Article summary

How to Change an Organization Without Blowing It Up

W I N T E R 2 0 1 3 V O L . 5 4 N O . 2

R E P R I N T N U M B E R 5 4 2 1 3

Karen Golden-Biddle

SLOANREVIEW.MIT.EDU

TOO OFTEN, conventional approaches to organizational transformation resemble the Big Bang theory. Change occurs all at once, on a large scale and often in response to crisis. These approaches

assume that people need to be jolted out of complacency to embrace new ideas and practices. To

make that happen, senior management creates a sense of urgency or takes dramatic action to trigger

change. Frequently, the jolt comes from a new CEO eager to put his or her stamp on the organiza-

tion. Yet we know from a great deal of experience that Big Bang transformation attempts often fail,

fostering employee discontent and producing mediocre solutions with little lasting impact.1

But meaningful change need not happen this way. Instead of undertaking a risky, large-scale

makeover, organizations can seed trans-

f o r m a t i o n by co l l e c t ive l y u n cove r i n g

“everyday disconnects” — the disparities

between our expectations about how work is

carried out and how it actually is. The dis-

cover y of such disconnects encourages

people to think about how the work might

be done differently. Continuously pursuing

these smaller-scale changes — and then

weaving them together — offers a practical

middle path between large-scale transfor-

mation and small-scale pilot projects that

run the risk of producing too little too late.

Researchers tend to overlook this op-

tion because few managers have employed

it until recently, assuming they needed to

take an all (Big Bang) or small (pilot proj-

ects sequestered away from the dominant

organizational culture) approach to orga-

nization change. That may have been more

true in the past when organization bound-

aries were less malleable, communication

How to Change an Organization Without Blowing It Up There is a middle ground between wholesale change and tentative pilot projects — and it could allow your organization to operate far more effectively. BY KAREN GOLDEN-BIDDLE

THE LEADING QUESTION What in- creases the odds of successful organizational change?

FINDINGS There is a middle path between a risky, large-scale makeover and lim- ited pilot projects.

Look for disconnects between how you expect work to be done and how it actually is done.

Determine how to turn the inevitable surprises you and your organization discover into oppor- tunities for change.

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WINTER 2013 MIT SLOAN MANAGEMENT REVIEW 35

Health-care employees can identify new ways to improve patient care.

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C H A N G E M A N A G E M E N T

more difficult and people less mobile. However,

today’s complex and connected global environ-

ment makes step-by-step transformation by

managers inside most organizations a real possi-

bility, if senior leaders recognize and help cultivate

their employees’ collective capability to discover

everyday disconnects. Organizations can practice

uncovering these disconnects on a scale extensive

enough to make a real difference, yet at a rate that

keeps the effort focused and manageable within

budgetary and time constraints.

My research has found that organizations take

three approaches to discovery that are particularly

effective both for uncovering everyday disconnects

in their work and for seeding transformation from

the bottom up. (See “About the Research.”) These

techniques can be used together, in any combina-

tion, or individually. All three techniques share a

common trait: They take rigid, prescriptive activi-

ties like work design, best practices or training;

strip them of their chief assumptions; and turn

them into powerful instruments for finding new

and better ways of getting things done.

The three techniques are:

1. Work discovery: Instead of assuming that you

know how work is designed, examine it firsthand as

it is actually conducted. Determine how to turn the

(inevitable) surprises you uncover into assets.

2. Better practices: Instead of simply adopting

other organizations’ best practices, screen the way

work gets done in your organization through those

best practices in order to generate new ideas. In

other words, use best practices to generate even

better practices.

3. Test training: Instead of locking down stan-

dard oper ating procedures dur ing t r aining ,

experiment with other, potentially better possibili-

ties for changing the way the work will get done.

Use training for testing these possibilities.

Each technique strips away assumptions and

gains additional power by pairing something unfa-

miliar with something familiar. Work discovery

pairs the familiar territory of managers’ offices with

the less familiar territory of frontline operations. A

focus on better practices imports the unfamiliar

into the organization via others’ practices and pairs

them with the (familiar) way work is currently

being done. Test training pairs new standard oper-

ating procedures with possible new procedures that

emerge during training. Such pairings prompt peo-

ple to look beyond familiar expectations and see

the actual work in light of the possible instead of

just the prescribed or presumed. By using these

techniques, people throughout an organization can

collectively surface everyday disconnects, see new

possibilities in deeply familiar contexts and gener-

ate new ways of working. As a result, improvement

multiplies methodically, reliably and continuously,

and you can achieve continuous, sustainable

change in the organization without having to blow

it up and then reassemble the pieces.

The Three Discovery Techniques Generating new possibilities for organizational

change requires a collective capacity to see beyond

what is currently done. Yet moving past what we ex-

pect to see and identifying new possibilities is not a

capability that has been cultivated widely, either by

individuals or by organizations. Absorbed in our

everyday work, we overlook possibilities right in

front of us. That’s a problem. After all, renowned

management thinker Peter Drucker once explained

his ability to generate insights by saying simply, “I

just look out the window and see what’s visible —

but not yet seen.”2 As Drucker suggested, the ability

to see past what is currently seen — and, in the

workplace, currently done — is essential for trans-

formation. Fostering this capability begins with

implementing discovery techniques.

Work Discovery: Examine Firsthand the Work

Where It Is Actually Conducted Seeing the orga-

nization’s work as it is conducted by people on the

front lines takes senior managers and others out of

their familiar habitats and enables them to compare

close-up observations of the work with their expec-

tations, uncovering disconnects in the process.

Consider, for example, how people in ThedaCare

Inc., a medium-sized community health system in

Wisconsin, created a new model of inpatient care.

Known as collaborative care, the model has garnered

national visibility for its exceptional quality and

safety, as well as patient and clinician satisfaction.

This model is designed around the patient, pulling

care to the bedside whenever needed and enabling

staff to focus on getting patients well.

ABOUT THE RESEARCH This article is based on ideas developed from more than 25 years of research,i teaching and conducting executive edu- cation and consulting in the theory and practice of large-scale change.

The research I have con- ducted comprises three large, multiyear and multi- site ethnographies — a Fortune 200 manufacturing organization, a large non- profit service organization and a provincial health-care system in Canada — as well as interview-based investigations of organiza- tions undergoing large-scale change, including Theda- Care. The ideas have been refined and tested in execu- tive education sessions with, for example, the company Ericsson and the American Society of Health System Pharma- cists, as well as in MBA and EMBA courses.

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For Kathryn Correia, senior vice president of

ThedaCare at the time, the origins of the innovative

collaborative care model began in 2003. Seeing her job

as bringing out the best of the organization, she

looked around the hospital, searching for possible

answers to questions such as: “What is it that has to be

right? What is the most important thing a hospital

actually contributes to the delivery of high-quality

patient care, versus the many things that we do in little

clusters such as radiology, lab, outpatient surgery,

respiratory therapy?” Early conversations ensued with

managers and clinicians (including nurses, physicians

and pharmacists) around these questions. To look

more closely at the hospital’s emergency, inpatient

and outpatient flows of care delivery, Correia brought

together a broad group of clinicians and managers

from across the system. Because each clinician knew

only part of the flow of patient care and the managers

weren’t in constant contact with direct patient care,

the group decided to map the current care delivery

flows from the viewpoint of patients.

They could have taken a different approach, of

course. For example, they could have sat down with

a flow chart and figured out inefficiencies; they

could have identified how medical/surgical units

are organized in other systems; or they could have

searched the literature for ideas that had worked at

other organizations. Instead, acting as if they were

patients, the group members followed the paths

typical patients take in receiving care. Those fol-

lowing an inpatient’s path experienced the flow

from admission to discharge. Those following an

outpatient’s path experienced the flow from visit-

ing specialty physicians’ offices to getting tests done

and returning to the physicians’ offices.

The managers and clinicians soon noticed that

once patients made contact with ThedaCare’s sys-

tem and were admitted, the care flow was anything

but clear. Patients went off in different directions

depending on what tests were ordered or why the

patients had been admitted.

When the clinicians and managers came back to-

gether, they realized there was no way to map the

care flow. While they could see how patients got into

the hospital through the admission process, they

had no clear idea of how patients got out. There was

no obvious pattern for how patients moved through

the system to get well and be discharged.

Having uncovered the disconnect between their

expectation (that there was a clear patient flow) and

the reality (that there wasn’t), the team wondered if

they might benefit from walking alongside real

patients in order to get a deeper understanding of

patients’ actual experiences of the care flow. Mem-

bers of the team were assigned to individual patients

and asked them to describe what was going on for

them during each step of their experience. Conven-

ing afterward, the group agreed that the results were

eye-opening. They had seen for the first time how

much the outpatient and inpatient flows were inter-

fering with each other and with getting patients

well. For example, if it was midafternoon and inpa-

tients needed tests in radiology to determine if they

could go home, they had to wait until they could be

squeezed in between previously scheduled appoint-

ments — often causing hours of delay.

Above all, the team members noticed how much

of what went on actually got in the way of care and

created negative experiences for patients. A partic-

ularly revealing example was the long distances

outpatients had to walk to get to labs so they could

undergo tests that doctors had prescribed for them.

Walking with the patients, the team members

observed that some — for example, the elderly, pul-

monary patients (who have trouble breathing) and

others who were seriously ill or severely out

of shape — were out of breath by the time they

reached the blood-work lab. They saw patients

struggling and worrying about being late as they

tried to find their way through the seemingly end-

less corridors. No one had noticed this before. The

system was placing undue burdens on these

patients. The clinicians and managers had not

expected that, and they knew it was definitely not

how they wanted to treat patients. As one manager

later said, “It was a big ‘aha.’ And it helped make vis-

ible that we were doing neither inpatient nor

outpatient care as well as we would like.”

This “aha” moment brought quick agreement to

focus first on redesigning inpatient care. And it

helped the team members realize that while they

wanted to deliver the best care, their hospital’s cur-

rent efforts were vague at best and chaotic at worst.

Extraordinary efforts were often required to advance

patients through the system. For example, nurses

would need to make repeated “hurry-up” calls to

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obtain overdue lab results needed to determine what

antibiotics the patient should receive. The preva-

lence of these efforts pointed to the critical role of

nurses in providing ongoing, high-quality care. By

the end of the initial stage, the team members all had

vivid, firsthand experience of critical disconnects,

and they were beginning to generate alternative pos-

sibilities for how work could be done differently.

Embracing the need to change inpatient care

delivery, hospital clinical staff and managers, in con-

versation with ThedaCare leadership, undertook the

building of a new model. A new, smaller design

group again followed the flow with patients, this

time creating a highly detailed chart of the current

inpatient care process and paying close attention to

how this process kept patients in the hospital, with

little work consistently directed toward helping

them get out. This approach contrasted with a com-

mon hospital practice of hiring utilization review

nurses (“care managers”), who assemble documen-

tation focused on justifying to insurance companies

why patients are admitted and need to stay longer.

The vice president of nursing described how the

team “realized at a different and deeper level that the

old process was oriented to justifying patient stays.

We needed a different process — one that focused on

optimal recovery and on pulling the patient through

the hospital system.” In the ensuing months, the or-

ganization’s leadership supported the team’s efforts

to build a new model. For example, the team noticed

that nurses lacked important information about

why physicians pursued specific treatment plans.

Having that understanding of care was not only use-

ful in answering patient questions but also critical in

identifying potential errors, such as improper treat-

ment sequencing. To address this and other

concerns, all clinicians were given access to the con-

text and rationale of a specific treatment plan as part

of the care process redesign, and a clinical trio, com-

prised of a nurse, physician and pharmacist, was

created. The trio met together with the patient and

family to determine a single plan of care.

The new model of general acute care the organi-

zation created, which ThedaCare calls collaborative

care, enables staff to think about patient stays with

an emphasis on getting patients well. In contrast

to models organized around medical condition,

the collaborative care model is designed to help

advance all patients similarly through the system,

regardless of medical diagnosis, while also accom-

modating each patient’s unique needs.

The scope of change in process was extensive. The

doctor, nurse and pharmacist trio would collectively

meet with the patient and family within 90 minutes

of admission. The electronic medical records were

redesigned to reflect a single plan of care. The typical

centralized nursing unit was replaced with multiple

nursing alcoves located just outside patient rooms.

And patient rooms were designed for safety, privacy

and easy interaction with the care team. Designed

during 2005 and 2006 and first implemented in Feb-

ruary 2007 in one medical-surgical unit, this care

model has subsequently spread to all medical-surgi-

cal and many specialty units with dramatic results.

When patients in the initial collaborative care units

were compared with like patients on non-collabora-

tive care units, the team found that average length of

stay decreased by at least 10% with the new model,

and direct costs decreased on average 20% to 25%.

Nurse productivity increased by 11%, and the per-

centage of patients who were satisfied with their care

increased to 95%, up from 68% prior to implemen-

tation of the new model.3

Although the implementation of collaborative

care at first glance looks similar to a traditional pilot

project in that it involved the use of a design team

and was first rolled out in one unit, it was conceived

as part of a larger exploration of what care delivery in

the broader system at its best might become. The ini-

tial unit design and rollout was always connected to

this larger possibility, even though the possibility

itself was in the process of becoming defined.

The care process redesign did not start by trying

to improve unit functioning and then scaling up.

Rather, the team began by exploring care delivery

through mapping inpatient, outpatient and emer-

gency care flows. Only after examining actual

patient experiences and learning how their system

burdened patients were the team members able to

settle on inpatient care as a starting point and to

imagine real possibilities for designing a fully

patient-centric care model.

Finally, while implementing the new model in the

first unit, staff and leadership examined and identi-

fied the specific units next in line for the new model.

This examination prompted consideration about

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what parts of the collaborative care model were

essential to retain and what could be altered in

spreading the model to subsequent units. Those in-

volved in the first unit rollout had come to understand

that the relational aspect of the model was most im-

portant to retain. It mattered that the nurse, physician

and pharmacist trusted each other and interacted

well with each other and with the patient and family.

While other parts of the model might be altered, the

collaborative clinical trio would remain.

Better Practices: Instead of Adopting the Best

Practices of Others, Screen Your Work Through

Those Best Practices in Order to Generate New

Ideas Organizations often devise new ways of work-

ing by simply adopting best practices used elsewhere.

But such best practices can be more effectively used

as a discovery technique, enabling people to go

beyond replication and discover new possibilities for

meaningful change.

Using others’ best practices as a discovery tech-

nique asks people to compare their expectations of

how work is currently done with what might be of-

fered by the best practice. This discovery tool

imports the unfamiliar in the form of others’ best

practices and pairs them with the familiar. Exploring

this pairing enables people to move beyond their ex-

pectations and tease out new possibilities that are

suggested by best practices elsewhere. Overlaying

your current practices with someone else’s best prac-

tices in this way generates better practices — better

than best because they are relevant in highly specific

ways to your organization’s work.

Consider the checklist, a well-publicized best prac-

tice. It was originally created to reduce errors and

standardize the behavior of airline pilots, and it has

since been widely adopted in other contexts. To re-

duce errors in surgical settings, for example, the use of

a checklist prompts members of the surgical team to

identify aloud their names and the name of the

patient, the procedure type to be undertaken and an

itemized list of the instruments and equipment at

hand. In exploring the use of the checklist, surgical

unit staff members of an academic medical center

were asked to use role-play as a way of experiencing

what this best practice might offer for their own work.

In the role-play debriefing, staff members were

asked two questions. The first question was, What

would you do differently in your work as a result of

practicing with the checklist, and what things do

you want to incorporate as unit practice? The

responses identified items that had been on the

standard checklist as well as some additional ones,

such as: Be sure the patient’s ID tag is visible; mark

with a red pen or bright highlighter any patient

requests or conditions requiring extra attention

during or after surgery.

The second question was: What didn’t the

checklist cover that you wished it had, and/or what

didn’t you know how to address in its use? Instead

of merely generating a list of items, this question

prompted an exploration of different possible clin-

ical relationships. The group considered not only

who was responsible for a given activity, which was

a question they had identified before starting the

role-play, but why that particular person was re-

sponsible and whether only one person actually

was or should be responsible. And they went fur-

ther and asked: What would it take for doctors and

nurses to work in full partnership? How might all

clinical members work to their fullest scope? By

considering what they didn’t know in addition to

what they had learned in exploring what the check-

list might offer, the staff could step back from their

usual absorption in their day-to-day work and gen-

erate new possibilities for enhancing how they

related with each other in delivering patient care.

Benchmarking, itself a best practice that identi-

fies others’ best practices, can also be used to spur

people to think about how the conduct of their

work could be organized differently. In attempting

to improve performance, organizations often com-

pare their work processes, strategy and performance

metrics to those of competitors. Such benchmark-

ing tells you how your organization stacks up

against best-in-class organizations and enables you

to take action to close the gaps with them.

But benchmarking deployed in this way results in

imitation. Granted, it is imitation of an organization

believed to be the “best,” but using benchmarking to

follow the leaders limits the usefulness of this tech-

nique for discovery by overlooking its potential as

something unfamiliar that can be paired with the

familiar to generate new ideas.

A university task force on curriculum redesign

used benchmarking for discovery when it expanded

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C H A N G E M A N A G E M E N T

the typical comparison group from competitor uni-

versities and their curricula to include the teaching

conducted in corporate, military and nonprofit orga-

nizations. Widening the focus enabled unfamiliar

organizations to be paired with the familiar content

and sequence of the university’s teaching in its current

curriculum. In exploring what the best practices in the

more unfamiliar organizations might offer, task force

members uncovered a disconnect — not in content,

but in pedagogy. A prime example was the difference

between the current university curriculum’s heavy use

of teacher-focused lecture and in-class sessions versus

the other organizations’ emphasis on learner-focused

experiences. Incorporating ideas such as technology-

enabled classrooms or student-generated content

altered how traditional teaching occurred and broad-

ened the notion of a course. As a result, task force

members were able to step back from the usual gap

analyses that benchmarking produces and not just

consider the curriculum but also develop a more

engaging model for teaching students that included

learning beyond the classroom.

Test Training: Use Training to Experiment With

Emergent Possibilities for the Way Work Will Be

Done Organizations typically test inventive solutions

that are in final development in order to identify ad-

justments or refinements prior to full implementation.

The benefits of this approach are well documented.

Mistakes are identified and more readily corrected,

opportunities for improvement are found and can be

incorporated and the product or model is optimized

and verified before full deployment.

In contrast to refining and establishing proof of

concept, test training focuses on uncovering dis-

connects between people’s expectations for how

proposed solutions might operate and the actual

experience of the solution in experimental settings

such as training or trials. This enables people to see

and come to understand what they don’t know

about the solution as well as to continue to shape it

for implementation, often in significant ways.

Consider an example from ThedaCare’s design

of its collaborative care model. To prepare for im-

plementation of the new model, nurses from the

unit were taken away from their normal duties for

six weeks, and physicians and pharmacists joined

them for intensive periods. Using volunteers as

“patients,” clinicians trained together in a mocked-

up collaborative care unit that matched the newly

designed ones, with private rooms for all patients;

newly designed supply servers outside the patient

room yet accessible to clinicians inside the room;

and, in place of the nursing station, a central area

visible from all rooms. Part of the training was

designed to inculcate new practices like getting

accustomed to what would be stored in the new

private rooms, using the new drug dispenser and

using revised electronic medical records to assure

reconciliation of medication.

A central feature of the new model was the cre-

ation of a trio of physician, nurse and pharmacist

who would deliver care at the patient bedside. To be

effective, the trio required its members to work as a

clinical team, asking questions of each other in front

of the patient and addressing patient questions as a

team. So a second part of the training was designed

to help clinicians see beyond their current expecta-

tions of how they should relate to one another and

entertain possibilities for greater collaboration.

Organization development specialists on staff

worked with nurses to help them see beyond their

existing role, which involved nurses taking direction

from doctors with little opportunity to give input, and

instead become partners with physicians and phar-

macists. As one specialist observed, “This is a different

challenge for nursing staff — to be able to give to and

receive feedback from other members of that profes-

sional team, especially if something is not going well.”

Conversely, organization development staff

worked with pharmacists and physicians to help them

let go of the expectation that they would perform all

the important tasks. As one pharmacist said, “We were

holding onto a lot of things that nurses were already

double-checking and that the doctors were double-

checking, so we needed to build more trust that it was

being covered.” The line manager responsible for phy-

sician engagement noted that trial made “the biggest

difference” in helping physicians accept being in a

team with nurses and pharmacists in the patient’s

room. They realized, she said, that they truly were in a

team and that the pharmacist and nurse had some-

thing to add and contribute and challenge them on, in

a more collaborative way. “The physicians now speak

about the learning that they’ve received because a

pharmacist or nurse is there,” the line manager said.

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Takeaways About Designing Discovery Techniques All three types of discovery techniques share char-

acteristics that differentiate them from more

conventional change practices. Building on organi-

zations’ experiences implementing them, I have

derived a set of key principles leaders can keep in

mind when encouraging the design and use of dis-

covery techniques within their own companies:

• Everyday disconnects should prompt collective re-

consideration (discover y) of expectations or

understanding of how work is conducted and the

entertaining of new possibilities.

• Discovery techniques generate insights and possi-

bilities for change because they help people come

to see what they don’t know rather than confirming

what they do know and maintaining the status quo.

• Discovery techniques operate by pairing something

familiar with something unfamiliar to uncover

everyday disconnects that illuminate people’s

expectations for work, and prompt consideration of

how it might be done otherwise.

• Discovery techniques are deployed in the midst of,

or close to, the doing of the organization’s regular

work. When disconnects are uncovered, it is this

close proximity that brings home the significance

and impact of what is not being done, as well as the

opportunity to generate new solutions.

• Instead of simply dismissing the current way of

doing things as out-of-date, discovery techniques

relate and draw upon the present, as seen in light

of comparing expectations and actual conduct of

work, in order to see future possibilities.

• Although individuals in some of the examples did

separately notice everyday disconnects, discovery

techniques work for seeding transformation be-

cause they connect such efforts and/or foster the

collective uncovering and engaging of disconnects.

By designing and adopting discovery tools that

uncover everyday disconnects, organizations can:

1. Achieve the benefits of transformation without

risking wholesale disruption of operations.

2. Build a culture of continuous improvement that

is embr aced by leadership and employees

throughout the organization.

3. Avoid the often exorbitant costs of Big Bang

transformation associated with wholesale re-

placement of employees.

4. Leverage existing employee knowledge and expe-

rience for transformation.

5. Cultivate collective, not just individual, capacity

in surfacing disconnects and generating new

insights and ideas that seed transformation.

Most importantly, organizations that cultivate

the uncovering of everyday disconnects and ex-

plore possibilities for meaningful change will find

themselves no longer caught between the equally

unattractive possibilities of Big Bang transforma-

tion or remaining in a steady state.

Karen Golden-Biddle is a senior associate dean, profes- sor of organizational behavior and Everett W. Lord Distinguished Faculty Scholar at Boston University School of Management in Boston, Massachusetts. Comment on this article at http://sloanreview.mit.edu/x/ 54213, or contact the author at [email protected].

REFERENCES

1. See, for example, B. Burnes and P. Jackson, “Success and Failure in Organizational Change: An Exploration of the Role of Values,” Journal of Change Management 11, no. 2 (June 2011): 133-162; K. Golden-Biddle and J. Mao, “What Makes an Organizational Change Process Positive?” in “The Oxford Handbook of Positive Organizational Scholar- ship,” ed. K.S. Cameron and G. Spreitzer (New York: Oxford University Press, 2011); McKinsey & Company, “Creating Organizational Transformations: McKinsey Global Survey Results,” August 2008, www.mckinsey- quarterly.com; and M. Beer and N. Nohria, eds., “Breaking the Code of Change” (Boston, MA: Harvard Business School Press, 2000).

2. R. Lenzner and S.S. Johnson, “Seeing Things as They Really Are,” Forbes, March 10, 1997.

3. C. Bielaszka-DuVernay, “Redesigning Acute Care Pro- cesses In Wisconsin,” Health Affairs 30, no. 3 (March 2011): 422-425.

i. See, for example, K. Golden-Biddle and J.E. Dutton, eds., “Using a Positive Lens to Explore Social Change and Organizations: Building a Theoretical and Research Foun- dation” (New York and Hove, U.K.: Taylor and Francis Group, Routledge, 2012); A. Langley, K. Golden-Biddle, T. Reay, J-L Denis, Y. Hébert, L. Lamothe and J. Gervais, “Identity Struggles in Merging Organizations: Renegotiat- ing the Sameness-Difference Dialectic,” Journal of Applied Behavioral Science 48, no. 2 (June 2012):135- 167; J. Howard-Grenville, K. Golden-Biddle, J. Irwin and J. Mao, “Liminality as Cultural Process for Cultural Change,” Organization Science 22, no. 2 (March/April 2011): 522- 539; and T. Reay, K. Golden-Biddle and K. Germann, “Legitimizing a New Role: Small Wins and Micro-Pro- cesses of Change,” Academy of Management Journal 49, no. 5 (October 2006): 977-998.

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