The Management of Change

1. The Management of Change Sandra Dawson & Pam Garside International Health Leadership Programme 2006

2. The session • Dos and Don’ts of Managing Change • Group Work and Feedback • Leadership,Delegation,Trust and Change

3. What is meant by ‘Change?’ ‘Improvement is an innocuous term. Even innovation is fairly innocuous. Change is not.Change means disruption,by definition” Tom Peters,1997 ‘Thriving on Chaos’

4. Dos and Don’ts of Managing Change

5. ‘Dos’….annotated with your experiences of the reasons which led to a successful change

6. 1 Have very clear goals-know why you’re doing it and tell everyone • Have a good reason for the change which was highly sellable to the local community • Have evidence for your proposition • Coherent strategy and roll-out plan • Goals were clear • Articulating to staff of the ‘Whys’ • Clear goals,incentives timeframes • Having a pressing need and a high priority • Lack of data to support the problem identification • Background of problem not appreciated/understood • The lack of a vision to include alternative uses to community hospitals

7. 2 High level support for the change maintained throughout the process • Ministerial and CEO Support • Strong political will • Senior team, hands on engagement • Authority is most important • Persistence • Political Support • Lack of senior manager buy-in • Change of minister at critical point • Inadequate support of senior management,lack of alignment of management team re goals

8. 3 Involve / listen to people /engage stakeholders • Involvement of the physicians themselves in the process of development of guidelines for diabetes-this ownership was the reason for implementation • Well consulted • It was clear to me and my own management team that the turnaround in staff morale was due to staff’s understanding that we had listened to them and that we had valued their in put by implementing their recommendations • Active involvement of all those which were supposed to be affected by the change • Lack of support of stakeholders

9. 4 Communicate,communicate and then communicate again • Repeated persuasion of the senior management, with pros and cons of the change process. This was successful as I communicated the need clearly and with evidence and because the delegator was in a position of authority.Also this change was giving 6 other directors more authority • Well communicated • Lack of reception of message

11. 5 Champions on the Ground • Keenness to implement at operational level • Community champions advocating on behalf of the policy change • The large pool of potential trainees formed a major pressure group within the Medical Association

12. 6 Get the timing right and be in this for the long term • Reforms took the ‘long haul’ approach and required huge communication and engagement • Change of government facilitated the development of training

13. 7 Resource the process properly, establish a dedicated project team • Allocation of resources and budget for the whole change process • A Change Fund was identified but this was offset by the financial savings • Development Activities resourced from development partners • Get a champion to manage the programme • Inexperienced project manager was given too much latitude over the project

14. 8 Be honest and transparent with the facts • Transparency made the junior doctors more relaxed in dealing with authority

15. 9 Remember people are thinking ‘What does this mean for me’ • Understanding their fear (the staff) • Fears were addressed..securities provided

18. 10 Remember trust and dignity are easily eroded Build up Trust between parties who did not trust each other.How? By meeting to understand each other first and then work out details of process to create a true win/win environment for both parties

19. 11 HR processes are key:Training and development /plan exits/ do ‘deals’/ succession planning.Individuals have to trust the HR process and how it will treat them. Individualised training

20. 12 Evaluate!! Good monitoring and evaluation strategy

21. Dos that Pam and Sandra would add.. • Use line managers at every level • Symbols are critical • Create the team, keep the key people

22. Don’ts • Rely on videos,publications,and large meetings • Use jargon and over-intellectualise • Give inconsistent messages • Forget key stakeholders • Over-promise and under-deliver • Think that everyone who signed up on Day 1 will be with you on Day 60 or even day 600

23. Don’ts (2) • Forget middle managers and unions/staff side • Lose heart half way through-be brave and take measured risks,but to be adaptable is not necessarily weakness • Expect the world to stay the same as you progress through the change process • Forget the business must run day to day • Be confrontational • Have lack of alignment of goals • Underestimate resistance from stakeholders

24. Why do change programmes so often fail? • Success rates in Fortune 500 companies estimated at 25-50%-why? • Because ’leaders’ and employees see change differently • Change leaders fail to establish trust within their organisation • There is insufficient communication of the vision/goal/reasons for change

25. The Slot Machine model of change

26. Kanter’s Law.. ‘Everything can look like failure in the middle’ Prof.Rosabeth Moss Kanter,Harvard Business School

27. “Closing a hospital is like moving a graveyard-there’s not a lot of internal support for the move”

28. Work in groups to provide feedback on two sets of four change projects: Set 1 Community nursing designed to reduce emergency (Kyung) Community Ambulance Cover (Arthur) Staff Morale improvement (Al) Reform of PG Medical education (Dela)

29. Work in groups to provide feedback on two sets of four change projects: Set 2 New structure for health technical support unit (Aqila) Cross training of nursing staff (Murray) Roll out of anti retroviral treatment programme (Norbert) Moving primary care out of Tygerberg hospital (Japie)

30. Work in groups to discuss each change project: For each project • Describe it • Identify stakeholders • Summarise sources of resistance • What strategies/tactics were used, with what effect? What other tactics might have been successful? • Lessons learned Come back together in order to focus on what you have learned in addition to/or in amplification of, our collective learning…..