New message from Marcus in 2018

Hello again friends, Sorry for keeping you hanging around for the last part of the book, over Christmas and New Year but here they are - the end of the story. As an added bonus I'm releasing the entire end, not in chunks of 5 chapters each. I wanted to mention two topics that I get asked when presenting the story on stage, and that I presume some of you might think about too; what happened after you left and what about culture influence/difference. Without revealing too much of the end I devoted one entire chapter (chapter 20) of me reflecting back on what happened. In reality, this didn't happen as one continuous session but rather during many weeks where I went back and forth. But in the book, I'd thought it was better I spare the reader the gruesome details of my feeble mind structuring things. One of the things I don't mention (that much) in that reflecting the cultural differences between me and the Indonesians I interacted with. I brush on it in several places but never felt secure enough about the topics involved to make a deep reasoning. However, there were many differences that sure played in. Here I will only mention the things that I don't talk about (that much) in the book as in what made this work I was a man. Take a look at chapter 21 in the end - the last picture. The hospital was almost only women. I was (am still too) a man. I was appointed a leader. I was white. There's a lot of underlying power that comes with these attributes. No in #meToo times and with a strong focus on inclusion and diversity I realize that I had a lot of power by just being me. The Indonesian work culture is much about preserving hierarchy and making sure that you and the people above you don't look bad. I came in with nothing to lose. I was only there to help. They had nothing to fear from me. That meant that I was given some leeway that an Indonesian would never have got. That said - we (I and my wife Elin, that was in the same situation as me) had some really tough times and talks where we accidentally made people look bad, in their own mind. There was a real urgency to change. For those that read Kotter's excellent Leading Change book, you all know that an urgency to change is a vital component to succeed in change. This was very much present at the Bungsu hospital. It was a do or die situation. Remarkable my team in the Health Foundation of the Salvation Army seemed, for the beginning, to be the only ones realizing that. Not even the hospital management was very nervous about a 6 week from bankruptcy situation. I think they were counting on the support of the Health Foundation financially should it have gone really bad. Once the urgency was known and understood, via the help of visualization, throughout the hospital the change was made much easier and we could drive through many new ways of working. After long the staff of the hospital themselves was pitching ideas and changes too. Now, what happened after I left… Well that depends on how far you want to look. As I mention in some places in the book (in the end of CH20 for example) the spring of 2016 was truly inspirational and amazing to see. The hospital surpassed all targets we set up together, following our practices with the daily management stand up and improving the hospital in many small steps. Staff was super satisfied and many patients came to the hospital ensuring a financial height for the hospital, in its lifetime I would think. During the spring of 2016 (after we left) a new Salvation Army was appointed. In the early autumn, for some political and strange reason, the Salvation Army decided to not prolong the contract of Dr. Lillian, the director. The vice director Dr. Tika was on parental leave (and was not offered the same position on return). This meant that the most of management team that we had worked with, established practices with and changed the mindset in, was vanished in a few months. Add to that a new director that didn't share our values and much of the work we did was gone. The results plummeted fast too and soon the financial situation was back to what it was before the disaster. The staff was not happy either and people started to leave the hospital. However, the Health Foundation of the Salvation Army stepped in and ended the contract of the new director and from what I hear the hospital is now slowly improving again. Dr. Lillian and Dr. Tika have found other positions in other hospitals. This sad ending fills me with two feelings: sadness and hope. I'm sad of course that our hard work was obliterated in a stroke. This tells me that changing a mindset and culture is really hard. we spent about 1,5 year starting from an absolute disaster, which makes a great starting point for change, as I wrote above. Through many small changes and tweaks and constant coaching and presence of a change agent (me) in the management team, we finally got around to adopting a new culture and way of managing the hospital. Tearing down and destroying a mindset and culture is disappointingly easy. Install a management that doesn't believe in the current ways of working it will fall. Fast. It's easy to see why since people will not behave as expected, strive for other goals than what is appreciated etc - in short: the two views are in opposition to each other. The new management calls the shot so they have the upper hand. In the case of a hierarchical, do-as-you're-told, Indonesian culture it's a slam dunk case. Our new culture didn't stand a chance. That was the sad part - the hope part is that I know that we have inspired many people during the 1,5 year we were there. I hear stories from Dr. Lillian and Dr. Tika on how they apply the same kind of thinking in their new working place. I've also been told stories about how the staff resisted moving away from the practices that made them autonomous, important, powerful and accountable. It warms my heart to hear them ask for more transparency and inclusion - that they've come to expect from the principles we worked after. I'm filled with joy when I'm told about these principles being re-introduced after the new director was removed. That is the whole story as far as I know of it now. I hope to go back someday and give them a whole box full of this book. So that they can understand that what they accomplished was something amazing that no one expected and that people in the west are reading about, being inspired by and learn from. That has been my goal in writing this story. Thank you for reading it. We are approaching the finalization of the book and I'm planning to do the final editing during January, releasing the book in February or March.

 Mark As Complete