Leadership And Organizational Change PDF

LEADING ORGANIZATIONS Mahmoud Sakr, MD, PhD, FACS Professor of Surgery Faculty of Medicine Alexandria University  INTRODUCTION Leading organizations requires an understanding of how departments run & how they relate to...

LEADING ORGANIZATIONS Mahmoud Sakr, MD, PhD, FACS Professor of Surgery Faculty of Medicine Alexandria University  INTRODUCTION Leading organizations requires an understanding of how departments run & how they relate to each other Flexibility in organizational structures is essential to ensure best fit to local contexts Clinical leaders need to be aware of the different sources of their power & to know which form to exercise when Leadership plays a crucial part in shaping & changing the organization‟s culture The key organizational resource is its people & CPD is important for organizational effectiveness  A CAUSAL MODEL for Organizational Performance & Change Burke-Litwin Change Model  Organizational Performance & Change Model It explains the organization‟s component parts & how they relate to each other in a time of change It shows the hierarchy of factors within an organization & hence the flow of influence from one factor to the next. It revolves around 12 organizational dimensions (variables) It is based on the “open systems theory”, which suggests that “change comes from external influences”. Two main uses of this model: 1. Diagnose a problem within the organization 2. Create an action plan (for a change initiative) The model provides variable at different levels: 1. Total system: mission – strategy – culture 2. Local work-unit level: e.g. climate (perception of how work unit is managed) 3. Individual level: motivation – needs – values – job - person 4 Groups of Elements within an Organization 1. External environment 2. Transformational factors 3. Transactional factors 4. Performance External Environment Forces or conditions outside the organization that affects its processes: Government regulations (from current political priorities & changes in legislation to economic constraints on health services) Consumer behavior Customer satisfaction Media, etc. Individual &&Organizational Individual OrganizationalPerformance Performance The overall output of the organization. It is represented in several ways e.g. turnover, productivity, customer satisfaction, etc. Transformational Factors Strongly affected by ext. factors & strongly influences the transactional factors 1. Leadership It provides direction by developing a vision, serving as a role model & by motivation (to lead = to guide & influence) 2. Mission & Strategy It describes the purpose of the organization & its processes 3. Organization Culture The norms, believes & values that guide the organization behavior (This is the way we do things around here)  Transactional Factors Represent day-to-day operations within the organization (you do this for me, I do that for you) 1. Management practices (behaviors, activities, decision-making) 2. Structure (organization chart: hierarchy, departments, etc.) 3. Systems (PPs): mechanisms (information system, financial, production, marketing, HR, etc.) 4. Work-unit climate (team‟s working environment) 5. Motivation (to inspire & direct employees) 6. Task requirements & individual skills/abilities (match) 7. Individual needs & values (pay, work/life balance, etc.) Leadership Clinical leaders can make sure that whatever resources are available are used efficiently & effectively. Criteria for Allocating Clinical Resources Equity: All people who need care have access to services Allocative efficiency: Funds are not wasted on services which have low effects on health Technical efficiency: Only the minimum necessary resources are used to deliver a particular activity or set of activities Black & Gruen, 2005.  Clinical leaders influence decisions of health professionals Ensure implementation of EBP „OR‟ time is allocated optimally Expensive equipment & facilities are used in the best way  Vision, Mission & Strategy Clinical leaders providing the organization‟s vision need to ensure that it is consistent with both its mission & the strategies that have to deliver it. They must also ensure that appropriate strategies are developed & implemented. The 3 address different organizational questions & operate over different periods. Where is no vision, there ins no hope - George Washington  Concept Question Addressed Time Frame Mission Why does this organization Refers to the present exist ? (purpose) Strategy How will this organization Usually over 3-5 deliver its mission? years Vision Where does this Focuses on more organization see itself in distant future the future? Mission focuses on intended outputs & outcomes + recognising the inputs required to achieve the outcomes. Strategy provides the link between where we are now (mission) & where we want to be in the future (vision). Organizational Culture Definitions / Descriptions How things are done around here A set of meanings, ideas & symbols shared by a group & evolved over time. The social & normative glue that holds an organization together  The NHS contains many different sub-cultures (ethnic, religious, occupational, gender, etc. with complex relationships between them).  Thus managers, physicians, nurses, therapists, clerks, porters, cleaners, etc. each has a distinct sense of identity & purpose.  Clinical leaders need to understand the nature of their organization‟s culture, know how to assess it & recognize when change is necessary  Importance: Improve recruitment (70%) – improve employee retention (65%)  Management Practices How managers behave on a day-to-day basis in the delivery of organizational goals & of the factors that influence that behavior. Practicalities are best understood in terms of relationships i.e. managing relationships between: - Different groups of HCPs - HCPs & service users - HCPs & organizations to which they are accountable Clinical leaders may need to manage the tensions that exist between those with different sources of power (clinicians - administrators - finance officers) Power concerns the extent to which one individual has influence over another within a certain social system. A has power over B to the extent that they can get B to do something that B would not otherwise do Leaders need to know under what circumstances to exercise which form of influence or power. They should also be aware of the different kinds of power being exercised by others (resolve tension between doctors, administrators, finance)  Organizational Structure Organizational structure refers to „the formal division of work & labour, and the formal pattern of relationships that coordinate & control organizational activities‟ It is usually displayed in the form of an organizational chart. Prof. of leadership (Harvard Business School)  Clinical Leadership & Organizational Structure Highly centralized & bureaucratic structures do not have high performance, especially in rapidly-changing settings. Organizational change (develops from within, not just imposed from outside). Frequent reforms make organizations unstable (falls in performance). Mergers may NOT achieve what matters (e.g. concentrating expertise or removing duplication). Government (should be cautious about promoting the use of for- profit hospitals). Systems These are the P&Ps that facilitate delivery of the goals. They include systems for allocating resources, PISs & HR management policies (recruitment, CPD & appraisal). Their greatest assets are their staff, and to get the best out of them clinical leaders need to invest in them. An important role of the clinical leader is to understand how the organization works as a system & to ensure that all the parts work in harmony (balance). In reality, organizations lead 2 lives: formal public one (organizational charts & PP manuals) & informal one, which is the lived experience of the organization The informal side of an organization, with its traditions, feelings & attitudes, tends to dominate organizational life - a phenomenon sometimes called the organizational iceberg  Climate It refers to work unit members' shared perceptions about the policies, procedures & practices that are implemented in their work environment. According to their content, these shared perceptions can be clustered in homogeneous groups called climate facets (such as service climate or safety climate). Motivation Motivation is generally what energizes, maintains & controls behavior (difficult to measure) - To inspire & direct employees Motivating employees leads to increased productivity & higher levels of output. Motivated employees will: - Always look for a “better” way to complete a task - Be more quality-oriented - Work with higher productivity & efficiency Four Sources of Motivation - Internal motivation 1. Needs (from salary to a sense of fulfilment) 2. Cognition (fulfilling expectation i.e. compensation by value) 3. Emotions / behaviour (incentives vs punishment) - External motivation (work environment – cubical vs office)  Leading organizations successfully involves getting the most out of every individual & ensuring that they work effectively together. ORGANIZATIONAL CHANGE & DEVELOPMENT Change before you have to Jack Welch (GE-1981-2001)  A wise man once said: the world is changing very fast. The big will NOT beat the small anymore. It will be the fast beating the slow Thinking of Change as a WHAT problem What are we trying to accomplish ? What changes are necessary to get there ? What performance measures we are trying to effect ? What will signal success ? Thinking of Change as a HOW problem How do I get people to be open to change ? How do I get people to look at new ways of doing things ? How do I make this organization adopt electronic medical records system ? Thinking of Change as a WHY problem Why do we do what we do ? Why do we do it the way we do ? Why do we need to change how we do what we do ?  Change Requirements & Strategies Clear shared vision Creation of involvement & ownership Commitment of organization leadership Education & training Measurement & evaluation Reward system Communication (vital)  Three schools of change Planned Change An initial analysis leads to a change agenda, an action plan & an implementation program. On completion the change is subject to review or evaluation. Analysis Review & Change agenda evaluation Implementation Action plan Implementation program Emergent Change  Emergent change is based on the assumption that change is a continuous, open-ended & unpredictable process of aligning & re-aligning an organization to its changing env (market) (Burnes, 2009).  It is change that follows no big upfront plan e.g. the Internet – Netflix & Amazon (emerged without much of a central plan as the result of networks connecting to networks in an open way that followed a minimum set of shared standards)  Amazon‟s business began as an online bookstore, competing with Barnes & Noble. Today, its portfolio includes e-commerce, cloud computing, streaming, AI, etc. IT WAS NEVER PART OF THE PLAN  Focuses on 3 things at once: achieving current goals & objectives; innovating new ones; sunsetting old ones. Spontaneous Change Here change leaders concentrate on the relationships between elements within the system (e.g. people), focusing on behaviors rather than analysis. What we call spontaneous change is a method for inducing change in an organization without suffering any resistance. The magic is in the word 'inducing', because it doesn't say who 'induces'. The idea is to make change spontaneous i.e. make the people affected by the change be the ones who create the change.  Different Contexts for Change The known Here, there are clear cause-and-effect relationships: A causes B. If we want to achieve B then we can do A, and we can undertake research to check that A is better than X or Y at achieving B. In the domain of the known, leaders need to ensure effective ways of sensing incoming data, categorizing it & responding with predictive models in accordance with best practice The knowable Cause & effect relationships also exist here, but are less clear, because there is some distance between them in time or place. The relationships may only be known to a few experts. Research methods include experiment, fact-finding & scenario planning, aiming to elucidate the cause-and-effect relationships more clearly. Leadership here is „oligarchic‟, held by the small number of informed individuals who understand the challenges The Complex This domain contains discernible patterns (which help us understand problems) & cause-and-effect relationships. The number of agents & the frequency, richness & unpredictability of their interactions mean that patterns can be perceived, but not easily categorised or predicted. Applying the theory of change model in complex contexts can be challenging. How do you account for the uncertainty, diversity & dynamism of real-world situations? How do you avoid over-simplifying or over-complicating your assumptions & indicators? How do you adapt & learn from your feedback & data? The most effective leadership style is „emergent‟: which combines effective administrative procedures & safe governance with an enabling & adaptive approach The Chaotic “Chaos" is popularly used to refer to disorder or confusion. The ext. & int. complexity & uncertainty is too high to predict or control the future development by management of the organization. In this domain the system is too turbulent & time to investigate change is not available. Here, a leader needs to be able to act quickly thru a hierarchy where decisions can be relayed quickly & acted upon without question. Authority is required to „control‟ the space so as to move it into the knowable, the known or the complex  Behaviours when Leading Change The need to care Concentrating on the simple at the expense of the complicated Conversation as the vehicle for change Speaking to what matters to others Behaving like you (integrity not heroic) “Slowness to change usually means fear of the new.” Philip Crosby (1926-2001) (management theory & quality management practices) LEWIN’S 3-STAGE MODEL OF CHANGE  1. UNFREEZING Determining what needs to change: – Survey your organization. – Understand why change is necessary. Creating the need for change: – Send a compelling message about why change is best. – Communicate the change using your long-term vision. Ensuring support from management: – Talk (and listen) to obtain support. – Frame your issue as one that positively impacts the entire organization.  2. CHANGE Communicate widely & clearly about the planned implementation, benefits, and who is affected. Answer questions, clarify misunderstandings, and dispel rumors. Promote & empower action. Encourage employees to get involved proactively with the change, and support managers in providing daily & weekly direction to staff. Involve others. These easy wins can accumulate into larger wins.  3. RE-FREEZING Tie the new changes into the culture by identifying change supports & change barriers. Develop & promote ways to sustain the change long- term. Consider: – Ensuring support & adapting organizational structure. – Establishing feedback processes. – Creating a rewards system. Offer training, support & communication for short- & long-term. Promote formal & informal methods. Celebrate success !  RESISTANCE TO CHANGE Individual resistance Organizational resistance People don not resist change. They resist being changed Peter Senge (MIT) Managing Resistance to Change Talk to those who oppose the change Clarify information Be open to revisions Present negative consequences of resistance Emphasize positive consequences Involve resisters in face-to-face contact with supporters Create climate of trust, support & confidence Change will NOT come if we wait for some other person or some other time. We are the ones we've been waiting for. We are the change that we seek.  How can this be achieved ? "Never doubt that a small group of thoughtful, concerned citizens can change the world. Indeed it is the only thing that ever has.“ Margaret Mead American cultural anthropologist Patients will never care how much you know until they know how much you care Thank YOU