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Module 3 slides - School for Change Agents

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It is natural to resist change. Rather than seeing resistance as something negative, here we shift our perspective so that we see dissent, diversity and disruption as essential components of effective change. However, we need to build resilience in order to work effectively with resistance. This module offers some tools and techniques to ensure that we remain strong, adaptable and able to continue our work as change agents.
To find otu more about the School, please visit the website http://theedge.nhsiq.nhs.uk/school/module-3/

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Module 3 slides - School for Change Agents

  1. 1. #S4CA @sch4change theedge.nhsiq.nhs.uk/school/ Module 3: Rolling with resistance @Sch4Change #S4CA team Brought to you by the
  2. 2. #S4CA @sch4change School Lead: Helen Bevan @HelenBevan Olly Benson @OllyBenson Kate Pound @KateSlater2 Lead facilitator: Pip Hardy @PilgrimPip Chat Room Monitors Twitter Monitors Louis Warner @LouisWHorizons Technical Support Joanna Hemming @JoannaHemming Paul Woodley @PaulWoodley4 Kathryn Perera @Kathrynperera The team today
  3. 3. #S4CA @sch4change Joining in today…and beyond • Please use the chat box to contribute continuously during the talk • Please tweet using hashtag #S4CA and the handle @Sch4Change • Send a request to join our Facebook group School for Change Agents https://www.facebook.com/sch4change/ • We will produce summaries of each module discussion using Steller and put on the website
  4. 4. #S4CA @sch4change Each week we’ll cover different change agent capabilities 16th February: Being a change agent: change begins with me 23rd February: From me to we: making connections and building communities 2nd March: Rolling with resistance 9th March: Making change happen 16th March: Moving beyond the edge Source of image: thenounproject.com
  5. 5. #S4CA @sch4change Nurses, Midwives and Allied Health Professionals Use the school experience as part of your CPD reflective account for revalidation Doctors We have applied for CPD credits for the school Everyone If you watch all five of the talks and demonstrate you have applied the learning, you can apply to become a certificated change agent (and it’s free) Certification and Continuing Professional Development
  6. 6. #S4CA @sch4change Randomised Coffee Trial
  7. 7. #S4CA @sch4change • Email to join the RCT england.si-horizons@nhs.net • We will randomly match you with another participant in the School for Change Agents from anywhere in the world • At some time in the next four weeks, arrange to have a conversation over Skype (or other communication system) with a cup of coffee! Image source: Pinterest
  8. 8. #S4CA @sch4change When I meet with resistance at work, I… … initiate a conversation in the hope of understanding the other point(s) of view … know I’m right – I just have to persuade the resisters! … bring together people with different ideas and encourage the diversity of ideas
  9. 9. #S4CA @sch4change The role I identify with most closely: User of care system Campaigner Change agentEnquirer Chief listener Giver of care
  10. 10. #S4CA @sch4change Change agent capabilities in module 3 • Ability to look at “resistance” from multiple perspectives • Understanding of the relationship between intent and impact • Building resilience by mobilising and organising • Using the Stages of Change model to understand resistance and help people through change Source of image: thenounproject.com
  11. 11. #S4CA @sch4change Source of image: sport-fitness-advisor.com Any force that stops or slows movement Resistance
  12. 12. #S4CA @sch4change Why do organisational change programmes fail to achieve their objectives? The majority of reported reasons are related to resistance to change Source: McKinsey & Co
  13. 13. #S4CA @sch4changeImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
  14. 14. #S4CA @sch4change
  15. 15. #S4CA @sch4change ‘En este muno traidor No hay verdad ni mentira, Que todo esta en el color Del cristal con que se mira.’ ‘In this world of many mazes There is nothing false or true: All depends upon the hue Of the glass through which one gazes’. Sixteenth-century Spanish quatrain
  16. 16. #S4CA @sch4change In module 1, we talked about: Jeremy Heimens, Henry Timms This is New Power
  17. 17. #S4CA @sch4change Let’s think about “resistance” in old/new power terms
  18. 18. #S4CA @sch4change Let’s think about “resistance” in old/new power terms • Change can be planned and managed through a rigorous process • Resistance is a force to overcome • Resistance prevents change • Change agents must diagnose, manage and/or overcome resistance • Resisters can otherwise be known as “laggards”, “blockers”, “in denial”
  19. 19. #S4CA @sch4change Resistance to change: the old power mindset
  20. 20. #S4CA @sch4change A transformation programme Source: Sewell (2015) : Stop training our project managers to be process junkies
  21. 21. #S4CA @sch4change Old power mindset: the role of the change agent “The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to implement successfully and may not succeed at all” David Stonehouse The change agent: the manager’s role in change British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445 Source of image: Health IT Outcomes
  22. 22. #S4CA @sch4change • Change can be planned and managed through a rigorous process • Resistance is a force to overcome • Resistance prevents change • Change agents must diagnose, manage and/or overcome resistance • Resisters can otherwise be known as “laggards”, “blockers”, “in denial” • Change in human systems is often emergent and hard to predict • Change results from connections and interactions stimulating different viewpoints, shaping how people think about things • Resistance is an inevitable consequence of a complex change process • Resistance should be embraced and rolled with Let’s think about “resistance” in old/new power terms
  23. 23. #S4CA @sch4change Is your change programme a cathedral or a bazaar? http://www.unterstein.net/su/docs/CathBaz.pdf
  24. 24. #S4CA @sch4change Resistant behaviour is a good indicator of missing relevance Harald Schirmer http://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new- role-of-hr-driving-social-adoption-and-change-in-the-enterprise Source of image: driverlayer.com ‘‘
  25. 25. #S4CA @sch4change 1. Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system and by being welcoming 2. Create opportunities for everyone to express their views, spot opportunities and build on each other’s ideas 3. Create ways for people to reflect together to find meaning, understanding and shared purpose in the change Source: Peggy Holman New power mindset: the role of the change agent Source of image: rachtalks.pressprestige.com
  26. 26. #S4CA @sch4change
  27. 27. #S4CA @sch4change Recommended: Mark Jaben on the science behind resistance What NOT to do What TO do But what we do do Instead of buyers (who “buy-in”), we need investors
  28. 28. #S4CA @sch4change Data and facts don’t change our minds http://www.newyorker.com/magazine/2017/02/27/why-facts-dont-change-our-minds
  29. 29. #S4CA @sch4change Our effectiveness as change agents is not a matter of intention; it’s a matter of impact
  30. 30. #S4CA @sch4change • Helen’s intent was to give people quick solutions, help them do their work faster and get on to the next problem at hand • However, her impact was that people did not know how to solve their own problems so that Helen’s style was impeding their development Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee Source of image: thedigitalawards.com
  31. 31. #S4CA @sch4change Stop talking AT ME Start talking TO ME Source of image: prepbeijing.com
  32. 32. #S4CA @sch4change Which kind of activists are most successful at delivering change? Lone wolves Build power by expertise and information — through advocacy, oversight, contributing to committees, public comments and other forms of consultation Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century
  33. 33. #S4CA @sch4change Patient leaders as “lone wolves” “What I am ranting about is the way in which patients are being streamed into advisory sub committees, the way we are being used as tokens and to help tick off the right box….. Where is the attitude that patients are part of the team in healthcare, that we are partners? Why are we always asked to participate inside a pre-determined frame? When will we see co-design of new policies, and ultimately co-production?” Annette McKinnon
  34. 34. #S4CA @sch4change Which kind of activists are most successful at delivering change? Lone wolves Build power by expertise and information — through advocacy, oversight, contributing to committees, public comments and other forms of consultation Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century
  35. 35. #S4CA @sch4change Which kind of activists are most successful at delivering change? Lone wolves Build power by expertise and information — through advocacy, oversight, contributing to committees, public comments and other forms of consultation Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action Organisers Build power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century
  36. 36. #S4CA @sch4change Which kind of activists are most successful at delivering change? Lone wolves Build power by expertise and information — through advocacy, oversight, contributing to committees, public comments and other forms of consultation Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action Organisers Build power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century
  37. 37. #S4CA @sch4change Which kind of activists are most successful at delivering change? Lone wolves Build power by expertise and information — through advocacy, oversight, contributing to committees, public comments and other forms of consultation Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action Organisers Build power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century
  38. 38. #S4CA @sch4change Health communication and coaches Building leaders Source: Jönköping
  39. 39. #S4CA @sch4change Focus on the “We” “Great social movements get their energy by growing a distributed leadership” Joe Simpson
  40. 40. #S4CA @sch4change
  41. 41. #S4CA @sch4change “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
  42. 42. #S4CA @sch4change • smoking cessation • exercise adoption • alcohol and drug use • weight control • fruit and vegetable intake • domestic violence • HIV prevention • use of sunscreens to prevent skin cancer • medication compliance • mammography screening The model is mostly used around health-related behaviours
  43. 43. #S4CA @sch4change • smoking cessation • exercise adoption • alcohol and drug use • weight control • fruit and vegetable intake • domestic violence • HIV prevention • use of sunscreens to prevent skin cancer • medication compliance • mammography screening It works for organisational and service change too! The model is mostly used around health-related behaviours
  44. 44. #S4CA @sch4change “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit Prochaska, DiClemente & Norcross (1992)
  45. 45. #S4CA @sch4change “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet Prochaska, DiClemente & Norcross (1992)
  46. 46. #S4CA @sch4change I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  47. 47. #S4CA @sch4change I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  48. 48. #S4CA @sch4change I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! I am continuing to not smoke. I sometimes miss it – but I am still not smoking “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  49. 49. #S4CA @sch4change I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! I am continuing to not smoke. I sometimes miss it – but I am still not smoking “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  50. 50. #S4CA @sch4change Prochaska, DiClemente & Norcross (1992) “Stages of change” Transtheoretical model of behaviour change
  51. 51. #S4CA @sch4change • Which stage do most change activities in health and care focus on? • Which stage are most people actually at? Some questions
  52. 52. #S4CA @sch4change The reality of our change situation • Our tools are often not effective at the stage of change that most people we work with are at • It’s hard to engage people in change • It’s hard to get people to make the changes we want them to make • People get irritated, defensive, irrational • We feel powerless in our ability to lead or facilitate the change 90% of the tools available for health and care change agents are designed for the “action” stage
  53. 53. #S4CA @sch4change • Designed for Stage 4 – ACTION! • Mandated it through targets • Despite compelling case for change – people often resisted it • People did the task and missed the point Example – WHO Surgical Safety Checklist
  54. 54. #S4CA @sch4change Source: Russ et al (2015) A Qualitative Evaluation of the Barriers and Facilitators Toward Implementation of the WHO Surgical Safety Checklist Across Hospitals in England: Lessons From the “Surgical Checklist Implementation Project” Ann Surg Source of infographic here
  55. 55. #S4CA @sch4change “In hospitals without adequate resources and efficient systems, simply requiring the checklist to be used might not only fail to improve patient safety but might also introduce new risks for staff and patients. This is the exact opposite of what the checklist was designed to achieve”.
  56. 56. #S4CA @sch4change • Lower our ambitions for improvement • Focus our energies on those who are already in the “action” stage • Put negative labels on those who are not yet at the action stage such as “blocker” or “resister” or “laggard” • Blame “the management” for not enforcing change So what do we TEND to do when people resist?
  57. 57. #S4CA @sch4change The single biggest problem in communication is the illusion that it has taken place George Bernard Shaw ‘‘
  58. 58. #S4CA @sch4change • Listen and understand • appreciate the starting point • elaborate interests • Roll with resistance • Don’t argue against it • Be curious and accepting • Encourage elaboration of resistance • What makes it so hard? • What would help? • Build meaning and conviction in the change So what SHOULD we do? See Motivational interviewing as a change management strategy
  59. 59. #S4CA @sch4change • The focus should be on creating awareness for me of the need to change • Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation • I am not thinking about changing my behaviours, actions or work processes • The problem or issue is outside my frame of awareness or my perceived need
  60. 60. #S4CA @sch4change If your horse dies, get off it Cherokee proverb Source of image: fenwickgallery.co.uk ‘‘
  61. 61. #S4CA @sch4change What happens next • If you pre-registered with your Break out room number, you will be transferred there • If you haven’t registered with a room, we are offering a separate phone conference that you can join: 0800 917 1950 33136606#
  62. 62. #S4CA @sch4change In the breakout room • If you get stuck, ask for help here • Your facilitator will be in the room. They can be identified with the presenter ball next to them. • You can mute and unmute yourself using the Mute button • We’ve occasionally seen instances where screenshare appears. We therefore strongly recommend you close other windows you have open on your computer.

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