MAKING THE CASE FOR CHANGE

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2 MAKING THE CASE FOR CHANGE

3 WHAT COULD HELP? New ways of thinking about change management Leadership for change Creating a culture of improvement Using proven methods to ensure sustainable change

4 UNDERSTANDING THE CONTEXT FOR CHANGE (1) Operating within the new commissioning/policy structures Organisational savvy and horizon scanning Integration, reconfiguration MH funding to increase 1.4% per annum ( 120m) 1st MH Trust CCG rating good Launch my MyNHS website

5 UNDERSTANDING THE CONTEXT FOR CHANGE (2) NHS England 5 Year Forward View (5YFV) Using existing research and evidence to consider WHY change is needed, WHAT success might look like, HOW to get there Population health improvement Patients in the lead of their own health and care Improved responsiveness of NHS New care models (Dalton review) Working with National Voices and NHS Citizens Funding gap 30bn by 2021

6 HOW SHOULD LEADERS OPERATE IN THE NEW NHS? (CASS BUSINESS SCHOOL) Go out of their way to make new connections Have an open, enquiring mind, unconstrained by current horizons Embrace uncertainty and be positive about change Draw on as many perspectives as possible Ensure leadership and decision making are distributed throughout the system Promote the importance of values-invest as much energy in relationships and behaviours as in delivery Recognise transitions for staff and peers

7 LEADERSHIP TRANSITIONS

8 A TRANSITION CHECKLIST

9 A NEW DIRECTION FOR CHANGE MANAGEMENT What is the vision? Person and quality centred, integrated, highly technologically enabled value for money system How do we get there? Not the same way we got where we are today

10 WHERE ARE WE NOW? An emphasis on structure and process Increased focus on integration Moving to reconfiguration across systems Some good results, but a realisation that transformation does not flow from redesign work alone Recognition of importance of human factors in change (self awareness, EQ, versataility)

11 CHANGE AND SUSTAINABILITY 2/3 rd improvement projects fail WHY?

12 WHY DO CHANGE EFFORTS FAIL? Designed using the same mindsets, beliefs, rules as have been used before A voltage drop occurs between radical change aspirations and reality of implementation Fail to let clinical and managerial leaders lead Scale and pace NHS Institute

13 SUSTAINABILITY The likelihood of successful, sustainable change is maximised when there is Clear benefit to stakeholders Continual support to maintain understanding and skills The change principle is built into the structure of the organisation A built-in ongoing measurement system It is made mainstream

14 WHAT DO WE NEED?(1) A new direction for large scale change systems thinking Clinical quality and patient experience outcomes A renewed focus on leadership for this change Ability to create a culture for change, including permission for clinical teams to make changes Nurturing and developing teams to take responsibility

15 WHAT DO WE NEED? (2) To address the patterns in the system which often remain unchallenged and unchanged Adoption of specialist improvement knowledge and expertise to support change at critical mass Greater use of innovation and technology - match daily life Respond to impact of genomics personalised care Respond to changed social culture for patients

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17 NEW IMPROVEMENT PERSPECTIVES (1) Social mobilisation metaphors for improvement High energy Using imagination, engagement, participation, mobilisation HELEN BEVAN/PAUL PLSEK

18 New improvement perspectives (2) Clinical System metaphors for improvement Effectiveness and efficiency focus Metrics and measures Clinical systems improvement Service/pathway redesign Evidence based care

19 WHICH DO WE NEED? BOTH OF COURSE

20 How do we do it? Mobilisation, energy Programme management which enables, doesn t paralyse Good enough plans Awareness of human factors Systems thinking Outcomes based Leadership skills at all levels Culture for improvement Evidence based models

21 MODELS

22 JOHN KOTTER S 8 STEP PROCESS- BASED ON WHAT STOPPED CHANGE PROJECTS BECOMING SUSTAINABLE OUR ICEBERG IS MELTING CHANGING AND SUCCEEDING UNDER ANY CONDITIONS A FABLE

23 The 8-Step Process of Successful Change based on the key elements needed STARTING OUT 1. Create a Sense of Urgency 2. Pull Together a Powerful Guiding Team 3. Develop the Change Vision and Strategy MOVING ON 4. Communicate for Understanding and Buy-in 5. Empower Others to Act on the Vision 6. Plan for and Produce Short-Term Wins 7. Don t Let Up- Consolidate Improvements and Produce still More Changes SUSTAINING CHANGE 8. Create a New Culture Where New Approaches become The way we do things around here

24 DISPERSED LEADERSHIP Leadership Skills at all levels of the organisation Influencing Thinking about resistance Culture change

25 To have an effect on other people or things through one s own behaviour/approach, e.g. changing behaviour of others or changing the nature or course of direction of events

26 INFLUENCING STYLES Use of different power sources when we are trying to influence others also relates to (and can be driven by) the Influencing STYLE we use. Research suggests two main types of influencing styles: - Push and Pull

27 PUSH STYLES People are influenced by convincing proposals that are well supported INVOLVES PROPOSING, GIVING INFORMATION, BLOCKING OUT OTHERS IDEAS MAY ALSO INVOLVE LOGICAL REASONING, REWARD AND PUNISHMENT REQUIRES GOOD QUALITY, INFORMATIVE IDEAS/PROPOSALS

28 INVOLVES TESTING UNDERSTANDING, SEEKING INFORMATION, BUILDING ON IDEAS MAY ALSO INVOLVE PERSONAL DISCLOSURE AND INVOLVEMENT, SHOWING POSSIBILITIES REQUIRES GOOD QUALITY QUESTIONING Pull Styles People are influenced by tapping into their needs, motives, aspirations, concerns

29 COMBINING THE TWO STYLES If you use both styles during an influencing situation, they ll cancel each other out Choose a style and stick to it! Therefore you need to be aware of your preferred/typical influencing style: - How do you tend to influence others?

30 CHANGING BEHAVIOURS 84% of the population is unlikely to change its behaviour based solely on arguments of merit, scientific proof, great training or jazzy media campaigns. The majority of those who try new behaviours do so because of the influence of a respected peer. DR EVERETT ROGERS

31 ACTIVITY Reflect on a time when you needed to influence someone to change What style do you think you used? How effective was it? How might you flex your style to respond to different situations in future?

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33 THINKING DIFFERENTLY ABOUT RESISTANCE Natural Normal Logical 33

34 SOURCES OF RESISTANCE 1) Psychological resistance to change Fear of unknown Unpredictability of consequences of change builds discomfort and negative reactions Fear of failure May require advanced/different skills beyond their training or capability. Fear of being unable to make change happen Perceived threats to identity and self esteem Linked to threat to self efficacy leading to loss of status or control over service

35 2) Logical resistance to change Power and Conflict: Resistance to change occurs when a change may benefit one department within the organisation while harming another. Misinterpretation of change: People resist change when they do not understand it. Such situation occurs when the proposed change is not consulted with the employees and supposed to be enforced as an order. People like to know what going on in their organization, especially if something is related with their jobs. Do not agree with the impact of changes: When employees feel that the change would increase their working hours, tasks and duties and the benefits and rewards are not seen as adequate, they resist.

36 3) Sociological resistance to change Group Norms Over a period of time, the members of a group develop understanding and interpersonal relationship. The group members resist the change when they believe that it will alter interpersonal relation and coordination among group. Disturbance in established patterns Teams tend to develop a pattern of working. When this is threatened resistance can occur Culture Risk averse cultures which do not allow experimentation, and innovation and creativity are not fostered

37 Levels of resistance Levels Observed Symptoms Possible Causes Strategies Level 3 Personal Resistance - Opposes your ideas - Resists you, not the idea - Sarcasm - Poor relationship - Cultural differences - History - Personality conflicts - Start relationship building before introducing ideas - Bridge building strategies during planning phases Level 2 Emotional or Psychological/Physiological Resistance - Blood pressure rises, adrenaline flows, pulse increases - Triggered without conscious awareness - Fear they will lose power/control, status, face or respect - Feel incompetent - Feel isolated - Exceeds personal tolerance levels - LISTEN to THEM - Align need for change with something THEY value and identify what THEY can gain from it. - One-on-one meeting Level 1 Technical Resistance - Vocal disagreement - Rational argument - Doesn t seek to understand - Lack of information - Disagree with the idea - Confusion - Presentations - Q&A Sessions - INVOLVE THEM - Use influencers

38 BUT REMEMBER.. You may not be meeting resistance, it may be the stage of the change process you are at.

39 Different people adopt the change in different ways Innovators 2.5% Early Adopter s Early Majority Late Majority Laggards 13.5% 34% 34% 16%

40 CHANGE IS ALWAYS SLOW, THEN FAST, THEN SLOW 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% Cumulative Adoption Rate Time

41 Discussion on tables Think of a time you have met resistance to a change you were trying to implement. What type of resistance do you think it could have been How did you respond? Could there have been a better way?

42 UNDERSTAND THE CONTEXT AND THE CULTURE How we behave What we believe Rules we follow Individuals perceptions of how previous change has been handled Change Agent needs to acknowledge what s gone on before and its impact 42

43 CULTURE AFFECTS HOW EVERYTHING IS DONE WITHIN YOUR WORKPLACE Interpersonal relationships Performance Decision making Communication Teamwork Handling conflict Change and Innovation

44 CULTURE S LIKE AN ICEBERG Reward Systems Dress Code Organisational Structure Job Titles Artifacts Values Physical Layout Technology Use How We Talk to Each Other Underlying Assumptions 44

45 WHAT MAKES A CULTURE FOR IMPROVEMENT? Patient centred Belief in human potential championing a mindset for innovative change Creativity and experimentation encouraged - creating a climate of high expectations Clear standards for behaviour set, with celebration and reward for achievement Recognition of the value of learning Effective team working with broad communication shared stories and symbols of success Honesty and trust demonstrated

46 LEADERSHIP AND CULTURE CHANGE (1) A successful improvement culture can only be built not imposed Everyone s responsibility at all levels The most powerful leader is the one who has the most personal influence, not the most resources or the biggest job Leaders work interdependently, engaging others to work together Leaders see and synthesise the future They explain it with certainty and clarity, and communicate in a way that resonates at all levels

47 LEADERSHIP AND CULTURE CHANGE (2) Leaders turn this into aspiration and draw people forward They have the courage to go first They have the stamina and resilience to take on set backs, and keep pushing on Leaders build high performing teams around them not the usual suspects or most senior They use their organisational skills to enable these teams to plot the journey from the current to future desired state They walk as though they mean it they live by what they have helped create

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49 WHAT IS A SYSTEM? A set of things working together as a network: a complex whole

50 JOINED UP CARE Patients and service users want services that are organised around, and responsive to, our human needs. We are sick of falling through gaps. We are tired of organisational barriers and boundaries that delay or prevent our access to care. We do not accept being discharged from a service into a void. We want services to be seamless and care to be continuous. That means primary and community health services, social care services, and services from voluntary organisations should all mesh together to help us succeed in managing our lives and conditions. National Voices, 2011

51 DISCUSSION? Can you think of a time when you have collaborated across boundaries (at work or outside of work) to achieve an outcome? What made it difficult / easy? What was the outcome? Discuss with one other person

52 PROVIDING WHOLE-SYSTEM LEADERSHIP PRACTICAL TIPS To emulate people who are successful in leading complex systems, the following seven key steps are critical: 1. Go out of your way to make new connections 2. Adopt open, enquiring mind-set. Refuse to be constrained by current horizons 3. Embrace uncertainty and be positive about change adopt an entrepreneurial attitude

53 PROVIDING WHOLE-SYSTEM LEADERSHIP PRACTICAL TIPS 4. Draw on as many different perspectives as possible; diversity is non-optional 5. Ensure leadership and decision-making are distributed throughout all levels and functions 6. Establish a compelling vision, shared by all partners in the whole system 7. Promote the importance of values invest as much energy into relationships and behaviours as into delivering tasks.

54 LEADERS OF CHANGE Think of a farmer rather than an architect Farmers enable the conditions for growth to occur, they nurture but cannot control everything Plans and designs can never be complete on paper good enough plans with adjustment on the way Experiment and see what happens Work on creating generative relationships Let go of figuring it all out and we ve always done it this way Paul Plseck

55 ACTION! Identify 3 things you will do differently to lead change to overcome hurdles and create a culture for continuous improvement