The anatomy of health changes

We are on the verge of a major change in the health system both here in New Zealand and in the wider world. We face to sad paradox – while an estimated 870 million people are under nourished, over 1.4 billion are over weight. Both phenomena create consequent health problems, causing human misery and depleting our resources. Fortunately an increasing number of us are gaining more nuanced appreciation of this problem. It is clear that the problem of excessive weight is as much about the quality of food eaten, as its quantity.

The industrialisation of the globe has generated huge benefits for us and supported the development of modern health services. But consequent changes in our diet and lifestyle are eroding and even negating these benefits. We eat too much energy dense and nutrient poor, over-processed food.

A paradigm shift

It is helpful to understand the forces at work through the concept of the paradigm shift. Thomas Kuhn coined the term in his book The Structure of Scientific Revolutions in 1962. He argued that rather than evolving steadily, science progresses through periods of revolution and orthodoxy. After the revolution, a new scientific orthodoxy is established, but over time becomes resistant to change and new influences. The next revolution will only happen when the sheer quantity of new information and thinking displaces the old.

paradigm shift nutritional food

The dynamics of a paradigm change

We are approaching this point now. Industrialisation has provided us with convenience foods that are highly processed and nutrient poor – much of the nutrition in food simply doesn’t survive through processing and distribution systems. The health system has largely accommodated this situation and accepted it as “normal”. In Western economies, the majority of health resources go into dealing with the consequences of poor nutrition (this is still contentious, but it is not the focus of this article to argue this point). And incidentally, many health professionals and health service and supply industries benefit financially while the situation persists. Another force that supports this paradigm is the food industry that produces this “fake food”. Based on ineffectual public policy, it also appears that the majority of policy makers are embedded in this paradigm.

The new paradigm is based on the understanding that eating nutrient rich food that is minimally processed supports our health. One of the main forces supporting this change is the Internet. The exchange of scientific and clinical information about nutrition is intensifying exponentially and is available to an ever-increasing group of health literate users. These people can find supportive health professionals in their communities and online. Some cafés and restaurants are following the trend and providing nutritious and tasty food.

The broader sustainability movement supports this new paradigm. Approximately 26% of the New Zealand population fits the Lifestyles of Health and Sustainability (LOHAS) market demographic. The Living LOHAS report describes the demographic:

LOHAS aligned consumers look behind products and services to an Hippocratic oath assessing whether they should buy a given product or service. They probe for alignment of organisational intent. Authenticity of the offer is mandatory and the company is mandatory. LOHAS consumers want to know “where does it come?”, “how is it made?”, “what is it packaged in?” and “what will happen when I dispose of it?”.

Imagine the health we will enjoy when we embed this new thinking in health systems adding to the known benefits of industrial age healthcare – hygiene, infection control, appropriate surgery and physical trauma treatments for example.

The ethical challenge

The story of the two stonecutters illustrates the ethical paradox many health professionals face.

A man once encountered two stonecutters and asked the first “What are you doing?” He replied, “cutting a stone”. When the second stonecutter was asked, he replied “I’m building a cathedral”.

We have plenty of very competent and dedicated health professionals who are skilfully and diligently cutting their own stones. Its not so easy to find those who can find cognitive space for both their specialist skills and an overview of the system’s effectiveness. While practising ethically in their own professional space, they participate in a system that inflicts damage on society and an increasing burden on taxpayers. Where are the cathedral builders?

Engaging to change

For those of us who wish to promote a health revolution, engagement is a key to change. In the discursive battle that accompanies any significant paradigm change, it is easy for the antagonists to dichotomise, but this often leads to entrenched and reactionary views. Niki Harré’s excellent book Psychology for a Better World, suggests that people need to be engaged emotionally to further any worthwhile cause. She also emphasises the need for the need for positive example – leading by example.

I changed my diet for the better on being diagnosed as pre-diabetic. These changes helped me to lose 13 kgs in four months. The health benefits for me have been so dramatic that I need little motivation to stay on this path. In my journey I have found good friends with good advice, a rich resource on the Internet and supportive health professionals.

My work provides opportunities to work with health professionals and community health activists creating a rich matrix of people wanting change. We need to seek out those health professionals who can see the bigger picture and work together for change. Thus two avenues of change are created, a grass roots led change and , sooner or later, policy change.

What do you think?

Useful links

Here are some of the materials that I have found useful. Gareth Morgan is a New Zealand economist who puts his massive intellect to work on various social issues. His book Appetite for Destruction elaborates on the dangers of “fake food”. He also provides an economist’s perspective on how a government might profit from a radical overhaul of health funding, including taxing “fake food”.

Several competent physicians provide mountains of information on health and nutrition:

The Green Med Info website includes a huge resource of research papers on health and nutrition.

 

 

Conscious capitalism

Management students study the eras of their discipline including classical, human relations, scientific management etc. What is emerging for me is a more epochal change in management – the transition from self-serving capitalism to conscious capitalism.

It is always hard to define a starting point for massive change, but, as will be explained, I will go with 1962. Here’s John Mackey, CEO of Whole Foods explaining the basics of conscious capitalism.

Self-serving capitalism

Self-serving capitalism is based on greed. Altruistic motives are also there, but they are subjugated by the profit motive. Some underlying assumptions, revealed in business discourse, frame its mode of operation:

  • “business is business” – tells us that business operates by its own rules. It somehow decouples from universal moral values and creates its own world-view and playing arena. Another telling discursive phrase is “its nothing personal, its just business”.
  • “the bottom line” is code for, among other things, profit is the dominant consideration.

U.S. company Enron has come to personify the worst of self-serving capitalism. If you are unfamiliar with the Enron story here is a link to the documentary trailer.

Before determining the origins of conscious capitalism consider that the father of capitalism, Adam Smith, wrote two books about economic philosophy, The Wealth of Nations, but also A Theory of Moral Sentiments. The latter argued that sympathy, a proper regard for others, is the basis of a civilised society. Conscious capitalism was still-born as business focused more on the “invisible hand” of the marketplace.

The dawn of conscious capitalism

Dr Paul Ray has identified an emerging sub-culture – the cultural creative. He defines them in this video.

In the U.S. cultural creative are fast becoming a dominant segment of society. In his extensive research quantifying this demographic, Dr Paul Ray noted that they are to found in many other countries, but they often under-estimate the size of the demographic, as they are mostly invisible in the media.

Cultural Creatives

The growth of the cultural creative demographic in the U.S. [1]

Dr Ray identifies 1962 as the dawn of the demographic. Rachel Carson published Silent Spring and Betty Friedan The Feminine Mystique – the former signaling the start of environmentalism and the latter reframing women’s role in society.

In Megatrends 2010, Patricia Aburdene identifies cultural creative a the demographic that drives conscious capitalism.

The engagement connection

A significant milestone along the road towards conscious capitalism was Edward Freeman’s articulation of stakeholder theory in Strategic Management: A Stakeholder Approach.

conscious capitalism

From self-interested capitalism to conscious capitalism

 The concept of the stakeholder displaced the singular focus on returning profits to a businesses financiers, to the more balanced and sustainable stakeholder approach.

Great companies embrace social media

While many are wary of employees spending too much time on social media, some great businesses are showing us how social media can enhance business. This video features Erin Lieberman-Moran from the Great Place to Work Institute.

Note that Erin recognises a high level of trust as the enabler for businesses to use social media effectively.

Social media and crisis communication

Ethical Corporation’s July 2012 report researches how companies respond to consumers and activists in a crisis. While the full report, with a price tag of £695 targets corporate customers, the Ethical Corporation provides some great information along with this excellent infographic.

Social media crisis Infographic

Engagement and the Regeneration Roadmap

Engagement processes are at the leading edge of sustainability. The Regeneration Roadmap is an initiative of Globescan and SustainAbility aiming to achieve sustainable development within the next generation. Their focus is on the private sector to drive a lot of change.  This video features global thought leaders articulating the road to sustainability. As you watch, notice how pivotal engagement is a agency for change.

Mobilizing the Response from The Regeneration Roadmap on Vimeo.

Gro Harlem Brundtland, a past Norwegian Prime Minister and Director General of the World Health Organisation. She is currently a Special Envoy on Climate Change for the United Nations. She places engagement at the heart of change.

Personal engagement, personal commitment and building confidence with other people and other nations is the only way to move forward.

The video reinforces the need to generate positive discourse around sustainability, articulate a vision of a sustainable planet and create a culture to embed sustainability as a way of life.

For more videos by these gifted thinkers go to the Regeneration Roadmap website.

A policeman’s lot is more engaged – national | Stuff.co.nz

A policeman’s lot is more engaged – national | Stuff.co.nz.

Improvements in staff engagement in the Police can partially be attributed to technology innovations. The New Zealand Police have introduced technology that enables police to report incidents remotely. That information is then processed by administrative staff enabling the police to focus on their front-line work.

This is an example of how job design can improve engagement. Based on Hackman and Oldham’s job enrichment model we can ask questions such as:

  • How can we create more skill variety?
  • How strongly do our people identify with their work?
  • What makes work meaningful for our most engaged?
  • Do our people have the autonomy they need to do a good job?
  • Do they get appropriate feedback about their performance?

Job enrichment model (Hackman & Oldham

A tribute to Stephen Covey (1932 – 2012)

Stephen Covey made an enduring contribution to both business thinking and personal development. His book The 7 Habits of Highly Effective People published in 1989 has sold over 25 million copies. Time Magazine rated The 7 Habits as one of the 25 most influential business management books. He has featured in all of the Thinkers 50 lists from 2001 to 2011. But rather than continuing to list his achievements, I would like to focus on what Stephen Covey means to me – just one of his millions of readers.

Working at the boundaries

Stephen Covey wasn’t just a business writer. His books crossed over into the realm of personal development. He bridged these two spaces in a manner rivalled by few. One of his other stand out books Principled Centered Leadership offered guidance relevant to both worlds.

A member of the Latter Day Saints church, Stephen Covey was a deeply religious man. For me, his integration of business and religious thinking has been inspirational. No one has done it better with that level of success. His model of intelligence exemplifies this integration. In the 7 Habits, well before emotional intelligence was popularised, he identified four dimensions of the self, the intellectual, physical, emotional and spiritual.

Later, in The 8th Habit, Stephen Covey applied this model to the business world. He advocates a “whole person in a whole job” where each of the four dimensions of the self are expressed:

  • use me creatively (mind)
  • pay me fairly (body)
  • treat me kindly (heart)
  • in serving human needs in principled ways (spirit).

The big picture

With his skills of integration Stephen Covey masterfully sketches out the big picture. His “five economic eras”, from The 8th Habit encapsulates human economy from the hunter/gatherer age, beyond the current information age, to his envisioned “age of wisdom”. He draws on Peter Drucker’s thinking on the massive leaps in productivity from age to age.

The great value in this concept is in understanding the limitations of legacy industrial age management processes when they are applied to information age contexts.    

“Its no longer a world of controlling people, it’s a world of unleashing people”.

 

The engagement connection

Stephen Covey’s clear articulation of the requisite leadership capabilities of the knowledge age focus heavily on communication. He offers lots of great communication tools and concepts such as the “emotional bank account”, but his greatest contribution in the communication realm is “voice”. When I first encountered The 8th Habit, I was a little cynical, thinking “how many other habits will be generated for future books?” But my cynicism evaporated with his masterful articulation of voice – the 8th habit is “find your voice and inspire others to find theirs”. This is an emancipating concept beautifully aligned with the needs of the age. For me, enabling voice, is central to the engagement process. Ideally, the loudest, or most powerful, or best resourced voice is not the only one heard.

Because he painted conceptually with such a broad brush, Stephen Covey’s work will remain relevant and will inspire for years to come. The concepts he articulates work at the level of principle and character and are therefore of universal application. May he continue to inspire!

Narcissism: The Difference Between High Achievers and Leaders – Justin Menkes – Harvard Business Review

This HBR post from Justin Menkes is another contribution to the ever-growing body of evidence that effective leaders are good people that care for others. As Justin Menkes states:

Only an individual who feels genuinely invigorated by the growth, development, and success of others can become an effective leader of an enterprise.

When reading this article you will find a strong correlation between effective leadership and engagement.

Narcissism: The Difference Between High Achievers and Leaders – Justin Menkes – Harvard Business Review.

Change and engagement, part one

The way we are changing is changing. The predominant approach to change has been to mandate it. An elite, at the top of the organisation, perceive a need for change and direct others to implement it. They will anticipate some resistance and have some strategies ready to overcome it. Often this change will involve some type of restructuring.

There is mounting evidence that this type of change doesn’t work very well and may actually deplete rather than add value. For some organisations, the frequency of this type of change results in a series of self-inflicted, debilitating injuries.

A recent Bain & Company study of 57 major reorganizations found that fewer than one third produced any meaningful improvement in performance. Some actually destroyed value.

Mandated change, bold strokes and long marches

Twenty years ago, in her book The Challenge of Organizational Change, Rosabeth Moss Kanter and her co-authors identified two types of change, bold strokes and long marches. Bold strokes are big strategic moves, such as buying another company, generating a large capital investment, or developing a new product. Bold strokes are usually mandated by the actions of “one or a few people”.

(Tom Peters’ take on mergers)

Long marches are more operational initiatives such as merging departments, transforming quality or customer relationships. According to Rosabeth Moss Kanter, “they require the support of many people and cannot be mandated in practice”

Of course we will continue to need a degree of mandated change, and other stakeholders such as government will mandate external change. We just need to hope that the skill and ability to design and manage change will improve.

Too frequent use of restructuring will come to be seen as the  corporate equivalent of the old medical practice of blood-letting and a sure symptom of dysfunction.

According to Rosabeth Moss Kanter, long march change will have more dependable long term results and is more likely to change culture and habits. She then elaborates on the enduring foundation of sustainable organisational change – decision making.

Every large and complex organisation has many thousands of people who have each day the opportunity, or are literally required, to take action on something. We think of these as “choice points.” For an organisation to succeed in any long-run sense, these millions of choices must be more or less appropriate and constructive day in and day out. But this is an immensely difficult problem, because it requires the ultimate in decentralisation – literally to the individual level – along with centralisation in the sense that those individual choices must be coordinated and coherent.[1]

This same theme is echoed two decades later by Marcia Blenko in the Harvard Business Review:

In reality, a company’s structure results in better performance only if it improves the organisation’s ability to make and execute decisions better and faster than its competitors.[2]

Her she is elaborating on the centrality of decision effectiveness in sustaining effective change.

The engagement connection

Marcia Blenko’s establishes a link between decision effectiveness and employee engagement. Rosabeth Moss Kanter emphasised the importance of “choice points” throughout the organisation. And while the focus is on big business, even small businesses manifest thousands of choice points if we consider all employees and stakeholders.

Embedding a stakeholder ethos (including employee engagement) throughout the organisation will build resilience and adaptive capacity. Over time, it is more likely that those highly engaged staff will be making decisions and choices aligned with the best interests of the company. And over time there will be less need for mandated change.


[1] Rosabeth Moss Kanter, Barry Stein and Tod Jick. The Challenge of Organizational Change: How Companies Experience It and Leaders Guide It. New York: Free Press, 1992, page 492, 495

[2] The Decision-Driven Organisation, by Marcia Blenko, Michael Mankins and Paul Rogers In Harvard Business Review June 2010, page 57

Engagement and community building – the White Dog Café

In 1983 Judy Wicks started the White Dog Café in Philadelphia. It has become an exemplar for a community-based enterprise.

Where I live, community enterprise is slowly but surely being eroded as an increasing number of national or international chain stores supplant local stores. While this typically provides benefits such as cheaper goods the longer-term impacts are not beneficial for the local community (more about this in a later blog).

The White Dog Café started off as a restaurant, and remains a restaurant, but it has become the centre of a local network of suppliers, customers, employees and community interests. In the early years of the restaurant, Judy became increasingly troubled that the meat on her menu came from industrial farms. She changed to free range pork and then other meat and chicken and free range eggs. If produce is available locally, and is preferably organic, the White Dog Café purchases it in preference to imported food.

Initially Judy regarded locally sourced production as a point of difference for her restaurant, but her thinking evolved to consider the greater good and she went about engaging other restaurateurs in the concept. Her engagement with local farmers and growers created momentum for the establishment of the Fair Food initiative. Farmers and growers benefit from having a larger market for their produce locally. This animal welfare aspect of the White Dog Café remains one of her strongest motivators.

Networks of services

A restaurant depends on a web of services to operate. As Judy sorted out the produce for her menu, she became aware of a series of expanding possibilities to make the restaurant more sustainable and support the local community. She sourced renewable electricity and created a solar-heated water supply. Organic waste is composted and other waste recycled where possible. Local products are used whenever possible – for example locally produced soap is purchased for hand washing. For those products not available locally, such as tea, sugar and coffee, Fair Trade sources are used.

The invisible had works when we live in the same community.[1]

Staff also benefit from the sustainability philosophy – Judy pays a “living wage”. The Restaurant also supports a number of local community service projects such as Crime Victim Services and many others.

Business philosophy and selling the business

The mission statement of the White Dog Café is “Serving our customers, serving each other, serving our community and serving the earth”. Business decisions are based on serving the greater good, growing consciousness and increasing happiness.

After 30 years in the restaurant business Judy decided to sell the restaurant to help her focus on the promotion of sustainability. She wanted to keep the mission of the White Dog Café alive, so she found a local purchaser and retained the rights to the name of the business. To perpetuate the sustainability agenda she set up a Social Contract that keeps the White Dog Café on the same trajectory. The purchaser is able to set up other branches as long as they have 51% local ownership. This video outlines Judy’s perspectives, the restaurant’s operations and the Social Contract.

Above all, Judy has show how one business can generate social good by building rich networks in its local community. Do you know of other examples?

image credit: Real People Eat Local

Book review – We: How to Increase Performance and Profits Through Full Engagement

Rudy Karsan and Kevin Kruse’s book is pragmatic and of use to anyone looking to improve employee engagement. The book is organised into four parts. The first two deal with the individual and I will get my objections to them out of the way before discussing the gems to be found in parts three and four.

In parts one and two the focus on the individual is understandable – as engagement happens from heart to heart. We know that globally, the rates of disengagement are too high and too many people are disconnected from their work. I also accept that people will feel more fulfilled if they find meaning and purpose in their work – but after reading the first few chapters I was left with an impression that we are Homo economicus – we are one dimensional and our primary function is our work. Through our work we will find fulfilment and happiness. But it feels like a rationale to get people to work harder.

As a New Zealander one bad habit my fellow Kiwis share with the people of the United States (the home of the authors) is that we work long hours – we work too hard. Work-life balance is seriously out of balance. In this context I get concerned when I encounter an evangelistic approach towards the virtue and necessity of hard work.

The positives

Having got that out of the way, this book has many gems. The authors have obviously rolled their sleeves up and got involved with engagement processes. They share the three questions they use to gauge engagement (you will find them in the book). I am a fan of short and open survey questions and intend to incorporate these into my work.

The authors make a beautiful distinction: harmonisation = engagement + alignment.

Engagement is the catalyst to get you to that extra edge in performance, while alignment ensures everyone is heading in the same direction. (page 145)

They raise the bar for us here. Some organisations struggle to get to the point of surveying staff about engagement. They may or may not do anything with the information gleaned. To ensure the material issues blocking greater engagement are addressed, and then to go on to align people across the various structural and ideological barriers in an organisation is a worthy aspiration.

Another concept that resonates with me is their management prescription, embodied in chapter eight – “great managers focus on growth, recognition and trust”. This chapter atones for the issues outlined earlier. The authors prefer valuing employees to recognising employees. To survey your employees, survey them to see to what extent they agree with the statement “I feel valued as an employee of this company.” They prefer it to “I receive recognition when I do good work”.

Valuing is about appreciating the worth of something (someone) and of esteeming something (someone) highly. When we value employees, we appreciate them for who they are and what they bring to the organization. We acknowledge them not merely for tasks, but to the deeper intrinsic worth they add to the organization by just being there. (page 177)

When authors apply concepts about qualities of character, such as trust and trustworthiness, they reveal to me a deeper understanding of the human condition than encountered in many business books. Rudy Karsan and Kevin Kruse highlight trust as an important driver of employee engagement. To understand this better they suggest questions such as: “How can our leadership team foster greater trust among employees?” The three qualities that inspire trust are competence, caring and commitment.

It is hard to find books that focus on engagement – so this one is well worth the purchase price. If you know of others you would recommend, please comment.

We: How to Increase Performance and Profits Through Full Engagement by Rudy Karsan and Kevin Kruse (2011) New Jersey: John Wiley

website: www.wethebook.com