Changing how we change
Continuous improvement is the essence of clinical governance. But continuous improvement requires change, and change can be confronting. As we predictably move towards a more digitised world - including in healthcare, and aged care – change is also inevitable.
Studies have demonstrated that change is successfully sustained only 25% of the time. This aligns with commentary that 70% of change initiatives fail. Reasons for failure may be related to weakness in the systems and processes inherent to the change itself (such as new software), or in the preparation and upskilling of workforce (such as in using the new software). These domains are relatively straightforward and can be managed through best practice and experience.
However, there are more complex aspects of change management which can be particularly challenging. Unless we get these right, change will be ineffective, unsustained – or completely fail. One of the more complex parts of change relates to how people respond to it, and the extent to which they are engaged and empowered in the process.
This aspect of change management requires robust change leadership – in understanding (and responding to) human factors of change, and assessing alignment of the change (or malalignment) with an organisation’s culture. These elements are crucial to the success and sustainability of change. But how do we address these challenges?
Firstly, it is important to identify the range of possible reasons why people may be resistant to change. Change can be an emotive experience, and has been observed to be ‘unsettling for some people, because their sense of security and wellbeing often comes from predictability and routine’. Therefore, effective management in driving sustainable change requires a genuine insight into how it impacts the workforce, and how it challenges them (physically, mentally, emotionally – or perhaps even spiritually). This understanding must include the impact of organisational culture on the proposed change, and vice versa.
To that extent, solid approaches to change management align with the principles of clinical governance it may seek to support - in that the people must be at the centre. Jason Clarke cleverly described the ‘Four Doors of Change’:
Door 1: What could we do before that we can still do?
Door 2: What are the things that we couldn’t do before and we still can’t do?
Door 3: What are the things that we could do before and we can’t do now?
Door 4: What are the things that we couldn’t do before but we can do now?
These four doors may be applied as a framework to implement change and influence a positive shift in mindset.
Further, communication provides the key to these doors. Through the understanding which these four questions can support - and the acceptance they can promote - we move from a culture where we instruct our workforce what to change and how, to one where they drive the change themselves.
There are other frameworks that can support this process, such as the SCARF model set out by Dr David Rock, where:
• ‘S’ is for status – which refers to people’s sense of worth, and their feeling of importance relative to others;
• ‘C’ is for certainty – that is, certainty about the future, since uncertainty can cause stress;
• ‘A’ is for autonomy – which is about a person’s right to make decisions, and provides a sense of control;
• ‘R’ is relatedness – meaning how people relate to each other and whether they feel safe;
• ‘F’ is for fairness – this refers to the perception of fairness (in exchanges between people)
Ultimately, continuous improvement in person-centred care must be driven by person-centred change management in order to truly succeed.
In this way, those who are subject to the change can be engaged and empowered to implement and sustain it.
Enrol in the AICG Certificate in Clinical Governance and bring a person-centred change mindset to your Clinical Governance, Leadership and Culture activities within your organisation.
All accessed on 12/11/22:
S. Leaver. ‘Predictions 2022: This is A Year To Be Bold’. Forrester, 26 October 2021. Accessed at: Forrester's Predictions 2022: This Is A Year To Be Bold
‘Digital Health’. AIHW, 7 July 2022. Accessed at: https://www.aihw.gov.au/reports/australias-health/digital-health
S. Cheu. ‘ADHA outlines digital health in aged care plans’. Australian Ageing Agenda, 30 April 2021. Accessed at: https://www.australianageingagenda.com.au/technology/adha-outlines-digital-health-in-aged-care-plans/
V. Lipman. ‘New study explores why change management fails – and how to (perhaps) succeed’. Forbes, 4 September 2013. Accessed at: https://www.forbes.com/sites/victorlipman/2013/09/04/new-study-explores-why-change-management-fails-and-how-to-perhaps-succeed/?sh=312279427137
N. Nohria & M. Beer. ‘Cracking the Code of Change’. HBR, May-June 2000. Accessed at: https://hbr.org/2000/05/cracking-the-code-of-change
‘Improvement Leaders’ Guide – Managing the Human Dimensions of Change Personal and Organisational Development’. NHS, 1 June 2005. Accessed at: https://www.england.nhs.uk/improvement-hub/publication/improvement-leaders-guide-managing-the-human-dimensions-of-change-personal-and-organisational-development/
A. Berzon. ‘What are the ingredients for successful change in complex adaptive systems?’. AICG Patient Safety + Quality Care Symposium, 15 September 2022.
J. Clarke. ‘Embracing Change’. TEDxPerth, 22 December 2010. Accessed at:
(368) TEDxPerth - Jason Clarke - Embracing Change - YouTube
N. Temelkovski. ‘Why people resist new ideas in the workplace and how to turn it around’. Melbourne Business School News, 15 April 2019. Accessed at: How to Deal with Resistance to New Ideas at the Workplace | MBS
G. Stokes. ‘Introduction to the Scarf Model’. The Change Space, 5 August 2020. Accessed at: https://www.thechangespace.net/articles/introduction-scarf-model