Leadership Of A Culture Change Process

Leadership of a cultural change process

Ian Brooks Principal Lecturer, Faculty of Management and Business, Nene College, Northampton, UK Explores the successful role of leadership in initiating and sustaining a major process of change. The findings build on the work of others who have so ably demonstrated the influence of powerful leaders. Research is based on qualitative data from an ethnographic study which immersed itself in the minutiae of organizational life. Outlines the processes that have unfolded in the wider context of NHS change. Discusses the findings and debates supporting evidence. The resultant model of change indicates that successful leadership of cultural change requires leaders to think culturally, to be guided by a cognitive model of change and to employ the cultural tools of symbolism while actively focusing on the politics of acceptance. Hard systems and structural changes can be implemented in parallel with soft symbolic and political activity. A highly receptive context, either real or created, assists by providing a trigger for change.

© Ian Brooks, 1996.

Leadership & Organization Development Journal 17/5 [1996] 31–37 MCB University Press [ISSN 0143-7739]

Introduction This paper explores the successful role of leadership in initiating and sustaining a major process of change. More emotively, it illustrates how a chief executive, Frank Collins, and a cadre of skilled managers, managed to win both hearts and minds. In the space of three years’ consultants in a National Health Service (NHS) general hospital changed from outright objection to overt support of their unit gaining self-managing Trust status. These consultants had begun to own the change involved, a fact so graphically and symbolically illustrated by their unanimous signing of the Trust status proposal document. This paper builds on the work of others who have so ably demonstrated the influence of powerful leaders (Tushman and Romanelli, 1985) or new chief executives (Grinyer and Spender, 1979; Slatter, 1984). Although this may appear to contradict of the work of cultural purists, who argue that things are largely unaffected by the intervention of leaders, and by more recent research which suggests that leadership is a pluralistic phenomenon (Bate, 1994), there is, nevertheless, a compelling story to tell. The paper does not claim that one man, or even the management team, transformed the organization, but that a new CEO and senior team actively, persistently and consistently sought to bring about organizational change and achieved considerable success in that endeavour. In 1990, three years before the hospital (referred to throughout as GH) applied for Trust status and shortly before the CEO arrived, there was a front-page article in the local newspaper, signed by over 20 senior consultants at the hospital, strongly opposing any moves towards Trust status. Change to Trust status represented a counter-cultural invasive force that was alien to the “local cultural infrastructure” (Brooks and Bate, 1994). In 1993 the Trust status application document was signed by the 15 original consultants who were still working at GH and who earlier had publicly denounced change. The

CEO characterized this voluntary signing-up as, “symbolic of a changing of hearts and minds”. This is seen as a considerable achievement by all who were interviewed during this research exercise, including the consultants themselves. For the CEO it was merely the tangible manifestation of a more significant cultural change to an organization “that now wants and expects to succeed”. There has been considerable research in the field of leadership. Initially, it was thought that good leaders possessed a series of traits that accounted for their success. These are well summarized by Stogdell (1974). The Ohio State University studies argued, more convincingly, that leadership is better explained by behaviours. Unfortunately both schools are acontextual, that is, they ignore the setting or contingent factors. Contingency theorists, such as Fiedler (1967), recognize that interpersonal relationships in a context are critical to leadership endeavours. This paper further explores the importance of context and builds on more recent research on the symbolic (Bate, 1994; Johnson, 1990) and political roles of leadership. Hence this paper suggests that the softer, more symbolic and less tangible, aspects of leadership are every bit as important in securing speedy transformation as the more tangible hard structures and systems changes.

Research design This paper is based on qualitative data from an ethnographic study which was immersed in the minutiae of organizational life. Central to the data collecting process was a series of 20 semi-structured interviews with an array of personnel from the Trust hospital. Research concentrated on purposive sampling. Initially, senior personnel were interviewed, including two lengthy interviews with the chief executive himself. This was widened to include junior, non-medical and non-managerial employees. Eventually, domestic staff, porters, executive and nonexecutive board members, the deputy chief executive and other senior and middle

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managers, including business managers and a number of clinical professionals, were interviewed. All interviews were taped and comprehensive transcripts made. Over 30 hours of “rich description” (Geertz, 1973) resulted. Analysis was based on predesigned categories, compiled by reference to literature in the fields of leadership, culture and organizational power. Some of the data, in the form of respondents’ discourse, is reproduced in this paper to help tell the story.

Context The processes outlined in this paper unfolded in the wider context of NHS change. The NHS reforms have stimulated considerable research, largely flamed by political and social ideologies and focused on marketization, managerialism and conflicting value systems. It is extensive, covering widely different issues and topics like financial management and information systems, the political-managerial and professional-managerial interfaces, and NHS structures, systems, policies and control mechanisms. There has been far less research at the micro process level of organizational leadership. In the public services generally, and the NHS specifically, a top-down invasive model of change has predominated, inspired by political agendas and prevailing socio-economic and technological conditions. Managers in the NHS generally have been positive about the changes. Manifestations of managerialism abound: strategic planning systems, business plans, mission statements, business managers, and new initiatives like learning organization theory, TQM and Investors in People proliferate (Lawton and Rose, 1991; Pollitt and Harrison, 1992; Talbot, 1994). NHS managers, as opposed to clinicians and trade unionists, are seen as the beneficiaries of change (Ferlie, 1994). This research was undertaken in a medium-sized general hospital (fourth wave) NHS Trust which gained its new status in April 1994. The hospital has made considerable progress in many respects in recent years and is generally considered to be a fast improving and sound Trust. The critical managerial-clinical interface appears to be a more constructive relationship than others reported elsewhere. Considerable progress has been made on external measurements of quality and operating success. The chief executive has recently moved to a larger hospital Trust.

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The leadership of change Turnaround involved an all-embracing attempt at organizational change and not a merely persuasive campaign aimed at 15 consultants. This section will demonstrate the multiple, largely parallel, approaches adopted by the CEO and his new management team.

Management of hard infrastructure The management team oversaw the restructuring of the organization, including the development of separate clinical directorates, each headed by a lead consultant who sits on the senior management executive. Business managers were introduced to each directorate and a small senior management team appointed and developed. Systems were introduced to facilitate the achievement of operational and strategic objectives. Financial systems, annual planning cycles, internal tracking systems, administrative systems and financial methods were upgraded to cope with the internal market and subsequent Trust status. They enabled the organization to cope with and prosper in the newly introduced “internal market” in the NHS and, eventually, to gain Trust status. They also facilitated the shortening of waiting lists and the achievement of many externally and self-imposed targets.

Politics of acceptance There is ample evidence that the CEO and management team paid particular attention to the politics of acceptance. They adopted a more collaborative and less coercive (Dunphy and Stace, 1988) style than is often the case in many organizations. The CEO engaged in a great deal of discussion at an early stage and particularly involved individuals and groups who held both formal and informal power. These included a group comprising the lead consultants and the senior management executive, external bodies like purchasing authorities and, later, general practitioner (GP) fundholders. Initially, these were largely exploratory meetings in which ideas about the future of the hospital were discussed openly. The CEO developed a highly visible, energetic and dynamic approach, assisted by an effusive and out-going personality, which was, initially at least, aimed at gaining acceptance of the need for change. The CEO saw his first task as “gaining their [senior consultants’ and managers’] understanding of the environment”. At the early stage a consultant commented that “this was the first time we had been engaged in discussion of this nature”. Collective action was emphasized and views sought. Instilling in

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others a sense of ownership of both the problem and the solution was seen as crucial by the senior managers. Rapidly impending, centrally imposed change in 1991 created a trigger for action. This was the adoption, throughout the NHS, of an internal market for the purchase and supply of health care and related activities. The CEO’s awareness of this was evident: “we were on an 11-month, externally imposed process of change, and the clock was ticking. It was no good saying, “we’re a little bit sleepy can we make it 18 months?: [it was] not-negotiable. On 1 April 1991 you would be delivering!”. He consciously heightened this sense of impending crisis while instilling confidence that “we” were competent to manage the required changes. Use was made of such phrases as “go under”, “we will not survive” and “falling-over”. These, the CEO later agreed, were quite startling messages.

‘…The imposed change and the urgency it created were, the CEO argued, “very useful”. They helped legitimize the change process and the discussions with consultants and managers and establish the management team, not as the source of the demand for change, but as the body of experts who could provide the solutions…’

On regular walkabouts he would ask people how they were prepared for the forthcoming reforms. He argues: “I used that ever-decreasing time frame as an opportunity to legitimize my discussions”, and he admits to “consciously using some form of crisis language”. This initial approach was largely, but not exclusively, focused on senior consultants and other senior and middle managers in the organization. His aim was clear to ensure that “the road was clear for us to introduce the reforms”. The imposed change and the urgency it created were, the CEO argued, “very useful”. They helped legitimize the change process and the discussions with consultants and managers and establish the management team, not as the source of the demand for change, but as the body of experts who could provide the solutions. The CEO was aware of this role, suggesting that: “it wasn’t me as the new manager who wanted the change because I had perceived a weakness in the organization, but I was here and so were the reforms and ‘we’ had to do something”. The organization coped well with the introduction of the internal market, so that after 1 April 1991 “we were able to congratulate ourselves”. This “small win” (Weick, 1979) served to reinforce the change process. There then followed, quickly on the heels of this success,

a series of senior management and consultant away-days and other discussions “to start thinking strategically and introduce an annual planning cycle”. The away-days were used to design the mission of the organization. Although as one senior manager noted, somewhat inevitably, “some consultants were embracing it better than others”, one consultant, who enjoyed the experience, suggested that “for the first time we realized that there were as many views as [there were] people present”. This divergence of opinion between consultants from different directorates helped legitimize management intervention still further. Leadership was viewed as essential to ensure fair-play. This teasing out of ideas and the process of gaining ownership of strategy were operationalized alongside the hard structural and systems changes discussed above. Winning over consultants was facilitated by the appointment of business managers who “would act as their assistants” and help them with day-to-day administrative responsibilities. Couching this in terms of “assistance” and relieving them of tiresome administration seemed to reduce the sense of prevailing managerialism which many medical personnel resent. Another structural change which addressed the political issues that surround change was the decision to make the medical directors (the lead consultant in each of 12 directorates) the majority group on the senior management executive. This was a vital symbolic gesture in managing the political acceptance of strategic change. It helped reassure the consultants and indicated to other clinical personnel that their voice would be heard. It also symbolized the intent to encourage consultants to own both the management and the change processes. Although the CEO continued to “lead the agenda”, a consensual approach was usually adopted. Nevertheless, as one consultant put it, “the management team was a forum in which [the CEO] comes with ideas and we leave with them”. There were a couple of occasions when the CEO gave way to collective consultant opinion, although he argued that these were of symbolic value in signalling his desire to gain collective ownership of the strategic organizational processes. One senior manager argued that the approach taken and the range of tactics outlined above “locked people in to the strategic management and change processes”.

Management of symbols Many organizational leaders virtually ignore both the concept and the reality of culture,

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while others consider culture as a contextual variable which resists or, on rare occasions, promotes change. This latter category of manager thinks about culture. The CEO in this case, it can be argued, thought culturally: that is, he apprehended the situation in cultural terms and used cultural tools to manage change. The distinction is significant. He made considerable effort to utilize the power of symbols. He showed awareness that his actions carried both overt face-value influence and symbolic significance. This enabled him to calculate the effects of his language, dress, style and actions in symbolic and, therefore, cultural terms. What is more, this knowledge consciously influenced his approach. It can be argued that a leader’s effectiveness is, in part at least, determined by his ability to make activity meaningful (Pondy, 1978) and to communicate that meaning and vision to those in the organization (Peters, 1978). The CEO chose the power of symbols to assist in this process. Thus his insistence on “wearing jeans and t-shirts” and playing loud pop music at middle management away-days was a symbolic attempt to reduce barriers and to introduce “fun”; the suggestion being that experimentation and change were exciting experiences. He graphically symbolized innovation and enthusiasm by his style of facilitating meetings. Darting from flipchart to flipchart, synthesizing debate, publicly embracing respondent concerns and views. Stories of his energetic, probing, listening, experimental style are numerous and he actively encouraged their dissemination. Additionally, the CEO’s frequent gifts, such as baskets of fruit, to islands of progress in the hospital and sub-units which had exceeded targets, symbolized the rewarding of desired behaviours and attitudes.

‘…Public criticism following press coverage of an overseas visit, some difficulties in engaging trade unions on issues such as local pay, and interface difficulties with a local Community Trust ensured that progress was often painful…’ Twelve staff representing a diagonal slice of personnel from across the organization, were designated networkers by mutual agreement. The aim was to facilitate communication, largely between lower levels and the executive group. It proved to be a useful tool with which to hear common reality on the ground; but symbolically it also demonstrated management’s desire to listen. Acutely aware that symbols can be interpreted differently by various audiences, the management team was careful to ensure that the networkers

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were never used to disseminate managerial information nor instructed to persuade people of the benefits of change. Of course it was not all “fun and flipcharts”, as the CEO was at pains to acknowledge. Progress often was slow. Public criticism following press coverage of an overseas visit, some difficulties in engaging trade unions on issues such as local pay, and interface difficulties with a local Community Trust ensured that progress was often painful.

Ritual Ritual is a prescribed activity, usually rigidly observed in a solemn and ceremonial fashion, which holds symbolic significance. The NHS is characterized by ritual. For example, the daily drugs and drinks dispensing round at 6 a.m., which often involves waking patients prematurely, the procession of hand maidens waiting on a surgeon, and each clinical discipline’s insistence on collecting the same personal data from patients, all take on ritualistic significance (Brooks, 1996). These and many other rituals serve to preserve the existing culture. New rituals were created which symbolized change. It is their symbolic significance, rather than the importance of the activity at face value, which is crucial in attempts to manage cultural change. Hence reclassification of hospital porters, cleaners and catering staff as ward assistants was signalling a new and enhanced social identity for this group which helped to overcome old demarcation issues. Frequent away-days became rituals which symbolized a genuine attempt to listen to and resolve employee concerns and to help people makesense of the ongoing changes. The away-days became rites of sensemaking, as the CEO explained: “I started to do some work with the consultants, to help them to understand the nature of the environment and of the internal responses required in terms of skills, competences and structures.” Further extensive discussions with senior and middle managers became rites of challenge, as the CEO, it was noted, “encouraged questioning of the way we do things”. It was suggested that “it is essential to have some radical people in the organization to continually challenge”. The frequent attempts to benchmark the hospital’s performance and activities against the best in the sector served, in a ritualistic fashion, to challenge existing practices. During his first few months at the hospital, the CEO walked the job and confronted people concerning their plans to manage the new requirements of operating in an internal market. This rite of legitimacy was justified by the CEO: “I could legitimize asking the

Ian Brooks Leadership of a cultural change process

question of people who had not changed significantly for more than a decade.”

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Stories Organizational stories symbolize what is important in an organization and help to shape its culture. The stories of how the CEO held meetings, refusing to sit down, jumping from whiteboard to flipchart, noting ideas for public consumption and so forth, are told by many respondents in the hospital. For them it symbolizes an open, frank and dynamic style of management, and also indicates that new ideas are welcomed and that challenging existing practices is the norm. It indicates a desire to listen to and involve many people in creating the agenda for change. The CEO’s behaviour, particularly on away days has, according to one consultant, “locked him in the folklore of the organization”. It has, a senior manager confided, “changed people’s view [of him] from a manager to a leader”.

Values Collectively held values underpin organizational culture. It is not surprising that attention to the organizational value system became a top priority for the management team. From the early stages, planned workshops and impromptu discussions with senior and middle managers and consultants worked on developing the organizational mission – perhaps the prime symbolic expression of any organization. The workshops sought to build gradually a value statement which reflected both individual’s personal values and the fundamental purpose of the hospital. The resulting statement is simple and holds few surprises; but, far more importantly, it is owned by many.

Discussion and conclusions We have explored some of the activities of the CEO and the management team in their endeavours to manage change in this rich context. We will now assess the likely reasons for the success of their strategies and present a simple model which illustrates these observations.

A receptive context for leadership Although to a certain extent an organization has the ability to renew and replenish itself, rapidly changing external environmental conditions, such as those experienced in the NHS in recent years, demand the intervention of leadership at the organizational level. External pressure for change operating on this scale “demands invention and creativity beyond the performance of role

requirements; it requires leadership of a high order” (Katz and Kahn, 1966). The arrival of this charismatic, dynamic and change oriented leader, who rapidly assembled a skilled cadre of managers, coincided with the need for such talents. In other words, the organization was a highly receptive context. Leadership was needed to make sense of environmental flux and, paradoxically, to help produce stability of purpose out of the ensuing chaos. Leadership qualities and the emotional involvement and loyalty of followers were enhanced by the context. As the introduction of the internal market and other government-led invasive changes were imminent, the organization experienced stress and crisis which facilitated leadership attempts at change. It is not surprising that the leader in question heightened the sense of crisis. Environmental change and perceived crisis produced followers – the essential ingredient for all leaders. The period 1990-95 could be viewed as a turnaround at GH. At the commencement of this period, the appointment of a new chief executive held symbolic significance. He was a professional manager and not, as always previously had been the case, a clinician. It was change itself which was signalled. This paper has argued that the CEO had many of the characteristics of a skilled turnaround manager: that is, leadership and motivational skills, flexibility and courage. In short, he was the right person at the right time (Slatter, 1984).

Thinking culturally Slatter (1984) argues that leadership in turnaround situations involves: • communicating a sense of direction; • establishing a sense of urgency; • defining responsibilities; • resolving conflict; • conveying enthusiasm and dedication; • giving due credit and rewarding success. The new CEO must also take on the burden of communication further down the organization. This paper has illustrated that the leadership was well blessed in these areas, yet it has been the use of symbolism and skills in managing the politics of acceptance which really ensured the success that has been experienced. Two imperatives in the management of cultural change are the leadership’s ability to think culturally and to conceptualize, via a working model, the change process (Brooks and Bate, 1994). There is considerable evidence that leadership in this case thought culturally and created and communicated a

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vision and model of change. The extensive and conscious use of symbolism, the intentional proliferation of organizational stories, the attention to personal and shared values and the development of rites of legitimacy, renewal, sensemaking and challenge are testimony to this.

‘…leadership established where the organization was coming from and where it needed to be, what is more a cognitive map was employed which guided activity along that journey. This involved conscious and purposeful operation, simultaneously, at the tangible or overt levels and at the political and cultural levels…’

Model of change The process of change management conceived of and undertaken by the CEO and his management team was based on a cognitive model of change that was not articulated, but which served to delimit and guide his leadership activities. The author has attempted to conceptualize and illustrate that model here after piecing together the research evidence (see Figure 1). This paper has outlined, albeit briefly, the threepronged approach to change management adopted in this context: that is, a focus on the politics of acceptance, the management of symbols and the concurrent management of a “hard” infrastructure. The three approaches combine to form an integrated and purposeful leadership endeavour. These mechanisms have been employed during the process of change to “move” the organization from its position in 1991 towards the desired state. The mental map owned by the team would have been less concrete and certain than the model suggested here. Nevertheless,

Figure 1 Model and process of change Current state

R E C E P T I V E C O N T E X T

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Process of change

Politics of acceptance

Management of symbols

Management of the “hard” infrastructure

Desired future state

R E C E P T I V E C O N T E X T

possession of such a model of change and the ability to conceptualize the process are important leadership qualities. They comprise, in political jargon, “that vision thing”. Hence leadership established where the organization was coming from and where it needed to be, what is more a cognitive map was employed which guided activity along that journey. This involved conscious and purposeful operation, simultaneously, at the tangible or overt levels and at the political and cultural levels. When studying change in a Civil Service agency, Brooks and Bate (1994) argued that four aspects essential for facilitating successful change were absent, so making change problematic and probably doomed to failure. It was noted that major change is best stimulated by a real or perceived crisis which serves as a trigger and by leadership paying careful attention to the politics of acceptance. This involves change agents diagnosing the current state of the organization and its culture and holding a vision of the desired future state. These features are encompassed by the model shown in Figure 1 and were addressed by management in this case. Hence the new CEO entered a receptive context and helped create the appearance or enhance the reality of crisis. The trigger was in place. The politics of acceptance were managed by focusing on powerful formal and informal leaders, symbolizing an intent to listen to everyone and take on board their concerns, and to restructure in favour of clinical personnel. Leadership was highly aware of the present state of the organization and its culture and held a vision of the desired future state; a vision that was continually and collectively constructed and deconstructed and which evolved from a cultural and political process of dialogue. The CEO actively managed cultural change in the hospital by utilizing the power of symbols. This process of change was punctuated by the consistent upgrading of systems and structures which facilitated improvements in efficiency and effectiveness, enabling more tangible changes to be registered and acknowledged. Although the desired future state is an everevolving ideal, leadership successfully guided this organization through its period of greatest change since its opening.

References Bate, S.P. (1994), Strategies for Cultural Change, Butterworth-Heinemann, Oxford. Brooks, I. (1996), “Using rituals to reduce barriers between subcultures”, Journal of Management in Medicine, Vol. 10 No. 3.

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