Change Designs Member LOGIN

Change Designs



Dealing with an employee morale problem

The organizational problem.

It started off as a morale problem. But as I spoke to different stakeholders, it became more complex.

I was called into a hospital by their HR manager. The hospital needed to improve morale amongst its nurses. But as I spoke to different stakeholders, the problem became more complex.

  • The HR managers told me that morale amongst nurses was at an all time low. They also mentioned that the hospital was trying to change its culture to become more patient and profit centric.
  • The matron of the hospital was concerned about the poor relationships between the nurses, their unit managers and the doctors. The unit managers were upset by the way that doctors by-passed them and shouted at their nurses. The nurses and their managers blamed arrogant doctors for the poor morale in the hospital.
  • The CEO was concerned that the doctors, who he saw as clients and partners of the hospital, were not happy with the service they were getting. The doctors, chose to locate their independent practices at the hospital, but had the freedom to take their business to another hospital, anytime they wanted. Losing specialists to competing hospitals would affect his hospital's brand and offering - as well as its profitability. He was also tired of being the only leader in the organization, and wished that the managers would begin to take responsibility and act like leaders.

The Organizational Development intervention the client wanted.

The CEO, matron and HR manager all agreed that they wanted a one-day workshop for all internal managers in the hospital. They wanted the workshop objective to be: "To help the managers to develop a common focus regarding what they would need to do as a united team, over the next 18 months."

The thinking behind the design of the OD intervention.

I knew that I had to provide far more than what they'd asked for in their workshop objective. And far more than even the problems they had briefed me on. In choosing my design for the workshop, I needed a tool that would:

  • Build trust. Allow the managers to vent their frustrations in a way that allowed every manager to be heard. But not in a way that would degenerate into a negative gripe session about the doctors.
  • Get the managers to see all the problems facing the hospital - not only their own problems.
  • Get the managers out of the habit of blaming doctors or the hospital for problems that they could resolve themselves. Get them to take responsibility and begin acting as leaders.
  • Get them to stop seeing themselves and their nurses as being victims of the arrogance of doctors, and to start seeing the doctors as important customers of the hospital.
  • Support the move to a patient centered and profit oriented culture.
  • Help them to identify the most important issues that they as a leadership team need to deal with.
  • Help the managers to develop a common focus for the future. One that not only solved their frustrations, but one that would make them excited about their future in the hospital.
  • Help the managers to identify the core changes they would need to make to achieve the future they wanted.
  • Help them identify projects that would help them to implement those changes.
  • To do all of this in a way that would build a leadership team. One in which team members take responsibility and support one another.

The constraints I needed to work within.

  • The hospital could only afford the time for a one-day workshop.
  • There would be 32 people in the group.
  • In this workshop, the process would be as important as the content. Therefore the way in which the group developed their own solutions, was as important as the solutions they developed. We needed a process that would encourage participation, buy-in, ownership, build the managers confidence and energize them.

The tools I decided to use in the one day workshop.

1. The main tool I used was The Change Puzzle Kit

I had one kit for each group of 8 delegates. Each kit consists of:

The organizational development tool I chose for this complex OD intervention was "The Change Puzzle Kit."
  • Two laminated charts. (A1 size). The first chart is called The Organisation Of Today. The second chart is called The Ideal Organisation Of The Future. The design on each chart is of the organization as a puzzle comprising 20 organizational development pieces.
  • A set of water soluble pens which allows the delegates to write directly onto the laminated charts. The charts can be wiped clean and used again.
  • A box of clue cards to help the groups think about the 20 organizational elements from an Organizational Development and systems thinking perspective, as they complete their charts.

facilitator-cards2. The secondary tool I used was a single activity from The Powerful Facilitation cards.

These workshop activity cards are designed like recipes. They provide detailed workshop activities to achieve specific workshop goals. I chose a card that helped a group to create a vision in a way that created fun and positive energy.

The workshop design.

I chose The Change Puzzle Kit because it allows a group to do the complex systems thinking they needed to do to solve their own problems, in a very practical and very participative way.

This is the process I followed.

  • systems-thinking-toolTo ensure that everyone could participate, I divided the larger group into 4 groups of 8 delegates per group.
  • These groups were mixed to provide as much variety as possible. We mixed the groups so we had different functions (HR, marketing, administration & nursing), and people of different ages and races working together in each group.
  • Each group had their own change puzzle kit to work with.
  • I used this diagram to explain the process we would be following which was:
    • We would take a 'systems thinking' photograph of the hospital as it was today - with all its frustrations and all its strengths. To do this we would use The Organisation of Today charts and cards.
    • We would do a right brained exercise to look at what the hospital would be like 3 years into the future, if it was delighting its patients, was profitable, and a place where the managers would be proud to work.
    • We would translate that right brain 'vision of the future' back into left brained, systems thinking. We would look at the elements that would need to be in place for that vision to work. To do this we would use 'The Ideal Organisation Of The Future charts and cards.
    • We would then compare what came out of our two charts. From this, we would choose a few core changes. Changes that would help us to solve the most important of today's problems, and move us towards the future we wanted.
    • We would then create some projects to make achieve these changes.

How I used the change puzzle kit.


Step 1. Provide an overview of the change puzzle

systems-thinking-toolThe attention span of most groups for listening to a presentation is less than half an hour. So, to keep the group's attention, I provided a very quick overview of the charts and clue cards they would be using.

Step 2. The groups analyze their organization as it exists today - using 'The Organisation of Today' charts and cards.

2.1 Instructions:

Each group was given the chart "The Organisation Of Today" plus the 20 clue cards about the current organization. They were also given a set of water soluble pens. They were asked to write on their chart how they saw their hospital today in terms of each puzzle piece or OD element. They could use the clue cards to help them. Each person was encouraged to write how he/she viewed the situation independently of their group as the group didn't need to achieve a consensus. I also explained that some people see things in a positive light, others in a negative light and others prefer to put down facts. All of these views were equally valuable.

2.2 Activity:

Each group spent about an hour recording their answers. Then instead of having formal feedback, each group simply read what the other groups had written on their charts. This was to prevent a very tedious feedback process - and potential conflict.

2.3 What came out:

The three groups were surprised that they had similar responses. For example: They felt their roles were not clear enough. They were too 'rank obsessed.' They felt doctors had too much status and that they needed to be empowered more. There was too much gossip. People operated in cliques. No one was taking responsibility. They felt they needed to acknowledge one another more. They wanted to create a culture where people 'don't feel intimidated when someone shares skills.' But most of all, they were surprised by how much negativity came out. 'Surely there are some good things too?' One person asked.

2.4 Why this happened:

Their common responses were due to two design factors - the mixing of the groups, and the systems thinking behind the design of the chart they used. Negative responses are common amongst groups when they analyze their current situation. Groups are more positive when they create their own future.

Step 3. Groups develop a vision of the future.

I used a creative activity from the Create fun and energy section of the Powerful Facilitation cards. I needed to turn around the group's energy from negative and powerless, to positive and creative. I also needed the groups to develop a vision of their future, which was far more creative than simply that of solving their frustrations of today.

As they developed their right brain picture of the future hospital, the groups became energized. Alive. Full of fun. They began laughing. They worked well as a team. They started coming up with brilliant ideas of how they could add value to the doctors, and earn their respect. They created slogans for themselves showing how they would care - for their patients, their doctors and one another. This was the turning point of the workshop.

Step 4. Groups complete The Ideal Organisation of the Future charts.

4.1 Instructions and activity

roleI remixed the groups - so that each of the four visions were now represented by members within each new group. I then asked the groups to complete the Ideal Organisation of the Future charts. In doing so, I asked them to think about what would need to be in place for them to be able to live their visions. I encouraged them to be creative. This is because I wanted them to come up with more than simply the opposite of the problems they'd identified in their The Organization Of Today charts. I wanted them to capture all the wonderful ideas they'd had in their right brain vision, onto the 'Ideal organisation of the future charts.' I suggested they also look at the future clue cards to generate even more creative ideas.

4.2. What came out

What came out of this activity were wonderful positive ideas that not only solved the problems they'd identified in their organization of today charts, but started achieving all the objectives I'd hoped for when designing the workshop. For example, in order to clarify roles, they though of having a monthly picture board, entitled 'meet the team'. They decided to have a day where they would change roles with one another. They decided to have a programme where as managers, they would 'go back to the floor' for a day, to better understand some of the issues that both nurses and doctors faced. They would visit the receptionists of doctors to find out all the doctors preferences. Then they would educate one another and their nurses on how to provide great service to each doctor. They decided that one thing that would demonstrate patient centered care, was to think of ways for caring for families of patients who came from out of town. They created slogans for themselves that demonstrated customer care. They decided to lead their teams by getting each unit to develop their own vision linked to the hospital vision. The team became quite excited about what was possible.

4.3 Why this happened.

The groups' energy had already turned during the previous exercise. Building on this, we know that groups are always more positive when they are allowed to be creative, and when they focus on the future. The "Ideal Organisation of the Future" charts are designed in a way that combines creative thinking and a future vision. Also, by analyzing all the OD elements that would be in place to support their vision, the group could see that achieving their vision was possible and practical. This made them feel hopeful about their future.

Step 5. The groups choose core changes.

The group was blown away by all their wonderful ideas. But there were too many to implement all at once. They needed to apply the 80/20 principle.

Once again I remixed the groups. I asked them to choose 2 changes that would:

  • Solve the biggest problems identified in "The Organization of Today charts"
  • Help them move towards their most exciting ideas in "The Ideal Organization Of The Future" charts.

I asked them to record these changes in a 'From' and 'To' table.

  • The 'From' would be drawn from "The Organization Of Today" charts.
  • The 'To' would come from "The Ideal Organization Of The Future" charts."

The four groups were surprised that they all came out with the same core changes. This happened because of the design of The Change Puzzle Kits - which gets everyone to use systems thinking, and because we kept mixing the groups.

They immediately started volunteering for projects around the core changes.

The end result

I then got the groups to list what they'd achieved as a leadership team during the day, and what they wanted to do after the workshop. What came out was how amazed they were at what they'd been able to achieve in one day. They left the session excited and motivated.

You may also like:

Tools to use to develop a change strategy.

  • change-puzzle-kitThe change puzzle kit A systems thinking and organizational development diagnostics tool. Diagnose an organization. Understand the impact of your change on every element of your organization. Identify what needs to be in place to support your change. Understand culture. Identify core changes.
  • change-strategy-toolkitWinning the game of change Develop a change management or organizational development strategy for your organization or project. Use the 64 cards to choose practical interventions for your strategy.

Tools to use to implement a change strategy.

  • magic-change-toolkitMagic change toolkit An exciting change management toolkit for change agents. Filled with recipe cards or activities to manage any change, reduce resistance and build excitement.



This will pin this article to the community board for guests or to your own private board for members who are logged in.

Change Designs
provides resources on Leadership,  Strategic Planning, Change Management, OD ... for organizations, teams & individuals.
Use our member guides & tools to solve problems & achieve success at work.

Customer Service

return to top home
RSSRSS feed for new articles and products from Change Designs

© Change Designs 2011. All rights reserved. The reproduction of any content or material contained in this website is expressly reserved to Change Designs CC, under Section 12(7) of the Copyright Act of 1978. Reliance on the information contained in the articles, products and other related content published on this website is done at your own risk and subject to our “terms and conditions”.