In this video, we're going to review and discuss some of the frameworks and processes of change. As we discussed before, change management can be messy. There may not be one singular correct way to do it, but having a structured approach will help us learn and will help us avoid some common pitfalls. Before we get going, I would like you to think about your own change efforts that you've been a part of, ones that you've led or otherwise participated in. And I'll ask you to pause the video here for a moment and do some activities and some deep thinking because this will actually help us move forward. And our goal, long term, with this entire lesson is to set you up so that you have a strong rooted framework of your own that will help you in your work. So, at the starting point, let's think about what your model of change is. So, I want you to think about efforts that you've been in, describe your model for change. What has a process looked like? What have been the key things that have driven change, that have made change occur, or some things that have prohibited you from being successful? I want you to write those things down. Draw a picture, a framework, a model of change, and we'll take that and elaborate on it through the rest of this lesson. So, I'd like you to do that now, to pause the video, and write down, draw your model for change. Great. Thank you. We're going to take that and we're going to look at what your model looks like compared to some of the models in the literature where you can enhance your own or you can reorganize your own so that you have something that works for you. So, we'll start with the simplest model of change we can manage. In this model, we start with the current state, that is how our organization currently functions, what our work processes are, what our structures are, what our outcomes look like, and we got to go through some change process. So, the current state has to be modified in some way and we're going to arrive at our future state, which we hope is better in terms of the outcomes we see, it's better for the staff, it's better for the patients, it's a wholly better organization. To get there, this involves three main steps. So, we have to unfreeze what our current state is. Organizations tend to want to stay the way they are because, again, change is effortful. We need a good reason to change and we'll talk about that. The change process itself is a search. We're trying to discover what that new way of work might look like. Even if we're implementing something very prescriptive like a bundle or a best practice, often, we're going to have to think through how we can actually achieve that. Does it have implications for supply or equipment? Does it have implications for staffing or our work processes throughout the day? What do we need to do to reorganize ourselves? And that's part of the search process. And then of course, once we reach that future state, we need to make sure the gains or the improvements we've found stay there. Organizations also have a tendency to migrate back to what their resting state is, their normal state, through habit, through other forces. It may be difficult to maintain or sustain changes. So, there's a refreezing that has to happen, so that the new state becomes the new normal state from here on out. And another way to think about this, which is very helpful in my mind, is to think of this as a messaging and a transition between messages of pain and remedy. There's an old saying that change only happens when the pain of staying the same finally exceeds the pain of change. And there's a little bit of truth to that. And we need to be mindful of how we message the change throughout this process. And one way to think of it is this, and to organize and think about how are we communicating about the change or messaging the change through our process. So, the anticipated or the current really talks about the current state of our organization or the envisioned future state, that anticipated thing that's going to happen, and the problem and opportunity here are really the messages of pain which is the problem or opportunity which is potentially the remedy. So, if we're talking about a current problem, the situation is that we're already in trouble, and we need to act or we're going to have an immediate loss of something. So, this is how we can unfreeze an organization. This could be performance as an external measure that generates revenue. We could be at risk for losing revenue based on our current performance. We can also think, though, proactively prospectively. If we act now, we'll be able to better position ourselves in the future. There's something you can capitalize on. So, if we act now, good things are going to happen and the pain that we're trying to message is the loss of potential advantage down the road. Similarly, an anticipated problem is we're not in trouble now, but because things are changing, we can be down the road. So, if we don't go through the effort of changing now, we're going to lose something down the road, we're going to lose something that we already have. And finally, we can have an anticipated opportunity. We're down the road. We could position ourselves to be in a situation of great benefit if we do something, and the pain, of course, as we're avoiding the loss of potential advantage or benefit. So, things to think about as you try to cast what your problem is, what that thing it is you're addressing about the organization currently, think about that in terms of current or anticipated problems in the state of the organization and what the problems or opportunities may be moving forward. Another key thing to think about anything about having your framework or model of change is to think about, as an individual, what drives people to do things differently. And there's a lot of research on this now that people are driven by two systems. One is old, evolutionarily speaking, and it has to do with emotions, and it's not particularly logical or rational but it drives a lot of what we do. And the second system, that's our rational logical system or conscious deliberation where we can reason out and make good informed choices. Both of these influence our behavior. And when they conflict, when our emotional system tells us something different than our rational system, the emotion will win. So, we want to make sure in our efforts that we address both of these issues and we take both of them very seriously. And we have plans to connect with people emotionally and connect with people rationally. And many times, we want to direct the mind so we make sure we have clarity around what it is we're proposing and what it is we want to see happen. And if we see resistance, to make sure that we're doing that clearly, because many times, we're not engaging the rational system effectively. We've not communicated what it is we're trying to achieve. Conversely or simultaneously, we also want to motivate the heart, the emotional system. We really want to touch people there and move them because that, of course, needs to be there as well. And sometimes, if we see people resisting out of what appears to be laziness, or disinterest in what's going on, they may be exhausted. And engage people in that way and understanding how the change you're proposing can help alleviate some of that, or it can at least be sensitive to that. So, those are a lot of ideas behind what drives change and what we can do to be more effective at changing behavior in organizations. We'll talk now about a process-oriented framework, so a step by step guide of things you can do to pull those ideas together. The unfreezing, the search, the refreezing, addressing people's emotional side, and the rational side, let's try to pull that together into one framework where we can clearly apply this to our projects. So, John Kotter has developed such a model, it's been around for quite a while and helps pull together some of these issues. The first step is to create a sense of urgency, and this relates back to our idea of messaging pain and remedy. What are the challenges we face? What are potential losses, potential gains? How does our change address those issues? We're going to pull together a guiding team after we built a sense of urgency who are going to be our partners and making this change happen. It takes lots of perspectives. We'll talk more about this in the stakeholder analysis piece, but we need representation and participation from all of the groups whose work will be impacted by the change we're proposing. We want to develop that change vision and strategy. Again, this is clearly communicating that future state. We have problems, absolutely, but we need a positive vision of something to work forward to and we need a clear plan to get us there, and engaging your stakeholders to collectively develop this, is going to be a really important step to moving things along. The last piece, communicating for understanding and buy-in. We talked about if you see resistance it's because you may not have clearly articulated the nature of the change or what can be gained from it. That's a critical component to. Listen to your stakeholders, your change team to help develop those messages that can help get people on board with your efforts. We want to empower others to act. This goes back to our idea of having a fair, open and participatory process, where people feel they are agents of change and not recipients of change. So, finding other ways to engage others to get this change realized and into place is very, very important. Producing short term wins. Again, change is effortful, it takes effort. People need to feel like they're being successful. They need to feel like they're actually making change happen so, this can be small tests of change, preliminary data on an outcome measure or a process measure, different things will help people maintain that level of effort, energy, and motivation to see that good things are happening because of their efforts. So, that's a very important piece. The last one seems simple but it's hard, it's don't let up. Many change efforts fail because they give up too soon, or they give up at the first sign of potential failure, or the first barrier they run into. Being persistent takes a very, very long time. And the last piece talks about creating a new culture. What can we do to make the new, the future state that we've arrived at, our new normal state? And this involves thinking through, with your stakeholders, what can we do to make this change a permanent change. One last framework to think of as you go through this, is the idea of moving from that current state to a desired future state. There are two things that work here. So, there are some driving forces that are going to try to push you and push the organization to some new state, and there are some restraining forces that are going to hold you back. So, driving forces can be all the effort and the energy you may put in, as a part of a change team, that could be training staff, that could be putting new order sets in, that could be changing policies. All these things are driving people to do things differently, and the restraining forces could be things like workload, they could be exhaustion, they could be people's perceptions of the initiative, they could be competing priorities, they could be lots of different things, and that's the point, understanding what is driving your change forward and what may be holding your change back. And the lesson from the literature is clear. You can address driving forces and, of course, that's the right thing to do, but without addressing restraining forces, you may not get the result that you want. One of the big missteps is not addressing or planning for the things that are holding you back. So, one easy tool to implement within your change team is to do an analysis of those things as a part of a meeting, getting your stakeholders around the table to think through, what are the things that we're implementing to move us forward? What are the things we see that are holding us back? And from that, if you can get broad input on what those things are as a group, you can prioritize and plan to address those. And again, we want to strengthen our driving forces but we really want to try to mitigate our restraining forces, too. Those can be more challenging to do but they're more fruitful for the success of your project. So, a few lessons learned on the change models and frameworks to date. There are many different models, there may not be one right way to do it. It's messy. But having a framework can really help you through this process. It helps you organize your thoughts, be proactive in addressing the restraining forces or the barriers. You have to be proactive in learning from your experience as well. We want to think about change as a process unfolding over time and not an event, not something we do or something that happens at one point in time, but it's a process, and much of the work leading up to any actual change in the organization is critical to this. What we do to identify and build that sense of urgency, how we message the pain and remedy, how we engage stakeholders and build our change team, that's a lot of work that comes in the upfront part of a change management process that's really going to determine if you're successful or not. And carefully communicating these messages of pain and remedy, what are people's thoughts on the loss that's involved with change, on the work that's involved with change, on the potential for gain that's involved in the changes you're proposing, listening to people, and reflecting that through how you message your effort is very, very important. And of course, throughout this, focusing on the mind, the rational side, the rationales, the logic behind what we're doing, but also connecting to people on a motivational level, on an emotional level, what is in it for them, what is in it for their patients that they're there, caring for diligently, what is it that's making the world a better place, not just the logic, but what's going to move people.