1. People Matter Material adapted from Core Skills 2 Human Dimensions of Change Janet Harris Service Improvement Manager

2. Session Aims Understand why the Human Dimensions of Change are important Consider what needs to change Understand how complex adaptive change techniques will support service transformation and the different approaches needed Have a better understanding of why people resist change and ways to respond to resistance Understand how to use the Force Field Analysis Tool

3. ‘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.’ William Bridges

4. Why is it important to manage the human dimensions of change? Change in Healthcare = people changing Estimated 80% of change projects failure = failure to manage the people issues Need to understand the ways people react to change –minimise the risks of failure –maximises skills and talents of the team

5. What Needs to Change? People need to understand what needs to change Audiology now part of 18 Week Target What needs done? How are we responding? What type of change are we going through?

6. Complex Adaptive Systems Health and social care systems meet the classification of a complex adaptive system. BUT….complex systems have systems within systems – and some of these might be simple

7. Complex Adaptive Systems Collection of partsCollection of parts Share an environment or spaceShare an environment or space Parts can act independentlyParts can act independently Parts are interconnectedParts are interconnected Action by any part affects the wholeAction by any part affects the whole Examples: immune system, insect colony, flock, stock market, just about any collection of humans Audiology, ENT Services

8. Stacey Agreement and Certainty Matrix A method to select the appropriate management actions in a CAS

9. Close to Certainty Far from Certainty Close to Agreement Far from Agreement Stacey Matrix Anarchy Simple

10. So what do we already know about change? Change happens to us all..whether we like it or not! And it works best when………... It is owned by the people working in the system We consider the impact of change on people

11. Exercise in Pairs How Does that Make You Feel?

13. Transition Curve Progress through curve depends on: –Personality type –How much feel in control of change –How much other change is going on in life –Past experience

14. 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. Change is different from transition Change is external, transition is internal. Adapted from William Bridges, Managing Transitions

15. Change and learning Comfort Zone No learning No change Panic Zone people close uppeople close up they freezethey freeze they don’t learnthey don’t learn

16. Change and learning Discomfort Zone uncertaintyuncertainty learninglearning Panic Zone Comfort Zone

17. Leaving the comfort zone ‘To leave the comfort of the status quo, most individuals need to believe that the change is truly imperative and that there is a more attractive alternative’ Silversin/Kornacki

18. Resistance is Inevitable Resistance in inevitable in any change process Don’t struggle Embrace it as a positive force of change

19. Why might resistance be positive? Not all change is good – might stop you walking over cliff edge Even if change good – elements of approach may need refining Shows people care Psychological importance – buys time for individuals to acclimatise (Klein)

20. Why do people resist change? Poor Leadership –Failure to make case for change –Behaviour of leaders contradicts proposed change –Failure to communicate effectively with those expected to make changes –Mixed signals re priorities Organisational/Environmental Issues –Organisational structures work against change –Too much change –Time & energy to implement change detracts from another priority

21. Why do people resist change? Skills Issues –Don’t know how to effectively implement change –Don’t know how to stop doing what currently do –Don’t know how to do replacement activities Group/Psychological Issues –Threat to power/influence/autonomy –Investment in status quo –Group issues –Personality –Amount of change in personal life

22. a)People are less likely to resist when actively involved in change decisions (Lawrence, 2001) b)Understand why people resist – and remember it may be for good reasons c)Focus on reducing resistance rather than forcing the drivers d)Resistance is better than no response

23. Methods for responding to resistance How Do We Reduce Resistance? Education and communication - including asking people why they are resisting Participation and Involvement – including piloting changes with willing team Facilitation and Support – including training Negotiation and Agreement – including use of incentives for change Not recommended Manipulation and co-optation Explicit and implicit co-ercion (Taken from Kotter and Schlesinger, 2008)

24. Lewin’s Force Field Analysis

26. Exercise Identify the Goal Identify the current situation Identify what things are driving audiology services to meet the 18 week target? Identify the human elements that may be restraining audiology services from achieving the 18 week target?

27. Dig Deeper Identify causes of each of the restraining forces identified Where are the priorities? Are there any common themes? What solutions can you propose? Go back to your organisation and prove or disprove driving or restraining forces

28. “..Success is the ability to go from one failure to another with no loss of enthusiasm”. Winston S Churchill

29. Summary of Day Seven Key Messages Work out the type of change – simple/complex People need to know – why change? People need to have sense of what changing to Involve Involve Involve We are all different – so need to use a variety of methods Resistance can be positive and helpful Listen…seek first to understand and then to be understood