Last year we created a video explaining the benefits of coming to the Annual Lean Healthcare Transformation Summit. The experiment went pretty well, so we are doing it again. Click on this image to watch the video.
Today I am on my way to another annual conference, the 21st Annual International Deming Research Seminar. I presented a paper last year on the topic of “Understanding and Application of Deming’s System of Profound Knowledge in Healthcare“. This year’s paper is a continuation of that theme – the absence of discussion (or understanding of) managing variation, which was one of the fundamental bodies of knowledge that Dr. Deming spoke and wrote about. I blogged about this year’s paper here.
What I am thinking about today, is the word “transformation”. We say that we wish to transform healthcare, and that transformation of management is necessary for that. But what do people mean by the word “transformation”? My hunch is that there is variation in what they intend to mean, and variation in how others interpret the meaning.
Anyone can put the word “transformation” into an internet search engine. I did just that, and obtained this:
Definition #1 doesn’t tell me much (act, process or instance of transforming).
Definition #2 doesn’t sound like what I want (false hair worn by women).
Definition #3 looks promising (operation of changing), but it seems to be primarily related to mathematics.
Definition #4 (genetic modification) seems off the mark.
So it’s back to the internet, and I find the following related to “business transformation”:
Well, that seems closer, but is it really what we are talking about? Is it really what is needed? Change does not always equal improvement.
I remember Dr. Deming talking about this in the late 1980s and early 1990s. He spoke (and wrote) about “transformation of management”. What did he mean? If you read his 1993 (2nd Edition) book The New Economics, you’ll find this advice in Chapter 4:
“The prevailing style of management must undergo transformation. A system can not understand itself. The transformation requires a view from outside. The aim of this chapter is to provide an outside view-a lens-that I call a system of profound knowledge. It provides a map of theory by which to understand the organizations that we work in.
“The first step is transformation of the individual. This transformation is discontinuous. It comes from understanding of the system of profound knowledge. The individual, transformed, will perceive new meaning to his life, to events, to numbers, to interactions between people. Once the individual understands the system of profound knowledge, he will apply its principles in every kind of relationship with other people. He will have a basis for judgment of his own decisions and for transformation of the organizations that he belongs to. The individual, once transformed, will:
Set an example,
Be a good listener, but will not compromise,
Continually teach other people,
Help people to pull away from their current practice and beliefs and move into the new philosophy without a feeling of guilt about the past.
“The outside view. The layout of profound knowledge appears here in four parts, all related to each other:
• Appreciation for a system
• Knowledge about variation
• Theory of knowledge
“One need not be eminent in any part nor in all four parts in order to understand it and to apply it. The 14 points for management (Out of the Crisis, Ch. 2) in industry, education, and government follow naturally as application of this outside knowledge, for transformation from the present style of Western management to one of optimization.”
If you were to get your hands on a copy of the first edition of The New Economics, you would see that Dr. Deming thought the word “metanoia” was more appropriate. Metanoia is a Greek word (from metanoiein to change one’s mind, repent, from meta- + noein to think, from nous mind) that has been associated with “spiritual conversion” of the individual. Deming described this change as a reorientation of one’s way of life to apply the principles of profound knowledge in every kind of relationship with other people.
I don’t know why the wording about “metanoia” was removed from the 2nd edition. I need to talk to some people who may know the answer to that at this year’s Deming Research Seminar.
David McKenzie has some interesting thoughts in his blog post “Leadership Metanoia – Transform the Way You Think.” Here are a few excerpts from his post:
Metanoia is to leadership, as exercise is to a healthy body.
Metanoia occurs when a current belief that motivates actions is superseded by another stronger, deeper truth.
Effective leadership requires constant metanoia, constant transformation in thinking.
Here are some examples of leadership metanoia.
- Previous leadership belief: ‘I am responsible to…’
- Metanoia transformation: ‘I am responsible for…’
- Previous leadership belief: ‘I should get all the praise’.
- Metanoia transformation: ‘I should give praise generously’.
- Previous leadership belief: ‘I must know everything.’
- Metanoia transformation: ‘I need others to know the technical stuff whilst I deal with the leadership stuff’.
- Previous leadership belief: ‘I hold all the power’.
- Metanoia transformation: ‘Shared power builds strength across the team.’
- Previous leadership belief: ‘I am the problem-solver for everyone.’
- Metanoia transformation: ‘I need to empower people to solve their own problems.’
- Previous leadership belief: ‘Everyone should listen to me.’
- Metanoia transformation: ‘I should listen to others.’
- Previous leadership belief: ‘I work in the business to improve the business.’
- Metanoia transformation: ‘I work on the business to improve the business.’
Interestingly the word metanoia is translated into the English as the word ‘repent’. Repent does not go deep enough for this rich Greek word. Repent only implies a sadness and regret for previous behaviour. True metanoia sees the error of thinking and replaces it with a deeper truth. That deeper truth is transformational and changes actions.
This makes me think about the “white coat leadership vs. improvement leadership” lists that Dr. Toussaint includes in nearly every one of his presentations.
We have been taught, trained and treated from the behaviors in the left-hand column. For most of us, it started in first grade. These actions come from beliefs and assumptions that must be thrown overboard. If we think that merely changing the forms, structures and things on the surface, then I think we are falling short. Some may say we are transforming, but has the thinking changed?
We use this iceberg metaphor to explain the relationship between how we think, which drives our understanding of guiding principles, which affects the kinds of systems and structures that we put in place. Systems drive behaviors. We know this to be true. In order to truly and permanently affect what we see on the surface (behaviors, outcomes, results), we need to decide to change the way that we think. We need to learn about the knowledge behind the behaviors in the right-hand column. To move from the left to the right is difficult, hard work. I think that means more than transformation. I think I see the wisdom about Dr. Deming’s use of the word “metanoia”.
No matter what you call it, you will learn a lot and see yourself as part of the critical mass that is moving from the left-hand to the right-hand side. Join us – at the 6th Annual Lean Healthcare Transformation Summit.