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School for Health and Care Radicals Slides for Module Three

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School for Health and Care Radicals Slides for Module Three

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School for Health and Care Radicals Slides for Module Three

  1. 1. #SHCR @School4Radicals Module 3 Rolling with resistance http://www.theedge.nhsiq.nhs.uk/school/ Module
  2. 2. #SHCR @School4Radicals • Please use the chat box to contribute continuously during the web seminar • Please tweet using hashtag #SHCR and the handle @School4Radicals • Request to join our Facebook group School for Health and Care Radicals • We will produce summaries of each module discussion using Steller and put it on the website • Join in the #SHCR Tweetchat each Tuesday at 1900 (GMT) Joining in today…and beyond
  3. 3. #SHCR @School4Radicals The team today Session lead: Helen Bevan @HelenBevan Learning lead: Pip Hardy @PilgrimPip Session chair: Kate Pound @kateslater2 Twitter monitor: Olly Benson @ollybenson Chat monitor: Hannah Wall @hw4ll Case study alumna: Liz Lamb @IseeQI Case study alumna: Line Walker @walker1104
  4. 4. #SHCR @School4Radicals
  5. 5. #SHCR @School4Radicals Example school communities since module 1 • Mental Health Group #SHCRmh • Person Centred Care #SHCRPCC • 6Cs #SHCR6Cs • #matexp • Jo Scott-Jones & Dr Jo – New Zealand • Mark Davis & Maxine Craig – North East of England • Digital group • Altstrat • Western Australia People looking for a group • Radiology / AHPs Have we missed you off? Tell us in the chat box or on #SHCR
  6. 6. #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.
  7. 7. #SHCR @School4Radicals With which role do you most closely identify? Receiver of care Campaigner Change agentAwesome Chief listener Giver of care
  8. 8. #SHCR @School4Radicals Study guides Programme Study Guide: www.slideshare.net/TheEdgeNHS/school-for- health-and-care-radicals-iii-study-guide- 2016?related=2 Module 3 Study Guide: http://www.slideshare.net/TheEdgeNHS/school- for-health-and-care-radicals-module-3-study- guide-2016
  9. 9. #SHCR @School4Radicals Today • What do we mean by resistance to change? • Some different ways to look at resistance • Impact and intent • Building resilience • Using the Stages of Change model to understand resistance and help people through change • Questions and call to action Sourceofimage:www.freshnessmag.com
  10. 10. #SHCR @School4Radicals Source of image: sport-fitness-advisor.com Any force that stops or slows movement Resistance
  11. 11. #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
  12. 12. #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 “
  13. 13. #SHCR @School4Radicals In module 1, we talked about:
  14. 14. #SHCR @School4Radicals Let’s think about “resistance” in old/new power terms
  15. 15. #SHCR @School4Radicals • 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” Let’s think about “resistance” in old/new power terms
  16. 16. #SHCR @School4Radicals Resistance to change: the old power mindset
  17. 17. #SHCR @School4Radicals An example “old power” transformation programme
  18. 18. #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 Old power mindset: the role of the change agent
  19. 19. #SHCR @School4Radicals • 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
  20. 20. #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/
  21. 21. #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
  22. 22. #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 ‘‘
  23. 23. #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 ‘‘
  24. 24. #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 New power mindset: the role of the change agent Source of image: rachtalks.pressprestige.com
  25. 25. #SHCR @School4Radicals
  26. 26. #SHCR @School4Radicals Our effectiveness as change agents is not a matter of intention; it’s a matter of impact
  27. 27. #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
  28. 28. #SHCR @School4Radicals Stop talking AT ME Start talking TO ME Source of image: prepbeijing.com
  29. 29. #SHCR @School4Radicals
  30. 30. #SHCR @School4Radicals A ‘resilient’ material can bend under strain then spring back. Human resilience, however, is a much more complex, dynamic process, one fundamentally based on interconnectedness – with strong connections to others, a sense of meaning and purpose, and the capacity to deal with each unfolding moment by flexibly responding to life’s pressures and constraints Jennifer Napier Resilience: how we keep sailing A description of resilience fit for a health and care radical Source of image: pinterest.com
  31. 31. #SHCR @School4Radicals Early thinking on resilience “Hardy” “Invulnerable” “Invincible” Source of image: forums.marvelheroes.com http://go.sdsu.edu/education/do c/files/01370- ResiliencyLiteratureReview(SDSU ).pdf
  32. 32. #SHCR @School4Radicals Resilience: what does the evidence base tell us? • Researchers increasingly view resilience not as fixed attributes but as an alterable set of processes that can be fostered and cultivated • Resilience can grow or decline over time depending on the interactions taking place between a person and their environment and between risk and protective factors in that person’s life • We can build protective factors that enable us to reduce the negative impact of stressors and support positive change Source: Ryan Santos http://go.sdsu.edu/education/doc/files/01370- ResiliencyLiteratureReview(SDSU).pdf
  33. 33. #SHCR @School4Radicals Ways to build resilience as a leader of change 1. Get social support 2. Try not to see crisis as insurmountable problems 3. Accept that change is part of living and alter the things you can alter 4. Find ways to move towards your goals 5. Keep a hopeful outlook 6. Build your own self efficacy 7. Look after yourself Source: adapted from The road to resilience, American Psychological Society
  34. 34. #SHCR @School4Radicals Resistant organisations: moving to the edge https://julianstodd.wordpress.com/2015/11/10/laying-the- foundations-for-change/
  35. 35. #SHCR @School4Radicals 1. strong sense of “self-efficacy”  belief that I am personally able to create the change 2. able to join forces with others to create action 3. able to achieve small wins which create a sense of hope, possibility and confidence 4. More likely to view obstacles as challenges to overcome Four things we know about successful boat rockers Source: adapted from Debra E Meyerson CHANGE me BEGINS WITH
  36. 36. #SHCR @School4Radicals Self-efficacy There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change and get good outcomes Source of image:www.h3daily.com
  37. 37. #SHCR @School4Radicals ‘We cannot direct the wind but we can adjust the sails’ Jennifer Napier Source of image: www.encore-editions.com
  38. 38. #SHCR @School4Radicals Ways to build resilience as a leader of change 1. Get social support 2. Try not to see crisis as insurmountable problems 3. Accept that change is part of living and alter the things you can alter 4. Find ways to move towards your goals 5. Keep a hopeful outlook 6. Build your own self efficacy 7. Look after yourself Source: adapted from The road to resilience, American Psychological Society
  39. 39. #SHCR @School4Radicals We can make ourselves more or less vulnerable by how we think about things. George Bonanno Loss, Trauma, and Emotion Lab, Columbia University
  40. 40. #SHCR @School4RadicalsImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
  41. 41. #SHCR @School4Radicals C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  42. 42. #SHCR @School4RadicalsSource: 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 Make it a personal PERFORMANCE target.
  47. 47. #SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  48. 48. #SHCR @School4Radicals You don’t know you’re going to get a “No” until you ask, and if you don’t ask, you’ve given yourself the “No”. Jack Canfield Source of image: blog.mindjet.com
  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 Telling her story Line Walker @gmacscotland
  52. 52. #SHCR @School4Radicals
  53. 53. #SHCR @School4Radicals
  54. 54. #SHCR @School4Radicals
  55. 55. #SHCR @School4Radicals “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
  56. 56. #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
  57. 57. #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
  58. 58. #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)
  59. 59. #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)
  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. “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
  61. 61. #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)
  62. 62. #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)
  63. 63. #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)
  64. 64. #SHCR @School4Radicals Prochaska, DiClemente & Norcross (1992) “Stages of change” Transtheoretical model of behaviour change
  65. 65. #SHCR @School4Radicals • Which stage do most change activities in health and care focus on? • Which stage are most people actually at? Some questions
  66. 66. #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
  67. 67. #SHCR @School4Radicals • 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
  68. 68. #SHCR @School4Radicals 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
  69. 69. #SHCR @School4Radicals “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”.
  70. 70. #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?
  71. 71. #SHCR @School4Radicals The single biggest problem in communication is the illusion that it has taken place.” George Bernard Shaw ‘‘
  72. 72. #SHCR @School4Radicals • 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
  73. 73. #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
  74. 74. #SHCR @School4Radicals If your horse dies, get off it.” Cherokee proverb Source of image: fenwickgallery.co.uk ‘‘
  75. 75. #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
  76. 76. #SHCR @School4Radicals Telling her story Liz Lamb @IseeQI
  77. 77. #SHCR @School4Radicals Rolling with resistance: a doodle
  78. 78. #SHCR @School4Radicals Next opportunities for learning • Next Tuesday, 23rd February 1900-2000 GMT: Tweet chat #SHCR • Next Thursday 25th February 1430-1600 GMT: Module 4: Making change happen
  79. 79. #SHCR @School4Radicals Take part in a RCT! • Randomised Coffee Trial! • Randomised Coffee Trial! Randomised Coffee Trial! Just email radicals@nhsiq.nhs.uk
  80. 80. #SHCR @School4Radicals Get certificated! • Complete a change • Reflect on it • Complete the change agent application form and submit • More details in the weekly newsletter School for Health and Radical Change Agents
  81. 81. #SHCR @School4Radicals The 30 day change challenge form a team and take action to make a difference If you would like to take the 30 Day Change Challenge: • form a team • agree a change to undertake as a team • complete the change • review and learn • and celebrate http://theedge.nhsiq.nhs.uk/wp-content/uploads/2015/11/SHCR-30-Day- Challenge-Guide.pdf
  82. 82. #SHCR @School4Radicals Further modules 25th February: Making change happen 3rd March: Moving beyond the edge
  83. 83. #SHCR @School4Radicals Questions for reflection • How do I experience resistance? • How can I make sure that the changes I make achieve the impact I desire and… • are sustainable? • do not create dependency? • generate self-efficacy in others? • What do I need to do to develop resilience so that I can roll with resistance? Questions for reflection
  84. 84. #SHCR @School4Radicals Questions for reflection • Look after myself: commit to doing one thing every day that gives me joy/makes me feel good. • Identify three things I can do to support colleagues through The Stages of Change. • Make time in my diary for The Edge talk on resilience! (11th March 09.30-11.00 GMT) Call to action
  85. 85. #SHCR @School4Radicals Goodbye and good luck! ‘Success is not final, failure is not fatal: it is the courage to continue that counts.’ Winston Churchill Goodbye and good luck!

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