Overcoming the Challenge of Change with Results Based Accountability

By: Kate Tye, Senior Manager of Primary Care Support and Development, Wentworth Healthcare Limited

I was at a health workforce conference a few years ago and a question was asked of the panel: “When is there going to be a break in having to continually change?” The representative from the panel replied with “change is a certainty, and if you are not willing to change then you will find this sector a challenge, as it is inevitable!.” This person appeared to be in a state of what many call “change fatigue.” Change is inevitable, but how we prepare for change, respond to change, and effect change influences the impact of that change – not only on a community or organisation – but also on individuals.

As the cartoon above clearly identifies, we want change for our communities, but when we are actually asked to change ourselves in order for that change to occur, our response might be very different. In order to change the outcomes for children, families, adults and communities, we ourselves must change, our organisations must change, the way we deliver services must change, and the way we interact with those around us must change. So to effect change, we must change.

How do we prepare for change to impact change in our communities?

One of the biggest barriers to change is how we and those around us see the change. Do you see change as a threat? What impact do you think that change will have on your job, your position in your organisation or community, and yourself?

When you look at the reasons why change fails, it has a great deal to do with employee resistance. In 2005, a Prosci report of 411 companies undergoing significant change found that the number one reason for employee resistance to change was a lack of awareness of the need for change. Communication on why change is necessary, what will occur if we don’t actually change, and why we need to change now is critical. The first step in the ADKAR Change Management framework is building the awareness of the need for change. Some factors that will influence the success of building awareness include:

• How individuals and partners currently view the situation
• Credibility of the person communicating the message
• Circulation of inaccurate information
• Contestability of the reasons for change (adapted from Hiatt, J., ADKAR, 2006. PROSCI)

The next step in the ADKAR process is creating the desire to support and participate in the change. There are many components that will influence the success of this step, including:

• The type of change and how it might impact each partner and organisation
• The community, organisational, and environmental context surrounding the change
• Each partner’s current situation (what will the changes impact?)
• What motivators there are for people and partners to change (motivation to change is very individual) (adapted from Hiatt, J., ADKAR, 2006. PROSCI)

When we are talking about changing the way we work and interact in order to effect community change, the Results Based Accountability™ (RBA) process of identifying ‘Ends’ (conditions of wellbeing we want for our community members) can strongly influence the two ADKAR stages. Obtaining agreement on Ends (population outcomes) within a collective impact initiative, determining what the data says (measuring indicators), and clearly communicating why there is a need for change is critical in gaining Awareness of the change and increasing the Desire to participate in the change process.

The next two steps in the process are 1) gaining Knowledge of how to change and 2) ensuring there is an Ability to implement the required skills and behaviours to undertake the change. The RBA ‘Turn the Curve” process (questions to help us get from talk to action) helps collective impact initiatives identify critical Knowledge needed to undertake the change and ensure there is an Ability to implement mutually reinforcing activities.

As with the first two stages, there are influences on the success of the Knowledge stage which include:

• Current knowledge base of partners and organisations
• The capability of partners to gain additional knowledge, including their willingness to do so
• Resources available in the community to help support the change
• Access to existing knowledge and resources (adapted from Hiatt, J., ADKAR, 2006. PROSCI)

When determining the ‘story behind the baseline’ (factors influencing the current state of our community), resources and existing knowledge are identified. This informs the next step in the RBA process: ensuring that we have all the ‘partners who have a role to play’ and what additional resources, knowledge, and capability they can bring to the collective.

The Ability to implement the required skills and behaviours aligns well with the RBA steps of ‘what works to do better’ and ‘what do we propose to do’. As with the other stages, there are influences on the success of the change, which may include:

• Time available to implement the change
• Availability of resources to support the development of the new way of working and ability to implement the skills and behaviours
• Partners’ and organisations’ ability to change their behaviour and the way they deliver services and interact with others
• Ensuring that the activities that have been agreed on meet the criteria for selecting strategies (leverage, feasibility, specificity and culture) (adapted from Hiatt, J., ADKAR, 2006. PROSCI)

Finally, the Reinforcement needed to sustain the change is incredibly important. How many times have you been involved in planned change and the organisation or the community (collaboration or collective) has undertaken all of the first 4 steps, but when it comes to the Reinforcement of the change, it begins to fall away? This often happens in a collective environment. We are challenged to change, we begin the change and start to work differently, but we slip back into our old patterns. To really impact change in communities, we must work differently. Coming to meetings and being involved in a collective/collaboration is only one part; we must also be willing to work differently to avoid returning to our silos once we get back to the office.

Reinforcement aligns well with the RBA ‘s focus on continuous improvement: the iterative process of evaluating the effectiveness of our mutually reinforcing activities (performance measures), regularly reinforcing what is working, readjusting when necessary, and learning what needs to be changed to create leverage (Turning the Curve at the performance level). As you may have guessed, there are factors that influence success of the Reinforcement stage:

• Association of the reinforcement with actual demonstrated progress or achievement – this is where tracking of performance level data is really important
• The absence of negative consequences for poor performance, and instead creating a a culture of continuous improvement
• An accountability framework (RBA) that creates an ongoing mechanism for rteinforcing the change (adapted from Hiatt, J., ADKAR, 2006. PROSCI)

What are the Core Competencies required to lead change in a community?

The Promise Neighbourhoods Institute and the Annie E Casey Foundation state that there are five competencies required to create effective results-based leaders. We have added another one: understanding how to manage change to get results.

These six core competencies include:

1. Leaders who are results-focused and data-driven: using the RBA framework to provide the discipline, data, and outcomes-focus to achieve results. This is critically important and provides an accountability framework that enables communities to track, improve, and leverage their change.
2. Using oneself as an agent for change: believing that individuals are capable of leading from whatever position they hold, in order to be a catalyst for change. You do not need to be in a leadership role to lead results-driven change.
3. Understanding how to manage change to get results: understanding what managing change means in a collective environment, and using change management to engage and drive change.
4. Addressing racial, class, and cultural disparities: recognising that race, class, and culture have an impact on outcomes and opportunities for vulnerable children, young people, and families. These must be addressed in order to reduce disparities.
5. Mastering adaptive leadership skills: applying skills that drive system reform and community change which only occurs when you have the skills to impact the attitudes, values, beliefs and habits of key stakeholders.
6. Collaborating with others: understanding yourself and others to get results by building capacity to develop group consensus and facilitate result driven meetings; so the group has the capacity to work differently aligning their actions and work towards achieving results.

About the author:

Kate Tye is Senior Manager of Primary Care Support and Development at Wentworth Healthcare Limited. She is passionate about quality service delivery in the health, community services, and education/training environment through the equipping of staff/potential staff and organisations to achieve their potential. She achieves this through working in close partnership with the organisations and their teams to reach their potential and strategically plan for the future. (LinkedIn)