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Sustaining Change: Making the Gains Stick Martha Kathryn (M. K.) Key, Ph.D. Principal Key Associates Nashville, TN.
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Sustaining Change:Making the Gains StickMartha Kathryn (M. K.) Key, Ph.D.PrincipalKey Associates Nashville, TN
A licensed clinical-community psychologist, Dr. Key has over 30 years experience in organizational quality. She teaches, consults, and speaks on topics such as leadership, customer value management, tools for change (improvement and innovation), corporate culture, team development and facilitation, mediation of conflict, and creativity. Prior to forming Key Associates in 1997, she was vice president of the Center for Continuous Improvement with Quorum Health Resources, Inc. There she managed a national learning institute with a curriculum in CQI, which educated thousands of people across the country. Her doctoral, masters and bachelor of arts degrees, Phi Beta Kappa, cum laude and Honors in Psychology, have all been with Vanderbilt University. She has served for years as adjunct associate professor of Human and Organization Development, at George Peabody College of Vanderbilt. In addition to numerous professional articles, she has authored the book, Managing Change in Healthcare: Innovative Solutions for People-based Organizations (McGraw-Hill, 1999), and co-authored Corporate Celebration: Play, Purpose and Profit at Work (Berrett-Koehler, 1998)with Terry Deal, The Manual for Designing Change in Healthcare (McGraw-Hill, 1997)and Thought Packages That Produce Results: Just-in-Time Modules for Continuous Improvement (Quorum Health Resources, 1997). Please visit her website, http://www.mkkey.comand subscribe to KEYZINE, a free monthly electronic magazine on leadership topics. She can be reached at (888) 655-3901 or keyassocs@mindspring.com .
Let’s Begin! • Decide upon a change you have recently attempted in your NICU, which: • You have struggled with. • You would like to talk about here today. • You can see room for improvement in your strategy, and • You would like to leave here with a modified plan for that change effort.
The Personal Energy of Change Recall an experience you didn’t want to end - but it did. 1. What was it? 2. Before you knew the end was coming, what was it like? 3. What was your initial response when it ended? 4. What was your eventual response? 5. How did it ultimately turn out? For the good, or bad, or both? - from Woodward and Buchholz (1987), pp 43-44.
Learning Points: Personal Change • Most change is both loss and gain • Change is a highly personal experience and varies across individuals • Typically, people experience a negative reaction first--fear, anxiety, insecurity--which may appear to be resistance • Perception of change differs depending on whether it is imposed or chosen • Change creates energy which can be mobilized in a number of ways • After the reactive phase, comes the creative phase --here is where people have a choice • It takes time to work through change
The Timing of Change Pick an area where you chose to change your behavior, e.g., to quit smoking, lose weight, fix your golf swing. STAGING: 1. Ignoring/Resisting 2. Attending 3. Planning 4. Execution (& Relapse) 5. Embedding
Laggards 100% Skeptics Critical Mass Early Implementers Innovators 0% Adoption Over Time People Vary in Adoption of New Ideas Everitt M. Rogers, Diffusion of Innovations (1983).
Why Might People Be Resisting? • Change isn’t self-initiated. • Routine is disrupted. “The way things are done around here.” • Fear of the unknown. • Purpose of the change is unclear. • Fear of failure. • The rewards don’t match the efforts. • Respect for the leaders of the change. • Personal loss. • Additional work commitment. - John C. Maxwell (2001)
With Resistance 1. Surface it. 2. Honor its expression. 3. Explore it (and learn). 4. Recheck status of agreements.
What is Culture? • Informal rules that spell out how people are to operate. • “The way things are done around here.” • Shared assumptions (beliefs, values, mental models) and the behavior, norms, accepted practices, and artifacts they spawn. • The character of members of a society. • Not written down, but learned by living in it. • The sum of a society’s habits.
Cultural Levers • Articulating the values of the organization • Being ever present (MBWA) • Creating experiences and story-telling in ways that teach values • Role modeling (Walking the Talk) • Policies, procedures, practices consistent with the values • Symbols (e.g., space, rewards, rituals, ceremonies) • Language (what gets talked about and how) • Heroes/heroines (who gets recognition) • Articulating how decisions get made
Killer Phrases • It won’t work • It’s not in the budget • We will need to hire more staff • We have too many projects now • That’s not our problem • Here we go again • It’ll mean more work • Who thought that one up? • Yes, but • It’s too late • That’s the dumbest thing I ever heard • Our system isn’t set up to do it that way • It’s too expensive to do it that way • Are you kidding? • If it ain’t broke, don’t fix it • We’ve always done it this way • Don’t go there • They won’t let us • The physicians won’t go for it • Administration won’t go for it • Others?
Coercion • Intimidation • Manipulation • Structural • Negotiation • Persuasion • Modeling • Education/Information • Inspiration PUSH PULL Continuum of Push-Pull
Methods of Influence PRESENT STATE FUTURE STATE Push Strategies Facilitation Pull Strategies
Change Hangs in the Balance The benefits of the change plus the discomfort with the present must be greater than the perceived cost of the change.
Change the Leadership… • Change the Organization: • Positive Relationships • Improve Trust • Making Personal Changes—Going First • Guide Vs. Control • Walk the Talk • Visionary, Inspiring, Enthusiastic!
The Power of Vision • The mind thinks in word pictures • Helps to be on the same script and page • Direct, align and inspire others • Elevator and escalator speech • Light the next few steps • Don’t make excuses for the past
On Leading Change 1. Establish A Sense of Urgency 2. Create a Unified Guiding Coalition 3. Establish and Reinforce the Vision 4. Communicate, Communicate, Communicate 5. Remove Barriers 6. Create Short Term Wins 7. Go First--Model the Way - John P. Kotter, Leading Change (1996).
“In times of change, all norms and customs that people count on are stripped away. Communication fills that gap.” -Tim Coan, Colleague
Communicate, Communicate, Communicate • Use every vehicle/forum—formal and informal • Establish a Communication Plan • Lead by example • Establish two-way communication • Keep focus positive • Keep message simple • Explain seeming inconsistencies • Encourage differences of opinion
In Times of Change • Communicate, communicate, communicate • Resolve ME issues quickly • Toughest is not knowing • Expect resistance and use the energy for positive change
Create Short-term Wins • Keep the momentum going • Actively create wins • Make short-term wins visible • Support/reward noble experiments that failed • Celebrate/reward successful team wins
Driving Forces Restraining Forces Present State Desired State Force Field Analysis
Why Change Efforts Fail • Did Not Establish a Great Enough Sense of Urgency • Failed to Create a Powerful, Unified Guiding Coalition • Lack of a Vision • Under-communicating by a Factor of Ten • Not Removing Obstacles to the New Vision • Not Planning for and Creating Short Term Wins • Declaring Victory Too Soon • Not Anchoring Changes in the Company’s Culture • - John P. Kotter. Leading Change (1996).
Poor Great 1 2 3 4 5 Communicating with Employees Helping Employees through Change Explaining the Vision and the Next Few Steps Achieving Real Buy-in On a One-to-One Basis Removing Obstacles to the Vision Planning for Wins and Celebrating Them Being Innovative, Flexible, Adaptive and Nimble How Well Are We...? -Thanks to Marti Smye, You Don’t Change a Company by Memo, (1994).
Change Management Principles • Become fierce opponents of waste and non-value-added work • Establish social support mechanisms • Replenish people’s reserves • Remind people of the purpose and values of your organization • Enliven the vision: bold aims, daring deadlines • Connect with your customers • Lead and let everyone lead • Move forward • Understand the resistance but lead those willing to move ahead (20%) • Cultivate a climate for change • Use the energy of change • Find the learning opportunity • Focus people on what they can control • Seek wide participation • Communicate so that people have access to information • Free up thinking • Celebrate the gains - M. K. Key, Managing Change in Healthcare: Innovative Solutions for People-based Organizations, (1999).
