Change Management

Change Management Edward Crooks MD, CMQ, CLSSBB

Change Management Consequences of no change • Stagnation. • Inability to adopt new knowledge and technology.

Change Management • Change is constant and occurs at all levels of HCOs • Each level of change requires different strategies, depending on: • The type of change. • The people involved. • The magnitude of the behavior that must be modified to the make the required change.

Change Management Change must be managed in a planned and productive manner and requires the skills of a healthcare quality professional.

Change Management The question facing most organization, is not whether change is needed, but rather how much and how frequent.

Change Management Factors critical to assessing change in organizations: • The limits of human performance in being able to respond to change. • Actual capacity of the system to handle change. • Individual resiliency • Leaders - establish the culture of change, role model flexibility and the behaviors needed to adapt to change.

Change Management The levels of Change • First Order • Involves small, relatively easy steps and requires minimal effort to achieve. • Has no significant effect on systems or organizations. • Second Order • Complex and requires a significant change in behavior to achieve the desired new ways of performing new process.

Change Management • Change requires energy, effort and work. • In order to implement change a well-designed plan should include sufficient resources and time frame to complete each step in a plan

Change Management Change States • People will be influence by others and interpersonal interactions. • No single conceptual model is useful for all changes Transition State Future State Current State

Change Management Final success of any change will be based on the perception of and acceptance by the people involved in the change.

Change Management Participants who view the change as positive are more likely to value the results. If person are not part of the change process they probably not accept the changes that result evident by • Returning to old way of doing things • Work-around • Sabotage

Change Management HQP roles: • Change agent • Improvement Advisors • Facilitators HCP must pay attention to the personal side of change in order to manage the process of change successfully.

Change Management ‘All changes do not necessarily lead to improvement, but all improvement requires change.’ (Institute for Health Improvement).

Change Management Change Models • Lewin’s Change Model • Palmers Change Model • DeWeaver and Gillepsie’ Change Model • Galpin’s Human Side Change Model • Kotter’s Heart of Change Model • Prochaska’s Transtheoretical Change Model

Change Management Lewin’s Change Model • First Premise - Motivation and readiness for change must occur before change can actually take place. • The impetus for change is base on a ‘forced field’ of driving and restraining forces. • In order to produce change, the force field has to be of such that the driving forces are stronger than the restraining forces.

Change Management • The force field and therefore the impetus to change is more affected by removing the restraining force than adding more driving forces. • There has to be some level of frustration or dissatisfaction with current situation to create the motivation for change. • Effective change managers will use the dissatisfaction with the status quo to begin the movement to change.

Change Management Change States Learning new information, attitudes and processes Unfreeze old behavior Intervening Change Refreeze new behavior Transition State Current State Future State

Change Management Steps in the Change Process • Unfreezing - old behavior • Remodel – beliefs, expectation and norms. • Refreeze – new behavior

Change Management Force Field Analysis • Tool used to analyze a situation or process to be change. • Force Field Diagram consist of two columns: one for driving forces and the other for restraining forces. • Brainstorming and brainwriting is used to identify the driving and restraining forces.

Change Management • The significance of each force is demonstrated by the size of the arrows. • For change to be possible, the driving forces must be greater than the restraining forces. • Key management strategies is to reduce the number of restraining forces

Change Management

Change Management Palmer’s Change Model Uses 7 key elements describing change from a current state through a transition state to an improve future state. • Leading change • Creating a shared need • Shaping a vision • Mobilizing commitment • Monitoring progress • Finishing the job • Anchoring the change in the systems and structure

Palmers Change Model LEADING CHANGE Creating a shared need Shaping a vision Mobilizing Commitment Current State Transition State Improved State Monitoring progress Finishing the job ANCHORING THE CHANGE

Change Management Key management strategy in using Palmer’s model is to first assess the “readiness” for change by using the change readiness guidelines.

Change Management How to use the table • Assess readiness in each of the categories. • Add the first three categories. • Identify any category rated < 50% • Add categories 6 and 7

Change Management Low likelihood of success: • Sum of categories 1, 2 and 3 < 50% • Any category < 50% • Sum of 6 and 7 < 50% The greater the percentage of readiness for change, the greater the likelihood of success.

Change Management DeWeaver and Gillepsie’s Change Model • Most useful when objective measures that can predict accurate results are in place. • It depends on an orderly system in which objects behave predictably and new information can fit into existing structures, • Consist of five stages – individual progress through these stages at different rates and can revert to previous stages at any time.

Change Management Stages • Awareness stage Person • Knows something about the change • Or is aware of the change • May have heard it mentioned and explained • Does not have a strong opinion about it • May deny that the change will affect him or her • Curiosity stage Person • Expresses concern or curiosity about the change • Ask questions about the effect the change on him or her • May be defensive or in denial about the change

Change Management • Visualization stage Person • Seeks to understand (by asking questions and seeking information) his or her relationship to the change and the effect of the change on him or her or on the organization as whole. • Learning stage Person • Takes part in learning how to implement or use the change and may offer opinions and concerns about specifics of the change. • Use stage Person • Actively uses the change and integrates the change into his or her daily work habits and can describe or explain the change to others.

Change Management Specific Strategies • Awareness stage • Advertise in various media • Highlight the positive effect of the change • Link the change to meeting staff needs and eliminating problemw • Curiosity stage • Provide clear, concise explanations • Answer all questions • Take time to elicit concerns • Acknowledge the difficulties that the change may or will cause. • Create dissatisfaction with status quo • Generate interest in new approach

Change Management • Visualization stage • Demonstrate the change • Conduct user testing and reviews of proposed change • Learning stage • Focus on educating staff regarding the change • Conduct workshops or training sessions • Provide materials that will make the change easier to use • Use stage • Provide technical assistance • Ensure that enough resources are allocated

Change Management Galpin’s Human Side of Change • Based on a nine-step process in which change is a deliberate planned process. • Planning for change will ensure the greatest degree of success. • The changes can be either strategic change or grassroots change. • Strategic changes are Stages 1,2,3,4,and 5 • Grassroots changes are 7 and 8.

Change Management Adapted from The Human Side of Change, by T.J Galpin.

Change Management Galpins 4 Communication Phases • Build Awareness Phase (Stage 1 and 2) • Project Status Phase (Stages 3, 4, 5, 6, and & 7) • Communication Plan Phase (Stage 8) • End of Change Process – follow up with staff (Stage 9)

Change Management Change Management Tool • This tool focuses on the cultural aspect of change and identified those factors associated with the culture of the organization that should be assessed in order to achieve success. • Use a proactive approach to manage specific items that will impede the change process.

Change Management Kotter’s Heart of Change Model • Change is based on ensuring that people fully accept and incorporate the change into their belief system. • Kotter’s Model consist of eight steps.

Cultural Screening Tool • Rules and Policies • Goals and Measurements • Customs and Norms • Training • Ceremonies and Events • Management and behaviors • Rewards and recognition • Communication • Physical environment • Organizational structure Desired Change SustainedChange

Change Management Kotter’s Heart of Change Model • Increase Urgency ( requires evidence that change is actually needed • Shake up the status quo • Create a feeling of urgency. • Get people ready to move • Use tools such as dramatic presentation • Compelling stories • Build the guiding theme • Organize a team of influence • Right people in the right place with the right change process • Fully committed to the change initiative • Well respected within the organization • Have the power and influence to drive the change effort • Diverse to provide multiple perspective of the change and stakeholder’s interest

Change Management Kotter’s Heart of Change Model • Get the vision right • Clear vision is essential • Vision steers the team into the new direction. • Providing this direction is leadership’s responsibility. • Communicate for buy-in • Communication, communication, communication • Clear, credible and heartfelt messages – genuine, gut-level buy-in • Communication should be simple and sincere • Rid communication channel of the ‘junk’

Change Management Kotter’s Heart of Change Model 5. Empower action • Remove Barriers – promote confidence 6. Create short-term wins • Provide visible immediate successes communication, communication • Inspire people to believe that change can be implemented

Change Management Kotter’s Heart of Change Model 7. Don’t let up • Leaders need to support the change overtime • Build on the momentum of short-term wins by keeping sense of urgency alive. 8. Make the change stick • Once change is implemented, it must be ingrained in the organization.

Change Management Prochaska’s Transtheoretical Change Model James Prochaska’s approach to changing behavior is called the Trans-theoretical or ‘stages of change’ model. The concept of this model has been applied to numerous individual behaviors such as • Weight loss • Smoking cessation • Substance abuse treatment

Change Management The stages of change explain the individual’s readiness to change behavior, rather than a process change. It is useful for working with individual employee, patients and providers to change behavior. Stages are: • Pre-contemplation • Contemplation • Preparation • Action • Maintenance • Termination

Change Management • Pre-contemplation • There is no intention to take action within the next 6 months • Contemplation • There is intention to take action within the next 6 months • Preparation • There is intention to take action within the next 30 days and there have been some behavioral steps in this direction. • Action • Behavior have changed for less than 6 months • Maintenance • Behavior has changed for more than 6 months • Termination • The behavior will never return and there is complete confidence in the ability to cope without the fear of relapsing.

Change Management Problem identified Contemplation Motivational force for change Preparation Action plan developed Action New behavior reinforced Maintenance Old behavior is gone for good Termination

Change Management Model assumes that a person will not change his or her behavior until ready. Planned change is dependent on the readiness of the individual not the organization. The individual must moved from a state of pre-contemplation to contemplation for change to take place. Useful with special populations and health behavioral changes: CHF patients, smoking cessation and weight loss programs and adherence to medication regimen.

Change Management Useful with special populations and health behavioral changes: • CHF patients, • Smoking cessation and • Weight loss programs • Adherence to medication regimen

Change Management