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Chapter 8
Managing change - moving
to a self care culture
We need to change our behaviour as an individual health professional or a practice or PCT organisation, if we are to genuinely provide support for self care and enable patients and members of the public to change to self caring behaviour too. So this chapter emphasises how you can make and sustain that change.
The process of change
Look at the flow chart in Figure 8.1 about how people usually react to change. You start off by being taken by surprise about a change, even if you anticipate it. Promoting a culture of self care support across general practices and pharmacies would be a change for most primary care practitioners and teams. You tend to move from the shock of being expected to change to pretending it is not going to happen.
After the denial phase in the change process, you move on to find somebody to blame for what has happened – blaming the messengers who announce the change. After the blame comes self-blame (e.g. ‘I’m no good at promoting self care’).
Part of the next stage, the bargaining, is negotiating that if you do it this way you are going to be able to do that. Eventually you arrive at the resolution phase where you have accepted the change.
When change is imposed by others you are very much more resistant, so you move more slowly. If the effect of the change is serious, your feelings about it will be stronger and you will spend longer in the phases of denial, blame and self-blame.1
You need to identify clearly the causes for dissatisfaction with the present situation (that is, too little self care by patients), and then have a clear idea of where to head.Map out how to reach that target. Find the way in staged steps to measure your progress towards the target.
People play roles in response to change:2
- the rebel: ‘I don’t see why I should’
- the victim: ‘I suppose you will make me, but I will drag my feet’
- the oppressor: ‘you all have to do it’
- the rescuer: ‘I will save you all from this terrible change’.
There is a dearth of evidence about how to secure change in clinical behaviour. There are plenty of worthy books and articles on ways of making and managing change, and much is known about the effects of change on an organisation and workforce. The gaps between theory and practice and the general lack of application of research into clinical practice are well recognised.
Managing change within the PCT or practice
To bring about change and get evidence about the effectiveness of self care into practice:3
- consider what individual beliefs, attitudes and knowledge influence professionals’
and managers’ behaviour
- be aware of important influences in the organisational, economic and community
environments of practitioners
- identify factors likely to influence the proposed change
- plan appropriate interventions: multi-faceted interventions developed as an integrated resource targeting different barriers to change are more likely to be effective than single interventions
- interventions are targeted at overcoming potential barriers
- keep people informed by describing the evidence and need for change, in words and
ways they can comprehend
- motivate people to tackle the change – show why the change is necessary and
important, who else supports the change, how problems associated with the
proposed change can be solved
- provide adequate resources to underpin the change of practice – such as people
with the right level of knowledge and skills
- incorporate monitoring and evaluation of the change from the planning stage and
throughout the activity
- implement the change and find ways to maintain and reinforce the new practices e.g. reminder systems, educational programmes
- disseminate information about the change in ways that are appropriate to the nature and setting of the participants.
The nature of resistance to change will be specific to any particular situation.