Find information about a range of approaches to managing organisational change – from Action Learning Sets, to the 7s model.
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A type of chart that helps to identify the key issues that cause negative or positive impacts on a service. The number and /or percentage of different factors are mapped on a graph and put in order of frequency with the most common on the left. Those that contribute to the first 80% of an impact are seen as the most important (‘the vital few’) with those which contribute to the remaining 20% seen as relatively unimportant (‘the trivial many’).
The purpose of the chart is to show the relative importance of each of a list of categories / factors in relation to the specified unit of measure. In the context of improving quality, it is used to highlight the most common errors, the most frequent types of customer complaints, or the most complained about product or service etc. Effort is concentrated on solving the problems with the most frequent occurrence (towards the left hand of the distribution).
Strengths and limitations
Focusing on the most frequently occurring problems promotes organisational efficiency, and the social process involved in data collection and analysis may promote organisational cohesion and the ‘acceptability’ of a proposed change. However, the analysis does not indicate the root cause of problems - only their relative frequency - and therefore cannot be used in isolation to identify a specific course of action in response to the identified problem. Further, while they show which problem is the most frequent, they do not indicate the severity of each problem, and thus relatively infrequent problems with catastrophic impact would not be prioritised. In relation to social care change it can be a helpful means to focus on the issues of most importance and so define how best to channel the available energy and resources. However there is a danger that issues that are not that common may be of great importance to the people concerned and there must be sensitivity to the potential that the concerns of the few are not overlooked. There is also potential for us to analyse what can be easily gathered and counted and the limitations of data must also be recognised if it is being used to prioritise the focus of a change initiative.
- Tague, N.R. (2004) Seven basic quality tools, the quality toolbox, Milwaukee, Wisconsin: American Society for Quality
- Wilkinson, L. (2006). Revising the Pareto Chart, The American Statistician, 60; 332–334.
Performance appraisal systems involve the direct evaluation of performance (individual or group) by others (manager or peer). Their main use is to link organisational goal-setting processes with systems of reward in terms of pay and career progression. While this may act as a powerful incentive for improving individual and team performance, traditional appraisal systems often show poor effects. As a result, newer forms of appraisal, which seek to enhance employee involvement and better balance employee and organisational need, are gaining ground:
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Appraisals are conducted for a variety of purposes including skills development and decisions over pay and promotion. Given multiple purposes, appraisal systems are best tailored to balance multiple organisational and employee needs, through direct involvement of appraise, co-workers and managers in assessing the purposes of any appraisal, and adjusting process to fit the purpose, whether pay, development or promotion.
This is a checklist tool to support reflection on the environment in which an organisation, or specific sub-unit of it, operates. It is an acronym of seven factors:
- Political – the internal and external influences which may affect organisational performance and the options available to it
- Economic – the extent and nature of the competition faced by the organisation, or the services provided by it, and the economic resources available to it
- Sociological – changes in demography or broader culture which may affect the demands for services provided by the organisation
- Technological – innovations in ways of doing things and / or tackling new or old problems. Not necessarily limited to technical equipment, such innovations may include ways of thinking or organising
- Ecological – definition of the wider system of which the organisation is a part, and how it interacts with the people and organisations within this system
- Legislative – the legal context within which the organisation operates
- Industry – a consideration of the attractiveness of the industry in which the organisation currently operates.
PESTELI may be used to assess factors which may favour the organisation and those which may prevent it growing and achieving its mission. Its potential value resides in using the information derived from the assessment to inform strategic change interventions.
Strengths and limitations
The strength of the approach lies in its potential to stimulate reflection on a range of potentially important factors in organisational performance. The danger common to all such checklist approaches is that once an entry is made under each heading this may be considered to be the end of the process of reflection, bringing discussion to a premature close before the full complexity of the factor has been considered. Similarly, a common mistake is to make entries under the headings without reference to the underlying objectives of the organisation, and without informing any change programme. While the tool may be used to promote reflection in the light of major developments with the potential to radically alter the operating environment of the organisation, these insights will be of little consequence unless the tool is used to inform a wider organisational change process.
In relation to social care change PESTELI will help to define the purpose of a service or organisation and the political pressures that a change process will have to respond to. Its broad headings mean that it can be adapted for use in a social care context.
- Hervé, B. (2011) Scenario planning: managing uncertain futures, British Journal of Healthcare Management, 17, 11, 516-21
- Wood, M. (2003) Disability, participation and welfare, Journal of Integrated Care, 2003 11, 2, 43-8
- Johnson, G. and Scholes, K. (2001) Exploring Corporate Strategy: Text and Cases, 6th edn, Harlow: Financial Times Prentice Hall
Plan-do-study-act cycle (PDSA)
The PDSA cycle is a four-stage process improvement model used to rapidly trial planned changes to practice, incorporate the lessons learned from the trial into the change process, and integrate continuous improvement into the new service.
Stages in the PDSA Cycle
- Planning: this initial stage requires a thorough diagnostic evaluation of the problems / issues that need to be addressed by the change – firstly to identify their probable causes and secondly to design possible solutions;
- Doing: a small-scale (pilot) project is undertaken as a limited implementation of the proposed change(s). Data is collected and observations made to identify the impact of the change and any unintended consequences;
- Studying: results of the pilot are compared with expectations to identify unintended consequences and shortfalls in improvements;
- Acting: improvements to the proposed intervention are made, incorporating lessons learned from the pilot phase. The changes may be tested again in another pilot, or the decision taken to proceed to full implementation. Ongoing quality improvement activity (continuous cycles) may also be adopted
Strengths and limitations
The main strengths of PDSA cycles are derived from the rapid testing of proposed changes on a small scale. This allows changes to be achieved relatively quickly and cheaply, with good early indication of the strengths and weaknesses of the proposed changes. Data from the pilot intervention enables the early identification of potential problems, and the involvement of staff in the implementation and improvement process means that they are less likely to resist the changes – they are part of the solution and their input is central to the process.
In relation to social care change, PDSA provides a means to test out improvements in service delivery that have been suggested by people accessing services, their carers, staff or other stakeholders and to learn what works and what does not. It will require senior management to allow frontline staff to test out new ideas and to introduce systems to share this learning across the organisation.
- Langley G.L. Nolan K.M. Nolan T.W. Norman C.L. Provost L.P (2009) The Improvement Guide: A Practical Approach to Enhancing Organisational Performance (2nd Edition). Jossey Bass, San Francisco
- Taylor, M.J., McNicholas, C., Nicolay, C., Darzi, A., Bell, B., and Reed, J.E. (2013) Systematic review of the application of the plan-do-study-act
method to improve quality in healthcare, BMJ Quality and Safety, 0; 1-9
- Quality and Service Improvement Tools, NHS Improvement Guides
Stakeholder mapping techniques are used to assess the attitudes of a range of stakeholders to the proposed course of action, and to select the most appropriate course of action with regard to each. The most widely used technique is the Mendelow Power-Interest Grid, which presents the two dimensions of interest in a grid, and indicates the course of action required for such a stakeholder.
Figure: Power / Interest Grid (Mendelow, 1991)
Stakeholders are defined as those who have an interest in the actions of the organisation, either directly or indirectly. Used to clarify the potential consequences of proposed changes for a range of affected parties, stakeholder analysis helps planners of change to prioritise the stakeholder groups to engage with, and the manner in which they should be engaged. They may be undertaken at the start of the change project, or periodically throughout the change process.
Strengths and limitations
The simple diagnostic tool may helps to identify the key people needing to be informed about the project during implementation, including potential risks and the possible effect of ‘negative’ stakeholders.
In relation to social care change it helps to identify the governance and political processes that will be important to navigate and the stakeholders that could be a barrier to what is proposed. However it does have limitations in that it suggests that most energy should be spent on stakeholders with most power which could mean that those with less power but who could be principally affected by the change are neglected.
- Johnson, G. And Scholes, K. (2002) Exploring Corporate Strategy, Financial Times/Prentice Hall
- Mendelow, A. (1991) ‘takeholder Mapping’, Proceedings of the 2nd International Conference on Information Systems, Cambridge, MA (Cited in Scholes, 1998).
Process modelling may be used to clarify the range of different views on, and expectations of, current processes. It seeks to visually represent the dynamic interaction between different elements of a system and may be used to engage those involved in discussions about potentially beneficial changes. Process modelling tools are adaptable, can be used in different settings, and may be used as stand-alone diagnostic tools as well as supporting a wide range of interventions such SSM and organisational development.
Two principle methodologies are Process Flow and Theory of Constraints.
Process flow diagrams capture all of the individual stages in a process in an accessible manner. They may be developed to show what should happen, what actually happens, or what a team would like to happen in the future; often, all three are developed so that teams develop their ‘ideal’ process in the light of their detailed understanding of the shortfalls in current practice against expected processes.
Stages of process modelling:
- Facilitator brings together the staff responsible for each stage of service delivery to map out the process. Staff members are asked to consider the process as it should currently operate, and write out each step on a ‘post-it’ note and assemble the process by posting the notes on a flip-chart in sequence. They are encouraged to discuss this as they work and capture all of the steps to provide as accurate a picture as possible.
- Discussion continues until everyone is happy that the process has been accurately captured.
- The facilitator leads discussion on differences between the process as it should happen, and what actually happens in practice. Staff members capture the differences with additional ‘post-it’ notes to detail problems with the current process.
- The facilitator then leads a final discussion in which staff members are encouraged to suggest alternatives that make the pathway more efficient, through removal of redundant stages or duplications.
Strengths and limitations
The approach is a good way of exploring the current reality of processes from a range of perspectives. It is often used as a starting point from which to plan an ‘ideal’ process which improves on current practice.
In relation to social care change it can engage people accessing service, their families and other stakeholders either directly or indirectly in mapping out how processes can and should work. If being applied in a service it is important that there is support from senior management – if not then the service may not be able to make the changes due to standard organisational processes and standards.
- ISO (1985) Information processing – Documentation symbols and conventions for data, program and system flowcharts, program network charts and system resources charts, International Organisation for Standardisation. ISO 5807:1985.
The approach consists of a range of tools designed to bring structure and coherence to a time-bounded change process. It shares generic functions with the wider range of change management approaches:
- The assumptions underpinning plans and analyses are made explicit;
- Iterations are required between planning, analysis and action; and
- Comparison of actual achievements with anticipated results is used to make changes in implementation and assess success
Such projects have four defining features:
- Defined objectives (performance, time, cost);
- A temporary life-span;
- Limited resources, not all of which may be under the direct control of the project manager; and
- A wider organisational context with multiple other purposes
Large-scale projects are typically grouped into a programme of linked projects, each constituent part considered as a discrete entity.
The project process consists of five stages:
Stages in project planning
- Defining project goals which are measurable and attainable
This requires generating a shared understanding of why a change is necessary; what the change hopes to achieve; its scope and constraints
- Planning the work programme to meet the specified objective(s)
This requires mapping the interdependencies of component parts required to meet intermediate goals, activities and resources required
- Monitoring progress
Assessment of progress against the plan and undertaking corrective actions as required to ensure delivery
- Completion (‘embedding’ within mainstream activity)
Adapted from Iles and Sutherland (2001, p. 68)
Given the complex nature of projects, a wide range of tools is available to support their management. The most common are briefly introduced, additional information available as indicated in ‘further reading’ below.
- Work Breakdown Structures (WBS): – The first step in detailed project planning, WBSs define project scope, specifying the work required and acting as a project boundary. General objectives are progressively broken down into increasingly defined areas of work, identifying the specific, detailed tasks required of individual team members.
- Milestone plan: – this specifies the sequence of achievements required to build towards attainment of the final project objectives, detailing the various stages of the project.
- Responsibility chart: – this details the lines of communication and responsibilities held by staff involved in the various project phases. It differentiates decision-makers, those that undertake tasks, those providing expert advice and those needing to be kept informed.
- Gantt chart: – effectively combining the milestone plan and responsibility chart. Tasks are indicated according to duration, showing for each task the prior tasks required to be completed and the subsequent tasks dependent on its completion.
- Network diagram: – this involves the explicit mapping of the interdependencies between tasks, to identify the critical path of activities required for the deadline to be reached.
- Risk Matrix: – this identifies potential adverse events which may impede project progress, plotting the likelihood of occurrence (low to high) with the potential impact to the project if the event occurs (low to high). It is designed to facilitate risk management to reduce the likelihood of occurrence or the potential impact, especially for those risks considered both likely and of high potential impact.
- Stakeholder analysis: – considered earlier, this requires an assessment of the power and interest of various stakeholder groups, in order to develop management strategies as appropriate.
Strengths and limitations
Strengths of the approach include clarity of direction, transparent accountability of participants and the anticipation of problems / difficulties before they arise. These significantly improve the experience of participants throughout the life of the project. However, their utility depends upon the degree to which adequate time is spent in their preparation (which is itself a limited resource) and also their use; a plan which is not referred to during implementation is simply a waste of time.
In relation to social care change, project planning can support with the organisation and coordination of change. There is a danger that a too rigid approach can lead to the process becoming more important than the outcome, and flexibility, accessibility of terminology and regular review of the overall purpose are vital.
- Frame, J.D. (1994) The new project management, San Francisco: Jossey Bass
- Kerzner, H. (2013) Project management: A systems approach to planning, scheduling and controlling, Hoboken: NJ, John Wiley and Sons Inc
- Meredith, J.R., Mantel, S.J. (2012) Project management: A managerial approach, 8th edition, Hoboken: NJ, John Wiley and Sons Inc
- Roberts, K. and Lundvigsen, C. (1998) Project management for health care professionals, Oxford: Butterworth Heinemann
- Rosenau, M.D. (1992) Successful project management: A step-by-step approach with practical examples, New York: Van Nostrand Reinhold
- Turner , J.R., Gruder, K., and Thurloway, L. (1993) The Handbook of project-based management, Berkshire: McGraw-Hill