Many of life’s challenges arrive at the hospital, requiring aid. The energy challenges we face today have arrived at the hospital. It’s become a topic of interest due to a number of factors–public concern on energy, government policy, declining margins and changes to healthcare revenue fundamentals, etc.
As a project manager, working with one of the country’s largest healthcare systems to help significantly reduce energy used to deliver health care, I recognize the transformation process in progress. You may be surprised to learn that, while I work for an MEP firm, this is not primarily an HVAC engineering project (while there are some such components, another engineering firm is doing much of this work). Rather, my team and I are focused on creating the conditions to achieve and maintain transformational energy efficiency goals. These conditions must be able to exist in an environment that historically has not supported a high priority on energy efficiency.
Creating an energy-efficient healing environment is a complex problem. The loudest voices in the room are concerned about delivering healthcare, not necessarily about delivering low energy. Not that they are not concerned, but rather, they may not see this as the necessary locus for their influence.
Energy is not an end but a means to an end. Energy is mission critical – energy efficiency is not immediately recognized as mission critical.
Complex systems can prove difficult to analyze and study intuitively because in complex systems’ cause and effect often does not share a linear relationship and is not necessarily sequential. Effects are not necessarily linear and not necessarily temporal. Yet, our brains are equipped to think in these ways. This means, it is often difficult to gain traction and support for such efforts to change non mission-critical complex systems. Other obstacles abound.
Because the effects of sub-optimal energy efficiency are difficult to see within complex systems, rallying sufficient support for change is difficult.
General Pathways to Change
Understanding change pathways is critical to influencing change in any situation. In general, when presented with an opportunity for change there are a few potential pathways.
1) No change – The situation remains the same.
2) Incremental change – Very modest change occurs, but the general situation remains constant. Incremental change may happen organically to a point, but is hemmed in by larger barriers that incrementalism cannot overcome. While incremental change is always occurring, transformational change is something entirely different and requires an impetus for that change.
3) Transformational change – The situation is completely transformed.
What are the factors that will make this possible and specifically how can an MEP firm help make this possible, beyond the HVAC systems? We can make it possible by understanding models for transformational change and providing technical expertise while walking with those who are undergoing change instead of telling them how to achieve the change.
One Model for Transformational Change – The Players & Process.
Whenever the necessary elements for transformational change come together to make something happen it is beautiful – it is art and science intertwined. It is the dance of the miraculous and the mundane, perhaps difficult to appreciate unless you see it through the right lens at the right moment. I am watching this unfold.
I highlight one pathway to achieve such transformation. (I admit there are others, so I welcome input, so we can all benefit from the collective experience.) This is a universal model that is applicable to all potential change situations.
Firstly, there is the need for leadership that has “the vision”; that sees the possibility. This leadership does not have to be the head of the organization but needs to be someone who can own the portfolio – someone who can say yes and champion the cause. If it’s the head of the organization, opportunities for influence could be greater, but it need not be the head of the organization.
Secondly, you need an Implementer. This person cannot be the Leader because the Leader needs a wider purview – needs to be able to see and operate within a wider scope. The Leader can inspire an Implementer or an Implementer can inspire a Leader, but the roles are almost never filled by the same person. The Implementer is someone who can:
- Convince people that the goal is possible.
- Overcome organizational inertia.
- Inspire colleagues to see things differently.
- Provide clarification of the goal particularly for those with differing foci.
Because we are talking about monumental change, this person is often relatively new to the organization or has undergone a significant personal transformation such that he/she can act outside the sphere of “incrementalism.”
But the Implementer plays another important role. Existing circumstances/beliefs/conditions/etc. exist for a reason. However, they often remain overtime for NO good reason, other than “It’s how we’ve always done it”. So the implementer also needs to be “the voice” for the following:
- The equilibrium (the status quo) is not okay, even if it feels comfortable to some.
- Incremental change from the status quo is not okay because the status quo is not okay. Change needs to be transformational.
- The transformational change is difficult but it is achievable.
- You have agency in the change – your role makes a difference.
- The change matters.
One may ask why the status quo is not okay. This is perhaps the most important role of the Implementer. By force of argument, by moral force, through quite certitude or through boisterous pleading, the implementer is able to embody the notion that the status quo is not okay. The Implementer often becomes associated with the very idea itself – that we need transformational change.
The Implementer allows everyone to see possibility where impossibility previously lived. Interestingly enough, the Implementer is often giving voice to a truth that exists within, but that has been silenced because of practicalities and people’s general inclination to embrace equilibrium. Thus the Implementer may face fierce resistance to the very idea of change.
In this model, the tipping point between incremental change and transformational change is the equilibrium point. The Implementer brings enough necessary people along to the point where the status quo is more uncomfortable than attempting to achieve change. The status quo may become uncomfortable for many reasons, perhaps because the Implementer was able to convince other that the truth is more important than the reasons to suppress truth or because others latch on to the authority of the Implementer. Reasons abound for the change. At the point which the status quo is more uncomfortable than the dislocations change may cause, transformational change is inevitable.
While the Implementer’s role is incredibly important and can often be exceedingly difficult, the Implementer is not the most important role in this transformation model. Everyone has a role to play in transformational change. The change is routed in the universalization of the idea that the status quo is not okay. This means that everyone must embrace the change. Participants must understand and truly believe in the value and role they play in the success of the transformation. If they do not participate in the implementer’s movement, the change is not possible.
Ideally, the Participants and the Implementer are co-partners. Participants listen to the Implementer, believe in the possibility of what was once thought to be impossible, understand their agency in the change process, find the individual and collective strength necessary to achieve a voluntary move from equilibrium, and live through the movement from equilibrium to transformation.
The Transformation Aiding Engineer
The process is ongoing. Our role, as Transformation Aiding Engineer, is to support the change that is occurring. We provide leadership. Interestingly enough, leadership looks very different in different situations, so we adapt to the situation at hand, providing what is necessary to aid transformation. In the specific case of this large healthcare organization, we actualize this transformational change model by doing the following:
- Provide a voice that can aid the Implementer’s voice.
- Show other examples of where transformational change has taken place to allay fears that it is impossible. If transformational change has never taken place before, create a plausible argument for its possibility.
- Walk with the healthcare organization to develop effective systems. It’s important here, that we are not writing reports telling them how to change. We show by walking with them as they create the change.
- Show that this is not just a technical challenge but also a challenge of adopting a new way of thinking throughout the organization. This is especially true for facility managers and staff but is also true for the entire organization. So we will be working on changing the equilibrium as it comes to behavior.
- Determine how to get the entire ecosystem (beyond the organization) to recognize and adapt to the change.
Applying to Energy Efficiency (Leading from the middle)
So as we watch this incredible transformative change occur, we also participate in the change.
The fact that we are engineers with experience depth in healthcare facilities is important. It gives us the ability to give credence to the Implementer’s voice and to help transform Participants to Implementers It also allows us to help chart a pathway forward. While we are performing work that some may turn to non-engineers to do, it is our technical ability that enables us to do this work more effectively than others. Yet, it is our ability to walk with the organization in the midst of transition that provides the breakout energy required to create transformative instead of incremental change. The Transformation Aiding Engineer works from within, understanding various systems of transformation and sustainably, filling gaps as necessary to move an organization towards transformation.
With this particular client the gap is small. They embody this model of transformational change to the point that they can recognize and identify model elements in movies, or in news stories. They even point out these roles within their own organization. For others, the elements of a pathway to transformational change may be nascent or non-existent. Sometimes the Transformation Aiding Engineer must act as the Implementer until a Participant (or participants) step into the role. In all cases, the Transformation Aiding Engineer fills in the gaps and walks with those undergoing change to make sure transformation wins over incrementalism.
– Troy S., Mazzetti Project Manager