improvement: the human side · improvement: the human side christine shea, med, phd institute for...
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Improvement: The Human Side
Christine Shea, MEd, PhDInstitute for Health Policy, Management and Evaluation,
University of Toronto
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“Did you ever feel like you’re part of something greater thanyourself?”
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Today’s Objectives
• Understand the difference between technicaland adaptive challenges
• Apply a theory of human performance
• Identify and understand resistance to change
• Address resistance using a positive andproductive approach
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Why I’m here
Secret Weapon in Improvement
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“I have a hard time finding a balance between work andwork”
Why bother?
Trying to make things betterBUT
It’s really hard!!FrustratingDraining
DemandingStressful
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Why bother? Complexity
• Ever increasing system complexity
– Technology, people, processes
– Macro, meso, micro systems
– Variety of levels of accountability
The secret of evolution is variation, which inorganizational terms could be calleddistributed or collective intelligence.
The Theory Behind the Practice: A Brief Introduction to the Adaptive Leadership Framework, R. Heifetz, A Grashow, M LinskyThis chapter wasoriginally published as chapter 2 of The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World, (2009) Cambridge LeadershipAssociates.
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Complexity in Healthcare
TDay
Patient
Hospital
Primary CarePhysician
Family Care Givers
Physical orOccupational
Therapist
Nurse
Personal SupportWorker
Pharmacist
Case Manager
Day CentreProgram
Technology, Drugs etc.
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Healthcare is evolving: adapt
• Propagate
• Adapt
• Experiment
• Diversify
• Re-organise / loss
• Time
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Work Avoidance
• Response to change– Fear of the unknown
– Lack of control…
Resistance
• Understand sources
of resistance
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How to thrive?
(R.M. Yerkes and J.D. Dodson 1908)
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Performance in Progress
Productive Range
Limit of tolerance
TechnicalChallenge
Time
Ten
sio
no
fch
ange
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
Adaptive Challenge
Threshold of learning
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Flourish or Perish
ProductiveRange
Limit of tolerance
Time
I understand we need to change.I trust you and I’ll help.I understand what I need to do.
I don’t want to hear any more bad news.I can’t make sense of any of this.I am so terrified I don’t understand aword you are saying.
Just tell me what I have to do …
Threshold of learning
Based on and adapted from R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
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What people won’t tell you, theirbehavior reveals
Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
Productive Range of Tension
DistressBlame others, distract attention, denial
DistressBlame others, distract attention, denial
Productive Range
Threshold of learning
Limit of tolerance
Time
Ten
sio
no
fch
ange
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“To thine own self be true”*
• Hot or not?
– What resistance strategies have you noticed in others?
– What are your resistance strategies?
– What triggers your resistance?
*From Hamlet; Polonius Act 1, Scene 3
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Work Avoidance/Resistance
• Displacingresponsibility
– Attack authority
– Kill the messenger
– Scapegoat
• Denial
– Keep smiling
– Keep smiling
– Keep smiling
• Distracting attention
– Pretend to be busy
– Define problem to fityour competence
– Make the problem toobig
– Restructure/reorganize
– Meetings with onlyinformation exchangewhen engagement isneeded
– Pick a fight
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Balcony to Dance Floor
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Today’s Take Away
• Technical vs Adaptive Challenges
• Resistance
• Productive range of tension
• Balcony and Dancefloor
For more information feel free to contact me: