Managing Change

Managing Change : 

Managing Change Edward O’Neil, Ph.D. Professor Family and Community Medicine and Dental Public Health Director of the Center for the Health Professions, University of California, San Francisco For more information, please contact: HTTP://WWW.futurehealth.ucsf.edu eoneil@itsa.ucsf.edu

Outline : 

Outline Context for change Strategy and change Elements of successful change

Developing Shared Direction : 

Developing Shared Direction “Change is persuading massive numbers of people to stop what they have been doing and start doing something that they probably don’t want to do.” - David Nadler, Champions of Change

Change is about leadership : 

Change is about leadership “There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things.” Machiavelli, The Prince, 1513

When does change occur? : 

When does change occur? Four Essential Things To Know About Change A General Theory Tipping Points Disruptive Innovations Adaptive Work

When does change occur? : 

When does change occur? General Theory Change = A< BCD A = benefits of maintaining status quo B = pain of maintaining status quo C = vision of a different world D = small steps to achieve the vision

When does change occur? : 

When does change occur? Tipping Points Law of the few Stickiness Power of context Source: Malcolm Gladwell, The Tipping Point (New York: Little Brown, 2000)

When does change occur? : 

When does change occur? Disruptive Innovations Technology runs ahead of markets and systems Resource allocation limits innovation Match innovation to market Most systems not facile at change Info systems do not support decision to accept innovation Early adopter advantage Source: Clayton Christensen, The Innovators Dilemma (New York: Harper, 1997)

When does change occur? : 

When does change occur? Adaptive Work Empathic mindset –where they hurt Values context – what is important Tension – what is and what should be Reframe – how it might be different Pathways – how they get from here to there Source: Ronald Heifetz, Leadership Without Easy Answers (Cambridge: Harvard, 1999)

Scale and Time : 

Scale and Time Source: O’Neil E, Kimball B. Health Care’s Human Crisis: Nursing. (Princeton: Robert Wood Johnson Foundation, 2002)

Context of change : 

Context of change Focus the change efforts on the right problem

We Value Change Differently : 

We Value Change Differently Personality preference (e.g. Myers-Briggs) Prevailing viewpoints of profession and/or organization Past experiences with change Stage of life and career Gender and culture Particular change being considered

Change and Strategy : 

Must we always be planning? Change and Strategy

Short History of Planning? : 

Traditional Planning - Late 1800s to mid 1950s led to …. Deliberate Strategic Planning - 1950s through to today Short History of Planning?

Approaches to planning process : 

Approaches to planning process

How confusing can it become? : 

How confusing can it become?

Deliberate-Event Planning Can... : 

Deliberate-Event Planning Can... Clarify values Educate the organization Build consensus Focus attention Explore new options Identify inconsistencies Allocate resources Inform action Recognize new partners

And, of course, its downside? : 

And, of course, its downside? Staff, committee or consultant intensive and driven Assumes rationality Sets up high expectations Expensive and labor intensive Reduces flexibility Removes accountability

Do planning theories come in waves? : 

Traditional Planning - Late 1800s to mid 1950s led to …. Deliberate Strategic Planning - 1950s through 1980s and the reality of this leads to … Emergent Strategic Action - From the late 80s for most of the economy and into the Future Do planning theories come in waves?

Emergent Strategic Action : 

Emergent Strategic Action Evolved when strategic event planning failed to address the complexity and dynamism of the environment Drawn from the patterns of past performance of the organization and the emergent realities of the world

Emergent Strategic Action : 

Emergent Strategic Action Fixated on encouraging action learning from outcomes transferring to other work Leader dependent, but in a rather Zen like manner

Emergent Strategic Action : 

Emergent Strategic Action “Unexpected travel plans are dancing lessons from God” Kurt Vonnegut, Cats Cradle

Deliberate and Emergent Change : 

Deliberate and Emergent Change Deliberate Plans for the future Think, then act Strategies are formulated What do we intend? Can be realized or unrealized Smart = devising better strategies Emergent Patterns from the past, present and future Action, then reflection Strategies form What is on the ground? Can become deliberate Smart = noticing patterns and legitimating

Deliberate and Emergent Strategy : 

Deliberate and Emergent Strategy “More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness, the other to total extinction. I pray we have the wisdom to choose wisely.” Woody Allen

Frame work for Action - : 

Frame work for Action -

Model for Leadership : 

Model for Leadership

Vision: : 

Vision: Provides the heart to go against the status quo Explains the world differently Combines emotion and reason Tied to values, past successes and future dreams Both brief and direct and deep and symbolic

Communication : 

Communication Clear, simple messages consistently expressed Internally to align purpose and work Externally to align common purpose and gain Remember the key to alignment is listening Make sure actions follows words Communicate, communicate, communicate Just when you are ready to give up, don’t

Creativity : 

Creativity We can’t get there from here Creativity comes by education and focused work Radical ideas arrive in a way they can be adapted not dismissed Be creative but allow time for acceptance and development

Creativity: Scamper : 

Creativity: Scamper A simple check-list to help you spur creativity, if in a systematic manner. Substitute? Combine? Adapt? Modify? Magnify? Put to other uses? Eliminate? Reverse? Rearrange?

Power : 

Power Getting it Using it Coping with complexity

Getting it : 

Getting it Clarity of vision Currency of information Access to decision making Good working relationships Good track record and reputation Integrity Capacity to align their needs and yours Resources or access to them Problem solving Awareness of others

Power and Complexity : 

Center for the Health Professions, UCSF Power and Complexity Diversity Low High Interdependency Low High Solo Professional Practice Multi-Specialty Group PHO Integrated Health System Hospital Plan Collaborative Practice

Relationships : 

Relationships Working through others Knowing your emotional intelligence Building networks Rewarding and celebrating Life balance

Relationships-Networks : 

Relationships-Networks Internal Securing and developing others Owning the work Motivation External Aligned with your vision and work Supports their desires and ambitions Shares the success and rewards

Virtue : 

Virtue Heart – Have the emotional issues been addressed? Head – Do you and they understand what is important? Hands – Do you and they have the skills to stay the course?