www.nelacademy.nhs.uk
0191 371 3634
Dr David Yarrow david.yarrow@time-for-change.co.uk
0191 289 3855

Please find someone you don’t know and talk to them for the next few minutes:
1. Introduce yourselves!
2. Take it in turns (2 minutes each) to talk describe something you’re enthusiastic about, and explain why you’re so enthusiastic about it.
This could be anything – a hobby/leisure activity, something you’ve done once and wish you could do again, the best meal you’ve ever had, the best decision you’ve ever made, a great piece of technology, best holiday, your great job….

This
handout
contains a selection of the slides used in this workshop.
After the workshop we will send email you a link from which you can download an electronic copy of all of the slides.

Change Management Fundamentals
Please think about these key questions as we get ready to start:
• If I asked you to describe one thing that you’re really enthusiastic about, what would it be?
This could be anything – a hobby/leisure activity, something you’ve done once and wish you could do again, the best meal you’ve ever had, the best decision you’ve ever made, a great piece of technology, best holiday, your great job…. (you’ll be asked to talk about this early in the workshop!)
• Why is ‘change’ and ‘change management’ important for you/for all of us in the NHS?

References & signposting
North East Leadership Academy: http://www.nelacademy.nhs.uk
Watch out for other NELA workshops on subjects related to ‘change management’, e.g.
‘Leading Complex Change’, ‘Polarity Management’, ‘Tipping Point Workshop’,
‘Innovation and Creativity’, ‘Facilitation Skills’.
The NHS Change Model : http://www.changemodel.nhs.uk
School for Health & Care Radicals: https://changeday.nhs.uk/healthcareradicals
Bridges, W. (2003). Managing Transitions: Making the Most of Change . 2 nd
Nicholas Brealey Publishing edition. London:
Cheung-Judge, M. & Holbeche, L . (2011). Organization Development: A practitioner’s guide for OD and HR.
London: Kogan Page
Gladwell M.
(2001). The Tipping Point: How little things make a big difference . London:
Abacus
Johnson, B. (1992). Polarity Management: Identifying and Managing Unsolvable Problems .
Amherst, MA: HRD Press
Kotter, J.P. (1996). Leading Change . Boston, MA: Harvard Busines School Press.
Lewin, K. (1951) Field theory in social science: selected theoretical papers . D. Cartwright
(ed.), New York, Harper & Row.
Merrill, D.W. & Reid, R.H. (1999). Personal Styles and Effective Performance . Boca
Raton, FL: CRC Press
Piderit A.K. (2000).
Rethinking resistance and recognizing ambivalence ; a multidimensional view of attitudes towards an organizational change , Academy of Management Review , www.findarticles.com
Rogers, E. M. (2003). Diffusion of Innovations.
Shapiro, A. (2010). Creating Contagious Commitment: Applying the Tipping Point to
Organizational Change (2 nd edition) . Hillsborough, NC: Strategy Perspective

• be aware of nature & stages of change and their implications
• understand responses to change and how they vary for different people
• be familiar with ‘ soft vs. hard ’ and ‘either/or vs. polarity management’ approaches to change management
• explore appropriateness of push/pull change strategies
• understand established & newer approaches to change management
• gain useful insights & practical ideas for effective change management

“Every behaviour is motivated by need. Change – any change – may be perceived as disruptive and potentially dangerous as the status quo becomes unstable.”
Maureen Mackenzie
Mackenzie, Maureen (Associate Professor of Management, Dowling College, NY) (2008). Senior
Leadership's Role in the Change Process. www.dowling.edu/faculty/Mackenzie/docs/change.pdf

• Write a list of words that you associate with the feelings you experience when you are going through CHANGE.
• Share these lists within your group, and produce a flip chart that summarises the group ’ s view of what it feels like to go through CHANGE.

’
• Now… thinking about some significant change(s) you have been through, can you describe your experience of change as a
PROCESS?
As a series of steps or stages?
• As a group, try to agree on how you would described the stages of this process, and capture this on a flip chart.

Let ’ s think about ‘ managing change ’
• Discuss within your group your experiences of trying to:
– lead a change initiative of some kind
– support a change that someone else is leading
– influence other people to change their views
– influence other people to change their behaviours
– If you wish to, draw upon some examples from outside working life as well as examples from ‘work’ settings.
• As a group, produce a flip chart that summarises the group ’ s experiences of
INFLUENCING OTHERS TO CHANGE .

Atticus stood up and walked to the end of the porch.
When he completed his examination of the wistaria vine he strolled back to me.
‘First of all’, he said, if you can learn a simple trick, Scout, you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view ’
‘Sir?’
‘-until you climb into his skin and walk around in it.’
Harper Lee To kill a mocking bird page 35

Change is… something we all know quite a lot about

What does the literature tell us about barriers to change?
• It always takes longer than you think
• Exaggerated expectations
• Scepticism
• Impatience
• At least 70 % of change efforts fail to bring about the desired results!

Delivering change feels complex ‘ cos it is!
• Our people are intelligent
• Passionate about their work
• Trained to be analytical
• Diverse professional backgrounds
• Faced with challenge, complexity and pressure
• Human
• Stretched

What do we have to do to influence change?

What do we have to do to influence change?

Change is…
Constant
Challenging
Diverse
Manageable?
Modellable
Predictable?
Variable
Change Management Fundamentals

Change management fundamentals
• There’s a lot of “change” about…
– In life
– At work
– In the NHS
• …and there probably always will be
Diverse

Change management fundamentals
Challenging
• People can be ‘good at change’… but we can also be quite attached to the way things are
• Observing the ways in which people respond to change ‘situations’, there are patterns, but…
– The same person will probably react differently to two different change ‘situations’, and…
– Two people will probably react differently to the same change ‘situation’
Predictable?

Change management fundamentals
– Opportunity
– Threat
– Major issue
– Irrelevance
– Something I have to make happen
– Something that others are imposing (trying to impose) on me
– Both something that’s imposed on me and something that I have to make happen
Variable

Change management fundamentals
Modellable
• There are lots (and lots!) of models/frameworks/theories about change and change management
– None of them are 100% ‘right’ or 100% ‘universal’
– But many of them can be useful
• There are thousands of people working on
‘change’ in healthcare, lots of help/advice available, lots of great resources.
Manageable?

Rogers:
Diffusion
Lewin
Some ‘ change models ’
Bridges: transitions
NHS
Change
Model
Merrill & Reid: personal styles
Johnson: polarity management
Gladwell:
Tipping Point
Shapiro: creating contagious commitment

We have tools – but no magic bullets!

Things they say about change
Transformational Transactional
Emergent
Intrinsic motivation
Planned
Extrinsic motivation
Pull
Soft systems
Push
Hard systems

As a group:
• What are your thoughts about these five
‘categorisations’ of change?
• I’ll ask each group to focus on one categorisation in particular, and lead discussion on it in a few minutes… but also think about the others
• Is there a dominant fit in your organisation, in terms of where ‘change’ is positioned within these categories?
Are there sub cultures within the organisation? Different types of changes?
• What works well/not so well in your experience?

“Some changes are more severe and challenging than others in their effects on the organisation and on employees. Managing change requires you to recognise the type of change you face, then it is easier to decide how to tackle it.”
Mee-Yan Cheung-Judge & Linda Holbeche
Transformational Transactional
• major, strategic changes • smaller-scale changes
•
•
• driven by need to align shape & • fundamental nature of the functioning of organisation with its strategic intent and/or by demands of the external environment profound, transformative
•
• organisation remains unchanged relatively simple changes with reasonably predictable outcomes e.g. changes to processes, structure, systems change requires a formal change model – orchestrated approach addressing both mechanics of the change and human/cultural aspects.
• tends to be aimed at achieving establishd goald in new, better ways
Sources: Cheung-Judge,M & Holbeche,L (2011). Organization Development: A practitioner’s guide for OD and HR . London: Kogan Page.
Pellettiere , V. (2006). “Organization Self Assessment to Determine the Readiness and Risk for a Planned Change”. Organization
Development Journal, 24(4), pp. 38-43).

Transformational Transactional
“The challenge many strategic leaders face [when attempting transformational change] is that it is NOT enough to change strategies, structures and systems, unless the thinking that produced those strategies, structures and systems also changes.”
Mee-Yan Cheung-Judge & Linda Holbeche

Emergent Planned
The ‘emergent’ approach
• outcomes cannot be predetermined
• there is no end point
• change comes typically
'bottom up ‘
• change can be seen as ‘ managed learning ’
The ‘planned’ approach
• change is a step by step process
• typically initiated top down
• objectives set in advance
• emphasis on thorough planning and project control

Are both the planned and emergent approaches necessary?
• plans needed to set direction…. but need to be flexible
• top down support is needed for bottom up change
• objectives need to be set and the team should be congratulated when each objective is achieved….. but improvement never ends
• correct use of improvement tools and techniques should be planned and monitored….. but gaining the commitment of people is vital

Intrinsic motivation Extrinsic motivation
• motivation that is driven by interest or enjoyment in the task itself
• exists within the individual rather than relying on external pressures or desire for reward
• people engage willingly, enjoy the intrinsic rewards of the activity
• focus on achieving outcomes
• motivation comes from outside the individual
• e.g. targets, performance management, rewards, threat of punishment
• competition is in an extrinsic motivator

Push Pull
• Need for people to realise the costs & risks of maintaining status quo v risk & uncertainty of making the change
• Push people by creating discomfort in the system e.g. educate people about consequences of not changing, remove buffers and expose people to the consequences of not changing .
• Assumption that intrinsic motivation is not sufficient to bring about change
“ Pull ” change strategies connect a change to things people care about and desire
– “ change attractors ” e.g.
• benefits for patients & carers
• positive outcomes for the individual
• - advantages for their immediate (e.g. team/department) and wider (e.g. organisation/profession) environment

Beware – only the tip of the iceberg!
Values, attitudes & beliefs, behaviours, informal groupings, power, politics & conflict handing styles.
Informal organisation
Formal organisation
Goals, strategy, structure, systems
& procedures etc.

What do we know about ‘ models ’ ?
• All models are imperfect
• All forecasts are wrong
• But some models can be useful
• They can help us to get a better grasp of complex realities
• Provide some useful insights
• Help to unfog the fog…. a little or a lot

Models of change
• We all use
‘ models ’ all the time….. often implicitly • ‘ Mental models ’ …. that are running in our heads

’
Kurt Lewin (1940s)

Kurt Lewin ’ s ideas about change
Current situation
Desired situation

As a group:
• Try-out a “Force-field analysis” of a specific change
• You could use a generic example like “deciding whether to move house” or deciding whether to change jobs”…
• …or, agree on another specific change that you can all relate to
• Step 1: generate ideas for DRIVING FORCES and
RESISTING FORCES
• Step 2: Draw the Force-field analysis on flipchart paper
• Step 3: Assign values (e.g. from 1 to 10) to each force
• Step 4: Conclude… is this change going to happen? If you want it to happen, how might you go about increasing it’s chances of success?
• If time allows, reflect on Lewin’s ideas – do they ‘work’ for you? Are they helpful as you try to better understand and manage change?

Kurt Lewin ’ s ideas about change
‘
’
1. Disconfirmation – dissatisfaction or frustration generated by data that
‘ disconfirm ’ our expectations or hopes
…but on its own, this isn ’ t enough…we tend to deny or ignore the information. Need to accept the info and connect it to something we care about. The disconfirmation must arouse ‘ survival anxiety ’ … if I don ’ t change, I ’ ll fail to meet my needs or fail to achieve some goals…

Kurt Lewin ’ s ideas about change
‘
’
2. Induction of ‘ survival anxiety ’ or guilt – but this tends to be resisted by our defensive reactions, manifesting as ‘ learning anxiety ’
If I allow myself to enter a learning or change process…admit to self & others that something is wrong… I ’ ll lose my effectiveness, self-esteem, even my identity.
Learning anxiety is the fundamental restraining force which can go up in direct proportion to the amount of disconfirmation… hence the need to create some form of ‘ psychological safety ’ ….

Kurt Lewin ’ s ideas about change
‘
’
3. Creating psychological safety – which helps to reduce learning anxiety, allowing me to feel the survival anxiety and thus be genuinely motivated to learn and change
Examples of change agents helping to psychological safety’:
‘ create
• Working in groups
• Creating parallel systems that allow relief from day-to-day work pressures
• Providing practice fields where errors can be embraced rather than feared
• Providing positive visions
• Breaking learning into manageable steps
• Providing coaching

William Bridges
“The three phases of transition”
“It isn’t the changes that do you in, it’s the transitions . They aren’t the same thing. Change is situational: the move to a new site, the retirement of the [boss], the revisions to the pension plan…
..Transition
, on the other hand, is psychological; it is a three-phase process that people go through as they internalise and come to terms with the details of the new situation that the change brings about…”

• Bridges talks about three stages:
– The ending
– The neutral zone
– The beginning
William Bridges (1995). Managing transitions: making the most of change (2 nd edition)

William Bridges ’ model of change
• The Ending
: we acknowledge that there are things we need to let go of, and we recognise that we have lost something
• The Neutral Zone
: the old way has finished but the new way isn't here yet, everything is in flux and it feels like no one knows what they should be doing, things are confusing and disorderly
• The Beginning
: the new way feels comfortable, right and the only way

William Bridges
“The three phases of transition”
Time 
The phases are not separate stages with clear boundaries….

William Bridges ’ model of change
For every change, we go through a transition…
• The difference between individuals is the speed at which we go through that transition, affected by a variety of factors:
– past experience
– personal preferred style
– degree of involvement in recognising the problem and developing possible solutions
– the extent to which someone was pushed towards a change rather than moving towards it voluntarily.
• Change leaders help people recognise the process and the stages of a transition as something that is natural.

John Kotter – the eight-stage process of creating major change

John Kotter – the eight-stage process of creating major change
1. Establishing a sense of urgency Examining the environment & ‘business’ realities
Identifying and discussing crises, potential crises, or major opportunities
2. Creating the guiding coalition Putting together a group with enough power to lead the change
Getting the group to work together like a team
3. Developing a vision and strategy Creating a vision to help direct the change effort
Developing strategies for achieving that vision
4. Communicating the change vision Using every vehicle possible to constantly communicate the new vision & strategies
Having the guiding coalition role model the behaviour expected of employees
5. Empowering broad-based action Getting rid of obstacles
Changing systems or structures that undermine the change vision
6. Generating short-term wins
Encouraging risk taking and non-traditional ideas, activities & actions
Planning for visible improvements in performance, or
“ wins
”
Creating those wins
Visibly recognising and rewarding people who made the wins possible
7. Consolidating gains & producing more change
Using increased credibility to change all systems, structures and policies that don
’ t fit together and don
’ t fit the transformation vision
Recruiting, promoting & developing people who can implement the change vision
Reinvigorating the process with new projects, themes and change agents
8. Anchoring new approaches in the culture
Creating better performance through customer- and results-oriented behaviour, more and better leadership, and more effective management
Articulating the connections between new behaviours & organisational success
Developing means to ensure leadership development & succession

John Kotter – Leading Change
Eight common errors in organisational change efforts:
• Allowing too much complacency
• Permitting obstacles to block the new vision
• Failing to create a sufficiently powerful guiding coalition • Declaring victory too soon
• Underestimating the power of vision
• Undercommunicating the vision by a factor of 10 (or
• Neglecting to anchor changes firmly in the corporate culture
100 or even 1,000)
• Failing to create short term wins

John Kotter – Leading Change
Common errors
• Allowing too much complacency
• Permitting obstacles to block the new vision
• Failing to create a sufficiently powerful guiding coalition
•
• Failing to create short term wins
Declaring victory too soon
• Underestimating the power of vision
• Undercommunicating the vision by a factor of 10 (or 100 or even 1,000)
• Neglecting to anchor changes firmly in the corporate culture
Consequences
• New strategies aren’t implemented well
• Changes don’t deliver expected improvements
• Implementation takes too long and costs too much

As a group:
• Reflect on the models of William Bridges and/or John
Kotter
• Do they make sense to you?
• Will they be useful as you seek to cope with change and to manage changes?

Rogers:
Diffusion
Lewin
Some ‘ change models ’
Bridges: transitions
NHS
Change
Model
Merrill & Reid: personal styles
Johnson: polarity management
Gladwell:
Tipping Point
Shapiro: creating contagious commitment

Change sponsor
Opinion leader

Please find someone you don’t know and talk to them for the next few minutes:
1. Introduce yourselves!
2. Take it in turns (2 minutes each) to talk describe something you’re enthusiastic about, and explain why you’re so enthusiastic about it.
This could be anything – a hobby/leisure activity, something you’ve done once and wish you could do again, the best meal you’ve ever had, the best decision you’ve ever made, a great piece of technology, best holiday, your great job….

How do ideas and practices spread?

How are ideas and practices spread?

“ I don ’ t know how it started either. All I know is that it ’ s part of our corporate culture ”

• Sometimes good ideas (and good practices) seem to ‘ spread ’ quickly and effectively, other times they don ’ t…
• List the factors that you believe are important in determining how quickly and successfully ‘ spread ’ of a good idea will occur

Some examples of ‘ spread ’

Sources: UK GSM networks - subscriber data http://www.prattfamily.demon.co.uk/mikep/subscrib2.htm
Mobile Operators Association http://www.mobilemastinfo.com/stats-and-facts/

In 2013, the percentage of UK adults using a mobile phone was 94%.
“There are now 82.7 million mobile subscriptions in the UK.”

Smartphone – “a mobile telephone with computer features that may enable it to interact with computerised systems, send e-mails, and access the web.”

Sources: Dedlu, H (2013). When will the US reach smartphone saturation? www.asymco.com
OFCOM (2010). The Communications Market 2010: UK. Online at http://www.ofcom.org.uk
OFCOM (2013). The Communications Market 2013: UK. Online at http://stakeholders.ofcom.org.uk

How readily do good ideas spread?

Dvorak keyboard www.keytime.com
http://gigliwood.com/abcd/abcd.html

In Windows XP
Control Panel/Classic view/Regional & languages/Details
Add/Keyboard layout/IME choose “ Dvorak ”
Apply/OK

In about 1930, Dr. August Dvorak, undertook a study of efficiency in the office.
He almost immediately discovered the awful history of the QWERTY keyboard.
C hristopher Sholes, the inventor of the typewriter (ca. 1870), invented the QWERTY layout by trial and error. In his early typewriter, the type slugs hit the bottom of the platen and then fell back down. Because Sholes didn't think of putting return springs on the type slugs, he had trouble getting any speed out of the machine because the type slugs would jam. So he moved the characters around in a way that made the most common combinations hard to type, in order to SLOW THE TYPIST DOWN so that jams would not occur.
I n practical terms, then, Sholes anti-engineered the keyboard. Dvorak found that the QWERTY arrangement is actually considerably worse than a random arrangement!

Rogers ’ hybrid corn study: the diffusion of innovation

How ideas and practices spread
% adopting the idea
‘ Late majority ’
‘ Early adopters ’
‘ Laggards ’
2.5%
‘ Innovators ’
13.5% 34%
‘ Early majority ’
34% 16% time to adopt
(Rogers 2003)

1. Awareness
2. Interest
3. Evaluation
4. Trial
5. Adoption
… spread is a social process
– it is about communication, observation, persuasion, evaluation, adoption or rejection…
Relative advantage
Compatibility
Complexity
Trialability
Communicability

Rogers ’ theory: The Diffusion of Innovations
(Also known as: “ how ideas & practices spread ” )
Everett Rogers (1962, 2003). The Diffusion of Innovations

(1971)
Determinants of successful planned change can be seen as people ’ s subjective evaluation of:
• Relative advantage
– delivers an advantage relative to the status quo
• Compatibility
– compatible with existing values, past experiences & needs; and able to be adapted to local circumstances
• Complexity
– relatively easy to understand and use
• Divisibility (trialability)
– able to be tried without great cost or effort
• Communicability (observability)
– the outcomes can be clearly seen by others

Case study: mobile phones/smart phones
• Review the spread of mobile phones or smart phones in terms of:
– relative advantage
– compatibility
– complexity
– trialability
– observability
•Is there an aspect of change that you’ll be trying to encourage, in your organisation? Can you think about it in terms of these factors?

Case study: mobile phones
• Review the spread of mobile phones in terms of:
– relative advantage (time management, freedom to move, emergencies, status symbol, small size, low cost)
– compatibility (familiarity with phones)
– complexity (operates like a traditional phone)
– trialability (borrow or pay as you talk)
– observability (highly visible)

Why might people not want to change?
THE RESISTANCE !

• Consider the idea of ‘ resistance ’ to change, and your experiences of it
• Do you ever ‘ resist ’ changes yourself?
If so, why? Would you regard yourself as a ‘ resistor ’ ?
• What strategies do you currently deploy to deal with resistance?

“Health and care radicals” talking about
“resistance to change”
• “Resistance isn’t negativity, but a chance to change our perception, engage and troubleshoot”
• “Sometimes having to listen and explain for those who need more convincing really pays off!”
• “Apathy kills changes, not resistance. Anyone interested enough to enagge is a potential advocate”
• “I firmly believe weall want to see a better care system – great core purpose, no-one is resistant to this”

‘
’
Change is a social process… how does it happen? Who can help to make it happen?
Malcolm Gladwell (2000). The Tipping Point

“ The Tipping Point is the biography of an idea… that the best way to understand the emergence of fashion trends, the ebb & flow of crime waves, the transformation of unknown books into bestsellers, or the rise of teenage smoking , or the phenomena of word of mouth, or any number of the other mysterious changes that mark everyday life is to think of them as epidemics….
…Ideas and products and messages and behaviours spread just like viruses do ”

3 characteristics of epidemics
Contagiousness
Little causes can have big effects
Change happens not gradually, but at one dramatic moment

SALESMEN
CONNECTORS
MAVENS

“Creating Contagious Commitment: Applying the Tipping Point to Organisational Change”

The Tipping Point Workshop
Results plotted in solid lines
% Advocates (Green)
% Apathetics (Red)

“ A problem to solve or a polarity to manage?
”

“ Where all think alike, noone thinks very much ”

7 levers of change in organisations

References & signposting
North East Leadership Academy: http://www.nelacademy.nhs.uk
Watch out for other NELA workshops on subjects related to ‘change management’, e.g.
‘Leading Complex Change’, ‘Polarity Management’, ‘Tipping Point Workshop’,
‘Innovation and Creativity’, ‘Facilitation Skills’.
The NHS Change Model : http://www.changemodel.nhs.uk
School for Health & Care Radicals: https://changeday.nhs.uk/healthcareradicals
Bridges, W. (2003). Managing Transitions: Making the Most of Change . 2 nd
Nicholas Brealey Publishing edition. London:
Cheung-Judge, M. & Holbeche, L . (2011). Organization Development: A practitioner’s guide for OD and HR.
London: Kogan Page
Gladwell M.
(2001). The Tipping Point: How little things make a big difference . London:
Abacus
Johnson, B. (1992). Polarity Management: Identifying and Managing Unsolvable Problems .
Amherst, MA: HRD Press
Kotter, J.P. (1996). Leading Change . Boston, MA: Harvard Busines School Press.
Lewin, K. (1951) Field theory in social science: selected theoretical papers . D. Cartwright
(ed.), New York, Harper & Row.
Merrill, D.W. & Reid, R.H. (1999). Personal Styles and Effective Performance . Boca
Raton, FL: CRC Press
Piderit A.K. (2000).
Rethinking resistance and recognizing ambivalence ; a multidimensional view of attitudes towards an organizational change , Academy of Management Review , www.findarticles.com
Rogers, E. M. (2003). Diffusion of Innovations.
Shapiro, A. (2010). Creating Contagious Commitment: Applying the Tipping Point to
Organizational Change (2 nd edition) . Hillsborough, NC: Strategy Perspective

Reflect upon what you have heard and discussed today
Have some of your existing views about ‘ managing change ’ and/or ‘ coping with change ’ been reinforced?
Have any of your existing views been challenged or refined?
Are there some lessons you can take away and use?
Is there anything you might do differently in future?

Using change models & tools in practice
• Right tool, right job ?
• Right style, right situation?
• Right approach, right time?
• Realistic expectations?
• Push/pull… intrinsic/extrinsic?
The best change tools match the requirements of the group and its context with the change strategy

Final thoughts/questions and evaluations