Pulling levers for organisational change
Or taking talk and identity seriously
The British Prime Minister went before the Parliamentary Liaison Committee the other day and complained about his inability to bring about change fast enough. He said:
“My experience now as prime minister is of frustration that every time I go to pull a lever there are a whole bunch of regulations, consultations, arm’s-length bodies that mean that the action from pulling the lever to delivery is longer than I think it ought to be, which is among the reasons why I want to cut down on regulation, generally and within government.’
Any democracy would want to have some degree of checks and balances for a potentially disruptive new infrastructure. In the UK though we seem to have more than most. I listened to Adam Tooze, economic historian, the other day expressing his admiration of the Chinese state managing to build 23,000 kilometres of high speed rail in a handful of years while the UK’s HS2 project, initiated in 2012, is unlikely to finish before 2030. And that’s just a line between London and Birmingham. It’s not often that citizens get consulted in China, though.
It’s clearly easier to move fast and break things than it is to move fast and build things in the UK, but in a country where political resistance is more possible, organisational change becomes more complex and uncertain. And even in conditions of oppression, as the social anthropologist James C Scott has documented in Weapons of the Weak, it is still possible to delay, subvert and obstruct.
It’s not Sir Keir Starmer’s thoughts on regulation that struck me, but rather the idea of pulling levers in government, or any other organisation to bring about change. And he actually made the pulling levers motion with his hands. This kind of thinking often carries over into people talking about ‘leveraging’ things to achieve certain organisational ends. This makes sense to me when we are talking about actual systems, like the tax system or an information system, where a small change can make a big impact, but much less so when people are talking about often quite intangible things like ‘culture’, ‘mindset’ and ‘values’. If culture is the complex web and history of meaning that we make together when we interact, in what way can this be intentionally ‘leveraged’ with a predictable result?
Two examples come to mind of failures to bring about change, which illustrate the problem in the idea of pulling levers, instead of understanding all change as political and involving negotiation, persuasion and compromise. The first example is an IT project conceived at the grand scale in the UK, and the second is initiative to change clinical practice in the NHS, based on evidence, in an organisation which claims to be oriented towards evidence-based medicine
Example one is the Choose and Book IT system which was the brainchild of the Labour government in 2004. Between the inception of the project and 2015 when it was quietly dropped, it cost more than £356 million. The system was intended to replace a paper system of GP referrals to specialist services with a digital equivalent, great, but also to offer patients the chance to choose their provider based on published performance data. The ‘choose’ of the Choose and Book system was an ideologically informed design parameter that assumed that NHS patients wanted to operate like consumers in any marketplace where they can shop around for what they thought was the best service. Time and again in surveys of citizens this has proven to be a misjudgement about what most people prioritise in healthcare (and also in education): what most people prefer, particularly in a context such as health where they are heavily dependent on expert opinion about quality, is a local hospital (or school) which offers good quality care (or education). The idea of a rational consumer armed with the requisite price data is out of place in this context.
So one of the largest factors that the evaluators of the project found for the failure of the project was that foot dragging and resistance by health care staff. They resisted because a significant proportion felt it undermined their relationships with their local, contextual and historical relationship with patients and other clinicians, and more broadly it challenged their understanding of what the NHS stands for as a universal service fee at the point of access, rather than a consumer-focused marketplace of services governed by metrics.
The evaluators concluded:
The overarching message that emerges from our work is that resistance to technology is much more complex than simple technical failure or some ill-defined combination of inertia, anxiety and Luddism on behalf of clinicians.
Resistance encompasses deeply held notions of professional excellence, and has experiential, social and material components.
In addition to the usual glitches, delays and clunkiness that accompanies any IT project, in this particular change initiative there was an ideological clash between those proposing the change and those expected to take it up.
As I have written elsewhere, at the heart of the matter is some core strategic questions such as who are we, what do we think we are doing, and who are we becoming?
The second example. In a paper which draws on the figurational sociology of Norbert Elias, academic Sue Dopson[1] carried out some research to explain the slow and problematic adoption of the Department for Health’s policy to change practice in the treatment of glue ear. The evidence showed that the orthodox treatment, the insertion of a grommet in the middle ear to drain fluid which had gathered there, was no more effective than watchful waiting. And the latter often had fewer side effects. The Department of Health issued guidelines with strict targets for diminishing the number of grommet insertions. Despite the evidence being described as ‘robust’, and which clinician in the NHS would claim that they were anything but an evidence-based practitioner, the targets proved very hard to achieve.
Taking Elias seriously, Dopson argues that a situation like this where there are a large number of interdependent groups, audiologists, doctors of different kinds, means that it is very difficult for any one group to control the outcome, not even the Department for Health. Despite the evidence, despite the fact that the NHS is a science and evidence permeated institution, there are still questions of politics, emotion and identity.
Groups in any organisation are in non-linear relation: the interweaving of intentions can bring about outcomes that no one person or group can predict. In What is Sociology Elias argues that because of our interdependencies a small intervention may bring about a large effect, meanwhile a large intervention may bring about no change at all.
Dopson observes:
There are also struggles between a variety of groups with different career interests, and these struggles involve emotive as well as cognitive elements. It is important to take these sorts of emotional resistances to change into account when building models of change, thus avoiding the construction of rationalistic models that can, at best, offer only a limited understanding. (2005: 1137)
and counsels against individualistic and simplistic accounts of how innovation happens. Unintended consequences, including not achieving what you set out to do, are not necessarily evidence of weak leadership and poor implementation, but may arise from the complex web of interactions over which no one person or group has control.
In the last post I argued that adopting a particular view of researching what is going on in organisations would lead to taking seriously what people say and how the make sense of their work situations. Organisations arise from people thinking, talking, doing, then talking about their doing with each other. In this post I begin to point to the importance of identity, emotions and the centrality of relationships. What matters or us at work will have stronger influence of what happens with change processes than any amount of pulling levers from above.
[1] Dopson, S. (2005) The Diffusion of Medical Innovations: Can Figurational Sociology Contribute? Organization Studies, 26(8): 1125–1144 ISSN 0170–8406.