I've been thinking a lot lately about resistance to change. The Rogers Adoption / Innovation curve (innovators, early adopters, early majority, late majority, laggards) is referenced in some form by most people involved in change management.

Now, I'm not an innovator myself. My special form of creativity doesn't manifest itself by coming up with new ideas that no one else has thought of, or completely new ways to do things. I'd tag myself as being in the early adopter or maybe early majority categories most of the time.

So it can be a stretch for me to work with the late majority or laggards. "Don't you know this will be good for you?" I ask incredulously. "Can't you see all the benefits and advantages that you will have once you've made this change?" I confess that I get very impatient sometimes.

Fortunately I have great team members that a) calm me down and prevent me from sending career-limiting emails, and b) remind me that you catch more flies with honey than with vinegar. Or, as the movie musical "Mary Poppins" character sings, "Just a spoonful of sugar helps the medicine go down."

(Of course, as she's singing that, she's snapping her fingers and making the children's clothes go back into the drawers without any effort on anyone's part.)

But in the real world, it's good to ask ourselves what's in it for the stakeholders, and try to see what would make the change more palatable. The trick is, it has to been seen as a value-added return even before the gains are realized. For example, a promise that the work will be easier might not be believed, even if you know it will be true.

Have you found a good way to engage stakeholders who might need a little extra encouragement to buy into a change plan? It would be most helpful if you would share your experiences!

I used to be really annoyed with people who took a wait-and-see approach to change. They're not resistant, exactly, and they might be classified as "late adopters." But I could understand active resistance better than passive indifference.

Now, however, I have a little different take on things. Because I have realized that if you wait long enough, you may find that whatever was changed comes back around again!

Such as...

• Centralization vs decentralization of departments or functions
• Use of consultants vs hiring internal resources
• Outsourcing vs insourcing

This reminded me about the lines from the Disney movie, "The Lion King," where young Simba gets the explanation about how the antelopes eat the grass and the lions eat the antelopes, and then the lions die and their bodies turn to grass (OK, you knew it would be a PG version) which is then eaten by the antelopes. So everything comes back to a big circle of replaying the same scenarios.

For process changes, it's easy to see how this becomes just another bright idea to wait out, to someone who's been around a long time. Especially when you're in an organization that promises that every change is NOT just the flavor of the month, and then six months later it's disappeared. So how can I criticize someone for saying, "Well, go ahead with this Lean thing, I'll just wait and see what comes of it before getting enthusiastic about it." After all, they've probably been right about all the other wonderful new initiatives and changes that have come and gone before.

Maybe you are fortunate enough to work in a place which has solved this circular pattern, or maybe you are trying to break out of that. Would you care to share your experiences, to help us put some perspective on the issue?

When I was leading a department, I never thought of myself as a process owner. It wasn't in my job description, and I never heard anyone used the term. It's one of those useful concepts that I wish I had known, prior to my Six Sigma and Lean education.

Here's my working definition: The process owner is that leader who is closest to the process itself, who has responsibility for achieving the expected outcome of the process, both before and after an improvement project.

So now, I try to introduce the term right away and use it frequently so that everyone knows what the role is, in respect to a project (and afterwards). I also try to spend extra time with the process owner if they are new to the role. Even then, though, it's hard sometimes to get across the continuing expectations. A statement that I hear frequently is, "I'm glad that the project is over - now I can quit being the process owner!"

Have any of you faced this challenge, or is it more clearcut in some industries than in others? Have you had to do extra education or mentoring of someone who was not sure they were a process owner - for either a project or a process? Do you have a different definition of process owner, that's been helpful for you?

It would be great to hear your thoughts.

Well, maybe I have more than one favorite tool - but there are 2 that are fun to use with a group.

One is sticky-note brainstorming. It avoids the perils of the regular "everybody call out their ideas" brainstorming, because (a) you get 100% participation; (b) you can get LOTS of ideas in just a few minutes; (c) you don’t need a scribe to try to capture everything as multiple people are speaking quickly; (d) you avoid people being worried about "what will my boss think" about an idea; (e) it’s anonymous so people are braver; (f) you can put duplicates on top of one another and categorize with ease, just by moving them around. Also (g) you can use colorful sticky-notes and make a cheerful impression rather than a boring one!

Secondly, if I’m using the group’s ideas to capture possible solutions, I really like to use an Impact/Effort Matrix. You may have heard of this under another name - it’s a 2x2 matrix with Impact along one axis (High, Low) and Effort along the other (Easy, Hard). I ask the group members to place the sticky notes in the appropriate category - if there’s doubt they can place them on the dividing line. Then I can facilitate the group to ask, "Does this idea belong here? Do we all agree that it’s High Impact (or whatever) and Easy to do?" If not, we have a good discussion and end up with consensus. It’s amazing how this helps to prioritize the efforts - we will definitely pursue the "High Impact, Easy" ideas; think about a plan for the "High Impact, Hard" ideas; see if we can catch some low hanging fruit with the "Low Impact, Easy" ideas; and forget about the "Low Impact, Hard" ideas.

These ideas can then be turned into action plans or placed in a parking lot as appropriate. Using the sticky-note brainstorming to get 100% participation, and the Impact/Effort Matrix to prioritize ideas, results in better decision-making and better buy-in to the resulting plans.

What are your favorite change management / process improvement tools?

While the iSixSigma.com site has been down, the rhetoric about "fixing healthcare" in the US has dramatically heated up. "We need to take the waste out of healthcare!" "We're paying too much for healthcare!" "Everyone should get all the healthcare they need regardless of cost!"

Without getting into the political debate, let's just touch on these points from a quality perspective.

There's a balance between cost, speed and quality that's quite a challenge in healthcare. For example, if I order $5000 worth of tests on day 1, and can tell you your diagnosis on day 2 and start treatment, what's that worth to you and your health (even if it turns out that 5 tests out of the 30 ordered didn't help with the diagnosis)? How about taking the cost-effective route: I'll order one test per day, evaluate the results, and then order the next test. It may take me 21 days to figure it out, while you are waiting all the while, but hey! it did cost less! So, in which example was there more waste???

Paying too much for healthcare... does that mean we are paying more than the value we receive, or just more than we desire to (or can afford to) pay? Most of us a) don't know how much our healthcare actually costs; b) can't judge the quality of the medical care we receive; and c) won't haggle over the cost of an IV solution when the care of a loved one is at stake. There's an emotional element of this debate that is not susceptible to logical reasoning. We see this in all the stories of people who have gotten poor care or ran out of money or their insurance wouldn't cover a certain procedure. If we try to "ration" care in the most logical way possible, we immediately run into the emotional (or moral, if you prefer) discussion about denying care to those who need it on a purely financial basis. The factual and emotional issues are entangled as we debate this topic.

Should everyone get the healthcare they need regardless of cost? It's my personal opinion that provision of basic services, including healthcare, should be a function of an organized society. But, it's not a "commodity" service like garbage collection, is it? Since we do have to look to our tax-paying citizens and employers to pay for "healthcare for all" - the question of course is, how much should each of us contribute to this worthy cause? And who decides how that money is to be used?

Having stirred the pot this morning, I will close by saying - it's a complex system!

• There are no "specifications" for inputs (patients who need care come in all conditions and with variation in their genetic, mental, physical, experiential, cultural, economic, and social backgrounds);
• Processes are highly complex with many stakeholders and overlapping responsibilities
• There is an expert-based culture of physician caregivers (now expanding slightly to other medical professionals);
• Outcomes may not meet the patients' goals through no-one's fault (you can mostly blame our biologically-based life processes, I guess) but which may in some cases be due to poor care or non-compliance on the part of the patient (for example, not taking medications in the way they were prescribed).

So I just caution you to think carefully about all the proposals that will be floated to "fix" the healthcare system, and don't jump to solutions too soon on this one.

Is healthcare in its current form in the US perfect? NO! But first I think we have to go back to quality basics and agree on who are the customers, and what is value-added to those customers. I've seen many more "solutions" floated, than thoughtful consideration of just what it is we want to get to. I encourage everyone to join this debate from the quality improvement perspective, and to lend your expertise to the discussion!

p.s. It's good to be "back on the air" again! Kudos to those at iSixSigma.com who have been working to resolve the issues that interrupted service over the past several weeks.

When I begin a new project, I include a Communication Plan as part of my team work. That is, we take the stakeholder list and think about who we need to be in communication with, as we move through the project phases. Some of you may do this based on an ARMI exercise (Approvers/ Resources/ Members/ Interested Parties) or Stakeholder Analysis exercise (List of key stakeholders and their estimated level of commitment to the project). We include activities like face-to-face conversations, presentations in department meetings, newsletter articles, postings on the web site, etc.

But even though we try to heed the mantra, "communicate 8 times, 8 ways" it seems like we always have a gap in our communication.

For example: Our team invites a key department leader to our project meeting; we discuss our project and get agreement as to next steps. We plan an elevator speech and ask the leader to discuss it at his/her next department meeting and get agreement to do that. We talk about possibly sending an email or posting information on the department's bulletin board for those who can't attend the meeting. All good so far!

Then, a week later - after the department meeting, and having seen for ourselves that the information is posted on the bulletin board, a few team members stroll through the department to gauge the level of buy-in. And - do they find that everyone is informed, interested, and enthusiastic about the project? Or, do they find that people are negative toward the new process that's coming their way?

Why, no! We find that most people remember vaguely hearing something about some new process, and others just give us blank stares. When the bulletin board is mentioned, we get the response "Oh, I know it's there but it never changes so I don't look at it."

So, what are our learnings from this type of situation? We only communicated once or twice, one or two ways - so obviously we would need to keep our communication plan active! But are there other ways that you have been successful communicating outside of your project team, as you make progress? Thanks in advance for sharing!

You've completed your planning phase - whether it's specifying value and mapping the value stream, Defining / Measuring / Analyzing, or Planning - and you're ready to move into Creating Flow, Improving, or Doing. Hooray! The pilot plan has been finalized, the Process Owner says it's fine, the team is ready to move forward. And then...

Little cracks start appearing in the plan. "We forgot about..." "One of our team members says the plan won't work because..." "We thought the computer system did THIS and instead it works like THAT so our plan needs to be changed!"

How many times have you gone through these pre-improvement jitters? Is it a matter of staying calm in the face of chaos, staying the course, trusting the process? Have you ever had an experience where you really did have to call a halt and regroup, because you found out that there was a major roadblock in your path?

As an optimist, I try to stay flexible and reassure the team that we can address issues as they appear, usually by obtaining additional information and clarifying the issue before deciding that we need to make a change. But I have had to halt a project just as we were moving into Improve, because the hospital decided to implement a new computer system in the department just at that time, rather than waiting for the project to be completed. And in fact, if we had completed our project without the new system, we probably would have had to re-do the process following the system implementation anyway. Plus, the same people who were on our team were also the people who were wanted for the design of the new system, so there was a resource conflict as well.

What we did was to put the project on "hiatus" for three months. Then, we re-measured and re-analyzed, to see if we still had the same critical factors, tweaked our Improve plan, and proceeded. It didn't feel very good at the time, but it all worked out in the end.

Have you had this experience? How did you handle a halt or delay in a project that was in full swing? Please share your stories!

Recently James Considine and Stephen Crate have posted about management styles....and their posts have really made me think about management and leadership in general, especially during these challenging times...

From my perspective, you have to lead people to achieve results. If you are a manager, indeed your job is to manage the business, but to lead and support people as well, rather than manage them. Given the right amount of coaching and "rope" if you will, your employees may surprise you in what they are capable of achieving.

I reported to a manager at one point in my career that I would do anything for. He really led me to higher performance and really coached me in my own management skills - and the things I learned I still use to this day. He always made clear what my objectives were and basically followed-up on progress on an as-needed basis, rather than telling me which discrete tasks to perform. It was my responsibility to come up with my own checkpoints and milestones in order to accomplish my goals, and with his input, I would execute the plan. Granted, there were times that demanded a direct order, but those were in crisis situations which demanded that style.

There are a lot of advantages to leading people to performance - but the biggest advantage is the teaching that occurs during the process. As a leader, a major responsibility that you have is to teach your employees how to plan and how to achieve goals. By doing this, you effectively raise the competence level of them, and better prepare them for more responsibility. This dramatically helps with succession planning for sure, and creates depth in your organization.

I've attended a lot of leadership development courses over the years, and received many handouts, folders, and binders chock full of ways to make myself into a better manager... of people, time, money, etc.

One precept that has stuck with me is that we should pay attention to the small things that are annoyances today, so they don't become bigger problems tomorrow. Even if it's unlikely that something will become a big problem, it's worth the effort to eliminate it so that it isn't draining our energy to deal with.

Ben Franklin figured this out long ago, with his saying "A stitch in time saves nine." As a youngster, I confess that this didn't make much sense to me. What is a stitch in time? (Is that a problem in the space-time continuum?) Saves nine what? Now I get it - sewing up a small rip saves it from getting larger and needing more stitches to fix later - perhaps after all my money has fallen out of the pocket! (Just goes to show why I wasn't any good in my Home Economics classes.)

In my daily work, I try to be on the lookout for those small things - like, my stapler broke and I can't take the time to order a new one, so I have to keep using paper clips that fall off. Like, my AAA battery died in my mouse but I don't have time to stop and get new batteries from central supply, so I'll use the keyboard alternatives. Like, one of may chair casters fell off and I've propped it up with a book "for now."

Sometimes it's a matter of looking at things from a lean perspective - kanban or 5S is very helpful. But it's also the concept of taking time to fix the small things, so that I don't spend a lot of time doing work-arounds which are innately less efficient and less satisfying.

Maybe you have already found this out for yourself - want to share any related examples or experiences?

My organization requires that we write our annual performance goals into a web-based system that can be sent to our bosses for their review. As I was working on this last week, it struck me that in the past I would not have written those goals the way I do now.

For example, "improve service" would have been a typical goal for one of my previous positions. Today I'd be examining: What data will be used to measure the improvement? What is the target? What type(s) of service would be in scope? What customer segment would be studied? Who are the stakeholders for this service, and how many would have influence or control over aspects of the improvement?

In other words, I'd be a lot more specific - call it SMART if you want - and at the end of the year I could clearly tell whether or not I had met the goal. In the past, I'd say "well I worked really hard all year on this and I think people are more satisfied with the service, based on the 2 - 3 customers I spoke with."

Now, it's still possible to "game" the system by picking easy targets that would be hard to miss, or choosing focus areas without established metrics. But, I wonder how much more effective I would have been as a supervisor, manager, or director if I had known and used a process- and metrics-oriented approach to leadership.

So here's my question to my readers! Have you used a Lean, Six Sigma, or other process-based approach your whole professional career, or did you learn it mid-career? It would be interesting to know what your reflections on the difference it might have made, had you been exposed to the concepts and methodology earlier in life - I invite you to share.

[Note: For those who may not have run into this acronym before, SMART refers to goals or metrics that are Specific, Measurable, Attainable, Relevant, Time-bound. There are a few variant versions but all reflect the same basic principles.]