I wrote a post about Indonesian culture. In it I wrote about my experiences in Indonesia and how I’ve interpreted what I’ve experienced as many people here lives in a world without WHY. Read more in that post.
In this post I wanted to continue my thoughts about this and specifically around what actually motivates Indonesian people. Or how I could motivate someone that lives in a world without WHY. How do you get someone to start thinking in long-term goals in a culture that do not? This is has been my task for the last 1,5 year and I’m still struggling. Sometimes I have, accidentally mostly, succeed too and in this post I wanted to describe HOW I did and why I think that it worked.
As before remember:
- these are my experiences by being here for close to 1,5 years, meeting the people I happened to meet during that time
- Indonesia is a VERY big country with a big, big spread between poor and rich, in education level, geographical and also cultural.
Should I make any generalizations (which I will) it’s based on my own experiences. If they are wrong or weak is due to that. If they are good… well I was lucky I guess.
BUT, one thing that I am quite sure of is that I’ve learned a lot about my own culture by studying the Indonesian culture. All the phenomenas that I’ve observed here can be seen in Sweden as well, but in lesser extension maybe.
Basically - I’ve learned a lot. I hope you learn something too
I thought that I’ll run you through one example (although I have many) and then tell you the parts that made this work. If only we were so smart that we thought about all of this before we created them… We did not. Instead this is how it came to be, trial and error.
At one of our hospital we did this; we had a hard time reaching through to them about focusing on running self-sustaining. In fact, when we first started to talk with them they didn’t really know how they were doing in terms of making or loosing money. At least, in regards to the last post, they didn’t show much attention to that. It ended up as it ended up.
We wanted to change this and asked them to break the costs and incomes down to months. No change. Even on a daily level we saw little attention being given to this.
Me and my colleague Anton came up with a long-shot idea; let’s turn our sights away from Rupiahs and instead break it down to number of patients. And make it even smaller and simpler by expressing the hospital target, with profit, in
number of patient services / day. That was 134 as it turned out.
If you wonder about the “patient services”, so did the hospital, but it’s basically just means that each patients can use one or more of our services, for example the poly clinic, the lab and the pharmacy - that would be 1 patient but 3 services “sold” to him. More about this under “Make it simple.
Great! We created a really big diagram where we plotted the number of patients needed per day and the target line. You can see the first version of our board to the right here.
Reaction: not much…
People looked generally uninterested or concerned. Even though the numbers we drew was ca 50-90 patient served per day. Half of what our goal was!
Then after a few days, just on a hunch, I asked my colleague Anton again: “134 is their goal, but that was including profit, right? How much was the profit?” 10%. So I did some math and came up with 120 as the break-even point.
I added that on the board and explained what was to the staff: “If we have fewer patients than this - we lost money by running the hospital that day. This is the ‘loose money’-line”. You can see that diagram to the left.
That was the most profound message I’ve ever delivered. I could literally see jaws dropped. A few people looked like they were about to cry. Heads were shaken in disbelief.
From that day on - we never looked back. We had their attention and I’m happy to say that we have now turned the hospital around. In February we broke the “not loosing money”-line for our average. Meaning: On average we make money everyday.
Ok - that’s amazing to me - and I’m thinking about documenting this better in another media. But why did it work?
Well… since it was trial-and-error (I’m proud to say) I can only comment on the things we did. This worked for us - let it inspire you.
Break it down
The first thing I found very useful when it comes to reach and get the attention of Indonesian people is to break long-term goals down to short-term goals. I’m talking really short term here. Daily goals, like we did above, for example. I’ve found this very useful, even if you have to make approximations.
“This is what we have to reach each day” - seemed to be much easier to grasp and act on than yearly or even monthly goals.
Point to the goal
However… with the daily goals it’s very easy to loose track about the long-term goal. That’s why I tried to sneak in many reminders or questions per day about WHY we did things. Always trying to bring it back to our overarching goals.
A few examples on how we did this:
- We created a board with activities that we were working on. For each of these we had a WHY state. It’s not “allowed” to put an item up without stating the WHY. Even the WHY that everyone knows. So “fix the leaking roof in the operating room”… WHY? According to our vision - why is this a big problem? “Because we are a hospital that want to improve quality and a leaking roof is simply not acceptable”. Restating the goal.
- We also introduce a column for definition of done for each item, that further aimed to clarified our expectations about this item and the outcome of doing it.
- For all numbers, good or bad, we ask ourselves “Kenapa”, why did this happen? In discussing this we further reminded ourselves about the goal and talked about how we could learn from what happened yesterday to amplify or hinder it from happening again
All in all we talked a lot about the vision but tracked the daily achievements. It took ca 4-6 months before I heard the first comments from the group (not from me) about if we doing the right things according to the vision.
Make is simple… no simpler still
We made a lot of simplifications that seemed to catch their attention. First we talked about monthly goal. Then daily but in monetary terms. Then we counted the number of patients served and averaged out the income per patient.
It turns out that to was a little bit too complicated: we could just count the number of patients in the hospital and average out their rate and get very close to the real life outcome per day.
It’s easy to think about 126 patients than about 8.034.034 Rp. per day. It’s easier to think about how many patients that walks through our door than how many services we have sold to them (and easier to count too). By continuously challenge and try to simplify our ways we got and kept the attention of the entire staff.
Yes - there might have been counting errors. But by following up the “actual” outcome in our books we could verify that it was not drifting too far from reality. It never did.
Involve at every levels
We showed the data in front of the staff everyday. The real day. Even the bad one. This is NOT the Indonesian way and even the staff was uncomfortable with that.
But as we started improve something cool happened. When the number for yesterday was revealed people started to cheer and applaud for good number and … well be silent … for bad. They cared!
By doing this transparent together we created a stronger “we”-feeling in the group. One great (although cheesy) suggestion came from the hospital: “Let’s do a yell-yell”. Here’s how it works for us:
Every morning there’s a morning prayer. Right after that the director goes through and plot the numbers from yesterday (and the cheering). Then just before we leave, someone is appointed to come forward to lead the yell-yell.
This person, hugely embarrassed but laughing (remember the group / individual culture from the last post) shouts:
Rumah Sakit XXX - apa kabar?
(The hospital - how are you?)
And everyone answers:
Told you. A little cheesy. But it means that we end each morning briefing with a laugh and everyone walks to their work in a good mood.
Trust in the little things … at first
In the beginning I was more or less telling the director what to say, word by word. I told her to promise things about the salary for the staff. I told her to do the numbers and what to say about them. Etc.
After a while I stepped back and let her run the morning briefing by herself: “You are in charge now”. She was very nervous for that in the beginning. I trying to help her improve and after just 1 week she did it without any problems. And came up with improvements and variants.
For 4 months I did the daily stand-up meeting with the management group that talked about our improvements per day. Then I handed it over to the director: “You are in charge now”. She was very nervous for that in the beginning. After each meeting I talked with her and suggested improvements. After a few weeks I stopped doing that. Because she was now in control.
I realize that I entrusted very small areas of trust to her (regarding THIS mind you. A director of a hospital has HUGE responsibilities that I didn’t touch). Little by little I stepped back and she stepped forward.
That worked really well.
The last thing I want to point out is something for just me. When we implement any change a good way to understand the people you are trying to change is to put yourself in their shoes. Now this is easier said than done since the changed behavior you want might be obvious for you but totally outrageous for them.
For example plotting the “real” number of patients we drew yesterday, good or bad, in front of the entire staff. I think that’s a great idea. Indonesian people think … you should not do that.
I try to play a jedi-mind-trick on myself, based on the title of an beautiful song: Imagine me, by Kirk Franklin.
What would be hard for me to change? Use that as your example when you meet confusion and resistance. If someone told me… “that I should not question the status quo. That would improve our outcome”, for example. That would be very hard to swallow. I would fight it. I would say they were wrong. I would expect that the showed me some kind of proof. I would be grumpy….
In short - I would resist the change. Imagine me.
There we go. A few items that we tried to motivate Indonesian people. It worked for us. Your mileage may vary.