‘But They Are Going To...’

Understanding group accountability

Published: Monday, December 21, 2015 - 15:28

Dealing with individuals is one important aspect of culture change. I addressed this in “How Does Your Organization Define Accountability?” Every organization has many tribes (i.e., departments or specific groups of individuals) that make up its culture. When changes affect departments, the issue of stated reason vs. real reason once again emerges, the most common response being, “We’re in favor of this, but they are going to....”

Faith Ralston is a colleague and dear friend of mine. Her landmark book, Hidden Dynamics (AMACOM, 1995), is refreshingly rooted in reality with none of the usual patronizing “Oh, go on, just do it!” platitudes of most books about culture change. Its practical, spot-on view of a typical workplace environment was seminal in helping me understand and deal with daily predictable emotions as well as those triggered by change. 

One of her exercises is particularly effective. She calls it “Accepting Responsibility for Your Own Life” (with credit to John Enright). I’ve adapted it to the 100-percent responsibility exercise.

100-percent responsibility exercise

Begin by having a group identify a difficult issue. From my seminars with quality leaders, I’ve learned that they need more practice in identifying the problems they run into with various groups and departments when trying to implement the results of a project. In a healthcare environment, typically the groups are physicians, nurses, medical support staff, middle managers, and executives. I ask them to:
1. Allocate 100 percent of the blame among the groups.
1a. Admit what percent of the blame they themselves are willing to accept for the situation.
2. Describe the specific behaviors they’ve encountered from each of these groups, and list every behavior on a flip chart (e.g., “They said...,” “They did...,” “They forgot...,”).
2a. Admit what behaviors they themselves exhibited that might not be helpful (e.g., “I forgot...,” “I thought...,” “I neglected...”).

I once taught a class on emotional intelligence (using Hidden Dynamics) to 30 nurses. One nurse suddenly blurted out, “I’m sick and tired of not getting any respect from physicians!” to which I could hear murmurings of, “Yeah, yeah,” from the rest of the class. 

So I asked the group, “What percent of this situation would you say is the physicians’ fault?” Most thought it was about 85 percent, although a nontrivial number of nurses said 90 to 95; one even said 100 percent! But they finally reached consensus on accepting 15 percent of the blame for the situation.

When I asked for descriptions of the behaviors they encountered, they filled five flip-chart pages. I then asked for the behaviors to which they themselves were willing to admit contributed to the situation, and, if I remember correctly, there were five behaviors.

I then proceeded to step three of the exercise by stating, “You are now 100-percent responsible for the situation.”

3. This step consists of revisiting each listed behavior and asking the group, “What could you have done that would have prevented this from happening?”

So as you address “They said...,” “They did...,” and “They forgot...,” ask them to finish statements such as “I could have said...,” “I could have looked...,” and “I could have stopped....”

As soon as I mentioned the need to assume 100-percent responsibility to the nurses, I heard a collective group gasp. Yet, as I revisited each physician behavior, there was something they could have done to prevent every one.

4. Without judgment (very important), ask them to be honest and admit why they failed to take the action or exhibit the behavior that would prevent the situation (e.g., they didn’t have skill, time, permission, willingness).

As this dialogue proceeds, determine which of the reasons are based only in a perception of fear and which reasons are true cultural handcuffs that any individual nurse knows would be futile to attempt to address on his or her own.

Cultural handcuffs must be formally exposed and dealt with

Cultural handcuffs are the troublemakers to change in any project’s remedial journey. Because they are implicitly tolerated as part of the everyday culture, no individual can easily deal with them. They need to be formally exposed, named, and dealt with. Dealing with cultural handcuffs will take a group effort (and usually an interdepartmental effort) that may even require scripting an appropriate response.

Any attempts by an individual or group to respond in the agreed-upon manner must then be consistently reinforced and supported regardless of any office visited by any affected party. Attempts to force discipline on such appropriate responses need to be used as “teaching moments” to establish the cultural belief that “past behaviors sabotaging an important solution are no longer being tolerated.”

One nurse said, “You know, if you did this with some physicians and got them to take 100-percent responsibility, we could then have a great dialogue,” to which I replied, “BRAVA! Who would like to be part of a group to do that?” Dead silence. Fear of physician retaliation was a very strong cultural belief that experience had reinforced, making it a cultural handcuff. Because no other groups wanted to supply interdepartmental support for a potential effort, the existing culture once again triumphed. 

What are your cultural handcuffs regarding project implementation, and what beliefs do they telegraph? Ask yourself, “If we allow that belief to continue, will we be successful?” If the answer is “No,” use a QBQ! (A question behind the question): “How do I create experiences that will change that belief?” As you think about that, and “they’re going to...” happens to pop into your head, I think you’ll know what to do.

If you try this on a problem, let me know how it went.

About The Author

Davis Balestracci

Davis Balestracci is a past chair of ASQ’s statistics division. He has synthesized W. Edwards Deming’s philosophy as Deming intended—as an approach to leadership—in the second edition of Data Sanity (Medical Group Management Association, 2015), with a foreword by Donald Berwick, M.D. Shipped free or as an ebook, Data Sanity offers a new way of thinking using a common organizational language based in process and understanding variation (data sanity), applied to everyday data and management. It also integrates Balestracci’s 20 years of studying organizational psychology into an “improvement as built in” approach as opposed to most current “quality as bolt-on” programs. Balestracci would love to wake up your conferences with his dynamic style and entertaining insights into the places where process, statistics, organizational culture, and quality meet.