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Directory Of Planning & Change Tools/Techniques

The Change Tool Kit
• FORCE-FIELD ANALYSIS – well-known planning/analysis tool
• SWOT and PEST(ELI) analyses – generic strategy/assessment tools
• 7 Factors of Successful Change
• Endings < Beginnings via the “Turbulent Zone” Schematic – Adapted from William
Bridges “Transitions”
• FIVE KEY STAGES IN SUCCESSFUL TRANSITION
• PLAN : ACTION : REVIEW (Plan : Do : Review) Model – Briner
• THE CLASSIC FOUR STEP APPROACH TO PLANNING CHANGE : Model: – Price
Waterhouse Consultants
• Types of Change : Chart
• Diffusion of Innovation and Change Adoption – Everett Rogers
• Change “Types” : Chart – Binnie & Williams
• Impacts of Change: Diagram – Colin Carnall “Coping Cycle”
• The Five ‘Whys?’
• Organisational Culture Matrix – Charles Handy

THE CHANGE TOOL-KIT

Here we summarise a whole range of Models and Tools/Techniques that can help to plan,
implement and manage change.

We have also collated these Models and Tools into a separate Document that you can
explore on the Health Knowledge platform; it can be downloaded for future use.

There is also an excellent booklet published by the NHS which describes a number of
these Models, and many others, in considerable detail. MANAGING CHANGE IN THE
NHS : 1. ORGANISATIONAL CHANGE A Review for Health Care Managers,
Professionals and Researchers, Valerie Iles and Kim Sutherland; 2. MAKING INFORMED
DECISIONS ON CHANGE, NCCSDO, London School of Hygiene and Tropical Health,
TEL: +44 (0) 20 7612 7980; :

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FORCE-FIELD ANALYSIS
This really is a relic from the Past – but useful hopefully in understanding how individuals in
organisations, as well as managers and leaders can be involved in proposed Change:

This Force-Field Analysis was collated from the inputs of over 150 people from all levels
within a London Health Authority where changes kick-started by The NHS Plan were soon
to get underway. Not only did it give ‘management’ an opportunity to present some of the
detail of the up-coming change but it also allowed ‘ordinary staff’ to discuss why the
change was deemed necessary, why it was happening now, what the impacts of the
change might be etc. This ‘pre-change’ activity was in fairness driven from near the Top of
the Authority but it was found from participant feed-back that it was appreciated, helped
people get a better ’feel’ for what was to come, to think about its impacts on their work
environment, on their work, on themselves – but also to ‘voice an opinion and/or some
thoughts – and to help plan ahead. (The facilitator of these pre-change workshops was
amazed by the way that when the Drivers and Resistors of Change were discussed in
open plenary session, he was normally well donw the 2nd page of flip-chart paper before
‘Patients’ even got mentioned!).

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Types/levels of Change

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THE TYPES AND LEVELS OF CHANGE

These days almost all organisations undergo almost continuous processes of change but it
is important to recognise the different kinds and levels of change that take place within an
organisational context:

STEP CHANGE is a major change, or programme of change, that occurs within a relatively
short period of time – from 2/3 months to perhaps 5 years. It requires major efforts and
organisation to effect and accommodate this kind of change. It is often done to combat
increased competition or to mitigate spiralling costs or to change to accommodate huge
new systems or technology.

Examples of STEP change would be major premises rationalisation, major stakeholder

(e.g. government) intervention. INCREMENTAL change is an altogether steadier rate of
change, although it can still prove difficult and challenging to manage. Many organisations
these days undergo almost unending incremental change – many of these incremental
changes interspersed by periods of “Step” change. Examples of Incremental changes
would be programmes to introduce performance-related pay or to gradually reduce work-
force numbers via voluntary redundancy and/or early retirement initiatives.

It is important to recognise that STEP and INCREMENTAL change are not mutually
exclusive. Programmes of INCREMENTAL change will typically not stop just because a
period of STEP change is planned or anticipated. In fact more and more organisations
these days are committed to programmes of what is called “Continuous Improvement” –
ongoing programmes of phased change that help organisations keep up-to-date, remain
efficient, productive – in commercial firms – competitive. In all these types and variations of
Change there will be impacts on the organisation’s people – its executives, its managers,
its supervisory staff, its “shop-floor” or “front-line” staff. Organisations ignore the fears and
needs of their work-forces at their peril.

The illustrative example on the previous page shows the change processes that have
occurred in the National Health Service since the early 1990s up to 2002 when PCTs and
SHAs arrived. The ?-mark prompted us to ask TWO questions – where now? – and where
next?

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Transforming Library and Information Services in the NHS

• A proposed Plan to synthesise Library & Information Services across the NHS:
• Develop a ‘strategic road map’ for library services within NHS
• Overarching aim to create a forward direction for library and knowledge services,
capable of supporting NHS in its business goals
• Seems to fit strategically with the Public Health I & I programme
• Created a Project Board (high level Team), used facilitation and numerous tools and
techniques; produced a Report
• Report now endorsed by key players/stakeholders
• Result a TRANSFORMATIONAL CHANGE PLAN
• Details below from http://www.tfpl.com/consultancy/sacasestudies.cfm?csid=b2

AN EXAMPLE OF AN APPROACH TO ‘TRANSFORMATIONAL

CHANGE’ IN THE NHS
(Text from TFPL web-site Case Study)
http://www.tfpl.com/consultancy/sacasestudies.cfm?csid=b2

TFPL was commissioned by NHS Direct Online together with the NHS Library Advisor, the
NHS Information Authority, and other key players in the NHS knowledge and information
network to develop a strategic road map for library services within the NHS.

The NHS required a fresh and compelling vision and strategic framework for the future,
encompassing national and local aspirations, together with top level plans for its
achievement. The overarching aim being to create a forward direction for library and
knowledge services capable of supporting the NHS in its business goals.

Working with a Project Board that represented considerable NHS LIS experience, TFPL
interviewed nominated stakeholders, assessed future NHS directions, current concerns
and future ideas from these interviews; facilitated a scenario planning workshop; and
prepared a summary of the roles of NHS LIS and potential forward directions for e-
consultation.

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The report recommended a strong framework for national coordination with a programme
to develop those services best delivered nationally (the published information
infrastructure) progressed in partnership with local services. The report recommended,
inter alia, that quality standards for NHS Library Services are formally adopted; that a
national framework for staff development and training is developed for NHS Library
Services, based on skills and competencies; and that a clear brand for NHS Library
Services is established for use throughout the NHS.

The final report has been endorsed by The NHS Library and Knowledge Development
Network (LKDN), NHS Libraries Advisor and the National electronic Library for Health
(NeLH) who are now working together to implement a programme of transformation in NHS
library services to enhance our support for clinical care, education and research in the
NHS.

“By developing an integrated and federated service, the National Library for Health will
enable us, as a community, to meet the various challenges highlighted by the TFPL
report”.
(LKDN and NeLH)

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Adopting Change

HOW PEOPLE RESPOND TO AND TAKE-UP CHANGE:

Everett Rogers developed his “Diffusion” model out of research he conducted into the rate
at which people adopt or take-up new “innovations”. The categories and proportions of
normal populations he identified from his research are very enlightening when considering
how people generally move toward/take up change.

Only 2.5 % typically rush towards new innovations, new ways of working - most prefer to sit
on the fence, watch what happens - whilst some are openly critical, can’t, perhaps won’t,
see the need etc. Typically there is a larger number (about 13.5%) who take-up
innovations some time after the “Innovators” have adopted them. This category Rogers
calls “early adopters” - part of the first sizeable “wave” of people who take up change,
innovation - many of them becoming committed disciples of the change or innovation in
question in due course. Next come what Rogers calls the “early majority” - typically they
have ‘watched and waited’ before either seeing the benefits and/or getting the confidence
to take-up the changes themselves. The ‘early majority’ are significant because they
represent typically 34% of the particular population. (Significantly, add the 2.5%
Innovators, 13.5% Early Adopters and the 34% Early Majority and you’ll note that they
together represent 50% of the total number of people – get this far and you should be
“well on the way” to attaining the changes you are implementing.)

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According to Rogers’ research a further 34%, known as the “late majority” follow in due
course - they are less change-orientated, slower to respond, need more convincing. But if
the change initiative can be kept going then typically the late majority do eventually come
“on board”.

Which still leaves about 13% so-called “laggards” who really don’t show an interest, don’t
really want to “get involved”. Some of them never do - they leave, or they become
“terrorists” (see Next Slide). Others succumb in due course, either through peer pressure
or because they finally “see the light”.

Attitudes to Change

CLASSIC “CHANGE TYPES”:

The types identified in this useful Model were developed by Binnie and Williams back in
the early 90s. The categories were determined from research the authors did into change
and the management of it within organisations. (There are some linkages here to Rogers’
“diffusion” model, explained in the previous Slide)
Missionaries are proud and pleased to embrace change – they adopt it, adapt to it quite
quickly and actively encourage others to do so too. Believers are just that - they see the
merits of the changes, believe in them - but are a little more cautious, less extrovert
perhaps than Missionaries - and are frequently convinced by a mixture of repetition of the
reasons for and benefits of the changes and through the influence of the Missionaries.

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Next come a much larger group “people who pay lip service” - they nod and acknowledge
that change is probably necessary but are typically not active in supporting or adopting it.
They might well be called “fence sitters”! The next category, and there are typically plenty
of these too, are “Hiders and Refugees” - they ignore or try to hide from the change - often
through fear (fear of the unknown) or because they are genuinely disinterested in it -
perhaps typically preferring the “status quo” (old or existing order) to the “new ways of
working”. Whilst “hiders and refugees” are rarely troublesome, the remaining categories
can be - especially to those trying to drive/steer through change. The first group Binnie
and Williams call “Members of the Underground Resistance” - they are actively and
probably fairly quietly (perhaps subversively) trying to “block the changes” and can be
dangerous. Whereas “Honest Opponents” declare their resistance - they openly
challenge the need for change, question the benefits. “Honest opponents” typically
identify themselves - by words and actions - as being against the changes. (If change
leaders/managers can convince an “honest opponent” that the changes are acceptable
then many others, often many of the “hiders and refugees” will sit up and take notice,
perhaps be convinced themselves about the need to change.) The last category -
“Emigrants” simply leave, wanting nothing to do with the changes, preferring to seek their
employment elsewhere!

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The Psychology of Change

THE PSYCHOLOGY OF CHANGE : the “Coping Cycle”:

This Model developed by Colin Carnall is based on research and observations of groups in
organisations undergoing change. His Model looks at the underlying psychology of change,
its impact on people; it identifies a number of key stages that people go through when
sizeable organisational changes is “in the air”. Stage 1 typically brings “denial” - apart from
a few ‘Missionaries’ most people don’t see the reason for or benefits of change, preferring
at this stage to cling to the ‘old order’. Why? Largely because they fear change - they fear
the unknown, perhaps fearing that they might lose their jobs or lose status, or have to
change locations, learn new skills etc.

“Self esteem” (blue line) holds up well in the First Stage and, perversely, performance (red
line) often improves for a while - people work hard to show management that the “old”
ways are OK - that they do actually “work”. In Stage 2 - “defence” - many people spend
time and energy defending the old way - some of the early adopters have “adopted” -
moved towards the change - but the majority typically remain unconvinced. During this
Stage both self-esteem and performance go down. Typically we are now headed into the
“turbulent zone”. In the next stage, Stage 3, more people begin “discarding”- starting, with
encouragement from the change leaders, the ‘Missionaries’ and some of the ‘Early
Adopters’, to “let go” of the past. But self-esteem and performance continue typically to go
down during this Stage.

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This may well not be a “happy time”. For by now we are well into the “turbulent zone”
where it has to be said many badly planned and/or poorly implemented change initiatives
flounder. Stage 4 (adaptation) is also in the “turbulent zone” but in this stage people are
not only letting go of the past, the old order, but are increasingly starting to move towards,
take-up the new ways. The ‘Underground Resistance’ won’t be, nor will many of the
‘Honest Opponents’ - yet! But during this Stage morale and self-esteem do generally start
to pick up, as does overall organisational performance. By this stage the changes are
starting to work - to take hold. Stage 5, (Carnall calls it “Internalisation”) is where the
changes really start to take effect; typically more and more people, probably many of the
‘late majority’, are now supporting, or starting to support, it. In well planned, well managed
change initiatives the organisation and its people come out of the “turbulent zone” into the
New Beginning - where typically morale and performance continue to improve.

Adapted from Bridges’ Model of Transition

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CHANGE and TRANSITION:

Change Consultant and Author William Bridges wrote, back in 1991, a successful book
called “Managing Transitions”. We have adapted Bridges work slightly to show how
“turbulent” change can often be and we will use the Model to steer us through this Module.

The first principle Bridges introduces us to is that in all change there is an “ending” and a
“beginning”. The “ending” is the end of an “old” way of doing things. The “beginning” is
the start of some “new” way of doing things. Bridges refers to the process of getting from
the End of the “old way” to the Beginning of the new way as a transition. He refers to
transition as a “neutral zone” between the “old reality” and the “new vision”, an area
where many, often most, of the problems of implementing and managing change are most
evident, an area where managing the change is at its most challenging.

The “neutral zone” writes Bridges is a “nowhere” between “two somewheres” – he

likens life in the neutral zone to letting go of one trapeze with the faith that the new trapeze
is on its way. In the meantime, he writes, “there’s nothing to hold on to.” !

We have re-named the Neutral Zone the “Turbulent Zone” because we feel it more
adequately describes the “atmospherics” when organisations and their people go through
major, fundamental (“step”) change (see Slide 9). With “step” change the transitional period
can be longer, the management challenges more intense - to be truthful, it also means the
chances of failure (of the change initiative) can be that much higher.

That is why we strongly advocate planning change initiatives, using a disciplined, planned
approach to managing change.

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Change (Transition!) is Everywhere & Managers

– and many Staff are in the Front Line
• Recent transition toward high performance customer/ consumer/patient focused work
teams and the introduction of multi-agency partnerships is resulting in significant
changes to the manager's role:
• Today’s managers must be able to:
• adapt to change and support others through change
• provide vision, principles, and boundary conditions
• align and encourage people toward a purpose
• set direction and strategy
• As teams and partnership-working take on more and more responsibility, the
manager's focus shifts from controlling and problem solving to motivating and
inspiring.

THE ABOVE – AND BELOW

Extracted From A Health Knowledge Module On ‘Understanding Individuals &
Personal Management Skills’

“In contemporary health services, there is undoubtedly a great deal of pressure on those in
management positions. This pressure comes mainly from having to cope with considerable
changes both internally and in the external environment. These changes are to do with the
consumers of the services; with the changing demands of the professionals who operate
the services as well as central policy and significant structural changes.”
(Rosemary Stewart, ‘Leading in the NHS : A`Practical Guide’)

The aim of this Section of HealthKnowledge is to introduce the concept of management in

the healthcare professions in the context of today’s fast-changing healthcare environments,
present various concepts and theories designed to help you understand, clarify and explain
issues in your own work situation and those of others.

Before we proceed to explore some of the key literature on managers and management it
is worth considering how the environments in which managers operate have changed over
the last 5 -10 years or so. (More on this in our Management module)

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Develop your Inner Circle

• a small group of key and committed people you can trust, who can work with you as
you ‘transition’
• some may not be in your close domain - but will have the vision, skills, ideas that you
need, they can contribute
• this may well not be a formal group

Your “Inner Circle”:

The concept of “Inner Circles” has particularly useful applications during change initiatives,
but has relevance practically all of the time. As a manager responsible for implementing
change programmes, you may well find this approach useful:

The idea is that you as a manager of change develop your own Inner Circle – effectively
your own personal “support group” of people.

This will not necessarily be a formal group, much more likely an informal network, a
distributed support mechanism - one you can call upon at key times during the change
programme.

The concept is that managers develop their own “circle” of people who can help and
support them, as necessary, as they move through the processes of transition. Often the
people in Inner Circles are managers - but not always; often they are people located quite
close to you in work terms - but again not always, they may for example be managers
undergoing the same or similar change programmes in other locations, other
areas/departments or they may be people with specialist knowledge or experience who
can be particularly helpful in key areas. Generally your Inner Circle will include people who
can help you, people - often in the midst of the change themselves - who you can talk to,
discuss problems and possible solutions.

Inner Circles are typically informal networks of people who support each other through
change. So informal that they may not even be referred to as “Inner Circles”, they may just
be there in the background as a people-based support mechanism helping you to manage
the transitions upon which your success will depend.

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and finally…
Three quotations we particularly like:

“We are more easily persuaded, in general, by the reason we ourselves discover than by
those that are given to us by others”
BLAISE PASCAL

“It is a fine thing to have ability, but the ability to discover ability in others is the true test of
leadership.”
ELBERT HUBBARD

“It is no use saying ‘we are doing our best’. You have got to succeed in doing what is
necessary.”
WINSTON S. CHURCHILL

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Evaluation
• What worked well for you today? (PINK)
• What key learning points will you take away and put into practice? (YELLOW)
• What are your Future Learning Needs? (GREEN)
• What could be improved – and how? (BLUE)

Please place your completed Post-Its on the relevant parts of the

Wall

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Leadership and Management Learning Log

PERSONAL LEARNING LOG

NAME: DATE:

THIS DOCUMENT IS DESIGNED TO HELP YOU BUILD ON THE LEARNING AND

ACTIVITES FLOWING FROM YOUR INVOLVEMENT IN THE ‘I & I’ PILOT WORKSHOPS.
THE LEARNING LOG AND ITS CONTENTS ARE CONFIDENTIAL TO YOU

Health
Development
Consulting

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The Personal Learning Log is intended as a record of all the learning points that you gain
during the training programme. The Learning log is a way of capturing the key points that
you want to remember.

The Learning Log is made up of a series of blank pages - one for each workshop in which
you have participated. These pages are based on the learning cycle shown below.

EXPERIENCE

REFLECT
PLAN

CONCLUDE

• You have a learning experience, be it a training session, workshop, a group

discussion or syndicate exercise
• You reflect on the experience
• You come to various conclusions, identify some further activities and/or learning you
would find useful
• You plan to incorporate your conclusions in your working and/or personal life

Please complete this Learning Log at the end of each Workshop that you attend.

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INTRODUCTION TO LEADERSHIP & MANAGEMENT

EXPERIENCE
What main areas of Content were covered and how?

REFLECT
What are the main learning points for you?

CONCLUDE
What conclusions have you reached about the knowledge/skills/processes you have
gained and need to develop further?

PLAN
How will you use these new skills/knowledge/processes in your work? How will you build
on them? What actions do you plan to take? And when?

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ADDITIONAL PAGES FOR YOUR NOTES

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ADDITIONAL PAGES FOR YOUR NOTES

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