Anesthesia, Antiseptics, and Applications: Gawande and Change Management In Law Firms

1 Aug

z-Operating RoomGuest Post By John Gillies, Director of Practice Support, Cassels Brock

Most of us in the KM community are aware of The Checklist Manifesto, written by Dr Atul Gawande. That book makes a convincing case of how checklists can be invaluable in many different environments, from a hospital’s intensive care unit to a jumbo jet cockpit, even for experienced “practitioners.” Although the book did not address our area of interest, it was clear how the lessons of that book could be applied in law firms. (See my book review on Slaw entitled The Checklist Manifest and the Smarter Lawyer.)

Since that book, Dr. Gawande has published other articles in The New Yorker that resonate with KM practitioners. For example, his piece entitled Personal Best noted that professional musicians and athletes get coaching throughout their careers, although it’s not something doctors generally do. It has interesting implications for law firm professional development, and for knowledge management professionals who address improving attorney and staff information management skills.

The subject of my post today, though, is his most recent New Yorker article, entitled Slow Ideas: Some innovations spread fast; how do you speed the ones that don’t? (Dr. Gawande recently discussed the article on this Colbert Report segment that touches on gay marriage, polar bears, and more). It directly addresses one of the key issues at the heart of KM, namely change management.

In a KM context, there are some changes that users seem to take to with minimal encouragement, such as the introduction of enterprise search. In that case, lawyers were familiar from their personal (i.e., Google) experience of the benefits of search and hence implicitly understood the potential advantages that enterprise search could give them. Adoption of many other KM initiatives, however, is much more difficult. Dr. Gawande’s article, then, offers us ideas as to how we might better foster adoption of our various initiatives.

Dr. Gawande discusses four different cases, two from the 19th Century and two recent ones. He notes that the use of both anaesthesia and antisepsis (namely, the avoidance of germs to minimize infection) were introduced around the same time. The adoption of anaesthesia was remarkably fast, whereas it took decades before doctors recognized, and then addressed by their changed behaviour, the effect of fighting germs in a medical environment. “The key message to surgeons, it turns out,” he says, “was not how to stop germs but how to think like a laboratory scientist.”

He notes that there tend to be two approaches to encouraging adoption, namely penalties and incentives (like Starbucks cards for contributing to the KM system!). But neither, he says, “achieve what we’re really after: a system and a culture where X is what people do, day in and day out, even when no one is watching.”

“To create new norms,” he advises, “you have to understand people’s existing norms and barriers to change. You have to understand what’s getting in their way.” In resisting the new change, people will often offer reasons that, at that time and based on their experience, seem like good, compelling reasons not to change. (One of the most common objections is, “All this will do is to increase my workload!”, and that statement is probably absolutely correct.)

What then is the way to advance? He refers to the work of Everett Rogers, who noted that “Diffusion is essentially a social process through which people talking to people spread an innovation.” (His groundbreaking book with that title contains many insights for KM practitioners.) Dr. Gawande says that that research shows that “people follow the lead of other people they know and trust when they decide to take up [the particular change]. Every change requires effort, and the decision to make that effort is a social process [emphasis added].”

He then relates the attempts by NGOs to wrestle with the (mostly) third world issues of cholera and infant mortality. In both cases, there are approaches that are not overly costly or difficult and can be taught, but (not surprisingly) changing existing behaviour is the hardest part.

In the fight against cholera, they distilled their “sales script” into seven easy-to-remember messages. They had the “coaches” first build a relationship of trust with the “users” and then have the “users” carry out the new task while explaining to the coach what they were doing as they did it. The same process has been used effectively in trying to address infant mortality.

One of the first arguments raised against these initiatives was that they were not scalable. But what became clear was that when they were able to show clear, tangible benefits, such criticisms were then weighed against the actual benefits. In the field of surgery, anaesthesia was recognized to be so important that it led to a new field of specialization and to there being (at least) two doctors, not just one, involved in each surgical operation.

What then are the lessons we can draw? I would suggest the following:

  • Identify your key pain points. What are the issues that do not consciously affect lawyers but in fact touch them in ways they don’t (yet!) perceive?
  • Understand the barriers to change. If you don’t know what they are, you won’t be able to overcome them.
  • Prioritize your efforts. Identify the single most effective advance you can make and focus your efforts on that. Don’t allow yourself to get distracted. KM efforts have tended to be focused on efficiency and effectiveness, in other words on cost savings. But law firm profitability is the most important issue to the partners. So, what is the one thing you can do that is most likely to improve profitability?
  • Focus your message. The ICU checklist referred to in Dr Gawande’s book was very easy to understand, but it took many iterations to get there. In the cholera program, they identified the seven key steps. Seven may be a key number: focus just on your seven items and leave the rest for another time.
  • First and foremost, establish a relationship of trust. Generally this is engendered by face-to-face contact over a period of time. (I’ve found that adding a glass of wine helps immeasurably – though not during office hours!) This aspect is a particular challenge to large firms with multiple offices, since it’s physically impossible to have personal interactions with people in multiple locations. But is the key ingredient. Perhaps, though, other tools, such as social media, will allow us to foster those relationships in a way that would not have been possible previously.

I look forward to future articles from Dr Gawande as the source of further insight and inspiration for our KM efforts.


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