Leading and Changing

School of Management, RMIT

Tuesday 9 December 2003

Assoc. Prof. Janet A Secatore

Director of Nursing

The Alfred

Change - a constant - lack of certainty

Complexity - always in crisis

Leadership - to manage / cope with change

Goals

Introduce (re-acquaint) you to ideas and authors

Encourage you to think, reflect, learn

Change

If change is happenning all the time, why

aren’t we very good at it?

Paradigms

establish boundaries

identify behaviours for success

Set of Rules & Regulations that

Characteristics of Paradigms

CommonUsefulReverse common senseMore than oneParadigm ParalysisParadigm FlexibilityCan choose to change paradigm

Change and Paradigms

Changes in societal paradigms

Changes in healthcare paradigms

Complexity

SimpleFollowing a Recipe

Recipe is essential Recipes are tested to

assure replicability of later efforts

No particular expertise; knowing how to cook increases success

Recipes produce standard products

Certainty of same results every time

ComplicatedA Moon Rocket

Formulae are critical and necessary

Sending one rocket increases assurance that next will be ok

High level of expertise in many specialised fields & coordination

Rockets similar in critical ways

High degree of certainty of outcome

ComplexRaising a Child

Formulae have only a limited application

Raising one child gives no assurace of success with the next

Expertise can help but is not sufficient

Every child is unique

Uncertainty of outcome remains

Plsek 2003

Complex Adaptive System

Collection of parts Share an environment or space Parts can act independently Parts are interconnected Action by any part affects the whole

Examples : immune system, insect colony, flock,

stock market, just about any collection of humans

Plsek 2003

Complex systems can be described by the following elements…

Structure (concrete attributes)

Process (sequence of events)

Pattern (phenomena, behaviours)

Plsek 2003

Medication Administration System

Structure

Pharmacy

Nursing Units

Elevators

Committees

Info systems

Individual roles

Etc.

Process

Ordering

Transcribing

Entering

Dispensing

Etc.

Pattern

Prescribing practices

Types of errors

Feelings & values

Supportive behaviour

Blaming

Fear

# of errors reported

Etc.

Plsek 2003

Organisational Change Efforts

Much change in structureClassic improvement work focuses on

processPatterns are more difficult and are often left

largely untouchedSuccessful transformation requires

integration and change in structure, process, and pattern

Plsek 2003

Five Key Patterns in Organisational Culture

Key patterns that need rethinking in health care organisations include:

the nature of relationships how decisions are made how power is defined, acquired, and used how conflict is handled how learning is supported

Plsek 2003

Leadership

Change our thinking, not structures

(Morgan)

Organisations are overmanaged and underled

(Kotter)

Leadership is “influencing others”

Neutral

Leadership

Positively influencing others

Giving people a reason to follow

Vision Precedes Success

Have to know what you want to be,

not just want to want to do

(De Pree)

Management or Leadership Role

Tool

A means to an end

What do you want to achieve?

Leadership

“Capacity to translate intention into

reality and sustain it.”

“Influence and organise meaning for

members of an organisation”

(Bennis)

Leadership

“Define mission.”

“Create a human community held together

by a work bond for a common purpose.”

(Drucker)

Leadership

“Capacity to hold a shared picture of the

future we seek to create.”

(Senge)

Leadership

“The first responsibility of a leader is

to define reality. The last is to say thank-you.

In between the leader is a servant.”

(De Pree)

Leadership

Leadership is that “influential increment

over and above mechanical compliance

with the routine directives of the

organisation.”

(Katz and Kahn, 1978)

“… to make the agony of decision

making so intense that one can only

escape by thinking.”

(Fred Friendly, 1993)