How successful large-scale change efforts make relentless day-to-day progress.

By Joe McCannon & Becky Kanis Margiotta

It just feels different.
That’s what we often say when we step into a transformative scale effort—an attempt to completely solve a social problem—that is making remarkable progress. While reflective planning and thoughtful strategy are important, the rare movements that really thrive also demonstrate a set of daily work habits that are strikingly distinct from those that stall. They relentlessly root out the trappings of “business as usual”—long meetings, painstaking consensus-building processes, endless email chains, to name a few—and create a “command center,” an operating culture that orients them toward rapid movement, boundless energy, and efficient execution.

Based on our support for several stand-out initiatives, and our experiences running the 100,000 Lives Campaign and 100,000 Homes Campaign—national efforts that engaged whole industries in reducing medical errors and chronic homelessness, respectively—we offer here 10 behaviors that seem to characterize successful orchestration of large-scale improvement. Taken together, they paint a picture of “a day in the life” of the rare movements that succeed.

They regularly return to shared aim—and shared meaning. Defining exactly what the effort should accomplish—by when—is a virtue for any initiative, regardless of its scope. It gives participating organizations and individuals direction, and creates a critical sense of urgency. What distinguishes exceptional initiatives is how seriously their leaders take the objective and how thoughtfully they connect it to lives of the people they serve; they are completely transparent about their progress and the impact their success or failure has on human lives. As part of national efforts to improve health care quality, for instance, a new best practice has emerged: When patients are harmed in the course of their care, hospital leaders come to know their names and life stories so that they can fully understand the consequences of their failures and deepen their commitment to avoiding future harm.

They name the enemy (fear) and eradicate it. “Fear,” wrote novelist Frank Herbert, “is the mind-killer.” In a movement to transform a field or an industry—when risk-taking, creativity, and selflessness are at a premium—fear is the most destructive force. It manifests itself in rigid rules of operation and approval systems, which in turn increase reluctance to take creative action. Successful initiatives vigilantly avoid these pitfalls, measuring the rate at which they test new ideas—and introducing incentives for trying and failing fast. They intentionally spread this culture to all participants in their work.

They reject tired hypotheses about what spreads change. Publications, websites, and conference presentations are not effective ways to inspire broad behavior change, yet activities like these often consume large proportions of time and money in large-scale initiatives; they are viewed as ends in and of themselves. Movements that really succeed impose budgetary limits on such activities and—like universities that promote faculty based on creating better outcomes instead of just publications—prioritize activities that have direct bearing on results.

They avoid hypnosis. Inertia is almost as destructive to large-scale change efforts as fear. Daily work habits—writing emails, attending standing meetings, preparing onerous reports—can all distract from the critical work of actually changing the world. In our work, we constantly question the value we derive from the activities we see on our calendar. We also avoid assigning “homework” of any kind; the only work we’re interested is the kind that contributes directly to solving the problem at hand.

They face into data (and go to the field). Every community participating in the 100,000 Homes Campaign knew the number of people they had to house each month for the initiative to meet its goal. On a monthly basis, communities gathered to study their progress and make adjustments if they were falling behind. Data was not used to punish or shame; it was used—constantly—to learn and improve. Doing so creates clear milestones and gives a steady rhythm to the work. It also tells leaders where in the field good work is happening so that they can go and study it more closely—another important discipline that limits insularity and speeds learning.

They avoid consensus. Many initiatives operate with the assumption that consensus is a virtue. In fact, consensus kills—by wasting time in debate and drawing attention away from important work that saves lives. In the US Organ Donation Breakthrough Collaborative , an effort that mobilized stakeholders across the country to change misperceptions around organ donation and significantly increase donation rates, the organization prided itself on having only one point of consensus—its aim. Other decisions were made quickly or subjected to small-scale tests in the field, thereby avoiding time wasted on contemplation and speculation.

They expect crises and encourage improvisation. On a visit to Sweden’s remarkable Passion for Life initiative—which engages groups of senior citizens in improving their own health and health in their communities—a member of the team there talked about how they constantly improvised in their work, “like jazz players.” They expect the unexpected (crises, new opportunities) every day and feel comfortable making quick adaptations and adjustments as long as they stay true to their original direction (the equivalent of the musical theme). Indeed, we cannot plan transformative change in advance; it is the product of opportunism and agility that, over time, moves whole industries and sectors.

Leadership removes barriers, above all. In most organizations and initiatives, staff regularly report to managers, painstakingly preparing detailed summaries of progress. In initiatives that really thrive, both managers and staff briefly review readily available data on progress, and then managers spend the balance of their time removing apparent barriers to progress. With this role reversal, the initiative focuses less on pleasing leadership and more on solving problems in the field.

They waste no will. To orchestrate large-scale transformation, an initiative cannot afford to turn away or discourage anyone who is willing to help, regardless of their experience level, background, or affiliation. Furthermore, the process of deciding who is “in” and who is “out” is too time consuming. Having a small set of very clear “asks and tasks” ready for anyone who knocks on the door to help— something that some political campaigns actually do well—is much more effective.

They cultivate a “recognition economy.” Numerous studies show that for most adults regular recognition of the good work they do is every bit as important to motivation as financial compensation. In initiatives that are typically lean on funds, scheduling regular celebration and appreciation is a critical source of energy for the initiative. In our work, we think of it as a “recognition economy” that we have to very intentionally manage to sustain energy and commitments.
While far from comprehensive, this list begins to describe what sets apart those initiatives that move aggressively from theory to action—and better results—every day. Hopefully it provides a lens through which large-scale movements can assess how ready they are for the daily work of orchestrating meaningful change—or, if they’re stuck, how they might do things differently.