module 3 - rolling with resistance
DESCRIPTION
These are the slides for Module 3 of The School for Health and Care Radicals, a five week virtual programme, designed to equip people across the health and care system with the core skills to improve their skills as change agents. It supports NHS Change Day 2014, the grassroots movement in which everyone who values the NHS can make a pledge of action to improve things for patients and the health and care system. Big change only happens in health and care because of heretics and radicals: passionate people who are willing to take responsibility and work with others to make change happen. Being a radical isn't related to hierarchy or position and you don't have to work in the NHS or social care to qualify as one. Registrants to the school so far include patients and carers, students, senior leaders, improvement facilitators and clinical and care staff. There is also a live weekly web seminar which will be available to 'listen again', supported by a raft of other opportunities, including coaching and mentoring, virtual discussions and tweet chats, and an ever- expanding portal of useful resources. Programme The programme focuses on five modules over five weeks, 9:30 to 11:00 am GMT Friday 31 January 2014: Being a health and care radical: change starts with me Friday 7 February 2014: Forming communities: building alliances for change Friday 14 February 2014: Rolling with resistance Friday 21 February 2014: Making change happen Friday 28 February 2014: Moving beyond the edge Tweetchat We will run a tweetchat each Wednesday from 16:00 to 17:00 GMT, based on the content of the module from the previous Friday. A tweetchat is a facilitated conversation using Twitter. The hashtag we will use for the tweetchats is #SHCRchat. The dates for the tweetchats are: 12 February 19 February 26 February 5 March There is no charge to join the School of Health and Care Radicals and it is open to all, whatever your role or level, and whether or not you work in the NHS Resources Resources from all modules can be found at: http://www.nhsiq.nhs.uk/9059.aspxTRANSCRIPT
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The School for Health and Care Radicals
www.changeday.nhs.uk/healthcareradicals
Module 3: Rolling with resistance
Supported by
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• Please use the chat box to contribute continuously during the web seminar
• Please tweet using hashtags #NHSChangeDay and #SHCRchat• We will produce summaries of the discussions of today’s module
using Storify.com and Pinterest and put these on the website• The conversation continues on the live chat forum at
www.changeday.nhs.uk/healthcareradicalsforum
Joining in today and beyond
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31st January: Being a health and care radical: change starts with me7th February: Forming communities: building alliances for change14th February: Rolling with resistance21st February: Making change happen28th February: Moving beyond the edge
Modules
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School statistics
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• What is meant by resistance to change?• Different approaches to resistance• Importance of diversity in leading change and its
implications in terms of resistance • Impact and intent• A story: Maxine Craig• Using the stages of change model to help people through
change• A panel discussion
• Questions and call to actionSource of image: www.freshnessmag.com
for today
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What do we mean by resistance to change?
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#NHSChangeDay #SHCRchat Source of image: sport-fitness-advisor.com
Any force that stops or slows movement
Resistance
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Change can either challenge or threaten us…….
Your beliefs pave your way to success or block you
Marsha Sinetar
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Diagnostic and dialogic approaches
to resistance to change
Source of image: cultureisconversation.wordpress.com
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• Change is something that happens “out there” in the organisation or system
• Resistance is a force to overcome• Resistance prevents change• Change agents must diagnose, manage and/or
overcome resistance • Resisters otherwise known as “laggards”,
“blockers”, “in denial”
Resistance: a “diagnostic” approach
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Resistance to change
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“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
Diagnostic: the role of the change agent
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• People make their own reality• Change results from transformational
conversations• involving more and different people in change discussions• altering how and which people engage with each other• by stimulating different perspectives to shape how people
think about things
• Resistance is an inevitable consequence of a complex change process (based on diversity)
• Resistance should be embraced and worked with
Resistance: a “dialogic” approach
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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
Dialogic: the role of the change agent
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“The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities. Do this before you start hiring consultants and rethinking your innovation process, there is no process that works without true diversity.”Idris Moore
Source of image: idsgn.org
Diversity is critical to innovation and change
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“Leaders and organisations must let go of the idea that there is “one right way” and instead focus on creating a learning culture where people feel accepted, are comfortable contributing ideas, and actively seek to learn from each other”Diaz_Uda, Medina and Schill (2013)
Source of image:fineartamerica.com
Health and care radicals should be champions of diversity for change
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In the context of “rolling with resistance”• What are the implications of embracing diversity
of thought, experience and background in our change efforts?
• What skills and perspectives do health and care radicals need to work effectively with diverse teams for change?
Source of image:fineartamerica.com
Discussion
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The effectiveness of change agents is not a matter of intention; it’s a matter of impact
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• 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
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Stop talkingAT ME
Start talkingTO ME
Source of image: prepbeijing.com
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• Build a trusting and supportive work environment
• Listen with an open heart and open mind• Fully commit to the change• Seek common purpose and common
interests• Take time to build relationships• Be open with my intent• Take responsibility for my own actions
What should I do?
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If your horse dies, get off itCherokee proverb
Source of image: fenwickgallery.co.uk
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Maxine’s story
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A tale of resistance and cream paint
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I’m right….
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It all depends…
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Every behaviour serves a purpose it makes us feel better and / or
keep us safe and secure
Even if in the long run that behaviour harms us
Even if we don’t recognise it in that way
(Kegan and Lahey , 2009, Immunity to Change)
So why don’t we change?
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The certainty of youth
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“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
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• 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
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• 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
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“Stages of change” Smoking
I am not aware my smoking is a
problem – I have no intention to quit
Prochaska, DiClemente & Norcross (1992)
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“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
Prochaska, DiClemente & Norcross (1992)
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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.
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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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!
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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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 am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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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 am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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Prochaska, DiClemente & Norcross (1992)
“Stages of change” Transtheoretical model of behaviour change
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• Which stage do most change activities in health and care focus on?
• Which stage are most people actually at?
Some questions
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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
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• Designed for Stage 4 – ACTION!
• Mandated it through targets
• Despite compelling case for change – people resisted it – no values connection
• People did the task and missed the point
Example - Surgical Checklist
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• 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?
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The single biggest problem in communication is the illusion that it has taken
place
George Bernard Shaw
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• Listen and understand• appreciate the starting point• elaborate interests
• Build meaning and conviction in the change• Roll with resistance (Singh) • Don’t argue against it• Encourage elaboration of resistance• What makes it so hard?• What would help?
• Build shared purpose
So what SHOULD we do?
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• 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
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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?
Our panel
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Post these or similar actions as a pledge on the NHS Change Day pledge wall http://changeday.nhs.uk/campaign• I will reflect deeply on how I operate as an agent
for change• I will consider the impact of my communication
and behaviour beyond my intent• I will listen to others’ views, engage others in
change and help others through the stages of change
Calls to action campaigns for this week
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• Wednesday 19th February 16:00-17:00 Tweet chat #SHCRchat
• Next Friday morning 21st February module 4: Making change happen
Next opportunities for learning
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1. What does resistance means to you? think about the things you resist as well as your
responses to others’ resistance
2. How do you work with resistance as a change leader?3. How can you make sure that the changes you make
achieve the impact you desire and also are sustainable? do not create dependency? generate self-efficacy in others?
4. Who you are interacting with and where they are on the Stages of Change model?
Questions for reflection