“Seeing” as a health and care radical

1. “Seeing” as a health and care radical Ability to make sense of, and reshape perceptions of ‘reality’

2. ‘En este muno traidor No hay verdad ni mentira, Que todo esta en el color Del cristal con que se mira’ In this world of many mazes There is nothing false or true: All depends upon the hue Of the glass through which one gazes (Sixteenth-century Spanish quatrain)

3. Seeing “Seeing, looking, monitoring, listening, perceiving and especially the indefinite concept of intuitive feeling ” Aubrey Jango

4. Task Have a table discussion: What are some of the different ways of “seeing” change?

5. What do we mean by resistance to change?

6. Resistance Any force that stops or slows movement Source of image: sport-fitness-advisor.com

7. Employee resistance is the most common reason executives cite for the failure of big organizational-change efforts Scott Keller and Colin Price (2011),Beyond Performance: How Great Organizations Build Ultimate Competitive Advantage Source of image: Businessconjunctions.com

8. Change can either challenge or threaten us…….Your beliefs pave your way to success or block youMarsha Sinetar Source of image: Creatememe.chucklesnetwork.com

9. Diagnosticanddialogicapproaches to resistance to change

10. Resistance: a “diagnostic” approach • Change is something that happens “out there” in the organisation or system • Resistance is a force to overcome • Resistance prevents change • Change agents mustdiagnose, manageand/or overcome resistance • Resisters may be otherwise known as “laggards”, “blockers”, “in denial”

11. Resistance to change

12. Diagnostic: the role of the change agent “The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to implement successfully and may not succeed at all” David Stonehouse  The change agent: the manager’s role in changeBritish Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445

13. Resistance: a “dialogic” approach • People make their own reality • Change results from transformational conversations • involving more and different people in change discussions • altering how and which people engage with each other • by stimulating different perspectives to shape how people think about things • Resistance is an inevitable consequenceof a complex change process (based on diversity) • Resistance should be embraced and worked with

14. Dialogic: the role of the change agent • Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system, and by being welcoming • Creat­e opportunities for everyone to express their views, spot opportunities and build on each other’s ideas • Create ways for people to reflect together to find meaning, understanding and shared purpose in the change Source: Peggy Holman

15. Diversity is critical to innovation and change “The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities. Do this before you start hiring consultants and rethinking your innovation process, there is no process that works without true diversity.” Idris Moore Source of image: idsgn.org

16. Health and care radicals should be champions of diversity for change “Leaders and organisations must let go of the idea that there is “one right way” and instead focus on creating a learning culture where people feel accepted, are comfortable contributing ideas, and actively seek to learn from each other” Diaz_Uda, Medina and Schill (2013) Source of image:fineartamerica.com

17. Discussion In the context of “rolling with resistance” • What are the implications of embracing diversity of thought, experience and background in our change efforts? • What skills and perspectives do health and care radicals need to work effectively with diverse teams for change? Source of image:fineartamerica.com

18. The effectiveness of change agents is not a matter of intention; it’s a matter of impact

19. Helen’sintent was to give people quick solutions, help them do their work faster and get on to the next problem at hand • However, her impact was that people did not know how to solve their own problems so that Helen’s style was impeding their development Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee Source of image: thedigitalawards.com

20. Stop talkingAT MEStart talkingTO ME Source of image: prepbeijing.com

21. What should I do to manage intent and impact? • Build a trusting and supportive work environment • Listen with an open heart and open mind • Commit to the change 100% • Seek common purpose and common interests • Take time to build relationships • Be open with my intent • Take responsibility for my own actions

23. If your horse dies, get off itCherokee proverb Source of image: fenwickgallery.co.uk

24. Task Have a discussion with others at your table: • How can I manage my intent and impact?

26. “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)

27. The model is mostly used around health-related behaviours • smoking cessation • exercise adoption • alcohol and drug use • weight control • fruit and vegetable intake • domestic violence • HIV prevention • use of sunscreens to prevent skin cancer • medication compliance • mammography screening

28. The model is mostly used around health-related behaviours It works for organisational and service change too! • smoking cessation • exercise adoption • alcohol and drug use • weight control • fruit and vegetable intake • domestic violence • HIV prevention • use of sunscreens to prevent skin cancer • medication compliance • mammography screening

29. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit Prochaska, DiClemente & Norcross (1992)

30. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet Prochaska, DiClemente & Norcross (1992)

31. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. Prochaska, DiClemente & Norcross (1992)

32. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! Prochaska, DiClemente & Norcross (1992)

33. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I am continuing to not smoke. I sometimes miss it – but I am still not smoking I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! Prochaska, DiClemente & Norcross (1992)

34. “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I am continuing to not smoke. I sometimes miss it – but I am still not smoking I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! Prochaska, DiClemente & Norcross (1992)

35. “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)

36. Some questions • Which stage do most change activities in health and care focus on? • Which stage are most people actually at?

37. 90% of the tools available for health and care change agents are designed for the “action” stage The reality of our change situation • Our tools are often not effective at the stage of change that most people we work with are at • It’s hard to engage people in change • It’s hard to get people to make the changes we want them to make • People get irritated, defensive, irrational • We feel powerless in our ability to lead or facilitate the change

38. Example - Surgical Checklist • Designed for Stage 4 – ACTION! • Mandated it through targets • Despite compelling case for change – people resisted it – no values connection • People did the task and missed the point

39. So what do we TEND to do? • Lower our ambitions for improvement • Focus our energies on those who are already in the “action” stage • Put negative labels on those who are not yet at the action stage such as “blocker” or “resister” or “laggard” • Blame “the management” for not enforcing change

40. The single biggest problem in communication is the illusion that it has taken place George Bernard Shaw

41. So what SHOULD we do? • Listen and understand • appreciate the starting point • elaborate interests • Build meaning and conviction in the change • Roll with resistance (Singh) • Don’t argue against it • Encourage elaboration of resistance • What makes it so hard? • What would help? • Build shared purpose

42. Example from the worksheet • I am not thinking about changing my behaviours, actions or work processes • The problem or issue is outside my frame of awareness or my perceived need • The focus should be on creating awareness for me of the need to change • Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation

43. Reflection Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model:  • What stage of change are some of the key people that you need to influence for your change initiative at? • What actions can you take to help them move to the next stage?

44. “Seeing” as a health and care radical • The big picture • Multiple perspectives • The positive intentions of others • Possibility of bad change processes rather than resistors, blockers and laggards • Hopeful futures, creative opportunities and potential • Multiple paradigms for change (eg, diagnostic and dialogic) • See myself in the context of my higher purpose

45. “Doing” as a health and care radical Skills and methods for creating change

46. Most large scale change doesn’t fullydeliver its objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey Gets anywhere near achieving the change and delivering the benefits @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5

47. Most large scale change doesn’t fullydeliver its objectives Delivers and sustains the change Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey

48. Image from: @TheWorldStories

49. Image from: @TheWorldStories

50. It is our contention that most change efforts are built upon the shaky foundation of five flawed assumptions; that change can be managed, that human beings are objective, that there are ‘X’ steps to change, that we have a neutral starting point for change, and that change, itself, is the goal Peter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf Source of image: Whatsthebigideascwartzy.blogspot.com