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Managing change in the nhs,what it takes to have a healthy relationship,how to plan a romantic valentine's day for her - Plans On 2016

Introduction Change is now considered to be the biggest challenge for virtually all organisations public and private, large and small - but especially for large, well established 'complex adaptive' organisations. The NHS is a very large organisation - the third largest employer in the world after the Chinese Army and The Indian Railways and has over many years and despite many efforts found it difficult to change.
The NHS is a large organisation employing people with a wide range of talents, perspectives and passions. The complexity is a result of the very specialisation that has produced so many advances in health care.
It is also important to remember that cause and effect relationships may not be easily apparent, and that an intervention in any part of a health care organisation will have outcomes in many others, not all of them anticipated, and not all of them desirable. Understand the CulturePlanning change requires a clear understanding of the culture of the organisation (using Charles Handy). Understand the Environment a) Use a Force field analysis to support the planning process and to start identifying how to manage the resistors to change. Force field analysis is a management technique developed by Kurt Lewin, a pioneer in the field of social sciences, for diagnosing situations.
Technological innovations - new approaches to doing new and old things, and tackling new and old problems; these do not necessarily involve technical equipment - they can be novel ways of thinking or of organising. Industry analysis - a review of the attractiveness of the industry of which the organisation forms a part. Address Attitudes to Change Types a) Remember attitudes to change and change types - the 'laggards', or 'hiders and refugees' will need to be dealt with differently from those moving willingly making the change. Effective implementation Consider interventions to effect change: REMEMBER Cochrane Systematic Review No Magic Bullets.
Ongoing leadership remains very important - typically assisted and supported by a core group of committed people who can help drive the changes through.
Sample grid for analysing the sources and potency of forces for changeUse The grid is useful for clarifying the underlying forces for change.
External factors (such as the economy, competitors' behaviour, and political climate) or internal features (such as the relative power of different interest groups, distribution of knowledge, and uncertainty) influence the change in directions outside the control of managers. The need to identify, explore and if necessary challenge the assumptions that underlie managerial decisions.
Understanding that organisational change is a process that can be facilitated by perceptive and insightful planning and analysis and well crafted, sensitive implementation phases, while acknowledging that it can never be fully isolated from the effects of serendipity, uncertainty and chance (Dawson, 1996).
An important (arguably the central) message of recent high-quality management of change literature is that organisation-level change is not fixed or linear in nature but contains an important emergent element.Episodic versus continuous change Another distinction is between episodic and continuous change. Transitional change seeks to achieve a known desired state that is different from the existing one. Systems thinking and change Many of the approaches to organisational change found in the literature give the impression that change is (or can be) a rational, controlled, and orderly process.


Within the NHS the term whole systems thinking is now routinely used by managers and clinicians. Largely for these reasons we have drawn on insights from systems thinking - as well as on other concepts discussed in this section - to help organise the groupings of change management models in Part 2 and to highlight the interrelationships between these.
Change is everywhere and the rate and pace of it is almost universally reckoned to be increasing.
Whilst we shall consider change and efforts to manage it generally in organisations we shall look specifically at key issues around change in the NHS.
Every government since 1948 has re-invoked its founding principles, but there is less agreement about how services based on these principles should be organized. It will be useful when looking at the variables involved in planning and implementing a change program and will undoubtedly be of use in team building projects, when attempting to overcome resistance to change. Clear and visible commitment from the top of the organisation is essential in large organisational change programmes, as those at the top can articulate the message to the 'disbelievers' and create momentum for change. They analyse respectively the 'sources and potency of forces for change', and the 'readiness and capability' of individuals and group to enact change.
On occasion, as Beckhard and Harris point out, the energy for change emanates from one particular senior manager, rather than from a variety of environmental sources such as demographic change and new technologies.
This appendix describes and reviews a range of approaches, models and tools which managers and practitioners may be interested to learn more about as part of understanding and managing change.
Even the most carefully planned and executed change programme will have some emergent impacts.
Episodic Change (often also referred to as 'Step' change) according to Weick and Quinn (1999), is 'infrequent, discontinuous and intentional'. It is change that enhances or corrects existing aspects of an organisation, often focusing on the improvement of a skill or process. Here, below, is a summary of the main areas covered and the tools explained in 'Making Informed Decisions on Change'. Several 'gurus' (including Tom Peters and Charles Handy) and academics (notably Colin Carnall author of several books on Managing Change) have drawn attention to the 'challenges of change'.
Alongside remarkable stability in the espoused purpose of the NHS there has been almost constant structural change. This interdependence and continuing technical and organisational advances mean that services and organisations within the NHS are dynamic as well as complex. First, the nature of the change demanded must be specified, using tools of the sort described in previous sections.
To begin the exploration, readers are introduced to some of the key terms and concepts in the literature. However, these decisions may be based on unspoken, and sometimes unconscious, assumptions about the organisation, its environment and the future (Mintzberg, 1989) and are, therefore, not as unrelated as they first seem.


Sometimes termed 'radical' or 'second order' change, episodic change often involves replacement of one strategy or programme with another.Continuous change, in contrast, is 'ongoing, evolving and cumulative' (Weick and Quinn, 1999).
Accordingly, change can be understood in relation to the complex dynamic systems within which change takes place.Systems thinking originated in the 1920s within several disciplines, notably biology and engineering, and grew out of the observation that there were many aspects which scientific analysis could not explore.
Then all forces for change, both inside the organisation and external to it, are listed along one axis of a grid. When they have done so they can determine the readiness and capability of these individuals and groups to enact the roles required of them in the change process.
These will demonstrate the diversity of thinking and activity encompassed by the single term 'change'.Planned versus emergent change Sometimes change is deliberate, a product of conscious reasoning and actions.
Such implicit assumptions dictate the direction of the seemingly disparate and unrelated decisions, thereby shaping the change process by 'drift' rather than by design.
Also referred to as 'first order' or 'incremental' change, continuous change is characterised by people constantly adapting and editing ideas they acquire from different sources. At a collective level these continuous adjustments made simultaneously across units can create substantial change.
It may, therefore, result in the creation of an organisation that operates in developmental mode - one that continuously learns, adapts and improves.
Capability is determined by whether they have the power, the influence and the authority to allocate resources, and the appropriate information and skills. The distinction between episodic (or step) and continuous (incremental) change helps clarify thinking about an organisation's future development and evolution in relation to its long term goals.
The puzzle is why the NHS has been so unchanging, given the barrage of attempts to 'reform' it'. Beckhard and Harris (1987) have developed a Readiness-Capability Assessment Chart which enables the user to list individuals or groups who are critical to the change effort, and to rank them (high, medium, or low) each according to their readiness and capability with respect to change.Use In health care organisation's power is derived from a number of different sources and is not easy to identify as in other industries.
Few organisations are in a position to decide unilaterally that they will adopt an exclusively continuous change approach. They can, however, capitalise upon many of the principles of continuous change by engendering the flexibility to accommodate and experiment with everyday contingencies, breakdowns, exceptions, opportunities and unintended consequences that punctuate organisational life (Orlikowski, 1996).Developmental, transitional and transformational change Change can also be understood in relation to its extent and scope. This chart helps bring it into the open, permits assumptions to be tested and information shared and this increases the validity of the information available to the change agent.
Ackerman (1997) has distinguished between three types of change: developmental, transitional and transformational.



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