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Leading Change

July 2019

Nicola Chandler, Director

www.nhselect.nhs.ukTwitter @NHSElect

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Welcome

Introductions

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Why does change often fail?

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Task

In small groups list as many reasons as you can

as to why “change often fails… “

5 minutes and then we will share

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You are not the first people to reflect on that question….

• Lots of theories• Lots of books• Lots of ideas

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Based on the work of Rick Maurer “Change without migraine” and John

Kotter “8 Step change model”

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The 8 Step Process of Leading Change

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Creating a Sense of UrgencyStep 1

Helping others see the need for

change

&

the importance of acting quickly

“For change to happen, it helps if the

whole organisation really wants it.

Develop a sense of urgency around

the need for change. This may help

you spark the initial motivation to get

things moving”

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STATUS QUOCHANGE

Creating a Sense

of UrgencyStep 1

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Help the teams see…

STATUS QUOCHANGE

How is this different to the past?

Why do I want to go here?

What are the benefits?

What will happen if we stay

here?

What’s going wrong?

What are the threats?

Creating a Sense

of UrgencyStep 1

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Creating the Guiding CoalitionStep 2

Putting together a group with a enough

power to lead the change.

Ensuring there is a

powerful group, with

the appropriate

leadership skills,

credibility &

authority to guide

the change process

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Who’s on your sideMapping it out….

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Stakeholder Mapping

Level of Interest

Le

ve

l of P

ow

er

/ In

flu

en

ce

Low High

Low

Hig

h

Key PlayersManage

closely

Keep

SatisfiedInvolve

Keep

InformedConsult /keep

informed

Minimal effortMonitor

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“if you want to go fast, go alone. If you want to go far, go together”

African proverb quoted by Al Gore

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Who are your stakeholders

Think of an issue you have and would like to address,

or an improvement project you’re working on, who are

your stakeholders?

15 minutes

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Developing a Change VisionStep 3

How the future will

be different from

the past - VISION

• Imaginable

• Feasible

• Desirable

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Posters

Meetings

Presentations

Announcements

Email

Blog

Frequent

Website

One to Ones

Ensure that as

many people

understand and

accept the vision

Step 4Communicating the Vision for

Buy-in

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Simple

Vivid

Repeatable

Inviting

Communicating the

Vison for Buy-InStep 4

Make your vision…

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Selling the change….

• People need to understand what you are talking about.

• People must feel emotionally why the change is critical.

• People must trust the source.

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TO SELL IS HUMAN

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To Sell is Human

• We’re all in sales now

• Over 40% of most jobs spent on selling – influencing, persuading and convincing

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The Six Pitches

SIX TYPES OF PITCHES

BEFORE YOU DO ANY OF THEM

0504030201

PixarOne-word Question Rhyming Subject Line Twitter

What do you want them to do

What do you want them to know

What do you want them to feel

? ??

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One Word

What technology company do you think of when you hear the word search?

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The Question Pitch

“Are you better off now than you were four years ago?”

When facts are clearly on your side, pitching with questions is more effective than pitching with a statement. Ohio State University.

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“If it doesn’t fit……you must acquit…”

“No Joke if you choke”

Speech and Language Therapy – Swallow assessment training

“Space on the Plate is Great”

Dietitians work on not overwhelming patients with food on a Dementia care ward

“Red to Green gets you seen”

Reducing hospital length of stay on hospital ward

Rhyming Pitch

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Subject Line

• Most important thing is who sent it

• Next the subject line

• Research found 3 reasons how people prioritise:

- Utility- Curiosity- Specificity

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Can you summarize your idea / project / plan in 140 characters?

Twitter Pitch

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01 02 03Once Upon A Time

Every Day One Day

0405& Because Of That,& Because Of That

Until Finally

Pixar Pitch

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The Pixar Pitch

1 3 5

2 4

Once Upon A Timethere was a widowed fish named Marlin

who was extremely protective of his only son, Nemo.

Every DayMarlin warned Nemo of the ocean’s

dangers and implored him not to swim far away.

One Dayin an act of defiance, Nemo

ignores his father’s warnings and swims into open water.

Because Of Thathe is captured by a diver and ends up as a pet in the fish tank of a dentist.Because Of ThatMarlin sets off on a journey to recover Nemo….

Until FinallyMarlin and Nemo find each other, reunite, and learn that love depends on trust.

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I Have a Dream….

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MLK video

https://www.youtube.com/watch?v=3vDWWy4CMhE

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CIVIL RIGHTS LEGISLATION: THE CASE FOR TRANSFORMATION

Presented by:

Dr Martin Luther King

1963

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WHAT I WILL COVER TODAY

• Background

• Key issues

• Previous actions against KPIs

• Performance to date

• KPIs moving forward

• Next steps

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BACKGROUND & OVERVIEW

Mission statement and action plan of USA

The Declaration of Independence (1776)

• Clear objective and target identified that all men are created equal

• Creator provides for certain “Rights” e.g. Life, Liberty, and the pursuit of Happiness.”

• The Constitution of the United States (1781, 1787)

KEY CONCLUSION

• Current progress suggest that a number of key KPIs continue to be missed

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CURRENT STATUS

• Implementation in some areas of Laws that are counter to key objectives

• racial segregation in all public facilities in southern states of the former Federacy (noted in red on map).

• Culture in southern states has developed that focusses upon: “Separate but equal”

• Evidence suggestions that emphasis is placed on ‘separate’ and ‘equal’ has not been achieved in many areas

• This raises serious issues regarding equity and perceptions of unfairness that must be addressed

• Ending segregation laws in south must be seen as vital first step in transformation programme.

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Our key

objective

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STRATEGY FOR ACHIEVING GOALS

• Focus on faith and belief

• Need to ensure consistent message and support for each other

• Use of prayer

• Acceptance that going to prison may be required to achieve vision

• Use of new mission statement: “Let freedom ring”

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KEY MILESTONES – GET EVERYONE EXCITED WITH A COMPLICATED GANTT CHART

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SUMMARY OF INITIAL FIRST STEPS

Check in with audience:

Who is inspired by this preparation to risk everything to achieve goals outlined?

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Connect to their emotions, Not rationale!

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Communicating the Vision

Refer to the handouts on 6 types of pitch…

• Give it a go…

• How will you get your message across….

• Capture your ideas on flip charts so we can

share with the rest of the room

15 minutes and then we will share

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Getting rid of obstacles

to change

Step 5 Empowering Others to Act

Changing systems

or structures that

undermine the

vision

Encouraging risk taking

and non traditional ideas,

activities, and actions

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Step 6Planning and Creating Short

term wins

Nothing Motivates

more than success

Identify

Improvements

Create Visible

Success as soon as

possible

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Consolidate Gains and Produce more change

• Keep up the urgency level

• Keep modelling the behaviours

• Celebrate Success

• Share information to convince others

• Reward and encourage

Step 7 Don’t Let Up!

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• Communicate the

improvements made

• Communicate the benefits

achieved

• Communicate where you

were and where you are now

Step 8 Embed New Approaches

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People and change

The Change Journey

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Signs of Grieving

Anger

Resistance

Exploration

Denial Commitment

Expect and accept signs of grieving

‘Well I guess we have to make the best of it’

It won’t affect me

What is so bad about the way things are around here?

Source: Elisabeth Kubler-Ross

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Discussion

At your tables discuss how you would support staff and

team members at each stage of the change journey.

• What would you do?

• What should you avoid doing?

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Signs of Grieving

Anger

Resistance

Exploration

Denial Commitment

Expect and accept signs of grieving

‘Well I guess we have to make the best of it’

It won’t affect me

What is so bad about the way things are around here?

Source: Elisabeth Kubler-Ross

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Resistance should be Understood

Not Overcome

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“I don’t get

it…!”

“I don’t like

it…!”

“I don’t like

you…!”

Rick Maurer: 3 levels of resistance

Lack of information, disagreement with data,

lack of exposure to critical information,

confusion over what it means.

An emotional reaction to change where we may

stop listening as we feel our survival is at stake.

They don’t trust you or may not have confidence

in your leadership; may love the change, but are

resisting you or those you represent.

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2

3

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“I don’t get

it…!”

“I don’t like

it…!”

“I don’t like

you…!”

Turning Resistance into Support

Make your case – explain why something must

be done; present the change using language

they understand; communicate in many different

ways

Remove fear & create excitement – emphasize

what’s in it for them; get them engaged; be

honest.

Rebuild damaged relationships – take

responsibility; keep commitments; find ways to

spend time together. Listen to the other side

and admit if you are wrong.

1

2

3

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1 4

Things we can currently do,

and will still be able to do

I don’t know how big a deal this change really is…

2 3

Things we can’t currently do, and won’t be

able to do

Things we can currently do, butwon’t be able to

do

Things we can’t currently do, but

will be able to do

Jason Clarke – embracing change © NHS Elect

I don’t know how big a deal this change is……Introduction of mobile working tablets for community nurses

Spend loads of time travelling to & from base, get stuck in traffic, work late into the night

Still be with our patients, still have our own case loads, still link with GPs, still be able to refer direct to therapies

Prescribe lots of different treatments, go home early on a Friday, kill our patients

Spend more time on patient care, deliver better care

We

cu

rre

ntly d

o

No

Y

es

In the future, we will be able to

No Yes

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Adopter Categories

Innovators

EarlyAdopters

EarlyMajority

LateMajority Laggards

Source: Rogers

2.5% 13.5% 34% 34% 16%

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William BridgesUnderstanding Transition

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Change is situational: new site, new boss, new team roles, new policy

Transition is the psychological process people go through to come to terms with new situations

‘Change’ and ‘Transition’ are not the same

Change is external, transition is internal

Source: Bridges, W. (1995) Managing transitions: Making the most of change, Nicholas Brearley, London

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William BridgesModel of Transition

NEUTRAL ZONE

BEGINNING

ENDING

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Managing endings

•Expect signs of grieving

•Help everyone to understand why

•Identify who’s losing what

•Mark endings

•Treat past with respect

•Let people take a piece of old way with them

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Video

The first follower………..

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3 Three things I have learnt or been reminded of today

2Two concepts or ideas that I intend to start or continue using in my work and organisation

.

1One thing that had the most impact on me during this Workshop

Action planning

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We are going to share this one

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References

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Beyond the Wall of Resistance, Revised 2nd Edition: Why 70% of All Changes Still Fail--And What You Can Do about It Paperback 2010by Rick Maurer

Our Iceberg is Melting: Changing and Succeeding Under Any Conditions Hardcover –2017by John Kotter & Holger Rathgeber