9.2. Planning tips for successful change

You might come up with a great solution to improve access or responsiveness – but not everyone seems to agree that it’s such a great idea. How can you plan for a successful change? What do you need to think about, do and say to make it more likely to achieve (and sustain) the change?

Major considerations

• What is the reason for the change?
• Draw out a map to show how you are going to achieve change, step by step.
• What is the incentive that will motivate people to get behind the change? Will additional incentives be needed?
• Is there a proven methodology that can be used to help make the change?
• How will you know that change has taken place? How will you measure it?
• How will you enrol the support of stakeholders?
• What training or education will people need to help make the change?
• What information are you going to use to support the change and sustain it?
• What feedback mechanism will there be to review the changes made?
• What personal support will people receive who are involved in the change?

Who will be affected?

Consider people involved indirectly as well as those involved in the task or activity and key decision-makers.

• It is often people who are not directly involved who can scupper progress – not because they are being uncooperative but because there are practical considerations that you haven’t considered.
• For instance, if surgery hours are extending, you will have thought about the staff who need to be on duty, but have you remembered the cleaners who might now have to work later? Are they able to do this?

How might people affected respond to the change?

‘It’s just change for the sake of change.’

‘Yet another government-imposed change.’

‘How are we supposed to cope with yet more change?’

‘It’s going to be a real benefit for our patients.’

‘It feels really positive that we’re shifting our focus to support our patients to care for themselves.’

How can you change negative perceptions? Perceptions are not right or wrong – they are just how people see things. For change to be successful, people need to see the future, after the change, in a more positive light. They also need to agree with you that the practice cannot stay as it is. If the change is being imposed externally, you still need to identify meaningful reasons for change and potential positive outcomes for all those involved.

When should you communicate with those involved?

• Early and often!
• Don’t wait until you have got answers to all the difficult questions and sorted out exactly how things will work in the new way – the risk is that the team involved in change will be disappointed and demoralised when others find fault with the thinking.
• Once you have considered how people might view the change, you need to have early discussions with them to establish their real perspectives.
• Encourage each person to explore how they feel and their worries – capture this in writing as you go along, so you can summarise back and check that you have understood their points correctly. This will increase their trust in the process and strengthen their belief that their input does count.

Do people recognise the need for change?

• If not, what else can you do to help them see this for themselves?
• Have there been issues or grumbles in the past about the existing approach that you can use to campaign for change?
• Can you get those who oppose change to conduct some interviews with patients so they can hear about how individual needs are not being met?
• Have you identified positive benefits of the future you want for the practice that are meaningful for all involved? The closer these benefits can tie in with people’s concerns and the reasons for change, the more motivated everyone will be to achieve it.
• Without a perceived need for the change, it will be very difficult to achieve it and make it last.

Welcome feedback

Welcome the feedback you are given. When people express their thoughts and feelings about change, this is valuable. If you label disagreement, concerns or reluctance as ‘resistance’, you might not utilise the full value of the feedback you are being offered.

Feedback shows that people care and view the change as important – but make sure it is specific and not just discomfort with any kind of change. Probe people to help them pin down what’s driving their anxiety or the cause of their disagreement.

Be warned. Apathy or passive agreement may disguise a lurking problem, which can sabotage the change at a later time. It’s better to have all the concerns out in the open as early as possible.

Next steps

Work with everyone including your critics to develop what you would like to change and how – involving them helps develop a sense of ownership. If there are too many people to work with simultaneously, ask individuals to be your ‘sounding board’ or ‘critical friend’, to spot flaws in your proposals and help develop better solutions. This is more effective than presenting the idea or solution without consultation and hoping people will agree with it.