School for Health and Care Radicals Slides for Module Three

#SHCR @School4Radicals

Module 3 Rolling with resistance

http://www.theedge.nhsiq.nhs.uk/school/

Module

• 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

The team todaySession 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

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

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.

With which role do you most closely identify?

Receiver of care Campaigner

Change agent Awesome Chief listener

Giver of care

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

• 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

#SHCR @School4Radicals Source of image: sport-fitness-advisor.com

Any force that stops or slows movement

Resistance

Employee resistance is the most common reason executives cite for the

failure of big organizational-change

effortsScott Keller and Colin Price

(2011), Beyond Performance: How Great Organizations Build Ultimate

Competitive Advantage Source of image: Businessconjunctions.com

“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

In module 1, we talked about:

Let’s think about “resistance” in old/new power terms

• 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”

Resistance to change: the old power mindset

An example “old power” transformation programme

“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 changeBritish Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013,

pp 443 - 445

Old power mindset: the role of the change agent

• 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

“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/

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

Resistant behaviour is a good indicator of missing relevance

Harald Schirmerhttp://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

‘‘

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

changeRobert J Marshak

Source of image: createbusiness.net.au

‘‘

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. Creat e 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

Our effectiveness as change agents is not a matter of intention; it’s a matter of impact

• 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 LeeSource of image: thedigitalawards.com

Stop talkingAT ME

Start talkingTO ME

Source of image: prepbeijing.com

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 constraintsJennifer Napier

Resilience: how we keep sailing

A description of resilience fit for a

health and care radicalSource of image: pinterest.com

Early thinking on resilience

“Hardy”

“Invulnerable”

“Invincible”

Source of image: forums.marvelheroes.com

http://go.sdsu.edu/education/doc/files/01370-ResiliencyLiteratureReview(SDSU).pdf

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).

Ways to build resilience as a leader of change1. Get social support2. 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

Resistant organisations: moving to the edge

https://julianstodd.wordpress.com/2015/11/10/laying-the-foundations-for-change/

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 action3. able to achieve small wins which create a sense

of hope, possibility and confidence4. More likely to view obstacles as challenges to

overcome

Four things we know about successful boat rockers

Source: adapted from Debra E Meyerson

CHANGE

meBEGINS WITH

Self-efficacy

“If you think you can or think you

can't, you are right.”

Henry Ford

“The ability to act is tied to a belief that it is possible to do so”

Albert Bandura

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

‘We cannot direct the wind but we can adjust the sails’Jennifer Napier

Source of image: www.encore-editions.com

Ways to build resilience as a leader of change1. Get social support2. 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

We can make ourselves more or less vulnerable by how we think

about things.George Bonanno

Loss, Trauma, and Emotion Lab, Columbia University

#SHCR @School4RadicalsImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Make it a personal PERFORMANCE target.

#SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

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

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

“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.

Telling her story

Line Walker@gmacscotland

“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

• 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

• 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

“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

I am making plans & changing things

I do in preparation.

I have stopped

smoking!

I have stopped

smoking!

I am continuing to not smoke.

I sometimes miss it – but I am still not

smoking

I have stopped

smoking!

I am continuing to not smoke.

I sometimes miss it – but I am still not

smoking

“Stages of change” Transtheoretical model of behaviour change

• Which stage do most change activities in health and care focus on?

• Which stage are most people actually at?

Some questions

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

• 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

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

“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”.

• 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?

The single biggest problem in communication is the illusion that it has taken

place.”

George Bernard Shaw

‘‘

• 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

• 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

Example from the worksheet

• 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

If your horse dies, get off it.”Cherokee proverb

Source of image: fenwickgallery.co.uk

‘‘

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

Telling her story

Liz Lamb@IseeQI

Rolling with resistance: a doodle

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

Take part in a RCT!

• Randomised Coffee Trial!• Randomised Coffee Trial!

Randomised Coffee Trial!Just email radicals@nhsiq.nhs.uk

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

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

Further modules

25th February: Making change happen3rd March: Moving beyond the edge

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?

• 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

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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