Table of Contents Overview 2 Proposal 2 Situational Context 2 SUMMARY OF RESEARCH & LITERATURE REVIEW 3 Framework 3 Diagnosis 4 Readiness Strategies 5 Leadership 5 Structure 6 Evaluation 7 References 13   Overview Proposal For our group change management model we chose Amelia’s workplace, a nursing directorate of the XXX which is about to undergo a significant changedue to budget cutsto staffing levels. Our presentation provided a detailed situational context of the change, an important variable in the change situation and a key factor in thechange model design. The diagnosis outlined a six-step frameworkto gather, analyse and evaluate macro and micro level organisational information to inform appropriate change intervention strategies. A diagnostic tool by Blackman, Flynn and Uygel (2013) is used to assess macro-level change readiness; a measure by Holt, Armenakis, Field & Harris (2007) to assess individual change readiness and a measure of individual resistance to change using diagnostic tool by Oreg (2003). We identified the hierarchical structure, transactional leadership and conflict between staff values and corporate objectives as obstacles to delivering rapid change. In response we proposed an integrated change model using Lewin (1951) 3-Step Change Model as the guiding framework, Kotter (2012)Dual Operating System as the renewed structure, and Kotter(2012) 8 Accelerators as the drivers ofthe change process. A key enabler of this model is a continuous cycle of feedback to inform and align the process and change recipients. We believe this model will facilitate widespread buy-in and commitment to deliver rapid and sustainable change. Situational Context The XXXfive year objective is to close existing gaps in health care service delivery inclusiveness and quality, whilst controlling costs and improving efficiencies. A 10% reduction in operating costs was handed down in 2015, with a further 12% reduction in staffing costs during 2016 (NHS 2014). The cuts are required to be in place within 6 months of the directive. The budget to facilitate this is limited to redundancy packages and limited training programs. Our subject, the nursing directorate, are responsible for assuring quality of care and preserving patient safety. Being a publically funded organisation the NHSE faces conflict betweenincreased demand due to ageing population, demands for higher quality services and a diminishing budget. The problem for the nursing directorate is, within six months how do they improve the breadth, quality and efficiency of their critical services within a 12% budget reduction in staffing costs? SUMMARY OF RESEARCH & LITERATURE REVIEW Framework Classical planned change strategies typically outlinea sequence of steps for altering individual and organisational behaviour to move an organisation from one fixed stage to another (Lewin 1951). These models take time to implement effectively as insufficient attention to detail through any stage may lead to an unsatisfactoryoutcome (Armenakis & Bedeian 1999).Hossan (2015) suggests lack of a proven framework to guide implementationis amajor cause of the poor success rate of top-down driven change initiatives, proposing Lewin’s (1951) 3-Step Model for Change as an appropriate framework for small scale incremental change in these conditions. Lewin (1951) described a successful change project as transitioning through ‘unfreezing’ of established behaviour and structure; ‘changing’ from uncertainty to a new understanding; and ‘refreezing’ as adopting a new mindset and practices. Lewin’s (1951) model appreciates that group behaviour is responsive to the context of a situation, and individual behaviour is constrained by group pressures to conform. Lewin (1947) also developed the Force Field Analysis model, describing the dynamics of change as upsetting the equilibrium of the group by strengthening driving forces and weakening restraining forces. Underpinning successful transition in Lewin’s models is strong, positive leadership to challenge held beliefs and attitudes that give restraining forces their power, and strengthening driving forces with an appealing vision of the new mindset and effective performance, instilling confidence in organisational efficacy to achieve the future state. (Hossan 2015). Diagnosis It is commonly understood that there is no hope of a successful change outcome if the organisation is not ready to adopt the change (Armenakis & Harris, 2009). For the desired outcome to occur, conflicts have to be resolved so that the employee's beliefs and cognitions align with those of the organisation's management (Holt et al. 2007, McComb 2013). Armenakis and Harris (2009) discuss a critical aspect of change readiness is correct diagnosis of the problem to inform appropriate actions. Lewin’s (1951) initial phase of change, ‘unfreezing’, involves developing diagnosis and intervention strategies to assess and cultivate change participants readiness to engage change. Blackman at al (2013) found that in cases of complex change, determining change readiness at both the individual micro level and organisational macro level are equally as important if change is to be successful. Building on Lewin (1951) Force Field Model, Blackman et al (2013)devised a quantitative diagnostic tool to measure the macro-level strength of change barriers and enablersto highlight where organisational adjustments were required to facilitate change readiness. They found key enablers were leadership power and distribution, a clear mandate, pattern breaking behaviour and shared understanding. Seven barriers were identified including operational structure and systems and power distribution indecision making. At a micro level, an employee’s willingness to participate is a key determinant of successful change implementation (Armenakis & Harris, 2009).Holt et al (2007)described readiness for organisational change as ‘a comprehensive attitude that is influenced simultaneously by the content, the process, the context and the individuals involved’ (p235). In developing their diagnostic tool of Readiness for Organisational Change, they found the most influential factors of individual readiness were beliefs surrounding their change-specific efficacy, organisational valence, managementsupport and commitment, and personal valence (p21). This research identified readiness was higher in group participants than individuals, and the level of readiness were predictive of measures of job satisfaction, affective commitment and turnover intentions (p21). Oreg (2003) found those who are dispositionally resistant to change are less likely to voluntarily initiate changes, and more likely to form negative attitudes toward the changes they encounter. In developing his ‘Individual Differences Measure of Resistance’, Oreg (2003)identified four sources of resistance; routine seeking behaviour, emotional reaction to imposing change, stress from short term and cognitive rigidity. The scale can be used to predict reactions to specific change. Readiness Strategies Armenakis and Harris (2009) discuss readiness strategies and common practices for overcoming resistance forces and effectively engaging employees, including intervening to inform and shape positive beliefs about the change, active participation in remediating change solutions relating to their area of work,and continual feedback to inform and align the readiness practices.Caldwell (2013) explains that habits, normative influence and uncertainty create forces that constrain favourable attitudes towards change can be overcome by promoting the change benefits to increase motivation, reduce uncertainty and increase perceptions of fairness. He explains thismobilising via 'felt need' is more effective than mandates or communicating directives. Leadership Buchanan et al (2007) find that transactional leadership disempowers staff, overlooks the value of team contributions and prevents delivery of sustainable change. Bass & Bass (2008) describe a transforming leader as one who would inspire higher levels of self-efficacy in staff, allowing them to transcend lower level security needs to attain self-actualisation. They posit that an effective heroic leader might exhibit transactional and transformational behaviours. Kempster, Higgs &Wuerz (2014) report that reliance on heroic leadership impacted adversely on change implementations due tolack of appreciation of the complexity of the change context. McComb (2013) finds this is particularly pertinent in health organisations as interventions must be seen as credible and appropriately designed by a diverse range of clinical and administrative professional networks for there to be wide spread buy-in. Understanding that follower’s prefer the certainty of unambiguous top-down direction, linked with participative collaboration and networked local activity(Collinson and Collinson 2009), Kempster et al (2014) found that distributed change leadership, as arelational process of many being involved with leadership, and participating in decision making and action taking in their localised context;increased engagement, commitment and learning, as well as contextualising the change to cope with the complexities of the situation. They find that distributed leadership emphasises leadership as a practice rather than a role (Harris and Spillane 2008) and has a positive effect on organisational change. Kempster et al (2014) conclude that distributed leadership and bottom up participation in the designing, pilot testing and implementation of localised structural or operational changes facilitates sociological and psychological processes of change, leading to wide spread buy in and more success. Structure Kotter (2012)incorporated distributed leadership in his ‘Dual Operating System’, advocating a networked collaboration of interprofessional volunteers working in synergy with the management driven hierarchy to champion vision, innovation of ideas, and inspired action, facilitating wide spread buy-in and more rapid change. The model as a complementary system, it can enact change without interrupting daily activities, informing and guiding the change process through a series of ‘accelerator’ drivers. Kotter (2012) recommends top-down delivery of the change imperative and vision, with continuous visible management support to clearly define the need, urgency and the commitment of management to the changes required. The intervention strategies are approached from the bottom up, involving peer driven diagnosis to assess readiness for change, interprofessional collaborationshares expertise across peer accelerator networks to innovate appropriate, effective interventions, and organisation wide initiatives to problem solve and drive innovation to develop new competencies, eliminate redundancy and waste (Kempster et al 2014). Kotter (2012) claims this process engages collective leadership, ownership and accountability for developing new competencies. Evaluation Patton (1987) discusses evaluation as a process of collecting and analysing information about a program’s activities and outcomes to make judgements about its effectiveness and to inform programming decisions (Patton 1987). As Kaplan and Norton famously wrote ‘what you measure is what you get’ (Kaplan and Norton 1992). Therefore, it is critical throughout the entire change process to measure and evaluate performance against the original objectives to continually inform and realign actions and the plan where necessary to ensure the change continually moves in the right direction (Blackman et al 2013). Blackman et al (2013) discusssome common factors in misalignment of evaluation and accountability due to premature evaluation before outcomes are delivered, inappropriate measures and bias, which may drive the change the wrong direction or to a standstill.   CHANGE PLAN FOR NHSE NURSING DIRECTORATE Using Lewin’s (1951) 3-Phase model as the guiding framework, incorporating Kotter (2012) Dual Operating System as the structure with Kotter (2012) Accelerate as key change drivers. Phase 1. Unfreezing 1. Establish a sense of urgency Urgency starts at the top of the hierarchy and must be strong to inspire determination. Communicate a clearvision of the future, describe effective performance and opportunities to appeal to rational and emotional need to succeed. Continually reinforce message to energise, drive action, participation and reassure of management’s commitment and efficacy. (Kotter 2012) 2. Build and maintain a guiding coalition (GC) Establish network of trusted interprofessional, multi-level volunteers including some leaders and managers, with broad range of skills and functions. Volunteers must bring energy, enthusiasm and commitment, and see themselves as change leaders. All are equal with decision making legitimacy to avoid retarding information flow.This shifts locus of authority to group level (Kotter 2012). Diagnosis Gather quantitative data about the functioning of the organisation to measure organisational readiness for change usingBlackman et al (2013) diagnostic tool. Measure strength of barriers and enablers, determine what can and needs to be changed to upset the current status quo. Source Blackman et al 2013 Gather qualitative data to measure micro-organisational readiness for change from personal interviews, and analysis of Holt et al (2007) and Oreg (2003) questionnaires. Evaluation and design of appropriate interventions to influence positive attitudes and perceptions towards the change. 3. Formulate a strategic vision and develop change initiatives designed to bring about the future vision The vision must be feasible, simple to communicate and emotionally appealing, painting a picture of what the directorate will look like in 6 months’ time. It serves to guide focus and rational decision making (Kotter 2012). Participationto develop change initiatives. Volunteers arrange communities of practice within their division to critically examine existing processes, identify redundancy and waste (Armenakis and Harris 2009; Kempster et al 2014) GC incorporates and hybridise processes, further eliminate redundancy and waste Motivation: Individuals start to internalise the need to change with perceptions of fairness (Caldwell 2013), ownership and accountability (Kempster et al 2014) Feedback: Visions and initiatives drafted for presentation to executive committee (EC) (Kotter 2012) Inform and Align: EC comments accepted as valuable input, reinforces management support and trust. Aligns distributed network with hierarchy (Kotter 2012) 4. Communicate the vision and the strategy to create buy-in and attract more volunteers Utilising all interpersonal communication and social networking avenues available, communicate the vision, the strategies and the action plan vividly, memorably and authentically,to engage discussion, feedback and shared vision in the ambition of the message (Kotter 2012). Encourage ‘viral’ sharing to create widespread enthusiasm. Encourage ‘comments’, ‘likes’ or ‘dislikes’, to continue to build on the sense of urgency created in step 1. EC requested to ‘like’ employee’s constructive feedback to show support and encourage wider input. Present initiatives for general input and feedback. Host support networks to generate deeper understanding and wider participation. Communities of practice to create pilots of the new processes, provide feedback and realign (Kempster et al 2014). Motivation: Individuals internalise the need to change, perceptions of fairness (Caldwell, 2013) Evaluation: Number of volunteers, level of enquiry, enthusiasm, and volume of sharing indicate how wide the level of buy-in is. Phase 2. Movement 5. Accelerate movement toward the vision by ensuring the network removes all barriers Sticking points are brain-stormed by the GC, the problem articulated and circulated to the wider organisation for input. Additional volunteers step forward with new ideas or information. Internal coaching, mentoring, training across professions and functions to broaden the skills of each individual to cope with the new tasks and responsibilities. Counter negative perceptions with reinforcement of positives of change and a vison of what success looks like. Communicate: EC reinforce belief in the ability of directorate to achieve vision. Evaluate number and effectiveness of new processes, establish Key Performance Indicators. 6. Celebrate visible, significant short-term 'wins' Provide continuous feedback by communicating short term wins and benefits that are obvious, unambiguous and related to the vision to expand buy-in, motivate and remove obstacles from sceptics. Communicate what is not working…..information missing? Advertise it to encourage volunteers, and reinforce the urgency. Phase 3. Refreezing 7. Never let up, keep learning and don’t declare victory too soon. Measure, evaluate and continuously review processes to ensure most efficient combination. Use the network to brainstorm other problems, 8. Institutionalise the changes in the culture Incorporate the new processes in the daily practice (Kotter 2012), set key performance indicators to enable ongoing evaluationto inform continual improvement of the processes. Conclusion: Initiating a rapid, planned change in a highly structured organisation like the NHSE is fraught with barriers to change from a rigid organisational structure (Blackman et al 2013), transactional leadership (Buchanan et al 2007) and conflict between frontline staff values and corporate objectives (McComb 2013). The complexity of this situation requires an integrated change model to enable top-down driven change with participative bottom-up collaboration to design appropriate and engaging change interventions and implementation strategies. Hossan (2013) recommends Lewin’s (1951) 3-Step Change Model as a proven framework to guide incremental change in rigid organisations. Blackman et al (2013) advise Lewin’s Force Field Analysis is a powerful diagnostic tool to understand what organisational adjustments are needed to initiate and implement sustainable change. They have adopted this model into their diagnostic tool to measure macro-organisational readiness for change. At the individual level, Armenakis & Harris (2009) find employee’s willingness to participate is a key determinant of successful change. Caldwell (2013) suggests participation increases engagement and perceptions of fairness, whilst promoting the benefits reduces uncertainty and stress. Kempster et al (2014) reports a positive relationship between distributed forms of leadership and positive organisational change. Kotter (2012) incorporated distributed leadership into his ‘dual operating system’ advocating a networked collaboration of change leaders who design and drive situationally appropriate change initiatives involving wide spread participation. The network complements the hierarchical structure utilising bottom up change strategies to meet top-down directives. A key enabler of this model is a continuous cycle of feedback to inform and align the processes and behaviour of the change recipients. Kempster (2014) and Kotter (2012) agree that distributed leadership and networked collaboration and participation facilitates widespread buy-in and commitment to deliver rapid and sustainable change.