In the Moment

It gets worse before it gets better: A Cautionary Tale

Erika Bailey

Working in the field of behavioural change, I’ve watched many teams try out new behaviours and strive to make them stick. Often the deep work of behaviour change isn’t so much the tasks we do, but how we relate to one another. Anyone who has ever tried to shift a culture to one that supports better outcomes can attest to the difficult journey it inevitably becomes. Cultural changes take time, and unfortunately it usually gets worse before it gets better. I’ll share a story with you to help illustrate the point.

Team X (due to the sensitive nature of this post, I’m going to keep the name and some context of this team to myself) works in an incredibly high stakes hospital environment. People used to like where they worked. It was fun, and collegial and a respectful place to spend the bulk of their days. Somewhere along the way, feelings were hurt, misunderstandings went unresolved, and the small-town environment of “everyone knows everyone’s business” sucked these talented and caring people into a culture of mistrust and heavy emotional baggage.

A small team from within was tasked to work on the infection rate in their unit, and they very quickly identified that the problem was not so much with clinical practice (everyone knows what to do to reduce infections), but in how they relate…and don’t relate…to one another when it really matters. This shows up when a member of the team needs to call out a breach of infection control protocol. Does she feel like she can do this? Will there be consequences if he calls it out? Together, we got to work on the issue of trust, not directly as in “hey guys, let’s work on trust!”, but instead by getting to work on the problem of infections, and setting up their interactions to allow for new, more trusting patterns of relating to emerge.

Things began to shift. People tried out some new ways of interacting. Even more exciting was the leadership of this initiative was coming from within. Their infection rates were going down and becoming less erratic. They were using their coaching in the best way: learning, readying, doing (on their own), evaluating and learning again. Then it seemed to go wrong again. Key players in the relational mess got very uncomfortable with the change in people’s patterns, dug in their heels and returned to creating animosity with a new energy (to make up for the lost time). The sense that people were moving 2 steps back felt worse than before. Many on the team focused on what was wrong and how this was their new reality, making it incredibly difficult to shift that focus to what is working (because something always is).

When we delve into behavioural change (the real stuff of culture shift), we invite some level of discomfort. The work comes in those intense moments when it seems like the effort is failing

Team X very bravely soldiered on. They set up meetings in a collaborative and respectful manner. They worked on establishing commitment from people to haul themselves out of the behavioural rut. They believed in the group’s ability to move past their organizational pain points. Little by little things continue to shift in the right direction to the benefit of the team and ultimately those patients who depend on a culture that works.

So here is the message of this cautionary tale. When we delve into behavioural change (the real stuff of culture shift), we invite some level of discomfort. The work comes in those intense moments when it seems like the effort is failing. Knowing that it almost always gets worse before it gets better, staying the course is critical to success. We must take an emergent approach where you developmentally evaluate how things are going and make tactical adjustments along the way but stick to the principles of what needs to be done.

Leadership needs to take note. This is not the time to make demands: “Fix this or there will be consequences!” or “Well this isn’t working, let’s scrap this before it’s too late”. It’s the time to remind yourself that getting people to work together is always a worthwhile task. Everyone has some work to do in moving through the discomfort of real change. Sometimes that work demands that you move through your own discomfort while you make space for that to happen with your team.

This too shall pass.

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