Why the best ideas usually fail

Wednesday, December 13, 2017 – Ellen Gardner

Instead of looking for better tools to help us implement large scale change, we should be creating better relationships, explained Dr. Michael Gardam at a recent Longwoods’ Breakfast with the Chiefs.

Have you ever been to a conference or event, heard about a great idea and thought, wow, I’m going to bring that back to my organization? After that initial burst of enthusiasm, the majority of those ideas never take hold. Why that happens and how to bring people along with your cool idea, has been the preoccupation of Dr. Michael Gardam and his colleague Leah Gitterman.

“The first thing you discover in the field of change management is that culture eats strategy for breakfast,” said Dr. Gardam, Chair of the Medical Advisory Committee at UHN, speaking to a receptive audience at the Longwoods’ Breakfast with the Chiefs on October 18. He and Leah woke up to that fact when they introduced the Hand Hygiene Hurdles at UHN. “We had all the tools, the posters, the education and then ran smack into culture,” he says. He frankly admits that in the beginning, it didn’t go well.

Failure has been a powerful motivator for Gardam and Gitterman, who’ve used those experiences to completely turn the notion of ‘scaling up’ on its head. “When it comes to spreading change, we’ve learned that what works in one place may not necessarily work in another,” he says.

The big stumbling block to getting engagement turns out to the one that’s toughest to change – people. Put them in the mix and even the tried and true formulas don’t always work.

Gardam breaks the challenges down into categories of being simple and complicated or complex. Although a high level of expertise is required to execute complicated situations – like sailing an aircraft carrier or doing cardiovascular surgery – but with the right level of experience, they are manageable. This is the world that gave rise to checklists.

Where organizations flounder is in complex situations, which Gardam says are unpredictable and like raising children, a whole other kind of beast.

“There is no role for formulae in raising children and there is certainly no guarantee of repeat success,” he said. It’s a simple but effective analogy since anyone who has raised children knows there is no ‘right way’ to do it – and so it goes, explains Gardam, for organizations as well. “They want a specific, linear path to improvement and it just doesn’t work that way.” At a time when everyone in the business world is looking for ways to minimize and reduce complexity, he takes the contrary path and urges them to embrace it.

One of the most direct ways to do that also seems like the most obvious. Give the frontline ownership over problems. “You just have to ask and they know the solutions,” he says. In his view, a big part of accepting complexity is making sure you hear from everybody – and that’s very different from asking for buy-in.

“Forbes magazine puts the term ‘buy-in’ as #2 on their list of most annoying examples of business jargon,” he says. (Number 1 is core competency). “The usual response from people after hearing about the amazing new idea is, why didn’t you talk to me before?”

How organizations manage to overlook the input of the frontline is well illustrated with the example of no-slip socks. “Falls are a big problem in long term care homes and at one facility we worked with, frontline staff came up with the brilliant idea of giving the residents no slip socks in different sizes,” says Gardam. Previously, the facility provided only one size and staff had noted that patients were tripping over the too-large socks that were meant to prevent them from falling!

Coming back to their plan for high compliance rates for hand hygiene at UHN. “In the beginning we failed because all the ideas had come from infection control and were pushed to the staff,” he says. The real agent of change turned out to be Olga, nurse manager of the orthopedic surgery unit, who would ask the surgeons to put out their hands and she would wash them as they walked by. Eventually they started doing it themselves and this led to very high compliance rates. “Obviously this solution worked for her unit but would likely not work if it was brought elsewhere,” said Gardam.

Here are a few of Gardam and Gitterman’s ideas on how to make big change stick:
  • Engage the willing – Work with the people who want to be involved
  • Co-create the solutions – Talk to the frontline to get to the root of the problem
  • Accept (and embrace) the complexity
  • Replace ‘buy-in’ with ownership
  • A new way of thinking – move away from convergent (defined, specific paths) to divergent (always looking for more options) thinking.
“It’s not about the tools when it comes to solving complex problems,” concluded Gardam. “It’s about the relationships.”

By Ellen Gardner, Senior Specialist, Communications and Marketing, HIROC

View Dr. Gardam’s Longwoods talk in its entirety