module 3 rolling with resistence final

#SHCR @School4Radicals

http://www.theedge.nhsiq.nhs.uk/school/

Module 3:

Rolling with resistance

Supported by

Joining in today and beyond• Please use the chat box to contribute continuously during the

web seminar

• Please tweet using hashtag #SHCR and the handle @School4Radicals

• Join our Facebook group School for Health and Care Radicals

• We will produce summaries of the discussions on each module using Storify and Pinterest and put on the website

• Join in the Tweetchat each Wednesday at 4-5pm (GMT) using the hashtag #SHCR

The team today

Session lead: Helen Bevan @HelenBevan

Learning lead and case study: Pip Hardy@PilgrimPip

Chat monitor:Dominic Cushman@domcushnan

Case study alumna:Vanessa Garrity@VanessaLGarrity

Icebreaker & twitter monitor:Kate Pound@kateslater2

When I meet with resistance at work, I…

… initiate a conversation in the hope of understanding the other point(s) of view.

… know I’m right – I just have to persuade the resisters!

… bring together people with different ideas and encourage them to use their energy for change.

With which role do you most closely identify?

Receiver of care Campaigner

Change agentAwesome Chief listener

Giver of care

Best role: Director of Possibilities!

Who are the students of the School for Health and Care Radicals?

• 77% - healthcare workforce (all sectors)

• 6% - local government which include social workers, public health

• 6% - education (research and universities)

• 11% - “others” which includes patients and carers, voluntary sector, consultant /private sector and police

The biggest learning groups in the School for Health and Care Radicals

• Nottingham University Hospitals, England – 65 people

• NHS England – 36 people

• Kingston General Hospital, England – 29 people

• Nelson Marlborough District Health Board, New Zealand – 23 people

The #WARuralHealth learning group

• What do we mean by resistance to change?

• Some different ways to look at resistance

• Importance of diversity in leading change and its implications in terms of resistance

• Impact and intent

• Using the Stages of Change model to understand “resistance” and help people through change

• What we tend to do when dealing with resistance and what we should do?

• Call to action and reflectionSource of image: www.freshnessmag.com

for today

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 AdvantageSource of image: Businessconjunctions.com

“Thousands of patients have died

needlessly because of a damaging reluctance amongst

doctors and the public to accept changes in the NHS, according to

the country’s top emergency doctor

What do we mean by

#SHCR @School4Radicals Source of image: sport-fitness-advisor.com

Any force that stops or slows movement

Resistance

In module 1, we talked about:

Let’s think about this in the context of “resistance”

Leading change in a new era

Dominant approach Emerging direction

• Change can be planned and managed through a rigorous process

• Resistance is a force to overcome

• Resistance prevents change

• Change agents mustdiagnose, manage and/or overcome resistance

• Resisters can otherwise be known as “laggards”, “blockers”, “in denial”

Resistance to change: the dominant approach

An example “dominant approach” transformation programme

“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 StonehouseThe change agent: the manager’s role in change

British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445

Dominant approach: the role of the change agent

Leading change in a new era

• Change in human systems is often emergent and hard to predict

• Change results from connections/interactions stimulating different perspectives, shaping how people think about things

• Resistance is an inevitable consequence of a complex change process

• Resistance should be embracedand rolled with

Dominant approach Emerging direction

• Change can be planned and managed through a rigorous process

• Resistance is a force to overcome

• Resistance prevents change

• Change agents mustdiagnose, manage and/or overcome resistance

• Resisters can otherwise be known as “laggards”, “blockers”, “in denial”

“Change doesn’t rain down on us from on high. Rather, its stories are co-

created and co-owned by the community. Or, at least they are if you want

the change to stick”Julian Stodd

https://julianstodd.wordpress.com/2013/11/29/the-co-creation-and-co-ownership-of-organisational-change/

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

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

Source of image: driverlayer.com

‘‘

Cultural change is a million

subversive acts of resistance.”

Brene Brown

Source of image: zazzle.com

‘‘

Language constructs our world(s) rather than reports the objective facts about the world. Therefore changing when, where, how and

which people talk about things – changing the conversation – will lead to organisational

change.”Robert J Marshak

Source of image: createbusiness.net.au

‘‘

1. Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system and by being welcoming

2. Create opportunities for everyone to express their views, spot opportunities and build on each other’s ideas

3. Create ways for people to reflect together to find meaning, understanding and shared purpose in the change

Source: Peggy Holman

Emerging direction: the role of the change agent

Source of image: rachtalks.pressprestige.com

“Having care wrapped around the person rather than the person pushed through the system.”

Lesley Young-MurphyNorth Tyneside Clinical Care Group

Case study: A story of resistancePip Hardy

‘I have a dream…’

www.patientvoices.org.uk

The evidence of experience

‘Statistics tell us the system’s experience of the individual, whereas stories tell us the individual’s experience of the system…’

Tony Sumner, 2009

The Patient Voices mandala

‘The stories go out, like flashes of light over the waves, as markers and guides, comfort and warning.’

Winterson 2004

“The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities. Do this before you start hiring consultants and rethinking your innovation process, there is no process that works without true diversity.”

Idris Moore

Source of image: idsgn.org

Diversity is critical to innovation and change

“Leaders and organisations must let go of the idea that there is “one right way” and instead focus on creating a learning culture where people feel accepted, are comfortable contributing ideas, and actively seek to learn from each other”

Diaz_Uda, Medina and Schill (2013)

Source of image:fineartamerica.com

As health and care radicals, we should be champions of diversity for change

In the context of “rolling with resistance”

• What are the implications of embracing diversity of thought, experience and background in our change efforts?

• What skills and perspectives do health and care radicals need to work effectively with diverse teams for change?

Source of image:fineartamerica.com

Discussion

Our effectiveness as change agents is not a matter of intention; it’s a matter of impact

• Helen’s intent was to give people quick solutions, help them do their work faster and get on to the next problem at hand

• However, her impact was that people did not know how to solve their own problems so that Helen’s style was impeding their development

Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee

Source of image: thedigitalawards.com

Stop talkingAT ME

Start talkingTO ME

Source of image: prepbeijing.com

• Build a trusting and supportive work environment

• Listen like an ally • Be open with my intent• Fully commit to the change• Seek common purpose and common

interests• Take time to build relationships• Take responsibility for my own actions

What can I do?

If your horse dies, get off it.”Cherokee proverb

Source of image: fenwickgallery.co.uk

‘‘

#SHCR @School4RadicalsImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Make it a personal PERFORMANCE target.

#SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

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 twelfthcontact

Source: http://www.slideshare.net/bryandaly/go-for-no

“Papers that are more likely to contend against the status quo are more likely to find an

opponent in the review system—and thus be rejected —but those papers are also more

likely to have an impact on people across the system, earning them more citations when

finally published.”V. Calcagno et al., “Flows of research manuscripts among

scientific journals reveal hidden submission patterns,”

Science, doi:10.1126/science.1227833, 2012.

“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

• 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

• 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

“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

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

I am continuing to not smoke.

I sometimes miss it – but I am still not

smoking

“Stages of change” Transtheoretical model of behaviour change

• Which stage do most change activities in health and care focus on?

• Which stage are most people actually at?

Some questions

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

• Designed for Stage 4 –ACTION!

• Mandated it through targets

• Despite compelling case for change –people resisted it – no values connection

• People did the task and missed the point

Example – WHO Surgical Safety Checklist

IN A NUTSHELL

• Evidence from observational studies that the use of surgical safety checklists results in striking improvements in outcomes

• Led to rapid adoption of such checklists worldwide

• Researchers studied effect of mandatory adoption of checklists in Ontario, Canada

• Use of checklists not associated with significant reductions in operative mortality or complications

• 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?

The single biggest problem in communication is the illusion that it has taken

place.”

George Bernard Shaw

‘‘

• Listen and understand• appreciate the starting point

• elaborate interests

• Roll with resistance (Singh) • Don’t argue against it• Encourage elaboration of resistance•What makes it so hard?•What would help?

• Build meaning and conviction in the change

So what SHOULD we do?

• 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

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

Case study: Stages of ChangeVanessa Garrity

“Tomorrow’s management systems

will need to value diversity, dissent and divergence as highly

as conformance, consensus and

cohesion.”

Gary HamelSource of image: www.fastcompany.com

Call to action for this week

• Reflect deeply on how you operate as an agent for change

• Consider the impact of your communication and behaviour beyond your intent

• Listen to others’ views, engage others in change and help others through the stages of change

• Wednesday 18th February

16:00-17:00 Tweet chat #SHCR

• Next Friday morning 20th February

module 4: Making change happen

Next opportunities for learning

1. What does resistance mean to you?

think about the things you resist as well as your responses to others’ resistance

2. How do you work with resistance as a change leader?

3. How can you make sure that the changes you make achieve the impact you desire and also

are sustainable?

do not create dependency?

generate self-efficacy in others?

4. Who you are interacting with and where they are on the Stages of Change model?

Questions for reflection

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