Leading and managing change

Organisational change

A systematic approach to reshaping organisations in line with their future goals, aims, vision and philosophy

The change management competency that relates to the ‘Leads Self’ element of LEADS is self-management. Change managers must be self-managers. Self-management requires resilience, flexibility and emotional intelligence; it means taking on personal responsibility for the change management effort.

Change management

A structured and intentional approach to change that may involve a detailed plan or a broader but deliberately chosen approach

The competencies that relate to ‘Engages Others’ are influencing others and communicating effectively. Change managers influence others through relationship-building, networking and writing communications. They also facilitate meetings to reach agreement between key stakeholders to the change.

Change managers ‘Achieve Outcomes’ through skilfully applying project management knowledge, tools and techniques. They structure and facilitate change to provide the required outcomes. They undertake impact assessments to gather evidence that these outcomes have been achieved.

Change managers ‘Drive Innovation’ as part of their job and in themselves, through continuous professional development. They acquire specialist expertise in communications, and in training, learning and development. They coach others to share their skill set and promote change management as a profession. Strategic thinking, analytical thinking and a holistic perspective are key intellectual skills for change managers.

In order to facilitate change, change managers must understand the environment in which the change will occur and ‘Shape Systems’: what kind of organisational culture exists, and how ready is the organisation for change? Change managers need to apply their thinking and judgement to the principles of change within their environment (Change Management Institute, 2012).

Kotter (2012) suggests that individuals and organisations will continue to see increasing rates of change into the 21st century. An environment of constant change will make an adaptive organisational culture and ‘teamwork at the top’ essential requirements. People who can communicate vision will be required to lead flatter hierarchies of semi-autonomous teams. Greater and more skilful use of change management methodologies is essential in order to achieve personal and organisational benefit.

People and change

Actively managing the change process requires a focus on the human element of change. The negative consequences of poor change management can be seen in time and cost blowouts, false starts and failure to complete projects, as well as adverse health outcomes in staff. The literature is clear that failing to manage change effectively can have serious psychological and physiological impacts on staff, and human resource implications such as increased staff turnover and absenteeism. For example, the human impact of a poorly managed change process can lead to deterioration in employee health and wellbeing, resulting in an early exit from the labour market (Vahtera & Virtanen, 2013). Some studies have reported employees experiencing disrupted sleep, depression, weight gain and high blood pressure (Ferrie, Shipley, Marmot, Stansfeld & Smith, 1998). Other negative impacts reported include an increased number of sick days (Hansson, Vingard, Arnetz & Anderzen, 2008) and a significant increase in staff receiving stress-related medication (Dahl, 2011). In the context of health services, poorly managed change can also have negative patient outcomes, including increased length of stay and mortality rates (Timmers, Hulstaert & Leenen, 2014).

To ensure that change is truly successful, change and transition are required (Bridges & Mitchell, 2000). Therefore, the manager needs to be cognisant of the two elements: change is the external process that impacts on the individual staff member (most organisational change could be considered external, such as policy, practice and structure), while transition is internal – the personal, emotional and mental process the staff member goes through to accept and adapt to the change. Through transition, the staff member accepts the change as personally ‘safe’ and perceives a personal and organisational benefit to modifying their practice or behaviour. Managers must fully engage their staff and assist them to transition from one process to another, working through all their employees’ issues and concerns with them so they embrace the proposed change.


The personal, emotional and mental process a person goes through to accept and adapt to a change

When staff experience a series of change cycles and go through the psychological stages of change repeatedly, it can lead to change fatigue (Bernerth, Walker & Harris, 2011). Upcoming change can also lead to anticipatory grief (Kubler-Ross & Kessler, 2005), associated with the future stress of change, particularly if previous change has been distressing to the individual. The prospect of a new round of change will stimulate grieving for the loss of the current situation, even before the change has occurred. The sense of loss can be due to perceived or actual loss, of status, influence, power, work history or emotional investment in a project, and to changes in the team and the prevailing culture. A clear change management plan provides a structured approach that may give some comfort to staff damaged by poorly managed processes in the past.

Change fatigue

Lassitude, apathy or passive resignation by individuals or teams as a result constant and continual organisational changes

Anticipatory grief

Mourning that occurs before an impending or known loss

In many ways, particularly during large-scale change, managers need to take staff through a process similar to the grief process described by Kubler-Ross and Kessler (2005). The stages of grief model has been adopted over the years to be used in the change process, as many staff feel similar levels of loss, grief and distress during organisational change. Managers should expect staff to go through a range of psychological stages until the change is fully integrated, including shock, disbelief, doubt in their own abilities, acceptance that the change is happening and finally practice and amalgamation. During this process, the individual and the team will experience self-esteem and morale highs and lows as they realign themselves to the new world of work (see Figure 26.1).

Figure 26.1 The stages of grief / change model

Frameworks for change management

Lewin’s field theory and force field analysis

The earliest popular framework of change, developed by Kurt Lewin (1947), is the simplest. It is because of its simplicity that it is a useful starting point. Lewin introduces the idea of the change process taking three steps: ‘unfreezing’ the original situation, ‘moving’, or introducing the change, and ‘refreezing’ the new situation in order to make the new standard permanent. He describes change as occurring through the interaction of social forces, some of which support change while others oppose it, within a ‘field of action’.

However, while Lewin does describe the opposing forces as a kind of force field, he does not recommend that change managers undertake the kind of force field analysis that commonly bears his name today. Force field analysis lists the forces for change on one side of a page and the forces against change on the other side. It simply and graphically illustrates where arguments and stakeholders sit in relation to the change. A popular tool for change managers, it is sometimes criticised as being too simplistic to be effective (Burnes & Cooke, 2013).

Kotter’s theory of organisational change

Fifty years later, John Kotter (2012) took Lewin’s (1947) three steps and expanded them into eight steps for successful change, as outlined below. Kotter’s work has been used extensively in a range of fields, including the health industry, to frame a structured approach to change management.

‘Establishing a sense of urgency’

In Kotter’s first step, the health manager must get enough staff to see there are challenges or opportunities that need to be addressed in the short term. Without an adequate sense of urgency, the manager will find it nearly impossible to achieve the necessary traction to start staff moving and taking the problem seriously. The manager may need to work through a range of staff emotions, such as complacency, anger, self-protection, pessimism, change fatigue, self-interest or reluctance. Each of these negative staff attitudes will need to be worked through to find the issues that unite the team to move forwards to address the problem in a coordinated fashion (Kotter, 2012, pp. 37–52).

‘Creating the guiding coalition’

Creating the guiding coalition relies on the manager developing a cohesive team to help drive and guide the change. Central to this stage of the process is to bring together the right people with the right skills to do the right job. The manager’s roles at this stage are to ensure good two-way communication, motivate staff and create a sense of excitement, share important information to developing trust, and establish team norms and protocols (Kotter, 2012, pp. 53–68).

‘Developing a vision and strategy’

The manager’s role in this crucial step is to help staff, and the guiding coalition, to see possibilities, what the future might be. The manager also needs to develop a solid strategy (plans and budgets) to underpin the future possibilities. They should ensure that they build on the sense of urgency and the reason staff accepted the change in the first place (Kotter, 2012, pp. 69–86).

‘Communicating the change vision’

At this stage the manager needs to communicate a clear and unambiguous vision. Staff are likely to have a lot of questions by this point, and the manager should be proactively answering questions and communicating to maintain momentum. It is important to keep on message and ensure that the message is communicated in clear language that staff can understand. It may be necessary for the manager to repackage the same message in different forms for all staff to be clear about why the change is important (Kotter, 2012, pp. 87–104).

‘Empowering employees for broad-based action’

The manager needs to remove barriers and allow staff to make the necessary changes. Barriers may be restrictive policies and protocols, outdated management practices, insecure managers and negative language regarding the change (Kotter, 2012, pp. 105–120). Kotter and Cohen (2002) suggest that at this stage, the manager should not try to do everything at once, instead breaking the solution down into smaller projects and allowing staff to act on these smaller, bite-sized objectives.

‘Generating short-term wins’

At this stage, the manager should try to achieve a number of small wins. This will bolster the guiding coalition and demonstrate that the overall process can be successful. Wins creates confidence in the change process and. help build momentum. Each win must be appropriately celebrated and communicated. The manager needs to provide constructive feedback to staff. Each win stage also provides a perfect opportunity to evaluate how the project is proceeding and what learnings can be used in other elements of the process (Kotter, 2012, pp. 121–136).

‘Consolidating gains and producing more change’

There is a danger of celebrating wins too early and stopping there. In this step, the manager needs to keep up the urgency and ensure that there is continued enthusiasm for the project. It is a good time to remind staff about how far they have come to date and how close the finished project is. Continuing to sell the vision is a positive way of encouraging staff to consider why they signed on in the first place and what is at stake if they finish the change prematurely (Kotter, 2012, pp. 137–152).

‘Anchoring new approaches in the culture’

At this final stage, the manager is responsible for ensuring the project doesn’t slip or the staff return to old habits, processes and approaches. New approaches and behaviours should be highlighted, recognised and rewarded. The manager needs to build the change into everyday work practices, including orientation of new staff and revised protocols and documentation. The completed change process must be communicated to staff and the improvements that have arisen from the new change emphasised (Kotter, 2012, pp. 153–166).

Feb 6, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Leading and managing change
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