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