Principles of Change

1 Institutional change

You are thinking of introducing a new appointment system at the practice, you have a role at the CCG and need to design a COVID vaccination plan, your house needs redecoration, you are the DG of WHO and need to improve access to primary care. These are not issues about helping an individual. They involve institutions – sometimes many. Let's take a look at a very popular method through which this can be done.

Throughout this section, we are going to focus on a change project that you want to focus on.

You might have identified an issue with your service that you feel needs to be addressed. It could be in relation to improving quality for patients, this could be the quality of care provided, the quality of service or another element of provision that you provide, for example, reducing the time that they have to wait for something or the amount of times they have to attend a clinic for the same problem. It might be that you have identified an error, a significant event, or waste in the service or maybe want to save costs in your system. Whatever the reasons for your change, the way that you go about designing and undertaking your change project is crucial to its success.

Briefly describe your change project, give it a title - write this down.

Why change or redesign services? Reflect on your project and think about some reasons why you might want to make a change. Write these thoughts down.

Change is not a simple and quick process. Good planning and design are important. Even after your project is implemented the process is not over. Simply changing the habits and processes of employees is not enough to make the desired impact or sustain the change. The changes need to become part of the core of your department or organisation. Keeping everyone on board and encouraging them to adopt the change and celebrating the successes are vital.

There are a range of change models available, for the course we are going to look at Kotter.

John Kotter is an American Professor of Leadership at Harvard Business School. In 1995 he developed an 8-step change model. The model sets out 8 key steps of the change process. He believes that if you neglect any of the steps, this can be enough for your whole change initiative to fail. Kotter argues that 70% of change initiatives fail, and attributes this to the fact that most organisations do not put in the necessary preparation or see the project through correctly.

Kotter's 8 step change model

The first three steps in Kotter's model are all about creating a climate for change. The next are on engaging and enabling the organisation, and the last, implementing and sustaining change.

How to achieve the 8 steps:

1. Creating urgency

• Identify the potential threats or consequences of not changing, what might happen if you don’t change?

• Find out what others are experiencing that might encourage them to want to change.

• Highlight the opportunities which may occur as a result of the change.

2. Form a powerful coalition

• Identify others within your department or organisation that would be interested and committed to the change idea.

• Identify any weakness in terms of individuals and teams that could be resistant to your change idea and engage with them early. Work with them to understand how to get them involved.

• Form a powerful collation team with all those that are supportive of the change idea.

3. Create a vision for change

• Define the ultimate vision, what does the change look like? Make it compelling.

• Ensure that you are able to describe and communicate the vision effectively and people can easily understand it.

4. Communicate the vision

• Communicate the vision powerfully and convincingly.

• Be prepared for, and handle any concerns honestly and openly. Don’t shy away from challenge.

5. Empower action

• Begin to delegate and disseminate

• Move on from pilot or test phases

• Check for potential barriers or people who are resisting and address them.

• Celebrate and encourage those who are supporting the process.

• Make sure the processes are aligned with other work going on in the organisation.

6. Create quick wins

• Identify short term early wins and celebrate each victory in the early stages.

• Have multiple short targets instead of one long-term goal.

• Reward the contributions of those who are helping to meet the targets.

7. Build on the change

• Analyse the success and receive feedback from experiences.

• Continue to make modifications based on feedback.

8. Make it stick

• Ensure the change becomes integral to the organisation and is visible to everyone.

• Ensure the support of leaders and everyone involved.

Let’s spend some time thinking about the first 3 steps in Kotter's model. Going back to your change idea, work on those first 3 steps. Write these thoughts down.

Creating urgency

Provide some reasons why you think your project is urgent, or what opportunities it presents?

Form a powerful coalition

Identify some people, departments, organisations or others who will be interested in being a part of your project? Think about how will it benefit them or support other areas they are working on?

Create a vision for change

Describe your vision for the future, what does the change look like? How will things be positively different and who will benefit?