It is an interesting place. I’m not talking to you with any official sanctioned, which is why I’ve been so restrained about the details of my organization. But I see a lot of overlap between my company’s journey and yours (although you seem to be two years farther down the road than we are!) so I get a lot of value out of reading these entries.

Thank you again.

On the “how did I do?” I work to bring understanding of how this helps the customer. Why not ask what their ideas are with an open ended question like, “Is there anything you would like me to know about what you do for the customer?”

Sounds like an interesting place. If I can impart my approach to regulatory controls it is that controls come from people just like you and me, who want to make sure that the right things happen for those we serve. The enjoyment of the work is looking at the controls and understanding what the people (often, the community) wanted when they put the controls in place. Sometimes, we can find a better way such that the controls are no longer needed. Other times, the controls are necessary, or even unnecessary waste, and the best we can do is to bring understanding and respect as to why they are there, such as, “the patient wants to make sure that they pay the right amount for this service.”

In a way it’s worked out, I’ve gotten a lot more observation done, and I’m learning a lot. Now more and more line staff are responding with more ‘you’re doing what? Well, it’s about time, that’s wonderful!’ instead of the ‘who are you and why are you bothering me’ sort of attitude.

The easiest answer for why people are nervous when you watch - I work in an inspected environment (FDA among others) and usually watchers are ensuring you are following procedure (and ONLY following procedure). People still ask me the ’so how did I do?’ type questions. I’m torn on that, do I tell them ‘oh I’m not watching you, I’m just writing down times…’ or do I take the opportunity to solicit kaizen ideas from them? I have data in front of me at that moment to tell them overall how the process is doing, should I get their input?

Good things being squelched comes directly from that ONLY following procedure idea. We actively discourage people from improving their processes in most cases, since they are supposed to follow the standard work without deviation. There’s more flexibility in the non-regulated work areas of course, but the core business is highly regulated and seen as immutable. Add in a somewhat adversarial relationship with the people writing the procedures, and things get rather interesting.

Do you have experience with moving deeply bureaucratic cultures towards continuous improvement?

Absolutely. We welcome others jumping in with their experiences.

I have a few more questions -

What are things that happened in the past to cause this reaction, when people came to watch?

Where there good things that happened that didn’t happen enough?

I can recount experiences where coming to shadow was received less enthusiastically. In these cases it was external entities where the invitation came from managers but the local staff didn’t know me.

In these cases, I have avoided asking too much, observing as much as possible, and very importantly, checking out “the story” that I would tell with them, before I go. Because I blog a lot of what I see, I will usually send them the blog entry that I create. As with a patient encounter, I will write everything that I see and hear as if the person who I am writing about is right there with me.

Is this an issue for me? Somewhat, yes. I’m in a culture where the survivors are those who have ignored the management fads and kept getting the work done. Attention is more often negative than positive, and everyone is often scared. This means that someone coming in asking questions about how the work gets done, or who is looking for ways to get the work done better, is the enemy. Attempts at Lean/Six Sigma improvement is the “quality thing” that must be kept out of your department at all costs.

I really need that culture to change. For the company, for my sanity. I think I knew what you were going to say, it’s just nice to hear more detail that little pieces will move before the whole, and that it can take a lot of time and effort to move the little piece.

Any advice from the culture war trenches is always appreciated. There are signs of hope here, I’m just trying to figure out what I can do to keep them growing.

Thanks for allowing continued conversation.

Andrea

In a nutshell, we kept going back. At this point 30 more times, to 30 different care sites. Some met their and our expectations. Some did not. But we kept going back with a regular cadence. I think it takes 3-4 times until people feel comfortable doing anything, and this was no exception.

I can’t say whether we caused a change here, whether this team was put together differently, or maybe a combo of the two. I can say that I can’t see any reason to stop doing it this way…

Are you in a situation where this is an issue? What’s going on in your environment?

Thanks!