how do you make things stick?

How do you make things stick?

March 18, 2017

#NHSTform#NHSTform

DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

Work complexity

@LynneMaher1 @helenbevan #qfm5 #quality2016 Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

Leading change in a new eraDominant approach Emerging direction

Most healthcare transformation

efforts are driven from this side

The power of co-creation

#NHSTform

People who are highly connected have twice as much power to

influence change as people with hierarchical power

Leandro Herrerohttp://t.co/Du6zCbrDBC

#NHSTform#NHSTform

What is the best way to spread new knowledge?

Source of data: Nick Milton http://www.nickmilton.com/

2014/10/why-knowledge-transfer-through.html

Social connection/discussion is 14 times more effective

than written word/best practice

databases/toolkits etc.

Source of image: www.happiness-one-quote-time.blogspot.com

#NHSTform#NHSTform

Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always

What change is happening in your unit?

What is the change you are working on right now?

-chat-

#NHSTform#NHSTform@tweetvandijk

#NHSTform#NHSTform

@tweetvandijk

@LynneMaher1 @helenbevan #qfm5 #quality2016

1. able to join forces with others to create action2. able to achieve small wins which create a sense

of hope, possibility and confidence3. More likely to view obstacles as challenges to

overcome4. strong sense of “self-efficacy”

belief that I am personally able to create the change

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

1. People speak intellectually but engage emotionally

2. Facts are hard to remember and easy to challenge

3. If we only talk about our success people won’t believe us

4. People don’t want more communication; they want meaningful communication

http://www.peterfuda.com/2014/10/30/traditional-comms-fail-engage/

Four gaps betweenhow we

communicate change

how people engage with that communication

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

George Bernard Shaw

‘‘‘‘

Vivid details

Source: Marshall Ganz

Effective Communication continues throughout the change

• Q- How is the project going?

• Change Agent- Good. The number of people who did not attend reduced by 20% and the staff survey showed that satisfaction had improved.

Are you excited by this?

#NHSTform

When we spread change through strong ties:• we interact with “people like us”, with

the same life experiences, beliefs and values

• Change is “peer to peer”; GP to GP, social worker to social worker, nurse to nurse, community leader to community leader

• Influence is spread through people who are strongly connected to each other, like and trust each other

The pros and cons of strong ties

Pros Cons

When we seek to spread change through weak ties

• we build bridges between groups and individuals who were previously different and separate

• we create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action

• We can mobilise all the assets in our organisation, system or community to help achieve our goals

Why we need to build weak ties AS WELL AS strong ties

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

• In situations of uncertainty, we have a tendency to revert to our strong tie relationships yet the evidence tells us that weak ties are much

more important than strong ties when it comes to searching out resources in times of scarcity

• The most breakthrough innovations and most radical change will come when we tap into our weak ties

Think about a change you are making or want to make. Who are your strong and weak ties?

Source of image:brucemacvaresh.com

Why did it go wrong?

Example

• 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”.

What has your observations been here?

Chatham House rules!

• 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?

• 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

If your horse dies, get off itCherokee proverb

Source of image: fenwickgallery.co.uk

‘‘‘‘

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton

If we want people to take action, we have to connect with their emotions through values

values

emotion

action

#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton#IQTGOLD#SCHR #Quality2015 @HelenBevan @BoelGare @jackielynton

“We have newset of clinicalGuidelines”

“I have a dream”

Source: @RobertVarnam

#hellomynameis

Kinds of people at workThe

ContributorsThe

CompliantThe

Contras

Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/

Kinds of people at workThe

ContributorsThe

CompliantThe

Contras

Gallup global research:•Only 13% of the workforce are engaged (Contributors)•Contributors create six times the value to an organisation compared to the Complianthttp://www.gallup.com/poll/165269/worldwide-employees-engaged-work.aspx

Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/

1. People speak intellectually but engage emotionally

2. Facts are hard to remember and easy to challenge

3. If we only talk about our success people won’t believe us

4. People don’t want more communication; they want meaningful communication

http://www.peterfuda.com/2014/10/30/traditional-comms-fail-engage/

Four gaps betweenhow we

communicate change

how people engage with that communication

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

George Bernard Shaw

‘‘‘‘

Vivid details

Effective Communication continues throughout the change

• Q- How is the project going?

• Change Agent- Good. The number of people who did not attend reduced by 20% and the staff survey showed that satisfaction had improved.

Are you excited by this?

#NHSTform

Effective framing: what do we need to do?

1. Tell a story2. Make it personal3. Be authentic4. Create a sense of “us” (and be clear who the “us”

is)5. Build in a call for urgent action

Source of image: woccdoc.org

Which do you like better?

1. Our infection rates are higher than they should be. We have new clinical guidelines. Let’s work together to implement them!

2. You are the one at the bedside. You know what works and what doesn’t. How can we tackle our infection rates?

3. Remember Mrs. Smith. She fully recovered from C-diff that she picked up on our unit. Just like you, I want to protect more of the chronic elderly. What do you think we can do?

It is a beautiful day

#WhatsYourStory Oct 5-9

Thank you!

marlies.vandijk@ahs.ca

@tweetvandijk

how do you make things stick?

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