Grampians Region HACC Program
HACC Managers Workshop, August 2014
Summary Guide for: Leading and Enabling Cultural Change
In order to effect change within an organisation leadership needs to be aware of a number
of factors including the importance of belief systems, staff motivation systems and how
these influence culture within the organisation.
The Importance of Belief Systems
Understanding the beliefs that influence staff carer and client motivations is important
because they have a direct effect on outcomes. Most beliefs are unwritten, unspoken and
even unconscious.
They need to be brought to a conscious level and discussed openly and respectfully in
order to bring about change
Understanding Staff Motivation
One of the strongest motivations in health and social care is being able to make a
difference in someone’s life. Staff may therefore identify strongly in their role as carers
and moving to a more supportive role may make them feel that what they have done in the
past is wrong. It is therefore important to acknowledge the past positively and reassure
staff that changes are being made because of changing demographics not past mistakes.
Dimensions of Culture
There have been a number of attempts to define culture but possibly one of the simplest in
this context is “It’s the way we do things around here”
Organisations do not necessarily have a uniform culture
A Strong Culture is one that goes back many generations and will be difficult to
influence. For example nursing which has military origins further back than Florence
Nightingale.
Sub cultures may develop in workplaces and may be related to Teams, professions, and/or
geography (organisations may have more than one outlet)
The role of culture is to maintain the status quo as a protection against anxiety. That is
know what to do and when and how to do it is a comforting routine for most people.
How is Culture Formed and Transmitted?
Culture is formed when particular practices are commonly used and normalised. This
means that there are ways of working that are known to members of a culture and new
members will only be accepted if they comply to cultural “rules”. It takes about six weeks
for this cultural acceptance to take place and most newcomers to the workplace are
anxious to be accepted in the culture. In practice this means that managers have a short
window in which to influence new members to a changed culture and need to make a
consistent effort to ensure new members are properly inducted.
The deeper the culture the harder it will be to effect changes. Even harder when a name is
attached to the culture eg”that’s the way we do things in Smithville”
Changing Culture
In order to embed change in the workplace leaders need to be familiar with the culture and
subcultures of their organisation.
An organisations culture is demonstrated overtly by its artefacts. There are the visible and
palpable signs of what the organisation stands for and include its style and placement of
buildings, uniforms, decoration, systems, information and documentation and its espoused
values-what it says it does-goals, philosophies, vision and mission statements.
Just as powerful are the underlying basic assumptions. These are unconscious taken for
granted beliefs, thoughts and feelings and are the ultimate source of values and actions.
They are usually undiscussed and seen as undiscussable.
What can influence and thereby bring about and embed change?
Primary embedding mechanisms
 What leaders pay attention to
 What is measured and controlled
 How leaders react to critical incidents and organisational crises
 Observed criteria by which leaders allocate scarce resources
 Deliberate role modelling
 Teaching and coaching
 Observed criteria by which leaders allocate rewards and status
 Observed criteria by which leaders recruit, select, promote, retire and
excommunicate members.
Secondary embedding mechanisms
 Organisational design and structure
 Organisational systems and procedures
 Organisational rites and rituals
 Design of physical space, facades, buildings
 Stories, legends and myths about people and events
 Formal statement of organisational values, creed and philosophy.
In order to affect change managers need to direct their attention in the first instance to the
primary mechanisms. Secondary mechanism will re enforce and help to bed in the change.
The Role of Resistance
Understanding and managing resistance is important in changing culture. Resistance is a
common response to change but there may be important information in the resistance
including who is finding the change difficult, what people hold dear and pointing our
errors or problems with the change
Managing resistance.
Try to work out what it is telling you apart from the natural resistance to change.
Bring resisters with you in the change process but do not allow them to dominate it.
Involve them in meetings and listen to what they have to say. Try to work out the nuggets
of truth in what they are saying. Is it real concern, are their errors in the change process,
do they have enough information to make the change.
When resistance is persistent and counterproductive after more than fifty percent of the
staff are on board with the change and negative comments continue to undermine change
publically, the following process can be followed. When comments are made, indicate
that you will speak with the person privately later about their concerns. If after speaking
with the person three times they persist then the dispute can be addressed publically in a
meeting by indicating that you have addressed their concerns a number of times and it is
inappropriate for them to continue to bring them up in this way.
Make sure the majority of staff support the change or you run the risk of a counter sub
culture developing with a stronger resistance to change.
The ASM and Cultural Change
Recognise that as leader you may be dealing with multiple cultures including
 Community support workers whose work puts them in the most influential
position with clients and carers. Their existing culture has roots in the nursing
culture and has been built over time both within their own work and within the
organisation.
 Clients and Carers also have a culture. Theirs may vary significantly from family
to family and person to person.
 Some elements of emerging care eg consumer directed care may be in direct
contrast to existing culture and therefore require more detailed explanation,
modelling and measuring.
 If change is to be effective it will require a shift from a number of cultures
Practical Strategies
 Develop an understanding of what underpins culture and practice in your
workplace. Ask open question and clarify answers with all parties.
 Make conscious the unconscious by discussing it openly and with respect. Use
staff meetings to discuss beliefs and what influence they have.
 Change the symbols and language. Change information provided to clients.
Change the language you use and you expect your staff to use. Change the
symbols in your organisation including templates, documentation, physical spaces
and signage.
 Use case studies to illustrate good practice and use reflective practice with staff.
 Ask staff to present case studies in staff meetings and at staff appraisals
 Promote reward and recognise positive effort and examples. Pay attention and be
seen to pay attention to the right things.
 Celebrate success
 Measure things which are important. (outcomes not outputs)
 Provide necessary knowledge, skills and systems support. Show interest in what is
learnt in training and ask questions about how it will be integrated in practice. A
new “way of doing things” needs to be modelled on the job. Those who
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demonstrate good practice should be utilised with newcomers as part of the
orientation process.
Change the socialisation process in your workplace by modelling behaviour
yourself and making yourself available to talk through new cases or issues.
Help new staff to be integrated into the workplace and provide good induction
materials. (for ASM the MAV Induction resource for HACC assessment is also
good for general induction to HACC and the Introduction to ASM
e learning is suitable for all new comers.
All leaders know that change is inevitable. Change is also part of the ongoing nature of
health and social services. To provide the best service we can to consumers we need to
have a process for adopting new ways of doing things as new information becomes
available. One of the guiding tools is a quality process and one of the simplest quality
processes is the PDSA cycle. If your service lacks a quality process as a leader you will
need to adopt one.
Change is not achieved by osmosis or simply waiting and hoping that people will see the
logic in what is required. It is achieved by adopting the many practical strategies listed
above and by persisting over time.
Adapted and provided by Grace Bryden
ASM Industry Consultant