Affecting Change – Barriers to Change 1 Barriers to Change A Core Leadership Attribute Seminar on Affecting Change Created By: Glenn C. Hamilton, MD, FACEP

Affecting Change – Barriers to Change 1

Barriers to ChangeA Core Leadership Attribute Seminar on Affecting Change

Created By:Glenn C. Hamilton, MD, FACEP

Vice Chair and Professor, Department of Emergency MedicinePast-President, Society for Academic Emergency Medicine

Wright State University, Dayton, Ohio

Tenet Editor:Maria Moreira, MD

Program Director, Denver Health Residency in Emergency MedicineDenver Health Medical Center, Denver, Colorado


Change is the only constant.

- Heraclitus of Ephesus

http://upload.wikimedia.org/wikipedia/commons/f/fa/Heraclitus,_Johannes_Moreelse.jpg


Change is All Around Us- Emergency Medicine

• Academic heritage• Medical training structure• Rising census• Technology advancements• Treatment evolutions• And so much more…


Outline

• Key Terms

• The Process of Change

• Barriers to Change

• Overcoming Barriers


Key Terms

Change is a never ending process of readjustment and readaptation, as man responds behaviorally to ever

changing circumstances.

Shcwartz BM and Ewald RH. Culture and society; An introduction to cultural anthropology. 1968

DEFINITION


Key Terms

Senge et al. The Dance of Change: The Challenges to Sustaining Momentum in Learning Organizations. 1999

Profound Change is organizational change that combines ‘inner’ shifts in

people’s values, aspirations, and behaviors with ‘outer’ shifts in

processes, strategies, practices, and systems

DEFINITION


The Process of Change- Forms of Change

• In concepts• Philosophies• Programs• Products• Services• Facilities• Technologies

• Processes• Systems• Attitudes• Behaviors• Relationships• Image• And more…..

Jay Morley and Doug Eadie. Leading Change. The Extraordinary Higher Education Leader. Washington, DC: National Association of College

and University Business Officers, 2001.


The Process of Change- Forces of Change

1. Need for certainty, stability, & predictability

2. Need for a sense of purpose

3. Need for control

4. Need to have connection

5. Need for successAdapted from www.5Forcesofchange.com

http://www.5forcesofchange.com/


The Process of Change- Forces of Change

• E.g.,– Press-Ganey Scores

• Need for connection• Need for success

– Consultant availability• Need for certainty, stability, & predictability• Need for control• Need for success


The Process of Change- Requirements

• Innovation

– Creativity & change initiatives

– The planning process

• Implementation

Jay Morley and Doug Eadie. Leading Change. The Extraordinary Higher Education Leader. Washington, DC: National Association of College

and University Business Officers, 2001.


The Process of Change- Change Theory

• Human systems

– Homeostasis

– Equilibrium


The Process of Change- Change Theory Examples

• Process Evolution– Iterative evaluation

results in continuous

quality improvement

– Evolution vs.

revolution

Assess

Depl

oy

Identify

Implem

ent

Evaluate

ProcessEvolution



Lippitt’s Seven Phases of Change1. Diagnose the problem

2. Assess the motivation/capacity for change

3. Assess the resources/motivation of the change agent

4. Choose progressive change

5. Clearly define the role of the change agents

6. Maintain the change

7. Gradually terminate from the helping relationship

Lippitt, R., et al. The Dynamics of Planned Change. New York: Harcourt, Brace and World, 1958.



Kurt Lewin’s Three-Step Change Theory

1. Unfreezing the existing status quo

2. Change movement to a new state

3. Refreeze the situation to make the

change permanent


The Process of Change- Kotter’s 8-Step Change Model

1. Create urgency2. Form a powerful coalition3. Create a vision for change4. Communicate the vision5. Remove Obstacles6. Create short-term wins7. Build on the change8. Anchor the change into culture

John Kotter. Leading Change: Why Transformation Efforts Fail. Harvard Business Review, March-April 1995.


The Process of Change- Resistance to Change

• Recognition &

Anticipation

• Overcoming barriers


The Process of Change

Change alone is eternal, perpetual, immortal…

- Arthur Schopenhauer


Barriers to Change

• Organizational

• Individual & Group

• Leadership


Barriers to Change- Organizational

• Organizational Culture Inertia

• Existing Power Structures

• Previously Developed Work Groups

• Institutional Memory



• Organizational Culture Inertia– Bureaucracy and ‘Iron Rice Bowl’



• Existing Power Structures



• Previously Developed Work Groups, Committees, TF, etc…



• Institutional Memory

– Failure of previous change initiative

– Skepticism and doubt

– ‘Not again’


Barriers to Change- Individual & Group

• Fear of the Unknown• Fear of Failure• Conflict of Beliefs• Losing Something of Value• Leaving a Comfort Zone• False Beliefs• Misunderstanding & Lack of Trust• Lack of Inertia



• Fear of the Unknown– Uncertainty

– Emotional discomfort

– Resistance is felt to be anxiety-reducing



• Fear of Failure– Capabilities compared to required– Unwillingness to learn new skills– Resistance is felt

to confer success by virtue of default



• Conflict of Beliefs – Disagreement

about the need for change

– Conflict between beliefs and solutions

– Resistance is felt to avoid compromise



• Losing Something of Value– Perceived loss generates fear and

resistance to change– Resistant is felt to prevent loss



• Leaving a Comfort Zone– Multiple emotions generated

• Fear, anger, passivity• Risk avoidance

– Resistance is felt to assures comfort



• False Beliefs – Rumors

– ‘No problem’

personalities



• Misunderstanding & Lack of Trust – Not understanding implications – Not trusting the advocate or vessel



• Personal Inertia

– Change requires effort

– Fatigue and burnout pose barriers to change

– Lack of compensation

– Lack of reward - Sir Isaac Newton


Barriers to Change- Leadership

• Lack of clarity

• Failure to inspire

• Loss of focus

• Lack of attention to stakeholders

• No defined beginning and end



• No clear vision, direction, priorities



• Failure to inspire, engage, and motivate



• Loss of focus during process



• Lack of specific attention to key stakeholders



• No defined beginning and end



• Management failures that compound existing barriers– Failure to explain the need for change– Failure to provide information– Failure to consult, negotiate and offer support

and training– Lack of involvement in the process– Failure to build trust and sense of security– Poor employee relations


Overcoming Barriers

• An individualized process• Recognition & insight • Anticipation of resistance• Acknowledge of magnitude• Direct address• Empower Ownership


Overcoming Barriers

• Empower Ownership

– Share information

– Provide guidance

– Stretch your people

– Make it fun, actionable, & visible

– Help them feel the challenge- Johnson LK. Overcoming Barriers That Destroy Teams.

Harvard Business School Working Knowledge. 2005


Summary

• It is essential to understand the widely varied means by which “change” may fail to insure a well-planned organized, and implemented process to assure success.


Suggested Readings

• Texts– Kotter JP, Leading Change, Harvard Business

School Press, 1996– Carr, DK, Hard KJ, Trahant WJ, Managing the

Change Process, New York, McGraw-Hill, 1996.– Bridges W, Managing Transitions: Making the

Most of Change, 3rd ed, Philadelphia, PA. Da Capo Press, 2009.


Suggested Readings

• Articles– Kotter JP, Leading Change: Why Transformation

Efforts Fail, Harvard Business Review, Mar-Apr 1995: 59-67

– Kotter JP, Schlesinger LA, Choosing Strategies for Change, Harvard Business Review, July-Aug 2008; 130-139.


National Residency Leadership CurriculumQuestions?

??


National Residency Leadership CurriculumSpecial Thanks!

Funded By:An American College of Emergency Physicians Chapter Grant

Endorsed By:American College of Emergency Physicians

Emergency Medicine Council of Residency DirectorsEmergency Medicine Resident’s Association

Society for Academic Emergency Medicine


National Residency Leadership CurriculumSpecial Thanks!

Senior Editors:Stephen Wolf, MD, FACEP

Andrew French, MDMatthew Mendenhall, MD, MPH

Tenet Editors:Britney Anderson, MD

Barbara Blok, MD, FACEPJeffrey Druck, MD, FACEP

Maria Moreira, MDLee Shockley, MD, MBA, FACEP

Administrative Editor:Barbara Burgess


National Residency Leadership CurriculumThank You!

For More Information Please Visit:www.DenverEM.org www.CoACEP.com

http://www.denverem.org/

http://www.coacep.com/

Documents

Affecting Change – Barriers to Change 1 Barriers to Change A Core Leadership Attribute Seminar on Affecting Change Created By: Glenn C. Hamilton, MD, FACEP