Teaching Implementation Change Management
Change Management Overview and Objectives
Display Slide 63, “Change Management,” as the class reassembles before discussing the last implementation topic.
In discussing Slide 64, “Objectives,” as you transition from coaching to change management, note that success implementing and sustaining TeamSTEPPS depends on both individual and collective efforts. Individuals provide coaching to support individual team members. Change management is a group effort led by leadership at all levels of your unit and organization. Then briefly review the objectives for the discussion of change management:
- List the Eight Steps of Change.
- Identify errors common to organizational change.
- Discuss what is involved in creating a new culture.
- Begin planning your organizational change strategy.
While you can use the slides that follow to teach key change management concepts, an optional approach to teaching this section is by using a group exercise. Instructions for that exercise are provided at the end of this section (see Slide 81).
Eight Steps of Change
Using Slide 65, “Eight Steps of Change,” briefly preview the eight steps and then discuss each step using the slides that follow.
Setting the Stage
In introducing Slide 66, “Set the Stage,” you may want to acknowledge that staff are stressed, and many are experiencing burnout. Efforts to create a sense of urgency need to be framed in ways that do not raise staff stress levels but instead are viewed as a way to better manage them.
Explain that the first phase in implementing change is setting the stage. As noted previously, the first step is to create a sense of urgency. Ensuring a sense of urgency among people is crucial to getting cooperation for change. Unless individuals understand the urgency of a situation, complacency sets in and change becomes very difficult, if not impossible. Ask the class to think about the forces of complacency—what are some of them?
Note that this step requires beginning to think about the key stakeholders, groups, and individuals in the organization who must feel the need for change for team training to happen. Are they on board yet?
Talking about the need for change, the consequences of not changing, and ways to solve the problems is essential to making the case for change.
Gathering a Team
Display Slide 67, “Pull Together the Guiding Team.” Note that this step is the same as step 1 in the 10-step TeamSTEPPS implementation planning process and that the Guiding Team and the Change Team are different ways of describing the same group.
Developing a Strategy
In discussing Slide 68, “Develop the Change Vision and Strategy,” note that an organization fosters a “culture of safety” with its practices, processes, and procedures. Patterns of behavior determine the commitment, style, and proficiency of an organization in relation to safety. A positive culture of safety has:
- A foundation built on mutual trust.
- Shared perceptions on the importance of safety.
- Confidence in the efficacy of preventive measures.
Explain that the second phase in implementing change is deciding what to do. Leaders must create a compelling vision that answers the questions, “What do we want to achieve?” and “Where do we want to be in the future?” It is important that the vision engage both head and heart. Leadership must also develop the strategy to make the vision a reality. In addition, the Guiding Coalition should be instrumental in creating the vision and strategy.
As you discuss this topic, be prepared to answer questions about what to do if some or all of senior leadership is not fully supportive. Ask class members to share their insights on how to respond to this challenge.
Communicate for Understanding and Buy-In
In discussing Slide 69, “Communicate for Understanding and Buy-In,” it may be important to spend time on the first bullet point to help staff experiencing stress and burnout or seeing peers encountering these challenges.
Explain that the third phase in implementing change is making it happen. When the vision and strategies have been determined, they must be effectively communicated. Failure to implement change is often the result of undercommunicating or communicating poorly. In addition, everyone involved must both understand and accept the vision and strategy.
Creating a vision and implementing change take a great deal of time and hard work. It's essential that trust be built in the early stages within and among the Guiding Coalition/Change Team, staff, and leadership. It’s also important that an environment be established where concerns can be brought forward and discussed without fear of retribution. Every communication channel available should be used to put forth the vision and strategies in a planned way. It’s also essential that the Guiding Coalition and Change Team model expected staff behavior.
Accept and plan for resistance. Resisters help to clarify the problem. By addressing their concerns, you can actually improve the change.
Use the following actions to overcome resistance to change:
- Acknowledge change as a process.
- Empower stakeholders.
- Encourage all stakeholders.
- Set concrete goals.
- Show sensitivity.
- Model process skills.
- Develop strategies for dealing with emotions.
- Manage conflict.
- Communicate.
- Monitor process dynamics.
Empowering Others
Introduce Slide 70, “Empower Others To Act.” Note that leaders must change the systems or structures that undermine the change vision and remove other obstacles to change. They should also encourage risk taking and nontraditional ideas, activities, and actions. It is essential that leaders remove as many barriers as possible so that those who want to make the vision a reality can do so.
Empowering others to act involves each action noted on the slide. Ask the class which of these seem the most challenging or frequently neglected.
Producing Short-Term Wins
As you introduce Slide 71, “Produce Short-Term Wins,” ask your class which of these strategies they’ve seen used effectively and to share what made them effective. Note that creating visible, unambiguous successes connected to the change effort as early as possible shows the initiative is succeeding. Plan and create the wins and be sure to visibly recognize and reward people who made the wins possible.
Some additional issues to think through:
- Think through the power of short-term wins in the first unit to be trained or among early adopters of the change.
- Think of the method you use to integrate lessons learned into your own process modification. Will that method apply here?
- How do you plan to leverage lessons learned to drive change in the second unit to be trained? To design and drive change as you train up multiple departments across the organization?
- What measures provide evidence of success?
- Think about how to handle resistance. It takes a lot of courage to openly communicate when resisters are present (e.g., at a staff meeting). What method do you find successful for communicating to staff when numerous resisters are present? How can you leverage your Change Team to strategize, plan, and control the impact of resistance?
- What means or methods tend to build momentum? Is your facility a “storytelling” place? Are stories an effective manner to help staff hear and internalize the short-term “win”?
Don’t Let Up
Use Slide 72, “Don’t Let Up,” to make connections with content discussed earlier in your training. Note that many of these suggestions were addressed as parts of effective leadership and mutual support. And remind the class of the TeamSTEPPS tools they were taught. You may want to ask class members their suggestions for reinforcing and rewarding new behaviors with little or no cost.
Creating a New Culture
In discussing Slide 73, “Create a New Culture,” it’s important to remind trainees that they need to think of TeamSTEPPS as a framework to help achieve positive outcomes, as opposed to avoiding negative ones. Staff want to enjoy their work and want to help patients and keep them safe. Emphasizing what will make staff happy and fulfilled will make TeamSTEPPS more appealing than framing it as a way to prevent tragedies.
Emphasize that the final phase in implementing change is making it stick. Hold onto the new ways of behaving and make sure they succeed, until they become part of the group culture. Also develop a way to ensure leadership development and succession. Remember that changing culture comes last, not first. It is only after people change their actions that there can be a change in culture.
Organizational Change Exercise
Introduce Slide 74, “Organizational Change Exercise.” If you have time, use the organizational change exercise to discuss potential causes of failure and how they can be avoided in your TeamSTEPPS implementation. Have each group share their top one to three recommendations.
Common Errors
Display Slide 75, “Errors Common to Organizational Change.” Explain that training is not a standalone function. Pitfalls commonly arise and derail organizations that are overly eager in their rush to change. This slide lists common errors to avoid.
New approaches and methods become part of a culture when they are effective. Kotter identifies ways to institutionalize change and counter these errors. These include:
- Build new habits and skills.
- Provide opportunities for discussion and tools to reinforce skills, such as the TeamSTEPPS Pocket Guide, that may assist staff in institutionalizing processes.
- Reward incremental change.
- Make all staff accountable.
- Assign responsibilities for change actions.
- Encourage mutual leadership.
Culture Change
Display Slide 76, “Culture Change Comes Last, Not First!” The key message to stress on this slide is the need for patience. True culture change does take time and can’t be rushed. But you can also use this slide to stress the need to track key processes and intermediate outcomes so you can see incremental changes as your culture change efforts proceed more gradually.
You may also want to explain that, according to Kotter, the process of anchoring change in the culture has the following characteristics:
- It comes last, not first. Most alterations in norms and shared values come at the end of the transformation process.
- It depends on results. New approaches usually sink into the culture only after it's very clear that they work and are superior to old methods.
- It requires a lot of talk. Without verbal instruction and support, people are often reluctant to acknowledge the validity of new practices.
- It may involve turnover. Sometimes the only way to change a culture is to change the key people.
TeamSTEPPS Change Model
In presenting Slide 77, “TeamSTEPPS Change Model,” note that every effort to change is guided by a model and that a clear model will help foster a shared mental model among everyone involved in the TeamSTEPPS implementation.
Other Change Models
Display Slide 78, “Other Change Models.” Acknowledge the wide variety of change models and approaches that exist in healthcare. Ask participants which are used in their organizations.
Using Other Change Models
In discussing Slide 79, “Using Other Change Models,” the key message to stress is reflected in the last bullet point. TeamSTEPPS can be implemented using the language and processes and model your organization typically uses. Using that language will allow implementation to build on and reinforce other initiatives and avoid making TeamSTEPPS the flavor of the month.
Change Management Exercise
If you teach change management using a group exercise, you can introduce the exercise using Slide 80, “Change Management Exercise,” and skip all the prior slides except those noted below.
Alternative Approach to Teaching Change Management: Group Exercise
Almost every participant in TeamSTEPPS has been part of an organizational change initiative. Therefore, an option for teaching change management is to lead your class through a discussion, rather than lecturing on the topic of change management. The following exercise will facilitate that discussion and ensure that all important aspects of culture change are discussed. The group exercise steps are as follows:
Step 1. Storytelling (10 Minutes)
Instruct the participants to form groups of two or three.
Instruct the participants to each do the following: “Think of a story (e.g., a critical incident that you experienced) related to organizational change. The story can be an example of either a successful or unsuccessful change effort. It can be something related to work or not work related. Think about: How and why was the change introduced and by whom? How was it received? Were there any barriers? How were these barriers overcome? What happened? Was it successful? Why?”
Instruct the participants to take turns sharing their stories with their partners. While listening, they should take notes about things that were critical to either the success or failure of the change being described. Give participants 5 minutes to share their stories.
Ask three or more participants to share their stories with the entire group. Be sure to allow participants to ask the person sharing the story any questions. You should also ask questions or highlight key points, if appropriate.
Step 2. Identify Best Practices (10 Minutes)
Give participants 2 to 3 minutes to reconvene into their groups and identify best practices (i.e., do’s and don’ts) related to implementing new programs in an organization.
Lead a facilitated discussion in which participants present their best practices for organizational change. As the facilitator, you should record these best practices on a whiteboard or flipchart. (Note: It is possible to create a list of up to 50 best practices from this activity.)
Step 3. Prioritize Best Practices (10 Minutes)
Instruct participants to reconvene into their groups and identify the one or two most important best practices (i.e., do’s and don’ts) related to implementing new programs in an organization. Participants should identify their one or two practices from those listed in step 2; however, participants may add practices if they want.
Ask each group to report which best practices they identified as most important. Record the responses by placing checkmarks next to the best practices you listed on the whiteboard or flipchart. Be sure that all groups are given an opportunity to share their responses.
Ask the participants to review the final list of “important” best practices. Do they agree with the final list? Would they recommend any changes?
Step 4. Review Kotter’s Eights Steps of Change (5 Minutes)
Refer to Slide 65 and review Kotter’s Eight Steps of Change with your class.
Compare Kotter’s eight steps to the list the participants in your class identified.
Ask the class to discuss any similarities and differences.
Step 5. Errors Common to Organizational Change (5 Minutes)
Ask participants what some of the common errors are when trying to make an organizational change.
Compare the errors to those presented in Slide 75.