Davis Balestracci
Published: Wednesday, October 14, 2015 - 16:00 As most of you know, one of my mantras for change agents is, “Those darn humans! God bless ’em,” i.e., don’t be surprised by anything. People never seem to mind change... for other people or departments.
Ever heard this: “It’s about time someone did something about that. They really needed to change. Of course, here’s why that doesn’t apply to me.” (Suppress the urge to strangle.) Joseph Juran did an excellent video series during the 1970s called Juran on Quality Improvement, based on the ideas in his classic book Managerial Breakthrough, Revised Edition (McGraw-Hill, 1995), which is well worth reading. 3M had several copies of the videos, and I think I wore one set out. Combine Juran’s empirical practicality with Deming’s improvement theory, and you’ve got a dynamite combination. Juran taught me a lot about applying improvement tools appropriately. However, the most important thing I learned was quite unexpected. These are the resources that finally shed light on something that had been puzzling and frustrating me, which Juran formalized, calling it “resistance to change.” He separated any project into two pieces, the diagnostic journey, from symptom to diagnosing cause; and the remedial journey, from cause to implementing the remedy. He made the point that these have entirely different objectives, use different skills, and may even require different people. Dealing with resistance to change was a major piece of the latter journey that he felt needed to be formally addressed as part of any project when implementing its results. Yet as I witness project presentation after project presentation, I see resistance to change either glossed over, dealt with reactively in an ad hoc manner, or not managed at all. When you are witness to presentations like these and people tell you that groups were immediately accepting, don’t believe it for a minute! A handy piece of wisdom is Juran’s concept of “stated reason” vs. “real reason.” What people say when challenging a project result may not be the real issue. Many times, it’s a smokescreen either to distract you or make you go away. Three everyday examples from my experience: Another mantra for a transforming culture: The only person you can speak for is yourself. 2. In the early days of guidelines, one could virtually guarantee that at the initial presentation, the reaction from a group of physicians would be angry “Cookbook medicine!” Was this true, or was the real reason a perception of a deeper threat to autonomy, status, and importance? Something I’ve learned from my personal development and spiritual reading: Strong reactions are never for the reasons one thinks. Angry reactions in response to a proposed change are virtually never for the obvious (stated) reasons. Juran taught me that any change is a threat to something. There is the change itself and the social consequence of the change—the latter is an uninvited guest and your troublemaker. Until the perceived or real threats are named and dealt with, your project is going nowhere. 3. Physicians are feeling assaulted from all directions to become more productive and increase their patient satisfaction. With the increased use of statistics, especially statistical process control charts, poor, inappropriate analyses are presented to physicians to rank them and expose the “bad physicians.” Predictably, physicians’ initial reactions are defensive to the tune of “The data are wrong,” or “This isn’t in line with rigorous double-blind clinical trial research.” Stated or real? I have done many grand rounds for various physician groups, and when I show them the correct way to analyze such data—which, by the way, isn’t in line with rigorous, double-blind clinical research—they get it. They feel that if data were presented to them in this fashion, they would gladly deal with it collegially. Resistance is “disgustingly normal.” Resistance to change is predictable and should be anticipated with a formal plan. Juran gives several wonderful rules of the road to help, which I have covered in Chapter 8 of Data Sanity, 2nd Edition (MGMA, 2015). My next column will take the accountability theme of my last column one step further to deal with group victim behavior (especially the resulting stated reasons): “But ‘they’ are going to [fill in the blank].” Remember: Keep your radar tuned for stated reasons, which people may sincerely think are real reasons and state with heartfelt emotion. However, you won’t be fooled and can now begin to intuit what the perceived threats may be. 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.
Management What People Say May Not Be What They Really Mean
Until threats are named and dealt with, your project is going nowhere
Strong reactions come from perceived threats
1. A physician on an executive team was from the old-school belief system of physician entitlement. At any hint of physicians having to give up power to create more cooperation between executives and physicians, she would blurt out, “The physicians would never go for that!” After about a half-dozen outbursts like this, it was clear: She would never go for any perceived threat to entitlement and was putting up a smokescreen by hiding behind “the physicians.”
• Strong reactions are never for the reasons one thinks—and these could include your strong reaction to their strong reactions.
• It’s in the interval between the stimulus and response that the leader emerges.
About The Author
Davis Balestracci
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Comments
Change Resistance
It should also be noted that change "resistance" is not always what it appears to be. In one instance, a manager proposed certain procedural changes. The implementation team recognized that a similar plan had been unsuccessfully attempted before and suggested certain changes to address problems that had been encountered before. The manager labeled the team members suggesting changes as change resisters and subsequently as change saboteurs when the procedural changes did not produce the desired result.
In another instance, a management team adopted a productivity software package w/o consulting any users until after procurement was complete. Despite being told that the software was critically, perhaps even fatally flawed, when applied to the agency's existing business model and procedures, management insisted on a system-wide rollout. One of the flaws of the system was that it benefited one department by making other departments do all the data entry for the system. The departments doing the data entry not only got no immediate benefit from the data entry, they also still had to maintain existing paralell systems for their managers and received only limited and poorly defined benefit from the new system several years in the future. Yet management labeled the failure of the software package the result of "change resistance" on the part of the other departments.
Now don't get me wrong, I am all too familiar with change resistance. I have had to manage change resistant employees; and, I have had employees sabotage changes. As managers, however, we cannot hide behind the excuse of change resistance when we shoot ourselves in the foot.
Six Sigma is Easy. People are Hard!
People are excuse-making machines.
In healthcare, I find that people use "patient safety" as both a reason to change and a reason to avoid change.
People will challenge the data, challenge the analysis, challenge anything they can to avoid having to change how they do things.
We know from neuroscience that after a while, how we do things becomes hardwired in the brain.
So we first have to unlearn and unwire the old connections to be able to learn new ones and grow new neural pathways.
Every team has three players: dreamers, realists and critics.
Dreamers can see the future. Realists can implement it. Critics can tell you everything that's wrong with it.
Some critics want to avoid a failure of a change. Others want to prevent it.
The latter are the corporate immune system; they try to kill anything new and improved.
To succeed at Six Sigma, learn how to wrangle the critics.
And most people fail to anticipate the costs of not improving their work.