Touching what is, touching what might be.

On a martial practice mat, an attacker grabs the defender's hands, trying to keep her from drawing her weapons. Rather than resist the grab directly, she steps gently to one side while she lifts one hand skyward and plunges the other toward the floor in the move known as "tenchi nage," the heaven-and-earth throw.

This double connection repeats throughout world mythic literature--and it is fundamental to understanding change. To make use of the power living inside any new thing that comes our way, we first have to touch it--not tentatively but profoundly--at the same time that we maintain a firm connection with that which is deepest and most fundamental within ourselves.

Again, imagine the martial metaphor, two fighters in hand-to-hand combat. The attacker is most dangerous when he is about arms-length away (or further, if he has a baton or a staff)--near enough to hit me, but far enough to get a good swing. I will be safer if I can keep him at "mai-ai," far enough away that he can't hit me. But it's hard to keep him out, and at that distance, I can't do anything to him, either, nor can I make him stop his attack. But there is another position of safety that is far more powerful, the position some teachers call "bumping belts"--getting so close to the attacker that there is no space between us at all, for at least a moment.

The attacker has no room to swing, and my movements powerfully influence his. I have great leverage. From this position I can do many things, using the force of his attack to end the danger.

Many touch points

What does this look like in an organization dealing with change? It means creating a wide variety of touch points between ourselves and the change we are facing.

Let's take a large, multi-hospital system that has realized at the board and executive level that it needs greater diversity on its staff. This might be in response to outside demands, to changes in regulations, as a settlement to a suit, as a response to changing demographics, or simply by a change in the organization's own awareness. Organizations often look on such a need as a single demand, such as a demand for a change in hiring policies.

But in fact there are many ways to approach it--through neutral hiring policies, new kinds of outreach in recruiting programs, marketing and promotion that creates a stronger presence in different ethnic communities, staff training focused on greater intercultural sensitivity, even such simple things as the public celebration of different cultures' holidays, and charity projects that reach into ethnic communities. Making a wide array of responses to a problem gives the organization full contact with it, and draws the organization into full understanding of the problem. Most importantly, it creates a wide array of options, giving the organization the possibility of a flexible response that changes and shifts as conditions change.

New technology provides another example. We often encounter the question in reaction to a sales pitch: a vendor has proposed, say, a new imaging system. But to answer the vendor's proposal with a yes or a no is to approach a change that is undoubtedly headed our way--new technology--through a single touch point. Once it has become a yes/no question, it easily--in fact, usually--becomes a question with only one answer ("If I don't accept new technology, I am doomed.") for which you could end up paying almost any price.

You can change the nature of the new technology question by creating a number of touch points. Invite other vendors to give presentations and proffer proposals. Set up study teams to search for and evaluate new technologies. Study the existing technological system into which these new technologies have to fit. Begin a board discussion of the capital needed for technological expansion and renovation, and the implications of those capital needs in terms of possible partnerships, alliances, mergers, acquisitions, and other strategic moves. This moves you closer to the center of the change, but moves the center of gravity of the question back to you. It puts you and your organization in charge, rather than in reaction to vendors, and creates an array of options.

Ask a lot of questions

A key tactic in creating a variety of touch points is quite simple: Ask a lot of questions. Ask especially the questions that have difficult answers, or for which you suspect there is no answer. As leaders of organizations, we often spend much of our time talking--instructing, cajoling, giving others our vision, trying to get others to understand. Asking questions, and listening fully to the answers, interviewing people, can be a powerful technique of leadership, and a powerful tactic for bringing change up close where we can grapple with it. We can learn not only from the answers we discover, but also from what information is not available. You might learn, for instance, that the vendor has no consistent upgrade strategy, or no plans for networking the equipment, or is out of step with the movement toward industry standards.

The flip side of this is also true: sharing information. One of the five fundamentals of dealing with change is an abundance of information. Asking questions is designed to get more information. Giving away information is designed to make it easier for others to work with you on change, and to break the informational logjam.

It is useful to ask yourself: what is the unsayable truth at the core of this challenge? In trying to create more diversity, for instance, the unsayable truth might be that the people already in the organization are afraid of losing power to newcomers--or even their jobs. Or that embracing different cultures makes people feel out of control, aliens in their own work place. In looking at new technology, the unsayable truth may be that people fear that the onrush of technology will make it impossible for the institution to continue to exist in the same form. Or that they are right: the capital requirements may be too much, or the possibilities of the new technologies, combined with cost-cutting pressures, may make new types of organizations more effective than the one you have now.

These unsayable truths, brought to daylight, have enormous power. It is in fact, only by wrestling with these deep realities that the organization will be able to move forward. The act of bringing these realities to the surface automatically creates a range of touch points between your organization and the change it is facing.

Repeat

Expect repetition. Dealing with change is an iterative process. When you are effective in bringing the organization close to the change, and creating an array of touch points, some solutions will arise--new policies, purchases, markets--to make you more effective in that particular area.

Are you done? You are not done. Dealing with that level allows and encourages the next level to come to the fore. And the next level is likely to be more complex, deeper, more interesting in ways both good and bad. In fact, we are never done with any change. We keep working it through until it becomes part of some other change, as waves on the ocean become part of other waves. The "new imaging technology" question becomes part of the "new networked technologies" question, which gets absorbed into the "capital requirements" question, which re-asserts itself as the "strategic futures" question.

The endlessness of this process can lead to insanity or wisdom.

Touching bottom

If one hand is reaching out toward what is new, toward change and transformation, drawing it close, making many points of contact with it--what of the other hand, the hand that is dropping toward earth?

This is the hand of grounding, of knowing who you are and why you are there, of the story that the organization holds in common. We speak of "touching bottom," of coming to what is irreducibly our own. Medieval Christian mystics spoke of "anamnesis," the end of forgetting, the remembering of all that is most deep and constant. For each of us personally, anamnesis is about our deepest values and attachments--children, a mate, the values of love, integrity, our connection to life. Professionally, anamnesis means rediscovering constantly our real reasons for being in this profession--whatever sense of compassion or giving brought us to this position, with this knowledge and these special skills. As an organization, anamnesis means remembering our true mission, beyond mere survival, providing jobs, repaying the bondholders. Why did we bother to create this institution in the first place? Why do we put so much effort into recreating it day by day?

If I, as a professional, and we, as an organization, do not carry along a profound sense of these ancient values to every negotiation with change, then the power of these changes will sweep us away. We will have abandoned what we stood for, who we served, and all those who have helped us.

Paradox within paradox

It is a paradox: Embrace change, keep your base. Be rooted in the past, engage the future. Yet, there is another paradox within the paradox. Our values, our sense of who we are, can act as an anchor holding us back, rather than as a safety tether. Ideally, having a deep sense of who we are should allow us to explore deeply and confidently. More often, like the circus elephant's short ankle chain, linked to a huge stake driven deep in the ground, it prevents us from exploring: "This is the kind of person I am. I can't change." Or, it limits our exploration. As soon as we have taken a single step, we stop to pat ourselves on the back, take a break, and figure out whether maybe this is far enough: "Look how far I have gone, aren't I a hero of change?" To truly master change, we have to master the paradox of changing while staying grounded, of changing more deeply and readily the more grounded we are.

Joe Flower is Principal of The Change Project in Larkspur, California. He has written about change in health care for over a decade. Author of hundreds of articles, he is a Contributing Editor for the Healthcare Forum Journal and New Scientist, a system host of The Well Computer Conference, and a faculty member of HealthOnline. If any of the ideas presented in this column resonate with your experience, drop Joe a line at The Physician Executive, or at [e-mail] on the Internet.