Chapter 8 - part 2
Managing change - moving to a self care culture

Why people do not change

Resistance is a natural, universal, inevitable human response to a change that
someone else thinks is a good idea, and resisting change or improvement does not
make someone bad or narrow-minded. We have all done it and our response will be
one of three things: fight, flight or freeze.

There are lots of reasons why people may be hesitant about changing the way they do things. These may include:

having a poor appreciation of the need to change or considering the need to change to be secondary to other issues
having a poor understanding of the proposed solutions or considering the solution to be inappropriate
disagreeing how the change should be implemented
embarrassment about admitting that what they are doing could be improved
lacking trust in a person or the organisation, as they believe it has failed to successfully implement change in the past
anticipating a lack of resources.

People underestimate the barriers and hurdles to be overcome before change will be made and sustained. Barriers may be:

lack of perception of relevance
lack of resources
short term outlook
conflicting priorities
difficulty in measuring outcomes
lack of necessary skills
no history of multidisciplinary working
limitations of the research evidence on effectiveness
perverse incentives
intensity of contribution required.

Sometimes the problem arises from a malfunctioning organisation. If so, you need to implement a well thought out and substantial plan to overhaul your PCT or practice and remedy them.

Encouragement to change

Think about four levels of change:4

1 do you need to do something new?

2 should you do things differently – change a system or process?

3 should you do something different – change the purpose?

4 do you need to stop doing something – does the service or organisation need to exist at all?

Organisations are like weather systems, constantly changing and shifting. If you change one thing, it affects many others. The environment constantly alters so the 116 Supporting self care in primary care outside influences need constant monitoring. Strategies such as yours to establish a new culture of self caremust be flexible. People have to be supported in coping with the constant change. Remember to involve themfrom the outset, keep theminformed and part of the change process. Give them time to grieve for the past ways of working and time for criticism and interchange of ideas. Imposing change on your PCT or practice team will breed resentment and resistance to your hopes for their promoting and supporting self care.

Making the transition to supporting self care

Change happens all the time. So establishing a new culture of promoting and supporting self care within your PCT, practice or across your practice team, is just one more challenge for your change management skills. The transition will occur more smoothly by:

deciding what needs to be changed through gathering evidence about self care
sharing the responsibility for identifying the problems involved and finding the solutions so that everyone feels part of the process (ownership)
building in plenty of time to discuss the planned changes so that everyone feels that they have had a chance to put his/her points of view
making the changes in small steps
giving plenty of support to everyone in the team, and monitoring progress
giving feedback so that everyone knows how the changes are progressing and what their part in them means to the whole
celebrating completion of milestones in your action plan and continuing monitoring to prevent backsliding!

Getting there

People react better if they have a direction of travel. Remember to KISS (keep it simple and short), and pick two or three targets that mark the evolution of your new culture of self care, to focus on – as in Figures 3.1 (see p. 33) and 4.1 (see p. 44). If you set up too many targets, you will not finish any, and everyone will become discouraged.

Help everyone to understand the current issues and why the change to a culture of self care is necessary and will improve healthcare overall. Identify who is likely to lose what. Some health professionals may perceive they will lose status and power if patients are enabled to care more readily for themselves.

References

1 Upton T and Brooks B. Managing Change. Buckingham: Open University Press; 1995.

2 Riley J. Helping Doctors Who Manage. London: King’s Fund Publishing; 1998.

3 NHS Centre for Reviews and Dissemination. Getting Evidence into Practice. Effective Health Care Bulletin 5(1). London: Royal Society of Medicine Press; 1999.

4 Prochaska J, DiClemente C and Norcross J. In search of how people change. American Psychologist. 1992; 47: 1102–14.

part 1