enabling and supporting change - royal college of … · change is grappled with waugh 1998 “you...
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J’ai (ou j’ai eu) une affiliation (financière ou autre)
avec une entreprise pharmaceutique, un fabricant
d’appareils médicaux ou un cabinet de communication.
I have/had an affiliation (financial or otherwise)
with a pharmaceutical, medical device or
communications organization.
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Delete this box before presenting: Please keep only the applicable statement, shown above is Option 2
with Option 2 displayed on the previous slide.
Note: Please indicate the commercial organizations with which you have/had affiliations within the past two years, and briefly explain
what connection you have/had with the organization.
Supprimez cette boîte avant de faire votre présentation : Veuillez conserver uniquement l’énoncé pertinent; ci-dessus se trouve l’option 2, l’option 1 paraissant à la diapo précédente. Note: Prière d’indiquer le nom des entreprises commerciales avec lesquelles des liens existent (ou ont existé) dans les deux dernières années, et d’expliquer brièvement la nature de ces liens.
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.”
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
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?
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
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
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”
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