Tag Archives: culture

What’s in a Story?

It was just another Wednesday morning….. moving from meeting to meeting, maneuvering the ruts that the recent snow storm had left, and thinking about what was next on my list of projects, and how much work awaited me as I returned to my office. As I walked down the halls (perhaps it was the air of familiarity in my pace and the briefcase in hand that made them ask), I stopped briefly as I heard someone call out – excuse me…. can you help.

I stopped in my tracks….. a bit disappointed with my own lack of attention to my surroundings. There she was, an elderly woman with tears in her eyes and the sound of fear in her voice. She was trying to find her way; probably because a loved one or her husband of many years had just been brought into the hospital or had taken a turn for the worse…. She was alone and distraught and wasn’t able to follow the directions she’d been given by our switchboard. I looked at the piece of paper in her hand and started to offer her directions…. and immediately thought WHAT ARE YOU DOING….. nothing at this moment could be more important than helping this woman to get where she needs to be. So I stopped and said, why don’t I just accompany you to where you need to go. As we slowly walked down the hallway and we talked, she apologized for the ‘rust on her brain’ that morning. I re-assured her, and let her know that she had no need to worry – we’d get where she needed to be and we all have some rust that needs shaking off first thing in the morning. With others around I didn’t feel comfortable asking her to relay her story, or to ask why her brain was rusty that morning. BUT we safely got to her destination and her thanks and her touch on my arm as we parted said all that needed to be said….. When we forget that the most important part of what we do each day – is to take the time to walk with a patient or family member and help them navigate the unfamiliarity of our culture….. I’d say, we’ve lost our way.

Did it work? Was my story memorable? Was it easy to understand? Did I tell too much or too little? Was it believable? ‘Rememberable’? Entertaining? Did you identify with the character? Did it as Rossiter suggests, stimulate your empathetic orientation and provide a basis for both cognitive and emotional responses. Did it allow you to experience the story and the world views of another? As Rossiter suggests, there is power in stories, they can lead to experience based, constructivist pedagogy (p 1).

It was with my continued search for how we transform our cultures that I came across the work of Lamsa and Sintonen this week, and their advice that:

narratives are useful tools for interpreting and transforming abstract values into an understandable and rememberable form at the practical level among the organizational members. (p 108)

These narratives help us to reflect upon the type of organization we want to be. Perhaps they help us to move past single loop learning (stay tuned yet another post coming on that topic)….. and change our assumptions about the way things are done around here. I’d hope that anyone in my organization would have done the same thing on Wednesday morning OR, that they’d relate to my story and think a bit differently the next time they are faced with a similar situation. I didn’t save a life on Wednesday, it was just another day at the office – BUT, I hope my actions made a difference.

If I were creating the banner that hangs at our front entrance, I’d hope it would simply say – ‘our team is here to help when you need us’.

As  Lamsa and Sintonen suggest:

narratives not only define who we are but also what kind of an organization and what kind of people we should be. Thus they also tell us about the wishes, aims and morals of an organization. The participatory narrative enables the members of the organization to commit to self-reflection, and it serves as a method for their learning. (p 108)

A few years ago, our culture started down the path of the importance of stories. In the portfolio that I was part of, we started every meeting with a story. BUT, we’ve become so busy as of late, that we’ve started to slip back to old ways and old habits. As with anything, cultural changes are only sustained with continued dedication…… So, after my readings and critical reflection this week, I’ve sent a note to my teams and have updated our meeting agendas…… 1.0 on the agenda  now reads: positive stories of the week & thank you’s. As I talked about last week, it’s time to start ‘acting’ my way into it again :).

That little yellow challenge flag has been thrown…..Thoughts? Ideas? Your story?


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Can we become the culture that ‘learns the fastest’?

I recently spent some time in a beach chair (after a busy day on the golf course), reading a bit more about organizational culture. What does it mean? Why is it important?  And why do some organizations seem to drive excellence while others have a ‘that’s how its done around here’ attitude?

According to Glisson (2007) “a number of studies in various types of organizations link culture and climate to service quality, service outcomes, worker morale, staff turnover, the adoption of innovations, and organizational effectiveness (p 739 )”. For example, when we enter a hospital and a banner greets us that reads – the employees and physicians of X welcome you to our institution (FYI – this is a real life example) – we know we’ve likely hit upon a site where culture creates a sense of purpose and a feeling of family….. where people are valued for their expertise, where the stories we tell about colleagues are positive and supportive.  So what do they do differently at a place like X to create the type of culture we all hope to have?

With my own interest in healthcare, I loved the bold statement from James Anderson (retired CEO of Cincinnati Children’s Hospital Medical Center)….. who publicly declared that their organizational aim was to ‘become the organization that can learn the fastest’ and their goal is to ‘be the safest hospital’. Now that’s a leader with a clear vision of what a culture should be. A leader who models the change he wants to see. He and his team have defined excellence in their culture.

Changing corporate culture is difficult. According to Beer & Nohria about 70% of these cultural changes fail – mainly because we immerse ourselves in ‘an alphabetic soup of initiatives’…. I’m sure we all have organizational stories of our ‘flavor of the day’ initiatives where our employees just keep their heads down and wait for the next flavor, OR stories of the plethora of projects we ask our staff to take on at one time – with no additional resources or a firm commitment to stay the course and measure outcomes. BUT change is a topic for another post, so I’ll return to a focus on culture.

The signs and symptoms of an unhealthy culture (according to FCC) include a:

lack of teamwork; poor communication; siloed behaviour; infighting and competition for scarce resources; unclear objectives; overly complex customer interface; and blame, finger-pointing, fear, and mistrust. Organizations may do well on the bottom line in the short-term despite problems with the culture, but in the long-term an unhealthy culture leads to poor performance. (p 3)

Ultimately, the old adage that culture trumps strategy – is true….. the best strategy in isolation will fail every time.  I like the idea that culture isn’t “what we say, it’s what we do without asking”. “Where a healthy culture allows us to produce something with each other not in spite of each other” according to Nilofer Merchant.

What does it say about a culture, when on your first day of orientation, the CEO and Senior Leadership Team meet each new employee and say this is ‘how we do things around here’….. its our culture and the expectation of each of us on the team at FCC. Now that’s a culture that gets recognized and one where people say, I want to work there.

So….. what can WE do in our own organizations to transform our cultures?

There is a lot of great advice out there on leading cultural reform. For me, what resonates is the data specifically related to healthcare transformation. Back at James Anderson, building a culture of reliability includes things like: constantly asking why, a commitment to resilience, front line leaders rounding daily with staff giving 5:1 positive to negative feedback …..these are just a few of the examples you’ll find (on their website) of a transformed culture.

Christine Daley endorses the attitude of Anderson, and identifies that health care organizations often have trouble learning from our failures and using what we learn to make sustainable change. She quotes Senge and his belief that organizations have to strive to become learning organizations (or perhaps better described in my last post as those who practice organizational learning).  As Senge suggests, this process is one “by which individuals continue to expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free and where people are continually learning how to learn together (p 26)”.

What I’ve found, is that we are trying to change our culture of blame….. but so far, we have only created pockets of safety for our staff, it’s not safe everywhere and with everyone – we still have lots of work left to do. We often forget that practitioners are usually devastated by an error, sometimes they never recover. And rather than support them because we know it was the system that failed and not the well-meaning individual; instead we remind them constantly that they were the cause…. BUT, its hard in an industry when errors mean harm to the patients we work so hard to protect. When our errors end up on the front page of the paper and in a court room where the outcome is still to assign blame and cost.

It would be great if jargon like collaboration, innovation, creativity and continual self-transformation and learning could be terms that we take to heart in our healthcare cultures. I paused when I read Daley’s example of ‘knowing less than our individual members’ – where nurses are aware of new research that would enhance patient outcomes but are asked to work according to outdated organizational policies and practices (p 27). These comments were front and centre for me at a meeting this week, where we talked about specific policies that we are working on and the need to stop the ‘continuous tweaking’, that we should be satisfied with what we’ve got and move on to other and more important things. I wanted to say, stop, but, but, but….. there must be a way for us to continuously adapt our culture. We can’t just move on and be satisfied – but, being new to the committee I stayed silent (and thought yep, this IS how we do things around here)….

I  subscribe to Daley’s ideas of how we bring organizational learning theory to patient care:

Perhaps these themes (specifically adapted to our culture) will help us to see that organizations that practices continuous learning are likely also the ones that see cultural transformation.

Conceivably what’s working at FCC, can also be the 7 steps that will lead reform for us in healthcare:

  1. Identifying a need for change
  2. Establishing and articulating the vision
  3. Enlisting the appropriate help
  4. Leading from the top
  5. Communicating to engage all
  6. Sustaining the new culture
  7. Measuring progress

If it was/is possible at FCC, I believe that we all have bright people in our cultures who can also make it possible. When I look at my own culture (with my rose-colored glasses on),  I choose to believe we have: identified the need for change (#1), enlisted the external help that we’ll need (#3) AND I am hopeful that our leadership team holds ourselves as accountable and responsible to lead the change (#4). Now its up to all of us to ‘act our way into it’ as you’ll see next.

When I’m struggling to find a way to innovate or see my way to the end, the IHI (Institute for Healthcare Improvement) is often my guiding compass. This summer, they published an article that told me that creating a culture of excellence is not as difficult as we might think. They recommend that we ‘act’ our way into it…. that new cultures are not planned out on paper, but are acted out over time. They offer that there are a few ‘vital behaviors’ that create desired results – perhaps for front line staff it’s always asking for help or that leaders will visit the front lines every day….. but over time, if we all ‘act’ the same way and our teams see that this is the new normal, we’ll create a new attitude in our workforce. According to IHI, gone will be statements like ‘well those things just happen’ and ‘we’re not like them’ and instead we’ll hear ‘how could we’ and ‘why don’t we’ ( p 69).

It seems like a pretty simple theory…

It makes me think about the famous quote that many people have at the bottom of their e-mails that reads…. ‘be the change you want to see’ (Gandhi). And here I’ve been the one skeptical of those canned quotes…. seems they are effective after all.

SO….. that’s a lot of surmising (from a beach chair), but it has given me a new energy for what’s ahead and a bit of personal CPR for where our organizational culture is going. What about you – are you willing to ‘act your way into’ a new culture where we commit to ‘learning the fastest’?


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‘Knotworking’…. not to be confused with not working

My mission this week was to start reviewing the work of Tara Fenwick on workplace learning. My intentions were good, I downloaded a variety of her research and then made the mistake of starting with the article with the most interesting title “Organizational Learning in the Knots “. The metaphor of ‘knotworking’ resonated with me. I liked the idea of a focus on discursive practices (how cultural meanings are produced and understood), where learning happens via inter-organizational collaboration, and the potential to create cultures where expertise trumps hierarchical structures.

It seemed like a theory of learning that might help us thrive in these times of supercomplexity (that I talked of last week). I also agreed that it is a strategy that has already been observed and has the potential to be effective in healthcare practices.

So I was off…. there must be more written on a concept so easily to visualize. How did/do Engestrom and his colleagues define this concept?

Knotworking is characterized by a pulsating movement of tying, untying and retying together otherwise separate threads of activity. The tying and dissolution of a knot of collaborative work is not reducible to any specific individual or fixed organizational entity as the center of control. The center does not hold. The locus of initiative changes from moment to moment with a knotworking sequence. (1999)

Professor Yrjö Engeström, recently spoke of ‘knotworking’ as a space where separate actors can quickly come together and tie a knot and work together and solve a problem or design a task in the most efficient way possible (IFLA August 2012). He spoke of using the concept to transform our work cultures – allowing workplaces to be more flexible, fluid, and agile. The ability to form evolving partnerships and to work more closely with our clients.

The concept requires a shift in how we think about teams and our traditional organizational cultures. It requires managers/leaders to give up control and empower those around them who have the expertise. As Blackler and McDonald found, we must act in ways no longer bounded by the knowledge, practices and relationships that normally regulate our work. Decision making becomes less hierarchical; we create new cultures that moves across boundaries sideways – instead of having to ask for permission from above (Engestrom lecture).

Those who thrive are those who are tolerant of less structure, those able to tolerate the permeable open shape and everyday improvisation (according to Fenwick). It’s a self-reflexive process – where those moving in and out of knots are able to shape their own environment, rather than having it shaped for them. Knotworking also recognizes that in today’s society, expertise is often not held at a local level and is often inter-organizational. It encourages us to ask the question – who best to address this problem/opportunity – moving experts in and out as needed. And its a society where patients/clients are partners on the team – we actively listen to their perspective and what they might want from our service or product.

For those better able to visualize a concept graphically, Blackler and McDonald, help us to think of ‘inter-subjective’ sense making and identify quadrant four on their diagram (a rather new addition to org. learning).

The diagram addresses the complex collaborative requirements of today’s workplace and the importance of lateral, rather than hierarchical relations in the organization of technical work…..

There were a number of interesting accounts of knotworking in educational and healthcare practices that I reviewed, but I was best able to visualize its use when I listened to Engestrom speak of this concept used to examine the role and future of the academic library. The traditional home of knowledge. Where learners and researchers had previously gathered BUT where chairs now often sit empty. He spoke of how researchers have disappeared from the physical space and how they now sit at home retrieving sources and texts on-line. That the relationship is now often anonymous and the expertise of librarians is often underutilized….. he spoke of how all stakeholders had agreed that traditional services weren’t working and that a new concept with new ways to serve customers was needed.

So if the historical library evolved, what might a knotworking library look like?

What the group envisioned was that the client would become part of a research group – no longer an individual but a partner in co-configuring ongoing services. The role of the librarian would not be static but they will move from group to group and create knots to solve problems in a rapid and fluid manner. They’ll offer expertise where needed on resources, data management, publishing activities, while still providing traditional student services, etc. Everyone agreed that it will be demanding work, it will require quick learning and the ability to quickly adjust to new tasks, new clients and new groups – however it has the potential to be extremely rewarding work and it becomes a continuous learning process.

That example, helped me reflect on the practical application of this model and metaphor.

SO NOW WHAT: As I tell my own students…. break it down, pick just one thing that you can reflect upon and use to positively impact your practice.

For me, as I researched and reflected on the metaphor, I had many examples where teams that I’m involved with are approaching ‘knotworking’ and opportunities where we can take this to the next level….. However, one nagging relationship kept creeping into my thoughts. A situation where the knot is  double or triple tied …. it’s the knot that just won’t give way; there is no option for the ‘pulsating’ movement of tying, untying and retying together. No wonder that this is an area of discomfort, where we continue to have ‘conflict’ and ‘mis-communications’.  I’m seeking fluidity, I’d like to see these employees move in and out of our teams, take ownership, address the needs as they arise…… and this team is still embracing current hierarchical culture. More comfortable with Fayol’s traditional  management style – plan, direct and control activities – following traditional discursive practices. Perhaps what’s needed is a new approach – an understanding of the tensions. A meeting with this manager to ask how we might encourage more flexibility, support to adjust the locus of control to where the work is being done…. a time to pilot a few new practices.

Why not, for this group perhaps we can change what’s not working into ‘knotworking’…..

I think the concept has promise in today’s cultures where we are learning to work and working to learn….. what about you?

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