Just stumbled over an article sharing observations of a "bottom-up change" in two hospitals (https://hbr.org/2019/02/how-to-orchestrate-change-from-the-bottom-up). One was successful, the other not so much. Why? Medical doctors are not good at #humility either. This is a rather sad example of how a #transformation succeeds.
When colleagues (in this case medical assistants) where assisting doctors and trying to influence them to adopt to new ways with velvet gloves on, the change was more successful. “Favor lists” were used for example to prevent that the doctors are feeling threatened by the demand for change in their practices, and keep their ego intact.
I am thinking about teams who are ready to self-organize but their boss is not ready to let go. I believe, some of the tactics which helped to bypass class conceit with medical doctors might help when we try to transform leaders into agile leaders.
To me this is a perfect case illustrating the effects of a lack of humility in general within an organization.
So, velvet gloves on?
About the study: In a recent article in HBR, Kellogg, a Professor at the MIT Sloan School of Management, wrote about her ethnographic study of the primary-care departments of two U.S. hospitals which attempted a bottom-up change approach. Kellogg accompanied the two hospitals for two years, following their development in the change process by observing day-to-day work and interviewing the employees.
The hospitals were to implement the patient-centered medical home (PCMH) reforms. Doctors have to move from a reactive care to prevention and use evidence-based guidelines to treat patients with chronical illnesses.
About the findings: One hospital achieved a much higher adoption rate for PCMH practices than the other (unfortunately not all numbers are quoted in the article). As the most significant factor, the author identified the aid of a medical assistant. A medical assistant brings the patient from the waiting room to the exam room and do some pre-work, being in a central position within the doctor`s workflow. This is referred to as a bottom-up support.
One of the effective tools, the medical assistants were given are “favor scripts” to help persuade the doctors to implement the changes. They would quote: pose the change as something a doctor could do as a favor to them (“It’s very helpful for me if you would…”) as opposed to being a policy imposed by management (“We need to do this…”).
This way of “leveraging the structural power of low level workers to push change from the bottom up”, which also included to remind doctors, spread the word about successful doctors among others, is where Kellogg sees the key for a successful change.