1. Trust Is Critical to Adoption
I heard a story on the radio a few months ago that has stayed with me.
From a news perspective, this story is about changing healthcare practices to reduce costs, and the important role of data in this change. From my perspective, there is a scene-stealer in the story that eclipses those topics.
Brief synopsis: A group of health care providers in Camden, NJ analyzed data about emergency room use with the goal of reducing ER visits by those who didn't actually need emergency care (but rather the regular care of a primary care physician). They mapped hospital billing info and found hotspots within the city of "super users" of the ER. With this information they placed physician's offices directly in those hotspots - sometimes in the same apartment building with the super users. Result: over time, use of these local physician's offices has increased, and ER and inpatient visits have decreased.
Here's the part of the story that struck me:
"Dr. Jon Regis is a longtime member of the Camden coalition. ...Regis says it took longer than he had hoped to win over residents — almost two years. "We thought that since they were having such a difficult time, we could just open up the door and they would come down," he says. "That wasn't the case ... We had to do a number of different things, like health fairs and meet-and-greets. We had to engender a sense of trust in the residents before they would come down to see us," he says. "I think that was somewhat surprising. But we're starting to get past that now." "
Think about this - you have the chance to switch from trekking across town to the ER, where you experience long wait times and where the nurses are sometimes point-blank telling you you shouldn't be, to visiting a doctor just a few floors down in your own building. But you don't do it. There could be any number of reasons behind this - the main point is, even a change that's seemingly a no-brainer requires time and outreach in order to take hold. You need to trust that new system before you will start using it.
This story is a metaphor for practically every SharePoint implementation I've worked on, and I'm guessing it's the case for most IT projects, SharePoint or otherwise. It's not enough to introduce something life-improving and cost-saving to your end users; they need to trust that new system before they will use it, and in order for that to happen, it requires change management, which usually means you need to walk the halls, tell the story, meet the users on their own terms.
Unlike a hospital ER, a company might be able to shut down an old system or restrict access to it, but in my experience companies can't or won't do this, especially with entrenched systems like file shares and email. And if the doors remain open to the old system, without a serious outreach effort (marketing and communications), that convenient new time-saving application may take years to be fully adopted (if ever).
2. Trust Affects Governance, Too!
On a similar theme, last week Atul Gawande published "Slow Ideas" in the New Yorker. In this article he tells the story of how several life-saving innovations progressed through history. Some spread relatively quickly, like the use of anesthesia. Some have taking much more time to spread and be adopted, even though they are generally understood and accepted, like antiseptic behaviors. Gawande looks at the motivations behind the spread of ideas, and different approaches to changing behaviors - one being punishment or disincentives, and the other being incentives and rewards.
This is where the article started to sound like a governance story to me: you have a list of behaviors that you want your workforce to follow, for the good of all. In Gawande's example of reducing infant mortality in developing countries, this list includes handwashing, disinfecting delivery rooms, and keeping the newborn warm. Now, although I'm in no way trying to equate the impact or criticality of a hospital delivery room with an information technology system, in the organizations where I've seen new IT systems implented, there is also typically a list of desired behaviors, which may include the use of naming conventions, granting of permissions and rights based on role or training, and the following of a code of conduct, to name a few.
In both cases, if you ask the practitioners in the system whether they think the list of rules is a good idea, intellectually they would say yes - yet they don't follow them or carry out the steps on a daily basis. Why? To quote Gawande -
"...technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.
This is something that salespeople understand well. I once asked a pharmaceutical rep how he persuaded doctors—who are notoriously stubborn—to adopt a new medicine. Evidence is not remotely enough, he said, however strong a case you may have. You must also apply “the rule of seven touches.” Personally “touch” the doctors seven times, and they will come to know you; if they know you, they might trust you; and, if they trust you, they will change. That’s why he stocked doctors’ closets with free drug samples in person. Then he could poke his head around the corner and ask, “So how did your daughter Debbie’s soccer game go?” Eventually, this can become “Have you seen this study on our new drug? How about giving it a try?” As the rep had recognized, human interaction is the key force in overcoming resistance and speeding change."
In the article, Gawande gives several examples of how the placing of experienced trainers among the group of people whose behaviors they wanted to change, and bringing them into regular social contact, eventually brought about changes in those behaviors. His article is lengthy but in my opinion well worth the read to get a sense of the scale of the effort that is required to make even small changes that can have tremendous impact.
This is as true for your technology governance and adoption as it is for people in the medical field - your checklist won't be followed, and your system won't be adopted, if you launch it and only provide self-service training. To achieve the successful spread of the change, you need to go out among your user base, not just once but multiple times, subtly reinforcing the message and building trust.
Read More
Slow Ideas by Atul Gawande in the New Yorker's Annals of Medicine
In South Jersey, New Options For Primary Care Are Slow To Take Hold by Taunya English for NPR
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