leading & implementing complex change ian govier (facilitator) senior nurse advisor clinical...

Leading & Implementing

Complex Change

Ian Govier (Facilitator)

Senior Nurse Advisor Clinical Leadership Development Programme

Aim of the Programme

To assist the clinical leadership development

of Senior Nurse Advisors at NHS Direct Wales

Programme Objectives

The Programme will assist participants to develop their clinical leadership potential through:

Active participation in clinical leadership workshops and related activities;

Identifying and critically examining the key characteristics, attitudes and behaviours associated with effective clinical leadership;

Taking action to successfully lead the Nurse Advisor team and thereby enhance the performance and quality of health care provision provided by NHS Direct Wales.

Introductory Days x 2

Clinical Leadership an introduction to practices and principles July 25th & 26th

Module 1

Clinical Leadership developing & sustaining effective teamsSeptember 5th

Clinical Leadership exploring organisational influencesSeptember 6th

Module 2

Clinical Leadership leading and implementing complex changeOctober 24th

Clinical Leadership managing performanceOctober 25th

& improving patient care

Senior Nurse Advisor Clinical Leadership Development Programme

What do you want to ACHIEVE or CHANGE as a result of today / tomorrow?

The Healthcare Challenge

Permanent White Water (Vaill, 1996)

The Constants

Change Choice

Principles(Covey, 2006)

Leading & Implementing

Complex Change

PRINCIPLES

“The one indisputable fact that characterises

organisational life,

is that CHANGE is

inevitable.”(Alimo-Metcalfe & Alimo-Metcalfe, 2005)

Challenges to Developing Practice

“The greatest difficulty in the world is not for

people to accept new ideas, but to make them forget their old ideas!”

John Maynard Keynes ‘Are you kidding? I like it

here!’

Time for a Break

What do we believe about

CHANGE?V &

Q’aire

Hodson’s Change Model (1996)

Fear!• Position • Power • Pay • Possessions • People • Prestige  • Privileges

F

A ‘Familiar’ Grief and Loss Model

Lunch Time

2 Truths & a Lie

CHANGE

is stressful!

Thriving on the Stress of Change

+ commitment to change

+ feeling of being in control

+ see change as challenge

= thriving & stimulating

+ alienated from change

+ feeling of powerlessness

+ see change as threatening

= distress & illness

High Stress High Stress

What needs to happen or be in place to

realise successful

CHANGE?Group Work

Change and Transition

Change is not the same as transition. Change is situational: the new site, the new structure, the new team,

the new role, the new procedure.

Transition is the psychological process people go through to come to terms

with the new situation.

Remember that change is external and transition is internal.

William Bridges

The Discomfort Zone – where ‘real and sustainable change happens

(Senge, 2000)

TRUST- a key component for change

Contrasting Complicated and Complex Systems

Methods and Models for Achieving Change!

Approaches to Change and Improvement

A Model for Improvement

The PDSA Cycle to test a change / idea

PDSA Cycle in essence:

• PLAN: plan the change to be tested or implemented

• DO: carry out the test or change

• STUDY: study data before and after the change and reflect o what was learnt

• ACT: plan the next change cycle or plan the implementation

An 8 Step

Process

“The most general lesson to be learned from the more successful cases is that the change

process goes through a series of phases that, in total, usually require a considerable length of time. Skipping steps creates only the illusion

of speed and never produces satisfactory results”

Step 1: create a sense of urgency

Step 2: put together a guiding team

Step 3: create visions and strategies

Step 4: communicate for buy in

Step 5: empower people

Step 6: produce short-term wins

Step 7: build momentum

Step 8: nurture a new culture

The 8 Steps

"Those who are most successful at significant change begin their work by creating a sense of urgency among the relevant people. In smaller organizations, the 'relevant' are more likely to

number 100 than five, in larger organizations 1,000 rather than 50.... A sense of urgency, sometimes

developed by very creative means, gets people off the couch, out of a bunker, and ready to move."

Step 1 Create a Sense of Urgency

Step 2 Put Together a Guiding Team

"With the urgency turned up, the more successful change agents pull together a guiding team with the credibility, skills, connections, reputations, and formal authority required to provide change leadership. This group learns

to operate...with trust and emotional commitment."

Step 3Create Visions & Strategies

"...the guiding team creates sensible, clear, simple, uplifting visions and sets of strategies. In the less successful cases, there are only detailed plans and budgets

that...are insufficient, or a vision that is not very sensible..., or a vision that is created by others and largely ignored by the guiding team."

Step 4 Communicate for ‘Buy-in’

"Communication of the vision and strategies comes next - simple, heartfelt messages sent through many

unclogged channels. The goal is to induce understanding, develop a gut-level commitment, and liberate more energy from a critical mass of people. Here, deeds are often more important than words.

Symbols speak loudly. Repetition is key..."

Step 5 Empower People

"In the best situations, you find a heavy dose of empowerment. Key obstacles that stop people from acting on the vision are removed. Change leaders focus on bosses who disempower, on

inadequate information and information systems, and on self-confidence barriers in people's minds. The issue here is removing

obstacles, not 'giving power'."

Step 6 Produce Short-term Wins

"With empowered people working on the vision, in cases of great success those people are helped to produce short-term wins. The wins are critical. They provide credibility, resources, and momentum to the overall effort."

Step 7 Build Momentum

"...change leaders don't let up. Momentum builds after the first wins. Early changes are consolidated. People shrewdly choose what to tackle next, then create wave after wave of change until the

vision is a reality. In less successful cases, people try to do too much at once."

Step 8 Nurture a New Culture

"... A new culture... develops through consistency of successful action over a sufficient period of time. Here, appropriate promotions, skilful new employee orientation, and events that engage emotions can make a

big difference. In other cases... a great deal of work can be blown away by the winds of tradition in a remarkably short period of time."

Time for a Break

Achieving Change through

Well-formed Outcomes

Group Work

Realising Change and Improvement through

‘Logical Levels’

Group Exercise

‘Number Cruncher’

Group Exercise

“That which we persist in doing becomes easier -

- not that the nature of the task has changed, but our ability to do has increased.”

Ralph Waldo Emerson

The Five Whys

Five Whys is a simple tool that can be applied in many situations, to get

to the root of a problem (Senge et al., 1994).

It helps managers resist the temptation to deal with symptoms rather than causes.

Final Thoughts

When people who are not used to

speaking are heard by people

who are not used to listening, then real

change occurs

The Constants

Change Principles Choice

(Covey, 2006)

If we always do what we’ve always done…

…we’ll always get what we’ve always got!

What am I (are we)

going to do differently

after today?

…I’ll probably

do nothing about it!

If I do nothing about it in 24 hours…

The ‘Trim Tab’ effect

‘Trim Tab’

HMS NHSDW

Be a TRIM TABBER!

and finally…

If the world were merely seductive, that would be easy.

If it were merely challenging, that would be no problem.

E.B. White

But I arise in the morning torn between a desire to change the world and

a desire to enjoy the world.

This makes it hard to plan the day!

Thank You

DiolchWebsite: www.ctrtraining.co.uk

http://www.ctrtraining.co.uk/resources.php