Culture is a powerful force in sustaining change. Normally, our culture is invisible to us, like water is to a fish. But if you want to “see” your culture, just try to change it. The purpose of a culture (cult=to grow) is stability, predictability, and safety for its members. Culture is “the way things are done around here.” It is laden with beliefs, values, shared assumptions and the behaviors, norms, and accepted practices they spawn—all very slow to change. Various writers claim it takes anywhere from three to seven years to turn a culture. One exception is a radical change in leadership, which can flip a culture overnight.

Some ways to move a culture are to:

• Align the proposed change with the purpose, vision and values of the organization, e.g., saving lives
• Recognize and reward the heroes/heroines of the change effort
• Tell stories about the successes of the change effort
• Talk it up—language is a powerful cultural tool
• Have trusted leaders (include informal leaders) role model the way (Walk the Talk)
• Align policies and procedures (codified norms) with the change
• Make sure “symbols” reflect the change, i.e., use of space, celebrations, posters, buttons, ceremonies, rewards, etc.
• Be ever present (MBWA=Management by Wandering Around)
• Articulate how decisions will be made (by individuals, a team, the leader alone), understanding that people will support the decisions they helped make, through a culture of participation
• Use “homophily” or transfer of ideas among those who are alike (e.g., MD’s, RN’s, tribes, sectors, units)
• Employ “cross-overs” (people who belong to multiple tribes) to carry the message to new groups

Everett M. Rogers (1983) in his seminal work, Diffusion of Innovations, described the adoption of new ideas or innovations in a culture, by characterizing various groups within. These are:

• Innovators (2.5%), the dreamers, the risk takers, the people who read, go to conferences, and get excited about new ideas.
• Early Adopters (13.5%), the respectable localites and role models–they deliberate but seldom lead. This group is a prime target for initiating change, because others will follow them.
• The Middle Adopters (34%) respond to the opinions of others. They are late implementers and will watch to see who gets on the train before they get on the caboose.
• The Skeptics or Late Adopters (34%) push back but will adopt if everyone else does.
• The Laggards (16%) are the traditionalists, near isolates, who are against change and whose reference is always the past–“How we do things around here.”

From this, we learn that variation exists in who will adopt when, and that we will probably never have 100% adoption of a new idea. While the Laggards may have valuable feedback about the poor conduct of the roll-out, it is important to lead those who are willing to get on the train. A critical mass—enough to conduct a significant change—has been cited to be about 20%. Therefore concentrate on leading the Early and Middle Adopters, while learning from the Skeptics and Laggards.