System Change Through People Power
A look at how the Nova Scotia public health care system transformed from the inside out.
Many organizations faced with the significant challenges of improving organizational capability, creating better services, and becoming more agile—often with less money—forget that the key to the best possible future lies in the minds of the many that use, create, and deliver these services everyday. If an organization can harness that deep knowledge, powerful change for the better can unfold naturally.
Not a management consultant in sight
In Nova Scotia, large-scale change to the public health care system is happening through a process called Participatory Leadership, in which public health practitioners and others are co-designing and co-creating solutions to challenging organizational issues. This process allows all participants to contribute to—and thereby embrace—systems change. For context: Nova Scotia is 1 of 10 provinces and 3 territories in Canada with a population of almost 1 million people. The public health system employs approximately 500 staff in 38 office locations, and has a $52 million budget.
Director Janet Braunstein Moody explains, “We are doing things today that would not be possible if participatory leadership wasn’t the core operating process of the organization.” She describes the process as initiating, sensing, “presencing,” creating, and evolving, where the defining purpose of the organization and how the work is done is supported by intensive collaborative practices.
After working in healthcare for many years, Moody says she has realized that you can do almost anything with a shared vision; when there is awareness and comprehension of that shared vision, the needs of the whole outweigh the needs of the individual. This methodology has worked well in several areas, including budgeting; public health budgets are reviewed together and decisions on how best to spend that budget are now made as a group.
This system also means wise decisions get made, faster. In a recent meeting on policy legislation, one observer commented, “I have been working in policy legislation for 25 years. I have seen people trying for months, if not years, without success to achieve what you have in four hours.” Moody explains the reason why this works is because the organizational paradigm is inverted from top down. It’s built upon meaningful networks of relationships that are truly collaborative, and that evolve a shared vision and understanding of what needs to be done. Everyone can see the problem from a holistic perspective, and therefore has a greater appreciation for the right course of action.
As a consequence of adopting a collaborative, open approach, the commitment to work hard and for each other increases dramatically. Moody has observed that work and the meaning of work have become more satisfying and meaningful—even more fun—because it is a values-led work ethic. This values-led work ethic is based on the co-creation and adoption of a shared vision of the role and purpose of the organization. Moody also observes that systems change occurs when individuals change within the system, when each individual embarks on their own journey of transformation. This journey should not be underestimated—it is demanding of the individual at a very deep level, and taps into their core motivations, beliefs, and values. It is shaped by how groups come together and work together, and how they are enabled to look at the challenge at a systems level. One team member explains, “The core group experience was transformative, in that it allowed you to be who you are, both professionally and personally.”
Consequently, this process is fertile ground for people to develop as individuals and to grow into true, authentic leaders who have the deep respect of their co-workers and partners. Their leadership is based on the idea of stewardship not ownership, and many feel that for the time they occupy that role, it is a privilege. One practitioner explains, “What I’m understanding about myself right now is that when I lead with purpose, it’s very, very powerful. I think if you’d asked me before, I might have said that I led by accident.”
Participatory leadership is also demonstrative of the agile organization. Agility is related to what MIT professor C. Otto Scharmer, author of Theory U and an authority on participatory leadership, describes as an “evolved geometry that devolves power from hierarchies to evolving trusted networks of relationships.” In these kinds of organizational models, everyone (certainly in the case of Nova Scotia’s public health system) connects with each other in more meaningful ways—they are all part of the process. In these human-centered ecologies of organization, intellectual and social capital is released through a collaborative learning culture. Consequently, when the H1N1 epidemic broke out in Nova Scotia, the healthcare system was fleet of foot in responding to the unfolding danger. The individuals within the organization are highly tuned in to their personal and collective roles (deep democracy), and are able to come together quickly as a team, to be open, to listen deeply, to hear what is being said and respond purposefully—all of this demonstrates the capacity of participatory leadership.
Upgrading to the Human-OS
It is my belief that we create a better world through what we share. Upgrading our world and our enterprises to a human-centric operating system (OS) offers us greater opportunity, freedom, empowerment, mutualism, diversity, efficiency, independence, and even beauty. The aesthetics of the design process has led to exemplary outcomes for Nova Scotia—Moody tells me that the Canadian government is seriously interested in their organizational approach to leadership and systemic change.
It is clear that this human OS is the DNA, the very fabric of the systems design change within the Nova Scotia healthcare system. It demonstrates that people are motivated to contribute their creative best if they believe that it is worthwhile and that others find it meaningful. The Nova Scotia healthcare system is open and agile. It possesses the capacity to deal with complexity and is far more responsive because it is built on trusted, interconnected networks of human relationships. It is diverse and thinks of itself more as an organism than a machine. Faster alone, they say, but further together.
Read an excerpt from the book on which this post is based, No Straight Lines: Making Sense of Our Non-linear World.