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Module 3 rolling with resistence final

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These are the slides for SHCR II Module 3: Rolling with Resistance.
This module looks at the issue of 'resistance to change’: rather than seeing resistance as a negative thing, we shift our perspective so that we see dissent, diversity and disruption as essential components of effective change.

Agenda:
What do we mean by resistance to change?
What are some of the ways to look at resistance to change?
Importance of diversity in leading change and its implications in terms of resistance
Diversity is critical to innovation and change
Being a champion for diversity
Impact and intent
The effectiveness of a change agent is not a matter of intention; it’s a matter of impact
How to stop talking at someone and start talking to them
What you can do to build impact and intent
Using the Stages of Change model to help people through change
Why do people resist change?
What is the transtheoretical model of behaviour change?
An example of the model in practice
What we tend to do when dealing with resistance and what we should do
Questions and call to action

Questions for reflection:
What does resistance mean to you?
Think about the things you resist as well as your responses to others’ resistance
How do you work with resistance as a change leader?
How can you make sure that the changes you make achieve the impact you desire and are sustainable?
….. do not create dependency?
….. generate self-efficacy in others?
Who are you interacting with and where they are on the Stages of Change model?

Call to action:
Reflect deeply on how you operate as an agent for change.
Consider the impact of your communication and behaviour beyond your intent.
Listen to others’ views, engage others in change and help others through the stages of change.

Published in: Healthcare

Module 3 rolling with resistence final

  1. 1. #SHCR @School4Radicals http://www.theedge.nhsiq.nhs.uk/school/ Module 3: Rolling with resistance Supported by
  2. 2. #SHCR @School4Radicals Joining in today and beyond • Please use the chat box to contribute continuously during the web seminar • Please tweet using hashtag #SHCR and the handle @School4Radicals • Join our Facebook group School for Health and Care Radicals • We will produce summaries of the discussions on each module using Storify and Pinterest and put on the website • Join in the Tweetchat each Wednesday at 4-5pm (GMT) using the hashtag #SHCR
  3. 3. #SHCR @School4Radicals The team today Session lead: Helen Bevan @HelenBevan Learning lead and case study: Pip Hardy @PilgrimPip Chat monitor: Dominic Cushman @domcushnan Case study alumna: Vanessa Garrity @VanessaLGarrity Icebreaker & twitter monitor: Kate Pound @kateslater2
  4. 4. #SHCR @School4Radicals 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 them to use their energy for change.
  5. 5. #SHCR @School4Radicals With which role do you most closely identify? Receiver of care Campaigner Change agentAwesome Chief listener Giver of care
  6. 6. #SHCR @School4Radicals Best role: Director of Possibilities!
  7. 7. #SHCR @School4Radicals Who are the students of the School for Health and Care Radicals? • 77% - healthcare workforce (all sectors) • 6% - local government which include social workers, public health • 6% - education (research and universities) • 11% - “others” which includes patients and carers, voluntary sector, consultant /private sector and police
  8. 8. #SHCR @School4Radicals The biggest learning groups in the School for Health and Care Radicals • Nottingham University Hospitals, England – 65 people • NHS England – 36 people • Kingston General Hospital, England – 29 people • Nelson Marlborough District Health Board, New Zealand – 23 people The #WARuralHealth learning group
  9. 9. #SHCR @School4Radicals • What do we mean by resistance to change? • Some different ways to look at resistance • Importance of diversity in leading change and its implications in terms of resistance • Impact and intent • Using the Stages of Change model to understand “resistance” and help people through change • What we tend to do when dealing with resistance and what we should do? • Call to action and reflection Source of image: www.freshnessmag.com for today
  10. 10. #SHCR @School4Radicals Employee resistance is the most common reason executives cite for the failure of big organizational-change efforts Scott Keller and Colin Price (2011), Beyond Performance: How Great Organizations Build Ultimate Competitive Advantage Source of image: Businessconjunctions.com
  11. 11. #SHCR @School4Radicals “ Thousands of patients have died needlessly because of a damaging reluctance amongst doctors and the public to accept changes in the NHS, according to the country’s top emergency doctor “
  12. 12. #SHCR @School4Radicals What do we mean by ?
  13. 13. #SHCR @School4Radicals Source of image: sport-fitness-advisor.com Any force that stops or slows movement Resistance
  14. 14. #SHCR @School4Radicals In module 1, we talked about:
  15. 15. #SHCR @School4Radicals Let’s think about this in the context of “resistance”
  16. 16. #SHCR @School4Radicals Leading change in a new era Dominant approach Emerging direction • 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”
  17. 17. #SHCR @School4Radicals Resistance to change: the dominant approach
  18. 18. #SHCR @School4Radicals An example “dominant approach” transformation programme
  19. 19. #SHCR @School4Radicals “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 Dominant approach: the role of the change agent
  20. 20. #SHCR @School4Radicals Leading change in a new era • Change in human systems is often emergent and hard to predict • Change results from connections/interactions stimulating different perspectives, shaping how people think about things • Resistance is an inevitable consequence of a complex change process • Resistance should be embraced and rolled with Dominant approach Emerging direction • 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”
  21. 21. #SHCR @School4Radicals “Change doesn’t rain down on us from on high. Rather, its stories are co- created and co-owned by the community. Or, at least they are if you want the change to stick” Julian Stodd https://julianstodd.wordpress.com/2013/11/29/the-co-creation-and-co-ownership-of-organisational-change/
  22. 22. #SHCR @School4Radicals Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........ Sensemaking is not done via marketing...or slogans but by emotional connection with employees Ron Weil
  23. 23. #SHCR @School4Radicals 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 ‘‘
  24. 24. #SHCR @School4Radicals Cultural change is a million subversive acts of resistance.” Brene Brown Source of image: zazzle.com ‘‘
  25. 25. #SHCR @School4Radicals Language constructs our world(s) rather than reports the objective facts about the world. Therefore changing when, where, how and which people talk about things – changing the conversation – will lead to organisational change.” Robert J Marshak Source of image: createbusiness.net.au ‘‘
  26. 26. #SHCR @School4Radicals 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 Emerging direction: the role of the change agent Source of image: rachtalks.pressprestige.com
  27. 27. #SHCR @School4Radicals “Having care wrapped around the person rather than the person pushed through the system.” Lesley Young-Murphy North Tyneside Clinical Care Group
  28. 28. #SHCR @School4Radicals Case study: A story of resistance Pip Hardy
  29. 29. #SHCR @School4Radicals ‘I have a dream…’ www.patientvoices.org.uk
  30. 30. #SHCR @School4Radicals The evidence of experience ‘Statistics tell us the system’s experience of the individual, whereas stories tell us the individual’s experience of the system…’ Tony Sumner, 2009
  31. 31. #SHCR @School4Radicals The Patient Voices mandala ‘The stories go out, like flashes of light over the waves, as markers and guides, comfort and warning.’ Winterson 2004
  32. 32. #SHCR @School4Radicals “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 Source of image: idsgn.org Diversity is critical to innovation and change
  33. 33. #SHCR @School4Radicals “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) Source of image:fineartamerica.com As health and care radicals, we should be champions of diversity for change
  34. 34. #SHCR @School4Radicals 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? Source of image:fineartamerica.com Discussion
  35. 35. #SHCR @School4Radicals Our effectiveness as change agents is not a matter of intention; it’s a matter of impact
  36. 36. #SHCR @School4Radicals • 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
  37. 37. #SHCR @School4Radicals Stop talking AT ME Start talking TO ME Source of image: prepbeijing.com
  38. 38. #SHCR @School4Radicals • Build a trusting and supportive work environment • Listen like an ally • Be open with my intent • Fully commit to the change • Seek common purpose and common interests • Take time to build relationships • Take responsibility for my own actions What can I do?
  39. 39. #SHCR @School4Radicals
  40. 40. #SHCR @School4Radicals If your horse dies, get off it.” Cherokee proverb Source of image: fenwickgallery.co.uk ‘‘
  41. 41. #SHCR @School4RadicalsImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
  42. 42. #SHCR @School4Radicals C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  43. 43. #SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  44. 44. #SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  45. 45. #SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  46. 46. #SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  47. 47. #SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively Make it a personal PERFORMANCE target.
  48. 48. #SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  49. 49. #SHCR @School4Radicals Research from the sales industry: How many NOs should we be seeking to get? • 2% of sales are made on the first contact • 3% of sales are made on the second contact • 5% of sales are made on the third contact • 10% of sales are made on the fourth contact • 80% of sales are made on the fifth to twelfth contact Source: http://www.slideshare.net/bryandaly/go-for-no
  50. 50. #SHCR @School4Radicals “Papers that are more likely to contend against the status quo are more likely to find an opponent in the review system—and thus be rejected —but those papers are also more likely to have an impact on people across the system, earning them more citations when finally published.” V. Calcagno et al., “Flows of research manuscripts among scientific journals reveal hidden submission patterns,” Science, doi:10.1126/science.1227833, 2012. —
  51. 51. #SHCR @School4Radicals
  52. 52. #SHCR @School4Radicals “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
  53. 53. #SHCR @School4Radicals • 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
  54. 54. #SHCR @School4Radicals • 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
  55. 55. #SHCR @School4Radicals “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit Prochaska, DiClemente & Norcross (1992)
  56. 56. #SHCR @School4Radicals “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)
  57. 57. #SHCR @School4Radicals 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)
  58. 58. #SHCR @School4Radicals 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)
  59. 59. #SHCR @School4Radicals 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)
  60. 60. #SHCR @School4Radicals 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)
  61. 61. #SHCR @School4Radicals Prochaska, DiClemente & Norcross (1992) “Stages of change” Transtheoretical model of behaviour change
  62. 62. #SHCR @School4Radicals • Which stage do most change activities in health and care focus on? • Which stage are most people actually at? Some questions
  63. 63. #SHCR @School4Radicals 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
  64. 64. #SHCR @School4Radicals • 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 Example – WHO Surgical Safety Checklist
  65. 65. #SHCR @School4Radicals IN A NUTSHELL • Evidence from observational studies that the use of surgical safety checklists results in striking improvements in outcomes • Led to rapid adoption of such checklists worldwide • Researchers studied effect of mandatory adoption of checklists in Ontario, Canada • Use of checklists not associated with significant reductions in operative mortality or complications
  66. 66. #SHCR @School4Radicals • 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?
  67. 67. #SHCR @School4Radicals The single biggest problem in communication is the illusion that it has taken place.” George Bernard Shaw ‘‘
  68. 68. #SHCR @School4Radicals • Listen and understand • appreciate the starting point • elaborate interests • Roll with resistance (Singh) • Don’t argue against it • Encourage elaboration of resistance •What makes it so hard? •What would help? • Build meaning and conviction in the change So what SHOULD we do?
  69. 69. #SHCR @School4Radicals • 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
  70. 70. #SHCR @School4Radicals 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? Thinking about your own situation
  71. 71. #SHCR @School4Radicals Case study: Stages of Change Vanessa Garrity
  72. 72. #SHCR @School4Radicals Case study: Stages of Change Vanessa Garrity
  73. 73. #SHCR @School4Radicals “Tomorrow’s management systems will need to value diversity, dissent and divergence as highly as conformance, consensus and cohesion.” Gary HamelSource of image: www.fastcompany.com
  74. 74. #SHCR @School4Radicals Call to action for this week • Reflect deeply on how you operate as an agent for change • Consider the impact of your communication and behaviour beyond your intent • Listen to others’ views, engage others in change and help others through the stages of change
  75. 75. #SHCR @School4Radicals • Wednesday 18th February 16:00-17:00 Tweet chat #SHCR • Next Friday morning 20th February module 4: Making change happen Next opportunities for learning
  76. 76. #SHCR @School4Radicals 1. What does resistance mean 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? Questions for reflection

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