change. get used to it.


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Background slides from a conversation about change management that I had with an exciting group of master's students studying Public Health with a focus on Health Economics, Policy, and Management at the Karolinska Institutet, Stockholm, Sweden on May 14, 2013. Contact: at the Medical Management Centre, Karolinska Institutet.

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change. get used to it.

  1. 1. 2013 05 14carl.savage@ki.seget used to it.change.
  2. 2. SETTING THE STAGE…1. what’s the use of theory?2. why do science?3. why use methods?
  3. 3. Your mission:Become a health care quality improvement leader.
  4. 4. The challenge: ”Get MD’s to use EBM protocols”Pay-for-performance Analyze dissemination processWorkshops to motivate quality Continuous feedbackEducate the staff in use ofguidelinesUnderstand MD’s situation andchange their perceptionsTalk with physicians Change medical educationIdentify opinion leaders Include in licensing
  5. 5. ContentProcessContext• Change managers• Models of change• Formulation/implementation• Pattern through time• Assessment and choice of productsand markets• Objectives and assumptions• Targets and evaluationInternal• Resources• Capabilities• Culture• PoliticsExternal• Economic/Business• Political• Social(Pettigrew & Whipp, 1993)Essential ingredients of change
  6. 6. What AND how, not just what!”…any transformationjourney requiresinnovation bothin what you do andin how you do it.”(Nayar, 2010)
  7. 7. 1. Why?2. How?3. What(Sinek, 2011)
  8. 8. Some current change scenariosWhat is your strategy?1. Launch a stop smoking campaign at work.2. Set up a meeting time with a group of 4-5 busyprofessionals.3. Convince a primary care clinic to measure patientoutcomes.4. Implement process improvement in a hospital (IHC).
  9. 9. Reflect on your change strategies• What are the similarities and differences betweenyour change strategies?• Why do you think your strategies would work?• What assumptions have you made?• How have you addressed those assumptions?
  10. 10. 1. Why?2. How?3. What(Sinek, 2011)
  11. 11. ASSUMPTIONSPower and the people
  12. 12. ASSUMPTION 1.change is hardbecause of resistance to change
  13. 13. 30%(Kotter, 1995)(McKinsey, 2008)
  14. 14. (Rogers, 1962)(Gladwell, 2005)
  15. 15. (Rogers, 1962)
  16. 16. ASSUMPTION 2.motivation
  17. 17.’s the most expensive way to motivate people
  18. 18. THE CASE OF X & YY: ”I could use your help…”
  19. 19. Motivation 2.0Theory X• Dislike working.• Avoid responsibility and needto be directed.• Have to be controlled, forced,and threatened to deliverwhats needed.• Need to be supervised atevery step, with controls put inplace.• Need to be enticed to produceresults; otherwise they haveno ambition or incentive towork.Theory Y• Take responsibility and aremotivated to fulfill the goalsthey are given.• Seek and acceptresponsibility and do notneed much direction.• Consider work as a naturalpart of life and solve workproblems imaginatively.(McGregor, 1960)
  20. 20. Motivation 3.0• Purpose– Is my work meaningful?• Autonomy– Do I have the freedom todo my work?• Mastery– Do I have theopportunity to becomebetter and better atwhat I do?(Pink, 2006)
  21. 21. ASSUMPTION 3.the path of change is linear
  22. 22. Unfreeze• Awareness ofshortcomings• Uncertainty leadsto motivation tochangeMove• Search forknowledge andnew examples(Re)Freeze• New identity• New structures(Lewin, 1951)
  23. 23. Conventional Wisdom on ChangeKotter1. Establish a sense of urgency2. Create the guiding coalition3. Develop a vision and strategy4. Communicate the changevision5. Empower broad-based action6. Generate short-term wins7. Consolidate gains andproduce more change8. Anchor new approaches in thecultureModern Management Principles Standardization Specialization Goal alignment Hierarchy Planning and control Extrinsic, 1996)(Hamel, 2007)2011-09-01
  24. 24. ”pilot error””too much airplane for one man to fly”
  25. 25. Problem with Conventional WisdomIdentify aproblemCall in theexpertsDesigntheperfectsolution”Whoops””Deficit-based solution-focused change”2011-09-01
  26. 26. SO, WHY DO WE GET ”WHOOPS”?
  27. 27. How did we get into this mess?StressLook toauthorityPressure onauthority to”dosomething”Temptationfor a”quick fix”(Heifetz, 1994)
  28. 28. StressLook toauthorityPressure onauthority to”dosomething”Temptationfor a”quick fix”= A leadership challenge(Heifetz, 1994)
  29. 29. ASSUMPTION 4.we need to lead change by pushing* change*communicating
  30. 30. SimpleComplexComplicatedChaosCertaintyAgreementClose toClosetoFar fromFarfrom(Adapted from Stacey, 1996)ComplicatedWhere we act like we areWhere we actually are
  31. 31. (Glouberman & Zimmerman, 2002)
  32. 32. What’s the [type of] problem?SituationProblemdefinitionSolution andimplementationPrimary locus ofresponsibility forthe workKind of workType I Clear Clear Physician TechnicalType II Clear Requires learningPhysician andpatientTechnical andadaptiveType IIIRequireslearningRequires learningPatient >physicianAdaptive(Heifetz, 1994)
  33. 33. Adaptive leadership1. Get on the balconya) Identify the adaptive challengeb) Regulate distressc) Direct disciplined attention to the issues (not stress reducing distractions)d) Give work back to the people, at a rate they can stande) Protect voices of leadership without authority2. Distinguish self from role3. Externalize the conflict4. Use partners5. Listen, using oneself as data; live with doubt6. Find a sanctuary7. Preserve a sense of purpose (Heifetz, 1994)
  34. 34. Creative tension[What is][What could be…]Where is the tension?
  35. 35. Change management• The Path– Shape the path• The Rider– Direct the rider• The Elephant– Motivate the elephant(Switch, by Heath & Heath, 2010)
  36. 36. If you don’t plan on improving things,don’tbother.
  37. 37. CHANGE IS PERSONAL:IMPROVEMENT ISYOURRESPONSIBILITYcarl.savage@ki.seMedical Management Centre, KI