ILM - Leading Innovation and Change ILM Award in Leadership & Management Oaklands, March 2013 Miodrag Ivanovic – March 2013
Aims To introduce participants to models of change management : Kotter Lewin PDSA NHS Change Model Henderson Manion SWOT To enable participants to examine how these models could inform their own plans for leading change Miodrag Ivanovic – March 2013
How comfortable are you? Miodrag Ivanovic – March 2013 How do you find the idea of change?
Why Innovate? Within the health sector there has been enormous focus on financial and performance measures, but there is now an increasing emphasis on quality of care. • 2008 Lord Darzi’s NHS Next Stage Review ‘Quality of care is the basis of everything we do’. • The vital role of frontline leaders is emphasised. • 2009 Kings Fund ‘From Board to Ward’ and ‘Putting Quality First: Building on ‘From Ward to Board’. • Kings Fund 2011 The Future of Leadership and Management in the NHS: No More Heroes. Miodrag Ivanovic – March 2013
Question? Will your speciality: Change or perish? We are living in turbulent times Miodrag Ivanovic – March 2013
Leading and Managing Change In order for change to be effective and sustainable it needs to be: • Well planned • Linked to individual’s goals and values • Integrated with organisational objectives and structures • Demonstrate improvement in patient experience, quality of care, use of resources Miodrag Ivanovic – March 2013
Kotter’s 8 step change model Miodrag Ivanovic – March 2013 Increase urgency Build the guiding team Get the vision right Communicate for buy-in Empower action Create short-term wins Don't let up Make change stick
Thoughts to consider Think about how these steps can inform a planned change. • WHO you need to get on board to make a change successful? • WHAT are the values that are central to a change? • WHAT change involves and WHY it is needed. • HOW you can create short-term wins. Miodrag Ivanovic – March 2013
Karl Lewin’s Field Theory Stages of Innovation Present Stage Transitional stage Future Stage ImplementationPhases Unfreezing Moving Re-freezing Miodrag Ivanovic – March 2013
DESIRED STATE Planning Change: Force Field Analysis CURRENT STATE Driving Forces National and local policy? Capacity and demand factors? Patient choice/experience? Individual and team commitment? Shared vision? Positive past experiences? Professional development Resisting Forces Perceived (or real) lack of skills? Change in working pattern? No additional resources? Negative past experiences? Miodrag Ivanovic – March 2013
People • Early adopters • Resistors • Laggards – people who are sluggish, slow to adopt& adapt Miodrag Ivanovic – March 2013
Approach • Power-coercive • Empirical-rational • Normative re-educative Miodrag Ivanovic – March 2013
PDSA Miodrag Ivanovic – March 2013
PDSA Model for Improvement • Aim • How will we know change is an improvement? • What changes can we make that will result in the improvements we seek? • PDSA cycle • What are we trying to accomplish? • Measurements • Change principles • Testing ideas/implementing changes Miodrag Ivanovic – March 2013
NHS Change Model 2012http://www.changemodel.nhs.uk/pg/dashboard Miodrag Ivanovic – March 2013
Emotional responses to change(7 stages of change, Manion, 1995) Miodrag Ivanovic – March 2013 Losing focus – produces feeling of confusion & disorientation. Decision making may be very difficult. Minimising the impact – tries to make light of what is happening whilst also trying to make sense of what is taking place The pit –low energy levels and marked changes in mood e.g. Anger, resentment, resistance
Emotional responses to change(7 stages of change, Manion, 1995) Miodrag Ivanovic – March 2013 4. Letting go of the past – emotions less raw (but may still manifest themselves), generally calmer 5. Testing the limits – stage of hopefulness where change is being accepted 6. Search for meaning – realisation and understanding of the process/experience 7. Integration – change is now part of life and whilst not necessarily wonderful, is lived with.
Henderson’s seven stages of change (1991) MiodragIvanovic – March 2013 What are we trying to do? What is the best way of doing it? What are we going to have to do? In what order will we do things? what resources will be needed? Is it going to work? Who is going to do what?
SWOT analysis Miodrag Ivanovic – March 2013 Strengths Weaknesses Opportunities Threats
How do you make people feel safe? Miodrag Ivanovic – March 2013 Create a culture of mutual support and respect. Facilitate staff to view the situation from a different perspective. Create a compelling and positive vision of how things could be Provide access to appropriate training and role models Provide coaches, feedback and support groups Ensure systems and structures are consistent
Resistance to change Miodrag Ivanovic – March 2013 A common and natural occurrence Resistance normally occurs for 2 reasons. 1. The person does not like the proposed change. 2. Misconceptions about what the change will mean and how it will affect them Can be accompanied by feelings of fear doubt and uncertainty.
How can they be overcome? Miodrag Ivanovic – March 2013 Sell the idea Encourage ownership and involvement Consider the characteristic s of the people you expect to adopt the proposed change. You could use Belbin (1993) work on team roles to establish team roles and maximise development of practice
Some helpful hints Miodrag Ivanovic – March 2013 Try to understand and respect the other person Develop a range of styles for working with others Ask open questions and listen carefully to the answers Create a rapport with the other person/persons Ask for feedback Try to understand that every behaviour is useful in some way. Behaviour is the most important information about a person
To summarise MiodragIvanovic – March 2013 There is nothing more difficult to take in hand, more perilous to conduct or more uncertain in its success, than to take the lead in the introduction of a new order of things. Niccolo Machiavelli
What next? • Reflect and read the PDF’s on change on Oaklearn and anymore you can find. • All the leadership books will have change chapters. • Explore the NHS Change model site in detail www.changemodel.nhs.uk • Decide on the change model(s) you will adopt for the ILM report. Prepare a rationale for your choice. You must show evidence of critical analysis here. • Apply the chosen model(s) in the ILM report. Miodrag Ivanovic – March 2013
Further Reading Kotter, J. (1996) Leading Change. Harvard Business School Press. Langley, C, Moen, R, Nolan, T, provost, L (2009) The Improvement Guide: A practical approach to enhancing organizational performance. Jossey Bass: San Francisco. Lewin, K. (1958) Group Decisions and Social Changes: Readings in Social Psychology. Rhinehart and Wilson: New York Miodrag Ivanovic – March 2013