Module 3 - Rolling with resistance
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Module 3 - Rolling with resistance

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These are the slides for Module 3 of The School for Health and Care Radicals, a five week virtual programme, designed to equip people across the health and care system with the core skills to improve ...

These are the slides for Module 3 of The School for Health and Care Radicals, a five week virtual programme, designed to equip people across the health and care system with the core skills to improve their skills as change agents. It supports NHS Change Day 2014, the grassroots movement in which everyone who values the NHS can make a pledge of action to improve things for patients and the health and care system.

Big change only happens in health and care because of heretics and radicals: passionate people who are willing to take responsibility and work with others to make change happen. Being a radical isn't related to hierarchy or position and you don't have to work in the NHS or social care to qualify as one. Registrants to the school so far include patients and carers, students, senior leaders, improvement facilitators and clinical and care staff.

There is also a live weekly web seminar which will be available to 'listen again', supported by a raft of other opportunities, including coaching and mentoring, virtual discussions and tweet chats, and an ever- expanding portal of useful resources.

Programme
The programme focuses on five modules over five weeks, 9:30 to 11:00 am GMT

Friday 31 January 2014: Being a health and care radical: change starts with me
Friday 7 February 2014: Forming communities: building alliances for change
Friday 14 February 2014: Rolling with resistance
Friday 21 February 2014: Making change happen
Friday 28 February 2014: Moving beyond the edge


Tweetchat
We will run a tweetchat each Wednesday from 16:00 to 17:00 GMT, based on the content of the module from the previous Friday. A tweetchat is a facilitated conversation using Twitter. The hashtag we will use for the tweetchats is #SHCRchat. The dates for the tweetchats are:

12 February
19 February
26 February
5 March

There is no charge to join the School of Health and Care Radicals and it is open to all, whatever your role or level, and whether or not you work in the NHS

Resources

Resources from all modules can be found at: http://www.nhsiq.nhs.uk/9059.aspx

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Module 3 - Rolling with resistance Module 3 - Rolling with resistance Presentation Transcript

  • The School for Health and Care Radicals www.changeday.nhs.uk/healthcareradicals Module 3: Rolling with resistance Supported by #NHSChangeDay #SHCRchat
  • Pledge today! http://changeday.nhs.uk #NHSChangeDay #SHCRchat
  • #NHSChangeDay #SHCRchat
  • Joining in today and beyond • Please use the chat box to contribute continuously during the web seminar • Please tweet using hashtags #NHSChangeDay and #SHCRchat • We will produce summaries of the discussions of today’s module using Storify.com and Pinterest and put these on the website • The conversation continues on the live chat forum at www.changeday.nhs.uk/healthcareradicalsforum #NHSChangeDay #SHCRchat
  • Modules 31st January: Being a health and care radical: change starts with me 7th February: Forming communities: building alliances for change 14th February: Rolling with resistance 21st February: Making change happen 28th February: Moving beyond the edge #NHSChangeDay #SHCRchat
  • School statistics #NHSChangeDay #SHCRchat
  • for today • What is meant by resistance to change? • Different approaches to resistance • Importance of diversity in leading change and its implications in terms of resistance • Impact and intent • A story: Maxine Craig • Using the stages of change model to help people through change • A panel discussion • Questions and call to action #NHSChangeDay #SHCRchat Source of image: www.freshnessmag.com
  • What do we mean by resistance to change? #NHSChangeDay #SHCRchat
  • Resistance Any force that stops or slows movement #NHSChangeDay #SHCRchat Source of image: sport-fitness-advisor.com
  • Change can either challenge or threaten us……. Your beliefs pave your way to success or block you Marsha Sinetar #NHSChangeDay #SHCRchat
  • Diagnostic and dialogic approaches to resistance to change #NHSChangeDay #SHCRchat Source of image: cultureisconversation.wordpress.com
  • Resistance: a “diagnostic” approach • Change is something that happens “out there” in the organisation or system • Resistance is a force to overcome • Resistance prevents change • Change agents must diagnose, manage and/or overcome resistance • Resisters otherwise known as “laggards”, “blockers”, “in denial” #NHSChangeDay #SHCRchat
  • Resistance to change #NHSChangeDay #SHCRchat
  • Diagnostic: 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 #NHSChangeDay #SHCRchat
  • Resistance: a “dialogic” approach • People make their own reality • Change results from transformational conversations • • • involving more and different people in change discussions altering how and which people engage with each other by stimulating different perspectives to shape how people think about things • Resistance is an inevitable consequence of a complex change process (based on diversity) • Resistance should be embraced and worked with #NHSChangeDay #SHCRchat
  • Dialogic: the role of the change agent 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. Creat-e 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 #NHSChangeDay #SHCRchat
  • Diversity is critical to innovation and change “The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities. Do this before you start hiring consultants and rethinking your innovation process, there is no process that works without true diversity.” Idris Moore #NHSChangeDay #SHCRchat Source of image: idsgn.org
  • Health and care radicals should be champions of diversity for change “Leaders and organisations must let go of the idea that there is “one right way” and instead focus on creating a learning culture where people feel accepted, are comfortable contributing ideas, and actively seek to learn from each other” Diaz_Uda, Medina and Schill (2013) #NHSChangeDay #SHCRchat Source of image:fineartamerica.com
  • Discussion In the context of “rolling with resistance” • What are the implications of embracing diversity of thought, experience and background in our change efforts? • What skills and perspectives do health and care radicals need to work effectively with diverse teams for change? #NHSChangeDay #SHCRchat Source of image:fineartamerica.com
  • The effectiveness of change agents is not a matter of intention; it’s a matter of impact #NHSChangeDay #SHCRchat
  • • 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 #NHSChangeDay #SHCRchat
  • Stop talking AT ME Start talking TO ME #NHSChangeDay #SHCRchat Source of image: prepbeijing.com
  • What should I do? • Build a trusting and supportive work environment • Listen with an open heart and open mind • Fully commit to the change • Seek common purpose and common interests • Take time to build relationships • Be open with my intent • Take responsibility for my own actions #NHSChangeDay #SHCRchat
  • #NHSChangeDay #SHCRchat
  • If your horse dies, get off it Cherokee proverb #NHSChangeDay #SHCRchat Source of image: fenwickgallery.co.uk
  • Maxine’s story #NHSChangeDay #SHCRchat
  • A tale of resistance and cream paint #NHSChangeDay #SHCRchat
  • #NHSChangeDay #SHCRchat
  • I’m right…. #NHSChangeDay #SHCRchat
  • It all depends… #NHSChangeDay #SHCRchat
  • So why don’t we change? Every behaviour serves a purpose it makes us feel better and / or keep us safe and secure Even if in the long run that behaviour harms us Even if we don’t recognise it in that way (Kegan and Lahey , 2009, Immunity to Change) #NHSChangeDay #SHCRchat
  • The certainty of youth #NHSChangeDay #SHCRchat
  • #NHSChangeDay #SHCRchat
  • “Stages of change” Transtheoretical model of behaviour change #NHSChangeDay #SHCRchat Prochaska, DiClemente & Norcross (1992)
  • The model is mostly used around health-related behaviours • • • • • • • • • • 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 #NHSChangeDay #SHCRchat
  • The model is mostly used around health-related behaviours • • • • • • • • • • smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake It works for organisational and domestic violence HIV prevention service change too! use of sunscreens to prevent skin cancer medication compliance mammography screening #NHSChangeDay #SHCRchat
  • “Stages of change” Smoking #NHSChangeDay #SHCRchat I am not aware my smoking is a problem – I have no intention to quit Prochaska, DiClemente & Norcross (1992)
  • “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 #NHSChangeDay #SHCRchat Prochaska, DiClemente & Norcross (1992)
  • “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 I am making plans & changing things I do in preparation. #NHSChangeDay #SHCRchat Prochaska, DiClemente & Norcross (1992)
  • “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 I have stopped smoking! #NHSChangeDay #SHCRchat I am making plans & changing things I do in preparation. Prochaska, DiClemente & Norcross (1992)
  • “Stages of change” Smoking I am continuing to not smoke. I sometimes miss it – but I am still not smoking I have stopped smoking! #NHSChangeDay #SHCRchat 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. Prochaska, DiClemente & Norcross (1992)
  • “Stages of change” Smoking I am continuing to not smoke. I sometimes miss it – but I am still not smoking I have stopped smoking! #NHSChangeDay #SHCRchat 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. Prochaska, DiClemente & Norcross (1992)
  • “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992) #NHSChangeDay #SHCRchat
  • Some questions • Which stage do most change activities in health and care focus on? • Which stage are most people actually at? #NHSChangeDay #SHCRchat
  • 90% of the tools available for health and care change agents are designed for the “action” stage 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 #NHSChangeDay #SHCRchat
  • Example - Surgical Checklist • Designed for Stage 4 – ACTION! • Mandated it through targets • Despite compelling case for change – people resisted it – no values connection • People did the task and missed the point #NHSChangeDay #SHCRchat
  • So what do we TEND to do? • 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 #NHSChangeDay #SHCRchat
  • The single biggest problem in communication is the illusion that it has taken place George Bernard Shaw #NHSChangeDay #SHCRchat
  • So what SHOULD we do? • Listen and understand • • appreciate the starting point elaborate interests • Build meaning and conviction in the change • Roll with resistance (Singh) • • Don’t argue against it Encourage elaboration of resistance • What makes it so hard? • What would help? • Build shared purpose #NHSChangeDay #SHCRchat
  • • 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 #NHSChangeDay #SHCRchat • 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
  • Our panel Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model: • What stage of change are some of the key people that you need to influence for your change initiative at? • What actions can you take to help them move to the next stage? #NHSChangeDay #SHCRchat
  • Calls to action campaigns for this week Post these or similar actions as a pledge on the NHS Change Day pledge wall http://changeday.nhs.uk/campaign • I will reflect deeply on how I operate as an agent for change • I will consider the impact of my communication and behaviour beyond my intent • I will listen to others’ views, engage others in change and help others through the stages of change #NHSChangeDay #SHCRchat
  • Next opportunities for learning • Wednesday 19th February 16:00-17:00 Tweet chat #SHCRchat • Next Friday morning 21st February module 4: Making change happen #NHSChangeDay #SHCRchat
  • Questions for reflection 1. What does resistance means to you?  think about the things you resist as well as your responses to others’ resistance 2. How do you work with resistance as a change leader? 3. How can you make sure that the changes you make achieve the impact you desire and also  are sustainable?  do not create dependency?  generate self-efficacy in others? 4. Who you are interacting with and where they are on the Stages of Change model? #NHSChangeDay #SHCRchat