH guests were used to looking deeply at systems and taking new perspectives in pursuit of their changes. The report calls out some of these whether it is understanding the oft-ignored implications for system users and consumers of healthcare systems, focus on risks, regulation and the critical role of trust. We discussed at length the kinds of painpoints that drive tension in the system and are insights for future transformation leverage – conservatism, safety regulation, bureaucracy, funding models, adoption issues, unnecessary hierarchy or power structures.

Habit 5 of experimentation was a key refrain. A lot of the discussion was also about taking experiments forward beyond their test bed and generalising them across the system. In healthcare this can be surprisingly slow and hard to achieve. Some of the simplest experiments, like a NZ experiment in paying specialists differently around GP referrals delivered huge benefits in wait times, abandoned appointments, patient outcomes, cost and system outcomes but were struggling to be adopted more widely given the changes required in technology, practitioner and payment systems to accomodate it.

A key frustration in the room was around the many agendas in healthcare, its regulators and funders. Habit 6 of Collaborating with Unlike Others was an essential part of many of the changes being pursued in the room. Adoption of AI solutions involved technology, regulation, privacy, safety and even the capabilities to appropriately leverage both the data and the outcomes of such a process. One technology that everyone in the room was pursuing for value demanded almost all the participants of the system to realise value and came with huge cost and complexity as a result. Separating simple experiments like producing patient guides to be reviewed by expert specialists were practical but large scale projects like application of AI in imaging demanded much more significant investments of time and expertise across the healthcare system.

I have already touched on the frustration in the room that things were not going faster. Habit 7 of persevering and resting was a theme. Change makers can’t do everything that they want to do. Many people in the room were already wearing multiple hats as practitioner, administrator, educator and more. That is exhausting, demands perseverance and careful husbandry of resources. In an environment where talent is scarce and budgets are inadequate we all need to take care of our projects and people.

Gathering the Friends

One day, I will write you a letter
after I have gathered enough words
and enough courage
Maria Luisa Arroyo Cruzado, gathering words

Elements of all seven habits were present in this facilitation work across the Australian healthcare system. I suspect any healthcare change maker could point to such old friends in their work. In hindsight what was not as consistent was the breadth of application of all seven habits and the depth of work.

Habits that are simple to describe are deceptively hard to do. Some of the habits fully adopted like Habit 2 and Habit 6 overturn existing relationships, power structures and understandings. They demand change at a fundamental level to the point, purpose and process of the systems in question. Truly great digital transformation that tackles the needs and opportunities in Australian healthcare demands this level of work and willingness to be overthrown.

Improving any everyday habit is an exercise in mastery. Kahane’s book gives us the simple steps to start this journey, but also highlights how far we have to go and how long change truly takes. As the old adage goes, “the best time to plant a tree was twenty years ago and the next best time is today”. While the habits can be challenging, their consistent and integrated practice helps us with tools to break logjams in our work in transformation and reflecting on the system of the habits brings new insights to shape the next phase of our work.

As we move beyond arguments about data and integration in Australian healthcare, we start to tackle real challenges of equity, capability, and sustainability. Addressing these issues will demand coordinated collaboration across government, industry, practitioners and consumers as we seek to leverage new digital technologies, particularly AI, without deepening social divides and breaking the system financially. That’s where the value lies and it will demand us to implement the recommendations of the report but also to tackle the consistent everyday practice of Kahane’s Seven Habits on a wider scale across the system.

And thus, with you believing me, I made
My prophecies, rebellious, unafraid . . . .
And that was foolish, wasn’t it, my dear?
Sterling A Brown, Challenge

Leadership in Transformation

Posted on by simongterry in Change, Future of Work, Leadership

A common topic of debate in the Responsive Organization movement is whether an organization can become responsive or it must be born that way.

Undoubtedly many of the leading case studies of future of work organizations are organizations created or rebirthed from near death by charismatic founders. Some use this as evidence that the elements of a responsive organization must be present from the beginning. In a previous post, I pointed out that we cannot rely on transparency alone to make change occur for us. The power structures in a traditional organisation will prevent most radical change.

I am unambiguously in the optimist camp. I am not alone and the company in the optimist camp inspires me. I have seen organizations change enough to not recognise their former selves. Change to more responsive ways of working is possible. The question is how.

What gets in the way

Chris Argyris’ classic article Teaching Smart People to Learn is a rich source of observations of what gets in the way of a Responsive Organization transformation.  In particular, Argyris notes that:

… There seems to be a universal human tendency to design one’s actions consistently according to four basic values:

1. To remain in unilateral control;

2. To maximize “winning” and minimize “losing”;

3. To suppress negative feelings; and

4. To be as “rational” as possible—by which people mean defining clear objectives and evaluating their behavior in terms of whether or not they have achieved them.

The purpose of all these values is to avoid embarrassment or threat, feeling vulnerable or incompetent. In this respect, the master program that most people use is profoundly defensive. Defensive reasoning encourages individuals to keep private the premises, inferences, and conclusions that shape their behavior and to avoid testing them in a truly independent, objective fashion.

These hidden values in most organisation get in the way of the transparency-led transformation that many hope to see. The Responsive Organization poses a threat to control, a threat of losing and negative feelings. Importantly the delegation of authority in a Responsive Organization may cause people anxiety as to objectives and rationale for action.

The role of leadership is to act as a counterbalance these natural human values and shift the behaviours to that of a Responsive Organization. We need to create rationales for action more powerful than embarrassment. We need to create community to generate trust, support and connection. We need to enable learning through conflict and experimentation. 

Purpose:

Leaders must create a strong rationale for the transformation. In cases of crisis, startup or near death of organizations, this rationale can often be imposed by a charismatic individual. The external circumstances enable a threat based narrative to bind people together in a defensive rationale for change.

However, most organizations are successful to their own terms. As Argyris notes, we want to feel successful even if our results don’t pass external muster.  

Leaders need to leverage two elements to create a strong rationale for change in this context:  

  • The Purpose of the organization: a purpose is the ultimate rationale for why people come together in an endeavour. It defines the common impact the group of people wish to have on the world.  As a higher agenda, it is the perfect rationale for change for even the most successful organisations.  Purpose is a mastery quest. Very few organizations have the capability to completely fulfil their purpose. They can however strive to better realise it.
  • External orientation: No closed system will find a rationale for change. External orientation is where organizations find the challenges and opportunities that define the purpose into specific improvement opportunities. Leaders need to relentlessly focus the organization on its customers and community to see transparently the challenges and opportunities that exist for change. Well defined external impacts in this community will be what can drive the autonomy of teams in the organization.  Using customer and community data in line with Purpose, also enables change agents to overcome embarrassment-based resistance in the organization.

Community:

Individuals will need support to take on the risks of a Responsive Organization. The role of leaders is to create the sense of community that will support an individual through that change. At the heart of that community will be engagement with others and a growing sense of mutual trust.  Leaders set the tone for any community. They must also work hard to reinforce these key community behaviours

  • Engagement: Engagement begins with transparency and connection. I cannot truly care about the others in my community until I know who they are and understand their purposes, concerns and circumstances. Leaders need to create the conditions to enable people to be more social, to connect, to solve and to share their work challenges together.
  • Trust: Engagement will build trust as it builds understanding. Transparency will reinforce trust. However, leaders need to take on the role of fostering responsibility and accountability as engines of growing trust in the organization.  When people see that individuals and teams are accountable for driving change then they will have greater trust in the change agenda.

Learning:

This post is deliberately not titled like a listicle e.g. ’The 3 or 6 things to transform an organisation’. Even a basic familiarity with change highlights that formulas will work only up to a point. Leadership needs to be adaptive to enable any system to change in a sustainable way.

To be true to their purpose and stakeholders, to leverage the potential of their community, each organization will take an unique path through change.  The role of leaders is facilitate the individual and organizational learning required:

  • Experimentation: creating a culture of rapid iteration to address challenges and opportunities will accelerate the cycle of learning in the organization. Leaders must help this experimentation culture to overcome the resistance identified by Argyris and also to spread and have a wider influence in the organization. Lessons learned must become new truths which will take a sense-making role for leaders in the wider organization and mean leaders must champion new ways of working when they arise, whatever the personal costs.
  • Conflict: The biggest reason that organizational transformations fail is an unwillingness of the leadership of the organisation to allow uncertainty and conflict. Conflict will happen. The uncertainty associated with conflict is inevitable. Efforts to suppress this will either undermine transparency, the rationale for change, engagement or learning. Failure to embrace conflict takes many names: politeness, bureaucracy, politics, corporate speak, history, culture, etc. Failure to embrace conflict is an unwillingness to learn and improve. There will always be resistance when change comes and it must be addressed. Leaders need to create and sustain the right kinds of constructive conflict – driven by purpose, based in facts from an external orientation & experimentation, mediated through an engaged community. 

Change is Coming. Lead.

I have seen the potential of purpose, external orientation, engagement, trust experimentation and conflict to drive change. Supported by leadership these are the elements of each organization’s transformation. These elements are critical to a Responsive Organization.

Throughout this post I have referred to leaders and leadership. This need not be hierarchical leadership. Clearly it helps if leadership and power are aligned in an organization in reinforcing the need for change. However, the changes described above are not capable of being implemented by top-down edicts. These changes must come as individuals and groups discover their power and are influenced as a result, This kind of leadership relies on influence and can begin bottom up or even from the middle management so often scorned in organizations.

Change is possible. Change is coming. Smart people can learn. Your people and your organisation can better realise their potential and their purpose. A Responsive Organization transformation will occur if you are prepared to lead the change.

Lead.

Change the Conversation

Posted on by simongterry in Uncategorized

A large part of the history of our technology has been the effort to use technology to control human behaviour. Technology transformation is often sold on the potential to better make humans do things that they should be doing. The failure of so many transformational technology programs is proof that human behavioural changes are a subtler and more elusive challenge. Changing the conversation is as important as changing the process.

The Business Case for Technology Transformation

Leadership mindsets from the industrial era often lead to the management question:

“What can we do to make people do the right thing?’.

Technology transformation is sold on a promise of offering the answer. Too commonly management will choose a new technology system or process as delivering a way to make people ‘do better’. For example:

  • Customer Relationship Management systems will deliver better conversations with customers and better sales force productivity
  • Human resources systems will deliver better talent, engagement and performance conversations and better compliance with required processes
  • Business Process Management systems will enable better and more granular control of the processes that people use to do the work
  • Enterprise collaboration tools will make an organisation more collaborative
  • Knowledge management tools will make organisations better informed
  • Better analytical tools using big data will deliver better decisions in organisations  

However, these technologies are usually only an infrastructure to support new behaviours and new conversations. Their capabilities underpin human behaviour. New processes will encourage change. New data capture and reporting may help measure activity. Without a willingness to change to new behaviours from users, the systems alone cannot make change without risk of major disruption or disengagement.

Technology rarely can require a new behaviour or a new conversation. Human creativity enables remarkable ways to cling to old ways in the face of new technology. Even to the extent that these technologies deliver better measurement of human activity, organisations are often frustrated to discover that the ability to measure and target activity simply generates activities to solely meet the measures, not behavioural change. Quantities are achieved as the cost of both productivity and quality. 

Change the Conversation 

Changing the leadership question can have a dramatic impact on how an organisation makes decisions. Here’s a different question for management to ask about a transformation of technology:

‘What do our people need to better deliver our goals?’

There are a number of advantages that flow from changing the conversation around change and transformation in this way:

  • Engaging your users: Instead of assuming management or a technology vendor has the answers, the question opens up a conversations for people who do the work to contribute and learn. Treat your employees as skilled knowledge workers and respect their creativity and opinions. These people will have the best context on what is causing the issues and what support they need.  Engaging their input will be the most powerful element of change in performance. At the end of the day, the behaviours that need to change are theirs.
  • Change the leadership conversation: Shifting from a control mindset to one that is about realising the potential of the team is a powerful change in an organisational conversation. A transformation can be a key way to help accelerate this change in mindset. If employees feel trusted and are free to share, many people will highlight the way that the leaders themselves may need to change as part of that transformation too.  The best change begins with those seeking to drive change.
  • You may not need new tools or a new process: How many systems have been implemented to solve issues which were simply a lack of clarity of purpose or objectives of work? Do people need new skills or capabilities instead of new systems? Do people need new freedoms, approaches & leadership support to respond in an agile way to market needs? Consider alternatives and additional elements to enable the behaviour changes that arise.
  • Inconsistent demands on people:  Engaging your people in change will highlight areas where you are being inconsistent. In a siloed organisation systems often work at cross purposes. Are you sure that all the other elements of your systems & culture reinforce the right goals? For example, it is common for people in sales and service roles to experience that their time is used up with low value compliance tasks. As a result high value customer tasks will get pushed from the system. Forcing additional compliance will only make that worse. If performance management systems and the real leadership conversations in your organisation work against your new system, it is dead before it is even deployed.
  • Engaging outside the organisation: Do your customers want to give you the data that you need for your new CRM or analytics system? Does the change in sales approach or work process improve their experience as well? Will great talent be rewarded by working in your performance management system? Are you sure you can articulate the value of these changes to external stakeholders? Your people will need to do so. Your people’s reluctance to do your view of ‘the right thing’ might be saving you from broader issues with customers or other stakeholders.
  • Pace of change: Changing systems takes time. When will the system need to change again to adapt to a rapidly changing market? Are your people holding back because they can see the next change coming? Are you better to focus on your ability to change behaviours in more agile ways than through changing technology systems?

Technology transformation can be a powerful enabler of organisational change. However, it is merely an enabler. Changing the leadership conversation is often the critical element to ensuring the success of a transformational change.

Image source: http://pixabay.com/en/ravens-black-birds-conversation-236333/