The struggle to have both a good personal life and a good career arises from a dominant societal image of the ideal worker as “career-primary,” the person who is able and willing to put work first, and for whom work time is infinitely expandable. This view translates into work practices that include dawn meetings; planning sessions that run into the evening, often ending with the suggestion to “continue this over dinner”; and training programs requiring long absences from home. Commitment is measured by what one manager proudly declared as his definition of a star engineer: “someone who doesn’t know enough to go home at night.” At lower levels in the organization, the belief in the dominance of work translates into tight controls over worker time and flexibility.

In situations where “ideal workers” are assumed to be those whose first allegiance is to the job, people with career aspirations go to great lengths to keep personal issues from intruding into work. Some people give false reasons for leaving work early: They feel that attending a community board or civic meeting is not likely to brand them as uncommitted, while taking a child for a physical might. Some secretly take children on business trips. Others leave their computers on while picking up children from sporting events, hoping that colleagues passing by will think they are in a meeting.

When Individuals Try to Change

BUSINESS CASE FOR RELINKING WORK AND FAMILY

As management’s support of family-sensitive work practices rises, employees experience less work-family conflict, leading to greater worker satisfaction and better quality of work.

Some workers, because of their positions, their financial resources, or their perceived value as employees, are themselves able, at times, to forge satisfactory links between work and family. The rest simmer with discontent. In all cases, energy and loyalty are diverted unnecessarily from the organization (see “Can Your Company Benefit from Relinking?”). Because people feel powerless to deal with these concerns on their own, relevant work-related issues cannot be discussed at the collective level, where real systemic change might yield significant business and personal results.

When individuals change, but the system remains the same, there may be unexpected negative consequences for both. For example, one team leader arranged a four-day schedule to cut down on a long commute and to spend more time with her children. Not only did this arrangement serve her needs, but because the team leader rotated group members to take her place on the fifth day, she developed their self-management skills. By all measures, including productivity and satisfaction, the group was thriving. But the arrangement did not last long. In the end, the manager was stripped of her supervisory duties and moved to the bottom category of performance. Management regarded the team leader’s efforts as a negative reflection of her future potential and management capability. Similarly, a full-time sales technician who negotiated earlier hours was forced to give up the arrangement because her managers were unwilling to adjust their daily demands to conform to the schedule they had approved. From the beginning, the managers imposed so many “exceptions” that the employee was putting in extra hours and was unable to pick up

her child at school much of the time — the reason she wanted the earlier hours in the first place. In the end, she reverted to her old schedule and became very disillusioned.

In this context, it is not surprising that managers typically view requests for flexibility as risky to grant. Even though they may sympathize and want to grant such requests, especially when it comes to their most valued employees, they worry about the potential negative consequences of allowing such arrangements. Not only do they worry that productivity might suffer, but they fear that, in negotiating and monitoring these special arrangements, they might have an increased workload. As a result, managers often end up sending negative signals indicating that the use of flexible, family-friendly benefits is a problem for them and for the company as a whole.

The important point is that it is problematic when work-family issues are viewed as individual concerns to be addressed only through flexible work practices, sensitive managers, and individual accommodations. This approach often fails the individuals involved, and it may lead to negative career repercussions. More important, by viewing these issues as problems, companies miss opportunities for creative change. For example, management could have perceived the unusual arrangement of the team leader with the four-day schedule as a chance to embrace this innovative work practice and to rethink the criteria for effective management. Similarly, the revised schedule of the sales technician could have been an opportunity to rethink the way time is used in the organization.

Consider, also, the following example: two workers, one in sales and one in management, requested a job-sharing arrangement that would have allowed each of them to spend more time with their families. In an extensive proposal, they outlined how they would meet business needs under the new arrangement. As an added benefit, they also suggested a way to revamp the management development process so that a sales representative, working under the guidance of a sales manager, took on limited management duties. Such an apprenticeship model promised to be a significant improvement over the existing practice of “throwing sales people into management” with little training. Nevertheless, the company rejected the proposal because it was seen as stemming from a private concern (a desire for more personal time) rather than a work concern (a wish to increase the organization’s effectiveness), and the opportunity was missed.

Thus, despite the potential benefits to the company, making the link between work and employees’ personal lives in today’s business environment is, to say the least, not easy. Significant organizational barriers — for example, assumptions about what makes a good worker, how productivity is achieved, and how rewards are distributed — militate against such linkage. Work-family benefits are often designed and administered by the human resource function but implemented by line managers. Associating strategic initiatives with line managers and work-family concerns with human resources reinforces perceptions that business issues are separate, conceptually and functionally, from individuals’ personal lives.

Putting Work-Family Issues on the Table

Putting work-family concerns on the table as legitimate issues for discussion in the workplace turns out to be liberating. By talking about such issues, people realize that they are not alone in struggling to meet work and family/ personal demands. Such discussions help people see that the problems are not solely of their own making, but stem from the way work is done today. The process of transforming personal issues to the collective level engages people’s interest and leads to more creative ways of thinking. It also provides a strategic business opportunity that, if exploited correctly, can lead to improved bottom-line results (see “Business Case for Relinking Work and Family” on p. 1).

For example, at one site we documented the work practices of “integrated” individuals — people who link the two spheres of their life in the way they work. We found that integrated individuals draw not only on skills, competencies, and behaviors typical of the public, work sphere, such as rationality, linear thinking, assertiveness, and competition, but also on those associated with the private, personal sphere, such as collaboration, sharing, empathy, and nurturing. Their work practices include working behind the scenes to smooth difficulties between people that might disrupt the project, going out of their way to pass on key information to other groups, taking the time from their individual work to teach someone a new way of doing something, building on rather than attacking others’ ideas in meetings, and routinely affirming and acknowledging the contributions of others. We showed the value-added nature of this work—the way it prevented problems, enhanced organizational learning, and encouraged collaboration. Offering a new vision of the ideal worker as an integrated individual, someone who brings skills to the job from both spheres of life, helps the organization recognize the importance of hiring and retaining such individuals.

Where appropriate, we also pointed out to management the dissonance between policy and practice. For example, at an administrative site, despite the presence of a wide range of work-family policies, managers limited their use to very minor changes in daily work times. Employees dealt with the situation by “jiggling the system” on an ad hoc, individual basis to achieve the flexibility they needed, often by using sick days or vacation time. Thus, for instance, a man whose mother was chronically ill had to take a combination of sick days and vacation days to be with her. The costs to the site for this companywide behavior were considerable in terms of unplanned absences, lack of coverage, turnover, and backlash against people who took the time they needed. It also created employee mistrust of an organization that claimed it had benefits but made using them so difficult that the result was lower morale and widespread cynicism.

By bringing family to bear on work, we also focused attention on the process by which work is accomplished (see “How Long Hours Become the Norm”). In one sales environment, for example, we found that a sales team habitually worked around the clock to complete proposals for prospective customers. In the morning, the workers were rewarded with cheers from managers and coworkers, complimenting them on their commitment and willingness to get the job done. In response to our interventions, one manager recognized that this behavior reflected poor work habits and made it tough on these people’s family lives. Not only were their families suffering, but it took several days for these workers to recover, during which time they were less productive.

The manager told his team that their behavior demonstrated an inability to plan. He also began to share his perceptions with other managers. As a result, the sales team began to recognize and reward new work habits such as planning ahead and anticipating problems rather than waiting until they were crises.

We have found that changes in work practices can be brought about by looking at work through a work-family lens, linking what is learned from that process to a salient business need, and pushing for change at each step of the process (see “The Synergy of Linking Work and Family”). We begin to make the systemic link between work practice and work-family integration by engaging three lines of questioning:

• How does work get done around here?
• What are the employees’ personal stories of work-family integration?
• What is it about the way work gets done around here that makes it difficult (or easy) to integrate work and personal life so that neither one suffers? Ultimately, however, success also depends on the existence of two specific conditions:
• a safe environment that minimizes individual risk, freeing employees to take part in the change; and
• room in the process for engaging people’s resistance — in other words, addressing their objections, concerns, and underlying feelings with a view toward creating options that were not previously envisioned.<;i>

Creating Safety and Engaging Resistance

By giving people permission to talk about their feelings and their personal dilemmas in the context of redesigning work, a surprising level of energy, creativity, and innovative thinking gets released. But raising these issues may not be easy for those who fear they will be branded as less committed or undependable if they acknowledge such difficulties. At the same time, managers who are used to viewing gains for the family as productivity losses for the business may fear they will bear all the risks of innovation.

Therefore, collaboration and sharing the risks across the organization are important aspects of the process. In concrete terms, this means getting some sign from senior managers that they are willing to suspend, if only temporarily, some of the standard operating procedures that the work groups have identified as barriers both to work-family integration and to productivity. Such a signal from upper management also helps people believe that cultural change is possible and provides higher-level support to individual managers seeking to bring about change. The point is that employees need concrete evidence that they are truly able to control some of the conditions that affect their own productivity. And managers need assurance that they will not be penalized for experimenting in this fashion.

The process of relinking work to family creates resistance because it touches core beliefs about society, success, gender roles, and the place of work and family in our lives. We found, however, that such resistance almost always points to something important that needs to be acknowledged and addressed collaboratively.

Engaging with this type of resistance means listening to and learning from people’s objections, incorporating their concerns and new ideas, and working together to establish a dual agenda. To be effective, the process cannot be shortchanged. It requires trust, openness, and a willingness to learn from others.

Challenges

The next challenge is how to sustain these efforts over the long term and to diffuse them beyond the local sites. Lasting organizational change requires mutual learning by individuals, by the group, and by the system as a whole. It is important to continue to keep the double agenda on the table, ensuring that benefits from the change process continue to accrue to employees and their families as well as to the organization. If not, the individual energy unleashed will dissipate — triggering anger and mistrust within the organization.

What’s more, if local changes are to be sustained and if lessons from them are to be diffused, the work needs to be legitimized so that operational successes become widely known. Given the tendency to marginalize and individualize work-family issues, the overt support of senior management is essential here. Such support reinforces “work-family” as a business issue that is owned by the corporation as a whole.

Lasting change also requires an infrastructure, a process for carrying the lessons learned and the methodology used to other parts of the organization. In one organization, that process took the form of an operations steering committee working hand-in-hand with the research team to carry on the work in other parts of the corporation.

Our experience also suggests that multiple points of diffusion must exist. We sought opportunities, for instance, to present our work as part of special events as well as operational reviews and to look for internal allies among line managers, people involved in organizational change, and so on. Diffusion is also a challenge because, as people reflect on how the various operational pilots meet business needs, they tend to want to pass on to other teams only the results that yielded the productivity gains, rather than information about the process itself. This tendency shortchanges the process and seriously undermines the chances for replicating its success and sustainability.

Conclusion

As corporations continue to restructure and reinvent themselves, linking such change efforts to employees’ personal concerns greatly enhances their chances for success. Such relinking energizes employees to participate fully in the process because there are personal benefits to be gained. It also uncovers hidden or ignored assumptions about work practices and organizational cultures that can undermine the changes envisioned.

But relinking work and family is not something that can be accomplished simply by wishing it were so or by pointing out the negative consequences of separation. It is something that touches the very core of our beliefs about society, success, and gender. And it implies rethinking the place of families and communities and a new look at how we can nurture and strengthen these vital building blocks of our society.

The assumed separation of the domestic and nondomestic spheres breeds inequality, since present practices, structures, and policies — at all levels of society — favor the economic sphere above all others. As a result, employment concerns are assumed to take precedence over other concerns; achievement in the employment sector is assumed to be the major source of self-esteem and the measure of personal success. And, since employment skills are most highly valued and compensated, they dominate government, educational, and organizational policy

In the end, the goal of relinking work and family life is not simple and it is not just about being “whole.” It is about shifting to a more equitable society in which family and community are valued as much as paid work is valued, and where men and women have equal opportunity to achieve in both spheres. Such change is possible and provides real benefits not only to individuals and their families, but also to business and society.

Suggested Further Reading

Bailyn, L., Breaking the Mold: Women, Men and Time in the New Corporate World. Free Press, 1993.

Hochschild, A., The Second Shift: Working Parents and the Revolution at Home. Avon Books, 1997.

Perlow, L., Finding Time: How Corporations, Individuals, and Families Can Benefit from New Work Practices. Cornell University Press, 1997.

Schor, J., The Overworked American: The Unexpected Decline of Leisure. Basic Books, 1993.

This article is excerpted from Relinking Life and Work: Toward a Better Future (Pegasus Communications, 1998), which is an edited version of a report originally published by the Ford Foundation.

Rhona Rapoport is co-director of the Institute of Family and Environmental Research in London, England. Lotte Bailyn is the T Wilson (1953) Professor of Management at the MIT Sloan School of Management. Deborah Kolb is professor of management at the Simmons Graduate School of Management and director of the Simmons Institute on Gender and Organizations. Joyce K. Fletcher is professor of management at the Simmons Graduate School of Management. Contributing authors include Dana E. Friedman, Barbara Miller, Susan Eaton, and Maureen Harvey.

The post Relinking Life and Work: Toward a Better Future appeared first on The Systems Thinker.

The decision-making styles that evolve in the fast-paced setting in which potentially life-threatening clinical outcomes are at stake have significant value. They let team members assess large amounts of data in a rigorous manner while acting quickly. But when transferred to other settings, such as hospital boards and committees, this particular approach to conversation and decision-making can be problematic.

Given their backgrounds, healthcare professionals generally expect that their roles in meetings of teams, boards, or committees will involve advocating for their constituencies and mandating solutions to problems. While more directive approaches play an important role when decisions must be made or actions taken, in other contexts, they can undermine team learning. In addressing issues of organizational strategy, long-term planning, and creative problem solving, generative dialogue has proven more effective than one-way communication. Failure to shift to dialogue-based forms of communication will ultimately have a negative impact on an organization’s ability to rapidly adapt to changing market trends and to truly explore the questions involved in reducing medical errors and improving outcomes.

One Organization’s Challenges

In addressing issues of organizational strategy, long-term planning, and creative problem solving, generative dialogue has proven more effective than one-way communication.

The governing board of one healthcare organization was typical of many in the industry. Physicians attended meetings with the expectation of advocating for their constituencies. Managers learned to fear these meetings, as interactions often focused on criticism of the existing situation or proposed solution. The group rarely explored the challenges through healthy dialogue.

To help determine the board’s future role, board members and other stakeholders participated in a retreat. The following perceptions surfaced:

• Physicians and managers believed that there was value in meeting together regularly.
• Both groups felt that the organization needed to address certain strategic themes.
• Managers understood that they needed to collaborate with physicians to elicit the full range of possible approaches to these issues.
• Physicians wanted to help create ways to approach these themes, but wondered if they would have the power and control to make policies and decisions.
• Both groups had difficulty seeing beyond the current board structure, envisioning that the same struggles and limitations would continue to arise.
• Others in the organization were passionate about participating in the process, although they had not previously been invited to do so.

The Compass Group

The consensus from the retreat was that merely tweaking the existing board structure would be inadequate; nothing short of a complete destruction of the structure, norms, and paradigms would provide the organization with the freedom to explore new paths to achieve its stated goals. With this understanding in mind, the board dissolved its existing structure in favor of a dialogue-based forum that was organized around the stated organizational imperatives of customer service, employee satisfaction, strong physician relationships, and financial stewardship.

This forum came to be called the “Compass Group,” because the group felt that these strategic themes were analogous to the directions on a compass. The Compass Group was seen as a risky endeavor. Much of this fear was based on the uncertainty of where dialogue around these concepts might lead. The organization, however, was able to understand that any learning involves some degree of risk.

“Uncoupling” Old Norms

Cultural and conversational norms had been a major barrier to true learning within the organization. Many feared that the old ways would carry forward into the current efforts. A number of important steps were needed to ultimately “uncouple” the organization from existing ways of interacting, thus allowing for new ways to emerge and thrive.

Associating Pain with the Status Quo. A critical event during the retreat involved discussing aspects of the meetings that board members disliked. Surfacing these feelings markedly raised the group’s level of discomfort with the status quo. This discomfort created a compelling need to move the initiative forward.

Incorporating New Perspectives. The group felt strongly that the constancy of the board’s membership over the past several years had contributed to some degree of stagnation. Understanding that many others in the medical group had expressed an interest in participating, members agreed to open the group up to others who possessed fresh perspectives.

Eliciting Desired Norms and Expectations. During the retreat, board members mentioned rewarding and fulfilling experiences that they had enjoyed in other meetings and committees. Common among these experiences were being heard, contributing proactively, understanding one another, practicing mutual respect, and building upon collective contributions to generate creative approaches. By listing these desired norms and expectations, the group was eventually able to develop momentum for change.

Generating “Buzz.” Through reports from the retreat, others in the organization became aware that the Compass Group was no ordinary board or committee. The communications were lively, genuine, and informal; they carried with them a feeling of realism, openness, and innovation that was not typical of standard emails and memoranda. This “buzz” was instrumental in generating interest among others who might not have been comfortable in the traditional board setting, and in creating expectations that helped to overturn the norms of the past.

Setting the Stage for Dialogue

Because of the risk inherent in any team process, a great deal of planning went into the initial dialogue session. The goal was for people to relax, engage in collaborative dialogue, and explore creative possibilities for action. The Compass Group followed some of the principles used in developing a World Café (see “Framing Questions and Guidelines”).

Establish a Clear Purpose. Unless the group had a clearly defined purpose and objectives, along with concrete outcomes, participants wouldn’t perceive significant value. For the first of the Compass Group sessions, the management team chose to focus on the strategic theme of customer service. With this theme in mind, participants addressed a series of questions that ultimately led to greater insight and collective shared knowledge on the topic (see “First Compass Group Session” on p. 9).

Invite Great Guests. The management team decided to invite all interested physicians, nurse practitioners, and physician assistants. In doing so, they conveyed the sense that the Compass Group was “no ordinary board meeting”; this innovative forum would truly make a difference.

Plan for a Safe and Welcoming Environment. In planning the session, organizers paid close attention to creating a physical space that would be perceived as inviting, hospitable, and intimate. The goal was for participants to feel a high degree of psychological safety. The creation of a welcoming environment began with the invitations themselves. Rather than relying on email, organizers selected stationary and fonts with earth tones to convey the message that this experience would be different.

Form Powerful Questions. Well-structured, open-ended questions hold tremendous value. These questions are the most important determinant of a successful dialogue session. Because the theme of the first Compass Group session centered on customer service, questions related to service and to recent internal efforts in measuring service perceptions were developed in a logical progression of discovery.

Facilitate for Success. The facilitator’s role was (1) to model the process for internal facilitators in the future, (2) to provide a structure for the evening by facilitating between rounds of dialogue, and (3) to provide some training around the skills involved in dialogue, with a heavy emphasis on inquiry. Members of the management team had already received some training in hosting a dialogue session and in facilitating smaller conversations, mainly by encouraging a balance of inquiry and advocacy. To leverage these skills, one management team member served as a facilitator at each table. The other members at each table were carefully distributed to ensure sufficient diversity of conversations.

The session opened with a time for attendees to arrive, get oriented, and enjoy food and beverages while conversing with colleagues. Participants wrote the answer to the question, “What is the location of your most memorable service experience?” on their name tags. They were encouraged to use this memory as a starting point for conversation with others.

The session began with an overview of the evening and a brief session on dialogue. Each round of dialogue was structured around a series of questions. In this particular case, a review of the organization’s patient satisfaction data and video reenactments of actual patient experiences were used as the starting point for forming questions. During the rounds of dialogue, the facilitators at each table helped to encourage effective inquiry and to surface hidden or underlying assumptions. In addition, they recorded the predominant themes that emerged.

Between each round, the tables shared their discoveries and insights with the larger group. In addition, they commented on their success with using dialogue skills. As one of the goals of the Compass Group was to provide an opportunity to share best practices, the group used a separate flip chart to capture these ideas. In addition, items that warranted action, follow-up, or future dialogue were documented on another flip chart.

After the Session

The feedback from post-session surveys was overwhelmingly positive. Participants reported that they had achieved a high level of shared understanding and accomplished a great deal. They also felt passionate about continuing the conversations.

The themes and best practices that emerged from the table dialogues were distributed to all members of the organization, along with a clear plan for future dialogue sessions on the other strategic directions defined by the compass. In addition, efforts to continue the discussion around service were implemented by providing weekly questions for each manager, physician, and department to use with their staff.

As in other industries, healthcare organizations tend to depend heavily on one-way communication, debate, and criticism. Unfortunately, these dynamics present a barrier to learning and to developing organizations that are able to innovate and adapt effectively to tumultuous market conditions, a necessity in today’s marketplace. Dialogue, specifically the skills of understanding mental models and balancing advocacy with inquiry, is essential for building organizations that learn effectively. By challenging the assumption that committees and boards must always be structured in the traditional manner, organizations may be more likely to explore formats that are more conducive to dialogue. Shifting to dialogue-based forums focused on strategic imperatives can be one approach that fosters learning in all kinds of organizations.

Manoj Pawar, MD, MMM, is a managing partner with Nivek Consulting and is the chief medical officer for the Exempla Physician Network. He is committed to developing high-performing teams and organizations in healthcare. He can be reached at pawarm@exempla.org.

Special thanks to Gene Beyt, MD, Richard Hays, DBA, Charles Jacobson, MD, and Bob Myrtle, DBA, for their wisdom, and for their gracious and insightful contributions in the development of this article.

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As with many neighboring countries, rural poverty and chronic hunger are extensive in Ethiopia. Over 60 million people (more than 80 percent of the population) live below a poverty line of $2.00 a day. Of those, 24 million live on less than half a dollar a day. Each year around 10 million people are at risk of starvation.

I had the opportunity recently to travel in Ethiopia with colleagues from partner organizations involved in a project within the Sustainable Food Lab called New Business Models for Sustainable Trading Relationships. Through the New Business Models project, we are focusing on improving five food supply chains in different parts of Africa. In Ethiopia, we are working to improve and expand trading opportunities for farmers growing white pea beans (navy beans) in areas that are vulnerable to chronic hunger.

Why Pea Beans?

White pea beans are grown in Ethiopia during two seasons — the short rainy season in the spring and the longer rainy season in the summer. It is not a locally consumed crop; 90 percent of the harvest is sold for export. Over 40,000 farmers were engaged in this export crop during 2007, and participation is expanding rapidly due the recent increase in prices.

Ethiopia’s climate, while very dry and vulnerable to extended droughts, is relatively good for pea beans. This and other pulse crops (beans, lentils, and peas) are considered “pro poor.” They dry well, can be stored easily, and require less fertilizer than grains such as teff. These qualities make them attractive to farmers with poor access to reliable transportation and little cash for fertilizers.

A Good Market for the Farmers

Prices Ethiopian farmers receive for white pea beans have been sharply increasing — more than 300 percent over the last four years. Before 2005, prices were at or below the cost of production. Currently, farmers expect prices to continue rising and, as a result, are rapidly expanding production areas. Land in Ethiopia is not privately owned; individuals have “use rights” to land as long as they live there. Farmers in Ethiopia typically have use rights to about two hectares, with half planted for food crops and half for market crops. As prices have increased, farmers have moved more of the market area to pea bean production.

Farmers sell their pea beans to traders, and the ability to set prices (market power) is currently in the hands of the farmers. The profit margins for traders and distributors are staying constant, suggesting a rare situation where they don’t have as much market power. New exporters, including farmer-owned cooperatives, are rapidly entering the market. With pea bean prices high and rising, the current market is working well for farmers including those in some of the traditionally most food-insecure areas.

Dilemmas of a Boom Market

With market power in their hands, farmers in Ethiopia are not engaging with the exporters in any long-term contracts for white pea beans. Instead, many are banking on the prices increasing even more. Farmers see no reason for building long-term relationships with buyers while the market is booming. Some are even breaking contracts with exporters, in hopes of receiving the latest high price.

But markets tend to correct quickly when demand is short and prices are high, and only slowly when prices are low and supply is too high. There is a real possibility that the white pea bean price will overshoot and collapse. A dramatic “market correction” could mean a rapid drop in prices and incomes in these areas of high poverty and food insecurity. We talked with farmers who were doubling their planting area in beans for 2008, and because they are expecting prices to keep increasing, they are holding all sales to the end of the harvest season in hopes of capturing the highest price. If the harvest overshoots the demand, or the local price shoots past the international market causing the exporters to leave, the farmers may find a very rapid drop in price at the end of the season. For many families, the cash from sales at harvest time is critical to their ability to get through the year. When we see this boom market, some of the questions my colleagues and I ask include:

1. What are the limits of price increases? How would farmers know if they were in danger of overshooting the market?
2. If there is danger of overshooting the market, should (and can) we encourage the farmers to be in longer term contracts?
3. With farmers who are so new to business planning, what does it take for them to think about a five-year plan or to think about contracting as a form of risk management and market stability?

Potential Ingredients of New Business Models

Our conversations with actors all along the supply chain — from farmers to exporters — revealed a number of places where market problems could potentially be addressed through better business models developed in partnership with all the businesses involved.

Seeds. The current variety of pea beans grown in Ethiopia has been in use for over 40 years, but yields are relatively low and variability quite high. Several exporters want to introduce new white pea bean varieties to increase both the average size and consistency of size of the beans. NGOs have been looking at introducing new varieties as a way to increase yields and boost production.

When times are good, Ethiopian farmers traditionally keep a portion of the harvest as seed for the next season’s planting. But when farmers need cash, they will sell the pea beans they have saved for seed. Then at the next planting season they will have to take seeds as a loan from traders. This is a problem for introducing new varieties because as soon as the farmer sells all the beans back to the trader, they are mixed in with the existing varieties and the purity of the new strain is lost. Catholic Relief Services, one of the partners in the New Business Models project, has been supporting farm groups to adopt a new pea bean variety and develop seed businesses. But growing white pea beans for seed is a different kind of business from growing for sale into the food supply chain. Farmers need to hold the seed after harvest and sell to other farmers at the next planting time. Without shifts in business understanding and a level of economic security, many farmers growing seed may fall back on selling the harvest as food when they need money rather than holding it and working the longer-term seed business.

Quality. New pea bean varieties that increase the quality of the crop can also pose challenges when selling into a system of small-scale traders. One new variety promoted for its increased size, higher yield, and drought resistance has brought lower prices to farmers than the old variety. The difficulty lies in finding the right buyer in the very complex system of local traders.

A trader who buys the new, larger-sized pea beans will need to have access to (or create) a separate supply channel that pays a higher price. But traders have not been profiting from the rising prices of pea beans, and have little margin for creating new systems. So, the new variety simply gets mixed with the rest of the pea bean harvest.

The current system — where individual farmers sell to small traders who sell to brokers who sell to exporters — has little incentive for better quality. There is no way for a price signal or even information on better management practices to get through the chain. Neither farmers nor traders are rewarded with higher prices for producing or buying pea beans of uniform size or high nutritional quality.

Contracts. Large buyers like to establish contracts in the beginning of the growing season for supplying seed and buying the grain grown from that seed. But in this time of rising prices, the farmer cooperatives and unions sometimes break contracts and ask for the new higher market price, refusing to deliver at the contract price. These farmer groups do not value the risk-sharing aspect of contracts — that they won’t capture all the price increase if prices go up, but they are protected from large losses if prices go down.

Market Information. Though everyone on the production side is very excited and expects prices to continue to increase, the farmers, traders, and cooperative managers say little about the international market in which they all compete. They don’t talk about the possibility of shooting past a competitive price point and crashing the market. Better systems of market price information through the chain need to be developed.

There are real opportunities to help set up good systems of price signals and clear communication of quality needs and supporting practices in the Ethiopian communities that grow, buy, process, and export white pea beans. Our goal is to move from short-term thinking where either the farmers maximize price (leading to overshoot and collapse of the market) or the exporters minimize price (leaving the farmer with no profit to invest in farm, family, and community) to developing business models that link the longer-term goals and knowledge of the exporters and farmers. We hope to create a more stable and profitable market for all involved and build the base for sustainable livelihoods in rural Ethiopia.

Don Seville is co-director of the Sustainable Food Laboratory, a multi-stakeholder project with the mission of innovating ways to increase the sustainability of the mainstream food system. In addition, he is a facilitator and systems modeler with the Sustainability Institute. For the past 10 years, Don has worked in a number of public policy and corporate strategy arenas, including sustainable agriculture, diabetes and obesity, energy utility strategy, and forestry. This article originally appeared in the Sustainability Institute’s Spring 2008 Letter from SI, Volume 2 Issue 1. 

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Undertaking a Multi-Level Effort

SoL consultants and internal consultants are designing ways to weave new thinking tools and techniques into the fabric of the NSA culture. They have been helping NSA’s senior leadership team redefine roles and responsibilities as a result of significant organizational restructuring, describe new leadership standards, develop an efficient decision-making process, and begin to run NSA like a business.

In addition, early in the change process, General Hayden identified a cadre of leaders who would champion the effort throughout the agency. Consultants are working with these leaders as well to help align their thinking and actions with NSA’s strategic and business imperatives — and to model new attitudes and behaviors for others at all levels within the agency. These change leaders recognize that in order to model new behaviors for others, they must first transform themselves. In moving away from a traditional hierarchy, many have found that they need different skills, such as the ability to lead change, foster collaboration, and empower employees.

To develop these skills, these leaders are working with what we call reflective partners, usually internal consultants or change agents who volunteer to support an executive in learning new ways of leading. Reflective partners in turn receive training from experienced coaches. This process allows both the leaders and their partners to improve their interpersonal skills.

The role of reflective partner takes different forms, depending on the leader’s needs. The goal of the relationship is to create time for leaders to reflect on how they interact with their peers and subordinates. Partners act as mirrors, helping executives gain insights into their actions and encounters with others. For instance, a reflective partner might accompany a leader to a meeting to observe and take notes on the interactions. The partner later provides feedback about the dynamics he or she observed and helps the leader learn from the experience.

Over time, leaders learn behaviors that can help them lead more effectively — and unlearn those that interfere with performance. The first people to notice changes in the leader are his or her direct reports. Once executives come to trust their reflective partners, they often invite them to work first with their direct reports and then with their larger organization to bring innovative ideas to more and more people.

We call this process spiral integration (see “Spiral Integration”). So far, we have noticed two types of spirals: a downward spiral (from executive to direct reports, as people further down the ranks become involved in learning different ways of working together) and an upward spiral (from executive to upper echelons, as interest in the change initiative surfaces from above). Spiral integration occurs naturally; it is not a program or a project to be managed. Instead, leaders model productive new ways of thinking and acting and then help others adopt those same behaviors. In this way, spiral integration is facilitating change throughout NSA.

Building In-House Capability

By increasing our capabilities within NSA to maintain momentum around continuous learning and change, we lessen our need for outside help. Two organizations — one formal, Corporate Development Services, and the other informal, the Learning Leaders — assist individuals, teams, and organizations in their efforts to change. Linked to the work being done by SoL consultants, these two internal groups provide continuity by sponsoring training courses, hosting learning events, and offering consulting services to people who are trying to transform how they and their organizations work.

Corporate Development Services is composed of NSA employees who have advanced training and education in applied behavioral sciences, specializing in organization development. This organization’s work is supported by the Learning Leaders, an informal network of NSA employees from a wide variety of disciplines who have a passion for innovative thinking. The Learning Leaders began more than four years ago as a grassroots effort to help bring about fundamental change at NSA. Many people in this network support spiral integration by serving as reflective partners, facilitators, and champions for change wherever they work.

Preserving the Best

The first year of the transformation initiative was marked by unprecedented changes as we implemented federally mandated reforms, restructured the organization, and named new leaders throughout the agency. The work with SoL focused on educating the top leadership team, building internal capability to support the change process, and beginning to work with mission teams. The second year was characterized by the launch of a reflective partnering practice for senior leaders, spiral integration in many parts of the organization as managers introduced new tools and techniques, and a “settling in” to the new organizational structure. In this coming year, we will expand our capability at all levels, work more with mission teams, and communicate stories and lessons learned to the workforce.

We have found that this gradual approach to change ensures that the best of NSA’s ethos — a dedication and passion for serving America — is being preserved. At the same time, the organization is developing the collaborative skills, agility, and speed we need to tackle the emerging challenges of the 21st century.

Rebecca Owens Pille leads Corporate Development Services and is the focal point for the Learning Leaders network. She has worked in the change arena within the federal government for over a decade and formalized her experience with a master of science degree in applied behavioral science from Johns Hopkins University.

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Rarely will a company retrospective be written by someone whose involvement with an organization’s senior management team can compare to Ed Schein’s relationship with DEC. From 1966 through the early 1990s, Schein coached DEC’s senior management team on problem solving and worked with founder and president Ken Olsen on a wide range of other matters relating to organizational behavior. Schein’s perspective on DEC is supplemented by those of the supporting authors, a bevy of historical documents, and interviews or correspondence with an extensive list of former DEC employees.

All told, what emerges from DEC Is Dead is an insightful, three-dimensional picture of Digital through its growth and maturity. Although the book is well organized and well written, be prepared for some hard thinking. Unlike so many business case studies that oversimplify the story, DEC Is Dead presents a sophisticated view of the company and rich lessons for other organizations.

Three Developmental Streams

Schein centers his analysis of Digital on three developmental streams that can be used to uncover the forces behind the evolution of any organization: technology, organization, and culture. Here’s how the author describes these streams:

The Technology Stream. The technological environment in which a company operates and its own contribution to that environment through its products

The Organizational Development Stream. The ways in which an organization working in this technological context begins, grows, evolves, and, in the case of DEC, dies; the structures and processes that result from success, growth, size, and age

The Cultural Stream. The founding values that are shared through early and continued business success and eventually become embedded as shared, taken-for-granted assumptions about how an organization should be run

The author’s primary proposition is that early on, these three streams were aligned at Digital, creating a highly innovative and entrepreneurial organization. But the streams evolve at different rates. Technology can advance rapidly, sometimes through spurts of extremely rapid change. Culture, on the other hand, is slow to change; by serving as the “brakes” on an organization’s development, it can gradually erode the company’s capability to succeed in the marketplace and can cause an increasingly poor alignment among the three streams.

At DEC, the powerful culture stream had served the organization well during the formative years of commercial computing. But following the emergence of open architectures, microprocessors, and numerous other innovations in the industry, the culture became a barrier to making the changes in the technology and organizational streams that were required for ongoing success. A look at DEC’s formative years describes the culture and how early success entrenched the cultural beliefs.

The Early Years

Technologically, DEC was at the cutting edge and was responsible for many of the innovations in computing that moved the industry from mainframe to networked minicomputers. Its engineering prowess enabled the company to continually churn out new products that delighted the technically oriented buyers of the era.

Organizationally, DEC was structured around product lines, driven in large part by the engineering focus of the leadership team. Supporting business functions, such as finance and marketing, were centralized. Decision making was decentralized, with Ken Olsen preferring to let his management team wrestle things out. Olsen typically played the role of devil’s advocate, challenging any stance his managers would take to ensure that it was robust. Because the organization was still relatively small, local leaders felt responsible to the whole of DEC, and decentralized decision-making usually resulted in decisions being made by the most informed party.

Underlying the technology and organizational streams was DEC’s engineering-oriented culture, which adopted many traits from MIT. As Schein makes clear in his account, in the early years, there was tremendous harmony among DEC’s three streams. The culture suited the organizational structure, which in turn buoyed an engineering effort that was giving the nascent IT market well-made and highly desirable products.

Resistance to Change

Nevertheless, as the marketplace evolved and the technological context shifted, the strong culture impeded DEC’s ability to match these changes. Success in its early years reinforced the belief in and support of the “DEC way of doing things.” Any attempt to effect a change that violated a core cultural tenet triggered the “cultural immune system,” a host of behavioral responses that resist the intended alteration. The statement “That’s not the way we’ve done it before” is perhaps the most common example of an immune system response. Such responses are not explicitly designed by anyone; rather, they usually arise from the well-meant defense of an organization’s core cultural assumptions.

Perhaps the most important example of how the dominant culture was hampering the organization’s development had to do with marketing. Because like in many engineering-dominated environments, marketing was almost a bad word at DEC, early attempts to strengthen its role were met with stiff resistance. DEC engineers held the long-standing beliefs that good products will sell themselves and that customers just needed to be educated on the features and quality of DEC products in order to be persuaded to choose them. Marketing executives arrived, found it virtually impossible to make a dent in the way DEC’s products were presented, and left for more receptive environments. Meanwhile, DEC was beginning to fall behind its competitors in terms of technological innovation and fulfillment of customers’ needs.

Too Little, Too Late

By the time Olsen left DEC in 1992, the alignment between technology, organization, and culture had deteriorated dramatically. In an effort to save the company, new CEO Robert Palmer made wholesale changes to the organization and culture in order to bring them in line with the realities of the current marketplace. Many DEC employees, recognizing that the changes meant an end to the company they knew, moved on to other firms in the computer industry. Although these changes were inadequate to provide for DEC’s survival as an independent entity, they helped the company hang on long enough to be acquired by Compaq in 1998.

Lessons Learned

What does the DEC experience teach us? Schein identifies 15 lessons for other organizations (see “Lessons from DEC”).

Depending on the reader’s background and interests, DEC Is Dead is more than a comprehensive case study of one company’s growth, maturity, and eventual decline. Organizational development consultants are offered fascinating historical accounts of Schein’s early innovations in the realm of change management and process consultation. Leadership coaches can draw insight from the book’s extensive coverage of Ken Olsen’s management and leadership style and its strengths and weaknesses across time. System dynamicists are offered a detailed example of how structure drives behavior. And strategists can benefit from seeing the company’s evolution from an entrepreneurial organization with an emergent strategy to one with a more modern, analytical one. The richness of the tale — and of Schein’s telling of it — will surely make it a classic for a variety of audiences long after the computer industry has moved on to its next set of established technologies and companies.

Greg Hennessy is president of Speed Circuit Training Associates, a provider of motorsports-themed organizational and professional development workshops covering team effectiveness, change management, and competitive strategy. Speed Circuit partners with indoor karting centers across the country to integrate the development of vital skills with the excitement of wheel-to-wheel racing.

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Nevertheless, despite the progress illustrated by these and other cases, the forces of unsustainable growth and resource exploitation have continued to compound. So the release of Limits to Growth: The 30-Year Update (Chelsea Green, 2004) by Donella Meadows, Jorgen Randers, and Dennis Meadows comes at an important time. For newcomers to the systems approach, the 30-Year Update presents the logic of overshoot and collapse and emphasizes the urgent need for sustainability without dwelling too much on the mechanics of the methodology (see “Key Terms”). At the same time, those already inclined to see things from a systems perspective not only have their mental models reinforced and refined, but also have a series of cogent examples to draw upon when spreading the gospel of sustainable development.

Systems and Growth

Three themes emerge in the book: background on systems and the mechanics of growth; the introduction of a formal computer model, known as World3, and some of the scenarios that it produces; and implications and recommendations (see “The World3 Model” on p. 9). Throughout the volume, but particularly in the first three chapters, the authors explain the basic laws of system structure and behavior with a lucidity that comes from decades devoted to the dissemination of these concepts.

Though usually considered “best practice,” it is not common to come across computer modelers who clearly communicate the purpose of their model and its associated boundaries; that is, the question the model was intended to address and those for which it loses its ability to provide meaningful insight. So it is a treat (for modeling geeks, anyway) to have the authors devote several pages to just these concerns in the course of their introduction to the World3 model. The central question they mean to address is: Faced with the possibility of global collapse, what actions can we take that will make a difference and lead to a sustainable future? It is clear that this is a model whose primary purpose is to help us think, not to provide the answer. In the course of laying out their model’s purpose, the authors make one of the best cases for “modeling for learning” that I have come across.

The authors introduce a variety of potential actions into the World3 model, at first, one-by-one, then in logically consistent groups. Each run, or scenario, provides insight into how that potential action or group of actions might affect the course of future events. In this way, Meadows, Randers, and Meadows are able to prioritize potential actions in order to come up with the set that offers the greatest opportunity for avoiding the worst consequences of collapse.

Recommendations for Action

In the end, World3 does provide an answer. Of the various assumptions tested and given the boundary conditions of the model, we can still make a transition to a sustainable global society if people around the world immediately take the following actions:

1. Stabilize the population
2. Stabilize industrial output per person
3. Add technologies to:
   • Abate pollution
   • Conserve resources
   • Increase land yield
   • Protect agricultural land

The bad news is that we have already begun to experience symptoms of overshoot—water tables are dropping rapidly in some areas and incidents of coral bleaching have risen but two of the most urgent signals. The good news is that, as the authors’ account of the ozone story demonstrates, once the global community sees the clear need for change, change can come about quickly.

According to the authors, people respond to signals that a system has overshot its limit in one of three ways:

1. Deny, disguise, or confuse the signal that the system is sending
2. Relax the limits through technological or economic action
3. Change the system structure Certain elements of society are

stuck in response 1, regardless of the growing mountain of evidence calling for action. We see this mindset in the refusal by some politicians to acknowledge the science behind global warming. Others place their faith solely in the market and/or technology, even though the price would be extremely high if the market system and new technologies fail to save the day. The only truly effective response is to change the system structure, the sooner the better.

This was the core message of the original Limits to Growth. And while that message became a part of society’s broad environmental consciousness, the warning went largely unheeded. The result is that the party’s nearly over, and we need to figure out how to minimize the hangover.

Restructuring Society

Because structure determines behavior, the highest-leverage approach to these problems is to change the underlying structures that have created them, such as farming techniques, forest management policy, end-user attitudes toward consumption, recycling, and reuse, and legislation regulating pollution. So how do we go about restructuring the global system? The authors share the tools they have found to be useful: rational analysis, data gathering, systems thinking, computer modeling, and clear communication.

Notice that these tools really have more to do with making the case for change than they do with enacting change that has been agreed upon. That is, they are exceptionally useful for helping lawmakers understand the need for change and explaining to corporate decision makers the logic behind a shift. These tools can even guide the overall implementation of a change effort. But once the case has been made, the day-to-day activities can look somewhat like business as usual: rewriting laws, redesigning products and processes, reorganizing departments, and so forth. The difference is that the guidance offered by these tools means the change is less like rearranging deck chairs on the Titanic and more like fixing the hole in the ship.

The 30-Year Update is compelling: We have already overshot the planet’s carrying capacity on numerous vital resources. Whether humanity is successful in avoiding the most disastrous effects of collapse will be determined in part by the actions taken by people across our society and planet. Unfortunately, politicians and other leaders often seem to be linear and “black-and-white” thinkers. Navigating the turbulence ahead will require decision making that appreciates non-linearities and shades of grey. The 30-Year Update will bring some to the sustainability camp. But more important, it will inspire others—those with the necessary perspective—to take action. There’s no time to waste.

Gregory Hennessy is honored to have worked with Dennis Meadows on several occasions and to have met the late Dana Meadows once.

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As vice president of Patient Care Services, I was one of those attending the initial session. After three days of intense learning, introspection, and experience with the five disciplines of organizational learning, we understood that we needed to become a learning organization in order to thrive as a rural healthcare system. Peter Senge’s book The Fifth Discipline was perfectly aligned with this goal and the values and culture of GMHS. It would become the foundation of our work. We knew we “weren’t in Kansas anymore.” Our lives had been changed forever.

Our story is much like the plot of The Wizard of Oz, as written by L. Frank Baum and immortalized in the classic 1939 movie. Dorothy lands in the strange world of Oz after her house is carried away from Kansas by a cyclone. She seeks to find the way home by following the Yellow Brick Road. Her intent is to find the Wizard who would bestow on her the knowledge to achieve her goal, only to find that she had the answer within her all along. Here is a summary of our journey.

Dorothy

Similar to the way Dorothy felt when she stepped out of her house to find she was in Oz, our team knew we could not go back to where we had been. We were aware of our destination —to become a learning organization —but didn’t know how we would get there. At first, we felt as though we were “off to see the Wizard,” whose magic would turn us into a learning organization. To get there, we had to “follow the Yellow Brick Road.” In our case, that meant to begin down the path of knowledge and exploration to find out how to become a learning organization.One sunny summer day in July of 1994, the executive team of Gerber Memorial Health Services (GMHS) set off to attend a three-day seminar entitled “Systems Thinking,” sponsored by the Butterworth Management Institute. GMHS is a 73-bed not-for-profit hospital and health system, located in Fremont, Michigan. The organization was one of the first members of the emerging Butterworth Regional Health Network, a group of hospitals interested in sharing resources to meet the needs of west Michigan.

As vice president of Patient Care Services, I was one of those attending the initial session. After three days of intense learning, introspection, and experience with the five disciplines of organizational learning, we understood that we needed to become a learning organization in order to thrive as a rural healthcare system. Peter Senge’s book The Fifth Discipline was perfectly aligned with this goal and the values and culture of GMHS. It would become the foundation of our work. We knew we “weren’t in Kansas anymore.” Our lives had been changed forever.

Our story is much like the plot of The Wizard of Oz, as written by L. Frank Baum and immortalized in the classic 1939 movie. Dorothy lands in the strange world of Oz after her house is carried away from Kansas by a cyclone. She seeks to find the way home by following the Yellow Brick Road. Her intent is to find the Wizard who would bestow on her the knowledge to achieve her goal, only to find that she had the answer within her all along. Here is a summary of our journey.

Dorothy

Similar to the way Dorothy felt when she stepped out of her house to find she was in Oz, our team knew we could not go back to where we had been. We were aware of our destination —to become a learning organization —but didn’t know how we would get there. At first, we felt as though we were “off to see the Wizard,” whose magic would turn us into a learning organization. To get there, we had to “follow the Yellow Brick Road.” In our case, that meant to begin down the path of knowledge and exploration to find out how to become a learning organization.

Scarecrow

We did not know the challenges ahead as we started down our Yellow Brick Road. At first, the learning curve seemed monumental. We attended conferences and studied the work of Peter Senge and others to learn the theory behind organizational learning (OL). After the first year, we came to a fork in the road. We needed a person who would be dedicated to leading and teaching learning organization theory. GMHS management made the decision to hire our first organization development (OD) facilitator. We came to think of this role as being that of the “Scarecrow.” In The Wizard of Oz, the Scarecrow represented the intellect. We needed to find someone to become the “brains” of our organizational learning journey, who would lead us to our destination.

After a few months of searching, we hired our first OD facilitator. At that point, the work intensified. We held visioning sessions and created a “Dream Team” that was responsible for bringing about cultural change. We conducted surveys of the organization to establish a baseline against which to measure progress. In 1997, we conducted Health Quest 97, an event designed to learn what our community wanted from us.

Tin Man

Then we came to the next fork in the road. We had collected much knowledge of what we wanted to create and had a clear vision of where we wanted to go. Additionally, we had learned the language of organizational learning. Now it was time to begin living what we had learned. This would not be the work of the Scarecrow, but of the “Tin Man.” In The Wizard of Oz, the Tin Man longs for a heart. Our first OD facilitator left to pursue other work, and we began the search for someone who could instill what we had learned into the heart and soul of the organization.

Wicked Witch

It wasn’t long after we hired the second OD facilitator and started back down the Yellow Brick Road that the “Wicked Witch of the West” chose to interrupt our journey. In 1998, the federal government enacted the Balanced Budget Act. Provisions of the Act decreased revenues to the healthcare system as a whole. GMHS found itself with a shrinking bottom line. If we didn’t do something quickly, we ran the risk of losing all we had built. The projected loss for the year was $1.2 million.

Lion

Would we have the courage to make the hard choices we needed to make? Could we cut programs that we could not support or for which the government no longer provided reimbursements? Could we reduce expenses to stabilize the bottom line? Could we afford to continue to invest in the tools and concepts of organizational learning? And, finally, in the face of our biggest challenge, did we have the courage to stand up and battle the “Winged Monkeys” of fear and despair? It was time to find our Lion, which in the book and movie represented courage. Our Lion came in the form of the executive team. We decided that if we abandoned the organizational learning initiative, the staff would never again follow us through a cultural change. Why should they?

Using OL tools and processes, we pulled together and created a battle plan. We divided the leadership group into three teams and sent them off to create a new leadership structure. We put safety nets in place, such as generous severance packages that would allow people to safely say “I can leave.” Our president made the hard decision to trim the executive team from five vice presidents to two. Those who left remain friends of the organization. We grieved the loss of our teammates and then moved on.

We have come to realize that we will always be evolving as a learning culture, searching for new answers, and creating our future.

With only two vice presidents and the president left on the executive team, we were afraid that we would not have enough time or exposure to continue the effort. To overcome this obstacle, we formed the Strategic Council. This team of 16 people became the implementers of the strategic plan set forth by the strategic planning body, the Organizational Improvement Council. We regrouped and started back down the Yellow Brick Road. We used OL theory to create our customer service program, improve processes, and design a leadership curriculum. In addition, we put in place a balanced scorecard to measure our progress.

One year later, we were back on track with a positive bottom line. We had reached the Emerald City. Everyone was rewarded with bonuses and celebrations. But where was the Wizard, who would bestow on us the status of “learning organization”? As we reflected one morning in Strategic Council, someone said, “We are a learning organization; the answer has always been within us. Look what we have become.” At that moment, we recognized that we didn’t need an outsider to lead us to our goal; we had reached it on our own.

The Ongoing Journey

Now, six years later, the organization is profitable and healthy, with strong cultural values of trust, integrity, service, and efficiency. Our mission and vision are clear and articulated to all. Our market share has increased by 11 percent. We are adding new services with a patient-centered emphasis and creating healing environments for those we serve.

We have come to realize that we will always be evolving as a learning culture, searching for new answers, and creating our future. When others see our success, they ask, how can we become a learning organization? Our answer is to “follow the Yellow Brick Road.” Their journey will be different than ours, but one day they will know that the answer lies within the people of their organization. Then they will be a true learning organization.

Sue Nieboer, R. N., is the vice president of Clinical Operations at Gerber Memorial Health Services, Fremont, Michigan. Within her responsibilities, she serves as the corporate compliance officer and oversees the Nursing Division, Quality Management Program, and other clinical departments. She is an advocate of organizational learning theory at GMHS and instrumental in sharing the GMHS story with other healthcare organizations in Michigan.

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Weighing the Risk

In recent years, groups that oppose vaccinations because of their potential health risks have sprung up. For instance, some activists claim that the mumps, measles, rubella vaccine is linked to autism, although medical groups studying the possible connection have concluded that the vaccine is not to blame. Anti-immunization groups also doubt the government’s ability to oversee vaccine safety, pointing to, among other things, its delay in banning mercury from injections, despite the fact that it can impair children’s cognitive development.

In response to such concerns, more and more people are choosing not to vaccinate. When weighing the risk of contracting vaccine-preventable diseases against that of experiencing one of the rare catastrophic reactions to the vaccine itself, they are banking on current low levels of infection and deciding to avoid the injections.

Health officials acknowledge that vaccines can cause side effects, ranging from mild (temporary pain at the injection site) to serious (between 1960 to 1999, 8 to 10 children a year in the U. S. contracted paralytic polio from the oral polio vaccine).

But they also point out that as more people avoid immunization, the incidence of certain serious diseases is bound to rise. As just one example, the Consumer Reports article cites the case of Mary Catherine Walther, who contracted Hib meningitis on her first birthday. Her local hospital in Tennessee hadn’t treated a case of the illness for eight years, since the introduction of a vaccine against it. Fortunately, the toddler recovered.

THE SWING OF RELATIVE RISK

As the incidence of a disease rises, people’s perception of the risk to their own health increases. Under these conditions, they are more likely to overlook the vaccine’s side effects. Use of the vaccine reduces the incidence of the disease. When infection rates fall, people’s concerns about vaccine safety grow. If enough people choose not to use the vaccine, the disease begins to spread again.

One reason that formerly dormant diseases can reappear is that they haven’t yet been eradicated worldwide. Travelers from countries where immunization programs have been limited can carry a disease to other regions. Or such illnesses could reemerge through more diabolical means. In June, a simulation exercise depicted a smallpox attack by terrorists that infected 24 people in Oklahoma. After an imaginary two weeks, 16,000 people in 25 states were infected; 1,000 were dead; and 10 other countries reported cases. Following these trends, within three weeks, there would be 300,000 victims, a third of whom would die. Without continued vigilance, such an epidemic could also happen with other serious illnesses that we have long thought were cured.

Relative Risk

The pendulum swing between concerns about disease to concerns about the vaccines themselves represents a classic balancing process (see “The Swing of Relative Risk”). When the threat of a specific disease is high, the vaccine’s desirability rises, regardless of safety concerns. When incidences of the disease are few and far between, people start raising questions about the vaccine’s side effects.

Rather than writing off such concerns as irrational, by recognizing this dynamic, public-health officials can anticipate and manage them through ongoing investments in vaccine safety, education, and immunization programs around the world. In fact, officials might consider activists’ skepticism to be a positive force, in that it keeps pressure on manufacturers and governmental agencies to continually improve these life-saving products. After all, no one wants the cure to be worse than the sickness.

Janice Molloy is managing editor of The Systems Thinker.

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