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Understanding the Chemistry and Physics of Change: Part 2 – The Chemistry

Written by Angelo Baratta on . Posted in Articles. 2 Comments on Understanding the Chemistry and Physics of Change: Part 2 – The Chemistry

In Part 1, we presented the Three Laws of Organizational Change:

  1. Law of Persistence: A person or process continues its current behavior (won’t change) until an unbalanced force is applied.baratta nov13
  2. Law of Power: The force required to cause a change depends on two things: the mass of the object (how big the thing is that we’re trying to change), and how fast we need to get to the new state.
    1. Force = how big X how fast
    2. Work = force X how far
  3. Law of Reciprocity: To change something we have to interact with it. Every interaction produces an equal and opposite response.

 The key conclusion based on these laws is:

In order to effect a change, a force is always required.
Change doesn’t just happen.

This means that change will never take place without work (energy over time). So what and where is the source of this energy? To answer this question we need to understand the Chemistry of Change.

What is the Source of Energy/Force For Change?

To affect an organizational change, we need a force that is strong enough, and we need the energy to see the change through to completion. But where does that energy come from? And what kind of energy is required for organizational change to succeed?

There are three distinct kinds of energy:

  1. Mechanical
  2. Electromagnetic
  3. Emotional

In every case, regardless of the type, energy is generated by difference; the greater the difference, the greater the energy.

Think of a hydroelectric generating station. What do you picture? Do you picture a dam and a waterfall? The energy generated is a result of the difference in height from top to bottom. The purpose of a dam is to create that difference. Water, moving from high to low, supplies the energy that turns the turbines and creates electricity; the greater the distance between the top and the bottom, the greater the force and energy.

‘Difference’ is the source of energy; and energy is required to exert a force.

Electricity is measured as the potential difference between two points.

To make a choice and pursue a goal that is different from the status quo requires emotional energy. When we care about something we have more energy for it. When we don’t care (apathy), we have no energy for it. Emotional energy is the energy required to fuel organizational change.

Without emotion there is no motion.

Since we derive energy from difference, it is a perceived difference in personal future value that triggers our chemistry of emotion. When we perceive a difference between where we want to be, and where we are, and when that difference matters to us, then that sparks emotion, and that produces energy for action (motion).

To effect an organization change requires emotional energy which can only come from people. In order to generate emotional energy in an individual, three conditions must be met:

  1. They must be aware of the impact of the change
  2. They must care about how it affects them personally, either directly or indirectly
  3. They must be able to place a personal value on the impact.

Emotional Energy = function of (perceived value of a difference)

A single organizational change can create multiple stakeholder impacts. A new status quo can lead to stakeholders experiencing one or more of the following perceived and real consequences:

  1. They can be better off—more value.
  2. They can be worse off—less value.
  3. They can be unaffected—no change in value.

Evaluating the difference for each stakeholder is the key to determining if we have enough power and energy to effect the target changes. Accomplishing this is difficult for a number of reasons, in particular:

  1. It can be difficult to accurately quantify the direct impact of a change.
  2. Even when we can quantify the impact, we cannot easily and accurately determine how that impact will be valued by each stakeholder.

For example: a $1000 per year raise to someone earning $20,000 may have much more value than the same $1000 per year raise to someone earning $100,000. This makes intuitive sense. But what about a $1000 raise to ten people, each currently earning the same thing? Will each place the same value on the same $1000 increase? Not necessarily. Value perception is individual and circumstance and time specific. There is no formula to compute it, as of yet. That same raise a month from now may be valued very differently than today by the same person.

What all this means is that as difficult as it is to quantify the direct impact generated by a change, it can prove almost impossible to quantify the value of that impact to each stakeholder, even when interacting with the stakeholders themselves. And to make things more challenging, that value is subject to change without notice.

To reiterate, there are three potential responses to a change, based on each stakeholder’s perception of consequences and how they value them:

  1. Response to a perceived increase in value: support/assist
  2. Response to a perceived decrease in value: block/resist
  3. Response to no difference in value: apathy/ignore

A perceived decrease in value as the result of a change will elicit a resistance response. Therefore, if every project you’ve been on had resisters, then maybe it’s the changes that need to be reviewed. Perhaps most organizational changes tend to result in a reduction in certain stakeholders’ value propositions. If that’s the case, resistance is only natural.

Chemistry is about the emotions generated by the stakeholder question, “What difference will it make to me?” In order to generate a force for change, we need to turn on people’s emotions in the direction of the desired change.

People will react to a real or perceived change in their value outcomes. People are less concerned about the technicalities of the change and more interested in the value impact of the change to them, real or perceived. The greater the distance between their perception of current value and potential future value, the greater the emotional force and energy. The change itself is not the cause of how people feel about the change. The perceived impact is the cause. And that’s chemistry. Feelings generate energy and force. Apathy generates inaction.

In order to increase the support energy and decrease the resistance energy, we need a good understanding of the total stakeholder impacts. But how do we get that?

Understanding the Difference : The Stakeholder Value P & L

A program/project may produce numerous individual change impacts. Any one of these may contribute to project failure. Therefore, it is crucial to understand all the forces (support, resist, apathy) that will come into play on that project. A Stakeholder Value Profit and Loss (P & L) Statement is a tool that makes all the potential impacts overt. Think of it as a P & L for the project.

To develop a Stakeholder Value P & L, identify the following for each stakeholder:

  1. The change
  2. Real impacts
    1. The impact of that change
    2. The direction of the impact; this determines the direction of the force—assist, resist, ignore.
    3. How each stakeholder feels about the impact of the change? Quantify likely range of values each individual stakeholder will attribute to the impact—strength of force.
    4. How long will the feelings last? This is a measure of how much energy is likely to be spent by each stakeholder. A stakeholder may initially react with great resistance but quickly lose interestor change their feelings. That’s a strong force but minimal energy.
  3. Perceived impacts(repeat a. to d. above)

More projects run out of energy before they run out of money, than the other way around.

And, by the way, running out of money is really running out of investor energy. Understanding the real and perceived impact of each change to each stakeholder group and individual stakeholder is essential to success. This should be undertaken at the very beginning of a program as part of the selection process. Don’t start a program that does not have sufficient force and energy to complete. The following formula summarizes the concept:

Force for change: Assist force – Resist force > force required for change

It would be nice if we could simply plug in numbers into this formula and generate an answer. But we can’t. What we can do is use our Stakeholder Profit and Loss Statement to analyze our change and develop alternatives that generate more assist forces and fewer and weaker resist forces. We can minimize the risk of failure but we cannot guarantee success.

Perception is Reality

Perception is reality. Right?

Perception is not reality. However, people make decisions based on their perception of reality. That means that as change managers we always have two choices.

  1. We can make real changes to our project which will result in a real change in the future reality, thereby changing the forces and energy available.
  2. We can affect the perception of the reality, while leaving real consequences alone, thereby changing the forces and energy available.

We can alter the available force and energy by changing the real impact or by changing the perceived impact. As an ethical manager, I would support improving the real impact and working to bring the perception in line with the reality. As a program/project manager you must be able to detect the difference and you should work to maximize the real value and bring perceptions in line wth the real.

When Does Change Management Begin?

All projects introduce change. Therefore, all projects require force and energy to complete. Understanding how much force and how much energy will be required is something every project needs to understand. And it needs to understand this at the very start of a project. In fact, I would say that it’s a requirement for starting the project. That means that a change management assessment, using the Stakeholder Profit and Loss Statement or similar concept, should be undertaken as part of the decision to proceed, rather than as part of the subsequent project planning and execution. Once a project is started, people’s commitments tend to become fixed and jeopardy becomes attached to major changes or to cancellation. Changing the impact reality becomes much more difficult once the plane is off the ground (so to speak).

Summary

Progress requires change. Change requires effort (work and energy). People are the source of the emotional energy required for project work. That energy can be applied in support of the change or against the change. The strength of the force will be determined by the difference in perceived value created by the change. The direction depends on whether the value goes up or down for a particular stakeholder. The job of the project manager with regard to change is to fully understand all impacts and how they affect each stakeholder’s perception of value. The Stakeholder Profit and Loss profile is a good tool for achieving that.

The best case is when every single stakeholder sees real value as increasing for them as a result of the change. This is the holy grail of Change Management. It is the single scenario that requires the least energy to implement any given change because the resistance forces will be zero and the support forces will be at maximum. It is the only condition that generates a win-win-win…. scenario. The focus of Change Management should be to create such scenarios, not to manage people through win-lose initiatives, as is too often the case.

Don’t forget to leave your comments below.

Understanding the Chemistry and Physics of Change: Part 1 – The Physics

Written by Angelo Baratta on . Posted in Articles. 4 Comments on Understanding the Chemistry and Physics of Change: Part 1 – The Physics

Change, what is it? What is its purpose?

Change is not some random event. Change is about status quo. It is the planned movement from the current status quo to some new status quo. Change, like a project, is transitional. It is the transition between two stable status quos, the current and the desired. Since change is not random, it is initiated by someone and affects others. A single change has multiple impacts. It’s not enough to understand just the nature of the change. We also need to understand the nature, target, and consequence of the stakeholder impacts.

There are three key conditions in Change Management that we need to understand and address:

  1. Single changes create multiple stakeholder impacts. A new status quo can lead to stakeholders experiencing one or more of the following consequences:
    1. They can be better off.
    2. They can be worse off.
    3. They can be unaffected.
  2. Stakeholder perception of the impact may be different from the reality. Each stakeholder will respond based on his perception of the project impact. Therefore, it’s critical for the change manager to understand each stakeholder’s perception versus reality.
  3. Stakeholder management and planning must take account of both the reality and the perception, for the change to succeed.

Change Management is a combination of art, practice, and science and it takes all three to get it right. In this first part, we’re going to explore the science aspect, in particular the physics of change. When a change happens, someone or something made it happen. The starting point for change is always the current state, which is subject to the Three Laws of Organization Change. I didn’t invent these laws. Sir Isaac Newton discovered and proved them. They are still valid today.

One of the first principles that came out of TRIZ research (theory of inventive problem solving) is that problems and solutions are repeated across industries and sciences. That means that quite often, a problem in one area has already been solved in a different area. That’s the case with “Change Management.” Sir Isaac Newton formulated and proved the Three Laws of Motion. But they could have been called the Three Laws of Change of Motion because they describe how change is made to happen. I’ve simply taken these three laws and repurposed them for organization change management. But they retain the same power and meaning as the original laws. Let’s review the original laws.

Newton’s Three Laws of “Change of” Motion are:

  1. First Law: A body in motion remains in motion. A body at rest remains at rest. Unless the body in acted on by an unbalanced force.
  2. Second Law: The unbalanced force required to move a body is defined by:
    • Force = Mass X acceleration (F = ma)
  3. Third Law: For every action there is an equal and opposite reaction. In every interaction there is a pair of forces.

Newton was a scientist. A scientist seeks to understand “how” something behaves. A philosopher seeks to understand “why.” The “why” is not always available to us.

Three Laws or Organization Change

baratta nov13
Now, let’s restate the laws for our organizational change management world. They explain a lot.
  1. Law of Persistence: A person or process continues its current behaviour (won’t change) until an unbalanced force is applied.
  2. Law of Power: The force required to cause a change depends on two things: the mass of the object (how big the thing is that we’re trying to change), and how fast we need to get to the new state.
    1. Force = how big X how fast
    2. Work = force X how far
  3. Law of Reciprocity: To change something we have to interact with it. Every interaction produces an equal and opposite response.

Implications of the Laws of Change in our Business World

First Law: The Law of Persistence

The status quo is persistent. The first law says that nature favors the status quo. Why? It doesn’t matter why. But for those who can’t rest until they know why, here’s a plausible reason. Nature is efficient. Since the status quo is where we need to be most of the time, nature has made the status quo free. We don’t need to exert any force to stay the course. But, in order for the status quo to be free and sustainable, then change must require force and cost. We get one or the other for free, not both. Nature has made a wise choice.

The world we know would not be possible without this law. Take baseball, for example. When the pitcher throws the ball, he’s applying a force to the ball while the ball is in his hands. As his arm moves through the air with the ball in his hand, he’s accelerating the ball. At some point he let’s go of the ball, removing the force. The ball is now on its own. If the first law didn’t exist, the ball would immediately fall, since the force is gone. Instead the ball continues its motion, even though there is no longer any force acting on it. It continues its journey to the batter. The batter then wants to change the motion of the ball, so he needs to apply a force to it. He does this with his swinging bat. The ball accelerates in the direction of the force of the bat until it leaves the bat. Again, if the first law didn’t exist, the ball would fall to the ground as soon as the bat lost contact.

Same deal in football or any other sport. Once the football leaves the quarterback’s hand, there is no force. Yet the ball continues in flight. Without the first law, it would immediately fall to the ground. It’s the same in our business world. Once we’ve established a way of doing things through training and coaching, we can leave it alone and it should faithfully continue to operate in the same way. We can expect that people and processes will behave today as they did yesterday. That allows us to focus on the things we need to change. Our world is stable, predictable. Imagine someone came along and tried to get our people to change their ways and that the first law didn’t exist. That person would have an easy time changing the team’s behaviour. We’d have to spend all our time making sure that didn’t happen. Fortunately that’s not the case. Change requires force, time and energy, so it isn’t easy for anyone to change our team’s behaviour. Of course, that means that if we want to deploy a change, we have to revert to using a force as well. We can’t have stability for free and change for free. We have to pay for on, and that one is “the change”.

But how much force is required for a particular change? That depends. The second law explains.

Second Law: The Law of Power

If we want to move a 20 tons truck we need a bigger force than moving a tricycle. Why? The truck is bigger. It has more mass. The greater the mass, the greater the force required. That seems pretty intuitive. If we don’t have enough force (not strong enough), the second law says, “Don’t waste your time trying.” We’re simply going to waste our energy.

In addition to force, there is another consideration, “How far do we want to move the truck?” This is a second component to the second law. Even if we are strong enough to move it, can we move it all the way to where we want? Moving an object a certain distance is work. Work = force X distance (how far). Even if we’re strong enough to get it started, do we have enough energy to exert that force over the distance required? If we don’t, then we shouldn’t bother trying, especially if we’re moving the truck up an incline. As soon as we run out of energy and stop pushing, the truck will roll back down to its previous state. Sound familiar? In an organization all changes should be considered uphill. Many changes are not sustained for that reason.

What does this mean for our business projects? If we are introducing a change that impacts 100 people, we need a larger force than the same change to 10 people. A change that impacts 10 powerful people will require greater force than one impacting 10 not-so-powerful people. One hundred people represent a bigger mass than ten people. So we need a larger force. If our change is small, then that’s like pushing the truck a small distance. If the change is big, then that’s like pushing the truck a longer distance. Our project requires enough clout (force) to impact our mass, and enough resources (energy) to move that mass to the new desired status quo.

Third Law: The Law of Reciprocity

The first two laws say that people and processes don’t naturally resist, they persist. Imagine you’re wearing very slippery skates on an ice ring. Imagine to you walk up to someone from behind, so that they don’t see you and don’t have time to react. You push the other person, who is also on skates. Who will move? Of course, you will both move. But has the other person deliberately pushed you? No, they haven’t. The third law says that force is an interaction. Force always occurs in pairs. So when you apply a force to a body, then the other body unwittingly applies an equal force to you as well. That’s not resistance you’re feeling. That’s persistence.

Now imagine the other person was facing you and just as you push them, they dig their skate tip in the ice and push back. Now you’d be experiencing two forces; you pushing him, and him pushing back. That would be resistance.

When we try to change something, it will always reciprocate. That’s nature telling us that change is not free. The third implies that tiny changes may be easy while large changes will be difficult, regardless of any overt resistance that may be offered for other reasons. Resistance is not the third law. It is another unbalanced force coming from someone else trying to make a change of their own. When there is resistance, there are at least two forces coming from two different sources.

Why is change difficult? How difficult is it? It is difficult so that stability can be easy. The level of difficulty will depend on the mass we’re trying to impact and how quickly we’re trying to impact it.

People don’t naturally resist change. They persist in status quo behaviour according to the laws of nature. If you ask someone “Why do you do things that way?” and they respond, “Because that’s the way we’ve always done it,” don’t laugh, thinking that’s a poor reason. Not only is it a good reason, it’s the law.

Next Instalment
In our second instalment, we’ll examine the impact of the three laws on program and project management. We’ll explore the chemistry of change and where Change Management best fits in a project: who should be accountable for change, and how it relates to stakeholder value management?

Don’t forget to leave your comments below.

From the Sponsor’s Desk – The Checklist Champion

Written by Drew Davison on . Posted in Articles. 5 Comments on From the Sponsor’s Desk – The Checklist Champion

Davison Oct23Co-Authored with Ruby Tomar

In my last post, we reviewed the challenges experienced by a project manager who saw an opportunity to improve the organization’s performance and took it, without official support. He launched a project to reduce the costs and time required to test the functionality for the consumer electronics device he and his team were supporting. It was a learning experience.

In this post, instead of the usual case, with the help of Ruby Tomar, we’ll look at a most informative book, the insights the author gleans about how to implement sustainable change and how you can leverage the Project Pre-Check building blocks or build your own to deliver your own sustainable change.

The book is The Checklist Manifesto: How to Get Things Right by Atul Gawande. He is a MacArthur Fellow, a general and endocrine surgeon at the Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker, and an associate professor at Harvard Medical School and the Harvard School of Public Health. He also leads the World Health Organization’s Safe Surgery Saves Lives program. 

Dr. Gawande poses a question many of us have asked over the years – how do seemingly intelligent, knowledgeable, talented and motivated individuals and groups manage to get so many things wrong. In his book, Dr. Gawande refers to the work of two philosophers, Samuel Gorovitz and Alasdair MacIntyre, in search of answers. They suggested a couple of reasons for failure. One is ignorance, where we don’t have the necessary knowledge and skills to do the job. The second is ineptitude, where we do have the knowledge and skills required but fail to apply it correctly. How do we fix that?

The challenges Dr. Gawande faces are similar to the challenges we face managing business and technology change. The best practices he uncovers and the lessons he learns are also applicable to our program, project and change management efforts. Dr Gawande reveals the power of a seemingly simple tool, the checklist, to improve performance, reduce costs, increase returns and save lives in a wide array of endeavours including surgery, emergency room settings, construction, natural disasters, restaurants, finance, investing and many other circumstances.

We have borrowed extensively from Dr. Gawande’s book, extracting directly and paraphrasing liberally to give you a sense of the challenges his team faced and the amazing results they achieved. We thank him for his amazing achievements, terrific insights and generous support.

The Situation

The World Health Organization (WHO) contacted Dr. Gawande in 2006 to help them develop a global program to reduce the risks of surgery. “Officials were picking up indications that the volume of surgery was increasing worldwide and that a significant portion of the care was so unsafe as to be a public danger. Worldwide, at least seven million people a year are left disabled and at least one million dead—a level of harm that approaches that of malaria, tuberculosis, and other traditional public health concerns.” Dr. Gawande accepted the challenge.

A group of health care specialists from around the world gathered in Geneva in early 2007 to tackle the challenge. They understood the enormity of the task at hand. Some suggested more training. Others proposed incentive schemes such as pay-for-performance programs. They considered a set of WHO standards for surgical care. Dr. Gawande looked for and analyzed examples of successful public health interventions that the group could learn from. He states “All the examples, I noticed, had a few attributes in common: They involved simple interventions. The effects were carefully measured. And the interventions proved to have widely transmissible benefits.”

One of his favorite cases was a public health program to address the perilous rates of premature death among children in the slums of Karachi. The program used hand washing with soap in six different situations where cleanliness would have the most impact. After the first year “the incidence of diarrhea among children in these neighborhoods fell 52 percent compared to that in the control group. The incidence of pneumonia fell 48 percent. And the incidence of impetigo, a bacterial skin infection, fell 35 percent.”

States Dr. Gawande “Thinking back on the experiment, I was fascinated to realize that it was as much a checklist study as a soap study. So I wondered: Could a checklist be our soap for surgical care—simple, cheap, effective, and transmissible?”

His colleagues answered his question in the affirmative with a number of examples:

  • The Columbus Children’s Hospital had developed a checklist to reduce surgical infections. After three months, 89 percent of appendicitis patients got the right antibiotic at the right time. After ten months, 100 percent did. The checklist had become habitual.
  • A Johns Hopkins pancreatic surgeon showed an eighteen-item checklist that he’d tested with eleven surgeons for five months at his hospital. Likewise, a group of Kaiser Hospitals in Southern California had studied a thirty-item “surgery preflight checklist”.
  • University of Toronto had completed a feasibility trial using a much broader, twenty-one-item surgical checklist. Their checklist had staff verbally confirm with one another that antibiotics had been given, that blood was available if required, that critical scans and test results needed for the operation were on hand, that any special instruments required were ready, and so on.

The checklist also included what they called a “team briefing.” The team members were supposed to stop and take a moment simply to talk with one another before proceeding—about how long the surgeon expected the operation to take, how much blood loss everyone should be prepared for, whether the patient had any risks or concerns the team should know about.

These checklists not only helped ensure essential tasks were completed consistently, they helped build teams capable of responding to the unexpected. At Johns Hopkins, after three months use, the number of team members reporting that they “functioned as a well-coordinated team” leapt from 68 percent to 92 percent. At the Kaiser hospitals, after six months and thirty-five hundred operations, the staff’s average rating of the teamwork climate improved from good to outstanding. Employee satisfaction rose 19 percent. The rate of OR nurse turnover—the proportion leaving their jobs each year—dropped from 23 percent to 7 percent. And the checklist appeared to have caught numerous near errors.

Dr. Gawande and his colleagues were convinced. Further testing was warranted.

The Goal

At the end of the Geneva conference, the participants agreed that a safe surgery checklist was worth testing on a larger scale. The focus was to introduce a practice to significantly reduce surgical risks globally.

The Project

A working group was formed. They took the different checklists that had been tried and condensed them into a single one. They added any other checks they could think of that might make a difference in care. They incorporated the communication checks in which everyone in the operating room ensures that they know one another’s names and roles and has a chance to weigh in on critical plans and concerns.

They set up a proper pilot study of the safe surgery checklist in a range of hospitals around the world.

When Dr. Gawande returned to Boston, he told the nurses and anesthesiologists what he’d learned in Geneva. His team agreed to try it out.

It didn’t work out very well. On the first attempt, there was confusion about how the checklist should be administered. It was supposed to be a verbal checklist, a team checklist. Some of the checks were ambiguous. The checklist was too long. It was unclear. Everyone was frustrated, even the patient. By the end of the day, they had stopped using it. Dr. Gawande states “Forget making this work around the world. It wasn’t even working in one operating room.”

So Dr. Gawande went back to the drawing board. He consulted with the experts at Boeing, which has decades of experience developing checklists to address emergency, life and death situations that are trusted and used religiously by pilots world-wide. He also reviewed the experiences, practices and applicability of checklists at a major construction firm, a successful high end restaurant, the experiences, good and bad, from Hurricane Katrina, and checklist use in finance and the investment world. In every case, good checklists, used as an integral part of the organizations’ operations, made a significant, positive contribution.

Dr. Gawande returned to Boston. He and his team applied what he had learned in his research. They made the checklist clearer. They made it faster. They clarified responsibilities. They tested it in a simulation rather than a real surgery. Then they tested it in real life situations one case at a time, in different locations around the world. After each test, they assessed how well the checklist performed and revised it accordingly until they had a checklist that seemed to do the job. The final WHO safe surgery checklist spelled out nineteen checks in all. 

The safe surgery checklist on patient care in its final form was tested in eight hospitals around the world. They collected data on the surgical care in up to four operating rooms at each facility for about three months before the checklist went into effect. 

In early 2008, the pilot hospitals began implementing the two-minute, nineteen-step surgery checklist. The hospital leaders committed to introducing the concept systematically. They made presentations to all affected personnel. The WHO team supplied the hospitals with their failure data from previous sampling so the staff could see what they were trying to address. They also provided PowerPoint slides and YouTube videos, one demonstrating “How to Use the Safe Surgery Checklist” and one entitled “How Not to Use the Safe Surgery Checklist,” showing how easy it is to screw everything up.

The Results

In Dr. Gawande’s own words:

“The introduction of the checklist was rocky at times. There was a learning curve, as well. However straightforward the checklist might appear, incorporating it into the routine was not always a smooth process. Sometimes teams forgot to carry out part of the checklist. Other times they found adhering to it just too hard. The difficulty seemed to be social. Very few knew immediately how to adapt their style to huddling with everyone for a systematic run-through of the plans and possible issues. The nurses seemed especially grateful for the step, but the surgeons were sometimes annoyed by it. Nonetheless, most complied. Most but not all.”

“The final results showed that the rate of major complications for surgical patients in all eight hospitals fell by 36 percent after introduction of the checklist. Deaths fell 47 percent. The results had far outstripped what we’d dared to hope for, and all were statistically highly significant. Infections fell by almost half. The number of patients having to return to the operating room after their original operations because of bleeding or other technical problems fell by one-fourth. Overall, in this group of nearly 4,000 patients, 435 would have been expected to develop serious complications based on our earlier observation data. But instead just 277 did. Using the checklist had spared more than 150 people from harm—and 27 of them from death.”

With these kinds of fundamental improvements in patient outcomes, one would think that hospitals and surgeons world-wide would be falling over themselves to adopt the WHO checklist. Unfortunately, that was not the case. As DR Gawande commented “We were thrown out of operating rooms all over the world.” Unfortunately, resistance to change is a universal phenomenon. But Dr. Gawande’s team persisted.

“Perhaps the most revealing information, however, was simply what the staff told us. More than 250 staff members—surgeons, anesthesiologists, nurses, and others—filled out an anonymous survey after three months of using the checklist. In the beginning, most had been skeptical. But by the end, 80 percent reported that the checklist was easy to use, did not take a long time to complete, and had improved the safety of care. And 78 percent actually observed the checklist to have prevented an error in the operating room.”

“Nonetheless, some skepticism persisted. After all, 20 percent did not find it easy to use, thought it took too long, and felt it had not improved the safety of care. Then we asked the staff one more question. ‘If you were having an operation,’ we asked, ‘would you want the checklist to be used?’ A full 93 percent said yes.”

“Since the results of the WHO safe surgery checklist were made public, more than a dozen countries—including Australia, Brazil, Canada, Costa Rica, Ecuador, France, Ireland, Jordan, New Zealand, the Philippines, Spain, and the United Kingdom—have publicly committed to implementing versions of it in hospitals nationwide. Some are taking the additional step of tracking results, which is crucial for ensuring the checklist is being put in place successfully. In the United States, hospital associations in twenty states have pledged to do the same. By the end of 2009, about 10 percent of American hospitals had either adopted the checklist or taken steps to implement it, and worldwide more than two thousand hospitals had.”

Not bad for a little nineteen point checklist and some brave checklist champions who weathered their colleagues’ slings and arrows to save thousands of lives. A paradigm shift perhaps?

How a Great Leader Succeeded

Dr. Gawande and his WHO team did an amazing job of covering the change management landscape. So how can you leverage these insights and reap the successes that the WHO team achieved on your projects? 

Project Pre-Check is an example of a practice for guiding business and technology change that addresses the key components of the WHO effort: a stakeholder model to ensure the right players are engaged and responsibilities are clear, a comprehensive, 125 point best practice based checklist (the Decision Framework) and a five stage process to guide the decision-makers from inception to value realization. Here’s Ruby’s assessment of Project Pre-Check relative to the fifteen best practices WHO leveraged on their project.

Fifteen WHO Safe Surgery Best Practices Addressed by Project Pre-Check Features
1. Burning platform: they had the insight and foresight to identify the growing surgical risks.
  • One of 125 plus Decision Areas in Decision Framework
2. Goals: they had the audacity to establish and share a common goal.
  • One of 125 plus Decision Areas in Decision Framework
3. Affordability: they knew how much they could afford to spend to solve the problem. As the WHO official told Dr. Gawande at the start of the project “Oh, there’s no real money”.
  •  One of 125 plus Decision Areas in Decision Framework
4. Champions: they recruited project champions starting with Dr. Gawande. What a great champion he turned out to be.
  •  One of four roles in Stakeholder model
  • Enabled with five stage Project Pre-Check process
5. Sponsors: the WHO team ensured that every hospital involved in the project had a local sponsor to shepherd the change, establish priorities, align accountabilities and demand or coax changes in behaviours.
  • Enabled with five stage Project Pre-Check process
  • One of four roles in Stakeholder model
6. Targets: they identified and engaged the affected targets whose behaviours needed to change for the project to be successful.
  • Enabled with five stage Project Pre-Check process
  • One of four roles in Stakeholder model
7. Team: they built a team to build local teams.
  • Enabled with five stage Project Pre-Check process
  • Shaped by Stakeholder model
8. Think big, do small: they thought globally but acted locally, a surgery, a hospital at a time.
  • Covered by some of the 125 plus Decision Areas in Decision Framework
9. Best Practices: they searched for and applied best practices.
  • Accessed through five stage Project Pre-Check process
  • All of the 125 plus Decision Areas in Decision Framework
10. Measurement: they measured the status quo and the measured the results of their changes
  • Enabled with five stage Project Pre-Check process
  • Covered by some of the 125 plus Decision Areas in Decision Framework
11. Communication: they reported their findings, before and after.
  • Enabled with five stage Project Pre-Check process
  • Covered by some of the 125 plus Decision Areas in Decision Framework
12. Prototype and pilot: they tested their checklists offline, piloted their designs, learned from their experiences and tested and piloted again until they were satisfied.
  • Covered by some of the 125 plus Decision Areas in Decision Framework
13. Local control: they adapted their solutions to suit the needs of each country, hospital and team.
  • Enabled with five stage Project Pre-Check process
  • Enabled by 125 plus Decision Areas in Decision Framework
  • Decision Framework Write-ins
14. Success breeds success: they used their successes to convert the doubters and bring on more champions.
  • It’s up to you!
15. Smart: they used checklists.
  • Tell the world about your successes!

The Project Pre-Check checklists are downloadable at no cost at projectprecheck.com.

We talked about two sources of failure up front – ignorance and ineptitude. Checklists can address both. They can help stakeholders identify what they don’t know, and get assistance. They can ensure that what is known and pertinent to the change in question is identified and applied appropriately. Use Project Pre-Check’s three building blocks right up front to conquer both failure factors. Or build your own. But please, USE A CHECKLIST!

And remember, if you have a project experience, either good or bad, past or present, that you’d like to share with others and have examined through the Project Pre-Check lens, send me the details. Thanks.

Don’t forget to leave your comments below.

About the Authors

ddavisonDrew Davison is a former system development executive, the owner and principal consultant at Davison Consulting and a senior consultant at The Manta Group. He is the developer of Project Pre-Check, an innovative framework for launching projects and guiding successful project delivery, the author of Project Pre-Check – The Stakeholder Practice for Successful Business and Technology Change and Project Pre-Check FastPath – The Project Manager’s Guide to Stakeholder Management. He works with organizations that are undergoing major business and technology change to implement the empowered stakeholder groups critical to project success. Drew can be reached at [email protected].

rtomarRuby Tomar is an action oriented, decisive and results focused Program and Project Manager with 16years of experience in the IT systems. With three patents filed and eight disclosures to her credit, Ruby is process and technology savvy with a strong inclination towards innovation and process optimization. She has worked in automotive, consumer, networking, and telecommunications industries and is an avid reader of technical and management research. She has an MS degree in Software Systems from BITS, India and is currently working as a Program Manager at HP. She can be reached at [email protected]

The Agile Project Manager: Living in the “Real World”

Written by Robert Galen on . Posted in Articles. 1 Comment on The Agile Project Manager: Living in the “Real World”

One of the things I hear most often in my public speaking engagements and workshops goes something like this:

GalenJuly10I’ll spend time speaking about an agile principal, or practice, or technique, or even a mindset. Someone in the audience politely raises their hand and asks a question. I’m paraphrasing a bit, but it usually goes something like this—

Bob, that sounds really nice as an academic scenario or generic advice, but in the real world, something like that will never fly. We have too many constraints. It just won’t work in our organization. It sounds nice, but…

And then there’s the inevitable follow-up question—

Can we still do agile if we don’t do that ____________?

Which often gets repeated over and over again as we explore additional principles and practices…

I often feel a wide variety of emotions as a result of these dialogues—from frustration to sadness to a smile at the repetition. Depending on the point being made, it’s usually an early indicator that I’m in for a tough go in the class. It often indicates that folks are being ‘told’ to attend and to “go Agile”, but who really don’t buy into the whole change thing. 

Where am I from?

I’ve started doing the following as part of my introduction in classes; heading them off at the pass so to speak. I’ll talk about my background. How yes, I’m an agile coach and trainer, so I’ve done some academic-oriented work: studying, reading, and the like. However, I’ve also spent 6 of the last 8 years as an internal Software Development organizational leader and agile coach. So, I’ve been living in the real world, with real world dynamics, challenges, and constraints. Given that, I’ve been able to generally make agile work in those contexts. Every idea or technique or practice or principle that I bring up, I’ve seen work in practice…in the real world.

Was it easy in all cases? Hell no. But did it “work”. Did it deliver in the “promises of Agility”? And the answer was yes. In fact, each organization that I was a part of transforming our customers, organization, and teams experienced significant benefit as a result.

So I try to tell students and attendees to listen with an open mind and not simply discount things because they might appear to challenge their current culture or practices. The key from my perspective is the open mindedness to simply consider Agility within their contexts. 

Another point being—I wanted to set the record straight that I wasn’t from another dimension or another planet. That yes, the last time I checked, I did live in the Real World.

Let’s get back to some specifics

So I thought it would be good to share some specific encounters of a “real world” kind. Here is a representative set of examples:

  1. But Bob, that whole notion of writing User Stories that are intentionally incomplete to drive feature/work conversations during the sprint sounds like a good idea. But around here, in the real world, I’m the only Subject Matter Expert who knows exactly what to build. So, I absolutely need write everything down well in advance. I don’t have time to work with the team and answer their questions in real-time. Heck that would be an incredible waste of my time.

  2. But Bob, I know the book says that we need an individual to serve as the Scrum Master and Product Owner for each of our Scrum teams. But I don’t have the headcount to go out and hire those folks. In the real world, I have what I have. So, we need to turn our functional managers into Scrum Masters and Product Owners (dual roles) for every 2 Scrum teams we have. Clearly it can’t be that hard to do these jobs—most of the responsibility is theirs already.

  3. But Bob, I clearly understand that our traditional metrics and project tracking will probably drive the wrong behavior in our agile teams. However, our C-level leadership and our PMO insist that we provide exactly the same metrics for our agile adoption as a means of measuring productivity levels before and after the adoption. Yes, we realize that they’re different, but we have no choice. The teams will just have to adjust to the fact that these real world metrics are still viable.

  4. But Bob, you must realize that we work in a fixed date & fixed scope environment. Our leaders will absolutely not accept a “We’ll know it when we see it” commitment level. That being said, we realize that agility struggles with this sort of commitment. How do we meet our real world commitment guarantees and still maintain our agility? Keep in mind Bob that we cannot negotiate or waffle on scope. We need to be able to make a 100% commitment and then deliver on that commitment.

  5. But Bob, this notion of a “self-directed team” seems to be central to the agile methods. However, we have a very seasoned management team that understands our business and technologies very well. There is simply “no way” we’re going to ask them to defer their opinions, directions, and accountability to their respective teams. Not in the real world. We feel that they are “good” managers that effectively delegate—so they already support “self-direction”. In other words, “trust, but verify”.

Why only 5?

But Bob, in the real world, there must be many more examples than you’ve provided of these sorts of exchanges. I agree. But I don’t want to be the only one offering the examples. I’d like to gather some from readers via comments.

Why?

Because I think we can learn quite a lot about agile adoption and transformation success by examining the resistance we regularly encounter. Instead of viewing resistance as such, perhaps we can learn from it, examine its root causes and drivers, and become better change agents as a result.

I’m also simply interested in hearing your stories. So, any “but, in the Real World” stories out there?

Thanks for listening,
Bob.

Don’t forget to leave your comments below.

Agile Transformation: The 3 Key Ingredients

Written by Salah Elleithy on . Posted in Articles. 3 Comments on Agile Transformation: The 3 Key Ingredients

“If you want to make significant improvements, work on paradigms. If you want to make small improvements, work on behaviors and attitudes”. – Stephen Covey, Living the seven habits

I always resisted wearing glasses thinking it will make my vision worse. When I started wearing glasses, I could see clearly now (Literally). It took an experience of wearing the glasses to shift my paradigm and change my mindset. 

Last year, I had the opportunity to attend an agile conference and the keynote speech was given by Jim Highsmith. He talked about adaptive leadership and he said: “agility is a strategic issue”.
As I listened to his phenomenal speech, I could visualize three overlapping flying wheels working in tandem.Salah May29 IMG01

Change initiatives usually start with the why. The purpose of undertaking such initiative. There must be a vision on why we are doing what we are doing. 

Once the vision is clear to some extent, the what and the how will follow. The “what” addresses what needs to be done to live the change we are envisioning and the “how” addresses the steps to be taken, the practices to be tried, the frameworks to be used and the processes to be implemented to make the change sustainable. 
This is not a linear process and we will most likely revisit the what and how and make sure they align with the why. At some instances, we may even have to revisit the why!

1. Why Agile?

Organizations are looking for better ways to become more efficient and more productive. Learning Organizations seek to continuously improve their product delivery process.

When successful individuals and/or organizations come to the realization that the way they are working is not working, they look for better ways of doing things. This is what happened when a group of developers came together and found the agile manifesto in 2001. The manifesto emphasized four different values which will be covered later in this article. 

Agile is not new however. In 1986, an article was published in HBR called “The New New Product development Game” by Takeuchi and Nonaka. The article highlights that in today’s competitive environment (in 1986 at the time), a holistic or ‘rugby’ approach- where a team tries to go a distance as a unit passing the ball back and forth will serve organizations better than the relay approach to product development which may conflict with the goals of maximum speed and flexibility. 

2. Being Agile?

Covey’s quote in the beginning of the article gives a hint on the most challenging aspect of any change initiative: Mindset. Ahmed Sidky (Dr. Agile) explains all about the mindset in one of his talks on agile mindset.

The purpose of this article however is to provide a few examples of what I believe can help organizations start reaping some benefits of living the Agile mindset:

Understand the Agile Manifesto

To be agile, companies must go back to the source and understand the values of the agile manifesto. 

Individuals and interactions over process and tools
Working Software over comprehensive documentation
Customer collaboration over contract negotiation
Responding to change over following a plan

That is, while there is value in the items on the right, we value the items on the left more.

Address the “Unaddressables”

Peter Bregman, the author of 18 minutes: Find your focus, master distraction and get the right things done calls the things that everyone is aware of but has not been addressed “The Unaddressables”. 

He reports that getting everyone together to address the “unaddressables” has proved to be very productive. This could be the first step towards building a culture of openness and honest feedback which is key critical for nurturing agile transformation initiatives.

Slow down to speed up

Reaching the point where people see the value of the change is very exciting. However, taking a step back every once in a while to take corrective actions and staying focused is important. Going full speed without taking time for reflection can be a recipe for disaster. In some agile practices, looking back at what is working well and what needs improvement is part of the process called “retrospective”. 

Bring ‘Silos’ together

Yes, the team may have been excited about the change but old habits die hard. Sometimes teams may revert back to their old habits when faced with a challenge. Specialized team members need to be committed to the transformation initiative. Continuous encouragement for collaboration and teamwork from the leadership team is a major aspect of the culture transformation agile needs to grow and blossom.

Maintain balance

Remember the agile manifesto values we covered earlier. This is where every organization has to find their balance. Review the agile values often to ensure that you are not going on one extreme or the other. As you noticed, there is some value to the items on the right but the items on the left create more value.

Measure

What is measured improves, says Peter Drucker. This can be challenging however it needs to be thought through to understand how to measure success so that results can be improved.

Learn to Unlearn (Inspect and Adapt)

Starting with a clean slate is ideal however it is rarely feasible. The idea is to promote a growth mindset culture. The idea is to strengthen the muscles for new habits which will eventually replace old habits.

3. Doing Agile

Putting it all in practice needs continuous nourishment. The ‘Doing’ part is another important ingredient that should not be left out.

Lead by Example

Strive to build a team to model the new behavior “the doing part” using existing processes/tools or acquiring new ones. This should address the frameworks/practices, relationships/structure and teaching/coaching (continuously raising awareness) and showing people how the process works.

Adopt a practice then evolve

Organizations who are new to agile usually adopt a practice and follow it (usually Scrum). It is critical to follow the framework/practice as is in the beginning without adding or deleting anything. (Refer to Shu Ha Ri)

At the end, there is no single prescription to change initiatives and every organization has to assess where they stand and what is working well for them. Sometimes, building on strengths is a more sustainable approach than trying to perform radical changes. 

It is one step at a time!

Don’t forget to leave your comments below.