Welcome to
Human Dimensions of Change
By end of today you will:
• Understand why the Human Dimensions
of Change are important
• Have an overall framework for managing
change
• Understand the difference between simple
and complex change – and the different
approaches needed
By end of today you will:
• Have developed your understanding of
how to work effectively with different
personality types when leading change
• Have a better understanding of why
people resist change and ways to respond
to resistance
• Understand the most common reasons
why change projects fail
By end of today you will not:
• Be an expert in change management –
can’t do that in a day
• Have lots of easy answers –real life
change is often complex and messy
• Have all your learning needs met all the
time – the group is too diverse for that.
Course Approach
• Some theory - its important and helps
give you confidence in your approach
but….
• Not theory for theory’s sake – has to
help you with real life.
• You bring the case studies – various
exercises where you will look at how
theory applies in your situation
Aims of Session One
• To understand why the Human
Dimensions of Change are important
• To provide a framework for effective
change management
• To understand the difference between
simple and complex change – and the
different approaches needed
Why is it important to manage the
human dimensions of change?
• Change in Healthcare = people changing
• Estimated 80% of change projects failure =
failure to manage the people issues
• Need to understand the ways people react to
change
– minimise the risks of failure
– maximises skills and talents of the team
Exercise in Pairs
Transition Curve
Progress through curve depends on:
– Personality type
– How much feel in control of change
– How much other change is going on in life
– Past experience
STEP ONE
THE CASE FOR CHANGE
‘People responsible for planning and
implementing change often forget that
while the first task of change management
is to understand the destination and how
to get there, the first task of transition
management is to convince people to
leave home.’
William Bridges
Why change? – how to generate
dissatisfaction with status quo
•
•
•
•
Patient Stories
Pathway Mapping
Use of data
Visiting other services…seeing what
is possible
Remember
and
Change and learning
Panic Zone
Comfort Zone
No learning
No change
•people close up
•they freeze
•they don’t learn
Change and learning
Panic
Zone
Comfort Zone
Discomfort Zone
•uncertainty
•learning
STEP TWO
VISION FOR THE FUTURE
Leaving the comfort zone
‘To leave the comfort of the status quo,
most individuals need to believe that the
change is truly imperative and that
there is a more attractive alternative’
Silversin/Kornacki
What to Change To?
Effectiveness of a Decision
=
Quality of Decision
x
Commitment to Implement
No Involvement = No Commitment
What to Change To?
• Ideally, involve those impacted in the
change in developing a vision for the
future:
– Miracle Question
– Value Stream Mapping
– Option Development and Appraisal
– Visits to other services
STEP THREE
PLAN TO GET BETWEEN
PRESENT AND FUTURE
If, overnight, I was to remove all cats
from the World - what would be different
a) Today?
b) In Six Months?
c) In Two Years?
Complex Adaptive Systems
•Collection of parts
•Share an environment or space
•Parts can act independently
•Parts are interconnected
•Action by any part affects the whole
Examples: immune system, insect colony, flock,
stock market, just about any collection of humans
Complex Adaptive Systems
Deterministic Systems (Machine Metaphor)
the system is predictable, if you understand the
rules you can predict the behaviour
Complex Systems (Environment Metaphor)
the sum is bigger than the parts – cannot predict
behaviour of whole system by understanding the
individual parts
What type of system are you trying to
change – simple or complex?
Complex Adaptive Systems
• Health and social care systems meet the
classification of a complex adaptive
system.
• BUT….complex systems have systems
within systems – and some of these might
be simple
Traditional Mgt Theory
• Based on the metaphor of the organisation
as a machine
• Theories or rules apply to the system and
result in a particular outcome
• Mismatch between theories and practice
• CAS Theory is an explanation of why
Simple
Complicated
Complex
Following a Recipe
A Moon Rocket
Raising a Child

Recipe is essential

Formulae are critical and
necessary

Formulae have only a
limited application

Recipes are tested to
assure replicability of later
efforts

Sending one rocket
increases assurance that
next will be okay

Raising one child gives
no assurance of success
with the next

No particular expertise:
knowing how to cook
increases success

High level of expertise and
many specialised fields
and co-ordination

Expertise can help but is
not sufficient

Recipes produce standard
products

Rockets similar in critical
ways

Every child is unique

Certainty of same results
every time

High degree of certainty of
outcome

Uncertainty of outcome
remains
Source: Zimmerman
Complex Adaptive Systems
What do we know and how does it help us?
We know:
Cannot predict effect of the change by the size of the
input. Small inputs can result in large changes, large
inputs can result in no change
Which means:
– Promotes an experiential approach to change try lots of different things on the margins (PDSA)
– Allows us freedom from thinking we must
work/plan it all out in advance.
Complex Adaptive Systems
What do we know and how does it help us?
We know:
Ability to predict in detail what will happen as a result
of any given change in system rapidly deteriorates
with time
Which means:
– Don’t spend lots of time on detailed plans
– Keep a close eye for unintended consequences
Complex Adaptive Systems
Unpredictable in Detail
Complex Adaptive Systems
What do we know and how does it help us?
We know:
They have distributed control rather than one command
centre
Which means:
– Recognises can’t control everything by issuing
orders from the top
– Solutions to issues are distributed throughout the
organisation and not confined to the top
– Need to find ways to ‘attract’ the system to change
rather than ‘directing’.
Throwing a Rock or a Bird?
y = x2 – b
f = ma
?
“attractor”
Source: Paul Plsek, based on Richard Dawkins
Complex Adaptive Systems
What do we know and how does it help us?
We know:
Much of the power for creativity and innovation lies not
with individuals but within relationships among parts of
complex system
Which means:
– place more emphasis on micro (people and
interactions) than macro such as strategy
– generative relationships - just putting different
people in the same room can result in change
Generative Relationships
“Occur when interactions among
parts of a complex system produce
valuable, new, and unpredictable
capabilities that are not inherent in
any of the parts acting alone.”
David Lane and Robert Maxfield
Complex Adaptive Systems
What do we know and how does it help us?
We know:
They are history dependent - shaped and influenced by
where they have been
Which means:
– Explains why good practice in one area doesn’t
always work in another
– But doesn’t mean we have nothing to learn from
elsewhere!
Complex Adaptive Systems
What do we know and how does it help us?
We know:
For a CAS to be sustainable there must be diversity –
key to innovation and long term viability.
Which means:
– Need to value our differences - our long term
success depends on the differences
– Must be prepared to ask the difficult questions - face
the taboos
– But must also manage the distress to keep it at
productive levels.
Complex Adaptive Systems
What do we know and how does it help us?
We know:
A very complex system can be (is) guided by a few simple
rules
Which means:
– Build a good enough vision – provide general direction
pointing, absolute boundaries and resources or
permission rather than trying to plan everything in detail
– Simple rules (often unstated) also maintain the system at
status quo
– Greatest leverage for innovation and change comes by
modifying simple rules
Good Enough Vision and
Minimum Specifications
•
•
•
•
Hunterdon Medical Center (USA)
Need: Community health initiatives
Approach: Nursing committee
Observation: After 6 months,
committee had not yet gotten out of
the hospital!
Good Enough Vision and
Minimum Specifications
• Instead... Simple rules
– A nurse can schedule up to halfday per week to work on
community health initiative
– Don’t do anything illegal
– Remain within the project budget
(all expenditures publicly posted)
Summary
Effective Approaches in Complex Situations
1) Give the change problem back to those
involved to generate solutions
2) Constructive open dialogues (seek first
to understand, then to be understood!)
3) Experiment – small scale change – PDSA
4) Simple rules
5) BOTH/AND not EITHER/OR
6) Role of management is
facilitating/enabling rather than directing
Giving up the Myths
1) Myth of Autonomy – everything you do
depends on others, you cannot do it alone
2) Myth of Control – can’t control everything,
need to win hearts and minds
3) Myth of Omniscience – you don’t have all the
answers as manager/leader
Often the toughest battle is not letting go of myths
yourself but getting your staff to let go of them
Applying the Theory
Important to identify when an issue is
complex and when it is simple – needs
different techniques
But
Remember a change initiative may
consist of both simple and complex
parts
Stacey Agreement and
Certainty Matrix
A method to select the appropriate
management actions in a CAS
Stacey Matrix
Anarchy
Simple
Close to
Certainty
Far from
Certainty
Simple Zone
• Know where you want to get to, have
clarity on steps need to take to get there
and agreement that it needs to happen
• Traditional management theory works well
here – project management approach,
which splits out tasks and assigns them to
individuals to implement
• Key role of management is ‘directing’ the
process to ensure project plan
implemented
Complex Zone
• Not clear if you make a change what the
impact will be and no agreement whether to
do it
• Key to working in this area is peoples beliefs
and ways of thinking
• Focus on involving people in identifying
issues and solutions, experimenting,
constructive dialogue and simple rules
• Key role of management is ‘enabling and
facilitating’ rather than ‘directing’
Examples
Anarchy
Priority actions to
improve treatment
of depression
Implementation
of advocacy
services in line
with mental
health act
Close to
Certainty
Far from
Certainty
In the zone of complexity…
Experiment
Constructive
dialogue
Simple
Simple
rules
Structure, process
and pattern mapping
Complexity – Where does your
change fit?
Pairs Exercise
•Think about a change you are currently
involved in and discuss how this fits into the
Stacey Matrix
•Remember, different aspects of the change
may fit into different parts of the Matrix
•Does the change management approach
being used fit with the type of change – and
if not what needs to change?
Summary of Key Steps
Story so far…
Step One
Make the case for change (Plan)
Step Two
Vision for the future (Plan)
Step Three Plan to get from A to B and do it (Do).
But also need
Step Four
Review and embed if working - do
something else if not delivering benefits
(Study/Act)
Formula for Change
DxVxF>R
Dissatisfaction
with current state
Vision for the
Future
Organisational
Resistance
First concrete
steps towards the
future
Beckhard & Gleicher
In this session we’ve…
• Looked at why the Human Dimensions of
Change are important
• Provided a framework for effective change
management
• Looked at the difference between simple and
complex change
• Given you a tool for working out what type of
change you are facing and looked at the
different approaches needed
The Road to Transformation?
Source: Gareth Morgan