managing human dimensions change

8/8/2019 Managing Human Dimensions Change

1/28

Improvement Leaders Guide

Managing the human dimensions of changePersonal and organisational development

The NHS Modernisation Agency is part of the Department of Health

Crown Copyright 2005

If you require further copies quoteMAILG052 / Improvement Leaders Guides , and contact:Department of Health PublicationsPO Box 77London SE1 6XHTel: 08701 555 455Fax: 01623 724 524E-mail: [email protected]

MAILG052 / Improvement Leaders Guides can also be made available onrequest in braille, on audio-cassette tape, on disk and in large print.

www.modern.nhs.uk


2/28

Managing the human dimensions of change 4

Improvement Leaders Guides

How you use the Improvement Leaders Guides is not prescriptive. You can startwherever is best for you, however experience has shown us that some of theImprovement Leaders Guides are best used sequentially.

The ideas and advice in these Improvement Leaders Guides will providea foundation for all your improvement work:

Improvement knowledge and skills

Managing the human dimensions of change

Building and nurturing an improvement culture

Working with groups

Evaluating improvement

Leading improvement

These Improvement Leaders Guides will give you the basic tools andtechniques:

Involving patients and carers

Process mapping, analysis and redesign

Measurement for improvement

Matching capacity and demand

These Improvement Leaders Guides build on the basic tools andtechniques:

Working in systems

Redesigning roles

Improving flow

You will find all these Improvement Leaders Guides atwww.modern.nhs.uk/improvementguides

Every single person is enabled, encouraged and

capable to work with others to improve their part ofthe serviceDiscipline of Improvement in Health and Social Care

DH INFORMATION READER BOX

Policy EstatesHR/Workforce PerformanceManagement IM&TPlanning FinanceClinical Partnership Working

Document Purpose Best Practice GuidelinesROCR Ref: Gateway Ref: 4701Title Improvement Leaders GuidesAuthor NHS Modernisation AgencyPublication Date April 2005Target Audience Medical Directors, Directors of Nursing,

Directors of HR, Allied Health Professionals,Emergency Care Leads, Directors of Modernisationand Service Improvement

Circulation ListDescription A series of guides based on the learning of the

NHS Modernisation Agency. Designed to helpfrontline staff improve the delivery of care topatients and users

Cross Ref: 10 High Impact Changes for Service Improvement

and deliverySuperseded Docs N/AAction Required N/ATiming N/AContact Details Jean Penny

NHS Modernisation Agency4th FloorSt Johns HouseEast StreetLeicester LE1 6NB

For Recipients Use


3/28

5

1. Why is t his guide important?

Many change projects fail, and the most commonly cited reason is neglect ofthe human dimensions of change. This neglect often centres around a lack ofinsight into why people are unhappy with organisational change, a poorappreciation of the process of change, and a limited knowledge of the toolsand techniques that are available to help Improvement Leaders. This guide willhelp you to understand and to better manage these fundamental aspects of thechange management process, and help you to empower, enable and engagethose you work with.

The psychology behind the human dimensions of change is an ever-growingarea and there has been much research and theorising on the subject. Thisguide has been written by experienced Improvement Leaders who are involvedin healthcare improvement initiatives. We have put together the models andframeworks that have helped us while working with a wide variety of people inhealthcare. It is a starting point for you as an Improvement Leader.

Two approaches to improvement


Anatomicalapproach ofimprovement

change is a stepby step process

it is typicallyinitiated topdown

objectives set inadvance (and setin stone!)

it goes wrongbecause of poorplanning andproject control

In practice, both approachesof improvement are necessary

you need to set a directionbut need to be flexible

top down support is needed forbottom up change

objectives need to be set and theteam should be congratulated wheneach objective is achieved butimprovement never ends

planning and monitoring is importantbut gaining the commitment ofpeople is vital

Physiologicalapproach ofimprovement

outcomes cannotbe predetermined

changecomes typicallybottom up

there is noend point

it goes wrongbecause ofpeople issues

Contents

1. Why is this guide important? 3

2. The process of change 6

3. Frameworks and models t o help 14

people t hrough the process of change

4. Engaging ot hers in improvement 36

5. Activit ies 39

6. Frequent ly asked quest ions 47

7. Summary 50

All models are wrong but some are quite usefulDerning


4/28


5/28


6/28


7/28


8/28


Capacity

Ask the questions what resources are needed to achieve the change? Dont forget resources

such as energy and capability how can the resources be generated or shared? has this person shown in the past that they are willing to try out new ideas?

It has been shown time and time again that it is most effective to test outnew improvement ideas with people that are willing to try new things

is there anyone this person respects both professionally and personallyand who has demonstrated the energy and capability to make changes?Could you put them in contact? Often we are enthused and energised byothers we see as similar to ourselves

First stepsAsk the question what first steps could people undertake which everyone agrees would be

moving in the right direction?

By working with the left side of t he equation, people will be pulled towards achange. Generally, it is better to pull people towards a change rather than push

people into it. People need to understand that the costs and risks ofmaintaining the status quo outweigh the risks and the uncertainty of makingthe change.

15

The thing that was astounding was mapping.We all thought we knew how the system workedbut none of us had a clue. Many times an hourmy mouth was just falling open because I didntrealise what a mess it was.Lead Clinician, Cancer Services Collaborative

Its got to be an advantage for everyone. Its gotto be a win-win type thing, its no good it justbeing absolutely brilliant for the patients, its gotto have advantages for virtually everybodyinvolved, because it will have disadvantages foreverybody involved as well probably. So theadvantages have got to be transparent andobvious and apply to staff as well as patients.Improvement Lead

I did have a problem with one consultantthe first thing I realised was that he didntunderstand a booked admission. After that, if Iwent to see consultants about booking, I took adiagram of what a booked admission was. Weassume they understand and they dont, andthats probably part of why theyre resistant to it.Improvement Lead, National Booking Programme

One of the reasons we got involved was becausewe care about the way that we deliver the serviceto patients we were interested in ways of tryingto improve you think, there must be a betterway of doing things.Lead Clinician, Cancer Services Collaborative


9/28


10/28


11/28


12/28


13/28


14/28


15/28


16/28


17/28


18/28


19/28


20/28

4. Engaging others in improvement

4.1 Winning hearts and minds

Since improvement depends on the actions of people, ultimately it comes downto winning hearts and minds. People are not machines. You cannot makeothers simply do as they are told, nor can you be everywhere at once in orderto watch others to ensure compliance. Command and control cannot work inhuman-intensive systems like health and social care because there can never beenough commanders and controllers to go around and none of us is willing toput up with the approach that would be required. So we need to win thehearts and minds.

Adapted from R Dilts and G Bateson

Psychologists suggest that change can occur at various levels, as depicted in thepyramid diagram above. Change at any level of the pyramid will typically have aknock-on effect at lower levels. For example, if you change your beliefs andvalues and come to believe it is bad to smoke, it is highly likely to lead you todevelop new capabilities by reading a book, attending a seminar or seeing a GPto learn more about stopping. This in turn will modify your behaviour bygradually cutting back and might further lead to changing your environment by

thoroughly cleaning your house to get rid of the smell. However, changes donot typically have a similar knock-on effect to higher levels.

purpose

identity

beliefs and values

capabilities

behaviour

environment


For example, if the GP prescribes a stop smoking treatment and gives you a

pamphlet for you to learn more but you do not believe you need to stop, youwill probably not comply with the treatment and your capability and behaviourremains unchanged.

This psychology applies to the issue of improvement. Individuals may modifytheir behaviour and participate in change during the course of a focusedimprovement effort. But if they do not emerge from the effort withfundamentally new capabilities, new beliefs and a new sense of purposeassociated with the change, old behaviours may soon return and theperformance benefits erode away. The new capabilities may include new waysof thinking, new skills and new ways of knowing if performance is good orbad. New beliefs may be that the new way is better than the old way to meetpatients needs, and a new sense of purpose may be real commitment to thenew way.


21/28


22/28


23/28


24/28


25/28


6. Frequently asked questions

QuestionDo the style frameworks described relate to patients and carers as well?

AnswerThey certainly do. They relate to everyone: patients, their carers and even yourfamily and friends.

Question

It sounds to me that some of this is about putting people into boxes and I amuncomfortable with this.

AnswerIt is not about putting people into boxes but about recognising and workingwith the styles we all have. Everyone has access to all the different elements inall the frameworks and will use them at some time but not with equal ease,comfort and confidence. The key to managing the human dimensions ofchange is to make the best links with each individual, talk their language andpresent information in the best way for them.

QuestionCan you tell me briefly what Emotional Intelligence is?

AnswerEmotional Intelligence is described as being the ability to monitor your ownand other feelings and emotions, to discriminate among them and use theinformation to guide your actions (Mayer and Salovey 1990) or knowing how

to separate healthy from unhealthy feelings and how to turn negative feelingsinto positive ones (Hein 2005). Basically it involves five characteristics andabilities to help us decide which goals are worth achieving: self awareness mood management self-motivation empathy managing relationships

Emotional Intelligence is very topical at the moment so if you want to knowmore go on the internet for these and other writers and researchers.

Next show the group a sad face and ask them to repeat the exercise writingdown the things that make them sad about the change.

after five minutes put the Post-its on the wall, group them, feed the resultsback and produce a list

Lastly, show the group a happy face and ask them to repeat the exercise,writing down the things that make them glad about the change.

after five minutes put the post-its on the wall, group them, feed the resultsback and produce a list

Learning point s people can see that they are not alone with their thoughts and reactions

use the three lists of reactions to look for similarities in peoples reactions tothe change

emphasise the positive reactions (happy) to the change look at the more negative reactions to the change, prioritise the issues

and consider possible actions


26/28


27/28


28/28

managing human dimensions change

Documents