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The New Pioneers: The Men and Women
Transforming the Workplace and Marketplace Digest of a presentation by Tom Petzinger, Nick Wolter,M.D.
and Tom Irons, M.D. Answers the questions:
The “Bacteria Model” of Management This truth became painfully aware to disease specialists at Northwestern Memorial Hospital, when it was learned that enterococcus, a bacterium resistant to all antibiotics, had infiltrated their institution. A state of emergency was declared. “Let’s meet first thing tomorrow morning, and then every Tuesday from there on,” they proposed. And that’s what they did. It was never dictated who should attend these meetings, nor was there ever any specific agenda. So whoever thought they needed to show up, did. Whoever needed to speak, would. Soon, interns and students were joining their ranks as well. As the disease began showing up in different departments, people from those groups began joining in as well. (After all, disease does not honor departmental boundaries. So why should the departments?) The dynamics of these meetings were constantly changing. The only common factor in these meetings was a shared sense of emergency. The people of Western Memorial Hospital were comparing notes in ways they never had before. In short, the humans had become as organic as the bacteria. By breaking down barriers, they actually learned from the bacteria. Take a Ride on the Clue Train Unwilling to watch American corporations turn the great new medium into a forum for their own contrived and sterile corporate images, these men created a web site of their own. They call it “The Clue Train.” (http://www.cluetrain.com) “People of earth...” the web site boldly announces, “A powerful global conversation has begun. ...Corporate firewalls have kept smart employees in and smart markets out. It's going to cause real pain to tear those walls down. But the result will be a new kind of conversation. And it will be the most exciting conversation business has ever engaged in.” What follows are the Clue Train’s “95 Theses,” modeled after Martin Luther’s like-titled proclamation of truth. In part, the 95 Theses include these thoughts: 95 Theses (abridged by Thomas Petzinger Jr.) 1. Markets are conversations. 2. Markets consist of human beings, not demographic sectors. 3. Conversations among human beings sound human. They are conducted in a human voice. 6. The Internet is enabling conversations among human beings that were simply not possible in the era of mass media. 7. Hyperlinks subvert hierarchy. 10. As a result, markets are getting smarter, more informed, more organized. Participation in a networked market changes people fundamentally. 13. What's happening to markets is also happening among employees. A metaphysical construct called "The Company" is the only thing standing between the two. 14. Corporations do not speak in the same voice as these new networked conversations. To their intended online audiences, companies sound hollow, flat, literally inhuman. 19. Companies can now communicate with their markets directly. If they blow it, it could be their last chance . 21. Companies need to lighten up and take themselves less seriously. They need to get a sense of humor. 30. Brand loyalty is the corporate version of going steady, but the breakup is inevitable—and coming fast. Because they are networked, smart markets are able to renegotiate relationships with blinding speed. 31. Networked markets can change suppliers overnight. Networked knowledge workers can change employers over lunch. Your own "downsizing initiatives" taught us to ask the question: "Loyalty? What's that?" 32. Smart markets will find suppliers who speak their own language. 41. Companies make a religion of security, but this is largely a red herring. Most are protecting less against competitors than against their own market and workforce. 42. As with networked markets, people are also talking to each other directly inside the company—and not just about rules and regulations, boardroom directives, bottom lines. 43. Such conversations are taking place today on corporate intranets. But only when the conditions are right. 45. Intranets naturally tend to route around boredom. The best are built bottom-up by engaged individuals cooperating to construct something far more valuable: an intranetworked corporate conversation. 49. Org charts worked in an older economy where plans could be fully understood from atop steep management pyramids and detailed work orders could be handed down from on high. 50. Today, the org chart is hyperlinked, not hierarchical. Respect for hands-on knowledge wins over respect for abstract authority. 53. There are two conversations going on. One inside the company. One with the market. 60. This is suicidal. Markets want to talk to companies. 61. Sadly, the part of the company a networked market wants to talk to is usually hidden behind a smoke-screen of hucksterism, of language that rings false— and often is. 62. Markets do not want to talk to flacks and hucksters. They want to participate in the conversations going on behind the corporate firewall. 65. We're also the workers who make your companies go. We want to talk to customers directly in our own voices, not in platitudes written into a script. 66. As markets, as workers, both of us are sick to death of getting our information by remote control. Why do we need faceless annual reports and third-hand market research studies to introduce us to each other? 71. Your tired notions of "the market" make our eyes glaze over. We don't recognize ourselves in your projections— perhaps because we know we're already elsewhere. 72. We like this new marketplace much better. In fact, we are creating it. 73. You're invited, but it's our world. Take your shoes off at the door. If you want to barter with us, get down off that camel! 74. We are immune to advertising. Just forget it. 76. We've got some ideas for you too: some new tools we need, some better service. Stuff we'd be willing to pay for. Got a minute? 77. You're too busy "doing business" to answer our e-mail? Oh gosh, sorry, gee, we'll come back later. Maybe. (Copyright © 1999 Levine, Locke, Searls
& Weinberger. Note that the 95 Theses can be viewed in their entirety at http://www.ClueTrain.com Emergent Loveseats and Complex Adaptive Ottomans Rowe Furniture knew what consumers had long known: that buying furniture was a drag. People don’t like to wait six months for custom furniture, nor do they particularly care for what is on the showroom floor. So Rowe created a system where you could custom design your own furniture on computer, right from the showroom floor. There was only one problem: How to get the manufacturing plant to deliver on the promise. Which brings us back to West Virginia. Rowe sent down a young, New York woman with an MBA to the plant to make it happen. Soon after arrival, she addressed the workers: “the assembly line is gone,” she said. “You have to design a new process for instantly creating custom furniture.” She then grouped all of the workers into twelve cross-functional teams. The next week, people arrived at work to find the assembly line was gone. Instead, new power tools hung from the ceiling in clusters. It was up to the workers to figure out what to do next. It was utter pandemonium—and an utter failure. Quality plummeted, even as the old-timers said “see? we knew it was going to happen.” But the woman had a secret weapon: information. She began giving workers reports daily, even hourly, so that they could deduce “what we did yesterday worked. What we did this morning didn’t work,” and so on. Soon, work patterns began to emerge – both among and between teams. Within just a few weeks, productivity increased 50%. Now they produce custom-designed furniture in just ten days. Creating Culture at Deaconess Billings What followed was two long years of conflict. There were many stormy arguments about who would serve as CEO of the new organization, as the doctors continued to reject every candidate brought before them. Finally, in 1995 a mediator was brought in to facilitate a discussion between the doctors and the board. It was an intense discussion, but it was also the first open communication in two years about the differing organizational cultures. Together, the groups asked some painful questions, such as “are the reasons for this merger still valid?” Much of this is typical, Nick Wolter points out. The pain of a merger often happens two to three years later. But amidst the pain, some other interesting things were also happening at Deaconness Billings Clinic. They created an operating council of physicians, and instituted seven service lines in which doctors were paired with administrators. Dr. Wolter claims that complexity theory does lends a healthy framework for addressing such changes. For example, a “good enough vision” was created for the organization: to partner with physicians, getting them to be part of both a community and an organization. Wolter observed several key themes during this process: Far from equilibrium conditions are important; the ecosystem metaphor is very important, especially as multiple stages of development are happening at any given time; self-organization and emergence are powerful, if one is able to overcome resistance and create the conditions. Particularly important was the principle of paradox and tension: How can organizations capitalize on those two states, rather than avoid them? To do so, we much break the habit of seeking only those who agree with us. One extremely painful period for the clinic began when a reduction in the workforce became necessary. Coming after all the management changes during the merger, it further shook the confidence of everyone in the organization about the future of DBC. However, it also accelerated the emergence of some other attitudes. For instance, it convinced people across DBC of the dangers of less-than-excellent business practices. As a result, the commitment to excellent business practices emerged so that another work-force reduction would be unlikely. More importantly, perhaps, the reduction created a platform for change that is still important at DBC. Today, the Deaconness Billings Clinic is introducing complexity applications throughout the organization. They have initiated Personal Service Excellence, in which they seek to improve the ways they treat each other, thereby improving the ways they treat customers. They have also developed a list of critical behaviors in terms of management performance. Increasingly, people see disagreement and diversity as important parts of a healthy, functioning organization. An Emerging Model: Tom Irons and HealthEast Irons had been with the medical school all of his career. About five years ago, he began to work on a project to increase the number of generalist physicians practicing medicine. Rather than focus on increasing numbers, Irons made it a challenge of creating a system of care. At the beginning, the key organizations in the deal weren’t communicating. Instead, they were fighting for dollars. So Irons set up some meetings, just to get together to talk. “We have different goals,” Irons said, “ but can’t we somehow find a common ground to collaborate in?” There was a beginning belief that the goal should be to form a company and buy up medical practices. Irons was even tapped to head up the IPA. But Irons just wanted to create a system of care that worked better than what was currently in place. Irons insisted that he did not want a control model. Still, the pressure he faced was intense: Doctors didn’t trust him because he was “owned” by the hospital; And the hospital didn’t trust him, because they thought his allegiance was with the doctors. Irons spent two years just building relationships. In the third year, Irons convened a group of doctors to try to think openly, starting with a blank slate. They started with just a few, minimum specifications:
Since then, two chaotic and difficult years have passed and a lot of things have changed. Most significant is a newly emerging mental model that health care is a shared responsibility that must unite health practitioners with the community. As an experiment, Irons bought a house and filled it with physicians, nurses, pharmacists, students and more with t he intention of improving community health. “I told them I wanted them to live and work together there. It truly is emerging as a community health center!” Irons says. “We really can change the whole system of care simply by sharing information and helping people help themselves.” Irons group has come a tremendously long way. But the ‘gulf is still there. They still don’t have the necessary relationships with administrators. But the good news is, they are talking openly at the highest levels about fears and beliefs. Change is certain to continue. About the Presenters Nick Wolter, M.D., joined the Billings Clinic Department of Pulmonary and Critical Care Medicine in 1982. He has also served as medical director, respiratory care, Deaconess Medical Center, and medical director, critical care units, Deaconess Medical Critical. In 1989, Dr. Wolter was elected chairman of the Billings Clinic partnership and, in 1993, the group practice integrated with Deaconess Medical Center, forming a medical foundation model. In July 1997, he was named chief executive officer at Deaconess Billings Clinic. Dr. Wolter received bachelor of arts degree, English, Carleton College; master of arts degree, American culture, University of Michigan; and medical degree, the University of Michigan Medical Center. He completed his internship and residency at the Mary Imogene Bassett Hospital in Cooperstown, NY, and returned to the University of Michigan. Tom Irons, M.D., is professor of pediatrics and associate vice chancellor for health sciences, East Carolina University School of Medicine. He directs the school’s generalist physician program, which is supported by the Robert Wood Johnson Foundation, North Carolina Office of Rural Health, North Carolina Area Health Education Center and Pitt County Memorial Hospital. He is president of HealthEast, Inc., a physician networking and support company that seeks to develop, sustain and integrate a national system of health care in the underserved areas of eastern North Carolina. He is currently involved with a number of national initiatives and also chairs or serves on a number of community and state boards and councils. Dr. Irons also is actively engaged in continuing education for physicians in a number of areas in pediatrics, including behavior management, child abuse, pediatric infections diseases and adolescent health. |