Tag: organizations

business

Strategy: Myths, fantasies, and reality

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A defining feature of sustained excellence in any enterprise is a good strategy — a vision and plan linked to the delivery of something of value, consistently. One of the big reasons many organizations fail to thrive is not just that they that have the wrong strategy, but that they don’t have one at all (but think they do). 

Strategy is all about perception.

Whether you think you have one or not is partly perceptive. Whether you are delivering a strategy in practice or not is also a matter of perception. Why? Because strategy is what links what you build your organization for, what you drive it toward, and what you actually achieve. Lots of organizations achieve positive results by happenstance (being at the right place at the right time). That kind of luck can happen to anyone, but it hardly constitutes a strategy.

Also, statements of intent are great for creating the perception of strategy because one can always say they are working toward something in the abstract, but without a clear sense of how intentions are connected to actions and those actions connected to outcomes, there really isn’t a strategy.

Do you have a strategy?

The best example of this is in the entertaining and instructive illustrative book ‘I Have a Strategy (No You Don’t)‘, Howell J. Malham Jr literally illustrates the problems that beset conversations about strategy as it chronicles two characters (Larry and Gary) talking about the subject and busting the myths associated with what strategy is and is not. One exchange between the two goes like this:

Larry: “Hey Gary, I was working a strategy to put a cookie back in a cookie jar but I tripped and fell and the cookie flew into my mouth instead. Good strategy, huh?

Gary: “That’s not a strategy. That’s a happy accident, Larry

The entire book is like this. One misconception after another is clarified through one character using the term strategy to mean something other than what it really is. These misconceptions, misuses, and mistakes with the concept of strategy may be why it is so poorly done in practice.

Malham’s work is my favourite on strategy because it encapsulates so many of the real-world conversations I witness (and have been a part of) for years with colleagues and clients alike. Too much conversation on strategy is about things that are not really about strategy at all like wishes, needs, or opportunities.

This isn’t to suggest that all outcomes are planned or connected to a strategy, but the absence of a strategy means you’re operating at the whim of chance, circumstance, and opportunism. This is hardly the stuff of inspiration and isn’t sustainable. Strategy is about connecting purpose, plans, execution, and delivery. Malham defines a strategy as having the following properties:

1. It has an intended purpose;
2. There is a plan;
3. There is a sequence of actions (interdependent events);
4. It leads toward a distinct, measurable goal

When combined with evaluation, organizations build a narrative and understanding of not only whether a strategy leads toward a goal, but what actions make a difference (and to what degree), what aspects of a plan fit and didn’t fit, and what outcomes emerge from the efforts (including those that were unintended).

A look at much of the discourse on strategy finds that many organizations not only don’t have strategic plans, they don’t even have plans.

Words and action

One of the biggest problems with “capital ‘S’ Strategy” (the kind espoused in management science) is that it is filled with jargon and, ironically, contributes greatly to the very lack of strategic thinking that it seeks to inspire. It’s one of the reasons I like Malham’s book: it cuts through the jargon. I used to work with a senior leader who used all the language of strategy in talks, presentations, and writing but was wholly incapable or unwilling to commit to a strategic direction when it came to discussing plans and actions for their organization.

Furthermore, it is only marginally useful if you develop a strategy and then don’t bother to evaluate it to see what happened, how, and to what effect. Without the action tied to strategy, it is no better than a wish list and probably no more useful than a New Years Resolution.

Those plans and linking them to action is why design is such an important — and sadly, highly neglected — part of strategy development. Design is that process of shifting how we see problems, explore possibilities, and create pathways that lead to solutions. Design is not theoretical, it is practical and without design doing design thinking is impotent.

Two A’s of Strategy: Adaptation vs Arbitrary

The mistake for organizations working in zones of high complexity (which is increasingly most of those working with human services) is assuming that strategy needs to be locked in place and executed blindly to be effective. Strategy is developed in and for a context and if that situation changes, the strategy needs to change, too. This isn’t about throwing it out but adapting.

Adaptive strategy is a means of innovating responsibly, but can also be a trap if those adaptations need to be built on data and experience, not spurious conclusions. Arbitrary decisions is what often is at the root of bad (or no) strategy.

Roger Martin is one of the brightest minds on strategy and has called out what he sees as sloppy use of the term adaptive strategy as a stand-in for arbitrary decision-making going so far as to call it a ‘cop-out’. One of the biggest problems is that strategy is often not viewed in systems terms, as part of an interconnected set of plans, actions, and evaluations made simultaneously, not sequentially.

Good strategy is not a set of steps, but a set of cascading choices that influence the operations and outcomes simultaneously. Strategy is also about being active, not passive, about what it means to design and create an organization.

Grasping strategy for what it is, not what we imagine it to be, can be a key factor in shaping not only what you do, but how well you do it. Having the kind of conversations like those in Howell J. Malham’s book is a means to get things moving. Taking action on those things is another.

 

Image credit: Photo by Paul Skorupskas on Unsplash

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Learning fails in bad systems

2348137226_2d6536745e_o_Edits.jpgEnormous energy is spent on developing strategies to accomplish things with comparatively little paid to the systems that they are being deployed in. A good strategy works by design and that means designing systems that improve the likelihood of their success rather than fight against them and this is no truer than in the effort to learn on the job.

 

A simple search of the literature — gray or academic — will find an enormous volume of resources on how to design, implement and support learning for action in organizations. At an individual level, there are countless* articles on personal change, self-improvement, and performance ‘hacks’ that individuals can do to better themselves and supposedly achieve more in what they do.

Psychology and related behavioural sciences have spent inordinate time learning how individuals and organizations change by emphasizing specific behaviours, decision processes, and data that can support action. A close inspection will find that relatively few strategies produce consistent results and this has to do less with execution, skill or topic and more with the system in which these strategies are introduced.

To illustrate this, consider the role of learning in the organization and how our strategies to promote it ultimately fail when our systems are not designed to support it.

Knowledge integration: A case study

Consider the example of attending a conference as a means of learning and integrating knowledge into practice.

Surajit Bhattacharya published a primer for how to get value from conferences in medicine, pointing to tips and strategies that a medical practitioner can take such as arriving a day early (so you’re not groggy), planning out your day, and be social. These are all practical, logical suggestions, yet they are premised upon a number of things that we might call system variables. These include:

  • The amount of control you have over your schedule week-to-week.
  • The availability of transportation and accommodation options that suit your schedule, budget, and preferences.
  • The nature and type of work you do, including the amount of hours and intensity of the work you perform in a typical week. This will determine the amount of energy you have and the readiness to be attentive.
  • The volume of email and other digital communications (e.g., messages and updates via social media, chat, project management platforms) you receive on a daily basis and the nature of those kinds of messages (e.g.urgency and importance).
  • The amount and nature of travel required to both attend the event and the amount you had prior to attending the event.
  • The level of rest you’ve had. Sleep amount, timing, and quality all factor into how much rest you get. Add in the opportunity to engage in an activity like walking, exercise or stretching that one might do and we see a number of factors that could influence learning performance.
  • The setting. The lighting, air quality and air flow, seat arrangement, room acoustics, and access to some natural light are all factors in our ability to attend to and engage with a learning event.
  • The quality and format of the content and its delivery. Speaker quality, preparation, content and overall performance will all contribute to the ability to convey information and engage the audience.
  • Food and drink. Are you eating the kinds of foods and beverages that enable your body’s performance? Do you have access to these foods and drinks? Are they served at times that suit your body?
  • Your level of comfort and skill at engaging strangers. This matters if you’re more introverted, dislike small talk, or are not energized by others.

These are all platform issues: those in which motivation and energy can be channeled to focus on and engage with learning content. The fewer of these factors present the greater the energy expenditure needed on the part of the learner.

Learning within systems

W. Edwards Deming noted that most of the issues of performance in any organization were due to processes and systems (estimated to be up to 85% or more) rather than individual employees. While Deming was referring largely to manufacturing contexts, the same might be said for learning.

Consider our example from earlier about the conference. We’ve already outlined the factors that could contribute to learning at the conference itself, but let’s extend the case further to what happens after the conference. After all, a surgeon, engineer, computer programmer, law clerk, or carpenter isn’t going to practice her or his craft at the conference; they’ll do it when they return to regular work.

Now consider what our attendee encounters after they have made the trip home to apply this newfound learning:

  • A backlog of emails, phone messages and other correspondence that has either been left untouched, scantly attended to, or fully managed. In the first case, the backlog might be high and requires a considerable amount of time and energy to ‘catch up’ on upon return, however at least the learner was fully present to perform the many activities suggested byBhattacharya in the earlier article. In the second case, there is a higher than usual amount to attend to and the learner might have been selectively disengaged from the learning event. In the third, the learner returns to usual life without a backlog but may have sacrificed considerable attention toward the usual correspondence than actually learning.
  • A backlog of meetings. Scheduled meetings, calls or other events that require a co-presence (virtual or physical) that were put off due to travel are now picked up.
  • A backlog of administrative tasks. Submitting receipts and conference expenses, regular accounting or administrative tasks are all things that either was left untouched or, in the case of submitting expenses, unlikely or impossible to do until the trip has returned.
  • Fatigue. Sitting in a conference can be exhausting, particularly because of the conditions of the rooms, the volume of content and the break in the routine of every day (which can be energizing, too). Add in any travel issues that might arise and there is a reasonable chance that a person is not in an optimal state to take what they have been exposed to and apply it.
  • The usual organization processes and structures. Are there are opportunities to reflect upon, discuss, and process what has been learned with others and spaces to apply those lessons directly with appropriate feedback? How often have we been exposed to inspiring or practical content only to find few opportunities to apply it in practice upon our return in enough time before the details of the lessons fade?

It’s not reasonable to expect to have optimal conditions in our work much of the time, if ever. However, as you can see there are a lot of factors that contribute to our capacity to learn and the required energy needed to take what we’ve been exposed to and integrate it into our work. The fewer of these situations in place, the greater the likelihood that the investment in the learning experience will be lost.

An organization or individual requires a platform for learning that includes systems that allow for learners to be at their best and to provide a means for them to take what they learn and apply it — if it’s valuable. Otherwise, why invest in it?

This isn’t to say that no good can come from a conference, but if the main focus is on actual learning and the application of knowledge to the betterment of an organization and individual why would we not invest in the platform to make use of that rather than discarding it.

Rethinking our systems

When I was doing evaluation work in continuing medical education I was amazed to see how often learning events were held at 7 or 8 am. The rationale was that this was often tied to shift changes at hospitals and were the one time of day when most physicians were least likely to have other appointments. This was also the time when physicians were either highly fatigued from a night shift or having battled traffic on their commute to work or were planning the rest of their day ahead — all circumstances when they might be least focused on actually learning.

This choice of time was done for scheduling purposes, not for learning purposes. Yet, the stated purpose of continuing education was to promote learning and its various outcomes. Here, the strategy was to expose medical professionals to necessary, quality content to keep them informed and skilled and doing it at a time that appeared most convenient for all is an example of an idea that had logic to it, but ultimately failed in most regards.

How? If one looked at the evaluation data, typically the results suggested this strategy wasn’t so bad. Most often post-event surveys suggested that the overall ratings were consistently high. Yet a closer look at the data yields some questions.

For example, the questions asked to assess impact were things like: did the presenter speak clearly? or did the presenter provide the content they said they would? In most cases, participants were asked if the speaker arrived on time, presented what they said they would, were intelligible and whether there was a chance the learner might find useful what was presented. It had little to no bearing on whether the content was appropriate, impactful or applied in practice. This is because the system for evaluation was based on a model of knowledge transmission: content is delivered to a person and, assuming the content is good, the lesson is learned.

We know this to be among the weakest forms of moving knowledge to action and certainly not something suited to more complex situations or conditions, particularly in health systems. This is still what prevails.

Design for learning

If you’re seeking to promote learning and create a culture where individuals across an organization can adapt, develop, and grow learning requires much more than simply sending people to conferences, hosting seminars, providing books and other materials or watching some instructional videos. Without a means to integrate and promote that new knowledge as part of a praxis, organizations and individuals alike will continue to get frustrated, lag in their efforts to anticipate and respond to changing conditions and will ultimately fail to achieve anything close to their potential.

Designing for learning is as much about a curriculum as the context for how that curriculum is delivered and how learners are set up to engage with it all in their organizations and everyday lives.

*This is literally the case because the volume of new articles being published daily is so high.

If you’re looking to create learning systems in your organization, visit Cense to explore what it can do for you in shaping your strategy and evaluation to support sustainable, impactful learning for complex conditions. 

Image credit: “Platform” by Martin L is licensed under CC BY 2.0

 

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Exploding goals and their myths

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Goal-directed language guides much of our social policy, investment and quests for innovation without much thought of what that means in practice. Looking at the way ideas start and where they carry us might offer us reasons to pause when fashioning goals and whether we need them at all. 

In a previous article, I discussed the problems with goals for many of the problems being dealt with by organizations and networks alike. (Thanks to the many readers who offered comments and kudos and also alerted me that subscribers received the wrong version minus part of the second paragraph!). At aim was the use of SMART goal-setting and how it made many presumptions that are rarely held as true.

This is a follow-up to that to discuss how a focus on the energy directed toward a goal and how it can be integrated more tightly with how we organize our actions at the outset might offer a better option than addressing the goals themselves.

Change: a matter of energy (and matter)

goal |ɡōlnoun:  the object of a person’s ambition or effort; an aim or desired result • the destination of a journey

A goal is a call to direct effort (energy) toward an object (real or imagined). Without energy and action, the goal is merely a wish. Thus, if we are to understand goals in the world we need to have some concept of what happens between the formation of the goal (the idea, the problem to solve, the source of desire), the intention to pursue such a goal, and what happens on the journey toward that goal. That journey may involve a specific plan or it may mean simply following something (a hunch, a ‘sign’ — which could be purposeful, data-driven or happenstance, or some external force) along a pathway.

SMART goals and most of the goal-setting literature takes the assumption that a plan is a critical success factor in accomplishing a goal.

If you follow SMART, Specific, Measurable, Attainable, Realistic, and Time-bound (or Timely) this plan needs to have these qualities attached to them. This approach makes sense when your outcome is clear and the pathway to achieving the goal is also reasonably clear such as smoking cessation, drug or alcohol use reduction, weight loss and exercise. It’s the reason why so much of the behaviour change literature includes goals: because most of it involves studies of these kinds of problems. These are problems with a clear, measurable outcome (even if that has some variation to it). You smoke cigarettes or you don’t. You weigh X kilograms at this time point and Y kilograms at that point.

These outcomes (goals) are the areas where the energy is directed and there is ample evidence to support means to get to the goal, the energy (actions) used to reach the goal, and the moment the goal is achieved. (Of course, there are things like relapse, temporary setbacks, non-linear changes, but researchers don’t particularly like to deal with this as it complicates things, something clinicians know too well).

Science, particularly social science, has a well-noted publication bias toward studies that show something significant happened — i.e., seeing change. Scientists know this and thus consciously and unconsciously pick problems, models, methods and analytical frameworks that better allow them to show that something happened (or clearly didn’t), with confidence. Thus, we have entire fields of knowledge like behaviour change that are heavily biased by models, methods and approaches designed for the kind of problems that make for good, publishable research. That’s nice for certain problems, but it doesn’t help us address the many ones that don’t fit into this way of seeing the world.

Another problem is much less on the energy, but on the matter. We look at specific, tangible outcomes (weight, presence of cigarettes, etc..) and little on the energy directed outward. Further, these perspectives assume a largely linear journey. What if we don’t know where we’re going? Or we don’t know what, specifically, it will take to get to our destination (see my previous article for some questions on this).

Beyond carrots & sticks

The other area where there is evidence to support goals is from management and study of its/ executives or ‘leaders’ (ie. those who are labelled leaders and might be because of title or role, but whether they actually inspire real, productive followership is another matter). These leaders call out a directive and their employees respond. If employees don’t respond, they might be fired or re-assigned — two outcomes that are not particularly attractive to most workers. On the surface it seems like a remarkably effective way of getting people motivated to do something or reach a goal and for some problems it works well. However, those type of problem sets are small and specific.

Yet, as much of the research on organizational behaviour has shown (PDF), the ‘carrot and stick’ approach to motivation is highly limited and ineffective in producing long-term change and certainly organizational commitment. Fostering self-determination, or creating beauty in work settings — something not done by force, but by co-development — are ways to nurture employee happiness, commitment and engagement overall.

A 2009 study, appropriately titled ‘Goals Gone Wild’ (PDF), looked at the systemic side-effects of goal-setting in organizations and found: “specific side effects associated with goal setting, including a narrow focus that neglects non-goal areas, a rise in unethical behavior, distorted risk preferences, corrosion of organizational culture, and reduced intrinsic motivation.” The authors go on to say in the paper — right in the abstract itself!: “Rather than dispensing goal setting as a benign, over-the-counter treatment for motivation, managers and scholars need to conceptualize goal setting as a prescription-strength medication that requires careful dosing, consideration of harmful side effects, and close supervision.”

Remember the last time you were in a meeting when a senior leader (or anyone) ensured that there was sufficient time, care and attention paid to considering the harmful side-effects of goals before unleashing them? Me neither.

How about the ‘careful dosing’ or ‘close supervision’ of activities once goal-directed behaviour was put forth? That doesn’t happen much, because process-focused evaluation and the related ongoing sense-making is something that requires changes in the way we organize ourselves and our work. And as a recent HBR article points out: organizations like to use the excuse that organizational change is hard as a reason not to make the changes necessary.

Praxis: dropping dualisms

The absolute dualism of goal + action is as false as the idea of theory + practice, thought + activity. There are areas like those mentioned above where that conception might be useful, yet these are selective and restrictive and can keep us focused on a narrow band of problems and activity. Climate change, healthy workplaces, building cultures of innovation, and creating livable cities and towns are not problem sets that have a single answer, a straightforward path, specific goals or boundless arrays of evidence guiding how to address them with high confidence. They do require a lot of energy, pivoting, adapting, sense-making and collaboration. They are also design problems: they are about making the world we want and reacting the world we have at the same time.

If we’re to better serve our organizations and their greater purpose, leaders, managers, and evaluators would be wise to focus on the energy that is being used, by whom, when, how and to what effect at more close intervals to understand the dynamics of change, not just the outcomes of it. This approach is one oriented toward praxis, an orientation that sees knowledge, wisdom, learning, strategy and action as combined processes that ought not be separated. We learn from what we do and that informs what we do next and what we learn further. It’s also about focusing on the process of design — that creation of the world we live in.

If we position ourselves as praxis-oriented individuals or organizations, evaluation is part of regular attending to the systems we design to support goals or outcomes through data and sensemaking. Strategy is linked to this evaluation and the outcomes that emerge from it all is what comes from our energy. Design is how we put it all together. This means dropping our dualisms and focusing more on integrating ourselves, our aspirations and our activities together toward achieving something that might be far greater than any goal we can devise.

Image credit: Author

 

 

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Grounding Your (Mindful) Organization

Finding your point of origin

Finding your point of origin

Building a mindful organization requires a sense of understanding where you are, where you came from and where you’re going. The first step is grounding your organization and learning about — and (re)creating your point of origin.

In 1806, what became the city of Detroit, Michigan was first designed and conceived. Unlike other cities, Detroit clearly defined itself by its geography explicitly and sought to build everything around a single point of origin. It is for this reason that there are roads such as 6 mile, 7 mile, and the popularized 8 mile to mark actual distances from this central point in the city.  The marker and monument photographed above serves as a reminder of Detroit’s history and offers a place to gain perspective on its present and increasingly its future as it undergoes a serious remake.

As a city, Detroit is seeking to re-ground itself as it looks forward by looking to the past and present at the same time. It is a city looking to recapture the entrepreneurial spirit that made it into one of the world’s great manufacturing centres in the early to mid 1900’s in a way that is more socially integrative than it was before.

Getting grounded

In a previous post, I highlighted eight stages to creating a mindful organization, one that is aware and conscious of itself and the systems its a part of. Grounding is the first step.

Below is a look at the different ways the term ground can be used. It’s important to note connection between the solidity of the terms, perception, place, and connection. Grounding means all of these.

Ground: Definition

Ground: Definition

At the heart of grounding is mindfulness: being fully aware of one’s self and setting in the context of the present moment. While mindfulness is about paying attention to the present moment, but not at the expense of the past, nor is it about inattention to intention moving forward. It is about being aware of the moment-by-moment connections between the person or organization and what is being experienced.  Mindfulness has many paradoxical elements to it, which is one reason it works well with complexity, which has its own paradoxes as well.

Mindfulness is a means of establishing that connection to our ground — whatever that might be. Grounding might be in community, fields of practice, time, markets or populations of interest or engagement and most likely is some combination of these.

Establishing your ground

Do you know the ground your organization is stationed? In answering that question it is worth asking some key questions:

1. Do you have a detailed, articulated strategy for your work linked to some clear purpose?  (In other words: do you know what the point of your work is and what you’re trying to accomplish?). The role of intention in mindful practice is enormous and being clear on what is intended from the work and being aware of that intention while the work is being performed is a key factor.

2. Do you have a means of matching your intentions and strategy to the work that you are doing? Many organizations have goals and visions, but no ongoing monitoring and evaluation methods to assess whether or not they are actually doing this work. This will be discussed in a future post, but it is worthwhile to ask early whether there is a means of assess what work you are actually doing?

3. Is your ground solid? This question looks at the logic of your enterprise. Whether you are a for-profit, not-for-profit, charity or some other enterprise there needs to be a solid connection between what you do, your products and services, and markets, partners, resources and income streams you have available. The Business Model Canvas is a tool that can help expose the logic — and the gaps in it — of your organization’s work. The canvas was an crowd-consulted, co-created initiative led by Alex Osterwalder that worked through a series of iterations to create a simple, easy-to-use framework for linking the various components of your organization’s mission together. By being aware of the logic of your business you’re able to be mindful of how those activities connect to your purpose, intentions and aspirations.

4. What will solidify your ground (i.e.: what has value?)? Dave Snowden from Cognitive Edge is critical of the approach of naming values as an organization. Snowden asserts that once values are named, they are summarily ignored. Value statements are useless unless they truly express some form of value, that is reflect where investment, decisions and actions of the organizations are placed. If one is acting with intention and a clear grounding, then these values become evident and the need to express them seems moot. A further problem is that the social pressures to name values that are acceptable (rather than consistent with practice) mean that we often find organizations with operationally meaningless values. If you don’t know what values like “inclusiveness”, “respect for diversity”, “participation” and “learning organizations” really mean in practice as well as intention, they don’t serve your enterprise.

5. How committed are you to standing your ground? Wherever your organization chooses to stand, that is the system that it will see. Once grounded, many path dependencies are set in motion, which will determine how aligned what you do, say, seek, and find in the future. In complex systems it is critical to have some flexibility in boundaries, however they must be set somewhere. Consider what it is that you value and whether you are committed as an organization to doing what you say and aspire towards. Visionary companies come from alignment between what the leaders say and what everyone does.

It’s never too late to ask yourself these questions whether you’re starting up or seeking to re-establish yourself or create a new path forward.

Just like Detroit, there is always a chance for re-birth. And just like Detroit, you’ll have that point to launch from and look back at to help you wayfind as you engage in complexity through your work. As we will see, knowing where you start from will help determine where you go.

 

For more information on this process of grounding and what it could look like for your organization contact CENSE Research + Design

 

Rebirth of Detroit

Rebirth of Detroit

Photo credits: Cameron Norman

complexitydesign thinkingpublic healthsystems sciencesystems thinking

Systems Thinking Perspectives on CQI and Public Health

Mapping the system

Mapping the system

Systems thinking involves taking account of where you stand, what you’re doing, and where the bounds of your influence and influences are. By learning how to think about systems, we are better able to design strategies to ensure that our engagements are producing the most beneficial results for our efforts and when combined with design thinking we gain further opportunities to shape the systems closer to what we aspire them to be.

I recently was invited to speak to the first meeting to advance CQI (Continuous Quality Improvement) in public health in Ontario (Canada) on the topic of systems thinking. The one day workshop was aimed at bringing together members from nearly every public health unit in the province to meet and discuss issues related to quality improvement and public health.

In twenty minutes we did a whirlwind through some of the key features of systems that are relevant to quality improvement by looking at the nature of systems (chaotic, complex and ordered) and steps that can be taken to understand them in terms of setting the appropriate targets, methods and tools for defining and assessing quality within such systems.

Understanding systems

By understanding the nature of systems we can avoid the trap of using linear metrics for non-linear problems. Much of the literature on quality improvement has its roots in manufacturing, which are largely linear systems that seek to predict, control and emphasize efficiencies and the elimination of waste. Yet, public health is largely about complexity. In a complex system, what might be considered inefficiencies could be natural byproducts of the system itself and cannot be necessarily avoided. Further, such ‘noise’ could be sources of innovation or weak signals that indicate something significant is to come.

Public health operates in a tricky space because it deals with highly complex problems and systems and linear, straightforward ones simultaneously.

Below is a summary set of slides used to highlight the talk (the original slides were more visual, but those don’t help you out if you hadn’t been in the room).

(For those who read this blog through subscription, you may not see the above presentation in your feed so here is the link)

Building Quality Into Systems Design

One of the central points I made was that systems can be (partly) designed and that developmental design is a process that integral to optimal functioning in a complex system. By paying attention to what is going on and the relationships that form within the system the feedback is set to allow for intentional development of the system itself. This does not assure control, but it allows for positive influence rather than being solely reactive to whatever the system produces. This is necessary if one is to promote quality and ensure quality not just measure it as if it was a static object.

Whether one uses linear, quantitative measures or more non-linear, multi-method approaches to assessing the quality of a public health product or service, the key is knowing what kind of system you are operating in.

My takeaway points were:

•CQI depends on seeing quality as embedded in and a product of systems;
•Systems are defined by where you stand in relation to them and how variation operates within the system;
•Where you stand determines your metrics for quality;
•Your metrics feed your improvement and (re)define quality by influencing where you stand.
The process then repeats iteratively and in an ongoing manner just as one repeats the use of the strategies below:
•Pay attention / pay intention;
•Map your system to intentions, people, settings, contexts based on what you see;
•Collect relevant, timely, useful data based on the context of your operations and strategy (build on what you map);
•Engage in collective sense-making of the data;
•Design & redesign your programs.
By setting up the appropriate processes and structures to monitor, assess, sense-make, and design programs in congruence with the type of systems programs and services are operating in, not only with public health professionals be better equipped to assess quality, they will be producing it along the way (and creating a learning organization in the process).
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Leadership and Systems Thinking Issues

John Wenger has written on the issue of leadership and systems thinking asking some pointed questions about how leaders can prop up a dysfunctional system inadvertently and how they can also actively serve as agents of change within it. This is the sort of discussions that more leadership training programs and systems thinkers in general could benefit to make the intangible nature of systems real.

quantum shifting

Business leaders: when I use the word “culture”, do you screw up your face and say “Love and peace, man”?  I’m no aging hippie; in any case, I was born 10 years too late to be part of that movement.  Business culture is no wiffly-waffly discretionary add-on.  It’s central to effectiveness and business improvement.  I do admit a fondness for better communication, greater self-awareness, lots more empathy and way less fear in the workplace (man), but this comes out of a firmly held view that there is huge scope for workplaces to be more humanised, which will have a huge impact on effectiveness.  I also have a firmly held view that a real leader is one who seeks to steward the business culture; not find things to measure so they can prove how useless people are.  My thinking about “culture” comes out of the intellectual rigour that is Systems Thinking.

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Knowledge Translation & the Systems Problem

Serendipity is a funny thing. Finding two or three themes that coalesce suggests to me that a blog post is necessary to bring them together.

This week the Canadian Public Health Association conference wrapped up in Toronto. Between the pre-conference workshops and the post-conference catch-up on email, Tweets and other media posts it was a week filled with concurrent themes:

1. Time Crunch: Too much to do and not enough time to do it for most people
2. Information Management: How to manage all the different media messages as a prosumer (a creator and consumer of content)
3. Knowledge translation: How to get the message to ‘stick’ and take our best knowledge and put it into action.

These are all different facets of a larger problem besetting those of us in the health professions and knowledge work trying to engage the public and peers using new media. In nearly all of the conversations and presentations I was a part of or witnesses, the question came down to this:

“How can we make it all work?”

The first point, which was discussed in a previous post, seems to be a growing issue that has been a continuation of a theme my entire adult life: people are busier than ever and the demands keep growing. What makes the current context different isn’t that the changes in technology are making this worse (because that’s always been the case), but rather that the rate of change is so fast.

My grandparents lived through the introduction of radio, TV and then the VCR as the major information technologies they had to deal with (computers existed, but they never used them or cared to). My parents have lived through those plus the computer, mobile phones, GPS systems, DVDs, and now PVR added to HD TV. They use email and surf webpages and My Mom recently got a Kobo ereader and loves it, but that might be the most high-tech entree that they engage in for the next while (unless someone can come up with a really good Sodoku system for my Dad).

Me? Add all of these and Skype, Twitter, Facebook, Blackberries/iPhones/Smartphones, Foursquare and the myriad cloud computing tools out there to my list. On a daily basis I probably read 100 blog posts, get more than 500 Twitter updates, see about 50 Facebook posts, receive 100 emails, and receive a myriad other number of Skype, GChat, Buzz, and BBM messages and voice mails. And that’s just correspondence and ‘keeping in touch’. I also have about a dozen books on my ‘about to read’ list and usually keep a pile of research articles I need to keep up with. At some point, this system of mine is about to break.

And then there is the physical world. My wife, my neighbors, my research team and other colleagues in addition to the people I meet on the street, in meetings, and who serve me at the local Starbucks.

I wish I was unique in this, but the truth is that a lot of people in academia, knowledge work, or the health system are in the same boat. Yet, we expect to reach these people so that they become better at what they do.

The conditions in which knowledge is shared is only part of the equation.

I recall a conversation with a colleague responsible for continuing education at a local hospital who told me about her challenge of keeping things interesting for the staff she trains. She does most of her training at 7am when there is a shift overlap. This means her audience is either exhausted from a 12 or 24 hour shift or half-asleep because they just woke up and have a shift ahead. As we talked, she laughed about how ludicrous the whole thing was. No matter how compelling the information is or how dynamic the presenter is, little will overcome this system design and its influence on learning. Yet, we accept it for what it is and try to envision clever ways to overcome these ‘inconvenient’ structural issues.

Same goes with social media. We expect to translate knowledge to busy people through tweets, Facebook posts, reports, and ads and yet fail to consider the context in which these messages are viewed. If there is too much going in, not much is really being translated.

It is with some irony that if the community we wish to reach is too busy or their information ecology too grand, then the effort required to translate anything will be far greater, putting more stress on those with the knowledge and adding to their ‘to do’ list. Take this further and you can see that we are in a race to the bottom.

And yet, that is what many seem prepared to do because no one – no one – I spoke with about these matters was prepared to do anything with the elephant in the room (that being the current information/work context). There was some begrudging acknowledgment, but otherwise a passive acceptance that workloads are high and the information landscape is vast, but that these factors can be overcome with the “right” strategy.

Too many cling to is this idea that if we just get the message right, time it perfectly, get buy-in from the end users (and maybe create a message with them), and use the appropriate medium, we’ll achieve knowledge translation. To that, I am reminded of Russell Ackoff’s statement about doing the “wrong things righter” . In this case, these are ‘right’ things, but without a system that supports integration capacity, it is just an exercise in looking good.

Knowledge translation scholars and practitioners have made enormous strides in acknowledging the power of integrated activities, marketing theory and practice, and getting beyond simply pushing content at people, but working with people in exchange relationships. The next critical skill they need to master is systems thinking and related action if any of those other great skills are to have meaning.