A sensitive reflection

A sensitive reflection

Sometimes you make a sensitive discovery. That is what happened to Wim Post, who called himself 'program manager' for years, but who actually was not.

One of my colleagues started talking about it. About 'programmatic work'. He referred to earlier experiences and the success he had had with it. I heard what he said and thought what I thought about it. That is, I thought: "I don't like it at all". Because I thought I understood what he meant. And so I started to think up counter-arguments. No... I didn't make them up, they just were there. What we were doing was in fact already programmatic! After all, the projects we were involved in fitted into our innovation agenda! The parts of it were already 'programmatic' anyway. In other words, what he proposed was old wine in new bottles. It was only semantic. And although I am very much into semantics... I really thought it was nonsense.

I was right

I did everything I could to prove myself right. I made analyses, produced PowerPoint slides, linked projects together using literal lines to illustrate the connection between things. And I discussed. Sometimes even vehemently and especially as I am: agile and with many words and broad arm gestures. It even happened that I exclaimed that I was "fed up" and absolutely did not want to work like this. This, of course, to the dismay of that colleague and the colleagues sitting next to him. When I returned to the living room of our office (yes... I even walked away agitated, you can imagine!) I was fortunately calm again. To the colleague in question I said with a wink, but also sincerely: "...but I still love you". Because he was and is a very smart and nice guy whom I like!

Well, that's how it went. I was against it and knew for sure: I was right! Right without asking what exactly my colleague meant by this 'programmatic work'. Or by, when he tried to explain, not asking and 'by listening to what he said and trying to understand what he meant'.


Just a short intermezzo. I studied education science. At the University of Utrecht, among other places. There, I specialized in the subject of 'innovation in education'. It was the eighties of the last century. Prof. Nijs Lagerweij taught us about the Concerns Based Adoption Model (CBAM). Well-known authors who wrote about it in the Netherlands were Van den Berg and VandenBerghe. The core of CBAM? In order to be able to adopt an innovation, you have to realize that there are (levels of) concerns: involvement (or concern). Can I do it? How should I do it? Will I achieve the same good results? But didn't I always do it well? Does the change give me enough satisfaction? Just to name a few types of concerns.


Back to our discussion. And then, suddenly, the penny dropped. I remembered CBAM for some reason and suddenly realized that I had concerns about programmatic work. All the questions I listed above... they all applied to me. After all, I had spent the previous 20 years or so getting used to 'project-based working'. How that works, how we as advisors to the board supported in making decisions... and so on. These were my routines to which I had become accustomed. Because I did not 'dare' to get rid of them, I tried with all my might to prevent change.

It was a painful discovery. For I caught myself in quite an inconsistency. After all... I regularly got worked up about the 'annoying counterarguments', the 'insurmountable problems', the 'we still have to cover this from the administration' and 'the processes or protocols don't allow this' arguments and all those other phrases that quite often frustrated innovations in which we were involved. Uttered by professionals and administrators. Could it be that, like me, they ultimately stem from concerns? And should perhaps attention first and foremost be paid to investigating them? In order to subsequently 'do something about it and with it'? Like the CBAM approach does?



To cut a (too?) long story short. We presented the idea to our board and they immediately agreed. So, since 1 January of this year, we have been working programmatically within the Noaber Foundation. Two programs have now been defined. The first is on population health and the second on lifestyle. And the third? We are still exploring that. We are wondering whether we can develop a program on the subject of culture and behavioral change. I am not ruling out the possibility that we will once again pull the old CBAM model out of the closet. Because changing behavior and culture probably has more to do with concerns than with all kinds of so-called (?) rational arguments. Also in healthcare!


It was this reflection that cleared the air with regard to the program discussion. I started asking questions about how and with what. I actively looked for examples of 'programs' and opened myself up to learning. In other words, I went from concern to comfort. But most of all... I became enthusiastic about the idea of working programmatically and even felt like it.