What are the five questions you ask yourself as you embark on a major change for service improvement? This was the question that RCN Scotland asked me to address when they invited me to take part in the ‘Expert Express’ session at their ‘Activists Conference’ last week. It was a great question!
The thing I value most about being asked to speak at such events is that to articulate my view, I have to think deeply about subjects I deal with every day. This preparation and subsequent reflection on the audience response enables me to deepen my learning even further and, importantly, to stay fresh in my thinking. Here are my five questions and why I think they’re important.
What is the issue we want to address?
Getting to the heart of the issue helps to identify the best approach to take and who to involve. It’s a simple but crucial question, to enable a shared understanding of the situation to emerge. Most issues are multidimensional. Unravelling some of the complexity will help to identify how you can make the biggest difference.
What do we want to achieve, by when and how do we measure progress?
A good process is essential, but a word of caution…. aspects of change can be planned but others are best left to emerge from the bottom-up. Too rigid an approach can squeeze out humanity. Equally too little rigour or lack of metrics can leave change programmes meandering aimlessly. Both approaches create anxiety if used in isolation. You need both but in balance.
The ‘Plan, Do, Study, Act’ framework (PDSA) is an example of a planned but emergent (adaptive) approach. It creates a safe space for teams to test interventions and modify them in light of experience.
How do we get the right people involved?
Had to be in my top five. If leading large scale change it will be worth carrying out a stakeholder analysis to design how best to involve people with different interests at the right time. Appreciative methods work best in identifying the strengths of the current situation. Teams are often left feeling that what they currently do is of no value. In reality it’s the system and/or environment that’s changed which, in turn, requires people to adapt or build on their current approach.
How do we contextualise the change and communicate it in multiple frames?
So much change nowadays involves bringing diverse teams together to work on a shared agenda. People from different backgrounds have unique histories and versions of reality. Creating the conditions for honest reflection enables them to acknowledge for themselves that they don’t share the same perspective and imperatives. Surfacing the issues can have a levelling effect. When the power base is equalised people are more likely to move forward together.
What impact will this change have on the system as a whole?
Taking a ‘systems perspective’ enables teams to view what they do within the context of the organisation as a whole. Changing one aspect of the service can have unintended consequences for another part of the system. The ‘Six Dimensions of Quality’ Framework is a helpful lens for considering the impact on the whole system. Value stream mapping (process mapping) helps you to look at how the system works from the client’s perspective. It highlights blocks and how best to overcome them.
And then there is the Transition…
Identifying the way forward, however, is only the beginning. Navigating the transition creates a different kind of energy. Having a deeper understanding of human transitions theory helps you to have the right kind of conversations until equilibrium is restored. And it will be. People have an amazing ability to adapt.
Just don’t expect the end state to be exactly as you had planned. The intricate interplay of people within a complex social system means that change programmes are rarely law-abiding. Something usually gets in the way, but if the end point is close to your aim for improvement then you are probably doing quite well.
What would your five questions be?