#RTR2016 @HelenBevan #RTR2016 Rewriting the Rules: Enduring and Emerging Approaches to Change Helen Bevan @HelenBevan #RTR2016 Download these slides if you want to follow them today: www.slideshare.net/HorizonsCIC/rewriting- the-rules-enduring-and-emerging-approache s-to-change
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#RTR2016
@HelenBevan #RTR2016
Rewriting the Rules:
Enduring and
Emerging
Approaches to
Change Helen Bevan
@HelenBevan
#RTR2016
Download these slides if you want to follow them today: www.slideshare.net/HorizonsCIC/rewriting-the-rules-enduring-and-emerging-approaches-to-change
1. Identify major themes and trends in the global world of change that are starting to shake our world of healthcare improvement2. Consider the implications for our own practice as leaders and practitioners of change and improvement3. Test out some of the new change methods and approaches in an interactive way4. Consider the opportunities and implications of these for our own practice as leaders of healthcare improvement5. Take home a toolkit of new and additional approaches to supporting change to complement your existing healthcare improvement toolkit and make your improvement efforts more likely to succeed
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• Welcome and introductions; outline of the day• What’s our message for today?• What is happening in the wider world of change?• Why this is the era of the healthcare rebel• Coffee break in the form of a RCT (randomised coffee trial)• Change starts with me• Lunch• Rolling with resistance to change• Leading change in a complex world: managing polarities
(including coffee)• Sharing lessons learnt
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What is your slogan for today?
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“New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)
Source of image: installation by the artist Adam Katzwww.thisiscolossal.com
Source: Sewell (2015) : Stop training our project managers to be process junkies
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Power in community“Power used to come largely through and from big institutions.Today power can and does come from connected individuals in community.When community invests in an idea, it co-owns its success.
Source of image: orton.org
Instead of trying to achieve scale all by ourselves, we have a new way to have scale. Scale can be in, with and through community.”
Nilofer Merchant
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“I have some Key Performance
Indicatorsfor you”
or
“I have a dream”
Source: @RobertVarnam
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“Tomorrow’s management systems will need to value diversity, dissent
and divergence as highly as conformance, consensus and
cohesion.”Gary Hamel
Image by neilperkin.typepad.com
is the new normal!
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“Tomorrow’s management systems will need to value diversity, dissent
and divergence as highly as conformance, consensus and
cohesion.”Gary Hamel
Image by neilperkin.typepad.com
“The single biggest mistake to avoid? Creating disruption at work. Focus on developing relationships, not disrupting and alienating people. Peter Vander Awera on learning from setbacks and failures
is the new normal!
##FabChangeDay
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What happens to heretics/radicals/rebels/mavericks
in organisations?
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@HelenBevan #RTR2016Source: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out
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We need rebels!•The principal champion of a change initiative, cause or action
•Rebels don’t wait for permission to lead, innovate, strategise
•They are responsible; they do what is right•They name things that others don’t see yet
•They point to new horizons•Without rebels, the storyline never changes
Join in one of our national Randomised Coffee Trials
fabnhsstuff.net/fabchangeday/rct/ or google “Fab stuff RCT”
Mental health – for anyone interested in mental health issues Dementia – for anyone interested in dementia issues Staff wellbeing – for anyone interested in how staff are cared forPatient Safety – for anyone with an interest in ensuring patient safety across the health and social care systemHome First – looking at the issues around how people who have long-term health conditions receive care outside of hospitalLearning and Leading Together – for anyone interested in how patients and healthcare staff can work together in genuine partnershipMatExp – for anyone interested in improving maternity experience – women and families as well as professionals
Research from the sales industry:How many NOs should we be seeking to get?
• 2% of sales are made on the first contact• 3% of sales are made on the second contact• 5% of sales are made on the third contact• 10% of sales are made on the fourth contact• 80% of sales are made on the fifth to twelfth contact
Employee resistance is the most common reason executives cite for the
failure of big organizational-change
effortsScott Keller and Colin Price
(2011), Beyond Performance: How Great Organizations Build Ultimate
Competitive Advantage Source of image: Businessconjunctions.com
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Looking back to:
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Let’s think about “resistance” in old/new power terms
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• Change can be planned and managed through a rigorous process
• Resistance is a force to overcome
• Resistance prevents change
• Change agents must diagnose, manage and/or overcome resistance
• Resisters can otherwise be known as “laggards”, “blockers”, “in denial”
Let’s think about “resistance” in old/new power terms
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Resistance to change: the old power mindset
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“The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to
implement successfully and may not succeed at all”David Stonehouse
The change agent: the manager’s role in changeBritish Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013,
Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........
Sensemaking is not done via marketing...or slogans but by emotional connection with employees
Ron Weil
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Resistant behaviour is a good indicator of missing relevance
Harald Schirmerhttp://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-role-of-hr-driving-social-adoption-and-change-in-the-enterprise
“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
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• smoking cessation • exercise adoption• alcohol and drug use• weight control • fruit and vegetable intake• domestic violence• HIV prevention• use of sunscreens to prevent skin cancer • medication compliance • mammography screening
The model is mostly used around health-related behaviours
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• smoking cessation • exercise adoption• alcohol and drug use• weight control • fruit and vegetable intake• domestic violence• HIV prevention• use of sunscreens to prevent skin cancer • medication compliance • mammography screening
It works for organisational and service change too!
The model is mostly used around health-related behaviours
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“Stages of change” Smoking
I am not aware my smoking is a
problem – I have no intention to quit
Prochaska, DiClemente & Norcross (1992)
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“Stages of change” Smoking
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
Prochaska, DiClemente & Norcross (1992)
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I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped
smoking!
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped
smoking!
I am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped
smoking!
I am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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Prochaska, DiClemente & Norcross (1992)
“Stages of change” Transtheoretical model of behaviour change
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• Which stage do most change activities in health and care focus on?
• Which stage are most people actually at?
Some questions
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The reality of our change situation• Our tools are often not effective at the stage of change
that most people we work with are at• It’s hard to engage people in change• It’s hard to get people to make the changes we want
them to make• People get irritated, defensive, irrational• We feel powerless in our ability to lead or facilitate the
change
90% of the tools available for health and care change agents are designed for the “action” stage
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• Designed for Stage 4 – ACTION!
• Mandated it through targets
• Despite compelling case for change – people often resisted it
• People did the task and missed the point
Example – WHO Surgical Safety Checklist
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Source: Russ et al (2015) A Qualitative Evaluation of the Barriers and Facilitators Toward Implementation of the WHO Surgical Safety Checklist Across Hospitals in England: Lessons From the “Surgical Checklist Implementation Project” Ann Surg
“In hospitals without adequate resources and efficient systems, simply requiring the checklist to be used might not only fail to improve patient safety but might also introduce new risks for staff and
patients. This is the exact opposite of what the checklist was designed to achieve”.
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• Lower our ambitions for improvement• Focus our energies on those who are
already in the “action” stage• Put negative labels on those who are
not yet at the action stage such as “blocker” or “resister” or “laggard”
• Blame “the management” for not enforcing change
So what do we TEND to do when people resist?
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The single biggest problem in communication is the illusion that it has taken
place
George Bernard Shaw
‘‘
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• Listen and understand• appreciate the starting point• elaborate interests
• Roll with resistance• Don’t argue against it• Be curious and accepting• Encourage elaboration of resistance
• What makes it so hard?• What would help?
• Build meaning and conviction in the change
So what SHOULD we do?
See Motivational interviewing as a change management strategy
• The focus should be on creating awareness for me of the need to change
• Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation
• I am not thinking about changing my behaviours, actions or work processes
• The problem or issue is outside my frame of awareness or my perceived need
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If your horse dies, get off itCherokee proverb
Source of image: fenwickgallery.co.uk
‘‘
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Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model: • What stage of change are some of the key
people that you need to influence for your change initiative at?
• What actions can you take to help them move to the next stage?
Thinking about your own situation
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“The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function”F Scott FitzgeraldAuthor, 1896-1940
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“Every conflict is an invitation to innovation.”
Mary Parker FollettSociologist, 1868-1933
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Polarities in today’s workshop
Old power AND New power List A AND List B
Hierarchies AND Networks Transactions AND Relationships
At the edge AND In the centre On the inside AND On the outside
Change methods AND Emergent change
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Polarity map concept
Source: Barry Johnson
+
–New powerOld power
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Polarity map concept
Source: Barry Johnson
Centralise Decentralise
+
–Centralise DecentraliseDecentraliseCentralise
Either-Or
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Q is a thriving, effective community of improvement leaders
The Q community fails to fulfil its potential
Example
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Positive results of focus on this left pole
Negative results of over-focus on the left pole to the neglect of the right pole
Negative results of over-focus on the right pole to the neglect of the left pole
Deeper Fear from lack of balance
Greater Purpose Statement - why balance this polarity?*
and
Adapted from the Polarity Management map, Polarity Associates
Polarity MapAction stepsHow will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures?
Action StepsHow will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures?
Early Warnings Measurable indicators (things you can count) that will let you know that you are getting into the downside of this left pole.
Early WarningsMeasurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole.