Creating organizational support for change.

When we lived in the mountains of Colorado, the deer regularly ate our plants, shrubs, and cherished crimson bush. Many solutions were recommended. None of them worked. Finally we were told that distributing chicken feathers around the plants would keep the deer away.

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We bought and distributed 40 lbs. of ground-up chicken feathers. They smell bad, especially when they are wet. However, they seemed to work. No deer came to eat our shrubs during April, May, or June. Therefore, we bought and distributed more ground up chicken feathers.

That year we had experienced a very wet spring. Apparently the deer had plenty of other wild food to eat during April, May and June. When that food disappeared during the dry month of July, however, the deer came, stood in the middle of the ground-up chicken feathers, and ate our well-watered shrubs.

Because two things have occurred simultaneously does not mean that one causes the other. Believing that the same relationship will occur in the future is called superstitious learning. What are you or your organizational leaders continuing to do because "it worked back then?"

What cultural assumptions, systems, and structures are still in place in your organization because they seemed to work well under a different set of environmental conditions at an earlier point in time? These cherished organizational relics may be major barriers to the changes required to meet the demands of today's environment.

As noted in our earlier columns, creating, communicating and building support for a vision is essential to engaging extraordinary long-term performance. However, organizational culture, systems and structures often act as barriers to successfully implementing the changes required to move toward that vision.

For example, if budgets from the past are used to guide future strategic thinking, limited innovative visioning will occur. If culture, systems and structures are inconsistent with a change initiative (which is not unlikely since they reinforce the way things were prior to the change), limited progress typically occurs.

Systems and structures guide behavior

Some organizational systems and structures--such as budgeting, feedback, goal setting/planning, performance measurement/appraisal, reward/compensation--communicate to people where they should focus their attention. If you want to focus people's attention in new directions in order to support implementing changes, these focusing mechanisms may need to be updated.

Other systems and structures--clinical guidelines, selection/retention, training--prepare an organization to take action. If you want those actions to change, new preparation systems may be required.

Yet other systems and structures--decision-making, conflict resolution and communication--tell people how they should relate to each other at work. For example, in traditional centralized organizations, decisions are typically made at the top, conflict is resolved by senior leaders and resulting communication flows downward from the top. Without altering these traditional systems and structures, attempts to encourage open information sharing are unlikely to be successful.

Do the current systems and structures in your organization support and reinforce the changes you are making to respond effectively to your environment? If not, what actions are required to increase the likelihood of implementation success?

Culture holds systems, structures, and resulting behaviors in place

Several years ago we visited Guinea Bissau in West Africa. People were kind, warm, and incredibly generous. While the women worked hard growing food, preparing food, cleaning homes and sewing clothes, men often played cards or sat talking with each other in the market place.

Little in the country seemed to work. The electric generator in the community, for example, had not run in years. The school, which was to have opened a week before our arrival, was still not in session, and no one seemed concerned. Famines were common and many health problems existed, with 20 percent of the children dying by the age of five.

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People wanted to have a better life and believed that this would occur if they had more "stuff." If people wanted this better life, why didn't the men get up and work to produce it? We were told that there was no work for men. Historically, men were elephant hunters and the elephants had all been killed during a prior war. Therefore, what could men do?

Culture is reflected in the assumptions, values, norms and beliefs that serve as the foundation for "the way we do things around here." Often they are so strong and ingrained that people are unaware that alternatives exist or are unable to see the wisdom in pursuing these possibilities. Therefore, any attempts to encourage new behaviors that are inconsistent with current cultural realities are likely to meet with stiff opposition.

For example, while providing additional sources of research support for health science faculty members probably fits their cultural assumptions and is likely to be well received, removing tenure in this environment is probably inconsistent with traditional cultural assumptions and is thus likely to be heavily resisted.

Some changes that initially appear to be unpopular can gain support if they are justified in terms of the degree to which they help maintain traditional cultural values. Cost reductions at a hospital are likely to be unpopular with the staff. Support is more likely, however, if they are explained as necessary for generating funds to invest in other areas that support the clinical quality mission of the organization. Such explanations minimize resistance to change by casting transitions in a favorable cultural light.

While it may be possible to frame some changes in a manner that minimizes resistance, the successful implementation of other transitions may require prior systematic changes in an organization's or industry's fundamental cultural assumptions.

For example, within health care, changes such as an increased focus

on improving population health or replacing paper with electronic records typically necessitate a cultural transition.

Do the changes being made in your organization fit with its current cultural assumptions? If not, what actions are required to increase the likelihood of implementation success?

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The successful implementation of change is facilitated when your organization's culture, systems, and structures support and reinforce the new vision, objectives, and behaviors. When this is not the case, the likelihood of a successful transition can be improved through adjustments in the factors presented in Figure 1.

When the people who must alter their behavior are supported in making these changes by your organization's culture, systems and structures, it improves the likelihood of change implementation success. Altering incentives and removing barriers to desired performance are two important steps toward creating a change-friendly environment that will be described in our future columns.

Edward J. O'Connor, PhD, is principal with the Implementation Institute, a professor of management and health administration at the University of Colorado at Denver and Health Sciences Center and a member of the faculty of the American College of Physician Executives. He can be reached by calling [phone] or by e-mail at [e-mail].

C. Marlene Fiol, PhD, is a professor of strategy and health administration at the University of Colorado at Denver and Health Sciences Center. She can be reached by phone at [phone] or by e-mail at [e-mail].

By Edward J. O'Connor, PhD and C. Marlena Fiol, PhD