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February 2012 | HefmA Pulse46 47HefmA Pulse | February 2012
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Science and more
specifically psychology
offer a means of
achieving objectives
in an NHS faced
with large-scale
organisational change
and cost reductions
By David Burnham and Lorie Farrell,
of Boston-based consultancy Burnham
Rosen Group
The majority of experts are offering wise
advice that may have different titles
and buzzwords but coalesce around an
emphasis on the importance of meaningful
work in engaging peoples’ best efforts,
increasing accountability, embracing
complexity and so on. There are training
courses which teach us new ways
to behave in line with these insights.
When we have time to stop and think,
we can reach for our training manual and
work through our checklist of things to
do to stay on track – all of which can be
undoubtedly helpful.
But what happens when there’s no time
to stop and think, when under pressure?
For most of us, that’s nearly all of the time?
What then? Our instincts take over. We don’t
have time to think deeply, we just do what
comes naturally.
The question of “why do we do what we
do?" continues to engage psychologists, yet
there are some truths. One is that we all have
habitual patterns of thought that shape how
we perceive each situation. Our perception of
each situation – what is happening and what
does it mean to me - drives what options and
priorities for action we choose and, in turn, the
outcomes we achieve.
Implicit Motives are patterns of thought
which often differ substantially from our
conscious or explicit motives. Our Implicit
Motives lie just below the thoughts we notice.
Importantly these implicit motives account for
most of the way we think and what we actually
choose to do.
Building on work at leading universities
worldwide, but particularly at Harvard,
Burnham Rosen Group has spent 30 years
researching how to use Implicit Motives
to develop superior performance in many
roles. In every role there is a threshold level
of knowledge and skill that is required to
achieve average performance. But why is it
that two people with very similar experience
and training can reach very different levels
of effectiveness in the same job? Burnham
Rosen Group (BRG) has found the key factor
that differentiates between top performers and
their averagely performing peers is their Implicit
Motives. Superior performers have consistently
similar Implicit Motives that are often very
different from those of their averagely
performing peers.
Does this matter? Yes. Average performers
can improve their effectiveness by learning
the Implicit Motives of top performers and top
performers can get even better because they
consciously recognise which of their thoughts
are really driving their best results. Further,
Burnham Rosen can help organisations to
select the person who is the most likely to
deliver top performance in a role. Also, as the
empirical research has identified which Implicit
Motives in leadership create a culture of pride,
ownership and accountability, it is possible
to intervene with precision to develop a more
positive, high-performance orientated culture.
In short, we now understand how to
develop the performance of people and
organisations and why our methods work. We
also understand why trying to become more
effective by learning to behave differently
may not work; if our Implicit Motives are not
driving our behaviour we have to consciously
remember to act in the new way. As soon
as our attention is hijacked by a stressful
situation we forget the actions we have newly
learned and do whatever our Implicit Motives
drive us to do.
Reassuringly, the Implicit Motives which
create top performance in leadership roles
drive behaviours which are consistent with
the broad sweep of advice given by the most
perceptive leadership experts who arrived at
their conclusions using intuitive reflection on
their wide experiences.
Sounds great in theory, but how well does
it work in practice? This case study describes
the impact created by a PCT that worked with
Burnham Rosen Group, using the science of
Implicit Motives to transform their organisation:
When work started the PCT had one of
the lowest rankings within the SHA. Initial
investigations established that merging several
PCTs and gaining control of a very challenging
financial situation had taken its toll. There
was a culture of short-term, reactive decision
making which, in effect, prioritised process
efficiency over patient outcomes. Trust
between individuals, teams and stakeholder
organisations was low. People found it hard
to relate their daily tasks to the overarching
objectives of the PCT. In fact, some people
were unsure what the PCT was attempting
to achieve. Volatile and stressful relationships
were getting in the way. As one manager put it
“I’m passionate about this organisation but I’m
not proud of it yet.”
The PCT Board understood that to succeed
in accomplishing the long-term purpose of the
PCT it needed to work on two goals:
• The leadership team needed to shift its
focus from internal process efficiency to
one of outcome
• Decision making needed to be made lower
down the organisation in order to create a
significant shift in staff engagement
and accountability.
The management team participated in a
careful Implicit Motive profiling process which
informed and guided their understanding
of how their individual Implicit Motives were
similar to, and different from, the Implicit
Motives that drive top performance in their
roles. They also learned how to generate
and reinforce the thoughts of superior
performance. By changing the way they
thought, the leaders were able to adopt
and sustain new behaviours which drove
different outcomes. Ongoing opportunities
were created within the PCT for managers to
support and challenge each other to continue
their learning and reinforcement of the Implicit
Motives that drive top performance. This
resulted in some partnerships that made a big
contribution to how well departments within
the PCT understood each other. For example
a member of the surgical team and a member
of the finance team met regularly to coach
each other.
Burnham Rosen’s culture survey tool
(built on the science of Implicit Motives and
empirical research into high performing teams)
was used to pinpoint areas for personal and
organisational development and measure
changes. It measures how people feel about
the norms and expectations in their workplace.
While there is no definitive ‘better’ or 'worse'
culture, this survey is designed to measure
people’s perceptions about norms and
expectations on dimensions which correlate
with superior performance. So, the higher
the score on a dimension, the more people
perceive the culture to be similar to other
superior performing organisations. The
lower the score, the more people perceive
the culture to be unlike that of superior
performing organisations.
There are four major categories which the
survey measures:
• Results Orientation – The extent to which
people perceive the organisation focuses
on accomplishing its goals
• Engaging the Group – The extent to which
people perceive that they are members
of a team where they and the groups of
which they are a part have the authority
they need to accomplish their goals and
will be held accountable for doing so
• Emotional Intelligence – The extent
to which people are aware of their
own values, purpose, feelings and
moods, and able to understand, work
and communicate with others and
maintain relationships
• Leading Change – The extent to which
the organisation encourages moderate
risk taking through valuing mistakes and
learning from them; it also measures the
quality of dialogue – are opposing points
of view encouraged and considered? Is
paradox embraced or eliminated?
Improvements in these cultural survey
results typically reflect changes six to nine
months before they register on most other
organisational measures of performance.
Managers can see the results of their efforts
quickly, which maintains enthusiasm.
A year after BRG’s work with the PCT was
completed my colleague Rob Jackson and
I investigated what the lasting impact of the
work had been. We were looking for robust
evidence of significant change in the way
managers thought and, if there was evidence
of change, what outcomes had been caused
by those changed thoughts? We conducted
structured interviews with 40% of people
(randomly selected) who had worked with
BRG and also many of their colleagues – we
wanted to see the picture from as many angles
as possible. These interviews lasted between
90 minutes and two hours. We were wary
of the possibility of influencing the responses
that interviewees gave to our questions so
the interviews were very carefully designed to
identify the Implicit Motives that really were
now driving events within the PCT. Records
of these interviews were than analysed to
identify the Implicit Motives driving events. Our
standard for proof of real change was that
we needed to hear corroborating evidence
spontaneously from at least two people.
We identified evidence of some significant
changes. Some leaders had definitely
developed new ways of thinking about their
role. The following are some verbatim quotes
from the interviews:
"I’m very different with the Acute Trust
now and much more focussed on the work –
concerned about what the targets mean for
patients. I focus on the analysis and don’t take
it personally. We have worked together much
more successfully and hit our targets.
"Our team liked us to be directive but
we decided to change so we tried to stop
fixing their problems. We wanted them to
set the agenda and find the work focus for
themselves. Get ourselves out of the loop.
Since doing this we have had no complaints
from users for six months and also lots of
positive feedback."
"My boss asks me questions more. She
is less inclined to give the answer. Exploring
issues together reveals options and has helped
me find solutions.
"We discuss preferences for project work
as a team. One year ago we wouldn’t have
done that because no one would feel confident
enough to say what they would like to do. We
would have just sat there and taken what we
were given, however much we hated the idea."
"Last year we just missed our infection
control targets for clostridium difficile. This year
we achieved a reduction of 118% (target was
60%). Wow, that feels so good to see how
many patients’ lives we’ve saved (about 40
year on year).
"These qualitative accounts of change
were reflected in harder, externally measured
outcomes. The PCT was ranked as the most
improved within its SHA. Some other very clear
examples of the strides made included; over
achieving targets for reductions in clostridium
difficile infections, a major initiative to prevent
ill health moved from being the worst in the
SHA to being best in region and used as
an exemplar by the Department of Health
and GP’s opposition to performance ratings
was transformed into active participation in
designing the measurement process.
"You can see why we are all very
proud of the work BRG and the PCT have
done together.
"We are all painfully aware that
unprecedented challenges face the NHS.
From facilitating the unheard of co-operation
between local services, building individual
engagement in the face of threatening change,
finding creative ways to keep services safe,
effective and affordable or reducing the carbon
footprint, the science of Implicit Motives can
be used to guide and illuminate the work of
everyone passionate about our NHS."
Superman
From Man
to
David Burnham is the
CEO of Burnham Rosen
Group, a firm specialising in
empirically based research
and development for
leaders, sales executives,
and HSE professionals,
among others. He holds an MBA from
Harvard Business School and he has
taught at a number of Universities and
Management Institutes.
Lorie Farrell-Thurber is a
management consultant
and associate of Burnham
Rosen Group. Before
joining Burnham Rosen
Group, Lorie worked within
the St Ivel company, a £350m subsidiary
of Unigate plc, spending four years as
its Director of Finance. She is a Fellow of
the Chartered Institute of Management
Accountants (CIMA) and is a member of the
CIMA Panel of Assessors.
ScienceScience
February 2012 | HefmA Pulse46 47HefmA Pulse | February 2012