CPD an emotional rollercoaster Aims: To raise awareness of the emotional aspects of change management (which are often ignored) and to introduce Fisher s transition curve to describe how mandatory CPD can trigger these emotions Learning outcomes: By the end of this session participants should be able to: - list the emotions commonly experienced as a result of change and identify how mandatory CPD can trigger these emotions - describe Fisher s transition curve and how this can be used to facilitate and support the emotional side of change Process of personal change The introduction of mandatory CPD is a cultural change for pharmacy. What do we mean by change? David Nadler says that: 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. There are two sides to change: The hard science: Systems, procedures, structures, strategy The fluffy bunny stuff: Culture, behaviours, emotions, values and people As scientists we have a tendency to forget the emotions triggered by change! John Fisher's transition curve - the stages of personal transition John Fisher's model of personal change - The Transition Curve (see page 2) - is an excellent analysis of how individuals deal with personal change and the emotions involved. This model is an extremely useful reference for individuals dealing with personal change and for managers and organizations helping staff to deal with personal change. We also believe the model will be useful for CPD Facilitators helping people to make the change and meet mandatory CPD requirements. 1
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The emotions experienced during the transition curve are as follows: Anxiety: The awareness that events lie outside one's understanding or control. Individuals are unable to adequately picture the future. They do not have enough information to allow them to anticipate behaving in a different way. Happiness The happiness phase may be (almost) passed through without knowing. In this phase it is the "Thank Goodness, something is happening at last!" feeling coupled with the knowledge that we may be able to have an impact, or take control, of our destiny and that if we are lucky/involved/contribute things can only get better. In this phase we generally expect the best and anticipate a bright future. One of the dangers in this phase is that we believe we will get more from the change than is actually the case. If unrealistic expectations are not managed the individual can become alienated. Fear & Threat It can be difficult to separate these two stages. People are unsure as to how they will be able to act/react in what is, potentially, a totally new and alien environment - one where the "old rules" no longer apply and there are no "new" ones established as yet. Guilt Recognition of the inappropriateness of their actions and the implications for them as people can cause guilt as they realise the impact of their behaviour. Depression This phase is characterised by a general lack of motivation and confusion. Individuals are uncertain as to what the future holds and how they can fit into the future "world". They appear to be adrift with no clear vision of how to operate. Disillusionment The awareness that your values, beliefs and goals are incompatible with those of the organization, In the case of CPD this would be the General Pharmaceutical Council (GPhC). The individual becomes unmotivated, unfocused and increasingly dissatisfied and gradually withdraws e.g. by just "going through the motions", doing the bare minimum and actively undermining the change by criticising and complaining. Hostility Individuals continue to operate processes that have repeatedly failed to achieve a successful outcome and are no longer part of the new process. The new processes 3
are ignored at best and actively undermined at worst. The hostile individual wants the change to fail. Denial Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defense mechanism and perfectly natural. Change; what change? People keep acting as if the change has not happened, using old practices and processes and ignoring evidence or information contrary to their belief systems. How does the transition take place? Much of the transition is done subconsciously. It may not be initially noticeable and only becomes clear if we look back and reflect on our situation. If we recognise where we are in the process, our reaction will depend on our personal style of interacting with our environment and how 'proactive' we feel we can be at seeking out support. Obviously should we feel disempowered this may well cause us to descend further down the slide into a deeper depression; reinforced by our perceived helplessness and all the implications associated with that. There have been a number of changes in the journey towards mandatory CPD which may have triggered a number of different emotions. (See diagram on page 6) 1. The early days of CPD: = Most likely to be associated with anxiety and happiness - 1996 - Pharmacy in a New Age (PIANA) consultation Most Pharmacists favoured CPD but opinion was divided on whether it should be made mandatory - 1998 HSC (Health Services Circular) - A first class service: quality in the new NHS. This HSC described the following: The Government will help ensure national quality standards are applied consistently within local practice through a system of clinical governance; through extended lifelong learning to ensure NHS staff are equipped to deliver change and are given the opportunity to maintain and develop their skills and expertise. - 1999 HSC CPD - Quality in the new NHS This HSC made the following main points: CPD should be focused on the needs of patients and should help individuals and teams deliver the health outcomes and healthcare priorities of the NHS, as set out in national service frameworks and local health improvement programmes. CPD should be a partnership between the individual and the organisation, its focus should be the delivery of high quality NHS services as well as meeting individual career aspirations and learning needs. 4
2. 2003 Royal Pharmaceutical Society of Great Britain (RPSGB) Consultation on mandatory CPD proposals = most likely to be associated with fear and threat as this was when it became apparent that CPD wasn t just going to be voluntary. 3. 2005 CPD became a professional requirement Pharmacists and registered pharmacy technicians have to sign an annual declaration to engage in CPD = most likely to be associated with guilt those who have signed but are not recording their CPD 4. Autumn 2006 - The Foster review regulation of non-medical professionals: Suggested that the RPSGB split its professional leadership and regulatory functions 5. February 2007 Pharmacists and Pharmacy Technicians Order 2006 (Section 60) This piece of legislation gave the RPSGB the legal power to make CPD statutory and publish CPD rules. Almost as soon as Section 60 was passed there was a realisation that the RPSGB will soon Rest in Peace! (See c6 & 7 below) 6. February 2007 White paper on: Regulation of Health Professionals in the 21st Century: This paper outlined plans to split the dual professional and regulatory roles of the RPSGB and set up a new regulatory body for pharmacy called the General Pharmaceutical Council (GPhC). 7. May 2007 The Carter Report on professional regulation and leadership in pharmacy: This report outlined the plans for the formation of the new pharmacy regulator, the GPhC. The Department of Health delayed making CPD a statutory requirement until the GPhC was formed and this led people to question whether statutory CPD would ever happen. 4 7 arrived with a bang! Emotions may have been all over the place but most likely to be associated with denial. 8. 2009 The RPSGB introduced CPD Standards as part of the code of ethics in March and started to call in registrants CPD for review in June. Many registrants experienced guilt if they were not meeting CPD standards; many of those who had not been asked to submit their CPD were in denial. 9. September 2010 - The GPhC became the new regulator for Pharmacy and CPD became a statutory requirement. 5
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How do we recognize what phases we are in? Part of the problem is that we do not recognise which element of the curve we may be in. One of the goals of the CPD Facilitator is to help make the transition as effective and painless as possible. By providing education, information, support, etc. we can help people transition through the curve and emerge on the other side. Three important rules: When change occurs there are three important rules to remember: 1. People are different 2. People are different 3. People are different Also each person will experience transition through the curve at slightly different speeds. The speed of transition will depend on the individual's self perception, beliefs, values, cultures and other past experiences, and of which combine to create their anticipation of future events. Everyone reacts in their unique way Some embrace change Others accept it Some will reject it Work on the 20:60:20 ratio (wild assumption but great starting place) 20% = supportive and positive 60% sit on the fence and will need influencing 20% will be negative Don t spend your time with the negative 20% - they will sap time and energy from you! Kurt Lewin describes change as a process of: Unfreezing giving up the old way of doing something Changing making the change Refreezing making the change stick so it becomes the way of doing things One of the problems with change is that it happens so fast that the refreezing stage often doesn t happen because a new change comes along! It could be argued that this is the case for mandatory CPD e.g. we have been talking about the big change mandatory CPD but there are also a number of changes along the way, all of which could trigger any of the emotions previously discussed. For example: A lot of Pharmacy staff got to the gradual acceptance stage and were regularly recording their CPD starting at either reflection or action. Then in late 7
2007 the RPSGB introduced the option of starting to record CPD at all 4 stages of the cycle. This triggered a number of different emotions for different people. For some it took them right back to the anxiety stage i.e.: - I don t know what is expected of me? - I don t know how to record CPD starting at planning and evaluation - I don t know if I m starting my CPD at the correct stage of the cycle Other people may have felt depression - Yet another way of recording CPD that I need to learn Or disillusionment : - I don t understand the theoretical basis on which you can start to record CPD at all 4 stages - What a load of nonsense! What will the RPSGB think of next Going back to our three important rules to remember when change occurs: 1. People are different 2. People are different 3. People are different Different people will experience different emotions to the same event. Also different people will have a different focus e.g. some will focus emotionally on the big picture e.g. mandatory CPD whilst others will focus on the finer detail e.g. a change in recording system. A piece of advice once you get to gradual acceptance try and focus on the big picture to try and avoid getting back on the emotional rollercoaster again! Fisher proposed the transition model as a linear transition. This is probably true if you focus on the big picture. However if you focus on the finer detail (smaller changes) the chances are it will feel as if you are jumping backwards and forwards with your emotions. However as previously mentioned the much of the transition is done subconsciously. Therefore it is far more likely that whenever another smaller change occurs on the journey towards mandatory CPD that you are starting another transition curve. In summary: Increased awareness of the emotional aspects of change can help CPD Facilitators to: recognise that it is OK to feel a range of emotions and that this is perfectly normal recognise that people react differently to change in terms of emotions get some of the emotional aspects about CPD into the open, e.g. it seems to be acceptable to complain about the RPSGB and plan & record but it also seems to be taboo to discuss an emotional response to CPD 8
Fisher s Transition curve provides a framework that CPD Facilitators can utilise to help discuss emotional aspects of CPD with those who they facilitate References: J.M. Fisher (2003) Process of Transition and Transition curve www.businessballs.com 9