### The Case for Quest %%Rewriting Notes[](31Dec23%20-%20The%20Case%20for%20Quest.md)]] 3rd Draft of: [[Digital Garden Lead In (rev B)]] Outline: [[DG Lead-in - Key Points rev B]] Diagram: [[D - Lead-in Message]] - History - February 9, 2024 - revised - March 6, 2024 - 5th pass - March 7, 2024 - See notes for changes I made while meeting with Sandra Simms - March 8, 2024 - Wrote beginning story section (Sarah's Story) and added to draft - March 8, 2024 - Made list of possible titles [[Lead-in Title Possibilities]] - March 20, 2024 - updated callout formats, moved tables to callout boxes, added graphic images, changed title. - April 25, 2024 - back to editing today. - April 26, 2024 - short editing session today - April 28, 2024 - made more edits - May 1, 2024 - editing and created table of qualities of complex change - May 2, 2024 - continued editing - May 5, 2024 - edited ED story - May 14, 2024 - editing ED story - June 28, 2024 - editing ED story - Notes - April 26, 2024 - - This article is currently too patronizing or condescending. It needs to be more contemplative, humble, and engaging while still being very confident. How would a sage talk with a newcomer? Is should have these qualities: - Calm, patient and filled with wisdom - Respect for initiate - Depth of understanding - Gently authoritative - Nurturing - Aiming to guide - Sense of reverence for knowledge being shared - Encouraging initiate's curiosity (and growth) - May 3, 2024 - - ==See Obsidian folder on sages== - April 28, 2024 - Should I break up this article into several serialized articles? - Can I improve the images? - May 2, 2024 - ==See notes about suggested improvements== from Sandra Simms in Personal Vault. - June 28, 2024 - If I beak up this article and connect with links, I need a place to put fragments of articles - July 12, 2024 - I make a decision yesterday, while talking with Sandra, to try making the case study/origin story the backbone of this article and make the technical parts the ribs (connected by links). I'm going to start a new revision of this article. [[Oakwood ER Story rev1]] - %% # Achieving Remarkable Transformations - see new list of possible titles [[Lead-in Title Possibilities]] ![[arun-clarke-VAxzTA5IStU-unsplash.jpg]] Photo by [Arun Clarke](https://unsplash.com/@arunclarke?utm_content=creditCopyText&utm_medium=referral&utm_source=unsplash) on [Unsplash](https://unsplash.com/photos/butterfly-perching-on-leaves-VAxzTA5IStU?utm_content=creditCopyText&utm_medium=referral&utm_source=unsplash) --- ## The ED That Changed Medicine: A Healthcare Transformation Story (part 1) On an unremarkable morning, Sarah, a normally vivacious 14-year-old, reported feeling ill, a complaint that seemed minor until it took a dire turn. Cathy, her mother, watched with increasing alarm as Sarah's discomfort grew into undeniable agony. Cathy decided to rush Sarah to the hospital emergency room, only to be met with a cold and unwelcoming scene. The harsh winter air outside the hospital did little to prepare Cathy for the chaos that lay within. The emergency room was besieged by suffering people, including people waiting outside in the harsh winter cold. Forced to leave Sarah at the entrance due to a lack of parking, Cathy's heart sank as she maneuvered through the crowded lot, her mind racing with worry. Upon reuniting, they faced the overwhelming crush of the waiting area, a battlefield of sick and injured people. Their fight to reach the reception was met by a non-clinical receptionist, though not uncaring, was simply a gatekeeper to the care Sarah desperately needed. While promised help as soon as possible, the reality of their situation was that Sarah was just one more face in a sea of need. ![[overcrowded-emergency-rooms (2).jpg]] As the hours drew on, Sarah's vitality waned under the sterile lights of the overcrowded and dirty waiting room. Cathy, gripped by fear, found herself in a relentless vigil by her daughter's side. Despite her efforts to comfort Sarah, the grim reality of her situation became increasingly hard to ignore. Sara was getting worse and she was not receiving the care she needed. The continuous influx of new patients only served to deepen the sense of despair that pervaded the waiting room. In the end, Sarah's quiet struggle came to a heartbreaking conclusion. In the impersonal congestion of the emergency room, she slipped away, her life ending before she could receive the care that might have saved her. Cathy, left to grapple with an immeasurable loss, was stricken with grief—a grief that was echoed in the faces of the hospital staff who had become all too familiar with such tragedies. This story, recounted to me on my initial day as a management consultant to the ER, was a sad reminder of the profound failures within our system of emergency care. The staff, weighed down by the burden of preventable losses, were in despair. Sarah's story, though unique in its details, was not an isolated incident. It was tragic confirmation of a deep problem. The urgent need to transform their ER was clear, and the heartbreaking memory of Sarah underscored the critical importance of transforming the ER at once. Read on to discover how this story became a powerful demonstration of unleashing complex change to create breakthrough transformation. %%[[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine: A Healthcare Transformation Story (part 5)]]%% --- ## Welcome to My Digital Garden About Transformation and Complex Change ![[juairia-islam-shefa-uJsp6Lyc25k-unsplash 1.jpg]] This article is part of my digital garden, my personal website. A digital garden operates somewhat like a public notebook or a personal wiki. It's characterized by its non-linear structure, ongoing changes, and (hopefully) the growth of ideas over time. My digital garden explores the connections between organizational transformation, complex change, and the quest to achieve the change. As with all digital gardens, it's a work in process. This article is a bit different in that it's the backbone article for my digital garden. I hope it conveys a summary of the most important ideas led me to create my digital garden. I invite you to read and interact with this and other articles in the garden. >[!Info] >This digital garden is about the quest for organizational transformation and complex change. > --- # Summary %%If this article is too long, it's going to need a summary. Use a TLDR at the end instead%% --- ## Transformation: Not What You Think! ![[giulia-may-cNtMy74-mnI-unsplash.jpg]] >[!Success] Big Idea >Transformation is not just a difference of degree, it's a fundamental difference of kind. This article grows out of my decades of management consulting work in organizational change. Within the world of organizational change, transformation is, by far, the most challenging. By transformation, I'm referring to a fundamental change that organizations undergo. It's not about incremental improvements, but about making deep, systematic changes to the organization. It's a break from the past. It's not everyday, normal change. Transformation typically differs from normal change in scope and scale. But, more importantly, it's a difference of kind. It differs from normal change in fundamental ways that most leaders do not realize. It is, at its essence, a fundamentally different kind of change. This table describes the traditional view of organizational transformation. > [! ] > | | Traditional Hallmark of Transformational Change | > | -------------- | -------------- | > | Complexity | Transformational change is complex and challenging. It requires substantial time, resources and commitment to achieve the desired outcomes. | > | Impact | Transformational change impacts the entire organization at a fundamental level. It's not confined to a single department, process, or function. | >| Strategic Redirection | Transformation is about redefining the purpose and direction of the organization. | >| Culture Change | A hallmark of transformational change is a profound shift in organizational culture.| >|Vision|Transformations are often driven by strong leadership with a clear vision for the future of the organization.| >|Disruption|Transformation involves a level of disruption to existing ways of working.| >|Innovation|Transformation is not continuous improvement, but is often based on innovative leaps and breakthroughs.| >|Long-term Focus|Transformation aims for long-term changes rather that short-term improvements.| >|Visibility|Transformations can often been seen and felt by a broad range of people including employees at all levels, customers, partners, funding sources, and possibly even regulators.| --- ## Why Is Transformation So Perilous? ![[loic-leray-fCzSfVIQlVY-unsplash.jpg]] We've been told that transformation, in spite of its fundamental differences, is amenable to traditional (normal) change-management approaches. If this were true, then we could expect the outcomes of transformation initiatives to be similar to those of normal change efforts. However, the failure rate for transformation is much higher than for normal change. McKinsey estimates that 70% of transformation efforts fail to achieve their goals [reference]. Others sources essentially concur. As a result, the risk of transformation is extreme and the consequences are arrested organizational development. >[!Success] Big Idea >70% of transformation efforts fail. > - McKenzie > It's should not be surprising that many leaders report their biggest worry, the one that keeps them up at night, is that their transformation will fail. They have good reason to worry, given the very real probability of failure. Considering the risk, leaders may find it hard to support a transformation initiative. So, what have we been told by experts about reducing the risk of failure? --- ### The ED That Changed Medicine: A Healthcare Transformation Story (part 2) I listened to the stories about the months and years following Sarah's death. I learned that the emergency department management hired, at different times, three highly-regarded consulting firms to make recommendations for changing the ED to be more responsive. The ED staff were desperate for help to avoid another tragedy. The ED director shared that the consultants made reasonable and well-informed recommendations. She went on to say that, regrettably, following those recommendations resulted in very little improvement. It was still essentially the same ED with the same problems. She wondered openly how I thought that I could do any better. As much as I wanted to, I couldn't answer her question. However, I asked to take the previous consulting reports to my hotel for the weekend, and I would do my best to address her question the following Monday. %%[[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine: A Healthcare Transformation Story (part 5)]]%% --- ## The Problem with Expert Advice and Popular Nostrums ![[frame-harirak-Ei_lQ6kTwiI-unsplash.jpg]] Conventional wisdom about why transformations fail is usually not helpful and often flat wrong. Take a look at the list below of common reasons given by experts to explain why transformations fail. >[!Info] Conventional Wisdom: Why Transformations Fail >- Poor planning and execution >- Unclear vision and strategy >- Lack of leadership commitment >- Inadequate communication >- Resistance to change >- Neglected culture >- Insufficient resource allocation >- Failure to engage employees >- Short-term focus As you look through this list, you may notice that these reasons are general. They apply to normal change as well as to transformation. Clearly, these points do not assume anything particularly unique or different about transformational change. They seem to assume that change is change -- the principles are the same. Because there is a fundamental difference between transformation and normal change, the normal rules don't apply. Using the list above will not significantly reduce transformation failures. (I know, I've tried many times.) The causes on the list may feel intuitively right and seem to be common sense, but they miss the point when it comes to transformation success with transformation is driven by other factors. Using conventional wisdom may help around the margins, but it miss the most fundamental driver of failure. >[!Success] Big Idea >Everything we learned about transformation was wrong. --- ## Why Transformation Projects Fail Unfortunately, nearly everything we were told about managing transformational change is essentially wrong. Transformations fail because we have misunderstood the essential characteristics of transformation. That is because we've been treating transformation as if it were complicated or really complicated change. It's not. Complicated change is normal change. Transformation is non-normal change. The principles of non-normal change are different! They are counterintuitive, even directly oppose the principles of normal change. Taking traditional measures to reduce the risk of failed transformations actually increase the risk and even literally bring about the failure. So treating transformation as normal change is the big failure mode; it eclipses every other reason generally given for failure. Normal change, in the language of complexity science is of characterized as either simple or complicated change. (We can ignore simple for our purposes.) But the science tells us that non-normal change, such as transformation, is actually complex change. From a complexity science perspective, complex change, while often mistaken for complicated change, is decidedly different. Transformations fail primarily because we mistake them for complicated change. Instead, if we treat them as complex change, everything changes. That's it. >[!success] Big Idea >The paramount reason that transformations fail is because we treat them as complicated, not complex, change. > So, by now, I'm sure you're asking what is complex change and how is it different. --- ### The ED That Changed Medicine: A Healthcare Transformation Story (part 3) %%This is a recent addition that needs editing%% When I first met, Connie, the director of the emergency department I found her to be polite but not encouraging. When I shared that I would like to help her transform the ED, her response was essentially, "Good luck!" I must have looked shocked because she immediately followed up with, "It's not you, but we've already had three consulting firms look at our ED and yet nothing much has changed." I went back to my hotel with three thick consulting reports. As I paged through them over my room-service dinner, it became clear that these were excellent reports by well-regarded consultancies. Why did they fail to make a difference? Could I offer anything with a better chance of success? It struck me that the three reports each shared an attribute that led to their failure. Each consulting report implicitly assumed that the change problem that the ED faced was one of normal change. Once the consultants assumed normal change, they inextricability followed by recommending traditional change management approaches. Their reports were full of strategic plans, project definitions, work breakdowns, activity tracking, roles and responsibilities, and so on. In other words, they assumed that change was change and the ED would simply be a complicated change project. Of course the consulting firms' healthcare experts recommended specific changes to the ED, but they assumed that traditional change management was sufficient to implement those changes and the changes were sufficient to transform the ED. Consequently, they recommended that the steps be planned in advance, built into a detailed project plan, resourced by subject-matter experts, and executed by completing items on a task list. They would report progress by measuring the percentage of tasks completed. The ED tried this approach, with slight variations, three times over five years. Each time they failed. The 70% failure rate was manifesting again! I was determined not to lead them down the path to failure again. I was left with a choice of gracefully bowing out of the engagement, or recommending a different approach. I could see that the authors of the three consulting reports each made a fundamental error. They assumed that change problem facing the ED was a case of normal, albeit complicated, change. Given their failures and my understanding of the situation after my first day, I saw the change problem a case of "non-normal," complex (not complicated) change. That would mean that the path to transforming the ED literally unknowable, even by healthcare experts. If so, then the ED team would need to navigate their transformation using exploration, discovery and application. Traditional planning-and-execution methods had not and would not achieve success. I decided that evening assume that their needed transformation was non-normal change and to recommend a non-traditional approach. %%[[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine: A Healthcare Transformation Story (part 5)]]]]%% --- ## What Makes Complex Different Than Complicated? %%Why Isn't Complex Complicated?%% ![[max-harlynking-_QcLpud-gD0-unsplash.jpg]] [Need two photos side by side - complex, complicated] Let's quickly recap. Organizational transformation is <u>not</u> complicated, but it <u>is</u> complex. Viewed from the lens of <mark style="background: #FFF3A3A6;">complexity theory</mark>, transformation is a specific case of complex change. Treating transformation as anything but complex change is the primary driver of failed transformations. It's also the dominant reason for soaring failure rates for transformations. Unlike transformation initiatives, normal-change projects can be considered complicated change. Complicated change requires is characterized by one or more subject-matter experts who can specify the steps needed to make the change. The steps of even complicated changes are either known or knowable by the expert. Managing complicated change is largely a matter of detailed planning and execution. Equipped with a goal, subject-matter experts, a detailed plan or roadmap, and controlled execution, we can accomplish normal change with reasonable expectations of success. Complicated change may not be easy, but we can figure it out and make it work. Traditional change management methods work fairly well for cases of complicated change. Those methods don't work for complex change, on the other hand, because it is something quite different. The table below makes a comparison. > [! Complicated vs. Complex Change ] >|Aspect|Complicated Change|Complex Change| |---|---|---| |Nature of the Change Problem|Knowable and analyzable. There are right answers.| Unknowable in advance; relationships and effects understood in retrospect.| |Approach to Change |Expert analysis and established methods.|Exploration, experimentation, and application.| |Predictability|Predictable outcomes.| Outcomes are emergent. | |Repeatability| Solutions are repeatable.| Solutions only repeatable if subject-matter expertise is developed over iterations.| |Expertise|Relies on expertise from specialized knowledge.| Requires expertise developed via collective change journey. | |Problem-Solving Process|Analyze, plan, and execute.| Explore, discover, and apply. | |Knowledge Requirements|Specialized subject-matter knowledge is crucial.| Diverse perspectives and adaptability are key. | |Management Approach|Top-down management can be effective.| Requires a more distributed or participatory approach. | |Examples|Building a bridge, complicated surgery.| Managing organizational transformation, navigating global markets. | | Solution Discovery | Solutions can be discovered through analysis. | Solutions emerge through experimentation, interaction, and adaptation. | | Cause and Effect | Cause and effect is discernible with expertise. | Cause and effect are only clear in hindsight. | | Change Dynamics | Changes are relatively stable and predictable. | Changes are emergent, innovative and sometimes novel. | I should be clear from the above table that complex change is not somewhat different -- a special case of complicated change. Rather, it's an altogether different form of change. Normal change is complicated change. Transformation is complex change. Our fatal mistake is not that we use complicated change-management approaches ineffectively; it's that we unwittingly apply complicated-change approaches to complex change when we should be using altogether different approaches. This is the real reason why over 70% of transformation initiatives fail. The problem is not that we're not effective at traditional change management (in fact, we're usually quite good at it), it's that traditional change-management practices are ineffective, and actually undermine, complex change. >[!Big Idea] >Our fatal mistake is not that we fail to use traditional change-management approaches effectively; it's that we unwittingly use complicated-change approaches when we should be using complex-change approaches. > Imagine what happens when we use traditional planning-and-execution (PE) methods in a complex-change (i.e. transformation) initiative. We try to break down the "project" into detailed actions even though the steps are actually unknowable in advance. We treat unexpected events like they are problems in defiance of the reality that novelty and emergence behaviors are essential ingredients of complex change. We measure progress by checking off planned activities rather than incorporating new discoveries and insights from ongoing experiments. We treat checking off the planned tasks as success while discouraging the search for game-changing innovations. In nearly every respect, the PE approach works against and undermines the the success of complex-change initiatives. <span style="background:rgba(92, 92, 92, 0.2)">So we know that the tools and processes that we're comfortable with are likely to be detrimental under conditions of complex change. So, how do we extricate ourselves from this dilemma? How can we successfully manage complex change.</span> %%Note: The paragraph above was intended to transition to another section of the article. It may be able to be used, but I need a new transition here.%% --- ### The ED That Changed Medicine: A Healthcare Transformation Story (part 4) %%This section needs editing%% To my great relief, the ED director and hospital executives were willing to try something new so they decided to accept my recommendation. They would attempt to transform their ED by treating the problem as non-normal change. However, it soon became clear that the executives had not really shifted their perspective. They were bewildered by the lack of detailed project steps and percentage of completion reporting. They wanted to know when they would receive the standard project reports on the ED. Understandably, they were still anchored in the traditional project management paradigm. The ED staff was concerned that the hospital executives, concerned about the risk of a big project, would pull the plug. The staff created some project-looking reports that we specifically used for executive reporting. Fortunately, while the long-term path forward was largely unknowable, we were able to cast past work and immediate next actions as a task sequence. While we didn't use traditional project management to guide the transformation, we found that speaking to executive management in project-like terminology was necessary to maintain their support. Traditional planning-and-execution methods were so ingrained into the fabric of the hospital that it was difficult for leaders to visualize a different approach, particularly when that approach emphasized uncertainty and unknowability, words that telegraphed risk. Just describing complex change and contrasting it with traditional change was not enough. It wasn't until the ED team began conducting experiments and achieving significant innovations that the executives gained full confidence in the new approach. %%Move this sidebar further down the article.%% %%[[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine: A Healthcare Transformation Story (part 5) ]]%% > [!NOTE] Sidebar: Quest Workshops > During subsequent complex-change initiatives, I organized one-day workshops where participants could engage with the complexity approach on a smaller scale. These sessions provided a hands-on experience of the quest framework, demonstrating that breakthrough results could be achieved, even in just one day. This experience highlighted that merely hearing about these concepts is not enough; true comprehension comes from direct, practical engagement. --- # The Futility of Managing Risk ![[patrick-perkins-ETRPjvb0KM0-unsplash.jpg]] Navigating transformations can be precarious terrain. While our aim is to mitigate risks, conventional risk-reduction strategies will steer us towards failure. Mitigating risk typically involves doubling down on planning and execution (PE) activities. While planning and execution are the hallmarks of traditional change management, they work in counter-intuitive ways for complex change like transformation. Herein lies the great tragedy: as organizations expend more and more resources on detailed planning and execution, they dramatically increase risk of failure for any complex change, including transformation. >[!Big Idea] >It is tragic when the organization put more emphasis on planning and execution, and by doing so, fatally undermine their transformation. Let's delve into why Planning and Execution (PE) often find themselves at odds with the requirements of transformative change. Transformation, along with any complex change endeavor, operates within a landscape characterized by these inherent factors: - volatility - unknowability - ambiguity - adaptation - emergence - novelty These factors shape the essence of complex change, yet they stand in stark contrast to the structured nature of planning-and-execution approach. Consequently, PE consistently proves to be dismally ineffective as a change management approach for navigating the landscape of complex change and transformation. From the standpoint of normal, complicated change processes, these factors are typically seen as highly undesirable and pose a risk of disrupting the Planning and Execution (PE) activities. Change leaders strive to eliminate these elements from their initiatives. Yet, when viewed through the lens of complex change, these same factors emerge as valuable assets that foster opportunities for critical discoveries, breakthroughs, and transformative changes. The following table outlines these factors and illustrates their conflict with the traditional planning-and-execution approach. It is important to note that these factors are not merely challenging; they fundamentally clash with conventional PE methodologies. > [!NOTE] Complexity Factors Impact on Planning and Execution Methods > > | **Complexity Factor** | **Meaning** | **Implication for Planning and Execution (PE)** | | --------------------- | ----------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------- | | Volatility | The unpredictability and variability of conditions in a changing system. | PE methods rely on predictability and stability, which conflicts with volatile environments. | | Unknowability | The inherent inability to fully predict future steps in a change process. | PE methods require predefined steps, which is problematic when future steps are unknowable. | | Uncertainty | Refers to a lack of predictability or clarity regarding future outcomes, events, or conditions. | PE methods rely on predictability and stability, which are at odds with uncertain environments. | | Ambiguity | Multiple possible interpretations, meanings, or directions in a changing system. | PE approaches demand precision and defined steps, which are challenged by ambiguity. | | Adaptation | The ability to adjust and respond to evolving circumstances, challenges, or opportunities. | PE typically involves a predefined path, making it less adaptable to changing conditions. | | Emergence | The unpredictable appearance of new patterns or behaviors. | In PE, emergence is viewed as a risk that disrupts plans and must be controlled. | | Novelty | The introduction of new ideas, methods, or solutions that deviate from the norm. | While PE values innovation, it often fails to it, favoring consistency and predictability instead. | --- ## Complexity Thinking is Different ![[charlesdeluvio-OWkXt1ikC5g-unsplash.jpg]] Let's examine how complexity thinking contrasts with the conventional planning-and-execution approach. Complexity science introduces the concept of complex change as non-normal change; it does not adhere to the typical rules found in the normal, business-as-usual organizational environment. In the normal world, next steps are either known or can be discerned with expert advice. However, in the realm of complex change, future actions are inherently unknowable, even with expert input. The only way to effectively navigate through a complex landscape is to iteratively uncover necessary actions as the journey unfolds and our competencies develop. This makes it a journey of exploration, discovery, and practical application. In navigating complex change, envisioning ourselves on a path of trials offers insights into the next steps. with the trials typically taking the form of small, rapid, fail-safe experiments. As a rule, these trials manifest as small, rapid, fail-safe experiments, progressively leading to more sophisticated experiments, novel insights and discoveries, and eventual breakthroughs. Throughout this journey, as questers engage in experimentation, they develop new capabilities essential for fulfilling their quest. Unlike traditional change methods reliant on detailed planning and execution (PE), this approach hinges on exploration, discovery, and application (EA). EA fundamentally diverges from PE, emphasizing a process of learning and adaptation. >[!Big Idea] >Unlike the normal world, things are <u>not</u> known and agreed upon in the complex world. We are likely to need guide, someone adept at steering the course through exploration, discovery, and application. The guide need not be a subject-matter expert but must be a journey expert. This guide plays a critical role by aiding questers when they sound the call to adventure, equip a team, navigate a path filled with trials and challenges, make innovations, and achieve pivotal breakthroughs. Ultimately, this guidance helps to effectively spread the change throughout the organization. The changes that result from this process often lead to fundamental transformation and renewal of the organization. The change makers and the guide need a method for navigating the complex-change journey. The method for creating complex change need not be complex. However, it can be remarkable. Change makers and their guides require a method to navigate the journey of complex change effectively. While the approach to creating complex change does not have to be complex, it must be remarkably effective. >[!Big Idea] >The approach for navigating complex change need not be complex, but it must be remarkably effective. --- ## An Alternative Approach (to Transformation) Organizational transformations are inherently complex, not just complicated. Complex changes, unlike complicated ones, cannot be fully planned or predicted. They require an adaptive approach that embraces exploration, discovery, and iterative application of learning. Traditional planning and execution methods, suitable for normal change, often fail in the face of transformation's inherently complex characteristics. Over 70% of transformation initiatives falter because they mistakenly apply rigid planning-and-execution methods to situations that demand flexibility and ongoing adaptation. To successfully manage complex change, organizations must embrace a process of experimentation and learning, viewing unpredictability as an opportunity for innovation and breakthroughs. This shift in approach moves away from top-down expert analysis to a more distributed, participatory method of managing change, crucial for navigating the volatile, uncertain, and ambiguous landscapes typical of transformations. This approach, based on complexity principles, represents a paradigm shift in organizational change management, fundamentally altering both the methodologies and the underlying assumptions about transformation. This approach reshapes our entire perspective on how organizations develop, marking a radical departure from traditional change management strategies. Embracing exploration and application of discoveries, complexity thinking recognizes that transformative change often emerges from contact with the unexpected and previously unknowable aspects of a complex system. As we delve deeper into this transformative mindset, let's explore specific tools and methods that can effectively support and facilitate complex change initiatives within organizations. New tools have been designed to harness the dynamic and emergent nature of complex environments, enabling leaders to guide their teams through the intricacies of transformation with agility and foresight. This new approach is based on the archetype of the quest. The following outlines the progression of an organizational quest. --- ## The Organizational Quest I have applied the framework of a quest to guide many organizations in a wide range of industries through successful transformative change. The framework has proven to be surprisingly reliable and effective. Here is a short summary of the quest approach to organizational change that is based on the archetypal quest framework. **A Trigger:** The seeds of a quest are planted when an organization faces a crisis or experiences a dislocation. The crisis may threaten its market position, profitability, supply of talent, culture or any other factor that affects the ability to thrive. If the threat is serious, the organizational will realize that it must respond by making major changes. It may sound an urgent appeal to rally support for action. **Objective and Duration:** The objective of an organizational quest to transform the organization so it can sustain prosperity. This quest is typically time-limited, with a deadline set to encourage urgent action and focused efforts on the necessary change. **Journey Structure:** The quest follows the archetypal journey of departure, discovery, and return. The questers are often a diverse team assembled from across the organization. They will dedicate themselves to making a transformational journey and returning with the means to renew the organization. **Uncharted Territory:** The quest team will be tasked with navigating unexplored territory that is specific to the organization and the object of the quest. Their search could be for anything from sustainable new technologies to new ways to meet customer needs. Their journey will involve searching for best practices, research into new approaches or technologies, developing new techniques, or anything else that carries the quest toward its goal. **Discovery and Application:** Throughout their journey, the team will conduct small fail-safe experiments to assess the feasibility of new ideas and their impact on the organization’s ability to thrive. This process typically culminates with significant breakthroughs that would have been inconceivable without the quest journey. **The Prize:** The prize of the quest is the new way for the organization. We should not be surprised if the quest yields a greater largesse than defined by the goal. The quest team will verify that the the solution is robust for widespread use and return with a plan to spread the new practices within the organization. **Sharing the Prize:** Upon returning from their quest, the questers may share their discoveries through a series of workshops, training sessions, digital content, or a company-wide open house. It is crucial that the new sustainable practices are sustainable. It may be a simple process for limited areas or need to be understood, adopted, and championed across all levels of the organization. **Growth and Development:** During the quest, the team members will develop into knowledgeable advocates for the new way and play a pivotal in helping the organization adopt a sustainable benefit. They will have gained skills that will be invaluable to the organization after the quest. Their growth enhances their capability to lead the organization's transformation and mentor others in the new practices. **Outcome:** Often the quest not only revolutionizes the organization’s practices, but also positions it as a leader in it's sector, attracting new customers and partners, and even transforming an industry or community. The quest turns a crisis into an opportunity, driving innovation and securing the organizations’s future. The "organizational quest" framework applies the structure of an archetypal quest to guide organizations through transformative change. This approach, which starts with a triggering crisis that jeopardizes essential aspects of the organization, requires a response through major changes. The quest typically has a clear objective and timeline aimed at renewing the organization's prosperity, involving a journey structured around departure, discovery, and return. The journey entails navigating uncharted territory specific to the organization's needs, such as searching for new technologies or customer engagement methods, and is marked by experimentation and discovery. Throughout this quest, the team undertakes fail-safe experiments to develop and test new ideas, which often lead to significant breakthroughs. The culmination of the quest is the integration of these new practices within the organization through various sharing methods, ensuring the practices are sustainable and widely adopted. This transformative journey not only addresses the initial crisis but often positions the organization as a leader in its sector, driving innovation and securing its future. The process embodies the dynamics of complex change, emphasizing adaptation, emergent leadership, and new discoveries in the face of uncertainty and novelty, reflecting how organizations must evolve to navigate and thrive in periods of complex change. The following table underscores how the quest approach relates to the elements of complex change. %%Put this table in a callout box.%% | Complex Change<br>Hallmark | <br>Relation to the Quest Archetype | | -------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Volatility | The quest often involves sudden changes and upheavals. Questers must navigate these swift changes in a complex environment or circumstances. They must remain resilient and proactive in the face of rapid change and new challenges. | | Unknowability | The future outcomes and the true nature of the challenges are often unknown to the quester. This unknowability compels the quester to rely on exploration, discovery and application of new knowledge. | | Uncertainity | The path forward in a quest is rarely clear. Questers often make decisions without having all the necessary information, progressing through small, fail-safe experiments. | | Ambiguity | The quester frequently faces situations where choices are not clear-cut, and the distinction between adaptive change and a dead end can be blurred. | | Adaptation | The questers ability to adapt to new realities is key. Each phase of the journey involves new challenges and discoveries, requiring the development of new capabilities, pushing the quester to learn and evolve at every step. | | Emergence | In the context of an archetypal quest, emergence refers to the process through which new properties, behaviors, or patterns arise that were not predictable from earlier conditions or states. This hallmark of complexity is crucial in the quest narrative, as it highlights the quester's development and evolution in response to their journey, leading to the realization of breakthrough capabilities essential for accomplishing the quest. | | Novelty | The quest journey introduces novel situations and dynamics that are unlike anything the quester has faced before. These novel experiences are essential for the quester’s growth and the development of innovative thinking and actions. Insights from novelty often serve as the catalyst for breakthroughs. | Let's illustrate the power of the organizational quest framework by returning to the real-life story from the emergency department. This story demonstrates how the principles of navigating uncharted territory, engaging in fail-safe experiments, and integrating new practices can lead to significant breakthroughs and sustainable improvements. --- ### The ED That Changed Medicine: A Healthcare Transformation Story (links and notes) %% - This section is the setup for the story - [[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine: A Healthcare Transformation Story (part 1)]] - This section is about hearing of Sarah's death - [[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine: A Healthcare Transformation Story (part 2)]] - This section is about taking home the consulting reports and deciding on a different approach - [[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine A Healthcare Transformation Story (part 3)]] - This section is about reporting to executive management. - [[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine: A Healthcare Transformation Story (part 4)]] - This ED section is about using the quest approach (not fully developed) - [[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine: A Healthcare Transformation Story (part 5)]] - %% %%Needs Development%% %%Move some material to earlier sections%% The staff was willing to try something completely new. We would approach the ED problem as if we were on a quest... %%Capturing a thought%% Working without outside subject matter experts, they drew on their own knowledge and experience. Through their development on the path of trials, they became the subject matter experts for an entire industry. Some went on to pursue their own consulting careers in ED medicine. %%[[Digital Garden Lead In (rev E-1)#The ED That Changed Medicine (5)]]%% --- ### The ED That Changed Medicine: A Healthcare Transformation Story (part 5) %% - The team - ER doctors - ER nurses - EMTs - Admin - Communications - (Hospital room control) - Met weekly as a full group - Sub groups met more often to explore and experiment - Roles for the Quest - Ran over 60 experiments - Small, fail-safe trials - As small as one shift, one day - Try ideas in real life - Examples - Bedside testing - Resource (vs acuity) based sequencing - DC non-urgent patients without taking them back to ER - Urgent care pathway - Modify utilization-based incentives for MDs - Most trials changed - Modified - Expanded - Dead-ended - Most trials led to more sophisticated and demanding trials that had greater leverage - Trials considered successful even if outcome not what was desired - If new learning occurred - If new learning led to a better trial - Successful apex experiments - Cataloged for future integration - Implemented immediately on a provisional basis - Integration tests - Combining several successful trials in one super-trial - Identifying problems and opportunities - Iterating to improve effectiveness - Identifying new areas of experimentation - Identifying gaps in the new system - Asking "Is this the breakthrough?" - Six intensive months - Much communication - Open houses - Report out at corporate meetings - Project updates to sponsor - Outreach to affected departments - Connecting with subject matter experts - Making the Breakthrough - Do the integration tests results meet our goals? - Have we left no low-hanging fruit? - Is the solution robust enough for everyday use? - Do the benefits exceed the costs? - Is it the best ethical approach? - Turn for home - Discontinue new trials and exploration - Turn focus to spreading the innovations %% ## The ED That Changed Medicine: A Healthcare Transformation Story (part 6) %% Spreading the change %% ### Sara's Legacy (conclusion to the ER story) %%Needs development - *Make this section to the end of the article.* - *The introduction to this story is at the top of the article.* - *This section needs substantial revision.* %% ![[11emergency2_4972915_ver1.0_640_480.jpg]] I want to share a story of my first chance to test these methods in a real (and very high-stakes) complex-change situation. My client was a hospital corporation where I was working with one of their emergency departments. [Link to ED case study.] My client applied the complex-change approach to a dangerously overcrowded emergency department with long waits to to be seen, visit times measured in days, patients waiting outside in the freezing weather to be seen, and where patients literally died while waiting for care. They transformed themselves into fastest emergency department in the United States. The waiting room was virtually empty, patients were seen by a doctor within 30 minutes, total visit time was less than an hour, and patients drove past closer hospitals for emergency care. No one died waiting for care. Total ED visits went up significantly as did net revenue. Their changes transformed their ED (and the other EDs in their system). Moreover, it transformed emergency care nationwide. Their initiative was recognized nationally, they won coveted industry awards, and they set new national benchmarks for emergency department effectiveness. They were soon hosting visits from other hospitals to spread the change. %%Move this to the end of the ED story.%% >[!Success] Big Idea >After previous failed attempts, the hospital corporation used the quest framework (based on complexity thinking) to create the nation's fastest emergency department, save patient lives, and transform the emergency care industry. --- ### ### The ED That Changed Medicine (continued) %%Needs work%% %%Should I move it to earlier spot?%% In the story above, we didn't have time to take the emergency department crew on a deep dive into complexity theory. On the other hand, we didn't have the expertise or inclination to do the change for them. So I suggested drawing on the archetype [metaphor] of a quest. I was aware of the deep connection between the quest archetype and complexity thinking. I proposed a quest that would be a journey that they undertook to achieve an extraordinary goal and secure the prize of renewal. It would be a race against time into uncharted territory, filled with challenges, obstacles, trials, and discoveries that could culminate in a breakthrough. They would start with a beginner's mindset and develop vital capability as they progressed. Once they had achieved the prize, they would spread it throughout their department and then across all locations. They enthusiastically signed on, launched their quest, and the rest is history. I was hopeful but frankly amazed by how well the quest approach supported complex change. --- >[!Success] Big Idea >The quest archetype reliably facilitates complex change. ## The Quest Drives Transformation ![[andrew-neel-1-29wyvvLJA-unsplash.jpg]] Quests are neither exotic nor rare. They take place all the time in all areas of human endeavor. Some well-known, real-world examples include: - The Lewis and Clark Expedition - The Apollo Moon Missions - Ernest Shackleton's Escape from Antartica - The Human Genome Project - The Discovery of the Higgs Boson - The Creation of Amazon.com - Jane Goodall's Study of Chimpanzees - The Quest for the Northwest Passage - The Race to the South Pole - Amelia Earhart's Attempts to Circumnavigate the Globe - Mankind's Quest to Stop Climate Warming Mythology scholars, such as Joseph Campbell, tell us that those who embark on a quest will 1) achieve their aim, 2) achieve something far greater, and/or 3) learn and grow in preparation the next quest. The emergency department quest achieved something far greater than their aim. The only losers are those who refuse the call to adventure and never attempt their quest. Of course, the other losers are those who are not aware of the complex change and unwittingly attempt to use traditional change methods instead. After being involved in dozens of successful organizational quests, I'm convinced beyond a doubt that the quest approach for complex change and transformation is real and effective. I want to use this digital garden to turn the quest into a structured and systematic approach and spread it among organizations that can easily replicate to achieve the same results. That requires a structured approach. ## ChangeQuest™ - Guided Discovery I started with the outline of an approach that seemed to work every time. I wrote a book about the approach called, The Quest Effect™. The next packaging step was a name, so I called the approach, ChangeQuest. I think of ChangeQuest as the complex-change process and The Quest Effect is the outcome of that process. Let's take a look at how ChangeQuest works. Most of us have some I idea about how quests play out in stories. You are probably familiar with well-known quests like King Arthur and the Quest for the Holy Grail, The Odyssey, Star Wars, The Lord of the Rings, or the Indiana Jones movies. All quests share the same archetypal structure that lays out the themes and the unfolding of events. Of course, every quest is different, but the deep, underlying framework repeats. The archetypal quest framework is recognizable, and repeatable, for complex organizational change and transformation as well. %%Move this section up to corresponding note?%% ## A Proven Method %%ChangeQuest process graphic?%% ChangeQuest is not necessary to be successful at complex change. However, organizations who can see themselves on a quest do not need to master the concepts of complexity theory and complex change. Participants only have to see them­selves on a quest and understand the relatively simple quest approach. If they can do that, the change will work. I've seen it work again and again. I want everyone to be able to take on complex change and transformation with high confidence of success. I want every organization to experience its own "Quest Effect." Instead of staying awake at night worming about your change initiative, I think every leader can be confident that they can lead complex change. Organizations need it. The world needs it. ## This Digital Garden is a Resource %%Do I need this section? - Yes, Drop%% --- %%Make this a footnote after Wrap-up%% %%Move this section to another document?%% This digital garden is, like all digital gardens, a work in process. I'm throwing my work out there, before it's perfected, because I need your guidance. Help me understand: - What works? What doesn't work? - What is clear? What is confusing? - Where you navigated with ease. Where you get lost? - What articles were helpful? - What new articles would help you be successful? - What I missed or misunderstood? - What will bring you back? - What I should work on next? - What would help you get involved? I invite you to freely use this digital garden and, if you want, provide feedback or words of encouragement. %%end the article with question(s) at the end%% %%next steps (harvest)%% %%Get back to the garden... fun play on Joni Mitchell song%%