Improvement: The Human Side Improvement: The Human Side Christine Shea, MEd, PhD Institute for...

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    Improvement: The Human Side

    Christine Shea, MEd, PhD Institute for Health Policy, Management and Evaluation,

    University of Toronto

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    “Did you ever feel like you’re part of something greater than yourself?”

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    Today’s Objectives

    • Understand the difference between technical and adaptive challenges

    • Apply a theory of human performance

    • Identify and understand resistance to change

    • Address resistance using a positive and productive approach

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    Why I’m here

    Secret Weapon in Improvement

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    “I have a hard time finding a balance between work and work”

    Why bother?

    Trying to make things better BUT

    It’s really hard!! Frustrating Draining

    Demanding Stressful

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    Why bother? Complexity

    • Ever increasing system complexity

    – Technology, people, processes

    – Macro, meso, micro systems

    – Variety of levels of accountability

    The secret of evolution is variation, which in organizational terms could be called distributed or collective intelligence.

    The Theory Behind the Practice: A Brief Introduction to the Adaptive Leadership Framework, R. Heifetz, A Grashow, M LinskyThis chapter was originally published as chapter 2 of The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World, (2009) Cambridge Leadership Associates.

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    Complexity in Healthcare

    T Day

    Patient

    Hospital

    Primary Care Physician

    Family Care Givers

    Physical or Occupational

    Therapist

    Nurse

    Personal Support Worker

    Pharmacist

    Case Manager

    Day Centre Program

    Technology, Drugs etc.

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    Healthcare is evolving: adapt

    • Propagate

    • Adapt

    • Experiment

    • Diversify

    • Re-organise / loss

    • Time

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    Work Avoidance

    • Response to change – Fear of the unknown

    – Lack of control…

    Resistance

    • Understand sources

    of resistance

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    How to thrive?

    (R.M. Yerkes and J.D. Dodson 1908)

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    Performance in Progress

    Productive Range

    Limit of tolerance

    Technical Challenge

    Time

    Te n

    si o

    n o

    f ch

    an ge

    Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.

    Adaptive Challenge

    Threshold of learning

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    Flourish or Perish

    Productive Range

    Limit of tolerance

    Time

    I understand we need to change. I trust you and I’ll help. I understand what I need to do.

    I don’t want to hear any more bad news. I can’t make sense of any of this. I am so terrified I don’t understand a word you are saying.

    Just tell me what I have to do …

    Threshold of learning

    Based on and adapted from R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.

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    What people won’t tell you, their behavior reveals

    Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.

    Productive Range of Tension

    DistressBlame others, distract attention, denial

    DistressBlame others, distract attention, denial

    Productive Range

    Threshold of learning

    Limit of tolerance

    Time

    Te n

    si o

    n o

    f ch

    an ge

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    “To thine own self be true”*

    • Hot or not?

    – What resistance strategies have you noticed in others?

    – What are your resistance strategies?

    – What triggers your resistance?

    *From Hamlet; Polonius Act 1, Scene 3

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    Work Avoidance/Resistance

    • Displacing responsibility

    – Attack authority

    – Kill the messenger

    – Scapegoat

    • Denial

    – Keep smiling

    – Keep smiling

    – Keep smiling

    • Distracting attention

    – Pretend to be busy

    – Define problem to fit your competence

    – Make the problem too big

    – Restructure/reorganize

    – Meetings with only information exchange when engagement is needed

    – Pick a fight

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    Balcony to Dance Floor

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    Today’s Take Away

    • Technical vs Adaptive Challenges

    • Resistance

    • Productive range of tension

    • Balcony and Dancefloor

    For more information feel free to contact me:

    christine.shea@utoronto.ca

    Slide Number 1 Slide Number 2 Today’s Objectives Why I’m here Why bother? Why bother? Complexity Complexity in Healthcare Healthcare is evolving: adapt Work Avoidance How to thrive? Performance in Progress Flourish or Perish What people won’t tell you, their behavior reveals “To thine own self be true”* Work Avoidance/Resistance Balcony to Dance Floor Today’s Take Away