challenging healthcare environments – My Blog

School of Nursing & Midwifery
Prof. Declan Patton
Leading and managing change
in challenging healthcare
environments
[email protected]
By the end of this class you will be able to;
1. Define managing change and leading change
2. Understand some specific skills for managing and leading change
3. Identify the steps of change
4. Identify principles of leading change management
5. Identify key elements of managing change in healthcare environments
Leading and managing change in challenging healthcare environments
Learning outcomes
School of Nursing & Midwifery
Prof. Declan Patton
Leading and managing change in challenging healthcare environments
What is managing change ?
School of Nursing & Midwifery
Prof. Declan Patton
There are a number of key features to managing change, these are:
1. Managing change is about having the ability to manage a complex situation and environment to bring about something
different
2. Managing change involves being able to assess, plan, implement and evaluate a situation in order to embed something
new into a practice system
3. Bringing about change is about developing something that is new and can sustain over time, it is not simply about
changing something in the here and now. This has previously been referred to as unfreezing old behaviours,
introducing new ones, and re-freezing them.
4. On the other hand, predictable change gives you time to prepare. However, in health care, change can often be
unpredictable and needs to happen fast, this is more difficult
5. The complexity of managing change is often represented in the juggle between managing people, technology and
systems
6. Even if change is endorsed, staff will want to understand why change is happening and how they will be affected. Clear
communication from the start is crucial
Leading and managing change in challenging healthcare environments
What is it like being the person leading the change?
School of Nursing & Midwifery
Prof. Declan Patton
1. Instigating change can be tiring as it involves you challenging the status quo and bringing others along with
you, providing that ground swell of positive motivation to make the change
2. The biggest challenge with this is convincing people that old habits can change, that there is a better way
of doing things
3. You will need time to bring about change and will have to be motivated and committed to do so, you will
also need to instill the motivation and commitment to change into others, this will all take time
4. In getting people onside, it is vital that you be clear about what is important and develop responses and
proactive actions accordingly, these responses and actions need to attract others to the change
5. It is also important that the vision you communicate to others is clear about what is now required, how
change will be measured and sustained over time and the benefits it will bring
6. You will also have to develop a change pathway that is attractive to people, for example, the change will
give them new experiences and meaning to what they currently do – you need to convince people that the
change is the right course to take
7. It is really important that the change is documented throughout so that future changes can be assisted by
what you did, and learn from what you did
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
However, there are barriers to change …
There are a number of barriers to change that you will need to build into your plan, all of these will need to be
addressed … Common barriers are …
 Staff being unaware of the need to change as they do not fully understand up to date evidence, or staff may
know about new guidelines but do not understand that their practice has got to change
 External motivating factors such as pay or incentives and internal motivating factors such as personnel drive
can effect ones motivation to change
 Staff commitments and priorities may effect their willingness to change
 Staff may find it difficult to change if an influential colleague disagrees with the change or the change is at
odds with other guidelines
 Staff may be worried that they do not have the skills needed to make the new change a reality
 Lack of resources, eg new equipment, may impede the change
 Organisational regulation and finances may impede the change
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
 Handling, mediating and resolving conflicts
 Coming up with solutions to problems
 Handling, storing and retrieving information
 Managing the career progression of people
 Controlling the change environment
 Assessing, planning, implementing and
evaluating actions
Specific skills you will need to lead and manage change
 Good decision making
 Appropriate planning
 Able problem solving
 Ethical soundness
 Selling the change as something new and
beneficial
Managing skills Leading skills
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Steps of change model
(Kotter)
Create sense of urgency
Build the guiding team
Develop a change vision and strategy
Understanding and buy-in
Empower others
Short term wins
Be relentless
Create a new culture
Leading and managing change in challenging healthcare environments
Steps of change
School of Nursing & Midwifery
Prof. Declan Patton
Here is what Kotter’s sequential steps entail …..
 Step 1: Create a Sense of Urgency: Help others see the need for change and the importance of generating new
ways of doing things
 Step 2: Pull Together the Guiding Team: Make sure there is a powerful group guiding the change – a group with
leadership skills, credibility, communications ability, authority, analytical skills, and a sense of urgency
 Step 3: Develop the Change Vision and Strategy: Clarify how the future will be different from the past, you need
to communicate that you have a firm understanding of this vision
 Step 4: Communicate for Understanding and Buy-in: Make sure as many others as possible understand and
accept the vision and the strategy, this will depend on the effectiveness of how you communicate your change
message
 Step 5: Empower Others to Act: Remove as many barriers as possible so that those who want to make the
change a reality can do so
 Step 6: Produce Short-Term Wins: Create some visible successes as soon as possible
 Step 7: Don’t Let Up : Pursue the change with even greater energy after initial successes
 Step 8: Create a New Culture: Hold onto the new ways of behaving and make sure they succeed until they
become a part of everyday life
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
How can an organisation and its people be led through
the steps involved in the change process?
What leadership principles should drive the change
process?
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Ten Principles of Leading change management (Aguirre and Alpern
2014, model)
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 1 = Lead with the culture
There are 3 types of Organizational Leadership Cultures:
 Dependent: leadership cultures operate with the belief that people in authority are responsible for
leadership
 Independent: leadership cultures operate with the belief that leadership emerges out of individual
expertise and heroic action
 Interdependent: leadership cultures operate with the belief that leadership is a collective activity to
the benefit of the organization as a whole
Leadership culture is the way things are done; it’s the way people interact, make decisions, and
influence others. Its important that you lead by example fostering an interdependent culture
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 2 = Start at the top
 Although it’s important to engage employees at every level early on, all successful change
management initiatives start at the top, with a committed and well-aligned group of executives
strongly supported by the CEO
 Work must be done in advance to ensure that everyone agrees about the case for the change and
what is needed for implementing it
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 3 = Involve every layer
 Change efforts must include plans for identifying leaders throughout the company and pushing
responsibility for design and implementation downwards, so that change “cascades” through
the organization.
 At each layer of the organization, the leaders who are identified and trained must be aligned to
the new vision and motivated to make change happen
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 4 = Make the rationale and emotional case
together
1. Articulate a convincing need for change
2. Provide a clear road map to guide behaviour and decision making
Leaders must customize the change message for different audiences, for example, managers and
employees
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 5 = Act your way into new thinking
• Make major, visible decisions with targets set out in days instead of weeks or months
• Spend time with all staff on the frontline, asking for their input and engaging them in
discussions about the change
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 6 = Engage, engage, engage
 Sustained change requires constant communication, not only throughout the rollout but after
the major elements of the plan are in place
 Use different types of communication, this will make your messaging more effective
 In your communications, keep the change to the forefront as well as how close targets are to
being achieved
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 7 = Lead outside the lines
 Change has the best chance of cascading through an organization when everyone with authority and
influence is involved. In addition to those who hold formal positions of power, this also includes other
recognized leaders such as people whose power is more informal and is related to their expertise, to the
breadth of their network, or to personal qualities that engender trust
 There are three types of informal leaders:
• Pride builders are great at motivating and inspiring others to take pride in their work
• Trusted nodes are go-to people. They are the ones approached by people who want to know what’s really
happening in the organization
• Change or culture ambassadors know how to live the change the organization is making. They serve as
both exemplars and communicators, spreading the word about why change is important.
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 8 = Leverage formal solutions
 Persuading people to change their behaviour won’t suffice for transformation unless formal elements
such as structure, reward systems, ways of operating, training, and development are redesigned to
support them. If organisation systems, training, processes and tools don’t support the change that is
being rolled out then it has less chance of succeeding and becoming the norm
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 9 = Leverage informal solutions
A change that fundamentally affects culture requires some extra attention. Staff
need to be engaged from an early stage working interdependently to effect and
maintain a culture shift that will help bring about the desired change
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 10 = Assess and Adapt
Measure the success of the change and adjust and adapt it based on the
current level of adoption
This involves establishing some key outcome metrics that indicate the success
of the change
 Once the metrics are established, they must be measured and monitored over
time, with possible tweaks being made to improve the move towards the
change
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Managing change in healthcare environment
Here are some key reminders …
 Effective change has been characterized as unfreezing old behaviours, introducing new ones,
and re-freezing them
 Predictable change allows time for preparation, whereas unpredictable change is more difficult to
respond to effectively
 Since changes in healthcare occur so rapidly, they are less likely to be predictable
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Managing change in healthcare environment
 Bringing about change requires the leader to challenge the status quo, and requires
perseverance against the habits and norms of established behaviours
 Bringing about change takes time and requires the commitment of time on the part of the
leader
 The leader must know the values that matter and focus on changing those as opposed to
reacting to every invitation for change
 The leader must be clear about what is important and develop responses and proactive actions
accordingly
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Managing change in healthcare environment
Change is not about telling staff what to do … Leaders have to learn how to
manage change
Leaders should help staff structure and build effective teams by developing new
organizational structures and creating a shared vision that staff understand and
have contributed towards
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Managing change in healthcare environment
 Establishing a clear vision about the direction of the change process is a key element for assuring
successful change
 Measuring and monitoring outcomes of the change process is essential for recognizing whether or not
the change process has fulfilled its purposes
 Since change is continuing to happen in organizations and associated modifications are taking place,
it is important for those who are in charge of the change process to record and focus on the emerging
problems due to change
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
References and further reading
 www.hse.ie/changeguide
 Al-Abri, R (2007) Managing change in healthcare. Oman Medical Journal. 22(3). P9-10
 https://www.nice.org.uk/guidance/lifestyle-and-wellbeing/behaviour-change
 https://www.nice.org.uk/media/default/about/what-we-do/into-practice/support-for-serviceimprovement-and-audit/how-to-change-practice-barriers-to-change.pdf
 https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4999-8
 https://www.bmj.com/content/361/bmj.k2014
 http://www.ihi.org/resources/Pages/Changes/default.aspx
 Aguirre DA and Alpern M . 10 principles of leading change management. Organization& People 2014, Issue 75
 Kotter, J. Leading Change. Harvard Business School Press, Boston, MA, 1996

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