From Davis Balestracci -- "But THEY are going to..."

Published: Mon, 09/28/15

From Davis Balestracci -- "But THEY are going to..."
[~925 words – take 4 to 6 minutes to read over a break or lunch.]

Group Accountability

Hi, Folks,
Dealing with individuals is one important aspect of culture change, and I addressed individual accountability last newsletter.  But every organization also has many tribes (departments) -- specific groups of individuals -- that make up its culture.  When changes affect departments, the issue of stated reason versus real reason once again emerges, the most common 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 is refreshingly rooted in reality with none of the usual patronizing "Oh, go on, just do it!" platitudes of most books on culture change.  Its practical, spot on view of a typical workplace environment was seminal in helping me understand and deal with the 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

Begin by having a group identify a difficult issue.  In my seminars of quality leaders, I've found that a good one is to identify the problems they run into with various groups/departments when trying to implement the results of a project.  In a healthcare environment, groups typically mentioned are physicians, nurses, medical support staff, middle managers and executives.  I ask them to:

1.  Allocate the 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 one on a flip chart.
  • They said…, They did…, They forgot…
2a. Admit what behaviors they themselves exhibited that might not be helpful.
  • I forgot…, I thought…, I neglected…
Time out:  I once had a class of 30 nurses in an emotional intelligence class I was teaching using Faith’s book.  One nurse suddenly blurted out, “I’m sick and tired of not getting any respect from physicians!” to which I could hear the “yeah, yeah” murmurings 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 around 85 percent, although a non-trivial number said 90 to 95 (one even said 100!).  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 pages of flip chart paper.  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.

I then proceeded to step three by stating:

3. “You are now 100 percent responsible for the situation.”

This step consists of going back to revisit each listed behavior and asking the group, “What could you have done that would prevent this from happening?”
  • They said…
    • I could have said…
  • They did…
    • I could have looked…
  • They forgot…
    • 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 don’t do the behavior that would prevent the situation.
  • Didn’t have skill, time, permission, willingness, etc.
As this dialogue proceeds, determine which of the reasons are: (1) based only in a perception of fear and (2) 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.  Since 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.  Any 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…

“Those darn humans – God bless ‘em!”

Fear of physician retaliation was a very strong cultural belief that experience had reinforced, making it a cultural handcuff.  Since 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! -- How do I create experiences that will change that belief?  As you think about that, if "But THEY are 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.

Until next time…

Kind regards,

P.S. Chapter 3 of Data Sanity expands many of Faith Ralston's ideas and includes another of her key tools for defusing emotionally charged situations.  It also provides a common language that would improve the quality of organizational communication with executives and middle managers when discussing your improvement process.
  • To order the e-book
    • MGMA site only (shortly to be available on Amazon)
Might you consider a  one to two day leadership retreat  with safe dialogue using the content of Chapters 1 to 4 & 9 to design a robust implementation process and reduce the inappropriate confusion, conflict, complexity, and chaos due to data INsanity and the "plague of vague"...and flesh out the critical mass of 25-30 percent of execs crucial to success?

Do you need a plenary speaker for an internal or professional conference  or some mentoring to help you "quantum leap" to a new level of eye-opening effectiveness or create the 25-30 percent critical mass above?

As always, I welcome contact from my readers with comments or to answer any questions.
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