Great ideas on fostering change in business and nonprofit settings. This is one of the challenging leadership and management aspects in Africa. These are simple ideas that deliver great results when followed methodically. They can give African leaders and manager better outcomes.

2. Change is the only constant in life.
HERACLITUS

3. Some Realities about Change
• Often provoked by external/PEST factors
• Also undertaken as an evolution process
in the organization life-cycle
• People dislike, fear, suspect change
• Change opposes values and ideas that
people hold dear (that is why some argue
that change should also target culture,
values and beliefs)

5. Roles in Change Management
• Change Initiator
• Change Agent
• Change Champion
– People or groups whose actions are aimed at
sustaining interest in the change process.
– Their roles include reminding people why change is
happening and its benefits
• Sponsor of Change
– Internal person, team or dept that is officially
responsible for coordinating the change process

6. Types of Changes in Health
Programs
• Level 1: Changes in clinical practices
• Level 2: Changes in providers’ behaviors
and attitudes
• Level 3: Changes in management
practices
• Level 4: Changes in management systems
• Level 5: Changes in organizational
strategies and structures

7. 500,000women die during
pregnancy and
childbirth annually
though the world
knows how to prevent
these deaths

8. 8,000,000people develop active TB annually and each
infects an average 10 to 15 others, though
treatment is known and could be easily
supervised

9. … health
professionals
chronically misjudge
what it takes to
make a lasting
change
(The Manager 2004, Vol. 13, No. 3)

10. factors influencing
translation of ideas
into workable
practices
Dedicated
change
agent leads
the way
Clear purpose
and expected
results of the
change
process
Staff
motivation
and ongoing
support
Clear
assigned and
accepted
responsibility
Environment
that
encourages
change

11. 1. Dedicated agent leads the way
Internal change
agent who cares
deeply about and is
motivated by need
for change
New practices
imposed from
outside last a short
time without internal
change agent
Not necessarily idea
originators, but
organizational
innovators

12. 2. Clear purpose and expected results
of the change process
Ensure all stakeholders
understand the
challenges your
organization is facing in
carrying out its mandate
and mission
Get stakeholder
consensus on one
challenge they believe
can be addressed by
changing ineffective
practices
Convince stakeholders
that the new practice:
Offers clear benefits to
them and their clients
Can be tested without
high cost/risks
Is consistent with
organizational values
Can be implemented
with minimal disruption
to services

13. 3. Staff motivation and ongoing support
throughout the process
Get the buy-in of
staff and others
you expect to
help
Get strategies to
maintain their
dedication
Document early
successes and
benefits

14. 4. Gain acceptance of assigned responsibility
Assign staff clear
responsibility for
implementing change and
encourage them to accept
it
Encourage staff to
recognize urgency and
priority of proposed
change
Provide information,
resources and skills
needed to take on new
responsibilities
Integrate new
responsibilities into
performance expectations
and hold them accountable
for achieving the assigned
part of the change process
Provide needed support;
demonstrate your
commitment; model the
new attitudes and
practices that you expect
them to adopt

15. 5. Promote environment that encourages change
Ride on
organizational
culture that
supports change
and learning
Where overall
culture inhibits
initiative, encourage
change in your own
unit
Build alliance with
other forward-
thinking managers
Use any positive
results to persuade
others to consider
the new practice(s)
Understand factors
that impede change
and keenly watch
out for them

17. phases of
leading a
change process
PHASE 1
Recognize
the challenge
PHASE 2
Identify
promising
practices
PHASE 3
Adapt and test
one promising
practice or set
of practices
PHASE 4
Implement
the new
practice(s)
PHASE 5
Scale up the
successful
new
practice(s)

18. Phase 1: Recognize a Challenge
Create with
staff a shared
vision of a
better future
Identify with
staff the one
serious
obstacle your
unit or facility
is facing
Determine
the
underlying
causes that
prevent a
solution (Ask
5 Whys)
Move from
“problem
mindset” to
“challenges”
mindset
Start to bring
senior
management
on board
(focus on
how to win
their support)

19. Phase 2: Identify Promising Practices
Characteristics
of a Promising
Practice
Deals with
issues relevant
to the identified
challenge
Has clearly met
program
objectives in
another setting
Has caused
observable or
measurable
improvements in
services
Features
elements that
you and your
colleagues want
to achieve in
your setting
Have been
tested in the
field and provide
credible
evidence of
success and
transferability
What practices
have been
introduced in
your org or
neighboring org?
What practices
have been
introduced
nationally?
What
practices are
endorsed by
reputable
national
authorities?
What
practices are
promoted by
international
agencies?

20. Phase 3: Adapt and test one promising
practice or set of practices
Create a
change
team
1. Work with team to
analyze similarities
and differences
between your setting
and the origin of the
promising practices.
2. Pay attention to org
culture and how it might
support or impede the
new practice. Find people
in the org who can help to
address cultural
elements.
3. Test the practice in
a small setting such
that the testing is
rapid and inexpensive
but representative of
a real life setting;
define results,
indicators and
approaches
4. Evaluate the success of
the small scale trial against
the indicators; use lessons
to eliminate obstacles; make
needed adaptations. Later
other parts of the org may
also make their adaptations

21. Phase 4: Implement the new practice
Expand use of the
practice from limited
setting to more places;
from one clinic to
multiple clinics; from
one hospital unit to
several units. Work
with change team to
generate interest,
curiosity, commitment
and ownership
1. Demonstrate to
senior mgt and unit
managers results of
the new practice,
approaches, and how
and when progress
can be assessed
2. Agree on required
steps, required tasks,
when, by whom and
with what resources
3. Ensure
understanding of
roles by those
responsible for tasks,
time and resources
have been given, and
are held responsible
for results
4. Monitor and
document progress
against mutually
agreed indicators;
make necessary
adaptations based on
lessons
5. Managers of new
implementing sites
identify all who are
directly or indirectly
affected and keep
them informed of
progress
6. Acknowledge
visible interim results
(small wins) to
encourage and build
confidence of staff as
they move towards
mainstreaming the
new practice
As the change team, which
now includes new
managers, succeeds in
implementing the practice
and making achievements
known, you will be building
a base of support among
influential stakeholders and
decision makers. Some of
these people will become
champions for eventual
scale-up.

22. Phase 5: Scale up the successful practice
At this point, you
may hand over the
scale-up to more
senior people with
broader authority
and contacts. But
first lay the
groundwork.
Redesign the
practice a bit to
be less costly but
maintain its
effectiveness
Build the change
into mgt practices
(use existing
policies, systems,
rewards,
structures, etc.)
Develop
communications
strategy to make
practice known to
target groups
(including
WIIIFM)
Be ready to serve
as a resource for
one-on-one
support as others
undertake their
change process

23. Dealing with People Reactions to Change
•Provide information
•Reinforce that change will happen
•State unmistakably when and how change will occur
•Suggest ways to respond to the change
DENIAL (shocked that change is
about to occur and uncomfortable
giving up familiar practices)
•Create opportunities for expressing anxiety
•Listen attentively to concerns
•Resist impulse to explain or defend the change
•Show understanding / empathy for feelings of loss and worry
•Understand motivations behind resistance and build coalitions that support the change
RESISTANCE (questioning
whether it will succeed; wondering
about ability to cope; worrying
about job security)
•Provide opportunities and resources for discovering new possibilities
•Involve staff in planning for new practice, setting goals, etc.
•Provide training to enable them carry out the new practice
•Encourage people to prepare themselves in teams and to support one another
EXPLORATION (After expressing
concerns and mentally detaching
from old practices, people start to
explore opportunities in new
practices)
•You no longer need to “manage” the change process
•Validate and reward their commitment and they will manage themselves
•Set long-term goals
•Provide needed support
•Get out of the way
COMMITMENT (People recognize
and understand the benefits of the
new practice for the client, the org
and for themselves; accept new
idea; get ready to comply; commit
to carry it out)

24. Interesting Reading on Change

25. END