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Margin is a Change Issue

A few years ago, I was called in to consult for a large IT transformation programme in healthcare. It concerned a large teaching hospital over a number of sites across a major city. The change would be so radical to current working practices that the systems provider had even built a simulated ward where the people who worked in that hospital could experience the new system and appreciate how radically different work would be after this change.

In itself, this was a powerful visionary tool. Healthcare workers could try this simulation to experience for themselves how much better life would be for themselves and, as a consequence, for the patients they treated. It was using the principles of agile development, where you give the customer an early taste of what they could have so that they can make informed choices about the details of the new product. It acknowledged that people need to experience before they can engage proactively in what they want.

The programme was now entering a critical phase. There was barely a year before the hospital would be switched over to the new system.

You have a problem…

However, there was a problem. As I interviewed them, none of the leaders of this change in the hospital had ever visited this simulation.

As I dug deeper, I discovered that all of the leaders were chronically time-poor. Even without the change, for most of them, their other workloads were rising. Other than attending the monthly meeting on the programme, they had zero capacity to engage with the change, let alone make it a priority in their work. Few seemed to have any solutions to delegating out some of their work to create margin.

And as I probed, I discovered it got even worse. The people below these senior managers and clinical leads, the people who would be expected to learn and operate the new system – the clinicians, paramedics and administrators – had no hope of finding the time to make this change as well as running a busy hospital network.

I felt there was a kind of collective denial. It was as if everything was expected from the supplier and that at the switch over, everything should run smoothly without any involvement from them. Some of the more political members of the leadership team I suspected were expecting the change to fail, so they did not want to be associated with it too closely.

It was a car crash waiting to happen. The programme manager was frustrated with his inability to get through to his customers. It risked all the investment they had made in the programme to that point (three years in).

Lack of time margins add up

This is where time, energy and space margins for each of us as individuals cumulatively impact the margin an organisation has or doesn’t have for its own change and development.

We can plan the most elegant change, using the most progressive approaches, such as this ward simulation, but if the stakeholder receiving it does not have the margins needed for transitioning to the new, then at best it will falter, at worst fail.

So, the prerequisites for change in the organisation receiving the change are almost more important than how the change itself is planned and presented.

Photo by Francisco Venancio on Unsplash

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