Managing Current Challenges in a Context of Ongoing Change Caroline O’Regan

1. Managing Current Challenges in a Context of Ongoing ChangeCaroline O’Regan Service Plan 2013 Tony O'Some challenges for managers... • While financial past is stabilising focus remains on • Cost reduction • Net reduction in staff 2,400 approximately etc • Zero tolerance budget deficit focus www.hseland.ie Learning supports: e-learning Finance module Contact tony.liston@hse.ie: for Financial Management blended learning programme

2. New HSE Directorate Management and Leadership Team • Director General Designate (Tony O’Brien) • Chief Operations Officer/Deputy DG (assignment Laverne McGuiness) • Chief Financial officer (open competition) 5 New posts established • Director acute hospital(NP) (21st Jan PAS begin recruit process for) • Director primary care (NP) • Director mental health (NP) • Director social care (NP) • Director health and wellbeing (NP) • Director shared services (Liam Woods) The Regional Directors of Operations will evolve into that of Regional Directors of Performance Improvement. System Reform: HSE will play a key role in bringing about the reforms set out by government in the Future HealthDocument 2012 – 2015. The new structures will grow from within the HSE Systems reform function will be established in the HSE and will operate on a programme management basis led by a Transition Programme Manager externallyrecruited and tap into the change management experience from Clinical Programmes; National Cancer ControlProgramme and the SDU = SDU governance from DOH to HSE . SDU responsible to reduce waiting lists and role in upgrading the IT capabilities of the health system.

5. A story of change...Dr. Spencer Johnson • 2 mice and two little people whose live in a maze. • It is actually reflecting ourselves and our behaviour when it comes to change. Like everything else CHANGE is inevitable. • Many people resist change and live their lives in fear of change. • Some will change according to time while most won't. • Some will take it as an opportunity while others will look at it as a threat. Which one is you? Your staff / team? Watch the video break into groups to discuss

6. Who moved my cheese?

7. Political • Technological • Research • World Health Organisation Internal and external environment

8. Stephen Covey: Circle of influence Circle of concern

10. What can you control? • What are your main areas of concern? • How can you influence the change? • What holds you back? • Where can you get support?

12. Change management Definition: Change management is a systematic approach to dealing with change, both from the perspective of an organization and on the individual level. Change management has at least three different aspects, including: adapting to change, controlling change, and effecting change. For an organisation, change management means defining and implementing procedures and/or technologies to deal with changes in the environment

13. Change Management Two types of change : Planned change refers to initiatives that are driven “top-down” in an organization Emergent change refers to a situation in which change can originate from any level in the organization.

14. Managing Change In today’s intense, global, never-sleep, technologically-driven economy, change happens – and it happens fast. If organizations don’t actively manage the implementation of change, this can lead to: • Frustrated employees who resist change • Confusion around why change is happening • Unclear roles and responsibilities and therefore delayed decisions and missed milestones • Missed deadlines critical to smooth transition The Solution : LEARN TECHNIQUES TO “MANAGE IT” Managing Change helps managers lead their organizations in implementing new directions. By developing an awareness of the key dynamics that makes dealing with transitions so challenging and understanding some of the key characteristics of why people are resistant to change, we can focus on successfully managing change.

15. People fear change…. ......but they need its stimulus too. You get more out of your people when you include them. Win or lose, you’re better if everyone is part of the team. People don’t resist change. They resist being changed! Peter Senge

16. Two different responses to change; “Negative”

17. One type of response!!...

18. What is your response to change? • Disgust? Perhaps you enjoy it?

19. “Positive” Supportive Blissful ignorance Realistic support 1. Uninformed Optimism (Certainty) 4. Informed Optimism (Confidence) Time Informed anguish Coming to terms 2. Informed Pessimism (Doubt) 3. Hopeful Realism (Hope) Overt checking out Covert checking out Resistant

20. Building capacity Resilienceis the ability that allows people to go beyond coping and surviving and actually prosper during change. We all have this capacity to varying degrees, the more capacity we have the more change we can absorb.

21. The basic characteristics of highly resilient people

22. Optimism Ability to • look on the brighter side of life & maintain a positive attitude, even in the face of adversity • Positive approach to daily living • Opposite of pessimism

24. ‘Learned Optimism’ Seligman • Over 30 years of psychological research • Over 500 scientific studies world-wide • More than 1 million participants “If you don’t like something, change it. If you can’t change it, change you’re attitude” – Maya Angelou

25. “Your thoughts can be your prison or they can set you free to soar”

26. Adaptability : Flexibility Ability to: • Adjust emotions, thoughts & behaviour to changing situations & conditions • Be adaptable • React to change without rigidity • Be open/tolerant to new ideas; changes.

27. Focused Ability to • Reality testing – “tuning in” to the immediate situation • Ability to assess correspondence between what’s experienced & what objectively exists • Seeing things as they are not how you want them to be without distraction • Keeping things in perspective

28. Ability to • think and act ahead of anticipated events; this means using foresight. • Anticipate and Plan (as much as possible) for the future • instigate action and creative ideas

29. Organised Ability to • Plan, Prioritise and Prepare • Use Lists with Deadlines and 4 D’s for emails Delete; Do; Delegate or Defer.. • Delegate  • Think Twice before You Say “Yes” • Manage energy not time.

31. “Our only security is our ability to change “–  John Lilly

32. Communicate: Overcoming Resistance to Change To maximize a positive response to change AND build commitment and shared vision have the following USEM parameters in place: U = people must understandwhat we’re doing and why S = people must have the knowledge and skillsnecessary to execute the change E = we must remove barriers in the environmentthat will prevent the change from being successful M = people must have motivation to change, i.e., they must want to help achieve the change

34. Non verbal behaviour communication circle

35. Tip of the Iceberg… Visible Behaviour Thinking + Feeling Attitudes + Beliefs Core Values/ Identity

36. Stress tolerance Is a crucial component having the ability to; • withstand adverse events; change and stressful situations without falling apart • Actively and positively coping with change and stress • Optimistic disposition towards overcoming change and problems

39. 13 mistakes and how to avoid them 1: Pressure to act quickly undermines values and culture Solution:avoid the temptation to announce instant decisions 2: Management exercise too much control: Solution:establish short term tasks that empower staff giving a feeling of control over results 3: Urgent tasks divert leaders’ attention from the mood of the organisation: Solution:Appoint a team of natural leaders to monitor the culture 4: Communication is haphazard, erratic and uneven: Solution:develop a interactive communication style…keep it going 5: Uncertainty creates anxiety: Solution:Establish certainty of process when there cant be certainty about decisions Ref: Rosabeth Moss Kanter 2011

40. 6: Employees hear it form the media first : Solution: develop networks of employee information chain 7: There is no outlet for emotions: Solution:Create facilitated sessions for venting. Acknowledge anxiety and grief. 8: Key stakeholders are neglected: Solution: manage relationships. Devise a plan to involve and communicate regularly. 9: It seems easier to cut than redeploy: Solution:establish a pool of strong performers from areas of cutbacks 10: Causalities dominate attention; pay attention to your “keepers” who many not know they are valued and decide leave: Solution:meet individually and show appreciation. Offer recognition for extra problem solving effort during the change. Ref: Rosabeth Moss Kanter 2011

41. 11: Changes are expedient, not strategic; leaders/managers often restructure by removing the weakest or newest people without regard to service – the unit does the same with lesser people – the opportunity to change is lost Solution:re-examine priorities to redirect activities towards more productive futures uses. 12: Leaders/managers lose credibility: The shock of change sometimes makes leaders’ words less credible. Motivation drops: Solution:Make short-term, tangible, doable promises, and keep them. 13: Gloom and doom fill the air: Everyone is preoccupied with the negative current situation. Morale sinks, hard to find the energy to be creative or productive: Solution: Show that there is a future beyond the change, repeat a credible positive vision. Emphasize the steps being taken, how we’re going to change Ref: Rosabeth Moss Kanter 2011

42. Other supports... The HSE Change Model describes the journey of transformation that enables people to move from the current situation to the desired future, in line with a shared vision for change. The HSE Change Model based on the four stages of the project management lifecycle: INITIATION • Step 1: Preparing to lead the change PLANNING • Step 2: Building commitment • Step 3: Determining the detail of the change • Step 4: Developing the implementation plan IMPLEMENTATION • Step 5: Implementing change MAINSTREAMING • Step 6: Making it ‘the way we do our business’ • Step 7: Evaluating and learning HSE Change Model adapted from: Kolb, D. and Frohman, A. (1970), Huse, E. (1980), Neumann, J. (1989), Kotter, J.P. (1995), Ackerman Anderson, L. and Anderson, D. (2001), McAuliffe, E. and Van Vaerenbergh, C. (2006), and Project Management Institute (2004)

43. Work shop Individually complete the following template(s) • 1.1identify what is driving the need for change and the degree of urgency? • Step 1 Preparing to Lead Change • 1.2 Activities for change : Communicate relentlessly (handout) • 1.3 Assess readiness and capacity for change Break into group of 5 + and discuss Plenary session share feedback from each group

44. In groups…. • Discuss the template forms you have just completed? • What change(s) are you currently facing? • What obstacles (if any) are you experiencing? • Where can you get support? • Share your learnings from a recent change you have been involved in? Plenary sessionfeedback from groups

45. Improving Our Services: A Users’ Guide to Managing Change in the HSE

46. Improving Our Services: A Users’ Guide to Managing Change in the HSE

47. 1.2 Activities for change: Communicate relentlessly Improving Our Services: A Users’ Guide to Managing Change in the HSE

48. 1.3 Assessment template overview (1) Improving Our Services: A Users’ Guide to Managing Change in the HSE

49. Harris, Readiness-Capacity Assessment Chart (1987: 63) Improving Our Services: A Users’ Guide to Managing Change in the HSE

50. Recap: Complete your PERSONAL ACTION PLAN