Unsticking the stuckness #4 - changing gear

Our stuckness theme arose because we regularly find in our client work that people appear to feel “stuck” in cycles of collective good intent but painfully slow impact.

With the help of our generous network of friends (take a bow Gopinath!) we’ve come to see however that organisational stuckness isn’t necessarily a total loss of forward movement. Instead it can feel more like getting stuck in second gear, while the revs go through the roof and you press the pedal to the metal, but don’t change speed.

The unpalatable truth is that while everyone can sign up to organisational or system change in theory, it both wastes people’s time and money when the organisation is stuck.

So how can an organisation or system change gear?

Ask and listen

Ori Brafman and Judah Pollock tell a great story from work done by the late Lisa Kimball about an American hospital attempting to stop the spread of MRSA. They were stuck with high infection rates and, as it turned out, a pretty dreadful working environment for some nursing staff. The leadership had engaged Lisa to help and she assembled a diverse collection of staff at one meeting, where they talked about protocols for washing hands and the importance of using really hot water, when a nurse piped up: “on our wing there is no hot water”.  Disbelief broke out, engineers went to check it was true and discovered the water that was supposed to be boiling was in fact ice cold. Nurses had been getting around the issues by collecting buckets of hot water from other parts of the building to bathe their patients! Instead of jumping to engineering solutions costing millions, the hospital leadership created some “white space”, inviting “unusual suspects” to speak up. At one of these meetings a janitor asked the nurses “are you sure the valve is on?”. The group immediately convened to a cluttered cupboard on the hospital wing, with a pipe and valve at the back, so old the paint was chipped off. The janitor turned the valve and they soon heard the sound of water rushing through the pipe – and with one turn of a valve the hospital wing entered the 21^st century!  Hot water restored and major investment avoided. Infection rates reduced. Result all round!

They shifted gear by asking the staff to get engaged and by genuinely listening to what they had to say.

Integrated Care Systems

The very same principles apply in Integrated Care Systems (ICS) and Sustainability and Transformation Partnerships (STPs) in the NHS and Local Government, as they do in individual organisations.

In a recent client project with a developing ICS we found middle managers being regularly frustrated by conflicting instructions between system leaders and their organisational managers. It was typified by one middle manager who described leaving an ICS leadership meeting agreeing to do one thing and then being immediately countermanded by her boss when she got back to the ranch and being instructed to do the opposite.

We all know leadership by slide-deck just doesn’t work. The ICS vision and strategy piece may be perfectly crafted and widely available on the shared drive, but it will rarely influence the work of next level reports unless they are genuinely engaged in its development, validation and improvement.

And there’s the rub. My middle manager example had a boss who had not been engaged in the development of the ICS vision and strategy either. It wasn’t their fault – they have busy lives already delivering the day job as best they know, and maybe sometimes trying to second-guess what’s best for their organisation.

In terms of ICS development , they feel like part of the forgotten tribe of managers who have the task of making the vision and strategy stuff happen on the ground, of designing the systems to deliver the strategy, running the programmes to join it all up and leading the projects to engineer the desired changes.  And taking the staff with them in the work.

Managers and front-line staff are the people who know from experience and practice where the obstacles and workarounds are, and they must make the vision concrete if the ICS or STP is going to shift gear. The fear of loss (of jobs, status, power or autonomy) or failure (to meet performance or cost reduction targets) that accompanies transformational change programmes is also mitigated by staffs’ ability to influence the future shape of their work.

Shifting gear

The gear shift comes by engaging the energy, common sense and creativity of the forgotten tribes of leaders, managers, supervisors and staff at all levels of an organisation to help find the solutions to building the vision, so they can in turn engage staff in open conversations to help design the solutions for Integrated Care.

So often people have simple solutions that could help if only they were invited to contribute to changing the gears. And yes, it means they get diverted from the “day job”, but if the way the day job is done undermines the greater good then the investment isn’t just desirable, it’s essential.