Richard K. WanyamaJuly 15 2015

ChangeFostering

Change is the only constant in life.HERACLITUS

Some Realities about Change

• Often provoked by external/PEST factors• Also undertaken as an evolution process

in the organization life-cycle• People dislike, fear, suspect change• Change opposes values and ideas that

people hold dear (that is why some argue that change should also target culture, values and beliefs)

Roles in Change Management

• Change Initiator• Change Agent• Change Champion

– People or groups whose actions are aimed at sustaining interest in the change process.

– Their roles include reminding people why change is happening and its benefits

• Sponsor of Change– Internal person, team or dept that is officially

responsible for coordinating the change process

Types of Changes in Health Programs

• Level 1: Changes in clinical practices• Level 2: Changes in providers’ behaviors

and attitudes• Level 3: Changes in management

practices• Level 4: Changes in management systems• Level 5: Changes in organizational

strategies and structures

500,000

women die during pregnancy and childbirth annually though the world knows how to prevent these deaths

8,000,000

people develop active TB annually and each infects an average 10 to 15 others, though

treatment is known and could be easily supervised

… health professionals chronically misjudge what it takes to make a lasting change

(The Manager 2004, Vol. 13, No. 3)

5factors influencing translation of ideas into workable practices

Dedicated change

agent leads the way

Clear purpose and expected results of the

change process

Staff motivation

and ongoing support

Clear assigned and

accepted responsibility

Environment that

encourages change

1. Dedicated agent leads the way

Internal change agent who cares

deeply about and is motivated by need

for change

New practices imposed from

outside last a short time without internal

change agent

Not necessarily idea originators, but organizational

innovators

2. Clear purpose and expected results of the change process

Ensure all stakeholders understand the challenges your

organization is facing in carrying out its mandate

and mission

Get stakeholder consensus on one

challenge they believe can be addressed by changing ineffective

practices

Convince stakeholders that the new practice:

Offers clear benefits to them and their clients

Can be tested without high cost/risks

Is consistent with organizational values

Can be implemented with minimal disruption

to services

3. Staff motivation and ongoing support throughout the process

Get the buy-in of staff and others you expect to

help

Get strategies to maintain their

dedication

Document early successes and

benefits

4. Gain acceptance of assigned responsibility

Assign staff clear responsibility for

implementing change and encourage them to accept

it

Encourage staff to recognize urgency and

priority of proposed change

Provide information, resources and skills

needed to take on new responsibilities

Integrate new responsibilities into

performance expectations and hold them accountable for achieving the assigned part of the change process

Provide needed support; demonstrate your

commitment; model the new attitudes and

practices that you expect them to adopt

5. Promote environment that encourages change

Ride on organizational

culture that supports change

and learning

Where overall culture inhibits

initiative, encourage change in your own

unit

Build alliance with other forward-

thinking managers

Use any positive results to persuade others to consider the new practice(s)

Understand factors that impede change and keenly watch

out for them

5phases of leading a change process

PHASE 1

Recognize the challenge

PHASE 2

Identify promising practices

PHASE 3

Adapt and test one promising practice or set of practices

PHASE 4

Implement the new practice(s)

PHASE 5

Scale up the successful new practice(s)

Phase 1: Recognize a Challenge

Create with staff a shared

vision of a better future

Identify with staff the one

serious obstacle your unit or facility

is facing

Determine the

underlying causes that prevent a

solution (Ask 5 Whys)

Move from “problem

mindset” to “challenges”

mindset

Start to bring senior

management on board (focus on

how to win their support)

Phase 2: Identify Promising Practices

Characteristics of a Promising

Practice

Deals with issues relevant to the identified

challenge

Has clearly met program

objectives in another setting

Has caused observable or measurable

improvements in services

Features elements that you and your

colleagues want to achieve in your setting

Have been tested in the

field and provide credible

evidence of success and transferability

What practices have been introduced in your org or neighboring org?

What practices have been introduced nationally?

What practices are endorsed by reputable national authorities?

What practices are promoted by international agencies?

Phase 3: Adapt and test one promising practice or set of practices

Create a change team

1. Work with team to analyze similarities

and differences between your setting and the origin of the promising practices.

2. Pay attention to org culture and how it might support or impede the

new practice. Find people in the org who can help to

address cultural elements.

3. Test the practice in a small setting such

that the testing is rapid and inexpensive but representative of

a real life setting; define results, indicators and approaches

4. Evaluate the success of the small scale trial against the indicators; use lessons

to eliminate obstacles; make needed adaptations. Later other parts of the org may

also make their adaptations

Phase 4: Implement the new practice

Expand use of the practice from limited

setting to more places; from one clinic

to multiple clinics; from one hospital unit to several units. Work with change team to

generate interest, curiosity, commitment

and ownership

1. Demonstrate to senior mgt and unit managers results of

the new practice, approaches, and how and when progress can be assessed

2. Agree on required steps, required tasks, when, by whom and with what resources

3. Ensure understanding of

roles by those responsible for tasks, time and resources

have been given, and are held responsible

for results

4. Monitor and document progress

against mutually agreed indicators; make necessary

adaptations based on lessons

5. Managers of new implementing sites identify all who are directly or indirectly affected and keep them informed of

progress

6. Acknowledge visible interim results

(small wins) to encourage and build confidence of staff as they move towards mainstreaming the

new practice

As the change team, which now includes new managers, succeeds in implementing the practice and making achievements known, you will be building a base of support among influential stakeholders and decision makers. Some of these people will become champions for eventual scale-up.

Phase 5: Scale up the successful practice

At this point, you may hand over the scale-up to more

senior people with broader authority and contacts. But

first lay the groundwork.

Redesign the practice a bit to

be less costly but maintain its

effectiveness

Build the change into mgt practices

(use existing policies, systems,

rewards, structures, etc.)

Develop communications strategy to make practice known to

target groups (including WIIIFM)

Be ready to serve as a resource for

one-on-one support as others undertake their change process

Dealing with People Reactions to Change

•Provide information•Reinforce that change will happen•State unmistakably when and how change will occur•Suggest ways to respond to the change

DENIAL (shocked that change is about to occur and uncomfortable

giving up familiar practices)

•Create opportunities for expressing anxiety•Listen attentively to concerns•Resist impulse to explain or defend the change•Show understanding / empathy for feelings of loss and worry•Understand motivations behind resistance and build coalitions that support the change

RESISTANCE (questioning whether it will succeed;

wondering about ability to cope; worrying about job security)

•Provide opportunities and resources for discovering new possibilities•Involve staff in planning for new practice, setting goals, etc.•Provide training to enable them carry out the new practice•Encourage people to prepare themselves in teams and to support one another

EXPLORATION (After expressing concerns and mentally detaching from old practices, people start to

explore opportunities in new practices)

•You no longer need to “manage” the change process•Validate and reward their commitment and they will manage themselves•Set long-term goals•Provide needed support•Get out of the way

COMMITMENT (People recognize and understand the benefits of the new practice for

the client, the org and for themselves; accept new idea; get ready to comply; commit to carry

it out)

Interesting Reading on Change

END