Changing the Tire at 80 MPH:
Leadership in the Face of Change
Uniformed Services University of the Health Sciences
October 11, 2011
Te d E p p e r l y, M D , FA A F P
Program Director and CEO
Family Medicine Residency of Idaho – Boise, Idaho
Clinical Professor of Family and Community Medicine
University of Washington School of Medicine
Past President and Past Chairman of the Board
American Academy of Family Physicians
Change
 Change is inevitable, difficult and messy.
 Success rates not impressive:
 Positive Change – 20%
 Partial Success or Outright Failure – 80%
Eric Beaudan, “Making Change Last: How to Get Beyond Change Fatigue”. Ivey Business Journal, Jan/Feb 2006
Ingredients for Change
Jacqueline S. Thousand & Richard A Villa: Managing Complex Change; 2001
Common Reasons Change Falters or Fails
 Weak case – low urgency,
lack of a “burning
platform”.
 Insufficient resources
(time, materials, tools,
training, leadership, $,
attention).
 Not enough
communication.
 Failure to anticipate and/or
respond to factors or events
that can derail change.
Beliefs About Change
 Negative Assumptions:
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It doesn’t improve things.
We never finish it.
Resistance will always kill
it.
Managers can’t lead it.
It ruins what we had
which was always better.
Why did it take 30 years to remove sails from steamships?
Copyright Allen R. Wenner 2007 | May be reused if acknowledged
Challenges
So What Do You Do About Leading Change?
Objectives
By the end of this lecture the learner will:
1. Recite the four stages of change.
2. Describe the three important elements of
leadership.
3. List at least five of the eight stages of creating
major change.
4. Describe the leadership differences between
buffalos and geese.
Staff Reactions to Change
 15% - Angry
 40% - Fearful,
Skeptical, and Distrustful
 30% - Uncertain but
Open
 15% - Hopeful and
Energized
The Three Faces of Change
Source: Ted Epperly, MD
Four Stages of Change
Foundational Elements in Leading Change
 Three Critical Success
Factors:
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Leadership
Teamwork
Communication
Two Styles of Leadership
Source: Ted Epperly, MD
Leadership
Three Important Elements of Leadership
1. The ability to set a vision for an
organization/team.
2. The ability to communicate that vision to the
organization/team.
3. The ability to gather the resources necessary to
help the organization or the team accomplish the
vision/mission or objective.
Dimensions of Change
 Conceptual/Cognitive
 Technical
 Structural
 Adaptive (human social)
Reframe Change
 How one views change – be positive!
 How we think influences how we act.
 WHAT – HOW – WHY.
 Perspective and Approach = Confidence
The Speed of Change
 People can successfully work with a lot of uncertainty
and newness (change); however…
 Speed exceeds individual absorption of change:
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Fatigue
Emotional Burnout
Interpersonal Strife
Inefficiency
Resistance
Illness
Quitting (in place or out the door)
Daryl R. Conner, Managing at the Speed of Change, Random House, 2006
Keeping Change Aloft
 Ups and downs.
 Keep change from stalling completely, losing
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momentum and stopping.
Focus on a strong start of initiative.
Leadership team leads by word and deed.
Pace the change.
Resolve to lead the change to the end.
Deal with obstacles to change.
Change Management Activities and Tools
INITIATING CHANGE
 Case for Change, What’s In It For Us, ROI (Heart/Motivation; Head/Reason)
 Clear Destination
 Engage and Communicate
FACILITATING, MANAGING AND LEADING CHANGE
 PDSA Cycles
 Critical Questions
 Engage and Communicate
 Be prepared for resistance and obstacles
 Recognition, Incentives/Rewards
 Bring in the customer: get ideas, feedback, perspective
MONITORING AND MAINTAINING FORWARD MOTION OF CHANGE
 Relentless focus on RESULTS AND GOALS
 Review of what’s working, what’s not
 Anchor changes in organization
Leadership
 Role of leadership team
throughout a project:
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Develop a compelling and
inspiring vision.
Empower all staff to
become active and creative
members of the project.
Oversee and monitor the
integration and coordination
of change.
Publically celebrate
milestones.
Actively solicit honest
feedback.
Teamwork
 Tools and Resources
 Ground Rules:
 Senior Leadership Team
Oversees - Integrates
Communicate and Engage
 Not just about doing.
 About being present with the people.
 We generally don’t lack ideas about what.
 The challenge is how to orchestrate the process.
Communication
 Develop process to deal
with issues that arise.
 Use staff meetings to
communicate progress
and changes in timelines.
 Meet at least bi-weekly.
 Post relevant
organization change
information.
Increasing the Speed of Change
 Communicate and
Engage
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Support People in the
Transition
Engage the Resistance
 Provide Training in the
New Skills
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Teamwork and
Communication Basics
Skills for New Roles and
Functions
It’s About the People
“We work hard at the details of new processes or new
technologies, but expect magic metamorphosis of
the people expected to use those processes and
technologies. We simply forget or ignore that
organizations change when the people in them
change.”
Shapiro, CREATING CONTAGIOUS COMMITMENT, 2003
The People
“I asked the manager how the change was going…His
response, “its going fine - except for the people.”
Shapiro, CREATING CONTAGIOUS COMMITMENT, 2003
The People
“It is typical to approach change with strategic plans,
supportive data, and structured timelines. All these
steps are necessary, but they risk failing without:
understanding that people are galvanized to change
at the feeling level”
The Message
Choosing the right words [increases] the space…for
new possibilities. Presenting the change as a way to
deliver better patient care (patient centered care)
makes it easier for staff to “feel good” about the
change.
Transition in Change
 Change is about the new.
 Transition is about the human psychological
response to change
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Begins with an ending – a letting go of the old
There is a time in the middle (aka, the neutral zone) – a time
when old identity and old reality are gone, but the new ones
have not yet taken root in your heart and mind
Ends with a new beginning – new energy, sense of purpose,
outlook, image of what is possible
William Bridges, Managing Transitions and Getting Them Through the Wilderness: A Leader’s Guide to Transition
The Change Lifecycle
Effective
Change
The Second Curve
Crossing the Desert
What Leaders Can Do
 Keep communicating.
 Lead by walking around.
 Picture the destination.
 Acknowledge difficulties, keep leading forward.
 Give it the time it needs, but avoid a stall or loss of
momentum.
 Cut off the old way but acknowledge it.
 Establish the new culture by anchoring it.
Getting to the New Destination
Engage Resistance
 All change runs into
resistance. Be prepared to
face open and low-lying
resistance; it can come
from unexpected sources
(yourself included).
 People who support change
in the beginning may move
to resistance at some point
in the process. It happens.
 Ignoring resistance will kill
the change effort.
Principles for Overcoming Resistance to Change
 It is natural and
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inevitable: Expect it
It does not always show
its face: Find it
It has many motivations:
Understand it
When you meet it, deal
with concerns rather
than arguments:
Confront it
There is no one way to
deal with it: Manage it
Hammer, Michael and Steven A. Stanton, The Reengineering Revolution, Harper Business, 1995
Three Questions to Ask
1. What is changing?
2. What will actually be different
because of the change?
3. Who’s going to lose what?
What is Changing?
 Describe the change clearly and concisely.
 Tie it to solving a problem or seizing an opportunity.
 Communicate this frequently.
What Will Actually Be Different?
 How will affect those who do the work?
 Vague and abstract to those it will affect – be clear!
 Describe what the differences will be; if they are not
fully known now, let people know that – say what
you know.
 Be honest; establish vulnerability and trust.
Who’s Going to Lose What?
 Shift of the organization’s structure.
 More flat organization which changes the role and
status of leaders, managers and staff alike.
 Can cause serious passive or open resistance in
organizations.
 For leaders a two-fold challenge: manage your own
reaction and help others manage theirs.
Who’s Going to Lose What?
 The best way to get people through the transition is
to affirm their experience and help them deal with it
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Listen
Understand
Bring issues out
Give people tools
Why the Three Questions Are Important
 Begin a process of essential communication.
 Create a climate of listening which reassures people
and defuses opposition.
 Can generate information that you as a leader
may not already know; this can help you as you lead
the change to completion.
 Will help you since you are in transition too!
Provide Training in the New Skills
 Opportunity to learn more.
 As leaders, facilitate and support the learning .
 We lead by what we say and what we do.
Five Characteristics for High Performance
Dysfunctions
What Leaders Can Do
Inattention to… Results Focus on collective results
Avoidance of…
Lack of…
Accountability Confront difficult issues
Commitment
Fear of…
Absence of…
http://www.youtube.com/watch?v=lC7CFB6A1Doandfeature=related
Conflict
Trust
Force clarity and closure
Demand debate
Be vulnerable
“Like a chain with just one link broken if even a single
dysfunction is allowed to flourish teamwork
deteriorates, politics prevail, results suffer, progress
stalls.”
Final Thoughts on Change
 Unpredictable and
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unwieldy.
Look out for obstacles,
resistance, fatigue and
other gnarly problems.
Steer a course through
turbulence.
Revise plans when
necessary
Resolve to “go on to the
end” and to succeed
Be visible.
Eight Stage Process of Change
7.
Establish a sense of urgency.
Create the guiding coalition.
Develop a vision and strategy.
Communicate the change vision.
Empower brand-based action.
Generate short-term wins.
Consolidate gains and produce more change.
8.
Anchor new approaches in culture.
1.
2.
3.
4.
5.
6.
Source: John Kotter – Leading Change
Sustainable Change
Keep your change alive on all three levels:
 The individual.
 The small group/team.
 The entire practice
system.
The Larger
System
Team or
Organization
Self
Small Changes can have a big impact
Changes don’t occur in a
linear fashion. Small
changes can have dramatic
effects.
“In the long run the only
sustainable competitive
advantage is your
organization’s ability to
learn faster than the
competition.”
- Peter M. Senge,
The Fifth Discipline, The Art and
Practice of the Learning
Organization, 2006
Integration
Symphony of Care
“Love is better than Anger.
Hope is better than fear.
Optimism is better than
Despair. So let us be
loving, hopeful and
optimistic people.”
- Jack Layton
Questions