1. Change – this time it’s personal!
Sue Price
Head of Service Improvement
Shropshire and Staffordshire Strategic Health Authority

2. “while the primary stimulus for change remains those forces in the external environment, the primary motivator for how change is accomplished resides with the people within the organisation” Benjamin and Mabey Facilitating Radical Change (1993)

3. Background
“Change may be an imprecise science, but evidence is available on what works and what does not, and the NHS must make use of this.”
White Paper - “A First Class Service”

4. Challenges and opportunities for the NHS
Changing pressures of the environment
Multiple stakeholders ~ internal/external
Changing technologies
Complex organisations ~ interdependence
People ~ experience of change interventions ~unforeseen/unintended consequences

5. Why do we need to change hearts and minds?
If we only change hearts people accept changes but do not understand them
If we only change minds then people are not committed to the changes

6. ‘Any improvement is a change, not every change is an improvement, but we cannot improve anything unless we change it’ Goldratt, Theory of Constraints (1990)

7. Change means doing things differently!
It creeps up on people…...
They nod happily about need for change
They vigorously agree with the new ideas
but..
They become nervous when they realise that they need to do think differently, not just other people

8. How comfortable are you?
Do you find the idea of change exciting or uncomfortable?

9. Change and learning Comfort Zone Panic Zone people close up they
freeze
they don’t
learn
Comfort Zone
P.Senge (2000) 12

10. Change and learning Panic Zone Comfort Zone Discomfort Zone
Uncertainty
Learning 13

11. Helping People to get to the Discomfort Zone
Encourage them to trial new things (even if they don’t work)
Create systems and processes that encourage a habit of experimentation
Provide support
It is OK to say “I don’t know”
Understand process of loss and bereavement
Don’t impose change
Create ownership and involvement 16

12. “It” is not Change - “It” is Transition
Change is a “doddle” –it happens – its external
Transition is an internal process of adjustment
Help people to:
Let go of the old
Move through the neutral zone
Accept the challenge of the new
IT is not change , this is external
IT is transition and how people handle it internally
Help people through the process – its part of your responsibility
William Bridges

13. Three phases of transition
Ending
Neutral
Zone
Beginning
Describe diagram
TIME

14. Help people to understand why ‘it’ is happening
“People responsible for planning & implementing change 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.
You’ll save yourself a lot of grief if you remember that”.
William Bridges
Leaving home

15. How well do you know yourself?
Are you ready to get to know yourself better?

16. Personal Styles ANALYTICAL DRIVER AMIABLE EXPRESSIVE Task focus
Aggressive
Passive
Combinations along the polarities – give us our motivational drives
AMIABLE
EXPRESSIVE
People focus
Merrill & Reid, Personal Styles and Effective Performance (1999)

17. How To Decide on your Personal Style
Quick questionnaire
Don’t over analyse
Check with other people
Work and home styles may be different
Most people will have a predominant and back up style but will be able to adopt approaches from other styles
A small number will not be able to identify a predominant style

18. Personal Styles Analytical Driver Amiable Expressive
formal
measured + systematic
seek accuracy
Driver
business like
fast + decisive
seek control
Amiable
conforming
less rushed + easy going
seek appreciation
Expressive
flamboyant
fast + spontaneous
seek recognition
Not everyone has 100% of one style
Identify your main style

19. Working with others
What are the strengths and weaknesses of this personal style?
How can others best communicate with this personal style

20. Analytical Driver Amiable Expressive under stress: fears:
Consider yourself in a situation of change: How do you behave under stress? What are your fears about change?
Analytical
under stress:
fears:
Driver
Amiable
Expressive

21. Under Stress Driver Analytical Amiable Expressive
will become autocratic
Analytical
will withdraw
Amiable
will submit
Expressive
will become offensive or sarcastic

22. Fears Analytical Driver Amiable Expressive not enough information
making a wrong decision
being forced to decide
Driver
loss of control
failure
lack of purpose
Amiable
not being liked
not fitting
lack of social status
not being recognised for efforts
Expressive
being ignored
being asked for detail
being linked with failure

23. Finding the balance Task focus ANALYTICAL DRIVER Get it right
Get it done
Aggressive
Passive
Get along
Get appreciation
Combinations along the polarities – give us our motivational drives
AMIABLE
EXPRESSIVE
People focus

24. It’s all about balance To get it done You need to get it right
To get it right you need to get along
This shows we need to work in all quadrants
To get along you need to make people feel appreciated

25. Three Phases of Transition and Personal Styles
AMIABLE
Ending
ANALYTICAL
Neutral
Zone
DRIVER
Describe diagram
EXPRESSIVE
Beginning
TIME

26. “If you always do what you do, you will always get what you got”.
So do something different
Albert Einstein
Any questions about what has been covered in this section?

27. Have you ever resisted a change?
Tell us about it and why you resisted

28. Why do people resist change?
Even the most well thought out, positive change will be a threat to some existing thing of value to some people.
“Every act of creation is first and foremost an act of destruction”
Pablo Picasso
STOP! – let us think – why do people resist change
What is change? – view quotation – creation out destruction
Rhetorical Question:-What do people “really” value?

29. Resistance is “feedback”
A “resistor” – term applied to someone who
“makes your life difficult” or “gets in the way” of the plan
If your starting point is
something wrong with the person & their resistance is “an illness to be cured”
Better to see resistance as
An attempt
Maybe poorly communicated, emotive, even hostile
To tell you something
about the change
how it is being managed
What is a resistor?
Ask people to define
Look at resistance as a form of communication, no matter how difficult it is.

30. Common reasons for resistance – the “vital few”
A desire not to give up something of value
A misunderstanding of the change and its implications
A belief that the change does not make sense to the organisation
A low tolerance to change
The Vital Few – are the key change reasons researchers have found people give for them resisting
John Kotter & Leonard Schlesiger – Harvard Business Review 1979

31. Variation in response
Normal distribution curve of reaction to change in organisations
Distribution curve within the organisation
Where are you operating the most?
Active resistors
Wait & see
Enthusiasts

32. Do not use all your energy on active resistors
Use your energy to shift distribution
Consider which key players are in which category & manage them accordingly
Use your time and energy wisely
Active resistors
Wait & see
Enthusiasts

33. Characteristics of Opinion Leaders
Higher social status
More years formal education
Greater literacy
Higher aspirations and ambitions
Tend to belong to larger groups
Demonstrate empathy, rationality
Exposed to and use variety of media
Greater knowledge of innovation
E. Rogers

34. You cannot always take everyone with you
True of large scale changes in the way an organisation works and behaves
Invitation
Ignoring
Coercion
Expulsion
In project of the scale most of you are operating – this is important to remember
On this scale: Are you operating all the way along the range or in a specific area
You may have to use some or all of these!
Involves actively removing people who do not work with the requirements of the change
Maximises the likelihood of people wanting to take part in the change
Focuses on achieving a critical mass
Uses organisational power to force people to accept change

35. Look for Motivators and Attractors

36. So… the next time you encounter resistance
Take time to engage in dialogue
Display genuine curiosity
Help them explain
Remember their viewpoint
Identify the assumptions
Show your position
Test – using various “what if” cases
If it does not work – slow the process down
Professor Sarah Fraser
1. With the presumed resistors – recognising your point of view may not be the “right” one.
2. About others feelings & views
3. The reasons for rejecting change
4. Is rational to them – try to understand their point of view
5. That both sides are holding – bring these into the open and discuss them
6. In a way others can see it
7. To see whether the resistors are ready to accept change
8. Keeping the dialogue open & honest

37. Go to the people Live amongst them Start with what they have Build on what they know And when the deed is done And the mission accomplished Of the best leaders The people will say “We have done it ourselves”.
Lao Tzu