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 changefreak.com.

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 Are you seeking out the "hidden genius" inside your organization, or are you trapped in the outdated belief that some people are paid to work and others to think?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 changefreak.com)

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 http://www.cdc.gov/handhygiene/ 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!"