1. Leading & Implementing Complex Change Ian Govier (Facilitator) Senior Nurse Advisor Clinical Leadership Development Programme

2. Aim of the Programme To assist the clinical leadership development of Senior Nurse Advisors at NHS Direct Wales

3. Programme Objectives The Programme will assist participants to develop their clinical leadership potential through: Active participation in clinical leadership workshops and related activities; Active participation in clinical leadership workshops and related activities; Identifying and critically examining the key characteristics, attitudes and behaviours associated with effective clinical leadership; Identifying and critically examining the key characteristics, attitudes and behaviours associated with effective clinical leadership; Taking action to successfully lead the Nurse Advisor team and thereby enhance the performance and quality of health care provision provided by NHS Direct Wales. Taking action to successfully lead the Nurse Advisor team and thereby enhance the performance and quality of health care provision provided by NHS Direct Wales.

4. Introductory Days x 2 Clinical Leadership an introduction to practices and principlesJuly 25 th & 26 th Module 1 Clinical Leadership developing & sustaining effective teamsSeptember 5 th Clinical Leadership exploring organisational influencesSeptember 6 th Module 2 Clinical Leadership leading and implementing complex changeOctober 24 th Clinical Leadership managing performanceOctober 25 th & improving patient care Senior Nurse Advisor Clinical Leadership Development Programme

6. The Healthcare Challenge

9. Permanent White Water (Vaill, 1996)

11. The Constants Change Choice Choice Principles Principles (Covey, 2006)

12. Leading & Implementing Complex Change PRINCIPLES

13. “The one indisputable fact that characterises organisational life, is that CHANGE is inevitable.” (Alimo-Metcalfe & Alimo-Metcalfe, 2005)

14. Challenges to Developing Practice “The greatest difficulty in the world is not for people to accept new ideas, but to make them forget their old ideas!” John Maynard Keynes ‘ Are you kidding? I like it here!’

15. Time for a Break

16. What do we believe about CHANGE? VV & Q’aire

17. Hodson’s Change Model (1996)

19. Fear! Position Position Power Power Pay Pay Possessions Possessions People People Prestige Prestige Privileges Privileges F

20. A ‘Familiar’ Grief and Loss Model

21. Lunch Time

22. 2 Truths & a Lie

23. CHANGE is stressful!

24. Thriving on the Stress of Change + commitment to change + feeling of being in control + see change as challenge = thriving & stimulating + alienated from change + feeling of powerlessness + see change as threatening = distress & illness High Stress

25. What needs to happen or be in place to realise successful CHANGE? Group Work

26. Change and Transition

27. Change is not the same as transition. Change is situational: the new site, the new structure, the new team, the new role, the new procedure. Transition is the psychological process people go through to come to terms with the new situation. Remember that change is external and transition is internal. Change is not the same as transition. Change is situational: the new site, the new structure, the new team, the new role, the new procedure. Transition is the psychological process people go through to come to terms with the new situation. Remember that change is external and transition is internal. William Bridges

28. The Discomfort Zone The Discomfort Zone – where ‘real and sustainable change happens (Senge, 2000)

29. TRUST TRUST - a key component for change

31. Contrasting Complicated and Complex Systems

32. Methods and Models for Achieving Change!

33. Approaches to Change and Improvement

34. A Model for Improvement

35. The PDSA Cycle to test a change / idea

36. PDSA Cycle in essence: PLAN: plan the change to be tested or implementedPLAN: plan the change to be tested or implemented DO: carry out the test or changeDO: carry out the test or change STUDY: study data before and after the change and reflect o what was learntSTUDY: study data before and after the change and reflect o what was learnt ACT: plan the next change cycle or plan the implementationACT: plan the next change cycle or plan the implementation

37. An 8 Step Process

38. “The most general lesson to be learned from the more successful cases is that the change process goes through a series of phases that, in total, usually require a considerable length of time. Skipping steps creates only the illusion of speed and never produces satisfactory results”

39. Step 1: create a sense of urgency Step 2: put together a guiding team Step 3: create visions and strategies Step 4: communicate for buy in Step 5: empower people Step 6: produce short-term wins Step 7: build momentum Step 8: nurture a new culture The 8 Steps

40. "Those who are most successful at significant change begin their work by creating a sense of urgency among the relevant people. In smaller organizations, the 'relevant' are more likely to number 100 than five, in larger organizations 1,000 rather than 50.... A sense of urgency, sometimes developed by very creative means, gets people off the couch, out of a bunker, and ready to move." Step 1 Create a Sense of Urgency

41. Step 2 Put Together a Guiding Team "With the urgency turned up, the more successful change agents pull together a guiding team with the credibility, skills, connections, reputations, and formal authority required to provide change leadership. This group learns to operate...with trust and emotional commitment."

42. Step 3 Create Visions & Strategies "...the guiding team creates sensible, clear, simple, uplifting visions and sets of strategies. In the less successful cases, there are only detailed plans and budgets that...are insufficient, or a vision that is not very sensible..., or a vision that is created by others and largely ignored by the guiding team."

43. Step 4 Communicate for ‘Buy-in’ "Communication of the vision and strategies comes next - simple, heartfelt messages sent through many unclogged channels. The goal is to induce understanding, develop a gut-level commitment, and liberate more energy from a critical mass of people. Here, deeds are often more important than words. Symbols speak loudly. Repetition is key..."

44. Step 5 Empower People "In the best situations, you find a heavy dose of empowerment. Key obstacles that stop people from acting on the vision are removed. Change leaders focus on bosses who disempower, on inadequate information and information systems, and on self- confidence barriers in people's minds. The issue here is removing obstacles, not 'giving power'."

45. Step 6 Produce Short-term Wins "With empowered people working on the vision, in cases of great success those people are helped to produce short-term wins. The wins are critical. They provide credibility, resources, and momentum to the overall effort."

46. Step 7 Build Momentum "...change leaders don't let up. Momentum builds after the first wins. Early changes are consolidated. People shrewdly choose what to tackle next, then create wave after wave of change until the vision is a reality. In less successful cases, people try to do too much at once."

47. Step 8 Nurture a New Culture "... A new culture... develops through consistency of successful action over a sufficient period of time. Here, appropriate promotions, skilful new employee orientation, and events that engage emotions can make a big difference. In other cases... a great deal of work can be blown away by the winds of tradition in a remarkably short period of time."

48. Time for a Break

49. Achieving Change through Well-formed Outcomes Group Work

50. Realising Change and Improvement through ‘Logical Levels’ Group Exercise

51. ‘Number Cruncher’ Group Exercise

52. “That which we persist in doing becomes easier - - not that the nature of the task has changed, but our ability to do has increased.” Ralph Waldo Emerson

53. Five Whys is a simple tool that can be applied in many situations, to get to the root of a problem (Senge et al., 1994). It helps managers resist the temptation to deal with symptoms rather than causes.

54. Final Thoughts Final Thoughts

55. When people who are not used to speaking are heard by people who are not used to listening, then real change occurs

56. The Constants Change Change Principles Principles Choice Choice (Covey, 2006)

57. If we always do what we’ve always done… …we’ll always get what we’ve always got!

58. What am I (are we) going to do differently after today?

59. …I’ll probably do nothing about it! If I do nothing about it in 24 hours…

60. The ‘Trim Tab’ effect

61. ‘Trim Tab’ HMS NHSDW

62. Be a TRIM TABBER!

63. and finally…

64. If the world were merely seductive, that would be easy. If it were merely challenging, that would be no problem. E.B. White But I arise in the morning torn between a desire to change the world and a desire to enjoy the world. This makes it hard to plan the day!

65. Thank You Diolch Website: www.ctrtraining.co.uk http://www.ctrtraining.co.uk/resources.php