The Best and the Worst of Kaiser Permanente

Transcript

Tim: So the first piece is to align around the shared purpose and you cannot have any successful change of any kind if you don’t have something about shared purpose.

Peter: I’m Peter Merholz.

Jesse: And I’m Jesse James Garrett,

Together: And we’re finding our way…

Peter: navigating the opportunities and challenges of design and design leadership.

Jesse: On today’s show, recently retired design leader Tim Kieschnick offers insights from his 30 year career in design and innovation at the health care giant Kaiser Permanente. He also shares with us his insights into the ways leaders hold back their teams through a model he calls The Leadership Ceiling, and what to do about it.

Introduction to Tim Kieschnick

Peter: So hi Tim, hi Jesse. Tim Kieschnick is someone I worked with for about a year, when I was supporting Kaiser Permanente a few years ago and he brought me into his team. And what I, I, I learned a lot from just that year that I spent working with Tim, Tim had worked at Kaiser for 30 years, he can correct me with anything that I’m wrong with in, in what I’m about to say, he worked at Kaiser for 30 years, helped establish their website, kp.org, their UX practice 25 years ago. And then when I was working with him was focused on this kind of combination of service design work to help the business think about omni-channel, cross-channel more strategic design challenges, as well as a human-centered design kind of workshop, facilitation, think Google Design sprint-type style work with different parts of the business.

And so, he and I, over lunches and coffees had a lot of conversations about design, design practice, leadership. And so I wanted to have him on the show and in particular, and we’ll, we’ll dive into this soon, he has this concept that he calls The Leadership Ceiling, and it’s a framework and I love frameworks.

And so we’re, we’re going to have him unpack his framework for thinking about how leadership works. So thank you, Tim, for joining us. Anything I miss, any, any high points about your time at Kaiser or outside Kaiser as a designer and design leader that we should know about?

Tim: Oh, no, that that’s pretty good in terms of the, the Kaiser years. I’ve– I would just augment it to say that, to me, design, human-centered design, et cetera, all of these methodologies for getting good things done quickly and well, and at scale, really go beyond any particular job or contexts. So I feel like I was doing design work before I knew it was design work.

And I feel like, you know, now that I’m retired, you know, banging around my house with hammer and screwdriver, I feel like I’m doing a, I’m doing design, I’m doing human-centered design. I’m doing agile. I’m doing all of that in my everyday life too. So I’m very much a design-your-life kind of person and approach everything as a design problem because you’re, you’re more likely to come out with a decent outcome faster.

“Everyone is a Designer”

Peter: I actually want to dig into that a little bit. One of the controversies within the UX design field is this phrase, “everyone is a designer.” A lot of people with the title Designer feel that commoditizes or minimizes their work and impact. If anyone can do it, why do you need to hire people with degrees in it and all that kind of stuff?

And I just wonder, again, given your, the arc of your career at Kaiser, you probably saw a lot of different shades of this, and your take on this controversy such as it is, is everyone a designer? Are some designers designer-er than others? Like how, how should, how, how did you end up thinking about it?

Tim: Oh gosh, everyone is not a designer. Unfortunately. The first thing is that if design is limited to the people who graduated from RISD with a degree in design, then we’re going to have a whole bunch of unsolved design problems. There aren’t enough professional designers to address the number of design problems that we have.

You just, we have to have people using the principles and some of the methods of design all over the place up, you know, just up and down the board. So there’s absolutely a place for the pros and the people who have formal training and the people who have experience and the people who geek out about this over several shots of espresso.

There’s absolutely a place for that. But as soon as we start to confine it to them, we’ve just really, really limited the ability of the world to solve the problems that we need. So I feel really strongly about that. It’s, it’s, you know what, let’s use those professional designers very strategically when really when we need them, but let’s get as many other people familiar with the, the mindsets and the methods of design as possible.

You know, for one thing, it’s, it’s a lot easier to work if I’m a professional designer, which I’m not, it’s going to be a lot easier for me to work with, with people who are not professional designers, if they have some sense of the mindset and some sense of the methods. Okay. So that’s the first thing it’s good for, for people to have, you know, have the, some of the mindset and methodologies, but then the other piece is just, I want everybody approaching problem solving in, in creative and methodical ways that, that explore the possibilities and that pay attention to the, the really the underlying needs and all that kind of stuff.

And it… I’ve, I’ve, I’ve, I’ve got a real chip on my shoulder for a prima donna designers who don’t want other people to talk about design, don’t want other people to try to do it, because really this is me, you know, it’s like I’m saying, you know, really, you know, professional musicians are the ones who know what they’re doing.

You know, we don’t want, we don’t want these amateurs around here, you know, strumming their guitar and singing “Blowing with the Wind.” And I think we really, really want as many amateur musicians as possible, you know?

I’m… we were talking just before we started recording about how I retired a year and a half ago, and I haven’t been in the business world except in my interactions with bureaucracies in Vermont, which… bureaucracies in Vermont is a really new thing for me. It’s great by the way, the bureaucracies in Vermont all have people attached to them. It’s just amazing. They’ve got these really nice people who pick up the phone and know my name after I’ve called them once before. It’s, it’s, it’s a really amazing thing.

They don’t have any computers. But they have telephones, and they have people, but anyway, so I’m banging around…. Yes. So I’m banging around my house and banging around the yard and, you know, I’m, I’m planting stuff in, in, in my yard. I am not a professional landscape designer. I’m not a professional gardener. I’m really glad there are people who can do that.

But if we have to leave that stuff to the professional landscapers and professional gardens, we’re going to have most of the, most of the, you know, yards and gardens in the world are going to be crap. And that’s kind of the way we are with experiences that, that companies, that software development, you know, the, that we provide, is most of them are crap because there aren’t enough designers to come in and the people who are there just don’t have enough clues.

So I, I, I’ve got a real chip on my shoulder about that. And I think as many people as possible who have some sense of this, the better.

Jesse: I’m curious about your experiences over the course of 30 years with the same organization, having these kinds of conversations with people about design, about its impact, about its influence, about how you bring people into those processes and how those conversations changed for you over the course of those 30 years? How was it different by the time you got out than it was when you started having these conversations about design and what it can do for organizations?

Tim: Oh, that’s– it’s a lot in there. One of the pieces is that some important changes happen really fast and a lot of important changes take a long, long time. And the ones that happen really fast, sometimes it didn’t happen as fast as it seemed like they did. We just don’t, we don’t hear about them until, boom, this thing gets implemented and you don’t see all of the slow stuff that built up to that. And so I’ve, I found it really, I don’t know if rewarding is quite the- quite the word, but meaningful to stick with something for a long, long, long time. And I know it’s, it’s, you know, it’s out of fashion, I’m a dinosaur, there’ll be nobody who works for the same company for 30 years ever, again, much less, 50 years.

And we don’t even use gold watches anymore. But there’s something about having a long-term intent and sticking with it throughout. And then the, the key to sticking it with throughout is, as you’re saying, Jesse is, is to be able to morph as I go so that I’m not in, you know, 2022, fighting the 1992 battles. And that’s really, that’s really interesting, but I really– it’s interesting, very interesting to, and, and rewarding to see, to take the long view and to see where we are now, relative to where we were, whether it’s with, you know, a corporation or whether it’s with you know, the you know, w- w- with the country or anything that has, you know, that has the stamina, the staying power to last long.

And one of the big things about that is this, this interplay between culture and leadership. So you see, and, you know, culture of course is more permanent than leadership and harder to change, but they’re, they’re very, very interrelated. And some of that led to, you know, my, my thinking about the leadership ceiling, which we’ll talk, talk about, I’m sure.

As you see the leaders, not just the, the, the people in positions of leadership changing, but as you also see the individuals changing and morphing over time, to be able to adapt to that, to be able to fight, to be able to be very intentional about choosing, Which battle am I working on right now? You know, which, which aspect of the culture am I working on and who am I working that with?

So when just before, Peter, you joined us, we had made a very– my small team had made, made a very intentional choice about which part of the organization to focus on. And it was interesting because, you know, we were trying to change the culture, to move the culture, to be more human-centric and more innovative and more designing and et cetera, et cetera.

And we didn’t go to the most high profile or the mo- the biggest bang for the buck. We went to the place that we thought would give us the best shot at creating the germ that would grow into the, into the large crop. And, and so it’s always again picking, you know, which, which piece are we going after at any time and being really intentional about that?

The other thing I want to say about that though, is, is in, in terms of the culture and there’s this theme at Kaiser Permanente around organizational structure, that is always the thing that is the best and the worst. The best and the worst of Kaiser Permanente all come from its organizational structure.

And so whether you are inheriting an organizational structure or you’re creating an organizational structure, it’s critical that you understand what is embodied in that structure. So Kaiser, Kaiser has th- this you know, really interesting organizational structure that most people don’t know about and that they shouldn’t have to know about.

But you have the physician, and the physicians, you’ve got primary care and you’ve got specialty care and then they’re all, you’ve got inpatient and outpatient physicians there. They’re all in, you know, like in a single physician group more or less. And then you’ve got the hospitals and then you’ve got the health plan, you know, sort of the the insurance side of the business and all of those three things come together and they include the pharmacies and they include the labs and they include the hospitals and they include the radiology of all of these different pieces that all have the potential to be integrated.

And because of that, you can do things you can’t do other places because of that integration. And because of that, the incentives of the organization are fundamentally aligned with the incentives of the patient. So it’s fundamentally for, for decades, it’s been in the Kaiser’s best interest as an organization to do what’s best for the patient.

Because of the organizational structure. And there are other places where the organizational structure is clearly set up, that what’s best for the organization is not necessarily best for the customer. And so how do you, how do you, you know, bake intentionality into the org structure. And Peter and I have talked about that a lot is, you know, how, how do you know it?

You know, part of it is the hierarchies and part of it is, you know, anything from the metrics to the physical plant, to whatever it is, but how do you, how do you systematize intentions? it’s just a fabulously interesting area.

The Leadership Ceiling

Peter: Well, we’ll see how, how, how we impact that. We’ve been alluding to the leadership ceiling and I feel that we should unpack that now. So the leadership ceiling, Tim, I’ll let you define it, but just kind of i- it’s, it’s a tool. Here’s, here’s my little tease. It’s a tool that you’ve not really shared with the world.

I’ve seen, you know, early writings about it. And I use it one-on-one with, you know, some of the design leaders I work with to help them think through their challenges. I found it remarkably valuable. So yeah. What is it, do you have a, you know, the, the elevator pitch on the leadership ceiling, and I’d also be curious, like how you arrived at it.

What, what was it that got you to realize this framework?

Tim: Okay. I’ll, I’ll start with the last question. So this, like many of my stories that goes back, goes back quite a while. So it, my, my son is 23 now, 23 years old. So– when he was four or five years old, my wife and I were shopping for where’s he going to go to elementary school?

You know, you’re going to go to the local public school, there are a number of private schools. So we did some shopping around. We found a private school that we liked almost everything about. For one thing it was cheaper than any of the other private, private schools around. We loved the teachers. We liked that the building was great. They had a fabulous approach to an integrated curriculum, that a great afterschool program that supported people who were, you know, we had two working parents, et cetera.

Just loved that,almost everything about the school, but we hated the principal. The principal was really problematic. So I called my dad because my dad was in schools and he was, he was a teacher and a principal and a school superintendent. He was, he coached principals. He was in schools his whole life, his whole career.

And I said, you know, “Dad, how important really is the principal? You know, my kid may never even interact with the principal. My kid’s going to be with the teachers.” And dad, he didn’t, he didn’t skip a beat. He said a school can never rise above its principal. So we ignored his advice. He was basically saying, no, you know, if you don’t like the principal that it; we ignored him, we went to that school.

And the short answer is by the time our son was in seventh grade, the school had gone bankrupt. And before that, most of the good teachers had left and the teachers that were still there were cynical and struggling, and it was a mess, the afterschool program when it was just, oh, you know, it was defaulting on the loans for the physical plant.

It was just a total mess. So he was right. You know, remember note to self, you know, dad is usually right. Even when he seems wrong, even when you know better. But then what happened was I, I started looking at this in my professional life and I was seeing places where I was either really frustrated and felt like it was not getting anywhere or places where I… I had thought I was getting somewhere, but then everything back-slid, and it turns out we weren’t getting there.

And I just felt like I was banging my head against the wall. And what I realized was I wasn’t banging my head against a wall. I was banging my head against a ceiling. And, and it was, and so I started calling that the leadership ceiling and basically every leader sets a ceiling above which the organization cannot rise.

Now, it might be a ceiling of, of people where, How well do we treat our people? It might be a ceiling of process. How good are we at being efficient and effective? How good are our processes? And it might be a ceiling of purpose. Why are we here? What are we trying to accomplish as an organization? Any three of those, it it could be any of those three kinds of, of ceilings.

Okay. Wherever the leader sets the ceiling, it doesn’t mean that the organization will go that high. It just means that the organization cannot go above it. So you can have a leader, a great leader, setting a high ceiling, and the organization below can be crap and not get anywhere. Or it can be a, a fantastic excelling organization, or it can be anywhere in between.

But if that leadership ceiling is low, there’s a very small bandwidth whi– within which that organization can operate. So that’s what I mean by leadership ceiling. And then the point is, what do you do about that? So I’m mostly not thinking about, you know, you know, I’m mostly not talking to leaders. I’m talking to the people who are working below leaders, which is pretty much everybody in the world.

And so for those of us who work under leaders, when that ceiling is lower than we want it to be, we have three choices.

A: we can try to work on, work Above the ceilings. That’s where I spent most of my career. And that’s where I got the most bruises on the top of my head. Because it’s just, it never works. You’re never successful trying to work above it in the long-term. Okay. So, A, work– try to work above it, not going to happen.

B: you can try to work Below it. Okay. So you can say, okay, that’s where the ceiling is. What am I going to do about that in terms of how I work? And it could be that your just biding your time waiting for leadership to change, waiting until your kid is out of diapers waiting until you’re out of grad school, you know, whatever it might be, or it could be that working under it, you just realize, you know, this is not the organization for me, my aspirations, what I want for myself in my job or in this organization is, is never going to happen with this set of leaders. I’m tired of biding my time. I’m going to bail. Okay.

And then there’s also a possibility that we can talk about later, if you want, about kind of creating a little bubble in the leadership ceiling, where I’m going to work in this little space where we’re going to be better than the, than the rest of the organization. Just the key is just don’t think that you’re actually, that you can get too far with that. You can get a little, you can make a little bit of a bubble, but what, what, what for me, what I usually would try to do is I would make that, try to make that bubble bigger and bigger and bigger and think that I could go further than I could with it.

So A, you can work above it. B, you can work below it, or a C: you can try to change the ceiling.

So that’s not for the faint of heart, but that’s gets you into the space of how do you influence, how do you influence up how do you drive change? And it’s an interesting approach to change, because it’s really about how do you change a leadership ceiling in which, and, and you know, which leaders are you after, you know, what kind of ceiling we trying to raise? How will we know when it’s higher? How was that, you know, as we were talking before, how do I w– my, my strategies and my tactics to morph over time to change that ceiling to make it higher. So that’s kind of in a rather large nutshell, maybe not in an acorn, what’s a large, not maybe, maybe in a coconut shell (laughs) leadership ceiling.

Peter: So you mentioned, uh, people, process, and purpose, and I think in our prior discussions about this, the leadership ceiling is only as high as the lowest of those three, right? So at Kaiser, Kaiser has a really high purpose. Right? Very patient-centered, very mission-driven. From what I saw, I wasn’t an employee, but it seems also very people-oriented, by and large good to the employees, a strong kind of ethical work environment.

But process was low, right? It was big. It was bureaucratic. It was difficult to get people aligned on projects. They would operate in a waterfall way when they would try to introduce new ways of working. They would, those new ways would end up getting kind of ground down in the machine of, of kind of legacy process. And so what I, what I saw was this disconnect between the talk of purpose and potential of the people, but the reality of the process and that process ended up lowering the ceiling, such that even if you, like, you couldn’t realize the purpose that was being laid in front of you, because the process was– wasn’t being raised as well. And so I’m wondering, kind of, is that, is that how it works, where, like you can only go as high as the lowest of those three?

Or do you, are those three different leverage points or like, how do you fiddle with those three Ps to try to engage?

Tim: Yeah, well, I, yeah, I think you’re right, you know, for an organization to really be all it can be to it gets to have all three, and you have to raise them all. That, that said, you know, if I were in a, in an organization that, you know, had a high purpose ceiling and a low process ceiling and a medium people ceiling, it might be that the people ceiling was more important to me. And that that’s the one I really cared about. So, you know, it’s really what I’m about with the Leadership Ceiling work is, is helping people figure out, you know, what’s it gonna take for me to be happy and satisfied and fulfilled and be meaningful in, in, in, in my work or in what, even if it’s not work, you know, in my organization.

And maybe I don’t want to work, you know, maybe I don’t, I’m just not a process guy. And, you know, and maybe, you know, the bad processes, you know, they bug me, but what really bugs me is when you know, somebody who’s not treated. Then I’ll go work out and I’ll try to raise that from medium to high or something like that.

Or maybe I’ll just lean into, you know, the leadership. Maybe the leaders have set a really high people ceiling, but that has not permeated the organization. So I’m going to try to raise the organization up to where that ceiling is, because remember it’s just, just because the leaders are setting a high ceiling doesn’t mean that the organization is getting there.

So it could be that, you know, they’ve set a high purpose ceiling and they’re saying, you know, we want to, you know, we want to change the way that people will use windows, not Microsoft Windows. They would, you know, the way that people look out their windows. We want to change that. And maybe I love that idea. I’m working for our window company and it’s not just about producing, you know, the same old windows as before we want to really revolutionize the world of windows. I may think, well, yeah, but you know what, w- w- we’re we’re really focused on just turning out the same window. So I want to help the organization rise to the level of what the leader is saying about who we are.

So you really have a lot of different choices on how you go and it’s about, you know, what’s important to you at this point in your life.

Jesse: I’m interested in these terms that you’re using high and low, to describe these ceilings and something in my brain just keeps asking the question: High and low. What is it? Potential? Is it performance? Is it scope of impact? What is being limited by the leadership?

Tim: Hmm. Maybe that’s best done by example. So let’s take an example of equity, inclusion, and diversity. So that would be a- a people ceiling. Let’s say you have leaders who are talking the talk they’re walking the talk, they’re baking it into their systems. You have a high leadership ceiling. You can still have an organization that’s not there where there are all kinds of problems, okay. But you’ve got a high ceiling.

You have high po– you might might just think of it as the potential. And what constraints is the leader putting on, on, in term, on it in terms of potential? And so what I like to do is look at this, think about well, what would it look like? If we were, if this organization were really rocking and rolling on that, what would, what, what would we be saying?

What will we be doing, how it would be baked in our systems and what actual results would we be seeing, measurable and qualitative, what results would we be seeing? And that’s the good and you want, and then you want to look at, you know, how far are, how close are we to that? If we’re not there, is… and if I don’t feel like that’s happening in my space, is that because I’m limited? Is it because it’s just a really hard problem to solve? Is it because the CEO is setting a ceiling or is it, or maybe the CEO is setting a high ceiling, but you know, a vice-president someplace below them is, is, is lowering it. So it’s all about kind of analyzing, what’s keeping us from being the best we can be in all of those places. And to do about it? How will I engage or not?

Jesse: Right, right. Yeah. That makes a lot of sense. And the reason I ask is because you know, you have these three Ps of people, process, and purpose, but as I think of my experiences working with leaders, or observing teams working with leaders and the ways in which leaders constrained the potential of the teams underneath them, a lot of those examples, at least off the top of my head, don’t fall into these three categories, but rather it was a shortcoming of imagination on the part of the leadership, a shortcoming of bravery on the part of the leadership, that kept the team in check. So I feel like potentially that these things that you’re describing, certainly organizationally, when you’re looking at organizational structures, people, process, purpose are great top-line things that you’ve got to hit, but I wonder about the subtler things, the ways in which from day to day, the ways that leaders show up squelch people and shut people down. And I think that I, and I wonder how much of that comes actually back to the character of the leader themselves and why they have such low expectations in some areas for themselves and for their teams, you know?

Tim: Yeah, I wouldn’t get too– I’m not too hung up on the three P’s there. It’s just, so it’s a way to, to think about them and I’ve, I could probably try to shoehorn, bravery and imagination into one of those, but, but you could feel free to say this leader is setting an imagination ceiling and then you would still do the same thing: you would say, “Well, what would it look like if we had a really high imagination ceiling in this organization?” Well, it would, you know, and it would look like there were new ideas coming from all levels of the organization on at least a weekly basis. You would, you could label behaviors that would be showing up in meetings and group interactions.

You would look at how metrics and project management support that. And then you’d also look at what would it look like if the leader set a higher imagination ceiling, you know, what would she be saying? What would she be doing? What would she be baking into the structure? And what results would we be seen as an organization?

And, and then some, because what happens if you follow that, that pathway of, of saying, doing, baking it in and results, if you follow that pathway, you might find out that the leader is saying all the right things about imagination. What they’re saying, all the right things about imagination, then maybe this is a place where you could actually help with some change by helping them understand how their actions are, are, are blocking something that they actually want, or maybe they’re saying the right things and their actions are right, but they’re still measuring the wrong things, you know, or, you know, the, the performance reward system is still, you know, rewarding the wrong things, or maybe, you know, the core software that the company uses to run, it has lack of imagination baked into it. And so it’s, so then there were, you know, th- then you start to get that, that gives you a lot of ammunition, or not ammuniation, it, it gives you a lot of, of, of grist for figuring out How are we going to influence this? You know?

Or you might look at it and you can, and you might say, you know what? I am not in a position to ever change or influence change in this organization for imagination. This… I’m just not in an imaginative organization and this organization over the next 10 years, I just can’t see it happening.

Okay. Then you, then you say, okay, well, I’m a, I’m not going to try to work above the ceiling and try to be super imaginative. I’m just, that’s going to be so frustrating. I’m going to be just humiliated. I’m going to be discouraged. I’m going to turn cynical instead. I’m going to say, okay, this is reality. I am in an unimaginative organization for as long as I’m here.

That means I’m going to work below that imagination ceiling. And I’m going to decide, how am I gonna approach that? You know? And as I said, you know, it might be that I’ll bail. Okay, good to know. I’m not going to try and try to be something that the organization won’t let me be here, or it might be I’m going to wait because you know what we are in the industry of windows and the whole windows industry has changed. And in another two years, it’s going to be so unavoidable that all the leaders in this company are going to realize the windows don’t mean what they used to mean. So I’m going to wait two years and I’m going to be ready so that when they say, “Hey, we need to c–, be more imaginative about windows,” I’m going to have my portfolio ready for them.

The potential power of Biding your time

Peter: Well, yeah. I, I’m terrible at biding my time. I’m a bailer which is why I’ve not lasted anywhere more than two years. But I think about at Kaiser, let’s take the Kaiser example, right. There were probably folks biding their time in some flavor of tele-health for decades. And then the world changed in March 2020, and they were ready to fill that void.

And I, and I– you were, you were still at Kaiser when, when the pandemic happened. I don’t know how long you had, what did you see in terms of that kind of massive context shift that maybe enabled some of this change to happen that, that people like you had been stumping for for probably at least a decade, if not longer?

Tim: The first telehealth projects that I was a part of were in, 1996, no, 1995.

Peter: By tele, that meant telephone health.

Tim: No,.. Nope, no. We’re talking ISDN video psycho, psychotherapy visits.

Peter: LIke CUSeeMe or something.

Tim: This was, this was, this was face-to-face with a patient and a doctor doing intake for psychotherapy as well as, as well as some similar things that we had.

We had some things going on with dermatology, with some things going on with home health nurses back in the late nineties, okay. And this is one of these changes that takes a long time because so many pieces need to be in place. And what we were doing during this biding our time is we’re biding our time un- until the world was ready for it. And a critical mass of physicians was ready for it. A critical, massive patients was ready for it. And the technology, both internal to Kaiser and the tech, the consumer technology was ready for it.

So biding your time, doesn’t have to mean give up and just forget about it. You know, in the early days we were flying really low under the radar and it used to be in, in those early days, like when we’re you doing this kind of stuff, when we’re doing the web stuff, our mantra was don’t do anything that will impact healthcare operations because then people will notice us, we’ll get in trouble, and the whole thing will, will be shut down. Okay.

But what we could do is we could figure out, well, what does it take? You know, what does it take to make this work for the doctor and the patient? What’s the minimum amount of technology you need for it? How would this impact the scheduling systems? Because scheduling is a big deal. So the, all of these different pieces came together. So for instance, Kaiser way back when decades ago was, was really working on scheduling systems that included being able to schedule a phone, a phone visit with the doctor.

Well, if you can schedule a phone visit, then you can schedule a phone visit with video in it. So all of these things were getting set up along with, you know, the policies and the legal stuff in addition to the technology. So when the pandemic hit and we needed to scale from a fairly small number of video visits to a huge number of video visits, there was some scrambling to be done, but that scrambling could be done.

And it could be done, you know, you know, let’s get, you know, let’s ramp up this server base and ramp up this bandwidth and blah, blah, blah, whatever it might be. But the fundamentals were there because so many people have been biding their time waiting for this moment, but they weren’t just sitting in a corner, hoping that someday happened.

They were saying, while we bide our time, we’re going to be ready because one of these days it’s going to be the time. We didn’t know it was going to be a pandemic that was going to make it happen, but we knew sooner or later this dam is going to burst, you know, in a burst in March of what was it, March of 2020, and boom, here we are.

So the, the biding your time, it can, it can feel like you’re just copping out and just settling, or it can just be a really realistic way to make progress.

“C”hanging the Ceiling.

Jesse: If you are in the position of having to engage with a leader, whose ceiling you are trying to change, I’m curious about how you do that. Especially, as a lot of these things, I feel like, are kind of inherent sometimes personality traits of these leaders. How much is asking a leader to change their ceiling, really asking the leader to change themselves. And how do you do that?

Tim: That’s what you want me to answer? How do I change human behavior in 10 seconds or less?

Jesse: I mean,

Peter: You have, you have at least up to a minute,

Tim: So the point there is, is, as I said before, it’s not for the faint of heart. And it’s not like, oh, instead of biding my time, I’m going to change the leadership ceiling, boom, boom, boom. It’s like, if you’re going to change that ceiling, you got to commit to it. You have to say, okay, I really want to do this and I’m really going to lean into it.

And then there are all kinds of things, you know, from collecting your allies, to understanding your targets, to coming up with an influence plan, to all of this kind of stuff. I’ll sort of start from, from the point of view of a leader. And then from the point of view of the person trying to change it from the point of the view of the leader, the first thing he’s got to understand, well, which leader is causing the, is creating the ceiling and what’s important to them.

So it could be, I’ve been in situations where I thought my boss was setting a ceiling, but it turned out she wasn’t the one setting the ceiling, it was her boss or her boss’s boss setting the ceiling and she couldn’t move beyond. So then what happens there is my boss is– is now an ally rather than the target of my, of my, my influence plan.

And, and I try to engage with her around that because she’s going to have a lot more insight and and influence in this process than I am. And if I can’t get her engaged in it, then I should probably try an entirely different route because if she’s not engaged, you know, that’s my biggest you know, that’s my biggest ally there.

So first, and, you know, and I’ve also been in situations where, so that was in that situation, in that example is I thought it was my boss, but it was really like, you know, say the CEO, you could also be in a situation where you think it’s the CEO, but CEO is when you look more deeply, no, the CEO is really right up there, but it’s at a level below.

I often find that, by the way, in, in large organizations, this isn’t just Kaiser, but a lot of large organizations I’ve looked at, the CEO can be setting a really high ceiling and the, you, you get like two levels below, and the two levels below, these are like, you know, division heads or department heads.

Those people are a lot less focused on raising the ceiling and a lot more focused on raising the floor. So they don’t want to have the organization be all it can be. They want to make sure that the organization is not as bad as it could be. And so they want to find the, the, the outliers that aren’t as good, and let’s just, you know, raise that floor. And there are times when that’s absolutely the right thing for an organization to be doing. The problem comes when you think that’s that, that means you can’t be doing the other end too, you know? I mean, “No, we, we can’t think big until we fixed all the small things. We can’t do any major enhancements until we fixed all the bugs,” that kind of stuff. But then when you get into the, you know, so then you, you, you, you need to, you know, there are all kinds of approaches to influencing leadership. They all start with understanding the target.

And then I would add if I’m going to be an agent of change in an organization, I need to, I need to be legitimate. I need to be perceived as legitimate. And Helen Bevan from, from the UK health system used to do something called healthcare school for healthcare radicals, great program on how to, how to drive radical change in healthcare. And she talked about different kinds of disruptors and, you know, the sort of the, the disruptors who are just breaking things and actually not being effective and the disruptors who are really effective.

Competence, Relationships, and Initiative (another framework!)

Tim: And the difference, what she would say is that one of them is really the, the loner and is driving people apart. And then the other one is collecting people around them. And so when I collect, if I’m trying to collect people around me, I like to think that there are three things that I need to do. I need to, and those three things I need to do that I need to attend to are: competence, relationships, and initiative, and I need to attend to those in that order, because if I start with my initiative to change things before I have any relationships, I’m just, you know, some guy over there who’s causing trouble.

I’ve got to have the relationships. Okay. Even if this is a four person organization, I’ve got to have relationships. Okay. And then if I’m trying to make relationships, but I am not perceived at being competent in my day job, I’m going to have trouble. So I have to start by, even if I think my day job is not what I really should be doing because I am a much more aspirational and inspired and just, I’m such an amazing person in this job is I’m so much more than this job.

I still have to be good at this job. Once I’m good at this job, then I can do other things, but I get good at this job that puts me in a position to get to collect relationships and to be established so that I have allies. And then that puts me in a position to take initiative. So I really believe competence, relationships, initiative in that order will get me to the place where I can understand the leaders and work with other people to drive change.

Peter: And then that speaks again to one of my, one of my failings when I’m working internally, but one of the things I can help the leaders that I work with when I’m their external partner, which is taking that long view. And I think, I think a lot of design leaders struggle with understanding the role that politics play in… the role that politics plays in, in achieving that long view. And my case study is actually from Kaiser, a different group that I was working with, where they brought in a really talented design leader, human-centered design and innovations kind of guy, and placed him in an organization where they were asking him to do some of that innovation work, but also to assess emerging technologies, you know, how are we going to apply artificial intelligence and machine learning to tell– to mental health chatbots or something, you know, imagine these kinds of… there’s all these companies building all this software that they’re trying to sell into Kaiser.

And someone needs to say like, yeah, this is pretty good. Or actually not, this is this isn’t good. And this leader could not get over being seen as, essentially an IT assessor, even though, that was part of the job. And if he could do that, if he could like create, a quarter of his time, a third of his time for that, he could be building… building, his case, demonstrating competence, showing that he has the interest of the organization at heart, and then slowly start making the kind of change and, and having the kind of initiative that you’re referring to.

But he, it was so… he was so idealistic and I think this is true of a lot of designers. Their idealism gets in the way of their pragmatism and then they just make no change because it’s either all or nothing. And so something I work with leaders on is trying to figure out what is the “one for them, and one for me” approach that allows you to eventually get to the kind of change you want.

But recognizing, especially in a company like Kaiser, I mean, what 300,000 employees, it’s been around for 80 years, like you’re not going to come in with your, you know, wearing a cape and, and, you know, whipping into shape in, in a week. So anyway…

Tim: Yeah. Yeah. And, and they, it gets it’s… that actually reminds me of our conversation about, about professional designers, because there are a lot of professional designers who just want to work with the design team. And everybody in the design team is golden. Everybody outside of the design team is, is other. tThose design teams can come up with some fantastic, beautiful solutions, and, it’s really hard for them to get those solutions adopted, or adopted at scale, you know, can maybe get them adopted with the people that they used for, for co-design as they went along. But for, for them to be successful, you have to have the great dynamics within the team.

You have to have great interactions between this team and all these other teams, you know, what’s in, you have to have great, great interactions between my scope and everybody else’s scope. And then you have to have great interactions with leaders, the problem is you see so many people, especially in a large organization whose primary, you see so many, uh, mid-level managers whose primary orientation is toward their leaders, so that they aren’t paying enough attention to the interactions with other teams, their interaction with their team, that it’s like, well, I don’t want to be like that where I’m just, you know, sucking up to the leaders that I’m giving, you know, I’m spending every Thursday, I’m giving them another 60 page PowerPoint, you know, status update. Okay. You also don’t want them to spend, you don’t want to just spend all your time interacting with the other team. So all you’re ever doing is project updates and having these endless meetings of everybody updating everybody else.

So that’s, you know, you, you got to come up with some sort of a way, and I think this is actually an open design question. I don’t think that even the world of scaled agile has really solved this yet, that I’ve seen is, is really optimizing all three of those pieces. Working together within the team, across teams, and between teams and leadership.

I think that’s was one of our big, next levels to reach just in terms of as, as, as designers, as people trying to make the world a better place. People trying to create better organizations is how do we get, you know, what are some ways to do that, to do all three of those at the same time.

Peter: Yeah. You either get all or nothing. You, you…, I talked to companies that either are all independent autonomous teams, working kind of essentially in isolation from each other and maybe doing good work in very small areas, but then when you bring it together, it’s a mess. Or you get this push to a over-engineered top-down or, you know, coordination and orchestration, but then the teams don’t feel like– the teams are, are simply being told what to do. They don’t feel like they have agency and that centralized planning doesn’t actually understand what’s necessary at all the little leafs, all those little end points.

Tim: Yeah. And, and it creates all these artifacts for, for the customer that the customer doesn’t understand why they’re doing such a stupid way. I’ll tell you right now, it’s because they spend all their time doing PowerPoint updates or it’s because they didn’t spend any time doing updates with the other teams.

So this team didn’t know that team was doing it or it’s because the leader just kept telling them what to do. And they could just kept doing that. So you can see it in the customer experience. And it’s so frustrating. It seems like such a simple thing once it hits the customer, but it’s very complicated behind that.

And I, I think it’s a very exciting place to see new models emerging. I don’t know what those models are.

Peter: I haven’t seen them yet, but if anybody listening to this…

Tim: I was hoping maybe they were in your book, Peter.

Okay.

Peter: Not yet. Not yet. Version two.

Tim: Next book.

Jesse: Peter, do you have something to announce today?

The importance of shared purpose

Peter: Sadly, no. Um,um, I want to get back to this theme of change. So, so you, you mentioned the challenges of changing the ceiling and working with those leaders and, and, and helping them figure out change. I’m wondering a little bit about organizational change and, and circling back around to the work that you’ve done, recognizing that not all …that we’ll, we will never have enough designers to do all the design work needed. How do we help in the case of a health care concern, right? How do we help, the people making policy plans or how do we help nurses and how do we help the folks doing intake? Or how do we help all those folks embrace design as, as a mindset and maybe some light set of practices in their work?

And I’m wondering what, if any change you saw in that regard on, on that part of your effort at Kaiser to, to get people, get more people more comfortable with these designerly like practices, right? We’ve seen a lot of corporations, try to take on design thinking, do it at scale, it gets its flavor of the month.

It, it, it works for a year and then two years later, no, one’s doing those things again. People vaguely remember that there was this thing called design thinking, and it’s just like nothing happened. And I’m wondering if you were party to anything that felt more lasting in terms of the kind of change, with, with that type of effort.

Tim: I would say yes, though not yet at scale. The challenge is to get it at scale, and what it’s making me think of is what we’re talking about a little while ago about the interaction between ceilings of people, process and purpose. So if I want to work with a bunch of frontline people at the call center, or nurses, or physicians, or who, whoever, you know, or, or, you know, developers, and I’m just jumping in to say, here’s some process stuff, we’re going to use this process, especially if I’ve, you know, if they don’t know me, like why would I, why would I ever expect that to be successful?

So there is something about finding a foothold and at Kaiser, the foothold was always purpose. So as I alluded to this before, because of the way Kaiser is structured, I think that that has enabled a, a lasting culture that really, really cares about Kaiser’s members. Really cares about the patients.

And you’ll see this in… it doesn’t have to be in a healthcare organization, caring about its patients. You know, you’ll see this in a software company that totally cares about its users or a grocery store that really cares about the shoppers. So the first piece is to align around the shared purpose and you cannot have any successful change of any kind if you don’t have something about shared purpose Bevan was also really, really strong on that.

Now it could be that you have a shared purpose, but it hasn’t been articulated well yet, okay. Kaiser Permanente, a really amazing thing happened through the marketing department several years ago when the, the, the Thrive campaign, thrive marketing and advertising came, came out, came out because what happened was people said, oh, trying to help people thrive, as opposed to trying to give people the correct surgery without errors, or trying to give them the right blood testing, or give them, you know, immunizations. They– they’ve, they suddenly coalesced around something that they already had, but didn’t have words for it. “Was off– what oft was thought, but ne’er so well expressed,’ it was, we are here to help these people thrive.

And by getting that language, then now I can go to a bunch of call center agents who have difficult, grueling, low paid jobs, and I can align with them that we are all trying to do the same thing here. If I haven’t and um– and that that’s the first step to doing some design work with them. The second thing is if I’m trying to do design work with them, and they’re just coming off of a 12 hour shift where someone, where some, you know, foreman was standing over them watching to make sure they coded every interaction correctly and then, you know, corrected them, and dinged them because their calls were too long and blah blah, you know, blah, blah, blah. And I’m trying to do design work with them, not going to work.

There’s a people ceiling there. So you have to get– the people have to be treated a certain way. You know, you have to get to some level of people being treated decently before they’re in shape to do design work with you.

And, you know, and in many places, in my, in my world, they, they were getting to that place. They were in that place. They’re moving toward that place. And those became greater opportunities, even if it was like, you know, they’re, you know, it’s not perfect, but it’s good enough now that I can actually think about it. Or in some cases we did things where we, w- we had buy, buy in from leadership. We could pull people out of their daily grind enough, that it was actually a break from that, for them to get, for them to do some design work. But if you’re just trying to throw it on top of everything else that they’re supposed to do, and then, you know, at the end of your, at the end of every day of your five day design sprint, they have to go in and do four hours of work to catch up with the emails that they missed during the day, we’re not going to do very effective design work.

So I really think all those things fit together. Start with what’s, what’s our shared purpose. You make sure they’re treated well enough to have some energy, to have skin in the game. And then, then it becomes all about process. Then, then you get into all, you know, what, for me is the fun stuff about co-design process and you know how to bring out the best in them.

And how do you help them feel like,how do you help them realize just how much expertise they have and how do you not only respect their ideas, but, you know, help them grow and nurture those ideas and flesh them out. And how do you give them some confidence that something’s actually going to happen from this, so that’ll, that it’ll be implemented afterwards. And then how do you do the thing that you, Peter, and I will never do, but that fortunately there are many more people in the world who are much better than you and I, this which is stick with it and still be there two and a half years later, you know, and, and that gets to, you know, how do you get the leaders to understand not just the words that are needed, but the actions and the structures that are needed, so this thing is going to keep going, so that it’s baked– so that design thinking is baked, not just into a five day design sprint, but design thinking is baked into the structure of how we do project management and how we, you know, do performance measurement and how we do budgeting and how, you know, et cetera, et cetera.

Jesse: I feel like inherent in so much of what you’re saying here is the ability to root out your natural allies in an organization and rally them to the cause and bring them in and bring them in around you. What recommendations do you have for folks to find their allies within the organization?

Tim: Oh boy. Well, the first thing is to watch the YouTube video, “How to start a movement,” which is really fun TED talk. And the, the main point out of that is that the first le– the people, the first leaders of a movement tend to, just like early innovators, tend to think that more is essential than what really is. So I have this idea for a new product. I’m going to make this new kind of shoe box. It’s going to change how shoes are stored and delivered. And I, and I’m trying to get the entire world now to buy into this new shoe box. And I think that the co– you know, and it’s it, it’s blue, it’s a certain color of a certain shade of blue, you know, and it’s, and it’s, it’s, it’s measured in centimeters rather than inches, which is so important because of how shoe si–, blah, blah, blah.

And I’m going to think that so many things about the shoe box that are critical. When really it’s just these two things, you know, it’s the material it’s made out of and it’s that it’s oval. Those are the only two things. Same thing with a movement. I think we need– I’m trying to do a movement now to turn this entire software development structure into agile.

And I think that it means that we have to use, you know, this tool for tracking all of our–see how long I’ve been out? I can’t even remember what the tools are the– and what do they call, what are the tasks? What are the tasks called? None of this. See, I think, I, I think I’ve, I’ve, it’s, I’m trying to drive agile.

We have to use this tool every, you know, every time we have a retrospective, it needs to follow this exact methodology and the, the, the what’s the agile leader person called? The…

Peter: I– Scrum master.

Jesse: Yeah.

Tim: Let me tell you, it feels… for those of you who have not yet retired, it feels great to To have forgotten the word scrum master in just 18 months. I’d be like I’m I’m, I’m I’m really rocking retirement. No, I hadn’t thought that it was wrong last January.

Peter: But you probably know you could probably distinguish between four or five different types of mulch.

Tim: Yeah, absolutely. But my point here is that if I’m trying to find those allies, I don’t need to find allies who agree with me in every detail. I need…and my shared purpose needs to be pretty high level. So that’s the first step to finding an ally. So if I’m like, if I’m trying to do to drive to user centricity, I’m, like, looking for people who really care about the user experience.

I’m not looking for, to, for people who call it human-centered design versus calling it innovation, innovation versus calling it CX, like whatever. I’m looking for people who really care about the customer. So go up a level to that. And then the second piece, which is just basic to any design work is, don’t get all people who are like me.

And so the people who I know best will probably be the people who are closest to me, who– people who think the most like me, know the same things as me. And so I have to find people who are not like me. I just have to find people like w- whether, whether, you know, across all aspects, whether it’s, you know, work background, cultural background, gender identity, work experience, personal hobbies, approach to project management, methodologies, the, the diversity there just becomes critical.

And since I’m really bad at that, because I don’t like to meet new people, it’s hard. And I’d rather stay safe with the people who are like me. That means that I need to hang out with people like Peter. I don’t know you well enough, Jesse, but you’re probably more like this, too. Peter, like people who will walk into any room and start talking to somebody they don’t know and be okay with that.

So I, you know, and I’ve, I’ve, I’ve intentionally recruited people onto my teams who are just really good at, you know, I remember a woman who just, who just moved on from the team that I was part of. It was her, I, I, had this whole orientation plan for, for our first two weeks. And we got into the sec, you know, the day five, and it was time for me to start telling, okay, now I need you to really need to set up conversations. And I’ve got a list of 15 people that I want you to just reach out, to, to get to know. And went to these 15 people, 10 of them, she had already, you know, gone for a walk with them, had lunch. She had just found them on her own.

So I, since I don’t do this to myself, I need people on my team who will, who will constantly be interacting with people who they aren’t working with on a project right now.

Jesse: So It’s almost recruiting evangelists for the cause.

Tim: Yes, it’s recruiting evangelists. And it’s importantly also recruiting listeners as those people are go– they’re going to be hearing things that I’m not hearing and it’s, it’s, it’s it’s evangelists and it’s influencers because if you’re going to make a change, especially a change that involves, changing we’re, you know, thoughts, words, actions of, of leaders, you need a whole network of influencers to come at this from a wide variety of angles. I need to find that, that link between someone I can influence and the person who I have no relationship with, I’m trying, if I’m trying to influence uh, a VP or a CEO who I don’t really know, I need to find somebody who I can ask, you know, what does Betty really care about? You know, when she wakes up in the morning morning, what is she excited about? What she worried about, what drives her nuts? I need that information. And then I need to know, and who has Betty’s ear? And it’s sometimes it’s her boss. And sometimes it’s this person that she plays tennis with and like, oh, Betty plays tennis with Rick. Oh, well, you know, Jesse knows Rick and, and I know Jesse, you know, so it’s, I mean, it’s, it’s politics. It’s absolutely politics. That is politics for a good cause. And it, you can call it politics or you can call it relationship building and networking.

Yeah. But it’s gotta be

Peter: We talk a lot about relationship.

Tim: Yeah. Yeah.

Peter: I wanted to ask you a question. Kind of rooted in the fact that you were, were at Kaiser for 30 years, which is uncommon… it’s it’s I, you know, it’s like being on a sports team, your entire career, like no one does that anymore either.

Right. Everyone’s always moving around. Yeah, we’ll see with Steph, uh, and I’m wondering how intentional your career choices were, how… the degree to which you fell into them. I’m asking because you might not have listened to our prior conversation was with a friend of Jesse’s and mine, Abby Covert, who made a choice to kind of remove herself from the kind of typical employment game and is now focused– she’s independent, she’s a writer. She’s made a choice to make a lot less money, but to do what she loves. And I suspect you were given opportunities to be an executive that you might’ve turned down because that wasn’t what you wanted or something that like, how did you, you know, figure out your path forward and what was, what were the, what were the decision points and the, and the influences and just, how did you arrive kind of at, at, at where you landed and now you’re retired, which is also a choice.

Um, I’m just kinda curious. Yeah. What, what w- what led to those decisions in, in your career path?

Tim: Boy, I might have more perspective on that in another year and a half.

Peter: Were you ever a striver? Were you ambitious or did– were you someone who just always found themselves in a situation like, I guess this is what I’m doing now?

Tim: Well, it’s not, certainly not the first and not quite the second. I do want to clear up that nobody ever wanted me to be an executive. Nobody ever offered me a position as an executive. I think that they, they knew better than that. And had they offered it, I would not have taken it. It just, just too much trouble, too much of a certain kind of responsibility, too much HR bullshit, et cetera, et cetera.

That said, I’ve always, just asked what’s the next step. And you know, I– I don’t know that I’ve, there may have been times when I thought about my own position more than a year out, but mostly not. Mostly, I’m like, where do I want to be a year from now? And I never interviewed for a– I’ve never taken– in the last 35 years, I never took a job that I interviewed for. So I always started, I started as a temporary secretary and turned that into being a you know, office manager turned that into being a network administrator and database manager, and then turned that into being a technology prognosticator, which then turned into e-health stuff, right.

And which then turned into UX. So it was always starting by being as competent as I possibly could be at my current job, as I was saying before, really starting with that and then having relationships with interesting people and then asking myself, what’s my purpose? So it really, I mean, for me, it really resonates.

I don’t know if it resonates for anybody else, but for me that has really worked. I’m going to be good at my job. I’m going to get together with people and get people to respect me and know people and enjoy working with them. And then I’m going to ask, what do I want? And I personally, I know it’s probably, you know, very, almost certainly a function of my privilege in that, you know, I always, we weren’t rich growing up, but we always had meals and we always had a roof.

There was never a doubt about that. If there was, my parents didn’t let us know. So I, you know, that privilege puts me in a position where I wasn’t concerned about that. So that got me to a place where it’s like, well, what’s really important to me right now. And at one point what was really important and what I was really learning about, what I really loved, was learning DBase3. And how do you, how do you program a database so that it’ll spit out the address labels you want. At one point, that was just really, really interesting to me. It wasn’t part of my job, but that’s what I did, right.

So always, you know, and another point, what was really interesting to me was um, uh, user experience and user experience methodologies and baking that into development methodologies.

And so that, wasn’t my job, but that’s what I did. And then, you know, you get to a point where, you know, I frequently, I would go to my boss and say, “Hey, I don’t know if you noticed, but I’m doing a different job than you hired me to do. And by the way, this job gets… the job I’m doing now should be paid better than the job that I was doing before.” But my, my, my path has always been, do my current job well, and then start doing my next job.

Jesse: So now you have moved on to your next job, the job of being retired.

Tim: I have moved on to my next job. Yup.

I think it’s it’s still evolving as it goes. I’ll be really curious to find out what my perspective on it is in another year and a half, because honestly I’ve been doing more about, poring into my new life in the woods in Vermont than I have been kind of poring over my, my, my work life. I will say that I feel, I feel a lot of pride in having stuck with something for so long. And the long, in the long view, you can really see progress. And in the short view, progress can be so, so frustrating. And the other piece of perspective is really using the leadership ceiling construct as an explanation.

You know, we’re, all of us, I think who are… all of us who are at all introspective and reflective about our lives are trying to make sense of what happened and what didn’t happen. How come, I never got that thing going, how come that didn’t work? How come that project that I just put my entire, well, how come that fell apart two years later, how come I never got off the ground? And the leadership ceiling has really helped me understand it, not just because, and I want to make clear, not just because, oh, you know, every time I got squashed, it was because of a leader, but it’s also because looking back and saying, you know what? I approached that situation with an inadequate assessment of where the leadership ceiling was, or invalid assumptions about what was important to the leaders so that I was ineffective at influencing them. So it’s really helped me make sense of when things worked and when things didn’t work, which things did I, where did I do things that got me where I was trying to go? And where did I do things that were, that were less effective for me?

Jesse: Fantastic, Tim. Thank you so much. This has been great.

Peter: Yes. Thank you.

Tim: My pleasure.

Jesse: Of course the conversation doesn’t end here. Reach out to us. We’d love to hear your feedback. You can find both of us, Peter Merholz and Jesse James Garrett on LinkedIn or on Twitter, where he’s @peterme and I’m @jjg. If you want to know more about us, check out our websites, petermerholz.com and jessejamesgarrett.com You can also contact us on our show website, findingourway.design where you’ll find audio and transcripts of every episode of finding our way, which we also recommend you subscribe to on Apple, Google, or wherever fine podcasts are heard. If you do subscribe and you like what we’re doing, throw us a star rating on your favorite service to make it easier for other folks to find us too.

As always, thanks for everything you do for all of us. And thanks so much for listening.