www.nelacademy.nhs.uk 0191 371 3634

1. www.nelacademy.nhs.uk 0191 371 3634 Change Management Fundamentals Dr David Yarrow david.yarrow@time-for-change.co.uk 0191 289 3855

2. Please find someone you don’t know and talk to them for the next few minutes:1. Introduce yourselves!2. Take it in turns (2 minutes each) to talk describe something you’re enthusiastic about, and explain why you’re so enthusiastic about it.This could be anything – a hobby/leisure activity, something you’ve done once and wish you could do again, the best meal you’ve ever had, the best decision you’ve ever made, a great piece of technology, best holiday, your great job….

3. This ‘handout’ contains a selection of the slides used in this workshop. After the workshop we will send e-mail you a link from which you can download an electronic copy of all of the slides.

4. Change Management Fundamentals Please think about these key questions as we get ready to start: • If I asked you to describe one thing that you’re really enthusiastic about, what would it be? This could be anything – a hobby/leisure activity, something you’ve done once and wish you could do again, the best meal you’ve ever had, the best decision you’ve ever made, a great piece of technology, best holiday, your great job…. (you’ll be asked to talk about this early in the workshop!) • Why is ‘change’ and ‘change management’ important for you/for all of us in the NHS? change

5. Aim of today …to help you to strengthen understanding of generic change principles and to be confident in applying them in your day to day work… change

6. References & signposting North East Leadership Academy: http://www.nelacademy.nhs.uk Watch out for other NELA workshops on subjects related to ‘change management’, e.g. ‘Leading Complex Change’, ‘Polarity Management’, ‘Tipping Point Workshop’, ‘Innovation and Creativity’, ‘Facilitation Skills’. The NHS Change Model: http://www.changemodel.nhs.uk School for Health & Care Radicals: https://changeday.nhs.uk/healthcareradicals Bridges, W. (2003). Managing Transitions: Making the Most of Change. 2nd edition. London: Nicholas Brealey Publishing Cheung-Judge, M. & Holbeche, L. (2011). Organization Development: A practitioner’s guide for OD and HR. London: Kogan Page Gladwell M. (2001). The Tipping Point: How little things make a big difference. London: Abacus Johnson, B. (1992). Polarity Management: Identifying and Managing Unsolvable Problems. Amherst, MA: HRD Press Kotter, J.P. (1996). Leading Change. Boston, MA: Harvard Busines School Press. Lewin, K. (1951) Field theory in social science: selected theoretical papers. D. Cartwright (ed.), New York, Harper & Row. Merrill, D.W. & Reid, R.H. (1999). Personal Styles and Effective Performance. Boca Raton, FL: CRC Press Piderit A.K. (2000). Rethinking resistance and recognizing ambivalence ; a multidimensional view of attitudes towards an organizational change, Academy of Management Review, www.findarticles.com Rogers, E. M. (2003). Diffusion of Innovations. Shapiro, A. (2010). Creating Contagious Commitment: Applying the Tipping Point to Organizational Change (2nd edition). Hillsborough, NC: Strategy Perspective

7. Learning outcomes • be aware of nature & stages of change and their implications • understand responses to change and how they vary for different people • be familiar with ‘soft vs. hard’and ‘either/or vs. polarity management’ approaches to change management • explore appropriateness of push/pull change strategies • understand established & newer approaches to change management • gain useful insights & practical ideas for effective change management

8. Your objectives

9. Why does change matter? Why is ‘change’… and change management’… so important to us?

10. “Every behaviour is motivated by need.  Change – any change – may be perceived as disruptive and potentially dangerous as the status quo becomes unstable.”  Maureen Mackenzie Mackenzie, Maureen (Associate Professor of Management, Dowling College, NY) (2008). Senior Leadership's Role in the Change Process. www.dowling.edu/faculty/Mackenzie/docs/change.pdf

11. Let’s think about ‘change’ • Write a list of words that you associate with the feelings you experience when you are going through CHANGE. • Share these lists within your group, and produce a flip chart that summarisesthe group’s view of what it feels like to go through CHANGE.

12. Let’s think a bit more about ‘change’ • Now… thinking about some significant change(s) you have been through, can you describe your experience of change as a PROCESS? As a series of steps or stages? • As a group, try to agree on how you would described the stages of this process, and capture this on a flip chart.

14. Let’s think about ‘managing change’ • Discuss within your group your experiences of trying to: • lead a change initiative of some kind • support a change that someone else is leading • influence other people to change their views • influence other people to change their behaviours • If you wish to, draw upon some examples from outside working life as well as examples from ‘work’ settings. • As a group, produce a flip chart that summarises the group’s experiences of INFLUENCING OTHERS TO CHANGE.

15. Atticus stood up and walked to the end of the porch. When he completed his examination of the wistaria vine he strolled back to me. ‘First of all’, he said, if you can learn a simple trick, Scout, you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view -’ ‘Sir?’ ‘-until you climb into his skin and walk around in it.’ Harper Lee To kill a mocking bird page 35

16. Change is… something we all know quite a lot about

17. What does the literature tell us about barriers to change? • It always takes longer than you think • Exaggerated expectations • Scepticism • Impatience • At least 70 % of change efforts fail to bring about the desired results!

18. Delivering change feels complex ‘cos it is! • Our people are intelligent • Passionate about their work • Trained to be analytical • Diverse professional backgrounds • Faced with challenge, complexity and pressure • Human • Stretched

19. What do we have to do to influence change?

20. Nature of change?

21. What do we have to do to influence change?

22. Change is… Diverse Constant Challenging Modellable Manageable? Predictable? Variable Change Management Fundamentals

23. Change management fundamentals Main Heading here Constant • There’s a lot of “change” about… • In life • At work • In the NHS • …and there probably always will be Diverse

24. Main Heading here Change management fundamentals Challenging • People can be ‘good at change’… but we can also be quite attached to the way things are • Observing the ways in which people respond to change ‘situations’, there are patterns, but… • The same person will probably react differently to two different change ‘situations’, and… • Two people will probably react differently to the same change ‘situation’ Predictable?

25. Main Heading here Change management fundamentals • A change ‘situation’ may be viewed as: • Opportunity • Threat • Major issue • Irrelevance • Something I have to make happen • Something that others are imposing (trying to impose) on me • Both something that’s imposed on me and something that I have to make happen Variable

26. Main Heading here Change management fundamentals Modellable • There are lots (and lots!) of models/frameworks/theories about change and change management • None of them are 100% ‘right’ or 100% ‘universal’ • But many of them can be useful • There are thousands of people working on ‘change’ in healthcare, lots of help/advice available, lots of great resources. Manageable?

27. Some ‘change models’ Bridges: transitions Lewin NHS Change Model Johnson: polarity management Merrill & Reid: personal styles Rogers: Diffusion Shapiro: creating contagious commitment Gladwell: Tipping Point

28. We have tools – but no magic bullets!

29. Things they say about change Transformational Transactional Emergent Planned Intrinsic motivation Extrinsic motivation Pull Push Soft systems Hard systems

30. As a group: • What are your thoughts about these five ‘categorisations’ of change? • I’ll ask each group to focus on one categorisation in particular, and lead discussion on it in a few minutes… but also think about the others • Is there a dominant fit in your organisation, in terms of where ‘change’ is positioned within these categories? Are there sub cultures within the organisation? Different types of changes? • What works well/not so well in your experience?

31. “Some changes are more severe and challenging than others in their effects on the organisation and on employees. Managing change requires you to recognise the type of change you face, then it is easier to decide how to tackle it.” Mee-Yan Cheung-Judge & Linda Holbeche Transformational Transactional • major, strategic changes • driven by need to align shape & functioning of organisation with its strategic intent • and/or by demands of the external environment • profound, transformative change requires a formal change model – orchestrated approach addressing both mechanics of the change and human/cultural aspects. • smaller-scale changes • fundamental nature of the organisation remains unchanged • relatively simple changes with reasonably predictable outcomes • e.g. changes to processes, structure, systems • tends to be aimed at achieving establishdgoald in new, better ways Sources: Cheung-Judge,M & Holbeche,L (2011). Organization Development: A practitioner’s guide for OD and HR. London: Kogan Page. Pellettiere, V. (2006). “Organization Self Assessment to Determine the Readiness and Risk for a Planned Change”. Organization Development Journal, 24(4), pp. 38-43).

32. Transformational Transactional “The challenge many strategic leaders face [when attempting transformational change] is that it is NOT enough to change strategies, structures and systems, unless the thinking that produced those strategies, structures and systems also changes.” Mee-Yan Cheung-Judge & Linda Holbeche

33. Emergent Planned The ‘planned’ approach • change is a step by step process • typically initiated top down • objectives set in advance • emphasis on thorough planning and project control The ‘emergent’ approach • outcomes cannot be predetermined • there is no end point • change comes typically 'bottom up‘ • change can be seen as‘managed learning’

34. Either/or…. or both/and ? Are both the planned and emergent approaches necessary? • plans needed to set direction…. but need to be flexible • top down support is needed for bottom up change • objectives need to be set and the team should be congratulated when each objective is achieved….. but improvement never ends • correct use of improvement tools and techniques should be planned and monitored….. but gaining the commitment of people is vital

35. Intrinsic motivation Extrinsic motivation • focus on achieving outcomes • motivation comes from outside the individual • e.g. targets, performance management, rewards, threat of punishment • competition is in an extrinsic motivator • motivation that is driven by interest or enjoyment in the task itself • exists within the individual rather than relying on external pressures or desire for reward • people engage willingly, enjoy the intrinsic rewards of the activity

36. Push Pull “Pull” change strategies connect a change to things people care about and desire – “change attractors” e.g. • benefits for patients & carers • positive outcomes for the individual • - advantages for their immediate (e.g. team/department) and wider (e.g. organisation/profession) environment • Need for people to realise the costs & risks of maintaining status quo v risk & uncertainty of making the change • Push people by creating discomfort in the system e.g. educate people about consequences of not changing, remove buffers and expose people to the consequences of not changing. • Assumption that intrinsic motivation is not sufficient to bring about change

37. Change attractors

38. Beware – only the tip of the iceberg! Formal organisation Goals, strategy, structure, systems & procedures etc. Values, attitudes & beliefs, behaviours, informal groupings, power, politics & conflict handing styles. Informal organisation

40. Models of change What do we know about ‘models’? • All models are imperfect • All forecasts are wrong • But some models can be useful • They can help us to get a better grasp of complex realities • Provide some useful insights • Help to unfog the fog…. a little or a lot

41. Models of change • We all use ‘models’ all the time….. often implicitly • ‘Mental models’…. that are running in our heads If I say this, she will react like that…. If he does this….. that will happen….

42. Kurt Lewin’s ideas about change Unfreeze Move Refreeze Kurt Lewin (1940s)

43. Kurt Lewin’s ideas about change Force Field Analysis Resisting Forces Driving Forces Current situation Desired situation

44. As a group: • Try-out a “Force-field analysis” of a specific change • You could use a generic example like “deciding whether to move house” or deciding whether to change jobs”… • …or, agree on another specific change that you can all relate to • Step 1: generate ideas for DRIVING FORCES and RESISTING FORCES • Step 2: Draw the Force-field analysis on flipchart paper • Step 3: Assign values (e.g. from 1 to 10) to each force • Step 4: Conclude… is this change going to happen? If you want it to happen, how might you go about increasing it’s chances of success? • If time allows, reflect on Lewin’s ideas – do they ‘work’ for you? Are they helpful as you try to better understand and manage change?

45. Kurt Lewin’s ideas about change ‘Unfreezing’ seen as 3 processes • Disconfirmation – dissatisfaction or frustration generated by data that ‘disconfirm’ our expectations or hopes …but on its own, this isn’t enough…we tend to deny or ignore the information. Need to accept the info and connect it to something we care about. The disconfirmation must arouse ‘survival anxiety’… if I don’t change, I’ll fail to meet my needs or fail to achieve some goals…

46. Kurt Lewin’s ideas about change ‘Unfreezing’ seen as 3 processes 2. Induction of ‘survival anxiety’ or guilt – but this tends to be resisted by our defensive reactions, manifesting as ‘learning anxiety’ If I allow myself to enter a learning or change process…admit to self & others that something is wrong… I’ll lose my effectiveness, self-esteem, even my identity. Learning anxiety is the fundamental restraining force which can go up in direct proportion to the amount of disconfirmation… hence the need to create some form of ‘psychological safety’….

47. Kurt Lewin’s ideas about change ‘Unfreezing’ seen as 3 processes 3. Creating psychological safety – which helps to reduce learning anxiety, allowing me to feel the survival anxiety and thus be genuinely motivated to learn and change Examples of change agents helping to‘create psychological safety’: • Working in groups • Creating parallel systems that allow relief from day-to-day work pressures • Providing practice fields where errors can be embraced rather than feared • Providing positive visions • Breaking learning into manageable steps • Providing coaching

48. William Bridges“The three phases of transition” Main Heading here “It isn’t the changesthat do you in, it’s the transitions. They aren’t the same thing. Change is situational: the move to a new site, the retirement of the [boss], the revisions to the pension plan… ..Transition, on the other hand, is psychological; it is a three-phase process that people go through as they internalise and come to terms with the details of the new situation that the change brings about…”

49. Bridges talks about three stages: • The ending • The neutral zone • The beginning William Bridges (1995). Managing transitions: making the most of change (2nd edition)

50. William Bridges’ model of change The 3 stages of Transition • The Ending:we acknowledge that there are things we need to let go of, and we recognise that we have lost something • The Neutral Zone: the old way has finished but the new way isn't here yet, everything is in flux and it feels like no one knows what they should be doing, things are confusing and disorderly • The Beginning: the new way feels comfortable, right and the only way