Chapter 6 Implementing iOCMTM Within Your Own Organization – Managing Organizational Change


Implementing iOCM TM Within Your Own Organization

Ideally, the decision to formally implement iOCMTM to support all change initiatives will originate at the executive level of your organization. But, circumstances are seldom ideal. It is important to understand that, while maximum benefits will be achieved by implementing a formal ­iOCMTM-based project management methodology rolled out across the organization by the program management office, center of excellence, or other project management governance group within the organization, there are still significant benefits that can be realized by following ­iOCMTM principles at a lower organizational level. Even individual change agents can take steps to improve task outcomes by integrating iOCMTM principles into their own, role-related task activities. But, regardless of how iOCMTM is introduced, the roll-out itself will require its own change implementation plan, and adhering to the basic structure of an iOCMTM implementation plan will still be critical to success.

The iOCMTM project structure is much like that of a large building, where pillars are spaced strategically to support the roof and to relieve overall stress by evenly dispersing the weight burden. To maintain structural integrity, the building must be set on a firm foundation—one able to keep the occupants safe during the strongest of storms. The principles of the iOCMTM project structure are applied for many of the same reasons. At the top is the vision statement, which covers everything. This vision is supported by five pillars, which are the five critical principles of iOCMTM (business benefits; 360° thinking; outcome-oriented project tasks; outcome-oriented governance model; and collaboration). These principles are applied to all phases of the project to maximize the support they provide to other elements of the project plan. And, finally, this structure is built on the foundation of personal commitment, without which, there will not be adequate stability and strength to support the project when major organizational storms arise.

Vision Statement

A formally approved vision statement must be produced at the beginning of an iOCMTM project to ensure the agreed requirements will result in a change solution that can deliver each positive outcome presented in that statement.

The vision statement will paint a picture of what things will look like when the iOCMTM change project is complete—not what a deployment plan will look like after integrating OCM principles into all tasks. So, without reference to project management processes, tasks, or even ­iOCMTM, you will need to define in detail what things will look like after iOCMTM has been implemented.

If this is an organizationwide implementation, then the vision will be much broader in scope (i.e., “Our technical and business organizations will have the skills, tools and support needed to work together seamlessly, to expertly design, build and implement transformational solutions that achieve maximum return on investment with minimal disruption to critical business functions”).

If your first implementation of iOCMTM is on a single technical ­project, the vision statement will be less broad (i.e., “Working with a single purpose, our project and business teams will work together to ensure our manufacturing team is provided the tools and processes necessary to enable a 10 percent increase in productivity and a 30 percent reduction in post-production rework. This will be done in a way that supports our corporate vision of ‘using streamlined processes to minimize waste’”).

And, if you if you are only able to implement iOCMTM into your personal role and responsibilities, the scope will be very narrow (i.e., “My meetings will provide measurable value to all attendees and focus on achieving critical outcomes. As a result, they will be an example others will choose to emulate”).

Because this vision will be used as a metric for whether or not the change transformation was successful, creating it requires a joint effort between the executive sponsor, the business sponsor(s), and the project management team (the only exception is when this is being done at the personal level). Again, when writing this vision statement, regardless of how broad or narrow the scope, it must be a picture of what success will look like, not a statement of how change will be accomplished.

Business Benefits

At the highest level, business benefits are defined as outcomes that support or enable stated organizational objectives. What is important to understand when implementing any significant change within an organization is that there is benefit only when the business agrees that there is benefit. The fact that project leaders can show that a new system is more reliable, or new processes are more efficient, or even that all technical requirements have been met, has little value if business leaders do not agree that the added efficiency and reliability actually resulted in the business benefits that were expected (whether or not those expectations were ever actually articulated or formalized).

Gathering technical requirements is a part of every change initiative, and yet, time and time again, projects that meet agreed requirements are still considered to have failed in providing expected business benefit. To address this disconnect between technical requirements and expected business outcomes, iOCMTM projects use a robust requirements gathering process that goes beyond identifying technical needs, budget constraints, and timing issues. In a series of meetings and workshops involving executive leadership and representatives from each stakeholder group (both collectively and independently) a series of who, what, when, where, why, and how questions are discussed, and ultimately, a formal, approved list of business and technical requirements are established. While this process takes longer than the traditional requirements gathering method, the outcomes provide a much clearer picture of the metrics that will be used to determine ultimate project success. This set of metrics will be used throughout the project to ensure the development team is focused on delivering business value, to provide guidance when setting priorities, and to build stakeholder support. Ultimately, tying project requirements to business expectations is the only way to ensure outcomes that deliver expected business benefits.

360° Thinking

Developing a clear picture of how processes, functional groups, business groups, suppliers, and customers within an organization are interconnected is the first step in understanding how to develop a change implementation plan that will be able to address all of the impacted parts of that organization. To do this requires 360° thinking, an analysis process that will be familiar to those acquainted with the scientific theory of ­systems thinking.

The formal practice of systems thinking originated in the scientific community, and it teaches that an entity is comprised of multiple, interrelated, and interdependent parts (i.e., the body is comprised of many organs, made up of different types of tissue, which are made up of different types of cells), and changing one element of a system affects other parts individually, as well as the system as a whole. Because of this, change must be viewed from the perspective of each part of the system before the extent of a change’s effects (negative or positive) can be determined. An example of this would be designing clinical trial protocols that make sure both intended, as well as unintended, outcomes are identified prior to approving a drug for use. In 1990, Peter Senge’s The Fifth Discipline introduced this scientific theory of systems thinking into the corporate environment, and at the time, it was hailed as “one of the seminal management books of the past 75 years” by the Harvard Business Review. This book became the foundation for a new business concept—organizational change management.

To demonstrate the need for this deeper level of stakeholder impact analysis, let us use the example of an organization implementing a new product lifecycle management tool that includes embedded engineering workflow processes. As part of these embedded processes, the change leaders have chosen to include mandatory data requirements on material type, material form, and part tolerances before a design can be released to manufacturing. The business value of adding this additional requirement to the engineering workflow has been projected to be an overall reduction of 2 percent to the manufacturing timeline, while only increasing the engineering timeline by 0.05 percent. The manufacturing group will see this as a significant benefit because it eliminates a mandatory review step currently required by the manufacturing group when each engineering design is received. But, it is possible that the engineering group will not be as happy with the change.

While the engineering group is truly committed to providing quality designs, they could argue that using embedded workflow processes with added mandatory stringent quality control is not necessary because there are already process requirements that address this issue, and a better solution would be to focus on ensuring compliance to existing standards. Or, they may express concern that the inflexibility of embedding these requirements into the tool’s workflow does not allow for those instances when the design has been fast-tracked and needs to be provided ASAP, with the additional material and tolerance information to be provided later. They may also point out that having to identify this information on every design, when there are known industry or company standards for many of the materials that are used, unnecessarily increases engineering task complexity while adding no value. These are all reasonable concerns that will need to be addressed.

But, what they probably will not say is that they do not want to do anything that slows their current pace of design completion because they receive a productivity bonus based on the average number of design requests completed in a month. Currently, if a design is sent back with a request for additional data, it has no negative impact on the engineer because each of these go backs is regarded as a new design request when calculating bonuses. In fact, because the time it takes to provide the additional data is much less than the time needed to create an actual design, these requests for additional information actually increase total productivity numbers and positively impact the bonuses awarded.

If this change is implemented as designed, the engineers will be required to provide detailed material and tolerance data on every design the first time it is submitted, and as a result, the time needed to complete each design will increase, and rework requests will be eliminated. Even though the actual number of designs, and the time required to complete them will remain virtually the same, each engineer will complete fewer design request monthly. Simply put, implementing this change will reduce this engineering group’s bonuses. If the change initiative leaders did not invest the time analyzing the planned change from every perspective, this impact would not be known, much less addressed. And, this would result in significant resistance to the change by the engineering stakeholder group and very low compliance after implementation.

The following figure is a graphic to show the actual task planning process for planning a meeting, based on the principles of 360° thinking:

Outcome-Oriented Project Tasks

Successful organizational change management is not accomplished through a set of tasks that take place outside of the real project activities. Realizing maximum benefit associated with organizational change management is a result of best practice organizational change principles being integrated into all tasks throughout the entire project plan. This fundamental truth is the heart of iOCMTM.

Effective organizational change management requires a shared understanding on the scope, purpose, and success metrics before formally launching a change initiative. Similarly, effective iOCMTM requires that, prior to assigning or beginning any task, there must first be clarity on the core purpose of the task, the desired outcome of the task, and the most effective process to accomplish the task.

Very early in my career, I was introduced to something called the task cycle process, which is a tool used in systems thinking, and provides the structure needed to insure all pertinent task data has been identified. This same task cycle process is used to insure that meetings, workshops, presentations, demonstrations, user acceptance testing (UAT), and training sessions are well-planned, productive, and designed to meet their intended outcomes. While working through the task cycle process, it sometimes becomes clear that completing a task as currently defined would not be the best way to achieve the stated purpose, and that redefining the task, or even replacing it with another task, would result in superior outcomes. The task cycle process consists of the following four parts:

Purpose statement: A declarative sentence summarizing the specific goals, process, and intended outcome of a task, written in this specific format:

“The purpose of this task is to _____ in a way that _____, so that _____”

Task products: Clearly defined desired outcomes (i.e., a commitment from a specific person to provide a defined resource; proof of completion of an assigned task; agreement on the As Is process; and so on).

Task process: The steps and methods to be used to complete the task (i.e., a team meeting; a solution demonstration; an e-mail; a workshop; a presentation; a document, and so on).

Task preparedness: The collateral needed to successfully plan and execute the task (i.e., knowledge; approval; venue; facts; sponsorship; tools; and so on).

Ideally, initial work to define high-level task outcomes for typical project tasks would be done in workshops at the program management office or center of excellence level by an organizational change management lead and experienced project leads. Yes, this takes time: luckily, the high-level task outcomes will remain primarily the same for the vast majority of tasks from project to project. As new change implementation project plans are developed, the project manager, organizational change management lead, technical leads, and business leads will review task outcomes and identify any project-specific modifications that need to be made and this additional information will be available to future project teams.

Outcome-Oriented Governance Model

An outcome-oriented governance model bases success on attaining a sequence of predefined outcomes that move the project closer to achieving promised business benefits.

The most common project management governance model is based on a gated review process, in which a review board is held at the end of each project phase to ensure the project has met all of the predetermined phase requirements, after which the governance review board will make a go or no go decision. If the decision is go, the project moves to the next phase. If the decision is no go, the governance board will decide whether the project will be given more time to meet the missing requirements (and if so, how much time), or if the project will be stopped. As I mentioned previously, actually shutting down a project is very rare.

Customarily, in project governance reviews the project manager will be asked to demonstrate that all predetermined requirements for the current project phase have been met. For example, if there are 150 tasks and four deliverables associated with the Planning Phase, and the project manager can provide proof that all 150 tasks have been completed (or has a realistic plan for completing any open tasks within a reasonable amount of time) and that the four deliverables have been produced, the review board will approve the project to enter the next project phase. This governance process is based on the traditional task completion success metric.

Unfortunately, because this task completion metric does not require any proof that the tasks were competed in a way that included sponsorship involvement, had SME support, advanced stakeholder engagement, or improved end-user adoption, the governance board has no way of knowing whether the project team has developed the organizational support necessary to consider the work in that phase complete.

On the other hand, when applying an outcome-oriented success metric, it is not enough to show that tasks have been completed. An iOCMTM governance review board will want to see proof that stated technical and organizational outcome expectations have been met for each task.

Even when an organization does not follow a formal gated review process, there can still be some form of project oversight to which iOCMTM, outcome-oriented metrics will be applied at the project management level.


The definition of collaboration in the context of iOCMTM is broader than simply working together as a group to achieve shared goals. It is acknowledging that each individual comes to the group with a unique set of skills, knowledge, and experience critical to ensuring decisions made by the group are well-informed. There is also the expectation that, at various times over the course of the project, individuals will be required to make compromises with regard to their personal preferences or goals to ensure that the group as a whole does not compromise on its ultimate commitment to achieving maximum business benefits with minimum negative impact.

At the beginning of this chapter, I explained that the iOCMTM project structure is much like that of a large building, where pillars are spaced strategically to support the roof and to relieve the overall stress by evenly dispersing the weight burden. This is most clearly demonstrated when examining the correlation between successful implementation of the first four pillars (business benefits, 360° thinking, outcome-oriented project tasks, and outcome-oriented governance model) and the ability to successfully implement the fifth and final pillar of collaboration. Each of the first four pillars of iOCMTM can only be implemented when project teams work closely with business teams, which builds trust and understanding.

It is not unusual to experience a certain level of tension between business and change implementation teams. This is understandable, as each group is looking at the issue from very different perspectives. Sadly, in many organizations, this tension results in an adversarial relationship, when at its worst, foments the belief that one group wins only when the other group loses. In this negative environment, project tasks are often executed in a way that does little to alleviate tensions between these groups because when input is required from business or functional SMEs, the process is executed more like an interrogation than collaboration. Often, the goal is to get data and move on, with little (if any) emphasis on working together to build mutual respect or develop a shared commitment to achieve a common goal.

When outside vendors or business consulting firms (bringing their own set of goals and objectives) are involved, this adversarial atmosphere can be even worse. When these expected tensions are not acknowledged and addressed throughout a project, it is impossible to develop a productive environment. Even if there were no other benefits involved, cultivating a collaborative environment to alleviate this toxic situation provides a strong case for implementing iOCMTM.

Personal Commitment

Without the foundation of personal commitment, there is little chance that an organization will be able to maintain a strong iOCMTM structure over time. This requirement for personal commitment applies not only to executive, business, and project leaders, but to everyone involved in the iOCMTM process. However, I do not want to focus on the general concept of commitment on an iOCMTM project. I want to focus on your personal commitment.

The fact that you have invested personal time reading this book tells me that you are interested in improving your organization’s change initiative outcomes. By now, you have learned that there is actual proof that validates the significant value gained by implementing a robust organizational change management component as part of a successful change project—proof based on years of data from thousands of change projects across the globe. You know the eight key elements of an iOCMTM project and understand the fundamental structure you need to put in place to apply best practice OCM principles by incorporating key ­iOCMTM elements into your change implementation project plan. But, reading a book to gain the understanding and knowledge necessary to design a successful change plan is not the same as making a personal commitment to take action.

While I do not know exactly what it is that would cause you to hesitate in making a personal commitment, I do know the reasons I have been given by people over the years. First, they assure me that they are convinced that iOCMTM principles are sound, but then they explain how their organization or project makes it uniquely difficult for them to apply these principles. I honestly cannot remember every reason that I have been given, but the following are the ones I have heard the most often:

  • Our executive leaders see no value in investing in organization change management
  • The project is being managed by outside consultants, and they have their own project management methodology
  • The project is already over budget and behind schedule
  • The relationship between the change implementation team and the stakeholders is extremely contentious and a collaborative working relationship is impossible
  • The people we need to support this change have zero motivation to do so because there is nothing in it for them
  • The entire project is a waste of time, because nothing will fix the underlying business problems that exists
  • No one will listen to me because I am not in a position of authority or influence
  • I just cannot devote the amount of personal time, energy and emotion needed when I have no faith that this project can ­succeed

Regardless of the specifics, the underlying message is virtually the same in each instance: “you do not understand how difficult our situation is, and you have no idea how truly impossible it would be to expect me to change it.”

But, the fact is, I understand exactly how difficult a situation can be, and what it is like to be faced with an absolutely impossible change project. I hope you will not mind my sharing the story of my most difficult project, one with seemingly insurmountable obstacles to success, but a devastating cost of failure. I am sharing this in hopes that it will show you that, even under the most difficult circumstances, there really is value in making a personal commitment to implementing these principles.

The Most Difficult Project of My Life

Two very young entrepreneurs, with far more excitement and enthusiasm than experience, built a moderately successful company. But, they wanted more: they wanted to find a way to increase their footprint in the marketplace and grow their existing business opportunities by offering the world something amazing. They were not averse to taking big risks, so they decided they would go all in. They invested everything they had into designing a new, truly unique product that required a very complex, made-to-order software program that would run on its own, one-off hardware system.

The product launch was a huge success, and because this was a product completely dependent on the quality and reliability of customized technology, the first year was devoted primarily to programming and re-programming to ensure the output was optimal. Things went well, and the new product had gained a strong following in its niche market space. About a year after the product was introduced, the company owners were noticing a slight decrease in system speed and a slight increase in upload times. This was not considered significant because overall reliability was not affected, and these problems were easily addressed with virtually no system downtime. But, over the next few months, they began seeing much more serious issues. The system maintenance group identified a growing number of corrupted data files, which prompted an in-depth, full system interrogation. What they found this time was devastating. Somehow, during the software design and development phase, a piece of defective code was introduced. What they previously thought were insignificant software glitches were actually a result of this defective code, which was working much like malware, destroying the system from the inside. If they did not find a way to fix this problem right away, all data files and scripts would be corrupted and the entire system would be inoperable. And, after consulting local experts, the shared consensus was that it was unlikely a viable fix could be found.

This presented the company leaders with a nightmare scenario. If they did nothing, not only would they lose their most valuable asset, there was a very real chance that the impact of this loss would be so devastating that the entire company would shut down. Even if they chose to try to salvage this asset, they had no guarantee they would succeed. This was not an off-the-shelf solution that could just be replaced. They had to find an expert able to identify the corrupted code and replace it, and then, somehow repair as much of the damage as possible to ensure the system did not lose any of the capabilities that made it such an outstanding success. And, this all had to be done as quickly as possible, or the damage would be irreversible. Even if they could find someone with the expertise to actually tackle this problem, they had very few funds left, so they would have to convince someone that this was a good investment, and that the opportunity for significant return far outweighed the risk of possible failure.

These young leaders did not hesitate; they began a global search for an expert in troubleshooting and repairing damage caused by malware and reached out to venture capital firms to seek the necessary funds. They were ecstatic when they secured a promise of funding from a reputable venture capital group (with the stipulation that the investors had final say over how and when funds would be distributed), and secured an expert IT consultant (one of only two that they could find) that who was willing to take on this project, even though it was made clear to them that the possibility of success was very low. They were ready to begin. The IT expert would design and manage the technical project plan and bring in contract IT resources as needed; the company founders acted as executive sponsors and overall program managers. But, because of the complexity of the business and technical issues involved, and somewhat conflicting interests among the business leaders, the investors, and the IT consultant, it was decided to bring on an OCM consultant. This is where I came in.

To be honest, the overview above is not completely accurate. You see, I thought it would be easier for you to relate to the difficulty of the circumstances involved if I first introduced them using a business metaphor. But now, I will share the actual details.

My Story

“Mom . . .” It was my son on the phone. His voice cracked, and then he broke down crying. Now, it is important for you to understand that this is a man not prone to being outwardly emotional, so I knew that whatever came next was not going to be good. When he regained his composure, he told me that rashes and colds his 18-month-old daughter had been experiencing with increasing frequency over the past few months was actually a type of cancer I had never heard of called juvenile myelomonocytic leukemia (JMML). He had arranged an appointment with the head pediatric oncologist at the local children’s hospital (which was also where my son worked in a nonmedical position), and he promised he would call me as soon as he had any more information. I told him that I knew he would be faced with many difficult decisions, and I promised that I would do everything in my power to make sure he had had all the support he needed.

After I hung up, I immediately went to the National Institute of Health website ( to get reliable information on this disease. I knew it was serious; it was cancer, after all. But, because of the significant advances in pediatric cancer treatments over the past few years, I was hoping to find references to one or more currently approved treatment protocols and to see which cancer institutes had the most successful track record when treating this disease. Nothing prepared me for what I learned. JMML is a very rare form of juvenile cancer. While the exact figures varied slightly, based on the information available at the time, the general consensus was that JMML made up less than 2 percent of all juvenile cancers. During this time, I was working at a biotech company that had developed a successful drug to treat HIV and was in the process of developing a drug to treat cancer, so, I understood that this was really bad news. This put JMML in the category of an orphan disease, and these diseases receive very little federal funding for clinical trials, are not attractive to drug companies or biotechs because the potential patient pool is so small, and finally, it is difficult to find physicians who have ever seen this disease, much less specialize in treating it. I also found out that because the disease was so rare, there were no approved treatment protocols.

My next move was to call someone I knew and trusted in our oncology group, explain the difficult situation we found ourselves in, and ask whether there was anything else that I could do to find more information and possible options for treatment. He explained we could do global searches for current research being done, as well as any trials for this disease that were in the process of enrolling new patients. Eventually, we found that there were two open trials for JMML. That was the good news. We also found out that there was not one recorded instance of a child with JMML living five years after diagnosis (the minimum requirement to be considered in remission), and that the average patient lifespan after diagnosis was 18 months. That was the bad news.

This was no business issue that would be addressed by designing a well-thought-out change implementation strategy; this was a very personal, life or death situation over which we had virtually no control. There was no project plan or engagement roadmap to put in place—there was just a small group of people desperately trying to do everything they could, every day, to move people to do what needed to be done. We were flying blind—but looking back, I can see how closely what we did followed best-practice change principles.

Setting the Vision

My son was very clear about his vision for success. From day one, he made it our shared purpose to ensure his daughter would experience both the joy and the normality associated with being a child, and the comfort and safety of being a part of a loving family.

I am stunned at how articulate and appropriate this was. It focused on what was really important: making sure everything that was done resulted in the best life possible for his daughter. He did not try to define how that would happen, only that every decision that was made would be measured by this standard.

Promised Business Benefits

In this case, the business was my granddaughter, and these were the benefits that we expected for her and that would support our shared vision:

  • 24/7 family presence when she was in the hospital
  • Her personal participation in family activities
  • Minimum number of hospital admissions, with each stay being as short as possible
  • Maximum protection from secondary infections
  • Access to world-class, cutting-edge medical care

360° Thinking

In our case, there were multiple systems involved whose impact needed to be considered.

  • The impacts of aggressive chemotherapy, surgery, and other medical treatments on my granddaughter’s physical and ­emotional wellbeing
  • The impacts of the emotional, financial, and physical stress on the immediate, as well as extended, family members
  • The impacts of the clinical trial chosen
  • The impacts of the specialists consulted
  • The impacts of the hospital staff support
  • The impacts of insurance coverage
  • The impact of bone marrow donor community participation

Outcome-Oriented Tasks

  • Every appointment with doctors, nurses, or other specialist was documented. Notes captured dates, times, attendees, conversations, suggestions, test results, prescriptions, and so on. This information was taken to every other appointment to ensure clarity, continuity of care, and understanding between everyone involved (this proved to be invaluable).
  • Every medical decision made was measured against the vision statement. For example, it was standard for children with JMML or similar catastrophic diseases to be admitted to the hospital at the onset of treatment and stay throughout the months-long process. My son would not agree to ongoing hospitalization and asked what needed to be done to ensure his daughter would only be hospitalized when it was absolutely necessary. When told this would not be possible because she would have a feeding tube as well as a line to administer medication throughout the process, he insisted on being taught how to use the feeding tube, administer her medications, and maintain the apparatus so that he could care for her at home. He was successful in changing the doctor’s initial orders of ongoing hospitalization to hospitalization only when absolutely necessary.
  • When family members accompanied my granddaughter during hospital stays, they actively engaged her in age-­appropriate games and activities (including supervised jumping on the bed and wagon rides around the pediatric oncology ward), sang with her, and read her stories. They also wiped down surface in her room with bleach wipes (focusing on doorknobs, light switches, and bed rails) to minimize transfer of viruses and bacteria. Additionally, they made sure that everyone who entered the room immediately washed their hands, regardless of whether or not they would be touching her.

Outcome-Oriented Governance

At the most basic level, governance is the process of insuring effective project decision-making that results in meeting predetermined project goals. My son owned this responsibility, and he made sure that, before every decision was made, it was measured against the metric of both the short-term benefits to his daughter’s physical and emotion health and achieving the ultimate vision of success. At first, the fact that a father would require every medical decision to go through this unconventional analysis was met with some resistance. But, as time progressed, my granddaughter’s oncologist and other medical specialists embraced this process and eventually began presenting options within the context of this vision.


There were multiple stakeholder groups, all sharing the same major goal—my granddaughter’s wellbeing. But, as is always the case, each group had other goals as well:

  • The attending pediatric oncologist was committed to providing the highest level of care. But, because there was no approved protocol for this disease, treatment could either be based on protocols for other childhood leukemias, or determined by participation in a clinical trial. The pediatric oncologist had to weigh the pros and cons of both scenarios and make a choice that would be good for the patient, acceptable to the hospital, and provide the best opportunity to gain valuable insight into treating childhood disease.
  • Because the hospital was self-insured, my son’s insurance provider was also his employer. As a result, the hospital had complete say in what medical procedures and medications were, or were not, covered. There was a process in place for an employee to request an exception. The board that oversaw this process, while genuinely concerned about providing quality health coverage for hospital employees, had the ultimate responsibility of representing the hospital’s interests.
  • Hospital oncology nurses and other medical staff interact with patients and their family far more often than the attending physician. These individuals have a myriad of duties related to supporting these patients and have to fulfill these duties with a limited amount of resources, time, and energy. Maintaining a schedule and avoiding disruption is critical. Additionally, because these people deal with very ill and often dying children every day, they must maintain a certain level of emotional distance, or it would be impossible to do their jobs.


The level of commitment by all our stakeholders was the highest I have ever seen on a project. But, even so, there were a few instances of significant stakeholder resistance—and each of these put our project at great risk. I will not go into detail on each, but I will share one example that illustrates the importance of understanding each of the groups involved from every possible perspective in order to mitigate resistance quickly and effectively.

Risk Mitigation

A few months after my granddaughter began the treatment defined by the clinical trial protocol, my son was notified that the hospital would be denying insurance coverage for a significantly expensive portion of that treatment, because it was considered experimental. As was the policy of the hospital, he was invited to meet with the board to provide any information that he believed may not have been available to them and might influence them to change their decision. He called me in a complete panic because they had only given him 15 minutes to prepare for this meeting, and he could not imagine what he could say that they did not already know. But, he also knew that, without insurance, there was no way to afford the treatment that she so desperately needed.

The emotional (and natural) choice would be to remind them that they were taking away this little child’s only hope, regardless of how small, and plead with them to be compassionate. But, this was unlikely to have a significant impact. As individuals, I am sure this would make them feel sad, but they had based their decision on all available medical data, coming to the conclusion that there was no reason to believe that approving the substantial expense for this experimental treatment would make any difference in the outcome.

So, what did we know about this group that could be used to motivate them to change their decision? First, we knew that the hospital’s reputation within the community was of paramount importance, because they relied heavily on private donations and endowments. Second, we knew that for the past few months, my granddaughter had been the poster child for the hospital; her picture and story had been used in local newspaper and TV stories to encourage people to save a child’s life by participating in the blood and bone marrow drives sponsored by the hospital.

Based on this information, I gave my son the following advice. When he was in the meeting, respectfully listen (without comment or complaint), and when they were done explaining their position, regardless of what was said, respond by saying,

I completely understand why you have chosen to make that decision, and I’m sure you will understand why I have to make this decision. When I leave here, I will contact every newspaper and TV station that reported on my daughter’s story to promote the hospital’s blood and bone marrow drives, and I will explain that because this hospital has chosen not to cover her medical expenses, and we are unable to afford them, the only way our daughter will get the treatment she so desperately needs is to reach out to our community and ask for donations.

My son called later to tell me that, when he was done, they asked if he would step out of the room so that that they could discuss the issue in private. When he was invited back in to the conference room about 10 minutes later, they told him that they had reconsidered their earlier decision to deny coverage, and they would now agree to cover this critical experimental treatment after all.

You see, these were dedicated people, accustomed to objectively reviewing all available information and making sound financial choices. They took the additional information that my son provided and made the calculation that waiving the hospital’s policy of not covering experimental medical expenses in this case would be far-less costly than losing the good will and generosity of the community.

This is only one example of the many times we needed to influence the actions of people that held a position of great power. In every case, we had no authority to insist they do what we needed them to do. We could only rely on a shared concern for my granddaughter’s wellbeing, our understanding of what each stakeholder group would consider most important (their unique perspective), and our commitment to building and maintaining collaborative relationships with everyone involved to influence their actions.

In the end, we did achieve that vision of success. My ­granddaughter experienced both the joy and the normality associated with being a child. She attended family birthday parties and weddings; she laughed and played and spent quality time with family and friends; and she knew the comfort and safety of being part of a loving family. And, I genuinely believe this was possible because every decision that was made, every action that was taken (both by family and by everyone involved in the medical community) applied the vision that my son had defined, and we all used as our metric for success.

And, while our actions did not guarantee my granddaughter would live longer, I know it improved her quality of life substantially. I also know that it provided the opportunity for her to benefit from ­cutting-edge ­medical care; medical care that resulted in her being one of the first children in the world to live long enough to be considered as having achieved remission from JMML. You see, my granddaughter is now a healthy, happy, amazing young woman who will be heading off to college next year.

To be clear, I did not include this very personal experience to imply that the issues you may be experiencing are not as serious or insurmountable as these. Rather, I am sharing this story to let you know that, even in the most difficult of circumstances, there are always steps you can take that will in some way positively influence outcomes.