Understanding change in organisations

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Understanding change in organisations

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During this session we will

• Discover how people respond to change and why -
  and begin to look at ways to support that change
• Consider the driving and resisting forces to
  change in organisations
• Look at the links between organisational change
  and service improvement

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"Change Management" is an oxymoron
Jim Clemmer

• holy war
• non-working mother
• mandatory option
• political principles

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Why do we have to change?

• What are the factors driving change in the NHS?
• Take a few minutes at your table to list some of
  the things/people/events that are pushing us to
  change the way we do things. Think about local
  and national forces for change.

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Whats stopping us?

• What are the factors for resisting change in the
  NHS?
• Now list some of the things/people/events that
  are resisting the change in the way we do things.
  

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Forcefield analysis
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Seeing the whole picture

• Quickly look at your list of factors driving
  change. Identify the STRONG, MEDIUM and WEAKER
  forces
• Do the same for the resisting factors
• Draw a forcefield analysis chart on the flipchart
  depicting these forces. Use really big arrows for
  strong forces, smaller arrows for weaker forces

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Making sense of the forcefield

• Change WILL happen if the driving forces are
  stronger than the resisting forces
• Driving forces tend to be external to the
  organisation
• Resisting forces tend to be internal to the
  organisation

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What can we do?

• What actions could we take to reduce the
  resistance to change in the NHS?

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Changes and transitions
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Change is different from transition
Change is situational new site, new boss, new
team roles, new policy. Transition is the
psychological process people go through to come
to terms with new situations William Bridges
Change is external, transition is internal.
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Three phases of transition
ENDING
NEUTRAL ZONE
BEGINNING
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Start with an ending

• Most organisations try to start with a
  beginning, rather than finishing with it.
• They pay no attention to endings.
• They do not acknowledge the existence of the
  neutral zone, then wonder why people have so much
  difficulty with change.

William Bridges
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Managing transitions

• Acknowledge it is difficult
• Help people to understand the need for change
• Keep what matters
• Get people involved working together
• Create temporary systems (PDSAs)
• Ensure people know what part they play
• Celebrate and give credit
• Communicate, communicate, communicate

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Process tips

• Brainstorm points of dissatisfaction (when people
  understand the problems, they are in the market
  for solutions)
• Use small groups to share their visions, then
  bring the whole group together
• Help people move into the future
• Identify resources in the organisation and how
  they can be developed
• Build small steps first (but think about the
  route!)
• Its not like crossing the road- remember Moses
• Mind your metaphors sinking ship or last
  voyage?

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The beginning

• Expect ambivalence
• The 4 Ps
• purpose
• picture
• plan
• part to play
• Celebrate the success!
• Starting is not the same as beginning!

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How do we engage people to change?

• The core of the matter is always about changing
  the behaviour of people, and behaviour change
  happens in highly successful situations mostly by
  speaking to peoples feelings
• John P. Cotter Dan S. Cohen

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Changing clinicians

• Professionals value innovation experimentation
  in their clinical work, but past experience of
  change gives them little reason to believe it
  will improve the quality of care or their own
  working lives
• Locock 2001 Research into Practice programme
  summary report No.1 July 2002

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Why are some people sceptical about change?

• Insufficient information about the nature,
  purpose significance of change
• Seeing change as being top down
• Believing there are other more important
  priorities
• The change is unfamiliar or irrelevant
• Fearing change will be threatening to individual
  status and power
• Research into Practice Summary Report No.1 July
  2002

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Why do people resist change

• Why do you resist change?
• Talk of a situation when you have resisted a
  change
• What did you do, how did you feel, what
  behaviours did you display

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Put yourselves in the shoes of the people you
will be dealing with and ask
Whats in it for me ?
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Diffusion of improvement
13 Early Adopter
35 Late Majority
35 Early Majority
15 Laggards
Everett Rogers (1995) The Diffusion of Innovation
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• No single method, strategy or tool will fit all
  problems or situations that arise. Managers in
  the NHS need to be adept at diagnosing
  organisational situations and skilled at choosing
  those tools that are best suited to the
  particular circumstances that confront them.
• Iles and Sutherland, Managing Change in the NHS,
  2001

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What are the implications?

• People who find the change/transition difficult
  get labelled
• .and treated as resistors of change
• because we dont understand or acknowledge this
  as a natural event we make the wrong or
  inappropriate interventions

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Help people to understand why change is happening

• People responsible for planning and implementing
  change often forget that while the first task of
  change management is to understand the
  destination and how to get there. The first task
  of transition management is to convince people to
  leave home.
• Youll save yourself a lot of grief if you
  remember that

William Bridges
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Remember.

• Without an ending, you cant have transition
• Without a beginning, transition is incomplete
• Without transition, the change changes nothing!

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In summary

• The human factors
• The driving and resisting forces
• All change starts with an ending
• We need to manage the transition
• Dont throw the baby out with the proverbial!
• Adapt your style according to the situation

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