Richard K. WanyamaNovember 06 2015

ChangeManaging

Change is the only constant in life.

HERACLITUS

A radical, fundamental, organization-wide reorientation to enhance performance, as opposed

to small scale actions.Examples are: change of mission; restructuring

operations; replacing a key process, etc.

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)

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

Forms of Change in Health Programs

• Change in clinical practices• Change in providers’ behaviors and

attitudes• Change in management practices• Change in management systems• Change in organizational strategies and

structures

500,000

women die during pregnancy and childbirth annually though the world knows how to prevent these deaths

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

… health professionals chronically misjudge what it takes to achieve

lasting change

(The Manager 2004, Vol. 13, No. 3)

5factors influencing translation of change 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

1 2 3 4 5

1 Dedicated change 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

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

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 and share early successes and

benefits

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

5 Promote environment that promotes 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

5 phases of leading a change process

PHASE 1

Recognize the challenge affecting your

work

PHASE 2

Identify promising practices

PHASE 3

Adapt and test one

promising practice or

set of practices

PHASE 4

Implement the new

practice or set of

practices

PHASE 5

Scale up the successful

new practice or set of practices

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)

1Phase

Recognize the challenge

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?

2Phase

Identify promising 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

3Phase Adapt and test one promising

practice or set of practices

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

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.

4Phase Implement the new 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

5Phase Scale up the successful practice

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 People are shocked that change is

about to occur and are uncomfortable giving up practices

that they are familiar with

•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 People still questioning whether the

new practices will succeed; wondering about their 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 the 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 organization and for themselves; they accept new idea;

they get ready to comply; they commit to carry it out.

Interesting Reading on Change

END