Incremental Change - Or Step Change? The Biggest First Decision in How to Manage Change

I often get asked the question: "In your experience, what is the single biggest issue affecting directors who are considering or embarking on a change initiative?"

This is good question and hard to answer because there are several key things that need to be addressed. But the single biggest early decision is to decide whether the change can be handled within the context of business as usual or not.

In other words is it incremental change or step change?

Addressing the following points arrives at the answer to that question:

(1) How's it going to be different when I've made the change?

(2) Why am I doing this - how's it going to benefit me?

(3) How will I know it's benefited me?

(4) Who is it going to affect and how will they react?

(5) What can I do to get them "on side"?

(6) What are the risks and issues that I'll have to face?

(7) What steps do I take to make the changes and get the benefit?

(8) How am I going to manage all this so that it happens and I succeed?

If the change involves any of these following factors then it will definitely need to be handled as a "step change" and treated as a specific initiative that sits outside of business as usual. The factors are: complexity, size, scope and priority.

So often I meet with directors and they complain that their staff "don't get it" or haven't "bought into" the change - or the vision for the change. Whereas I often find that is not the case, the issue is that they are just too busy. Let me illustrate this:

A couple of years ago I was invited to meet with the Operations Director and CEO of an NHS Health Trust. Their problem was that they were trying to drive through an initiative to improve utilisation of operating theatres - raising performance from 85% to 90% and they felt that their clinical directors and senior medical staff just weren't buying into it and supporting it. They felt that it was "them and us" scenario - "management versus medics".

The significance of this initiative was great because in the target driven environment in which UK Health care trusts operate, the achievement of this target unlocked 4m pounds sterling of annual central government funding [some 5% of their total funding].

Furthermore, they were investing an additional 10m pounds sterling in new operating theatres and productivity was key to them achieving the required ROI.

At the time of my visit, they were achieving the required targets only by buying in expensive third party resource.

Once I had met with a number of the key clinical staff, the real issue rapidly became very apparent: it was not that they didn't "buy in" - quite simply they were all too busy with their day to day responsibilities to be able to engage with this initiative.

What was needed was to take this outside of "hospital business as usual" and to make the appointment of a senior manager - freed up from the day job for a 3 months - to take complete ownership of the initiative and to ensure the prioritisation of it and the allocation of the required time and resource. So this was really all about the answer to question 8.

Last time I spoke with them, this is exactly what they did, and they succeeded.

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