Commissioning Skills Development Successfully Implementing Change Page 1
Agenda 2:00 2:15pm Welcome & aims of session 2:15 3:00pm Session 1: Key components of managing change 3:00 3:20pm Exercise: Managing change in practice 3:20 3:30pm Tea & Coffee Break 3:30 4:00pm Session 2: How to overcome the barriers and see a change through 4:00 4:20pm Exercise: Marshalling the forces of change 4:20 4:30pm Wrap Up Page 2
Welcome! Today s workshop will enable you to UNDERSTAND... The role of managing change in the commissioning cycle The wider influences that are crucial in managing change successfully BE ABLE TO... Apply the learning to practical examples Feel motivated and energised to go out and make change happen Page 3
Context Organisations of today live in a changing environment What is success? e.g. change initiative has delivered a sustainable change to the business, and met the desired change objectives as defined and agreed upfront with the Executive sponsor. Page 4
Brainteaser: Success/Failure Why do change programmes fail? Work 2s and 3s,.as many ideas as you can Then share with others on your table 5 minutes Page 5
Reasons for failure Page 6 Source: NHS Institute, 8 November 2007
Logistical elements Potential reasons for service redesign failure 1. Managing People 2. Managing Technical Requirements Page 7
Key components of managing change Page 8
Commissioning cycle PLAN Analysis & Prioritisation Engage: Communication and Change Management Pathway Strategy & Planning Implement Manage Commissioning Strategy Plan, with prioritised opportunities for improvement Pathway Strategies, with plan of market and non-market interventions to bring them about Change delivered on the ground Continual effective delivery of services & strategy Which part of the commissioning cycle is most difficult? Page 9
Implement PLAN Change delivered on the ground Why is this so hard? How do we make it easier? Start by understanding what change actually is... physically and psychologically Page 10
The physics of change What does it take to get this glass of water from room temperature (status quo) to boiling point? What does it take to get this tennis ball from stationary (status quo) to moving? There is one common factor... Page 11
In pairs talk through one of your change projects What were your source(s) of energy? What were the forces acting against this change? How do you overcome the forces acting against? Apply these principles to people From physics to psychology 5 minutes Page 12
Change versus the status quo People s experience makes them want to stay where they are Familiar past Old rules of control Old rules realpolitik Old social norms Implement Unknown future Great idea BUT Unproven strategy where s the evidence? Why fix it when it ain t broke? What s in it for me? Page 13
Overcoming resistance: important role for leaders Leaders have the most influence Identifying and getting the buy in from leaders is crucial Supporters Leaders Majority Page 14
Strategies to build coalition Your powers of persuasion must be applied to build a powerful coalition for change Entice and reward early adopters Make new more appealing Make old less appealing Tipping point reached Change systems Change organisation Page 15
Transition Curve a common tool Leading people through a transition curve is insufficient; we have to engineer focal events which change people s thinking Page 16 Tipping point
Exercise 1: Managing Change in Practice In groups of 2s or 3s Think of a recent example of a change project in your organisation 1. Where would you put most people on the transition curve? 2. Can you identify what was done to entice early leaders? 3. Can you suggest a focal event to establish the tipping point? We will then feedback to the whole group 10 minutes Page 17
Template for Exercise 1 Please complete in discussion at tables, one template per group 1. Where would you put most people on the transition curve 2. Can you identify what was done to entice early leaders 3. Can you suggest a focal event to establish the tipping point Page 18
Tea break Page 19
How to overcome the barriers and see a change through Page 20
Commissioning cycle PLAN Analysis & Prioritisation Engage: Communication and Change Management Pathway Strategy & Planning Implement Manage There will be multiple stakeholders throughout the commissioning cycle (internal and external) Page 21
Impact of change What s In it For Me What s Against My Interest Health impact Political dimensions Social dimensions Cultural fit Impact on my job Capability, structures Messages to build on these Messages to mitigate these Page 22
Motivation 2. Higher Purpose These actions will What is also meet the the benefit higher of this purpose action? O Potential for agreement 1. Starting 3. Way point forward Page 23 Source: Adapted from Neuro-linguistic programming (NLP) methodology
Tool 1 6 step model: Marshalling the forces for change Step 1: Identify the stakeholders CEO Re-eng. Lead Medical Director Proc. Lead Clinical Director Doctor Group 1 Doctor Group 2 X Y Z Page 24
Tool 1 6 step model: Marshalling the forces for change Step 2: Assess how much power they have to affect the change CEO Re-eng. Lead Medical Director Proc. Lead X Doctor Group 1 Doctor Group 2 Clinical Director Y Z Page 25
Tool 1 6 step model: Marshalling the forces for change Step 3: Assess whether they are now for or against the change CEO Re-eng. Lead X Medical Director Proc. Lead Clinical Director Doctor Group 1 Y Z Doctor Group 2 For Change Against Change Page 26
Tool 1 6 step model: Marshalling the forces for change Step 4: Assess how involved they are in the change Level of Involvement Re-eng. Lead Z X Proc. Lead Clinical Director Y Doctor Group 2 CEO Medical Director Doctor Group 1 For Change Against Change Page 27
Tool 1 6 step model: Marshalling the forces for change Step 5: Map the key relationships between the stakeholders Level of Involvement Re-eng. Lead Z X Proc. Lead Y Doctor Group 2 Relationships Strong Weak Clinical Director CEO Medical Director Doctor Group 1 For Change Against Change Page 28
Tool 1 6 step model: Marshalling the forces for change Step 6: Now the stakeholder map can be used to design the engagement strategy Level of Involvement Re-eng. Lead Point out personal risk Z Proc. Lead Y Doctor Group 2 CEO X Medical Director Clinical Director Leverage Relationship with Proc. Dir. Involve more in change Doctor Group 1 Sell the benefits For Change Against Change Page 29
Exercise: Orthopaedic re-design Scenario: You are a project team in a PCT who have been tasked with undertaking a service improvement project to reduce orthopaedic appointments at the local hospital. The PCT Director of Finance has informed you that the local hospital is close to breaching the 18 week wait for orthopaedics and has made this a top priority for the PCT. The volume of activity has increased considerably over the past 18 months and you have been asked to redesign and implement a new care pathway which will maintain and improve standards at the same time & reduce the no. of appointments at the hospital. Apply the 6 step model tool to this scenario, working as a table. You will need to invent personalities and relationships etc but you might base those on characters you know... 15 minutes Page 30
Exercise: Orthopaedic Re-Design List of possible stakeholders: PCT Director of Finance & Performance PCT CE Hospital CE PEC Chair Medical Director (Hospital) PCT Contracting Team GPs Local Involvement Networks (LINKs) Private Providers Community Services (Physio etc) Regional SHA PCT Public Health Department Patient Transport Team Add/Remove any Stakeholders you deem necessary Page 31
The 6 Steps Step 1: Identify your stakeholders Step 2: Assess how much power they have to affect the change Step 3: Assess whether they are now for or against the change Step 4: Assess how involved they are in the change Step 5: Map the key relationships between the stakeholders Step 6: Now start considering how the stakeholder map you have made can be used to design the engagement strategy Page 32
Tool 2 Steps to success Key tools and techniques used at each stage in the lifecycle reflect best practice for implementation planning ˆ Establish project team ˆ Project scope/brief ˆ Establish governance ˆ Project PID ˆ Risk identification and assessment ˆ Benefits profile ˆ Project planning ˆ Network diagrams ˆ Critical path analysis ˆ Deliver Products ˆ Change Requests ˆ Risk Management ˆ Issue/Exception Management ˆ Project reporting ˆ Realise and track benefits ˆ Identify lessons ˆ Close projects ˆ Project Reviews Page 33 Source: Adapted from NHS Institute
Tool 3 RACI model The RACI model can help clarify interdependent roles Responsible Person who works on the activity The Doer Accountable Person with yes/no authority Buck stops here Consulted Person involved prior to decision In the loop Informed Person who needs to know of the decision In the picture Page 34
Today s objectives What we ve covered today ˆ Given you an understanding of the role of managing change in the commissioning cycle ˆ Analysed the wider influences that are crucial in managing change ˆ Motivated and energised you to go out and make change happen! Page 35
What Next? PLAN SUCCESSFULLY IMPLEMENTING CHANGE Workshops: Assess Your Commissioning Competencies Good Grounding in Commissioning Strategic Planning & Prioritisation Procurement & Market Management Managing Performance and Decommissioning Successfully Implementing Change Courses: Masters in Healthcare Commissioning Commercial Skills Development Programme Page 36 Website: www.csl.nhs.uk Email: info@csl.nhs.uk
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