際際滷

際際滷Share a Scribd company logo

change. get used to it.

Carl Savage
Carl Savage

Background slides from a conversation about change management that I had with an exciting group of master's students studying Public Health with a focus on Health Economics, Policy, and Management at the Karolinska Institutet, Stockholm, Sweden on May 14, 2013. Contact: Carl.Savage@ki.se at the Medical Management Centre, Karolinska Institutet.

1 of 47
2013 05 14 carl.savage@ki.se get used to it.change.
SETTING THE STAGE 1. whats the use of theory? 2. why do science? 3. why use methods?
Your mission: Become a health care quality improvement leader.
The challenge: Get MDs to use EBM protocols Pay-for-performance Analyze dissemination process Workshops to motivate quality Continuous feedback Educate the staff in use of guidelines Understand MDs situation and change their perceptions Talk with physicians Change medical education Identify opinion leaders Include in licensing
Content Process Context Change managers Models of change Formulation/implementation Pattern through time Assessment and choice of products and markets Objectives and assumptions Targets and evaluation Internal Resources Capabilities Culture Politics External Economic/Business Political Social (Pettigrew & Whipp, 1993) Essential ingredients of change
change. get used to it.
What AND how, not just what! any transformation journey requires innovation both in what you do and in how you do it. (Nayar, 2010)
1. Why? 2. How? 3. What (Sinek, 2011)
Some current change scenarios What is your strategy? 1. Launch a stop smoking campaign at work. 2. Set up a meeting time with a group of 4-5 busy professionals. 3. Convince a primary care clinic to measure patient outcomes. 4. Implement process improvement in a hospital (IHC).
Reflect on your change strategies What are the similarities and differences between your change strategies? Why do you think your strategies would work? What assumptions have you made? How have you addressed those assumptions?
1. Why? 2. How? 3. What (Sinek, 2011)
ASSUMPTIONS Power and the people
ASSUMPTION 1. change is hard because of resistance to change
30% (Kotter, 1995) (McKinsey, 2008)
(Rogers, 1962) (Gladwell, 2005)
(Rogers, 1962)
ASSUMPTION 2. motivation
MONEY. its the most expensive way to motivate people
THE CASE OF X & Y Y: I could use your help
Motivation 2.0 Theory X Dislike working. Avoid responsibility and need to be directed. Have to be controlled, forced, and threatened to deliver what's needed. Need to be supervised at every step, with controls put in place. Need to be enticed to produce results; otherwise they have no ambition or incentive to work. Theory Y Take responsibility and are motivated to fulfill the goals they are given. Seek and accept responsibility and do not need much direction. Consider work as a natural part of life and solve work problems imaginatively. (McGregor, 1960)
Motivation 3.0 Purpose Is my work meaningful? Autonomy Do I have the freedom to do my work? Mastery Do I have the opportunity to become better and better at what I do? (Pink, 2006)
ASSUMPTION 3. the path of change is linear
change. get used to it.
change. get used to it.
change. get used to it.
change. get used to it.
change. get used to it.
change. get used to it.
Unfreeze Awareness of shortcomings Uncertainty leads to motivation to change Move Search for knowledge and new examples (Re)Freeze New identity New structures (Lewin, 1951) carl.savage@ki.se
Conventional Wisdom on Change Kotter 1. Establish a sense of urgency 2. Create the guiding coalition 3. Develop a vision and strategy 4. Communicate the change vision 5. Empower broad-based action 6. Generate short-term wins 7. Consolidate gains and produce more change 8. Anchor new approaches in the culture Modern Management Principles Standardization Specialization Goal alignment Hierarchy Planning and control Extrinsic rewards carl.savage@ki.se (Kotter, 1996) (Hamel, 2007) 2011-09-01
change. get used to it.
change. get used to it.
change. get used to it.
pilot error too much airplane for one man to fly
Problem with Conventional Wisdom Identify a problem Call in the experts Design the perfect solution Whoops carl.savage@ki.se Deficit-based solution-focused change 2011-09-01
SO, WHY DO WE GET WHOOPS?
How did we get into this mess? Stress Look to authority Pressure on authority to do something Temptation for a quick fix (Heifetz, 1994)
Stress Look to authority Pressure on authority to do something Temptation for a quick fix = A leadership challenge (Heifetz, 1994)
ASSUMPTION 4. we need to lead change by pushing* change *communicating
Simple Complex Complicated Chaos Certainty Agreement Close to Closeto Far from Farfrom (Adapted from Stacey, 1996) Complicated Where we act like we are Where we actually are
(Glouberman & Zimmerman, 2002)
Whats the [type of] problem? Situation Problem definition Solution and implementation Primary locus of responsibility for the work Kind of work Type I Clear Clear Physician Technical Type II Clear Requires learning Physician and patient Technical and adaptive Type III Requires learning Requires learning Patient > physician Adaptive (Heifetz, 1994)
Adaptive leadership 1. Get on the balcony a) Identify the adaptive challenge b) Regulate distress c) Direct disciplined attention to the issues (not stress reducing distractions) d) Give work back to the people, at a rate they can stand e) Protect voices of leadership without authority 2. Distinguish self from role 3. Externalize the conflict 4. Use partners 5. Listen, using oneself as data; live with doubt 6. Find a sanctuary 7. Preserve a sense of purpose (Heifetz, 1994)
Creative tension [What is] [What could be] Where is the tension?
Change management The Path Shape the path The Rider Direct the rider The Elephant Motivate the elephant (Switch, by Heath & Heath, 2010)
If you dont plan on improving things, dontbother.
CHANGE IS PERSONAL: IMPROVEMENT IS YOUR RESPONSIBILITY carl.savage@ki.se Medical Management Centre, KI

More Related Content

change. get used to it.

  • 1. 2013 05 14 carl.savage@ki.se get used to it.change.
  • 2. SETTING THE STAGE 1. whats the use of theory? 2. why do science? 3. why use methods?
  • 3. Your mission: Become a health care quality improvement leader.
  • 4. The challenge: Get MDs to use EBM protocols Pay-for-performance Analyze dissemination process Workshops to motivate quality Continuous feedback Educate the staff in use of guidelines Understand MDs situation and change their perceptions Talk with physicians Change medical education Identify opinion leaders Include in licensing
  • 5. Content Process Context Change managers Models of change Formulation/implementation Pattern through time Assessment and choice of products and markets Objectives and assumptions Targets and evaluation Internal Resources Capabilities Culture Politics External Economic/Business Political Social (Pettigrew & Whipp, 1993) Essential ingredients of change
  • 7. What AND how, not just what! any transformation journey requires innovation both in what you do and in how you do it. (Nayar, 2010)
  • 8. 1. Why? 2. How? 3. What (Sinek, 2011)
  • 9. Some current change scenarios What is your strategy? 1. Launch a stop smoking campaign at work. 2. Set up a meeting time with a group of 4-5 busy professionals. 3. Convince a primary care clinic to measure patient outcomes. 4. Implement process improvement in a hospital (IHC).
  • 10. Reflect on your change strategies What are the similarities and differences between your change strategies? Why do you think your strategies would work? What assumptions have you made? How have you addressed those assumptions?
  • 11. 1. Why? 2. How? 3. What (Sinek, 2011)
  • 13. ASSUMPTION 1. change is hard because of resistance to change
  • 18. MONEY. its the most expensive way to motivate people
  • 19. THE CASE OF X & Y Y: I could use your help
  • 20. Motivation 2.0 Theory X Dislike working. Avoid responsibility and need to be directed. Have to be controlled, forced, and threatened to deliver what's needed. Need to be supervised at every step, with controls put in place. Need to be enticed to produce results; otherwise they have no ambition or incentive to work. Theory Y Take responsibility and are motivated to fulfill the goals they are given. Seek and accept responsibility and do not need much direction. Consider work as a natural part of life and solve work problems imaginatively. (McGregor, 1960)
  • 21. Motivation 3.0 Purpose Is my work meaningful? Autonomy Do I have the freedom to do my work? Mastery Do I have the opportunity to become better and better at what I do? (Pink, 2006)
  • 22. ASSUMPTION 3. the path of change is linear
  • 29. Unfreeze Awareness of shortcomings Uncertainty leads to motivation to change Move Search for knowledge and new examples (Re)Freeze New identity New structures (Lewin, 1951) carl.savage@ki.se
  • 30. Conventional Wisdom on Change Kotter 1. Establish a sense of urgency 2. Create the guiding coalition 3. Develop a vision and strategy 4. Communicate the change vision 5. Empower broad-based action 6. Generate short-term wins 7. Consolidate gains and produce more change 8. Anchor new approaches in the culture Modern Management Principles Standardization Specialization Goal alignment Hierarchy Planning and control Extrinsic rewards carl.savage@ki.se (Kotter, 1996) (Hamel, 2007) 2011-09-01
  • 34. pilot error too much airplane for one man to fly
  • 35. Problem with Conventional Wisdom Identify a problem Call in the experts Design the perfect solution Whoops carl.savage@ki.se Deficit-based solution-focused change 2011-09-01
  • 36. SO, WHY DO WE GET WHOOPS?
  • 37. How did we get into this mess? Stress Look to authority Pressure on authority to do something Temptation for a quick fix (Heifetz, 1994)
  • 38. Stress Look to authority Pressure on authority to do something Temptation for a quick fix = A leadership challenge (Heifetz, 1994)
  • 39. ASSUMPTION 4. we need to lead change by pushing* change *communicating
  • 40. Simple Complex Complicated Chaos Certainty Agreement Close to Closeto Far from Farfrom (Adapted from Stacey, 1996) Complicated Where we act like we are Where we actually are
  • 42. Whats the [type of] problem? Situation Problem definition Solution and implementation Primary locus of responsibility for the work Kind of work Type I Clear Clear Physician Technical Type II Clear Requires learning Physician and patient Technical and adaptive Type III Requires learning Requires learning Patient > physician Adaptive (Heifetz, 1994)
  • 43. Adaptive leadership 1. Get on the balcony a) Identify the adaptive challenge b) Regulate distress c) Direct disciplined attention to the issues (not stress reducing distractions) d) Give work back to the people, at a rate they can stand e) Protect voices of leadership without authority 2. Distinguish self from role 3. Externalize the conflict 4. Use partners 5. Listen, using oneself as data; live with doubt 6. Find a sanctuary 7. Preserve a sense of purpose (Heifetz, 1994)
  • 44. Creative tension [What is] [What could be] Where is the tension?
  • 45. Change management The Path Shape the path The Rider Direct the rider The Elephant Motivate the elephant (Switch, by Heath & Heath, 2010)
  • 46. If you dont plan on improving things, dontbother.
  • 47. CHANGE IS PERSONAL: IMPROVEMENT IS YOUR RESPONSIBILITY carl.savage@ki.se Medical Management Centre, KI