Friday, November 20, 2009

The Line Between "Beyond" and "Too Far"

Continuing with my focus on this year's IBM CEO study, I would like to continue to focus on the qualities of the enterprise of the future. Nearly every element of this global survey points to the need for change leaders, people on the edge of innovation and change leadership!

The second characteristic of the enterprise of the future, according to the responses of over 1100 successful CEOs, is being "innovative beyond customer imagination." One could argue the level of innovation required in today's global markets goes beyond the innovation required at any time in human history. It is difficult to imagine a consumer in ancient Egypt browsing for gold jewelry pausing to check competitor's offerings on their Blackberry only to find that the emerging Babylonian empire offered jewelry of finer quality for half the price! Yet today communication about a company's offerings can travel at light speed, around the world, instantly communicating the good, the bad, and the ugly. My wife and hundreds of thousands of others still refuse to use plastic wrap in the microwave because of an internet rumor about it causing cancer; a loss to the folks who make Saran Wrap but a boom the makers of wax paper. I'm frankly shocked some enterprising entrepreneur hasn't come out with "microwave safe" plastic wrap to earn back market share! But I digress...The enterprise of the future must be innovative beyond the levels of past performance, beyond what even their customers can imagine.

Where do change leaders fit in this process? The CEO study identifies several implications. The enterprise of the future will be required to constantly experiment to find the balance between economies of scale and customer demands that demand customization. The thought of this kind of experimentation is enough to bring fear and trepidation into the hearts of those trapped in their risk adverse comfort zones. They will require leaders who can effectively manage the balance between constant experimentation and the need for stability. They will need to effectively manage the message of long-term stability through short-term innovation and change. Consider IBM: Once the largest maker of PCs, now the world leader in "smart." Or GE, once the world leader in manufacturing, now making its money through its various financial services. One could argue they manufacture today only to open the door to the financing opportunities it offers to customers. I'm sure this has not been an easy transformation for many within these organizations.

Innovation beyond customer imagination will also require a level of connection between an enterprise and its customers beyond anything we have seen in the past. Through technology and good, old fashioned interpersonal contact, deep relationships must be built between employees and key customers. Good change leaders will develop these relationships, seek to deeply understand what consumers require, and will then push their enterprise (and their customers) beyond what they believe is possible or expect. This requires the vision to see beyond today's expectations to where those expectations are going in the future. In a sense innovation creates new expectations rather than just anticipating where those expectations are going.

Maybe the best example of this I've seen recently is the dramatic announcement that the first "space hotel" may open as soon as 2012. I must confess that it has never crossed my mind that a vacation in space would ever be something I could consider in my lifetime, yet there are many around the world working toward this goal. It is anticipated that the first space hotel will charge 4 million dollars for a 3 day stay, but hey, isn't that what plasma televisions sold for just a few years ago? Okay, maybe not that much but just as out of reach for me... This is certainly an innovation that goes beyond most of our expectations; yet don't be surprised if the much anticipated trip to Disneyworld isn't soon replaced by the family vacation into orbit. I'm sure Disney has this somewhere in their strategic plan!

Back to the title of this blog post. There exists a fine line between "beyond customer expectation" and "too far." Possibly the greatest challenge for change leaders that thrive on risk and change is finding this line and carefully maneuvering their efforts around it. Consider for a moment GM and Segway's joint venture to build a car on Segway technology. While this certainly may go beyond expectations, is it going too far for where consumers are willing to go? Will this introduction in 2012 (what's the deal with 2012 and innovation anyway?) redefine consumer expectations or be a colossal waste of research money (or should I say US taxpayer money since the government owns GM now?). Only time will tell, but you have to admire the change leaders at GM and Segway that would invest in such a move...

Tuesday, October 20, 2009

"We are Successful, but Slow"

The title of this blog entry is a quote from a CEO interviewed for the 2009 IBM CEO study.  This landmark study of CEOs from around the globe found that the first success factor for the enterprise of the future is that they will be hungry for change.  The study found a serious gap between the expectation of significant change (83% of respondents) and having a track record for changing successfully (61%).  So what is causing this growing gap?  It isn't the presence of constant change; that has been a factor since the industrial revolution.  Rather it is the growing pace of change that is creating a gap between expectation and success.

The days of having a narrowly focused priority list is past (I'm sure this doesn't come as a surprise to anyone!).  Leaders now have to focus on a plethora of organizational concerns, from changing customer preferences to people issues to technology that is changing the world at a blinding pace.  In fact, CEOs in the study identified these as the top three external factors that have them most concerned:
1. Market Factors
2. People Skills
3. Technology
On closer examination, all of these factors relate to the ability of people within organizations to embrace and succeed in a changing environment.  In fact, CEOs rated insufficient talent as the top barrier to global integration, higher than government regulation and bureaucracy.  Now you know you have a serious problem if it rates higher than the incompetence and resistance of government bureaucracy!

A final interesting note I will touch on is the difference between underperforming and outperforming organizations.  Both of these classifications expect a high level of change in the future (83% and 85% respectively), and both acknowledge managing change as a key to the successful enterprise of the future.  The major difference lies in their track record of changing successfully in the past-the "change gap."  Underperforming organizations only demonstrated successful change 54% of the time, where overperforming organizations were successful 66% of the time.  This simply boils down to having a track record that gives the organization confidence in the face of constant, accelerating change.

So what does all this mean for a change agent striving to help an organization be successful integrators of change?  First it means that denial must be driven out of an organization.  The sooner an organization and its leaders recognize that change is inevitable and accelerating in pace the better.  What made you and your organization successful in the past may not be what makes it successful in the future!  How common it is to talk with members of an organization that is in its waning moments and hear stories of "the good old days" when business was booming or their services were in demand.  An organization's history is important, but it's future is even more important!

Secondly, change is not something that can be managed in an ad-hoc manner.  The successful enterprise of the future will have robust change management programs and processes that anticipate change and focuses on desired outcomes in an environment of accelerating change.  I believe this is what it means when an organization is "hungry for change."  It isn't just a matter of attitude, but also a matter of preparedness and process.  This can take many forms for the various challenges organizations face, but it will be a robust process.  Possibly it is a bi-annual strategy session where the organization gathers to assess progress and changing conditions.  Possibly it takes the form of a SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) that is updated and acted upon regularly.  Possibly it is the hiring of a board of directors that is optimally placed to anticipate changes and give great advice and guidance.  Or it may mean treating an organization's resources as venture capital to invest in new and innovative solutions.  Whatever form it takes, it will be systematic, comprehensive, and fast!

Is your organization successful, but slow?  Recognize today that the two simply don't go together when it comes to organizational effectiveness.  My problem with that quote isn't really an issue with its content, just it's tense.  Past tense makes more sense: "We were successful, but slow..."

Tuesday, October 6, 2009

Global CEO Survey Puts Change Leadership at the Forefront

I recently attended the annual convention for the Ohio Partnership for Excellence, the organization that assesses the Baldrige criteria for the state of Ohio.  It was a fantastic convention with many Baldrige award winners in attendance from around the country and from the manufacturing, health care, and public sectors.  One of the best presentations was by Harry Hertz, Director of the Baldrige National Quality Program.  During his key note address, he made reference to an IBM study that was just released in 2009 of 1,130 CEOs from around the globe.  This insightful survey produced what the study calls "the enterprise of the future," and the findings put change leadership at the forefront of enterprise strategy.  [A copy of this report can be found on the "Links and Files" page of the web site]  You might say some of the most successful CEOs in North America, Europe, and Asia are change freaks at heart (or at least recognize their need to become so)!

IBM leaders conducted 95% of the interviews face to face, which included almost equal numbers from Japan/Asia, Europe, and North/South America.  The study also sought to distinguish differences between financial performers and underperformers.  They analyzed the data carefully to identify key differences between these top tier performers and their lower performing counterparts.  The executive summary of the report is as follows:

Organizations are bombarded by change, and many are struggling to keep up. Eight out of ten CEO s see significant change ahead, and yet the gap between expected change and the ability to manage it has almost tripled since our last Global CEO Study in 2006.

CEO s view more demanding customers not as a threat, but as an opportunity to differentiate. CEO s are spending more to attract and retain increasingly prosperous, informed and socially aware customers.

Nearly all CEO s are adapting their business models — two-thirds are implementing extensive innovations. More than 40 percent are changing their enterprise models to be more collaborative. “ The rate of change has increased dramatically. Customers are demanding radical change in product innovation.

CEO s are moving aggressively toward global business designs, deeply changing capabilities and partnering more extensively.  CEO s have moved beyond the cliché of globalization, and organizations of all sizes are reconfiguring to take advantage of global integration opportunities.

Financial outperformers are making bolder plays. These companies anticipate more change, and manage it better. They are also more global in their business designs, partner more extensively and choose more disruptive forms of business model innovation.

Based on these observations, the study goes on to introduce the "Enterprise of the Future."  This successful enterprise is:
1. Hungry for Change
2. Innovative Beyond Customer Imagination
3. Globally Integrated
4. Disruptive by Nature
5. Genuine, Not Just Generous

It's not hard to identify the importance of effective change leadership in each of these elements.  Effective change management and innovation forms the core of the successful enterprise of the future!  In upcoming changefreak blog posts I will deal with each of these characteristics, and elaborate on the role of the change agent in each.

Wednesday, September 16, 2009

What is the Key to Sustainment?

If you've been a change agent/freak very long, you know the feeling.  It is that sick, sinking feeling in your gut when you just know you're wasting your time.  You've done the analysis.  You've trained the team.  You've even implemented their ideas and have seen dramatic improvements.  And you know it won't last.  You see the signs already.  The team speaks of "somebody" and "them" and "you" instead of "we" and "us" when talking about the changes.  You miss a day or even an hour of time with the team to return and see bad habits resurfacing.  You end the day or week wondering if your sweat and blood and tears were all shed in vain...

Okay, that may all be a little melodramatic, but you get the idea.  As much as most people hate change, there are still many, many people out there that love directing change...That love implementing change...That love driving change.  But there are few who are crazy enough to love LEADING change.  And leadership is what it takes to make it stick.  If you've been in the change business long enough, you've become acquainted with the frustration of seeing changes fail in the long run, in seeing improvements become backsliding into bad habits.  And you may have even grown tired of fixing the same problems over and over.  Is there any hope?

John P. Kotter comes to the following conclusion in a 2005 Harvard Business Review article on leading change:  "In the final analysis, change sticks when it becomes 'the way we do things around here,' when it seeps into the bloodstream of the corporate body.  Until new behaviors are rooted in social norms and shared values, they are subject to degradation as soon as the pressure for change is removed."  There has been a great deal of talk in recent years about changing "culture" in organizations, and that's really at the heart of Kotter's comments.  There are a few key elements to Kotter's observation that are worth elaborating on.

A good place to start in any organization is to ask the question "Just how do we get things done around here?"  That should actually be a difficult question to answer if an organization is serious about improvement.  Kotter says that change sticks when it becomes the way things are done.  Doesn't that statement seem self-contradictory?  Isn't one of the biggest barriers to change in any organization the stubborn insistence on "the way we do things around here?"  Clearly he cannot be talking about isolated changes that take place, but a culture that is accepting of change as necessary to improvement.  It is alluding to a corporate culture that is constantly proceeding through stages of improvement, followed by assessment and feedback that produces focused action and more improvement.

Kotter also talks of rooting behaviors in social norms and shared values.  Don't you have to change a person's values before you can change their behaviors?  If a person doesn't value hard work, how will they ever do it?  Don't get caught in that trap.  Often it is our behaviors that ultimately drive our values.  When I was a kid I didn't really value cleanliness or personal grooming.  There are pictures of me when I was ten where I looked like I hadn't combed my hair or washed my clothes in weeks!  Then when I was 19 I met a drill instructor at officer training school for the US Air Force that introduced me to the consequences of not following clear behavioral guidelines for personal grooming.  I still didn't value it very much, but you better believe my behaviors changed in a hurry.  My hair didn't touch my ears, my "gig line" was straight, and I actually learned how to use an iron.  Twenty two years I value personal grooming very much, although my focus has changed from hair touching my ears to hair growing out of my ears!

Finally, Kotter warns that until behaviors become part of the norm degradation in improvement will happen as soon as pressure for change is removed.  This is another lesson I learned in the military.  Years after my introduction to a demanding drill sergeant I was tasked with training young officers myself.  One thing I learned quickly was that there was no pressure I could put on another person that was as great as the pressure they would put on themselves if they were committed to excellence.  Once I had to remove a light bulb and white glove the inside of the socket to find a non-conformance on a room inspection.  The officer candidates were crushed, because they were certain their room was perfect.  They couldn't believe they forgot to wipe down the inside of a light bulb socket!  Now that is attention to detail!  As a leader, if you can create a culture that expects excellence in everything, you won't have to "drive" change.  Change will drive itself.

Which leads us to the question we started with in the title of this blog entry: What is the Key to Sustainment?  The answer to this may ultimately come back to what it is you're trying to sustain.  I would contend that specific changes can never be "sustained."  Either you continue to improve or you decline.  Either changes are improved upon or they are lost.  So the ultimate goal here is not to implement a change and then ensure it endures for the long haul.  The goal is to create a culture that demands excellence, that is always analyzing the way they "do things around here," seeking critical feedback, and taking action based on that feedback to improve.  Success (and sustainment of an improvement culture) is a never ending journey, but so is failure.  The difference all depends on the direction you are traveling on your journey...

Monday, September 7, 2009

Change We Can Really Believe In

I just thought I would take a moment to share with my fellow change freaks a couple photos of my birthday present from my two youngest children. I must admit it has caused a few "double takes" from folks who took a moment to read the cap.

Monday, August 24, 2009

Henry Ford a Change Freak?

I love old books. Just the smell, the texture, the excitement that comes from holding a book in your hands that is generations old can be amazing. I love reading primary history, history written by those who have lived what they are writing. History in many ways is corrupted when seen and summarized through the eyes of those who didn't live the events they write about. What becomes quickly apparent when reading old books is the reality that there is very little that is "new under the sun." Wisdom that creates best sellers today are often based on wisdom that is decades, if not centuries, old. A great example of this can be found in Henry Ford's "Today and Tomorrow," published in 1926.

Last week I shared the following quote from Ford's book with a Definity University Lean Certification class:

"Our own attitude is that we are charged with discoverinng the best way of doing everything, and that we must regard every process purely experimental. If we reach a stage...which seems remarkable as compared with what has gone before, then that is just a stage...and nothing more. It is not and cannot be anything more than that. We know from the changes that have already been brought about that far greater changes are to come, and that therefore we are not performinng a single operation as well as it ought to be performed."

It certainly appears that Henry Ford may have been a charter member of the Change Freaks! His approach to continuous improvement was certainly ahead of its time, an approach to continuous improvement that is still transforming organizations today. Here are a few thoughts on the wisdom we can find in the short excerpt above:
1. "Our own attitude..." Transformational change begins with attitude. It is not a program, an initiative, or a corporate goal. Real change leadership seeks to bring about an organizational culture that embraces change as the only way to move forward and thrive.
2. "...discoverinng the best way of doing everything" Every organization is on a journey of discovery. Be suspicious of any leader or organization that has a "program" to fix all the issues of an organization. As a change agent, don't slip into believing that all of today's problems can be solved with the same tools and methods you used in the past. This is expecially prevalent today with "programs" like lean, Six Sigma, ISO, etc. All of these are valuable, but they aren't silver bullets. Take the time to discover the new ways. Build on what you've learned, but don't limit yourself by making everything fit into your paradigms and previous experience.

3. "...every purely experimental" Observe the current condition. Make plans to improve. Execute on those plans with the required challenges. Measure and study the impact. Adjust your approach where needed based on what you have learned. And then start the process all over again. Nothing but the laws of God and nature are fixed. Everything else is an experiment!
4. "...far greater changes are to come" Changes that are successful simply point the way to greater changes that are to come. Don't get comfortable or the world (and your competition) will pass you by. Henry Ford was also famous for saying "You can have a car in any color you want, as long as it is black." Unfortunately, in some ways, he failed to act on his own wisdom!
5. "...we are not performinng a single operation as well as it ought to be performed." As shared in a previous post, real change begins with a hatred for the current state. Hatred. Not dissatisfaction-many people live their entire lives dissatisfied with the way things are but do nothing to change. Hate the inefficiencies you see in your organizations. Hate the shortcomings you see in your own life. Resolve to stay on the journey of continuous improvement. Nothing is as good as it can be this side of heaven, so resolve to do all you can to make it better.
Ford Motor Company is the only major US car manufacturer that hasn't been in line for government bail outs and subsidies. They are the only US automobile manufacturer not contemplating bankruptcy. I won't venture to claim to know all the reasons why, but I have to believe at least one factor is that they have a legacy of finding a better way to do business, of never being satisfied with how things are today. What legacy will you and your organization leave? What you do TODAY will impact TOMORROW in ways you cannot possibly imagine!

Tuesday, August 11, 2009

Change Agent Sees Change "Addiction"

After 20 years of experience leading change management programs in the U.S., Europe and New Zealand, BP executive Fiona MacLeod has concluded that the corporate world is "addicted" to serial change management programs that consume massive resources but ultimately fail to solve the problems they aim to address. "What really struck me is why so many of these change management programs fail, only to be followed by similar initiatives within one or two years, often before the original program is completed," said MacLeod, president of BP Convenience Retail USA & Latin America.

Thus begins a great dose of wisdom from change freak Fiona MacLeod, recently presented at the 2009 Wharton School of Business Leadership Conference. You can find the complete text of this great article on the links page. Not that I can add much to her comments, but I will take the opportunity in this blog to add a few words in response to some of her main points.

Can change be an addiction? While I am a firm believer that great good can come from change, and likewise great harm from a refusal to embrace change, I also agree that change for change sake can be dangerous. If all we are doing is rearranging the deck chairs on the Titanic, attempts at organizational change can be doomed from the start! So how can we avoid these change leadership failures?

Many change management programs are doomed to failure because "the change we are putting in place is not sustainable -- and sustainability is absolutely crucial," noted MacLeod. So what are some of the reasons for a lack of sustainability? MacLeod cites three examples:
1. New leaders are more focused on making a "big splash" than following a long term plan for change. In some corporate cultures leaders are expected to make an immediate impact with a flurry of activity, and often nothing covers incompetency as well as frantic and dramatic activity!
2. Employees don't understand why change is needed. This goes to the heart of showing respect to people, an absolutely necessary element to the transformation of an organizational culture. If employees are on a "need to know" basis concerning organizational performance, don't be surprised if they don't recognize the need for change.
3. Ownership of the change rests with an external team or consultants, and not with the leaders responsible for running the business. Every leader should have a mirror by their door with the words "The key to sustaining change" inscribed upon it. People tend to own what they create, not what was imposed upon them. If the leaders don't look in the mirror and see ownership of the change, the grass roots of the organization will never embrace it. "Never assume that leaders get it.... We need to take probably 10 times as long in engaging, empowering and educating our leaders than we actually think we do," MacLeod said.

MacLeod recommends putting "written charters and contracts in place...You need to constantly look at them and discuss them with people." People tend to perform to the level expected of them. The problem is, most leaders never clearly articulate the expectations they have of their team! Time taken to clearly document and articulate expectations is time well spent. Don't ever assume that people understand your expectations, unless you're prepared to be frustrated and disappointed. Oh, and they should clearly understand what they can expect from you as a leader!

One more point to highlight: "I put my winning, end-state organization in place from day one rather than waiting to decide which employees would stay to support the franchises and which would leave." I haven't seen this point covered very often by successful leaders, but it is very wise advice. Taking a long-term perspective on leading transformational change doesn't mean waiting to put a winning organization in place to lead the change. In fact, a failure to do so can be fatal to sustaining improvement throughout the organization. It is true that simply reorganizing or hiring a "superstar" is no guarantee for positive change, but it is equally true that leaving a poor performing organization in place will guarantee a lack of progress and sustainment. Deal with the hard decisions early rather than later. Nothing frustrates the champions of change in an organization worse than seeing leaders ignore or refuse to deal with those who undermine change.

What are your thoughts? Can change become a corporate "addiction?"

Monday, August 3, 2009

See the Need, Be the Change!

This week's inspiration doesn't come from a biography or a great leadership book. It comes from a t-shirt I recently saw at the Easton Mall in Columbus, OH. I was sitting in a book store coffee shop waiting on my wife to finish shopping (where I've spent about two of my twenty years of marriage! Two more I've spent waiting for her outside a ladies bathroom!). Anyway, sitting at a table close by was a woman wearing a black t-shirt with bold block lettering that spelled "Change Agent." Of course, this got my attention. Trying not to stare, I finally made out the small print beneath this title" "See the Need, Be the Change!" I loved it!

This t-shirt reminded me of one of my favorite quotes. Arun Gandhi has quoted his grandfather, change freak Mahatma Gandhi, as stating "We must become the change we want to see." How do we do this? We see the need, and be the change! So often we are tempted to wait for others to act. We complain about the world in which we find ourselves, and wish "somebody" would do something, but we feel powerless to make a difference. So we close our eyes to the need. We refuse to be the change.

The message this week is simple: Resolve this week to look carefully around you for opportunities for change that can make a difference. Then resolve, in at least one instance, to be the change that is needed. Don't underestimate the change this will require. It may require you to perform an act of service that sacrifices your dignity, that requires humility that is uncomfortable. Or it may require the courage to speak up for others who cannot. It may require you share an idea at the risk that it may be laughed at or rejected. Most of all, it will require action. Not talk. Not criticism or complaining. Action. Do something. Take a risk, and make a difference. Then take a moment to share with us what you resolved by leaving a comment to this post. Who knows, you may become the change you've wanted to see for so very long!

Wednesday, July 29, 2009

A New Kind of Normal

Greg Gadson didn't choose to be a change freak, but God had other plans for him. A 41 year old West Point Grad, a former linebacker on the Army football team, a commissioned officer and 20 year veteran of the US Army, Greg had a lifetime of successes. He was a decorated battalion commander serving in Iraq when his "trapdoor transition" took place in the flash of a second.

In the "About the Freak" section of the web site, I talk a little bit about "trapdoor transitions." I first heard the term from author and hero of mine Steve Farrar in his book "Tempered Steel." A trapdoor transition is a life changing event that isn't planned or anticipated, but fundamentally changes the direction of one's life. As you look through history at great men and women who changed the world, often you will find a trapdoor transition that led to that transformation. For Abraham Lincoln it was his first experience as a young man seeing an African slave sold at auction. For Ronald Reagan it was an assassin's bullet that narrowly missed his heart. For John Walsh it was the kidnapping and murder of his son. For Greg Gadson it was a road side bomb in Iraq.

A recent article in Homelife magazine tells the story of Gadson's trapdoor transition. He remembers being on patrol in his Humvee when a bright flash threw him from the vehicle. Landing with a thud far from the destroyed vehicle, his first thought was "Where's my rifle?" Moments later, as he began to fade from consciousness, he remembers thinking "God, I don't want to die in this country." When he awakened days later at Walter Reed Army Medical Center, he learned that his life had been saved several times, first by a fellow soldier on the field in Iraq and later by a string of surgeons fighting to save his life. While his life had been saved, his legs had not-both were shredded beyond saving and had to be amputated.

Greg recalls fighting a battle with depression that was harder than anything he had faced on the battlefield. But the experience taught him some valuable lessons about life. "I had to adjust to a new kind of normal. You've gotta fight to do your best no matter what unexpected challenges you face. Your life can change in a Baghdad minute, as mine did. Tomorrow isn't promised, so you must act to do your best with today, no matter what God has in store for you."

This is great advice for anyone facing change in their personal or organizational life. This message, given as part of a pre-game locker room talk, inspired the New York Giants to defeat the heavily favored New England Patriots in this year's Super Bowl. While Gadson now sports a Super Bowl ring for his contribution to the team, his greatest adornment is his character-formed and strengthened by an unexpected fall through a "trapdoor transition" he would have never chosen for himself.

Tuesday, July 21, 2009

What Gets Measured Gets Changed

Virginia felt powerless. She was one of the first women to ever be admitted to the surgical residency at Columbia University in 1933. Always a trail blazer, she didn't quit when told by the chairman at the end of her residency that, as a female, she had little chance of attracting patients and having a successful career. He persuaded her instead to join the college hospital staff as an anesthesiologist. She dedicated herself to the job and became only the second woman in the United States to become board certified in anesthesiology. She was often quoted as saying "Do what is right and do it now!" In spite of all this success, she felt helpless to change a situation that almost daily broke her heart.

As an anaesthesiologist, she was bedside for hundreds of births and was appalled by the the care that many newborns received. In the 1930s, delivering a child was the single most dangerous event in a woman's life: one in 150 pregnancies ended in the death of the mother. As shocking as these statistics are today, the odds were even worse for newborns: one in thirty died at childbirth, scarcely better than a century before. Virginia saw babies born blue and left unattended to die. Babies who were malformed, small, or not breathing were listed as stillborn and simply allowed to die with no attempts to revive them. She knew in her heart that many of them could be helped, but as an attending anesthesiologist she had no authority to help them or change medical practice. She wasn't an obstetrician, and she was a female in a male dominated world.

Then she had an idea, an incredibly simple idea that changed the course of medical history. She developed a measure for nurses to rate the condition of babies at birth on a scale of zero to ten. An infant got two points if it was pink all over, two for crying, two for taking good, vigorous breaths, two for moving all four limbs, and two it its heart rate was over a hundred. Published in 1953 the score turned an ambiguous and intangible concept (the condition of an infant at child birth) into data that could be collected and analyzed. Nurses and doctors had to pay more attention to the condition of an infant to rate its score, and during this time many babies improved quickly with simple care. The measurement started being applied virtually world-wide one minute after birth and again five minutes after birth. If for no other reason than the competitive nature of attending physicians, scores began to improve and thousands of lives saved. Neo-natal units and hundreds of other transformational changes to infant care such as ultrasounds, fetal heart monitors, and spinal and epidural anaesthesia were developed over the years to improve scores.

And the results? Today a full term baby dies in just one childbirth out of five hundred, and a mother dies in less than one in ten thousand. To put this into perspective, relative to the statistics of the 1930s over 27,000 mothers and 160,000 infants lives have been saved. And it all started with a frustrated and heart broken doctor who decided to measure what had never been measured before. Virginia Apgar changed the course of medical history and saved thousands of lives with her simple but ingenious measurement, which became know world-wide as the "Apgar Score."

One cannot improve what one cannot (or chooses not) to measure. Often organizations put measures in place to gauge the effect of their improvement efforts. But many overlook the power of the measurement itself. Simply giving timely and accurate feedback to those who can affect change can transform organizations. Perhaps the health care crisis in which we find ourselves today could have been averted if similar measurements had been put in place for all surgical procedures and hospital administrators. Who knows, what we choose to measure today may change the world tomorrow...

Tuesday, July 14, 2009

Change Leaders Embrace Humility

I once heard it said that there is no package as small as a person all wrapped up in themselves. This caution against pride is a bit humorous, but so very true. Not only can pride destroy relationships, corrupt organizations, and prevent personal growth, it can also be a major barrier to transformational change.

First, it is a barrier to change in the life of the one attempting to be a change leader. A change agent full of pride will never be a change leader. Nobody will accept feedback, encouragement, and coaching from a leader full of pride. This is an easy pattern for a leader to slip into, though. A good leader is supposed to have the answers, right? A good leader has experience and education that can enlighten their team, and when the pressure is on to make change quickly a leader must lead by the force of their confidence and pride. The problem of this approach is lack of sustainability. At best the organization won't "own" the change, they will simply comply. At worst the organization will fall apart due to infighting or resignations. The result is the same: half-hearted support of change that will backslide at the first opportunity.

Secondly, pride is a barrier to change in the life of the one who needs to embrace change. "How dare that leader come into this organization and pretend after a few short months that they know how to do my job better than I do!" This is unfortunately an all too common form of resistance to change. While the attitude can be justified any number of ways, in the end its root is pride. Sometimes a resistance to change is little more than offense taken to personal pride. Change is seen as a threat to a person's influence and power base because it levels the playing field between experienced icons and inexperienced newcomers. Just ask the former leaders of General Motors who wrote off the threat of the newcomers at Toyota. GM finance executive Nancy Rottering, who quit in frustration in 1987, said the attitude at headquarters was, “We’re GM. We know everything, we don’t need to change.”

This discussion reminds me of a great little story about a navy captain and lighthouse operator, well dramatized by the clip below (you can download this clip at

Tuesday, July 7, 2009

Affecting Positive Chage

Somewhere between Michael Jackson stories this weekend the news media reported on the resignation of Sarah Palin as the Alaska governor. In the clip below Palin talks repeatedly about "affecting positive change," a statement that has resulted in many debates over the airwaves about how an agent of change should go about influencing positive change. While my intent is typically to avoid the morass of politics on this blog, this is just to interesting to ignore. Palin supporter or not, her press conference and follow up interviews have definitely put being a change freak at the top of the news once again.

Watch a clip of the Palin News Conference

Palin begins her comments here repeatedly discussing "affecting positive change" and asserts that she will be able to do this better outside of government. In a later interview with CNN she said she doesn't "need a title to affect change." What do you think? Is a title or position needed to affect change? Certainly one can be a change agent without a title or leadership position. I'm reminded of a tough day I experienced years ago with attending officer training for the US Air Force. I thought I was doing well surviving the vigors of the training when I was called into a one on one meeting with my commanding officer. He bluntly asked what my problem was and stated that I wasn't showing the kind of leadership he expected from me. A bit surprised I responded by telling him that I was waiting until I had the opportunity to be in a formal leadership role at the training to show my leadership ability. Wrong answer. He gave me some advice I will never forget. He said a leader leads regardless of his position or title. A true leader (and change agent?) seeks opportunities to lead where they are, today. I took his admonition to heart and began to look for opportunities to fill a gap or volunteer when others hesitated to step forward.

I've since seen this same principle play out in my business experience as well. Many organizations are tyrannized by the "thems" and the "somebodies." Processes fail and because of the crazy decisions "they" have made, and the organization waits endlessly for "somebody" to do something! It's impossible to quantify the damage that "they" have done to business and the failure of the "somebodies" to do something about it!

Okay, seriously, isn't senior leadership support the key to real, transformational change? Well, certainly affecting change can be much more difficult if you don't have the support of your leadership. And transformational change can be helped along immensely through the active and public support of the organization's senior leadership. Not having senior leadership support can make being a change freak a bit dangerous as well. Business consultant and change freak Tom Peters has been quoted as saying "If you haven't been fired by age 30, you're not pushing your boundaries." I would suspect the firings he refers to has more to do with pushing the boundaries of your leaders than just yourself!

All this aside, you don't have to be a leader with the title and formal authority to affect positive change in your organization. You must have a personal commodity that is far rarer than titles and positions: you have to be willing. Willing to step forward when it would be more comfortable to hide in the crowd. Willing to take a risk by pushing the boundaries. Willing to take the unconventional path when others are cautioning you to slow down or conform. Willing to look in the mirror when others are searching for "them" and "somebody." Willing to be a change freak!

I suppose time will tell if Sarah Palin made a good decision in resigning the governorship of Alaska to "affect positive change." I suspect the most positive change she hopes to affect is to get her family off the firing line of the national media. But while a good point guard may pass the ball when she attracts a crowd, she certainly doesn't leave the game at halftime. Time will tell if this decision was unconventional brilliance or the swan song of a "Maverick." I'm not waiting to see. There's too much positive change to affect right where I am today...

Saturday, July 4, 2009

Tribute to a Founding Father & Change Agent

I thought the Independence Day holiday would be a good time to give tribute to a great change agent in American History: Samuel Adams. US history buffs know Sam Adams. Many of you may have always wondered who the beer was named after. Either way, you will benefit from learning more about this great man who changed history.

Samuel Adams was born in Boston, and lived nearly his entire life in this great city. He struggled to thrive as a businessman and tax collector in the Massachusetts colony, but his experiences brought him face to face with the tyranny of the British crown. A man ahead of his times, he saw storm clouds forming on the horizon of American history, and founded the movement that ultimately resulted in the American revolution. A man who consistently placed liberty for his people ahead of his own freedom and comfort, Sam Adams bore all the marks of a true change agent. Some in his day may have even called him a change freak!

Adams knew well the power of symbolism and inspirational images in encouraging others to change. He adamantly opposed the stamp act of 1765, a tax that sought, for the first time, to tax the internal affairs of the American colonies. The resistance he led was seen as rebellious resistance by loyalists, and an English writer went so far as to mock Adams and his followers as "sons of liberty." Rather than take offense at this characterization, they wore the title proudly and Sons of Liberty organizations followed Boston's lead and sprung up throughout the colonies. They created a slogan that inspired the colonies to resist the stamp act and other non-importation laws: "No taxation without representation!" Led by Sam Adams, the Boston group selected a tree at the center of Boston and named it the Liberty Tree. At this locations crowds gathered and inspirational speeches were given to encourage resistance to the Stamp Act (and a mob or two also started their destruction of the Governor's palace from this location). When the Stamp Act was finally repealed in 1766, thousands gathered at the Liberty Tree to celebrate.

It was at this time of peace and relative quiet that Adams recognized the danger that still loomed for the colonies. Yet as a change agent it was a frustrating time for him, as he saw the movement lose momentum and members in the years that followed. He struggled to bolster patriotic spirits, and his efforts met with a general apathy from neighboring towns. Yet it was during this time that Adams, as a change freak that was not to be deterred, found some of his greatest inspiration. When fellow Sons of Liberty member James Warren returned from canvasing towns throughout Massachusetts, he told Adams "They are dead, and the dead can't be raised without a miracle." To this Samuel Adams responded "Nil desperandum. Never despair. That is a motto for you and me. All are not dead; and where there is a spark of patriotic fire, we will rekindle it." It was just a few short years later that Adam's tireless efforts were rewarded. His circular letters to the other colonies proved to be the foundation of unity when British tyranny proved to be alive and well. He inspired a new nation to seek its Independence and helped change the world!

Change leaders, there will be times when you are frustrated and discouraged. Nil desperandum. Never despair. The change agents that ultimately change the course of history are often men and women who simply refuse to give up. Your tireless efforts today may change the future, even if you are struggling to see the results today.

Tuesday, June 30, 2009

The Change-Freak Checklist

I came across a very interesting article this week in the online Businessweek by William C. Taylor. The title of the article is "Change-Agent Checklist" (which would have been more catchy if it was entitled "Change-Freak Checklist!"). You can link to the full article here or find a pdf on the links and files section of

Early in the article Bill makes a profound statement for our times: "Indeed, when it comes to creating the future, the only thing more worrisome than the prospect of too much change may be too little change—especially in an economy where there are too many competitors chasing too few customers with products and services that look too much alike." He follows this with ten key question leaders need to ask themselves and their organizations. I would like to comment on a few that I found the most interesting here:

2. Do you have new ideas about where to look for new ideas? Good question. You don't have to have all the ideas, but you need to know where to look and who to ask. Are you expanding your reading and research, or are you stuck in your familiar (and comfortable) trade journals for your industries? Some of the best ideas come from learning about how other organizations in other markets and sectors have addressed their challenges. Inspired by other industries that had found ways to reclaim their scrap, Mike Yurosek found a way to reclaim 400 tons a day of damaged carrots and literally saved his business. You may have even eaten one of these "baby carrots."

5. Have you figured out how your organization's history can help to shape its future? Successful organizations leverage the experience of what they already know to go beyond what they have ever thought possible. The organizations that can leverage the experience of their organization and infuse it with the new ideas that come from fresh eyes and new approaches will be the ones that thrive.

8. Are you getting the best contributions from the most people? Are you seeking out the "hidden genius" inside your organization, or are you trapped in the outdated belief that some people are paid to work and others to think? Your best inspiration can come from the most unexpected places, often within your own organization. You just have to be humble enough to admit you don't have all the answers and enough respect for people to ask good questions and actively listen.

10. Are you learning as fast as the world is changing? I love this question. We live in a world that is changing at a record pace. The availability of information is unprecedented in our day, and learning individuals and organizations will be the victors in the future. Are you a "lifelong learner" or one who is content with what you have already learned? When you consider (cited in an earlier post) the fact that 42% of college graduates never read another book after graduation, I would presume that we have a lot of people that are falling desperately behind.

Resolve to not be one of them.

Tuesday, June 23, 2009

Overcoming Fear of Discomfort

Ever been in "the zone?" I'm told that for athletes it is an almost transcendental state in which athletic performance exceeds any prior experience. My 13 year old son was in the zone a couple of weeks ago at the University of Tennessee basketball camp, where he sank 21 of 24 jump shots in a drill and even gained the notice and appreciation of Tennessee coach Bruce Pearl. (Dad's hoping for a scholarship!)

The "zone" most of us are more familiar with is the "comfort zone." This is the state in which we are most comfortable, most at peace and free of fear of the unknown. This doesn't have to be a state of bliss. Even misery can have a sense of comfort if it is all a person has known. In fact, I've known many people over the years that wouldn't know what to do with themselves if they didn't have problems to complain about!

Unfortunately our comfort zones are a major barrier to transformational change. Just what is it that makes living inside our comfort zones so destructive to positive change? Well, the larger our comfort zones, the less personal and organizational learning takes place. You can picture it this way:

To the left we see a large comfort zone, a small learning zone, and a very large fear zone. This model is of a person that is very comfortable in their current circumstances, and any chance to those circumstances drives them almost immediately into fear of the unknown. They quickly retreat back into the shell of protection that comfort offers.

By contrast the model to the right is of a person that embraces change, and as a result never allows a comfort zone to calcify and harden. Their comfort zone is more of a yoke than a shell, and they have enough confidence in themselves and the future to have a small fear zone. They are grounded enough to know that even the trials and difficulties of life offer life lessons (they in fact offer the most profound life lessons). They live their lives in the zone between comfort and fear, what we will call the "learning zone."

So how do we overcome our fear of discomfort and expand the zone between comfort and fear-the learning zone? I don't have all the answers here, and believe the approach may vary by individual, but I am certain that this doesn't happen without focused effort. Here are a few suggestions:

- Try something new and different. Sometimes I struggle even trying a new restaurant when I know and like the familiar!
- Turn off the TV and pick up a good book. In light of the statistics this will make you a unique individual and greatly expand your learning zone. A few unbelievable statistics:
1/3 of high school graduates never read another book for the rest of their lives.
42 percent of college graduates never read another book after college.
80 percent of U.S. families did not buy or read a book last year.
70 percent of U.S. adults have not been in a bookstore in the last five years. (View Source)

- Organize and de-clutter your life. Much of our fear and desire for comfort comes from living a life surrounded by clutter and chaos. In some ways less really is more!
- Take time occasionally to write or journal. Many times I sit to write about all the things that are wrong in the world and find myself just being thankful for the good in my life (or realizing that much of the "bad" is self-induced!).
- Take some calculated risks and resolve to live a life that is "not safe but good."

If you were to ask those who know you best to write your epitaph, what would it say? Truly the greatest failure would to have an epitaph that reads "No hits, no runs, no errors..."

Monday, June 22, 2009

Overcoming a Sense of Loss

This past week my family and I packed up all our earthly belongings and moved to a new city and state. I will now be supporting the Columbus, Ohio office of Definity Partners so a move to central Ohio was necessary. While a family move can be an exciting and adventurous time, it can also be a very difficult change. This has brought "home" to me one of the greatest causes of resistance to change: Feelings of Loss.

When going through major changes often one of the strongest emotions is a feeling of loss. Loss for what used to be. Loss of great memories and people you loved. Feelings of loss for the "good days" and feelings of regret. Strong feelings of just wishing things could return to the way they once were and sometimes even resentment for those who drove the change in the first place. All of these emotions can be destructive to any transformational change.

The Change Cycle Model identifies Loss as the first stage of the change process. It is accompanied by feelings of fear, thoughts that are cautious, and behavior that is paralyzed. At this point it doesn't even matter if the changes are perceived as "good" or "bad," there is just a sense of loss for what "was." These are feelings that typically can't be avoided, they are inevitable. So, how do we overcome these feelings and ensure we move on in the change cycle as quickly as possible?

Some of the greatest wisdom on this topic can be found in the Bible, in Philippians chapter 3. Paul had lost nearly everything that he had acquired in this world. He lost his status as a religious and political leader, he lost his dignity, his freedom, and ultimately even his life for what he believed. Yet late in his life, at a time that he was imprisoned for his faith, he wrote "But one thing I do: Forgetting what is behind and straining toward what is ahead, I press on toward the goal to win the prize for which God has called me..." His focus wasn't on what he had lost (things he earlier referred to as "rubbish") but rather on what was to be gained. He was focused on the things that lay ahead and not behind. He had a worthy goal to press on toward, a goal that surpassed all that he had left behind.

We can learn much from this example. If you or your organization are suffering a sense of loss that is preventing the embracing of change, you may lack the purpose that can overcome this sense of loss. Your challenge is to frame up the future in terms of audacious goals and purposes that energize your efforts and give you a reason to embrace change. Often this is all in our perspective on what we are doing TODAY. Compare the perspectives below and how they might affect how one embraces change:

You're either assembling a car or you're providing transportation to the world.
You're either making a circuit board or you're providing technology that helps others.
You're either maintaining medical records or you're guarding the safety and health of your patients.
You're either laying bricks or you're providing a home for a precious family.
You're either forced to make a move or you're being placed in a new community to help others.

I believe a common thread in providing purpose for any change is the opportunity to serve and add value to others. Any other purpose will fail to motivate and last over the long term (yes, Eli, even "making money" may not be a goal worthy of overcoming loss and embracing organizational change). Just reflect on what our sense of loss is for when we face change in our lives or organizations. "I long for the days of EBITDA of 40 percent" is not a typical sense of loss. We long for the relationships that we have left behind. We long for the organizational effectiveness that came with having a great team that "gelled." We long for days when we were at peace with others and enjoyed productive days. Making money is a vehicle that makes adding value to others possible, but it cannot be the ultimate goal in and of itself if you hope to see transformational change.

If you and your organization are struggling with a sense of loss that is keeping you from embracing change, find a way to focus your future on serving and adding value to others. Even if you find it difficult to love what you do, love who you do it for!

Tuesday, June 16, 2009

Overcoming Fear of Failure

So why do people resist change? One could spend a lifetime trying to answer that question! In the next several blog entries I plan to tackle some of the most common reasons a person resists change. My musings will be based on what I've seen in others and what I have faced myself.

The first (and I believe the most prevalent) reason people resist change is fear of failure. We live in a culture that values success often above all else, especially professional success. Just reflect, what is the most common question someone asks when first meeting you? "What do you do?" Imagine answering that question with "I used to be an executive with a large firm, but I screwed up too many important things and wound up getting fired." Would that cut a conversation short? Would it quickly end the inquiry into professional success? I can remember being asked that question so many times during a period where I was unemployed, and remember just how self-conscious I felt in trying to answer it in a way that retained my dignity. Nobody wants to be a failure.

Yet there are a few things about failure that are important to remember. First, failure is an event, not a person. A person is not a failure. A person does things that don't succeed, and hopefully they learn from those things and become a wiser person for them. I know it is well known, but I continue to be inspired by Abraham Lincoln's story of repeated failures and persistence. Here are a few key ups and downs in the life of Abe Lincoln:

1831 – Failed in business
1832 – Defeated for legislature
1833 – Again failed in business
1834 – Elected to legislature
1835 – Sweetheart died
1836 – Had a nervous breakdown
1838 – Defeated for speaker
1840 – Defeated for elector
1843 – Defeated for Congress
1846 – Elected for Congress
1848 – Defeated for Congress
1855 – Defeated for Senate
1856 – Defeated for Vice-President
1858 – Defeated for Senate

So what kept Abraham Lincoln from giving up? First of all it was strong moral character. He believed in a Sovereign that controlled the circumstances of his life. He believed he could make a difference. This enabled him to fail forward, to get back up and try again, to take risks in business and politics knowing that the worst failure of all would be to stop trying!
Abraham Lincoln went on to be the greatest President in US history, saving the Union from the worst crisis in our 230 year history. Something you may not know is that Lincoln embraced change in spite of a fear of failure that nipped at his heels until the day he died. Below is a picture of the actual contents of Abraham Lincoln's pockets the night he was assassinated.
Among these articles was a newspaper clipping. It was worn and tattered, and had obviously been read, folded, unfolded, and read again numerous times. What was in this article that was so important to Lincoln that it didn't leave his possession until the night he died? Here is a scan of that very article from the national archives. It is an endorsement of Lincoln by British reformer John Bright. You may want to take the time to read it in its entirety, but let me highlight one section that is especially relevant to our discussion here. In the article Bright states "To some of his countrymen there may appear to have been errors in his course. It would be strange indeed if, in the midst of difficulties so stupendous and so unexpected, any administration or any ruler should wholly avoid mistakes...we see in it an honest endeavor faithfully to do the work of his great office." How encouraging this must have been to a man who was under relentless attack from all quarters! It is no small wonder why such a ray of encouragement would have found a place in his breast pocket, where it lay until he took his last breath.
Being an agent and leader of change doesn't take a super hero. The path will be wrought with fear and anxiety. We will fail sometimes. We will doubt and sometimes wonder if the easy path of resistance to change wouldn't have spared us some pain and failure. But lives like Lincoln's should encourage us to press on, to not give up, to embrace change and find encouragement where we can. May his story be an encouragement to you, and I hope it will be an illustration that will encourage those who are resisting change out of a fear of failure.

Monday, June 15, 2009

Help! I'm Stuck on the Escalator!

One of the most amazing places to observe and analyze human behavior is at the airport. This morning I traveled to a local airport to catch a flight to a client's site. I parked out in the remote lot where you can park for the incredibly low rate of just 12 dollars a day. I got out of my car, retrieved my bag, and walked by a shelter where several people were meekly waiting for the once in a blue moon shuttle to the main terminal. They stared at me as I walked by with a look that cried out "just where do you think you are going?" Unwilling to waste away 20 minutes of my life waiting on a shuttle, I was audacious enough (forgive me!) to walk the entire half mile to the terminal. For all I know they're still waiting for the shuttle to arrive and rescue them!

When I entered the terminal I witnessed a sight that strikes fear into the heart of every hard core traveler: A broken "up" escalator! To the right of the escalator the empty carpeted stairs yawned like a mouth mockingly laughing at my look of horror. To the left of the escalator I saw the line of unfortunate travelers, all waiting for the single elevator that could get them to their destination. Once again I committed the most audacious act...I slid the little t-handle back into my suitcase and (can you believe it?) picked it up off the floor and climbed the stairs all the way to ticketing.

All of this reminded me of one of my favorite commercials. I've taken the video and made a few minor modifications and titled it "Stuck on the Escalator: A Change Leadership Parable."
(I will also add a download able version to the files and links section of

If you have taken the time to watch this video, I must warn you of an unintended reaction you will have. Sometime in the next few days someone will be complaining to you about how "they" are making them miserable and how desperately they wish "someone" would do something about it... and you will think of this video and start laughing. You wont be able to help it. Don't be too hard on them, though, for this is unfortunately a typical helpless response to change in one's life and work.

It is with this inspiration that I will be focusing the next few blog entries on common barriers and obstacles to change. Many of these I have seen throughout my career in others, but many more I have battled in my own life as I have faced (and continue to face) significant changes. In the mean time, may you have the courage to walk instead of waiting for others to carry you and take the stairs instead of waiting for something to raise you up.

Saturday, June 13, 2009

Hand Washing in Hospitals (Part 3)

As Paul Harvey always liked to say, "Now for the rest of the story..."

Not to be deterred from her mission, our infectious disease specialist Deborah Yokoe turned to a new product as a potential answer to the hand washing dilemma: alcohol rinses and gels. These items had actually been used in Europe for almost two decades, but had only recently caught on in the United States. These gels have the same potency as hand washing but can be applied and air dry in 15 seconds. Yet even this solution was met with resistance and took over a year to be adopted in the hospital. The staff feared the product would produce noxious odors. Next came fears that it would be irritating to the skin. Then rumors surfaced that the alcohol gel would reduce fertility. All of these rumors were false, but it took months to dispel each through communication and training. With the eventual adoption of the alcohol gels, compliance increased from 40 to over 70 percent. But surprisingly hospital infection rates didn't drop at all! Apparently the 30 percent non-compliance rate still allowed plenty of opportunity for the transmission of infections.

Not to be deterred by the failures of the industrial engineering efforts and alcohol gel adoption, surgeon Jon Lloyd continued to struggle with finding a way to reduce infection rates. Interestingly he received inspiration from reading an article about a Save the Children program to reduce malnutrition in Vietnam. After years of trying to bring outside solutions into Vietnamese villages only to be met with resistance, missionaries instead chose to find solutions from village insiders. They studied villagers who had the best nourished children and discovered that these mothers were breaking with locally accepted practices in many ways. They were feeding their children even when they had diarrhea, giving several small feedings a day, mixing greens in with their food, and other revolutionary practices. Aid workers shared these practices with other villagers and posted results for all the villagers to see. The ideas began to take hold and malnutrition dropped by 65-85% within two years in every village where this approach was taken.

Lloyd was struck by this idea and evaluated how it could be adopted by his hospital to reduce infection rates. With the help of the infectious disease specialists thirty minute small group sessions were held with health care workers at every level from food service workers to surgeons to nurses to janitors. They simply started the sessions by saying "We have a serious problem with the spread of infectious diseases in this hospital and we are here to learn your ideas on how to solve it." Many said it was the first time anyone had ever asked them what they would do about the problem, and ideas came pouring out. As a result of these sessions, norms began to change. When new gel dispensers were received staff members took charge of where to place them. Nurses began to confront doctors who were bypassing good hygiene practices. Therapists who didn't like to wear gloves during procedures were convinced by peers that it was no big deal. Ideas and small victories were publicized throughout the hospital and recognition given.

The result: One year into the effort MRSA wound infection rates dropped to zero. The Robert Wood Johnson Foundation recently launched a multi-million dollar initiative to adopt this approach in ten more hospitals across the country and study the results.

So what is there to learn for your organization in this case study? I would be interested to hear what you think, so please feel free to comment on lessons learned!

Thursday, June 11, 2009

Hand Washing in Hospitals (Part 2)

I'm sitting here at the St Louis Bread Shop (Panera Bread to you folks not in St. Louis) wondering if the lady who grabbed my cinnamon roll with her bare hands followed proper hand washing guidelines...which brings me back to our case study...

So, have you figured out how you would save lives by improving hand washing compliance at your hospital? This is not only a change leadership challenge, but in this circumstance a case of life and death. The hospital in our case study hit this issue head on. When a new CEO took over the leadership of the regional health care network that included this hospital, he made the problem of hospital infections his top priority. To prove he could solve this problem, he hired a young industrial engineer named Peter Perreiah to focus on a single forty bed floor at the hospital. Peter adjusted his pocket protector and walked right onto the floor and asked all of the staff "Why don't you wash your hands?" Far and away the most common answer was a lack of time. So Peter set out to eliminate the things that wasted precious time.

He developed a just in time supply system positioned right inside patient rooms to prevent the staff from having to go in and out in search of gowns, gloves, tape, and other items. Rather than carrying their own stethoscopes and risk spreading infection from patient to patient, he positioned a designated stethoscope in each room. He made dozens of other changes to reduce waste in providing patient care, all with the intention of freeing the time needed for proper hand hygiene. Finally, like a good engineer, Peter arranged for every patient to have a nasal culture taken upon admission so he could carefully measure infection rates that originated in the hospital itself.

The result? MRSA infection rates fell almost 90 percent, from four to six infections a month to about that many in an entire year! But before you engineers and lean experts high five each other, here's the bad news. After two years only one other floor in the hospital had adopted similar changes, and when Peter left the hospital performance quickly backslid to baseline rates. The CEO ended up quitting out of frustration over the lack of progress. Nothing had fundamentally changed.

So, give this some thought. Why did changes that made care givers' lives easier and more productive, changes that produced significant and verifiable results, fail to spread or be sustained? Why did the inertia turn back to prior practices in the face of overwhelming evidence of success? Why do people fight change even when they know lives are on the line? Why do they fight change in your organization?

Wednesday, June 10, 2009

Hand Washing in Hospitals (Part I)

One of the greatest struggles of any change leader is process discipline. That's a fancy term for good old fashioned behavioral compliance! Doing what is right! Simply doing what you're told! There are few things more frustrating than establishing an improved process or policy, training everyone in your organization to understand its importance, and then having constant issues with the process or policy not being followed by those same people! A recent case study I read in Gawande's "Better" highlights this all too common frustration.

According to the U.S. Centers for Disease Control, two million Americans acquire an infection while they are in the hospital. Ninety thousand will die of that infection. By comparison, in 2005 just over forty five thousand people died in vehicle accidents in America! This makes the hospital one of the most dangerous places in America! Yet health care studies show that the number one preventative measure for hospital infections, hand washing, is only accomplished one half to one third as often as it should be to prevent these infections. Surely doctors, nurses, therapists, and other care givers understand the importance of hand washing. They would almost all acknowledge the importance of following hand washing standards and guidelines. And yet half of the time they choose not to, potentially spreading infections that take the lives of tens of thousands of people.

Deborah Yokoe is an infectious disease specialist at a major American hospital. Her full time job is to stop the spread of infection in the hospital. She has tried everything you can imagine to increase hand washing compliance. Threatening signs. Repositioned sinks. Additional sinks wherever they may be needed. Establishing "precaution carts" with everything needed for washing up, gloving, and gowning. She's given away movie tickets as positive reinforcement. She has stood guard at sinks and confronted doctors and nurses when they bypass the standards. She has issued hygiene report cards and assessments. And yet infectious rates at her hospital has not decreased. Care givers are still passing infections from patient to patient.

One barrier to good hand washing discipline is the time it takes to follow the strict procedure. If you're really interested in this topic you can go to to read the 56 page procedure and even take an online training course. If you are a health care provider who is planning to do surgery on me it is required reading! By the way, almost nobody actually adheres to this procedure. Why? Even if you could get the procedure down to one minute per hand washing, doing so between each patient could consume a third of a care giver's time! Doing so this frequently can also irritate the skin and cause dermatitis which, of course, increases bacterial counts on hands. That is probably why your doctor has another patient's pus under her fingernails when she is checking your incision for signs of infection.

If you were hired as a hospital administrator or infectious disease specialist and you were serious about being a change agent to save lives, how would you approach this challenge? In my next post I'll detail the approach this hospital took and the results it produced...

Monday, June 8, 2009

Don't Use a Hammer to Swat a Fly Off Someone's Head!

If you have kids, you understand the meaning of the title to this blog entry. If you work with people who act like kids, you are probably smiling right now. Let me clue you in on a secret: we all work with people that act like children sometimes. And if we are honest, we can act like a child sometimes too. Sometimes we are all selfish and lack some self-control. Why is this awareness important to a change leader?

Reflect on these questions and think about how these behaviors can undermine your effectiveness as a change leader:
1. Do you have solutions in mind before you completely understand the problem that needs to be solved?
2. Do you interrupt others to give them your solutions before they are done articulating the problem? Do you ever just wish someone would stop talking so you can have your turn?
3. Do you find yourself doing the right things but at the wrong times?
4. Do you ever have what you say overpowered by your tone and body language?
5. Do you let little things produce big reactions driven by emotion?

All of these behaviors have the same root cause: our selfishness. So how do you overcome these tendencies in yourself? How do you coach others who display these behaviors? Some of the best advice I've ever read on this topic is from John Maxwell. He suggests the following approach:

Listen. Ask questions. Listen again. Ask more questions. Listen some more. Then respond.

Asking good questions takes conscious effort and discipline. Believing you don't have all the answers takes patience and humility. But the result can be dramatic and sustained change in the lives of others...and yourself!

Sunday, June 7, 2009

Suggestions for Becomming a Positive Deviant

I recently started reading a book entitled "Better" by Atul Gawande. Atul is a young surgeon and the book is a treatise on improving performance in health care. So far it's an excellent book that I'm sure I'll comment on again in this blog. I started reading this book by reading the Epilogue first, something I don't typically do but the title fascinated me (the same title as this blog entry).

Gawande lists five ways to make a difference as a "positive deviant," which I think is a great name for a leader of change! His suggestions are unique and helpful for any change agent.

1. Ask an unscripted question. A surgeon makes his living talking to strangers, so he argues "why not learn something about them?" The same holds true for any change leader. Taking a sincere interest in others will do wonders when it comes time to lead them out of their comfort zones.
2. Don't complain. Be prepared with something positive to comment on when others around you begin to complain. Nothing saps your energy and creativeness like a bunch of people sitting around complaining.
3. Count something. You won't find this on many self help lists, but I think it is profound. He suggests that you find something interesting to you and start counting and analyzing. While a resident Gawande began to count patients who suffered post surgical complications because an instrument or sponge had been forgotten and left inside them. He found that the mishaps happened most often in emergency procedures or procedures that revealed unexpected results (like finding cancer during a gall bladder surgery). He soon worked with some colleagues to develop an automated system for keeping track of instruments and sponges. Count something that interests you and then make changes to improve!
4. Write something. It doesn't matter what you write, he says. A journal, a letter, even a blog! "Writing lets you step back and think through a problem. Even the angriest rant forces the writer to achieve a degree of thoughtfulness." Writing for an audience, no matter how small, makes yourself part of a larger world. I'm also hoping it keeps me accountable to always reading and learning new things that others might find interesting.
5. Change! People respond to change in one of three ways: A few become early adopters, most become late adopters, and a few become persistent skeptics who never stop resisting. Have you seen this in your change leadership efforts? In spite of the risks, make yourself an early adopter. It's the best way to make a difference in your life and the world around you.

Not only are these great suggestions for doctors, nurses, and hospital administrators, but they are also great suggestions for any leader of change. Challenge yourself this week to embrace at least one of these by creating a new habit and becoming a "positive deviant!"