making changes

• The Change Process

Clinical Change Proposal Dissertation NM 6068

Tracy culkin 2008/09

Learning OutcomesLearning Outcomes

• Aimthis session will be a revision on the subject of change management

• Objectivesby the end of the session you should be able to

• Give a definition of change management• Describe two models utilised for the change

process• Identify tools which can be used to demonstrate

resistance to change

DefinitionDefinition

• Change - to make different, to alter, to transform

(Geddes & Grosset 2005, p 54)

How do you react to change?How do you react to change?Activity :

• Think about a change that you have experienced at work• How did you feel about the change?• Were you involved in initiating the change or was it forced on you?• Were you able to influence the change at all?• Was it clear why the change needed to take place?• Did you understand exactly what would happen?• Was there any misunderstanding or disagreement?• Did it achieve the results that were intended?• Did it change your work in any way?• Was it stressful or threatening for you?• Was anything lost that you valued?• Was anything gained?

What Drives Change?What Drives Change?

• External Environmental Factors

• A ‘STEEP Analysis’ – can help you to identify factors that might influence change in your organization

• S sociological

• T technical

• E economic

• E environmental

• P political

What Drives Change?What Drives Change?

• Internal Organizational Factors

• Multiple factors – such as finance, budgets, staffing etc.,

• Multiple pressures on departments

3 Different strategies for 3 Different strategies for Implementing ChangeImplementing Change

• Power-Coercive Approach (Telling)

• Seen as the traditional ‘top-down’ approach

• The assumption is that those with less power will comply

• The person with most power controls the change process

• ‘Knowledge is power’


• Rational-Empirical Approach (Selling)

• ‘Knowledge is power’ still applies, but it is the intention to increase the knowledge of the workforce

• This is also a ‘top-down’ approach, but with more involvement of those involved


• Normative-RE-Educative Approach (Participating)

• This contrasts with the first two approaches• This is a ‘bottom –up’ approach• Seen as the optimum approach• Main features –• Involves individuals• Agree on roles and tasks• Good communication• Need for change agreed by the participants• Builds on abilities of those involved• Includes support for each other

Lewin’s (1947) three-stage model Lewin’s (1947) three-stage model of Changeof Change

• Unfreezing

• Moving

• Re-freezing

(cited Martin 2003, p 105)

• Unfreezing stage – people begin to accept that there is a need for change.

• Moving stage – when it is possible to make changes

• Re-freezing – when the change is consolidated and the changed state becomes the new normal state

A Systems Model of Service ChangeA Systems Model of Service Change

(Martin 2003, p 108)(Martin 2003, p 108)

Inputs

People (including

service users)

Resources

Environment

History

Transformation

Interactions

Processes

Activities

Tasks

Outputs

Satisfied service Users

Goals achieved

Resources used

Reputation

Leading Change as a Process Leading Change as a Process (Martin 2003, p11)(Martin 2003, p11)

Awareness

Developing Vision

Developing DirectionInspiring Action

Reviewing, Revising, Reflecting

Leading Transformational ChangeLeading Transformational Change(Martin 2003, p109)(Martin 2003, p109)

Awareness

Developing Vision

Developing DirectionInspiring Action

Reviewing, Revising, Reflecting

Improving services through interactions,processes, activities

And tasks

Inputs

People (including

service users)

Resources

Environment

History

Outputs

Satisfiedservice users

Goals achieved

Resources used

Reputation

Leading Change Leading Change

How to tackle ChangeHow to tackle Change

• Devise an overall strategy

• Turn the strategy into a plan

• Seek sanction from those in authority

• Implement the plan

Developing a Plan for ChangeDeveloping a Plan for Change

• What am I trying to achieve?

• What is the best way of doing it?

• What tasks and activities are involved?

• In what order should I do these?

• What resources do I need?

• How shall I review progress?

• Who will do what and when?


• Aims and Objectives –what are you hoping to achieve

• Decide on the Change Strategy

• Plan how the Change will be Evaluated to measure its success

• How will you fund the Change/what is your budget?

• Consider how Consent will be achieved to access the Clinical Area

• Consider Ethical Issues that may occur


• Tools to aid planning and Implementation of the Change

Gantt Chart

Forcefield Analysis

SWOT Analysis

Charting the Critical Mass

Gant ChartGant Chart

Identify Support &Resistance to Identify Support &Resistance to ChangeChange

Identify your environmentIdentify your environment

Commitment PlanningCommitment Planning

• Need to build a critical mass of supporters to implement Change

• Any change situation has a balance of ‘forces’, reducing constraints is more effective than increasing pressure

• A commitment plan chart will help you to identify those, who oppose, allow, help or make the change

What you need to do!What you need to do!

• Lead the change process

• Manage the process

• Inspire others

You need to consider the styles of You need to consider the styles of LeadershipLeadership that are that are appropriate for your appropriate for your ChangeChange

Barriers to changeBarriers to change

• It requires people to think differently• It requires people to do things in

different ways• It requires people to learn new ways• It requires additional effort from

people

• Resistance to change • People are frightened about having to

learn and change

Working with ResistanceWorking with Resistance

• Effective communication

• Careful listening

• Careful explanations

• Discuss the reasons for the change and the external pressures driving it, may help some to understand why it needs to happen

• Encourage participation – in developing the vision or the direction of the change – may not become enthusiastic, but will tolerate the change

• Negotiation over particular issues with individuals or groups –can win people over

How you may feel!How you may feel!

During this process of writing your dissertation, just think During this process of writing your dissertation, just think this is your last hurdle to obtaining your degree!this is your last hurdle to obtaining your degree!

ReferencesReferences

• Bridges, W (2002) Managing transition, Making the most of change. London: Nicholas Brealy

• Burnes, B (2000) Managing change: a strategic approach to organisational dynamics. 3rd edn. Harlow: Prentice Hall

• Davidson J (2002) The Complete Idiot’ s Guide to Change Management. Indianapolis: A Pearson Education Company

• Geddes & Grosset (2005) Concise Edition Dictionary and Thesaurus. New Lenark, Scotland:David Dale House

• Martin V (2003) Leading Change in Health & Social Care. London: Routledge

• Mulhall A (1999) Changing Practice: the theory. London: Nursing Times books

• Turrill T (1993) Change and Innovation. 2nd edn. Thirsk: Turrill Ltd.

making changes

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