Enabling and supporting change

Susan Lieff MD MEd MMan

October 25, 2014

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Learning Objectives

At the completion of this session you will be able to:

• Describe a conceptual model for change.

• Apply a conceptual model to a change project in one’s local context.

• Identify a variety of tools to support strategies for change.

Outline

Intro

Setting the stage

Orientation to change

Our stories and key learning points

Taking it home

What is change?

to make the form, nature, content, future course, etc., of (something) different from what it is or from what it would be if left alone

to become different, altered, modified, transformed or converted

something different (new)

something modified (redesigned old)

different perception (change in thinking)

http://dictionary.reference.com/browse/change

Why do we need change in health care?

• The world around us is changing all the time

• “We want to and can do better”

• We need to anticipate the future and know how to adapt what we do

• Societal, economic, political and technological pressures

“Different kinds of change”

Incremental Radical

• Continuous progression • Affects a part of the org • Planned or emergent • Managed through existing

structure & management processes

• Technology or product improvement

Paradigm-breaking or Transitional Transforms entire org Requires creation of new

structure & management processes

Breakthrough / new technology & products

Change is grappled with

Waugh 1998

“You don’t manage change. You help to create the conditions for it.

You help people to do what they already want to do.”

Change is grappled with

Influence Empowering Enabling

Persuasion Supporting Developing Celebrating

Many ways to think about enabling change

• Kotter’s model of transformational change

• Innovations - diffusion, disruptive, catalytic

• The learning organization

• Action research

• Project management

• Communities of practice

• Appreciative inquiry

• Complexity approaches

What are some changes that you would like to engage in in your local setting? within your scope of influence

Discuss with 2-3 others Pick something that you would like to work on

12

Kotter’s framework for planned change

Source: Leading Change by John Kotter and The Heart of Change by John Kotter and Dan Cohen

Build a Guiding Team /

Coalition

2

Formulate a Shared Vision

3

Create a Sense of Urgency

1

Creating a climate

for change

6

Create Short-Term

Wins

Communicate for

Understanding Ownership

4

Empower Action

5

Engaging and enabling

the whole organization

Make it Stick – a

New Culture

8

Never Let Up

7

Implementing and

sustaining change

Kotter’s Framework Step

1. “Create a Sense of Urgency”

3. “Develop the Change Vision & Strategy”

3 4. “Communicate for Understanding & Buy In”

5. “Empowering Others to Act”

4 6. “Produce Short Term Wins”

On your own

7. “Don’t Let Up”

8. “Create a New Culture”

Create a compelling story… don’t load up on urgency What is the problem or situation? What is the big opportunity? Are there compelling drivers? Why does this bother you / us? Why is this necessary now?

Create a compelling story

Who might care about this?

Frame the story in multiple ways to adapt to their different motivations

Aikin, Bridges

Society

The individual

The working team

The learner

The organization and its stakeholders (program, department, faculty, other)

Selling the problem – the pitch

• The hook – unique fact, opportunity or problem

–Gets attention / piques interest

• Passion / caring

–Why you care or are motivated

–Why now

Workout 1

• What are your selling points?

Kotter’s Framework Step

1. “Create a Sense of Urgency”

2. “Pull Together the Guiding Team” 3. “Facilitate creation of a shared Vision & Strategy”

3 4. “Communicate for Understanding & Buy In”

5. “Empowering Others to Act”

4 6. “Produce Short Term Wins”

On your own

7. “Don’t Let Up”

8. “Create a New Culture”

• Who are the stakeholders inside & outside the issue that you should engage?

• Who cares about or is impacted by this issue?

• Who can influence the process?

• Position, expertise, resources, information, social network, persuasive ability

Stakeholder Engagement

© Brenda Zimmerman

THE STAR

S

T

A

R

Separateness or differences

Tuning-Talking and Listening

Action Opportunities

Reason to work together

Trust high

high

high

high

Create a shared vision

• Our thinking is constrained by our unique internal lenses

• Broad engagement in generating the vision for the change

a more generative and creative output

ownership

Create a shared vision

Begin with the end in mind

• It is the destination

• Where will be when we get there?

• What will it look like?

• Can you communicate it in 5 minutes or less?

Workout 2

Who is going to be on your leadership team?

Kotter’s Framework Step

1. “Create a Sense of Urgency”

2. “Pull Together the Guiding Team” 3. “Facilitate creation of a shared Vision & Strategy”

4. “Communicate for Understanding & Buy In” 5. “Empowering Others to Act”

6. “Produce Short Term Wins”

7. “Don’t Let Up” 8. “Create a New Culture”

…Engage for Ownership… NOT buy in…

All new situations need new understandings 4 P’s

Purpose - Why

Picture – How will it look and feel

Plan – Step by step detail

Part – Give people a part to play

You can never communicate enough

Bridges

Empower people to act

• Remember to develop people so they have the necessary capabilities

• Remove obstacles

• Be flexible

• Build in slack

• Expect to learn & make adjustments as you go

• An innovation is an idea, practice, or object that is perceived as new by an individual or other unit of adoption

• Whether it takes off depends on:

– the innovation itself

– the situation

• Diffusion is slow in the beginning

Adoption of Innovation

Adapting to Change

0%

5%

10%

15%

20%

25%

30%

35%Innovators (3%)

Early Adoptors(12%)

Early Majority(35%)

Late Majority(35%)

Laggers (15%)

• Opinion leaders

• Respected

• Take risks

• Follow their own dictates

• Motivated by future opportunities

• See what is possible

• Stay with the herd • Conformist • Analytic, deliberate • Support evolution • Consult with colleagues • Motivated by present

problems • Pursue what is probable

Early Adopters

(Visionaries)

Early Majority

(Pragmatists)

What does this mean?

• Expecting to quickly convince the masses of a new controversial idea is naive

• Try & engage the early adopters first

In health professionals, we value

• Reliability

• Dependability

• Steadiness

• Process-orientation

Take the time to understand the thoughts, feelings and beliefs of the people that you are dealing

with

find change very unsettling

Part 3

Workbook PART 3

Kotter’s Framework Step

1. “Create a Sense of Urgency”

2. “Pull Together the Guiding Team” 3. “Facilitate creation of a shared Vision & Strategy”

4. “Communicate for Understanding & Ownership” 5. “Empowering Others to Act”

6. “Produce Short Term Wins”

7. “Don’t Let Up” 8. “Create a New Culture”

Transition “the psychological process that people go through

as they come to terms with the details that of a new situation that change brings about”

Endings and Letting Go Who will lose what?

• Old ways

• Behaviours

• Competence

• Satisfaction

• Identity

• Status

• Reward

• Relationships

• Community

• History

• Reward

As a clinician / friend …

What are the strategies that you use in helping people deal with the process of:

Anticipated bereavement or

Bereavement?

How could you use these in supporting people through change?

Endings need to be affirmed & talked about

• Respect and honour the past

• What behaviours that are being rewarded will they need to give up?

• Notice intangible losses and ripple effects

• What are the problems they will have with the change?

• How can we help them develop a new identity and sense of purpose?

• How can we acknowledge & eliminate their fear?

Neutral Zone Anxiety rises and motivation falters

• Communicate bigger picture

• Develop temporary roles (give people a part to

play)

• Set short term goals

• Provide training

• Remove barriers

• Review policies and procedures

• Strengthen group connections

• Ensure quick successes

• Celebrate small successes

• Appreciate

• Give small unexpected rewards

• Symbolize the new identity

Manage the new beginnings

Workout 4

How are you going to create those short term wins?

On your own another time

Kotter’s Framework Step

1. “Create a Sense of Urgency”

2. “Pull Together the Guiding Team” 3. “Facilitate creation of a shared Vision & Strategy”

4. “Communicate for Understanding & Ownership” 5. “Empowering Others to Act”

6. “Produce Short Term Wins”

7. “Don’t Let Up” 8. “Create a New Culture”

Making it stick

• Structures & processes

• Monitoring and feedback

• Recognition

• Reward

• Support

Take Home Messages