Identifying Successful Strategies for Addressing “Change Angst”

1. Identifying Successful Strategies for Addressing “Change Angst” Saudi International Medical Education Conference April 2012 M. Brownell Anderson NBME

2. Objectives • Describe the role that “change angst” can play in impeding or /advancing change. • Apply leadership skills from Kotter and others to the medical education setting. • Apply the identified success features to a current change effort at their home institution. • Evaluate appreciative inquiry as an approach for identifying and managing change angst. From work of Simpson, D. et al

3. Our work TODAY: Focus on Success – AI Approach • Examples of change ANGST? • Change Success? Appreciative Inquiry • Apply AI in Small Groups – 2-3 + Coach • Identify Common Features Successful Change • Groups Report on Success Features • Identify Cross Cutting Features • Work on Case Study • Summary and Closing • Transfer to Home Setting • References & Resources From work of Simpson, D. et al

4. Any Examples of Change Angst? • What was changed? • Who was involved? • Did “angst” help/hinder change? From work of Simpson, D. et al

5. Basics of Appreciative Inquiry • Assumption: • Every system has something that works right • Methods • Asset, forward based qualitative method (semi-structure interview) • Focus on success; explore in depth key elements • Analysis  Identification of • Themes • Strategies for overcoming barriers. From work of Simpson, D. et al

6. Basics of Appreciative InquiryUsed with/for: • Indiana U – 2004 JGIM - Professionalism • We use an organizational change methodology known as appreciative inquiry, which focuses attention on existing capabilities and successful experiences as a foundation for creating more of what is desired • Univ of Washington & UMKC - Professionalism • UW – Strategy for enhancing an institutional culture of professionalism (2007 Acad Med) • UMKC – Narrative storytelling as variant of AI to identify principles contained in definitions of professionalism to deepen understanding (2010 Acad Med) • Learning in Interprofessional Teams • Med Teacher/ AMEE Guide #28 (2009) • Emory, IU, Rochester, Baylor, Minnesota for Faculty Development • Core Curriculum session to enhance reflective learning - – Acad Med 2009 From work of Simpson, D. et al

7. Directions • Step back - Think of recent experience (last 3-4 mos) related to medical student curriculum. • Pick a time when you have felt most engaged, alive, absorbed, excited, proud. • Everyone have an experience? Need Help? • A learning experience with or between students and faculty • (Re) Affirmation of your role as a future physician, teacher, learner, educator, faculty member. • Occurred in any setting/context – in/out of class, as part of core/non-core pathway time, in a hallway/e-mail, in a clinic or the library, “nerd room”, Sim center, Starbucks. From work of Simpson, D. et al

8. Worksheet cont • Describe the experience in sufficient detail • What did it feel like? • How does it connect to something you value? • Who, What Where, When were you involved? • What did you and/or others do to contribute to this success? • What did you learn that might apply to other aspects of educational programs? • Analogy, image, metaphor captures what you learned? From work of Simpson, D. et al

9. < 1 Minute Reports Features & Themes From work of Simpson, D. et al

10. Cross-Cutting Themes 1. Strategies to build on? 2. Overcome obstacles? From work of Simpson, D. et al

11. What does the Literature Tells Us? Does it match our themes? Expand/Enrich our Understanding?

12. What does the literature tell us? • 50% of all organizational changes fail Beer, M, & Nohria, N. (Eds.). (2000). Breaking the code of change. Cambridge, MA: Harvard Business School. • Failure can • Happen early  failure of buy in/leadership group • Not be sustained  failure to live up to agreements • Peer pressure • Conflicting priorities So, how can change succeed? From work of Simpson, D. et al

13. Works on Successful Change:Identifying key characteristics • Herb Shepard: 8 Rules of Thumb for Change (1975) • John Kotter: 8 Steps of Change (1996) • Kerry Patterson, et al: Influencer (2008) • Six sources of influence • John D. Adams – review of various “models: • 8 + 4 themes for successful change From work of Simpson, D. et al

14. John Adams: 8 themes for successful change • Understand and accept the need for change • Believe change is desirable and possible • Sufficient passionate commitment: • changing habits (25% of people) • Specific deliverable goal and a few first steps • Structures /mechanisms that require repetitions of the new pattern • Feeling supported and safe • Versatility of mental models • Patience and perseverance From work of Simpson, D. et al

15. John Adams – 4 additional success factors • Clear accountability • Explicit boundary management • Critical mass in alignment • Rewarding the new behavior and withdrawal of rewards for the old behavior From work of Simpson, D. et al

16. From work of Simpson, D. et al

17. Case Study: Directions Work in small groups Read through the case study Complete the worksheets Share the key themes

18. Translating “Themes” Into Action Plans Taking the Literature and Themes – Apply to your “change” situation

19. Draft an Action Plan From work of Simpson, D. et al

20. Brief Reports of Selected Action Plans Translating “Themes” Into Action Plans

21. Using Success to Manage Angst → Moving forward in same direction From work of Simpson, D. et al http://executiveeducation.wharton.upenn.edu/wharton-at-work/0810/images/cartoon2b_lg-0810.gif

22. References & Additional Info • Adams JD. Transforming Leadership. 2nd Edition. Ed. Alexandria, VA: Miles River Press, 1998. • Branch WT, Frankel R, Gracey CF, et al. A Good Clinician and a Caring Person: Longitudinal Faculty Development & the Enhancement of the Human Dimensions of Care. Acad Med 2009;84(1):117-125. • Cooperrider DL, Whitney D. Appreciative Inquiry: A Positive Revolution in Change. San Francisco, CA: Berrett-Koehler Publishers, 2005. • Cottingham AH, Suchman AL, Litzelman DK, et al. Enhancing the informal curriculum of a medical school: a case study in organization culture change. J Gen Intern Med 2008;23(6):715-22. • Fryer-Edwards K, Van Eaton E, Goldstein EA, et al. Overcoming Institutional Challenges through Continuous Professionalism Improvement. Acad Med 2007;82(11):1073-1078 • Hammiick M, Olckers L, Campion-Smith C. Learning in interprofessional teams: AMEE Guide #38. Medical Teacher 2009;31(1):1-12. • Kotter,JP. Leading change. Cambridge, MA: Harvard Business School Press 1996. From work of Simpson, D. et al

23. References & Additional Info • Kouzes JM, Posner BZ. The Leadership Challenge, 4th Edition. San Francisco: Jossey-Bass; 2007. • Kumar LR, Chacko TV. Using appreciative inquiry on learning styles to facilitate student learning. Med Educ 2010; 44(11):1121-22. • Patterson K, et al. The Influencer: The power to change anything. McGraw Hill. New York. 2008. • Quaintance JL, Arnold L, et al. What students learn about professionalism from faculty stories: An ‘appreciative inquiry’ approach. Acad Med 2010;85(1):118-23. • Shepard, H. A. (1975). Rules of thumb for change agents. OD Practitioner 7(3), 1-5 • Simpson D, Lal A, Redlich PR. Sentinel Events as Surgeons – Appreciative Inquiry & Identify Formation. Focus on Surgical Education 2009;26(1):17-20. • Suchman AL, Williamson PR, Litzelman DK, Frankel RM, Mossbarger DL, Inui TS. Relationship-Centered Care Initiative Discovery Team. Toward an informal curriculum that teaches professionalism: Transforming the social environment of a medical school. J Gen Intern Med. 2004;19(5 Pt 2):501-4. • Whitney D, Trosten-Bloom, A. The Power of Appreciative Inquiry: A Practical Guide to Positive Change – 2nd Edition. Berrett-Koehler Publishers, Ind. 2010. From work of Simpson, D. et al

24. Herb Shephard’s Rules of Thumb for Change Agents • Rule I: Stay alive: • This rule is a double entendre—Herb advised us both to avoid “self-sacrifice” and to be “fully alive” in our work. • Rule II: Start where the system is • Rule III: Never work uphill • Corollary 1: Don’t build hills as you go • Corollary 2: Work in the most promising area • Corollary 3: Build resources • Corollary 4: Don’t over-organize • Corollary 5: Don’t argue if you can’t win • Rule IV: Innovation requires a good idea, initiative, and a few friends • Rule V: Load experiments for success • Rule VI: Light many fires • Rule VII: Keep an optimistic bias From work of Simpson, D. et al Shepard, H. A. (1975). Rules of thumb for change agents. OD Practitioner 7(3), 1-5.

25. Kotter, J. P. (1996). Leading change. Cambridge, MA: Harvard Business School Press. 1. Establishing a sense of urgency 2. Creating a guiding coalition 3. Developing a vision and strategy 4. Communicating the change vision 5. Empowering employees for broad-based action 6. Generating short term wins 7. Consolidating gains and producing more change 8. Anchoring new approaches in the culture From work of Simpson, D. et al

26. The Influencer: Kerry Patterson, et al.Six Sources of Influence From work of Simpson, D. et al