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Making Change Happen in Large Organizations: Top Down or Bottom Up?


A classic problem in organizational change theory is how to increase the odds of success when planning and implementing significant changes.  One way to proceed is the “cascade” or “waterfall” model, starting with the CEO and executive team, and then moving progressively “down” the organizational hierarchy.  Another approach is to begin with front-line workers, then move up and out; this is a “bottom up” or “grassroots” strategy.  There are pros and cons to each approach- the top-down strategy can take a long time to trickle down to the front lines and, by the time it gets there a great deal can be “lost in translation.”  The bottom-up, grassroots approach can lack significant executive sponsorship and can falter because it is not viewed as connected to the organization’s key strategic goals.   A third option is to combine elements of both, thus attempting to reap the benefits of each approach while mitigating its downside.   But is there a formula, or way of proceeding, that has the greatest odds of success?  In working with many large organizations and change projects over the last twenty-five years, I have found that the most reliable path to success is to plan that a change effort will be “top-down, bottom-up, middle out.”  Let’s take an example to illustrate why.

About three years ago in a large Canadian hospital, the Vice-President of Patient Services became concerned that there was a growing lack of respect in the workplace.   She formed this impression by observing, or hearing about, multiple conversations from different parts of the organization.  Some involved doctors and nurses, others involved allied health professionals, others involved issues of race, ethnicity, and gender.   The Vice-President (we will call her Karen) was concerned about a growing environment in which people were not encouraged to bring their whole selves, including their ideas, concerns, and passions, to the task at hand: “We were silo’ed.  We were not working well across functions; we were isolated rather than interdependent.  We needed to shift our thinking; we needed a fundamental cultural change.”

Karen decided to launch a diversity initiative, but not for the usual reasons: “We had diversity-related complaints, but they were symptoms of the broader issue.”   Some comments were racial, she said, but more indicated a lack of appreciation, sensitivity, and awareness of others’ contributions that was broader and more fundamental.  Karen took a “grassroots approach” to the issue, starting with a broad definition of mutual respect in the work environment.  She went around and solicited participation from unions, staff, and front-line leaders.  She created a Council and made people apply to be on it: “it was important to get the right people- those who were leaders and influencers and had no preconceived agendas.”

The Council began with sensitization, using an organization-wide survey to identify the biggest concerns and challenges.  There was a “phenomenal” response rate; “multiple things came out that guided our plan.”  The underpinning was an emphasis on mutual respect; this led the Council to create a task force that would develop a Code of Conduct.  The task force had representation from across the organization, including leaders, front-line workers, and community representatives.  The task force conducted a literature review and looked into what other organizations were doing.  The resulting Code of Conduct applies to “anybody and everybody” who comes into the hospital.  At the end of the process, the task force held a symbolic “signing ceremony” as a powerful sign that people were committing themselves to following the Code of Conduct:

The Hospital is committed to providing a safe, inclusive, and caring environment where we:

  • Treat one another with compassion, kindness, courtesy, respect, and dignity;
  • Recognize the unique role and contribution of each individual;
  • Work together;
  • Listen and communicate responsibly;
  • Take responsibility for our actions;
  • Act with integrity and fairness; and
  • Resolve differences and concerns in a sensitive and timely way.

At this point, the change had become what Karen calls a “bottom up, top down, middle out” initiative.  Front-line workers and staff were mobilized by Karen to create, shape, and endorse the Code of Conduct.  Senior management sponsored the initiative and became active supporters of it along the way.  Because of support from both levels, middle managers felt empowered and authorized to use the Code to create a healthier, more respectful work environment.  The result was both a “groundswell” of support for the initiative and a transfer of momentum to the clinical units, supported by the respective managers.  As it happened, Karen was promoted from VP of Patient Services to interim CEO after the Diversity/ Code of Conduct initiative had been running for two years.  She was unable to continue as champion of the effort and, when we reviewed the effort nine months later, commented that she felt that the effort had lost momentum.  Nonetheless, when asked what impact the Code of Conduct had had in the workplace, several managers were quick to respond with stories of how they had used the Code of Conduct to improve behavior and attitudes in their own areas.    One said, “It helps.  Just this week, I told one of the physicians that ‘you’re not behaving in line with the Code of Conduct; I can’t have you talking with my techs that way.”

Changes that are solely top-down or bottom-up tend not to have this kind of staying power.  We find that a critical of mass middle managers will use things like the Code of Conduct to positive effect if there is both a “push” from senior management and a “pull” from staff in support of the effort.  In this case, strong leadership from Karen got things started, and then the Council and Code of Conduct task force carried the effort forward.  It is also clear that by following several commitment-creating strategies, including consistent and widespread outreach and the signing ceremony, Karen created conditions whereby middle managers were using the Code as a tool well after the “Launch” phase of the initiative.  In effect, Karen ran a campaign for change which drew on a synthesis of the “bottom up” and “top down” models of change, and used a focus on middle management (or “middle out” model of change) to create a transfer of momentum throughout the organization.

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