Welcome to Human Dimensions of Change

1. Welcome to Human Dimensions of Change

2. By end of today you will: • Understand why the Human Dimensions of Change are important • Have an overall framework for managing change • Understand the difference between simple and complex change – and the different approaches needed

3. By end of today you will: • Have developed your understanding of how to work effectively with different personality types when leading change • Have a better understanding of why people resist change and ways to respond to resistance • Understand the most common reasons why change projects fail

4. By end of today you will not: • Be an expert in change management – can’t do that in a day • Have lots of easy answers –real life change is often complex and messy • Have all your learning needs met all the time – the group is too diverse for that.

5. Course Approach • Some theory - its important and helps give you confidence in your approach but…. • Not theory for theory’s sake – has to help you with real life. • You bring the case studies – various exercises where you will look at how theory applies in your situation

6. Aims of Session One • To understand why the Human Dimensions of Change are important • To provide a framework for effective change management • To understand the difference between simple and complex change – and the different approaches needed

7. Why is it important to manage the human dimensions of change? • Change in Healthcare = people changing • Estimated 80% of change projects failure = failure to manage the people issues • Need to understand the ways people react to change • minimise the risks of failure • maximises skills and talents of the team

8. Exercise in Pairs

10. Transition Curve Progress through curve depends on: • Personality type • How much feel in control of change • How much other change is going on in life • Past experience

11. STEP ONETHE CASE FOR CHANGE

12. ‘People responsible for planning and implementing change often forget that while the first task of change management is to understand the destination and how to get there, the first task of transition management is to convince people to leave home.’ William Bridges

13. Why change? – how to generate dissatisfaction with status quo • Patient Stories • Pathway Mapping • Use of data • Visiting other services…seeing what is possible

14. Remember and Hearts Minds

15. Change and learning • Panic Zone • people close up • they freeze • they don’t learn Comfort Zone No learning No change

16. Panic Zone • Discomfort Zone • uncertainty • learning Comfort Zone Change and learning

17. STEP TWOVISION FOR THE FUTURE

18. Leaving the comfort zone ‘To leave the comfort of the status quo, most individuals need to believe that the change is truly imperative and that there is a more attractive alternative’ Silversin/Kornacki

19. What to Change To? Effectiveness of a Decision = Quality of Decision x Commitment to Implement No Involvement = No Commitment

20. What to Change To? • Ideally, involve those impacted in the change in developing a vision for the future: • Miracle Question • Value Stream Mapping • Option Development and Appraisal • Visits to other services

21. STEP THREE PLAN TO GET BETWEEN PRESENT AND FUTURE

22. If, overnight, I was to remove all cats from the World - what would be different • Today? • In Six Months? • In Two Years?

23. Complex Adaptive Systems • Collection of parts • Share an environment or space • Parts can act independently • Parts are interconnected • Action by any part affects the whole Examples: immune system, insect colony, flock,stock market, just about any collection of humans

24. Complex Adaptive Systems Deterministic Systems (Machine Metaphor) the system is predictable, if you understand the rules you can predict the behaviour Complex Systems (Environment Metaphor) the sum is bigger than the parts – cannot predict behaviour of whole system by understanding the individual parts

25. What type of system are you trying to change – simple or complex?

26. Complex Adaptive Systems • Health and social care systems meet the classification of a complex adaptive system. • BUT….complex systems have systems within systems – and some of these might be simple

27. Traditional Mgt Theory • Based on the metaphor of the organisation as a machine • Theories or rules apply to the system and result in a particular outcome • Mismatch between theories and practice • CAS Theory is an explanation of why

28. Source: Zimmerman

29. Complex Adaptive SystemsWhat do we know and how does it help us? We know: Cannot predict effect of the change by the size of the input. Small inputs can result in large changes, large inputs can result in no change Which means: • Promotes an experiential approach to change - try lots of different things on the margins (PDSA) • Allows us freedom from thinking we must work/plan it all out in advance.

30. Complex Adaptive SystemsWhat do we know and how does it help us? We know: Ability to predict in detail what will happen as a result of any given change in system rapidly deteriorates with time Which means: • Don’t spend lots of time on detailed plans • Keep a close eye for unintended consequences

31. Complex Adaptive SystemsUnpredictable in Detail

32. Complex Adaptive SystemsWhat do we know and how does it help us? We know: They have distributed control rather than one command centre Which means: • Recognises can’t control everything by issuing orders from the top • Solutions to issues are distributed throughout the organisation and not confined to the top • Need to find ways to ‘attract’ the system to change rather than ‘directing’.

33. Throwing a Rock or a Bird? ? y = x2 – b f = ma “attractor” Source: Paul Plsek, based on Richard Dawkins

34. Complex Adaptive SystemsWhat do we know and how does it help us? We know: Much of the power for creativity and innovation lies not with individuals but within relationships among parts of complex system Which means: • place more emphasis on micro (people and interactions) than macro such as strategy • generative relationships - just putting different people in the same room can result in change

35. Generative Relationships “Occur when interactions among parts of a complex system produce valuable, new, and unpredictable capabilities that are not inherent in any of the parts acting alone.” David Lane and Robert Maxfield

36. Complex Adaptive SystemsWhat do we know and how does it help us? We know: They are history dependent - shaped and influenced by where they have been Which means: • Explains why good practice in one area doesn’t always work in another • But doesn’t mean we have nothing to learn from elsewhere!

37. Complex Adaptive SystemsWhat do we know and how does it help us? We know: For a CAS to be sustainable there must be diversity – key to innovation and long term viability. Which means: • Need to value our differences - our long term success depends on the differences • Must be prepared to ask the difficult questions - face the taboos • But must also manage the distress to keep it at productive levels.

38. Complex Adaptive SystemsWhat do we know and how does it help us? We know: A very complex system can be (is) guided by a few simple rules Which means: • Build a good enough vision – provide general direction pointing, absolute boundaries and resources or permission rather than trying to plan everything in detail • Simple rules (often unstated) also maintain the system at status quo • Greatest leverage for innovation and change comes by modifying simple rules

39. Good Enough Vision andMinimum Specifications • Hunterdon Medical Center (USA) • Need: Community health initiatives • Approach: Nursing committee • Observation: After 6 months, committee had not yet gotten out of the hospital!

40. Good Enough Vision andMinimum Specifications • Instead... Simple rules • A nurse can schedule up to half-day per week to work on community health initiative • Don’t do anything illegal • Remain within the project budget (all expenditures publicly posted)

41. SummaryEffective Approaches in Complex Situations • Give the change problem back to those involved to generate solutions • Constructive open dialogues (seek first to understand, then to be understood!) • Experiment – small scale change – PDSA • Simple rules • BOTH/AND not EITHER/OR • Role of management is facilitating/enabling rather than directing

42. Giving up the Myths • Myth of Autonomy – everything you do depends on others, you cannot do it alone • Myth of Control – can’t control everything, need to win hearts and minds • Myth of Omniscience – you don’t have all the answers as manager/leader Often the toughest battle is not letting go of myths yourself but getting your staff to let go of them

43. Applying the Theory Important to identify when an issue is complex and when it is simple – needs different techniques But Remember a change initiative may consist of both simple and complex parts

44. Stacey Agreement and Certainty Matrix A method to select the appropriate management actions in a CAS

45. Stacey Matrix Far from Agreement Anarchy Zone of Complexity Close to Agreement Simple Close to Certainty Far from Certainty

46. Simple Zone • Know where you want to get to, have clarity on steps need to take to get there and agreement that it needs to happen • Traditional management theory works well here – project management approach, which splits out tasks and assigns them to individuals to implement • Key role of management is ‘directing’ the process to ensure project plan implemented

47. Complex Zone • Not clear if you make a change what the impact will be and no agreement whether to do it • Key to working in this area is peoples beliefs and ways of thinking • Focus on involving people in identifying issues and solutions, experimenting, constructive dialogue and simple rules • Key role of management is ‘enabling and facilitating’ rather than ‘directing’

48. Examples Far from Agreement Anarchy Priority actions to improve treatment of depression Implementation of advocacy services in line with mental health act Close to Agreement Close to Certainty Far from Certainty

49. Simple In the zone of complexity… Chaotic Experiment Simplerules Constructivedialogue Structure, processand pattern mapping

50. Complexity – Where does your change fit? Pairs Exercise • Think about a change you are currently involved in and discuss how this fits into the Stacey Matrix • Remember, different aspects of the change may fit into different parts of the Matrix • Does the change management approach being used fit with the type of change – and if not what needs to change?