module 3 slides - school for change agents

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theedge.nhsiq.nhs.uk/school/

Module 3: Rolling with resistance

@Sch4Change #S4CA team

Brought to you by the

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School Lead: Helen Bevan @HelenBevan

Olly Benson @OllyBenson

Kate Pound @KateSlater2

Lead facilitator: Pip Hardy @PilgrimPip

Chat Room Monitors Twitter Monitors

Louis Warner @LouisWHorizons

Technical Support

Joanna Hemming @JoannaHemming

Paul Woodley @PaulWoodley4

Kathryn Perera @Kathrynperera

The team today

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Joining in today…and beyond

• Please use the chat box to contribute continuously during the talk

• Please tweet using hashtag #S4CA and the handle @Sch4Change

• Send a request to join our Facebook group School for Change Agents https://www.facebook.com/sch4change/

• We will produce summaries of each module discussion using Steller and put on the website

https://www.facebook.com/sch4change/

https://www.facebook.com/sch4change/

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Each week we’ll cover different change agent capabilities

16th February: Being a change agent: change begins with me

23rd February: From me to we: making connections and building communities

2nd March: Rolling with resistance

9th March: Making change happen

16th March: Moving beyond the edge

Source of image: thenounproject.com

http://www.thenounproject.com/

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Nurses, Midwives and Allied Health Professionals Use the school experience as part of your CPD reflective account for revalidation Doctors We have applied for CPD credits for the school

Everyone If you watch all five of the talks and demonstrate you have applied the learning, you can apply to become a certificated change agent (and it’s free)

Certification and Continuing Professional Development

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Randomised Coffee Trial

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• Email to join the RCT [email protected]

• We will randomly match you with another participant in the School for Change Agents from anywhere in the world

• At some time in the next four weeks, arrange to have a conversation over Skype (or other communication system) with a cup of coffee!

Image source: Pinterest

mailto:[email protected]



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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 the diversity of ideas

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The role I identify with most closely:

User of care system Campaigner

Change agent Enquirer Chief listener

Giver of care

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Change agent capabilities in module 3

• Ability to look at “resistance” from multiple perspectives

• Understanding of the relationship between intent and impact

• Building resilience by mobilising and organising

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

Source of image: thenounproject.com

http://www.thenounproject.com/

#S4CA @sch4change Source of image: sport-fitness-advisor.com

Any force that stops or slows movement

Resistance

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Why do organisational change programmes fail to achieve their objectives?

The majority of reported reasons are related to resistance to change

Source: McKinsey & Co

#S4CA @sch4change Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

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‘En este muno traidor

No hay verdad ni mentira,

Que todo esta en el color

Del cristal con que se mira.’

‘In this world of many mazes

There is nothing false or true:

All depends upon the hue

Of the glass through which one gazes’. Sixteenth-century Spanish quatrain

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In module 1, we talked about:

Jeremy Heimens, Henry Timms This is New Power

http://thisisnewpower.com/

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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”

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Resistance to change: the old power mindset

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A transformation programme

Source: Sewell (2015) : Stop training our project managers to be process junkies

https://acceleratingchangeprogrammes.com/2015/06/09/stop-training-our-project-managers-to-be-process-junkies/

https://acceleratingchangeprogrammes.com/2015/06/09/stop-training-our-project-managers-to-be-process-junkies/

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Old power mindset: the role of the change agent

“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 change

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

Source of image: Health IT Outcomes

http://www.bjhcm.co.uk/cgi-bin/go.pl/library/contents.html?uid=4973;journal_uid=22

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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”

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

• Change results from connections and interactions stimulating different viewpoints, shaping how people think about things

• Resistance is an inevitable consequence of a complex change process

• Resistance should be embraced and rolled with


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Is your change programme a cathedral or a bazaar?

http://www.unterstein.net/su/docs/CathBaz.pdf



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Resistant behaviour is a good indicator of missing relevance

Harald Schirmer http://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

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http://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-role-of-hr-driving-social-adoption-and-change-in-the-enterprise


































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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

New power mindset: the role of the change agent

Source of image: rachtalks.pressprestige.com

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Recommended: Mark Jaben on the science behind resistance

What NOT to do What TO do

But what we do do Instead of buyers (who “buy-in”), we need investors

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Data and facts don’t change our minds

http://www.newyorker.com/magazine/2017/02/27/why-facts-dont-change-our-minds




















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

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• 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

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Stop talking AT ME

Start talking TO ME

Source of image: prepbeijing.com

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Which kind of activists are most successful at delivering change?

Lone wolves Build power by expertise and information — through advocacy, oversight, contributing to committees, public comments and other forms of consultation

Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199336760.001.0001/acprof-9780199336760



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Patient leaders as “lone wolves”

“What I am ranting about is the way in which patients are being streamed into advisory sub committees, the way we are

being used as tokens and to help tick off the right box…..

Where is the attitude that patients are part of the team in healthcare, that we are partners? Why are we always asked to participate inside a pre-determined frame? When will we

see co-design of new policies, and ultimately co-production?”

Annette McKinnon

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Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action





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Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action

Organisers Build power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength





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Health communication and coaches

Building leaders

Source: Jönköping

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Focus on the “We”

“Great social movements get their energy by growing a distributed

leadership”

Joe Simpson

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“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


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I know my smoking is a problem – I

want to stop but no plans yet


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I am making plans & changing things

I do in preparation.



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I have stopped smoking!



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I have stopped smoking!

I am continuing to not smoke.

I sometimes miss it – but I am still not

smoking



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“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 Source of infographic here

http://www.nature.com/news/hospital-checklists-are-meant-to-save-lives-so-why-do-they-often-fail-1.18057?WT.mc_id=TWT_NatureNews

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“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

http://www.sustainableevolution.com/blog-1/2015/6/18/motivational-interviewing-as-a-change-management-strategy

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• 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 it Cherokee proverb

Source of image: fenwickgallery.co.uk

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What happens next

• If you pre-registered with your Break out room number, you will be transferred there

• If you haven’t registered with a room, we are offering a separate phone conference that you can join:

0800 917 1950

33136606#

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In the breakout room

• If you get stuck, ask for help here

• Your facilitator will be in the room. They can be identified with the presenter ball next to them.

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