Kanter and Research Associate Jonathan Cohen

MARCH 27, 2018
Professor Rosabeth Moss Kanter and Research Associate Jonathan Cohen prepared this case. Funding for the development of this case was
provided by Harvard Business School. Details have been disguised to protect confidentiality and anonymity. Names and details are not intended
to resemble an actual company. HBS cases are developed solely as the basis for class discussion. Cases are not intended to serve as endorsements,
sources of primary data, or illustrations of effective or ineffective management.
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Sandra Brown Goes Digital (C): Raising Quality in
a Healthcare Company
In early fall 2017, Sandra Brown reviewed events in the three years since she began working from
New Jersey as Manager of Quality Impact at NIN. She had started the job with responsibility for
building a movement to improve quality at the company. When she arrived, she learned that quality
problems were cyclical at NIN, but many leaders denied they existed or believed things could be
worse. There were signs of complacency and comfort with established procedures. Warning letters
prompted the hiring of consultants to fix the specific problem. The process was regimented, scientific,
and exhaustive.
NIN spent £1.5 billion over 20 years to develop its new cancer prevention drug within this culture.
For its late-2015 release, company leaders set a price and decided to target countries with higher rates
of the disease, such as Indonesia and Brazil, but quickly encountered difficulties. They projected sales
of $250 million worth of drugs in 2016; actual sales were $67.2 million, despite generally growing
sales. (See Exhibit 1 for NIN’s financial data from 2012–2016.) Critics questioned the drug’s high
price, frequent dosage schedule, safety, and overall risk reduction of 65%. New studies concluded
that the drug had side effects, including nausea, headache, and depression. A contamination issue at
a production facility in England had caused some shipments to be recalled and others delayed as the
problem was addressed. The government cooperation NIN had hoped for was slow to materialize, as
officials in some countries wanted further studies before developing widespread administration
programs, or before distributing drugs that had already been purchased. NIN leaders defended the
price and searched for technical solutions to improve the science and production process. Meanwhile,
competitors were working on new preventative drug treatments for the same disease.
By mid-summer 2017, Sandra Brown and Jay Gupta had worked for three years to successfully
create a movement within the quality division of NIN. They had experienced marked improvement
in quality through a dynamic effort to engage employees at all levels, and to develop solutions to
problems from the ground up.
Senior management took notice and wanted to explore ways in which to bring the movement to
the rest of NIN. In July, Brown and Gupta would present to the top 200 leaders in the 9,000-person
company. They wondered how scalable the movement could be, and in what new ways they could
apply it to benefit other parts of NIN and improve business performance.
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318-084 Sandra Brown Goes Digital (C): Raising Quality in a Healthcare Company
Getting Moving on Quality
Gupta and Brown wanted to shake leaders out of their mental comfort zones, to speak honestly
and openly about the problems and risks to the company of the status quo. They communicated that
the company was not living up to its full potential because of the way senior leaders and leaders
throughout the organization worked.
In fall 2014, Gupta called two mandatory meetings, one for site leaders in North America and one
for site leaders in the UK. Leaders at sites outside those regions flew to the closest one. Twenty-five
leaders attended each meeting. Gupta and Brown led the meetings.
In the morning, they presented the poor performance data to leaders. In general, key performance
metrics and objectives were met just 50% of the time. Some leaders suggested that was good enough,
but Gupta wanted that improved to 95%. Gupta told them: “You operate quality in a way which is
actually not ok but because everybody else does it it’s probably ok until somebody comes in and puts
a stop to it.” He was highly critical of past performance and previously proposed solutions that had
not brought about sustainable quality improvement. Gupta communicated that they were not living
up to the company ambition “to harness the power of biology to prevent human suffering,” with
large losses of production time, drug batches, and money. After lunch, Gupta described the leaders as
deflated. He had found an old motivational video that he played for them. It showed how great some
large companies used to be and what was being done internally at the time to motivate employees to
get beyond difficulties and become great companies again.
Gupta said that after the video: “On people’s faces they were like yeah there’s a way out of this,
we could do things differently, and then I said ok, but then we need to talk about, now that we agree
that this is not good, how can we together change that.”
In addition to getting leaders to understand that problems existed, Gupta instituted other changes
to support quality improvement efforts. He recognized that the structure of his global leadership
team, which met every two weeks by teleconference and four times per year in person, needed to
change to include the quality heads from each site. He believed this would force them to work
together and communicate. Gupta described the new dynamic: “Previously the global leaders could
say I need a report on this or that, can you run some numbers for me? At the site they would say why
would I do that, what am I going to get out of that? And then they wouldn’t do it, or they would send
in data that was not complete. Now they were on the same team and I was putting the global people
on the spot. I would say I hear there was an issue with this report, can you please explain why you
need the report and how it’s going to be used?”
Gupta prioritized better training for employees around engagement and agility. Around the same
time he hired Brown, Gupta brought in Dorothy Mills to develop a new training curriculum, one that
emphasized agile learning methods, quality, and consistent messages throughout the curriculum.
Gupta and Mills reduced the 72 Good Manufacturing Practices trainings at NIN to one in-person
training. They introduced a new sterility assurance training program. Even long-time NIN employees
came away from the trainings saying they gained a lot of new knowledge. And they started a
program about leadership in drug manufacturing operations.
Taking Our Chance
After meeting with leaders, Gupta and Brown asked site heads who they thought would be
interested in discussing the direction of NIN and how things might change. In late 2014, roughly 40
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Sandra Brown Goes Digital (C): Raising Quality in a Healthcare Company 318-084
people of all ages from four hierarchical ranks (NIN had 9 total ranks) participated in two days of
discussions in London.
NIN already had a mission statement that employees strongly identified with: “To harness the
power of biology to prevent human suffering.” Brown and Gupta wanted a mission for the new
movement to work alongside the company’s. They sought to improve quality through the movement,
but felt the new mission could not be confined to just quality. It had to unite diverse groups across
the company, and it had to be employees who owned the new mission.
The 40 participants in London spent two days discussing how best to word a new mission that
would engage employees and motivate them to improve performance. They wrestled over each
word. They disagreed strongly the first day, but persevered. Some continued the discussion over
drinks at a pub that first night. As some tuned into a football match on the pub’s television, the match
commentator talked about the importance of one team’s striker “taking his chances,” or scoring goals
when the opportunities arose during the match. The phrase struck a chord with participants at the
pub, and they took it back to the full group the next morning. Together, after two days they came up
with “Taking Our Chance” and developed a mission: “How will I take my chance today, to reduce
human suffering tomorrow?”
Brown traveled to NIN sites and held discussions with leadership teams and with volunteers at
each site. With leaders she discussed what it meant to be a leader, trust versus control, and how much
could be solved by one leader? Some leaders reacted with hostility. Some paid lip service. Others
were open-minded.
Employees whom site managers had identified as potentially being interested in Brown’s message
of change were asked to volunteer to attend a meeting where Brown presented the vision. She
envisioned a company of engaged employees at all levels participating and offering solutions to
company problems. She asked people to think about the question: “How will I take my chance today,
to reduce human suffering tomorrow?” After her presentation she would ask if the vision resonated
with people. What they believed, what they didn’t, what they thought possible at the site, what had
the challenges been? She then asked who supported it, and said anyone who didn’t could walk away
with no problem at the lunch break. Everyone returned.
In the afternoon, Brown asked participants if they were willing to promote Taking Our Chance,
engage colleagues in it, and build active support for it at their work sites. They all responded
affirmatively, and then asked how they should go about doing so. Brown replied they should figure
that part out. Leaders provided no roadmap, no training, and no direction, only the idea of Taking
Our Chance.
Participants took the idea of Taking Our Chance back to their coworkers. They formed groups to
help garner attention and win support. Some of the groups quickly realized that they needed to find a
name; The Petri’s formed in New Jersey, Go On! formed in England. They created logos and put them
on t-shirts, cards, and other promotional material. (See Exhibit 2 for The Petri’s promotional material.)
Sites developed different ideas to engage employees. Some utilized Chatty. Others preferred face
to face tabling events with free food. Some ideas would eventually get rejected as unrealistic, but
Brown encouraged creativity and independence. She explained: “In this process of them learning to
do things on their own, they realized they had to unlearn big huge ideas or unlearn perfection as
well. And that’s something very difficult for us in our company.” People also needed to learn that
authorizations were not necessary for small decisions.
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318-084 Sandra Brown Goes Digital (C): Raising Quality in a Healthcare Company
In June 2015, 50% of NIN employees had pledged support for Taking Our Chance. Brown noted
the 50% support as a threshold that ensured a “level of energy around change that you can then
channel into action.” It also differed from standard NIN practices in which an initiative would end
after meeting the goal. Brown and Gupta wanted to use the energy created around change to push
further action and improve quality.
Global Leadership Committee
In mid-2015, after securing support for Taking Our Chance, Gupta and Brown called for
volunteers across NIN to submit applications online for a Global Leadership Committee (GLC), a
group of 25 people who would work on change issues at the company for a 12-month term.
For the initial term, mid-2015 to mid-2016, they received 70 applications that they then
anonymized and selected participants from. Brown removed names from applications, but left details
about gender, tenure, function, and hierarchical rank. Each site had a set number of seats on the GLC,
and so each site had a jury, made up of 50% leaders and 50% volunteers, who selected participants
based on the information provided. Diversity criteria also factored in. Selectees were expected to
dedicate between 4 and 6 hours each week, on top of their regular work, to the GLC. Applicants were
strongly encouraged to consult their managers prior to applying; one selectee on the first GLC had
done so, was told no by his manager, and applied and participated anyway.
The first GLC consisted of employees from eight different hierarchical levels, from shop floor
operator to senior director. They met four times face-to-face during the year. For some, it was the first
time they traveled outside of their home country.
At the end of August 2015, the GLC held its first meeting and communicated with senior leaders
who were invited to that meeting. After the leaders left, the GLC was asked what they heard and
what didn’t they hear that they would have liked to? Concerns were discussed. They then formed
subgroups on topics of particular interest to work on in more detail. The first GLC selected
simplification, engagement, and training onboarding as key topics. New ideas and information
produced by the GLC would be relayed to the sites, which each had local teams modelled on the
GLC, and the local sites would work on local issues. Local groups would begin working each year in
September so they could work with the GLC.
Volunteers who worked on the onboarding process decided they wanted to establish a “buddy
system” that involved volunteers welcoming new hires to NIN. On one site the volunteers met with a
Human Resources representative about the idea. She told them the company already had an
onboarding process; they informed her this was not the same thing. She asked how they would select
volunteers; they answered that there was no selection, just volunteers. She asked them how
volunteers would be trained; they told her that volunteers were just welcoming new hires and
helping them with questions about the company and site. Lastly, she asked them, without formal
training, how could they be sure that volunteers said the right things?
Volunteers created the program, complete with a movie trailer that illustrated who they were and
what they did, and their fun, engaging approach to a “buddy” system based on “superheroes.” A
couple months later the Human Resources representative realized that her approach had been
informed by a company culture of control. She would later tell the story to colleagues herself. Brown
called it “something totally unusual, unseen, something really strange, and it was the best team ever,
we’ve ever seen, because they were motivated and driven by this common cause and common
purpose.” She added: “what we’ve created is an ecosystem of people who care for each other. We’ve
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Sandra Brown Goes Digital (C): Raising Quality in a Healthcare Company 318-084
been able to expand the identity of people beyond their role to consider the whole.” For year two,
Brown received 250 applications for the GLC.
Connecting NIN and Sharing Ideas
The social media platform Chatty and its translate function connected volunteers at NIN’s global
locations. Employees shared ideas and asked questions about practices or procedures to find better,
more efficient ways of getting things done. Visual capabilities allowed users to share pictures,
helping to create a sense of shared company community. Brown noted that Chatty helped them
“create a dialogue across hierarchies, which was not a given because it was so strong in our company,
across hierarchies, across sites, geographies, culture.”
As initiatives encouraged an “activist” mindset, solutions came from everywhere. In a facility
outside of London, an employee performing analytical testing using an old fashioned method found
a better way. He needed to weigh out one gram of a toxic reagent, plus or minus 10%, under a fume
hood. The old process involved placing the reagent on a balance to ensure accuracy; he did this 60
times a day. The employee had a newborn son, and he used a pre-measured scoop to make baby
formula for him. He approached the maintenance department and asked if they could make him a
one gram scoop similar to what he used for baby formula. They did so and he began using it. What
used to take him one hour each day now took five minutes.
A team that helped manufacture antibiotics in northern New Jersey instituted a “pillar system,”
proposed by the shop floor manager to empower his team. In this system, operators checked each
other’s work. Review became a peer approach rather than hierarchical. From mid-2016 to mid-2017,
no human errors occurred among this team. Site leaders in northern New Jersey, who previously
would attend management retreats together, started to invite people working in production at the
site to attend and share ideas with them.
Employees presented Gupta with solutions to problems he didn’t know existed. One day, he
discovered on Chatty that safety issues existed with syringes being used in some production
processes. There had been incidents of employees accidentally sticking themselves with needles.
Unbeknownst to Gupta, an employee developed a tool that allowed hands-free use of the needles. It
cost around 5 pence and since its introduction in early 2017, no needle-related accidents had occurred
at the site.
Volunteers created a database accessible to all employees to record and view “wins.” The database
allowed a user to enter a problem confronted, the solution developed, and what it saved the company
or enabled it to do. In May 2017, the database contained 1,400 wins. Global volunteers picked three
interesting wins each month and promoted them by interviewing the “win” authors and writing a
short piece on the story of the win. Stories circulated on Chatty; leaders received stories via email;
and TV monitors at the sites depicted the stories. In summer 2017, volunteers were working to
revamp the database and make it more visually engaging and appealing.
The open communication encouraged within was practiced by Gupta when engaging with outside
stakeholders. He worked more closely with regulatory agencies, informing them of the issues NIN
was working on with respect to quality, even when they presented potential problems for quality.
Rather than worry if an inspection would turn up something, he preferred to inform about what
worked and what didn’t, and how NIN was working to improve what didn’t.
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318-084 Sandra Brown Goes Digital (C): Raising Quality in a Healthcare Company
Challenges remained. Some managers felt that the volunteer initiatives were a “hobby,” and not
essential to the company. Brown characterized the attitude as “something you do when you finish
your work instead of understanding that it’s the way you do your work.” Some leaders considered it
unnecessary if the company was made lean enough.
Quality improved dramatically at NIN. By May 2017, sterility issues were down by 50% compared
to 2015; accidents by 40%. By June 2017, 90% of drug batches were produced on time, compared to
50% when Gupta took over; failures related to human errors and reconciliations decreased by 30–40%;
overall failures of batches lost were reduced as well.
Brown sought external awards to promote the initiatives. Taking Our Chance won an award in
2016; NIN was recognized for employee engagement, its excellence in quality and operations, and for
business transformation in 2017. In some cases, the volunteers applied for the awards. In fall 2017,
Brown was to get an industry award at a ceremony in New York City.
Taking the Next Chance?
At the end of June 2017, Brown and Gupta worked on a strategy document for the CEO of NIN,
James Cole, detailing how to expand the movement to the rest of the company. Despite positive
results related to quality, top leaders still needed convincing that similar movements could help
achieve desired results in different areas of the company.
Brown and Gupta were also scheduled to speak at a meeting of the top 200 company leaders in
California about the quality movement. Several leaders in R&D and Operations had expressed an
interest in expanding this to their divisions. But NIN consisted of 9,000 employees; its leadership had
not traditionally embraced engagement. Given the size and complexity of the company, questions
remained about the applicability of the movement model Brown had developed, and what would
need to be altered or developed further to allow it to succeed in transforming a company on such a
grand scale.
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Sandra Brown Goes Digital (C): Raising Quality in a Healthcare Company 318-084
Exhibit 1 NIN Financial Data, 2012–2016 (disguised)
Source: Company documents.
Exhibit 2 The Petri’s Card with Logo and “Taking Our Chance” Mission
Source: Company documents.
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