A Change Formula to Remember

This is probably the most useful change ‘formula’ I’ve ever come across.

D = Dissatisfaction with the status quo

V = Attractiveness of the vision for the future

F = ease of taking the first steps and

R = the strength of resistance to the proposed change.

I’ve often found the formula a useful reference point when attempting to make sense of a change programme. Basically the sum of DVF needs to be greater than R. If it’s not you’ve got some work to do. You need to find ways to strengthen D, improve and/or better communicate the V, offer more and/or easier options for F, reduce the strength of R or any combination thereof.

I was reminded of DVF>R during the recent holidays.

On Christmas Eve I attended a Nativity service at a Church in my local town. At the beginning of the service the lay preacher announced that free Christmas cards were available at the back of the Church for people to sign and send to Tony Blair. The cards urged the PM to keep the A&E open at the local District General Hospital. Someone then jumped up and announced to the congregation of about 300 that there also was an option to sign an online petition on the No10 website if people were too rushed today to do it. The next day I took my 11 year old son and his friend to Asda for a hot chocolate (I know all right). Anyway, a stall in the busy lobby was staffed by the Save Our Hospital campaign with more Christmas cards for Tony. More impressively, every 5 minutes someone was using the supermarket tannoy system to draw attention, in a very friendly way, to the stall and the campaign!

Quite a lot of R building up there there don’t you think? There might be a document about the proposed changes to 'acute care in the County' on a website someplace, I'm not sure to be honest. Some NHS folks locally need to get working on D V and F - and quickly - or we'll be stuck with unsafe, inefficient healthcare for another 15 years.

Steve

www.stevepashley.co.uk

Comments

[A consultant]

That isn't R building up, it's a different V. From their point of view, you are voicing the R.

This article shows just how institutionalised the deafness of the NHS to its users and owners has become.

[Steve Pashley]

Thanks for the post.

I know what you mean but I don't think it's a differnet V building up - not usually anyway - unless staying the same for a further 50 years is a Vision.

However, I think inplied in your comment is a criticism of NHS managers who, in the face of resistance, simply work more at D and V. This is the equivalent of just shouting louder at people. NHS manager do need to learn how best to work with R. Not simply accepting it, but listening, seeking to understand and then engaging in a genuine dialogue about whether there are other courses that can be taken that address the concerns of all parties.

Another option is to offer some first steps (F) that help people see new possibilities without committing to a new position that's irretrievable. MAybe a 6 month trial of a new serviuce pattern with the resistors being part of the evaluation panel?

I agree, the NHS is not great at this and does often give the impression of 'going through the motions' of listening.

[Robert "Jake" Jacobs]

This formula, originally developed by Dick Beckhard and adapted by my mentor Kathie Dannemiller, is I agree a powerful and useful tool.

Two additional thoughts:

First, there is work we have done more recently to enhance it by including a "C" which stands for capability of the system to implement the First Steps. Even the best action plans do not lead to change if the system lacks the capacity or capability to implement them.

Second, my friend and colleague Barry Johnson has done a lot of work in the area of Polarity Management <www.polaritymanagement.com>. Barry's supplement to the original Beckhard concept is that resistance is not something that has to be "overcome." From a polarity standpoint there is wisdom in the resistance that must not only be listened to in order to gain support but must be listened to because it contains essential truths that otherwise would be lacking from your picture of reality.

Be happy to speak more about this through our blog:

http://windsofchangegroup.typepad.com/blog/

Cheers!

[Steve Pashley]

Hi Jake,

Many thanks for the additional information. The C is a really useful addition - though quite a sobering challenge for many organisations I suspect!

The polarity management point is also really helpful to me. I have a personality that sometimes means I default into the 'perseveringly combative' and although i know this i sometimes forget.

btw, I've added Winds of Change to my blogroll.

Best Wishes
Steve

[nhs doc]

I like your blog and as an NHS doc am very much involved in implementing new targets. I think you have to look at where resistance is coming from 1) It relates to where ideas come from (the higher up it comes from the more dissociated from reality,) with govt at the top, (govt views NHS as a reelection tool nothing more, nor less) . You have to look at why the change is happening , too often it is change for the sake of change, also resitance is related to speed of implementation , too fast and more resistance and lack of evaluation of change and reaction to feedback ie possibility of stopping project if ineffectual.Why are we expected to be run like as a business when there are no incentives? People don't function that way . We should be paid according to output and have shares in our healthcare institution .

[Steve Pashley]

Dear NHS Doc, thanks for the response. Your comments have reminded me of a great site all about understanding and dealing well with 3 levels of 'resistance' to change. See http://www.beyondresistance.com/resistance_to_change.htm

Best Wishes
Steve

[nhs doc]

I agree that is a good site and a lot of changes imposed in NHS would fail test 1). An example would be colonoscopy screening in the over 50s . Now how that got the go ahead defies belief! It requires gastro consultants to do a colonoscopy "driving test" which many fail for idiotic reasons , then requires them to retrain, taking them away from doing gastroscopies and colonoscopies on urgent admissions delaying their discharge. Will the extra cancer pick up rate be worth the increased bowel perforation rate ?(side effect of colonoscopy ) probably not, but does anyone ever think of this? No and by the way I am not a gastro just pointing out the absurdities in NHS.