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					NHS Heart Improvement Programme                     Understanding Change in Organisations                       Trainers’ resource pack



Session title: Understanding change in organisations                    Total time: 115 mins

Session objectives:                                                     Learning outcomes:
Discover how people respond to change and why - and begin to look       Introduction to organisational change
at ways to support that change
                                                                        How people respond to change
Consider the driving and resisting forces to change in organisations
                                                                        Practical tools
Look at the links between organisational change and service
improvement



Requirements for this session
LCD projector, laptop with slides
Consider using microphones for audience and presenter if numbers and room big.
Flip-charts and pens




                                                                Page 1 of 15
NHS Heart Improvement Programme                 Understanding Change in Organisations                                Trainers’ resource pack




Timings        Aids &        Training notes                         Details                                Trainers personal notes
               prompts
(cumulative)
1 min          Title slide   Title slide                            Tutor and participant introductions.




                             Flipchart                              If running a stand alone session,
                                                                    welcome participants and
                                                                    introduce self.
                                                                    Ask participants to give a brief
                                                                    introduction, to include personal
                                                                    objectives for this workshop.
                                                                    Record objectives.
2 mins         Slide 2       Session objectives noted on slide      An organisation is defined as ‘two     Check slide animation
                                                                    people who agree to work on
               During this   Spread and sustainability of service
                                                                    common goals to achieve an
               session ..    improvements requires an
                                                                    agreed outcome’
                             understanding of how change
                             happens in organisations. We’re in
                             the improvement business and in
                             order for improvements to be
                             sustained we need to understand
                             how change happens in
                             organisations.
                             Organisations are made up of
                             people, so it is people we need to
                             focus on, however people behave
                             in number of ways which can be




                                                            Page 2 of 15
NHS Heart Improvement Programme                   Understanding Change in Organisations                             Trainers’ resource pack



Timings        Aids &          Training notes                        Details                              Trainers personal notes
               prompts
(cumulative)
                               clearly defined but is not always
                               predictable!
                               The successful change agent
                               devises strategies to overcome the
                               obstacles and facilitate change in
                               organisations


3 mins         Slide 3 and 4   People have a very personal           Quote from Ghandi:
                               response to change
               Calvin and                                            ‘If you want people to change – be
               Hobbes -                                              the change you want to see’ - To
               cartoon                                               support others through change, we
                                                                     need to change as well
4 mins         Slide 5         We need to get away from the          Practice what you preach
                               bumper sticker mentality and not
               Charles
                               pay lip service to change.
               Schultz


5 mins         Blank slide –   Clasp hands exercise-
               6
                               Everyone stand up. Clasp hands
               Exercise        together, which thumb is on top?
                               Now change so that other thumb is
                               on top.
                               How does that feel?
                               We’re all supposed to be in the



                                                               Page 3 of 15
NHS Heart Improvement Programme               Understanding Change in Organisations                            Trainers’ resource pack



Timings        Aids &      Training notes                        Details                             Trainers personal notes
               prompts
(cumulative)
                           change business and comfortable
                           with change – but perhaps we’re
                           only comfortable with change that
                           WE like! Indeed, unless we
                           continue to practise the new way,
                           we are likely to revert back to the
                           old way without realising!
6 mins         Slide 7     Not all change is good though and     Note picture – man changing light
                           the process needs to be thought       bulb on ladder sitting in water
               Ladder in
                           through!
               water…


7 mins         Slide 8     Change can’t be managed, it can       Oxymoron is a contradiction in      Note animation
                           be ignored, resisted, capitalised     terms
               Oxymorons
                           upon
                           BUT whether it is an opportunity or
                           a threat depends upon how ready
                           we are to receive it and how we
                           respond.
                           Are we going to be a victim or a
                           victor?




                                                           Page 4 of 15
NHS Heart Improvement Programme                  Understanding Change in Organisations                              Trainers’ resource pack



Timings        Aids &         Training notes                        Details                               Trainers personal notes
               prompts
(cumulative)
17 mins        Slide 9        Ask groups to jot down answers for    Examples may include, NSFs,
                              question on slide for about 5 mins.   patient choice, politics etc.
               Exercise -
               Why do we      Ask the tables for a few examples,
               have to        and give some feedback
               change?

27 mins        Slide 10       Another few minutes to jot down       Examples, peoples attitude, DR X
                              answers to question on slide          or Nurse Y or Manager Z usually
               Exercise
                                                                    blocks things, resources, fear etc.
               continued -
               What’s
               stopping us?
37 mins        Slide11        A pictorial way of looking at and
                              understanding the need to change.
               Forcefield
               analysis       Diagnostic technique applied to
                              ways of looking at the variables
                              involved in determining whether
                              organisational change will occur
                              Based on the concept of ‘forces’, -
                              perceptions of people in an
                              organisation about a particular
                              factor and its' influence




                                                             Page 5 of 15
NHS Heart Improvement Programme                    Understanding Change in Organisations                                Trainers’ resource pack



Timings        Aids &          Training notes                           Details                               Trainers personal notes
               prompts
(cumulative)
52 mins        Slide 12        Practical exercise to create a           Forcefield pictures can be
                               forcefield diagram                       constructed horizontally or
               Seeing the
                                                                        vertically, but make sure they give
               whole picture
                                                                        each factor its own arrow – large,
                               Allow at least 15 minutes for this.      medium or small according to the
                               When completed, ask groups to            strength of the force.
                               comment on what they notice about        You should be able to tell by
                               the charts. You want them to get to      looking at the finished chart
                               the points on the next slide!            whether the change will happen –
                                                                        i.e. are the driving forces
                                                                        cumulatively stronger than the
                                                                        resisting forces?
65 mins        Slide 13        Take feedback from groups – if           Driving forces initiate change or
                               time, ask to be talked through the       keep it going – tend to be external
               Making
                               charts
               sense of the                                             Resisting forces act to restrain or
               forcefield      Draw parallels with learning points      decrease the driving forces – tend
                               on the slide                             to be internal
                               This tool is very useful and has
                               practical applications when
                               launching projects
                               Effective use of the model:
                               It’s a very powerful visual aid to see
                               where the problems lie and where
                               to expend your energy!
                               Reducing resisting forces allow
                               movement towards the desired



                                                                Page 6 of 15
NHS Heart Improvement Programme                 Understanding Change in Organisations                             Trainers’ resource pack



Timings        Aids &        Training notes                       Details                               Trainers personal notes
               prompts
(cumulative)
                             state, without increasing tension
                             To help people understand that
                             change needs to happen, and to
                             focus on overcoming the resistance
                             to make the change easier and
                             more effective
70 mins        Slide 14      Ask for some suggestions from the    e.g. engage people early, make
                             floor.                               benefits explicit, give people
               What can we
                                                                  ownership and power over the
               do?
                                                                  change, target the enthusiasts


71 mins        Slide 15      Changes and transitions –
                             introducing new section




73 mins        Slide 16      William Bridges, in his book         For full information on this model,
                             ‘Managing Transitions’ has some      read the Bridges book
               Change and
                             helpful observations about making
               transition
                             change easier to manage and to
                             accept
                             William Bridges talks about how to
                             manage transitions -which helps us
                             to make the most of change




                                                            Page 7 of 15
NHS Heart Improvement Programme                Understanding Change in Organisations                               Trainers’ resource pack



Timings        Aids &      Training notes                           Details                             Trainers personal notes
               prompts
(cumulative)
77 mins        Slide 17    Unless transition occurs, change                                             Illustrate with change examples
                           will not work:                                                               from your own experience
               Three
               phases      Transition starts with an ending         E.g. changing your job – even
               diagram     (explicit and acknowledged)              though you want to go, there are
                           When we acknowledge that are             still losses such as close work
                           things we need to let go of, or that     friends, familiar work and travel
                           we have lost something                   patterns
                           Neutral zone is the no-man’s-
                           land between the old reality and         E.g. moving house – at first the
                           the new (past experience affects         house does not feel like home and
                           this)                                    may be in turmoil
                           No one knows what they should be
                           doing, things are confused and
                           disorderly
                           Transitions end with a new
                                                                    E.g. After decorating your home,
                           beginning (great opportunity for
                                                                    you can’t imagine how it looked
                           creativity)
                                                                    and felt like before the change.
                           There are a number of tools that
                           can be used to help make the
                           transition, and we will explore some
                           of these tools during this part of the
                           session




                                                           Page 8 of 15
NHS Heart Improvement Programme                   Understanding Change in Organisations                                Trainers’ resource pack



Timings        Aids &         Training notes                           Details                               Trainers personal notes
               prompts
(cumulative)
78 mins        Slide 18       Quote from Bridges
               Start with…




80 mins        Slide 19       Picture
               White cliffs   You can’t embark on a new voyage
               picture        without leaving the shore. But
                              having set off, it’s nice to look back
                              and enjoy the view!
81 mins        Slide 20       Moses was a great transition leader
               Moses slide    He spent 40 years in the wilderness
                              before reaching the promised land.
                              He led his people away from
                              persecution towards the land of
                              milk and honey. He painted a
                              powerful picture of what life would
                              be like if they followed him.
87 mins        Slide 21       Endings:                                 Expect feelings of grieving for the
                                                                       old way and openly acknowledge
               Managing       Help people to understand the
                                                                       these losses
               transitions    need for change. Changes are
                              external & internal – we looked at a     Define what is over & what isn’t –
                              tool to help you recognise both of       take what matters with you into the
                              these aspects (forcefield analysis &     new way of working, leave behind
                              what’s in it for them) Process           what didn’t work
                              mapping is a good tool to recognise



                                                               Page 9 of 15
NHS Heart Improvement Programme                   Understanding Change in Organisations                               Trainers’ resource pack



Timings        Aids &         Training notes                         Details                                Trainers personal notes
               prompts
(cumulative)
                              the need for change                    Stress the change will improve
                                                                     things for patients and staff – most
                                                                     important things for staff



               Slide 21       Neutral zone: (past experience         Get people involved & working          NOTE CONTINUED SLIDE
               (cont)         affects this)                          together and give them time to
                                                                     experiment by testing new ideas –
                              Recognise this is a difficult time
                                                                     through project teams, PDSAs


               Slide 21       Beginnings:                            Ensure everyone knows what their
               (cont)                                                role is in the new system
                              Don’t force a new beginning before
                              it’s time. Throughout all the 3        Check policies and procedures do
                              stages, give and receive               not send out mixed messages
                              information to people on what is
                              expected and what the outcomes
                              are
89 mins        Slide 22       Most beginnings abort because the
                              endings and transitions were poorly
               Process tips
                              managed




                                                              Page 10 of 15
NHS Heart Improvement Programme                  Understanding Change in Organisations                           Trainers’ resource pack



Timings        Aids &       Training notes                            Details                          Trainers personal notes
               prompts
(cumulative)
91 mins        Slide 23     Visualise what it will look like
               The          Ensure everyone knows their role
               beginning
                            Starts can be introduced and
                            planned but beginnings need to be
                            nurtured and felt (culture issues)
                            Planning is vital – it is very
                            uncomfortable for others if they
                            think you are making it up as you
                            go along!
92 mins        Slide 24     Build on what is good and mind            Don’t assume that you need to
                            what you throw out!                       throw everything out and think
               Baby and
                                                                      about keeping what works
               bathwater


93 mins        Slide 25     Slide has Cotter and Cohen quote          Can cross reference to
                                                                      ‘Leadership, Teams and Change
               How do we    The key to engaging with people’s
                                                                      Agents’ module
               engage       feelings and changing behaviour is
               people       through effective transformational
                            leadership.
95 mins        Slide 26     Slide has quote from research into
                            practice series.
               Changing
               clinicians   Clinicians see themselves as
                            innovators in clinical practice, but
                            are not always comfortable with




                                                               Page 11 of 15
NHS Heart Improvement Programme                Understanding Change in Organisations                           Trainers’ resource pack



Timings        Aids &      Training notes                          Details                           Trainers personal notes
               prompts
(cumulative)
                           organisational change




96 mins        Slide 27    From Research into Practice report      Can also cross reference to
                           – from scepticism to support – what     Culture of Organisations module
               Sceptics
                           are the influencing factors?
                           Scepticism often manifests as
                           resistance
                           Resistance to changes does not
                           indicate staff are unwilling to bring
                           improvements
                           Changes in clinical practice are
                           influenced in some degree by
                           research, however, organisational
                           change must rely more on
                           persuasion to be successful.
                           Persuading means influencing
                           people by getting them to alter their
                           attitudes and beliefs (more later in
                           the course)
                           People must become motivated to
                           change otherwise they will pay lip
                           service to it.




                                                            Page 12 of 15
NHS Heart Improvement Programme                    Understanding Change in Organisations                              Trainers’ resource pack



Timings        Aids &         Training notes                           Details                              Trainers personal notes
               prompts
(cumulative)
                              Having a few ‘resistors’ can be
                              helpful – stops you getting carried
                              away and going too far down the
                              wrong track!


106 mins       Slide 28       Being reasonable to change is            You might want to share a story of
                              easier if you have little to lose.       your own here, to get people to
               Exercise -
                                                                       open up themselves.
               Why do         Transition deficit causes over
               people         reaction to seemingly small
               resist…        changes (i.e. death of Princess
                              Diana – mass grieving possibly by
                              those who were still grieving their
                              own loved ones).
107 mins       Slide 29       Are they equipped for the job?           Slide shows man in shorts ill-       Note animation
                                                                       equipped for weather
               What’s in it   Are the expectations realistic?
               for me?
                              When people understand the
                              problems, they are in the market for
                              solutions.
108 mins       Slide 30       You may recall Everett Rogers, and
                              the diffusion of innovation. In this
               Diffusion of
                              slide the same model is to illustrate
               improvement
                              the diffusion of improvement.
                              Innovators are those who want to
                              change now, they require little
                              support or persuasion




                                                                Page 13 of 15
NHS Heart Improvement Programme                 Understanding Change in Organisations                         Trainers’ resource pack



Timings        Aids &        Training notes                          Details                        Trainers personal notes
               prompts
(cumulative)
                             Early adopters require some
                             support and information, but let
                             them do it themselves
                             Early majority and late majority
                             require significant support and
                             information to enable them to
                             change
                             Laggards are unlikely to adopt
                             change, despite evidence that it
                             works. Don’t spend resources and
                             energy trying to persuade them.
                             They are not bad people! They
                             have good reasons why they won’t
                             change.
109 mins       Slide 31      Mountain bike analogy – need lots
                             of gears to deal with varying terrain
               Mountain
                             – one size doesn’t fit all – need to
               bikes slide
                             adapt –see preceding and
                             subsequent slides

110 mins       Slide 32      Quote                                   Like choosing the gears on a
                                                                     mountain bike
               Iles and
               Sutherland
               quote




                                                            Page 14 of 15
NHS Heart Improvement Programme                   Understanding Change in Organisations             Trainers’ resource pack



Timings        Aids &          Training notes                       Details               Trainers personal notes
               prompts
(cumulative)
111 mins       Slide 33        Resistance can be helpful – try to                         Note animation
                               understand the reasons for
               What are the
                               resistance, and addressing these
               implications?
                               can help to improve outcomes


112 mins       Slide 34        Another quote from William Bridges
               Help people
               to
               understand…

113 mins       Slide 35        Another quote from William Bridges
               Remember…




114 mins       Slide 36
               In summary




115 mins       Slide 37        Picture of ‘one-way’ signs.
               Confused?




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