Development of effective decision-making skills and behaviors is the foundation of human reliability. This human element is crucial to your equipment and process reliability.
Process-oriented organizations drive value by improving their business processes and equipment performance. At the same time, however, a number of applications, including asset management, work process improvement, defect elimination and preventive maintenance, among others, can be powerful but incomplete applications when seeking to sustain a competitive edge.
To implement and sustain high-performing, reliable cultures, managers need to be as rigorous about diagnosing, designing and implementing changes to the human decision-making process as they are with their business and equipment processes. Equipment and process reliability ultimately rest with human reliability. Thus, cultural change at its deepest level requires examining human reasoning and its resulting decisions.
To establish a culture-of-reliability requires going beyond the traditional stew of copycat approaches and learning how to: (1) use actionable tools to implement and sustain reliability improvements and bottom-line impact by (2) collecting cultural action data and (3) learning how to use that data to uncover hidden bottlenecks to performance.
In the quest for high performance, well-intentioned managers often launch cultural change efforts using what they believe to be applied methods, like employee surveys, team building, empowerment, leadership style, systems thinking, formal performance appraisal, 360° feedback, you name it, only to be disillusioned in the end by the fact that more change efforts fail than succeed. Although they may be well-accepted, traditional change methods are not precise enough to create and sustain cultures-of-reliability and typically evolve into the next flavor of the month.
The learning exercise
For the past 16 years I have been conducting a specific learning exercise related to cultural change. The purpose is to help participants understand why implementation is so hard. There are five objectives for the session:
- To discover root cause of implementation barriers;
- To illustrate the interdependent relationship between learning and error;
- To determine how participants personally feel when they make mistakes;
- Based on their experience of error, to understand how humans design a culture-in-action to avoid errors and mistakes; and
- To determine the costs of error avoidance to business and human dignity.
To start, participants construct a definition of competitive learning which, at its root, is defined as the detection and correction of mistakes, errors, variance, etc., at ever-increasing rates of speed and precision—the heart of reliability. Through poignant illustrations, they learn that their organizations tend to focus on making fast decisions (“time is money”), timelines, milestones etc., but at a cost to precision, the quality of the decision.
Based on that definition, the participants are asked to reflect on a recent performance mistake they have made on the job or in life. The response from hundreds of them—male and female, Fortune 500 executives, managers, supervisors, engineers, technicians and craftsmen—are very consistent. When they make an error they feel: shame, anger, frustration, stupid, embarrassed, inadequate with an impulse to hide the error and, at the same time, a desire to fix it. The result is an emotionally charged picture of wanting to fix mistakes coupled with an overwhelming response to hide them for fear of blame.
As the exercise unfolds, participants gain insight into how learning and mistakes, trial and error shape performance and how ineffective learning patterns persist for years. For example, individuals from process industries have revealed they’ve known that less-than-effective outages and turnarounds have existed for years; that “lessons-learned” sessions don’t successfully address operations and maintenance infighting and squabbles over what quality work means and the validity of data; that stalled work management initiatives or reprisals for management decisions are a fact of life; etc. The list goes on and on. Discovering why his division had not been able to penetrate a market for over 20 years, one vice president-level participant summed up the dilemma this way: “The costs [of ineffective learning] are so high, they are un-estimateable.”
Through collective reflection in a larger group, participants come to realize that they all experience learning in very similar ways. They also come to learn that their reasoning is very similar. They typically espouse that continuous learning is important and mistakes are OK, but, in the final analysis, mistakes are categorized as critical incidents on performance appraisals or simply seen as ineffectiveness.
When performance appraisal is tied to pay, rewards and promotion, participants indicate that they would have to be foolish, if they “didn’t put the best spin” and save face at any cost. “I have a mortgage to pay” is how many respondents put it. At the same time, they acknowledge learning does occur, but at a rate that leaves much to be desired. “It’s not all bad,” is how many participants put it. Yet, this is not really a case of being bad. Rather, it is a case of sincere, hard-working people unknowingly designing a culture with a set of unintended outcomes.
At this point, participants begin to gain insight: they say one thing and do another. Moreover, they come to understand that it is easy to see defensive patterns in others, but not so easy to see defensive patterns in themselves. Not surprising, being defensive is espoused as not ok. Hence, good team players should be open to feedback. Not being open would be admitting a mistake, the very essence of pain.
In the final phase of the learning exercise, participants come to recognize that they have a strong desire to learn and they seek noble goals, but that fears of retribution for telling the truth, blame, fear of letting someone down or fear of failure, whether in substance or perception, contribute to a sense of loss of control. Unfortunately, this situation violates the first commandment of management: BE IN CONTROL.
The need for control translates into a hidden performance bottleneck, given the complexity of job interdependencies and systemic error. As one individual noted, “I can’t control what I can’t control, but I am held accountable. Accountability translates into who to blame.” Participants acknowledge that they subtly side-step difficult issues and focus on the more routine, administrative issues, thereby reducing emotional pain and conflict in the short term. They acknowledge that they bypass the potential for higher performance by not reflecting on gaps in decision-making.
Ironically, as these decision bottlenecks limit performance, expectations for better performance increase, often resulting in unrealistic timelines and more stress. Executives complain they just don’t get enough change fast enough, and middle managers and individual contributors complain of “micro-management.” Sound familiar?
The end result is that sincere attempts to improve the status quo slowly are cocreatively undermined and inadequate budgets and unrealistic timeframes are set. Good soldiers publicly salute the goals, but privately resist because their years of experience have taught them to think in terms of “what’s the use of telling the truth as I see it; this, too, will pass.” Ultimately, many see the “other guy(s)” or group as the problem and wonder why we can’t “get them” in line. This is the heart of an organizational fad—something that often is labeled as the lack of accountability.
Based on participants’ data generated from this learning exercise and action data recorded and collected from the field (see Part III of this series for the data collection method), a culture-inaction model, similar to that shown in Fig. 1, is created and verified with illustrations. Participants consistently agree this type of model is accurate and reflects their own current cultures-in-action.
The culture-in-action model is rooted in human reasoning. Given the assumptions of avoiding mistakes and being in control to win and look competent in problem resolution, the reasoning path is clear. The behaviors make perfectly good sense.
When seeking solutions, multiple perspectives will proliferate on which solution is best, some with more risk, some with less. Think of it as inference stacking. A complex web of cause and effect, solutions and reasons why something will or will not work are precariously stacked one upon the other, up to a dizzying height.
Determining whose perspective is right is problematic (“Your guess is as good as mine”). Hence, controlling the agenda to reduce frustration either by withholding information (“Don’t even go there”) or aggressively manipulating people to submit or comply with someone else’s views to get things done is a logical conclusion based on the underlying assumptions.
It is not surprising that executives seek to control their organizations and focus on objectives—and when they do this that middle managers privately feel out of control because they think they are not trusted to implement initiatives or handle day-to-day routines. This leads to the following managerial dilemma: If I voice my real issues, I will not be seen as a good team player. If I stay silent, I will have to pretend to live up to unrealistic expectations. Either way is no win (a real double bind).
To overcome this dilemma, people verify and vent their emotions one-on-one, i.e. in hallways, restrooms and offices. This way, they avoid confronting the real issue of how they are impacted by others, which is diffi- cult to discuss in a public forum (“Don’t want to make a career-threatening statement”). Instead, they seek thirdparty validation that their beliefs are the right ones to hold (“Hey, John, can you believe what just happened in that meeting? I don’t think that strategy is going to work; didn’t we try it 10 years ago?”). Even the best-performing teams demonstrate some of these performance-reducing characteristics. The culture becomes laden with attributions about others’ motivation, intent and effectiveness and it is labeled “politics.”
Routine problems often are uncovered, organizations do learn, but the deeper performance bottlenecks, hidden costs, sources of conflict and high-performance opportunities are missed because the focus is on putting the “best spin” on “opportunities for improvement” with a twist of language to avoid the “mistake” word. That’s because mistakes are bad and people don’t like to discuss them. Interestingly enough, there are even objections to using the word “error” during the process of the exercise. It is not surprising that when trying to learn and continuously improve a turnaround, business process or project, for example, people privately will conclude “Oh, boy, here we go again. Another wasted meeting debating the same old issues.” Negative attributions proliferate (“They don’t want to learn”) and underlying tension grows.
At this stage of the process, the pattern begins to repeat itself. As the project effort falls behind, expectations build. Typically, someone will be expected to “step up” and be the hero. With eyes averted, looking down, uncomfortable silence, someone “steps up” and often gets rewarded. Yet this heroic reward doesn’t address root cause (i.e. what accounted for the errors and frustration in the first place). Side-stepping or avoiding the more difficult-to-discuss issues don’t help uncover root cause, but, rather, lead to fewer errors being discovered. As a result, the business goal is pushed a little further out and economic vulnerability is increased.
If the market is robust, errors and mistakes may mean little to a business. The demand can be high if you have the right product, at the right time. As competition increases, however, or the market begins to falter, the ability to remain competitive and achieve what the organization has targeted is crucial. Competitive learning is the only weapon an organization has to maintain its edge in the marketplace.
Major culture-in-action features
In summary, the major features of a true culture-in-action are:
- Avoidance of mistakes and errors at all cost;
- Little active inquiry to test negative attributions;
- Little personal reflection (i.e. “How am I a part of the problem?”);
- Little discussion of personal performance standards by which we judge others; and
- Little agreement on what valid data would look like.
As the exercise winds down, it’s not long before someone asks, “So how do you get out of this status quo loop?” When this question comes, because it always does, I turn it back to the group and ask how they would alter this cultural system? The reaction is always the same—silence and stares. No wonder. The answer is not intuitively obvious, even to the most seasoned of practitioners and theorists.
The short answer is rather than “get” anyone anywhere, change has to be based on individual reflection and actionable tools driven through collaborative design and invitation. These actionable tools balance the playing field, at all levels, by helping create informed choice through daily decision-making reflection. Traditional intervention methods focus on changing behavior, learning your style or type, building a vision, etc. There are any number of approaches, all very powerful but incomplete without addressing the underlying reasoning (root cause) that is informing the behavior in the first place.
Coming next month
In Part II, a culture of reliability will be defined, as well as the role of reflection in organizational performance and the actionable tools of collaborative design. MT
Brian Becker is a senior project manager with Reliability Management Group (RMG), a Minneapolis-based consulting firm. With 27 years of business experience, he has been both a consultant and a manager. Becker holds a Harvard doctorate with a management focus. For more information, e-mail: firstname.lastname@example.org