System vs. Systemic Change - Sharpie as Management Tool?

Sometimes a systemic sea change is planned carefully, utilizing insights gleaned through months of evaluation, pages of data, and shepherded step-by-step through the implementation phase by multiple internal stakeholders guiding an organization to the next phase of evolution.

And sometimes, a small, almost unnoticed system change germinates when you put a Sharpie to a legal pad and try to write something amusing.

When I pasted this sign on my door, I was (literally) in the middle of two coworkers contentedly engaging in some good natured ribbing.

When voices started to rise a half-octave and the comments became a bit more pointed, I grabbed a legal pad, scribbled this sign, ripped off a piece of Scotch tape, and thumped it up with my palm.

Facetiously, I said something along the lines of "There. New rule. This is a place of UNIVERSAL RESPECT."

You wouldn't think a low-tech, handwritten sign that started out as a half-joking response to situational discomfort would actually influence a change in organizational behavior.

But in the weeks since I smacked up that sign (where it hangs to this day), I can't tell you how many times I've stopped comments in their tracks by pointing to the sign. I can't tell you how many times I've reevaluated my own comments, even my own internal thought processes, as a result of that yellow piece of paper.

Here's why something this simple works to change behaviors within a system.

I DO want to respect everyone who comes within feet of my office door. This text reminds me daily that when you enter, your concerns are my concerns. Your priorities are more valuable than my own. It is my job to treat you and your comments, ideas, questions, and challenges with the utmost respect by giving you my total and complete attention.

I think a coworker put it best when we were discussing the strange ripple effect of the sign (less teasing in my office, even less in our area of the hallway - coworkers who wanted to say something sarcastic literally delivered witty remarks feet from the office entrance).

He said: "Jen, you're in a constant daily battle not to be selfish."

All of us in healthcare today are fighting this same battle.

Systemic change, in some respects, is easier to influence (or easier to convince ourselves we are influencing). When we research change that we hope will create grand and sweeping improvement at the systemic level, it's easier to divorce our individual efforts and foibles from the actual daily success and/or failure of the plan.

But when we implement change on the micro level, when we make a ripple that spreads at the personal level and influences behavior within a small microcosmic system, it's nearly impossible to separate our hourly successes and failures from the goal.

I've had this photo of that sign for weeks now.

I'm writing about it tonight because today included one of those hours when I failed.

I made a sarcastic comment to a coworker that many would most likely shrug off as meaningless. But here's the rub: that sign is the first thing I see in the morning as I unlock my door. It's one of last things I see in the workplace at night before I head home.

That sign means I'll walk into work tomorrow, take off my winter gear, and go find my colleague. That sign means a "good morning" will be closely followed by an apology for not showing the level of respect I want to convey, the level of respect she deserves.

That text reminds me that nothing is more important than trying to change a faulty system within your own daily work.

If you can accomplish that, perhaps it's time to step up and pick a system within your organization that needs improvement (handwashing procedures, emergency preparedness, physician recruitment, employee recognition).

You can't realistically influence systemic change if you don't start at the level of an individual system. Grand plans are good, but small signs that generate results are even better.