Championing Change: Empowering people to innovate.
Michael McManus
Change is a fundamental aspect of delivering effective treatment within mental health services. Innovation enables us to respond to patient needs, work more efficiently and embed excellent clinical practice in accordance with latest research. It is widely reported that a key component for initiating and sustaining change is supporting and validating the emotional impact it has on our workforce. Yet, at times the growing pressures to meet demands with fewer resources causes personal factors to be overlooked in mental health services. Instead, projects can prioritise surface level adjustments that promote organisations without addressing underlying issues. This culture can lead to a demotivation of a work force whilst being counterproductive for services.
This blog reflects on observations of an innovative project that considered emotional transition of team members to collectively embed meaningful and effective change. This project took place in a forensic environment and was aimed at increasing opportunities for patients to engage in vocational activity. Patients within Forensic services experience a lack of opportunities to gain employment when discharged due to stigma and restrictions around their offences. This project considered ways to employ new technologies (virtual reality) for patients to develop accredited skills in otherwise inaccessible occupations (for example mechanics and construction. To successfully increase employment for these patients a clear strategy was communicated, evidencing the problems faced by services. I became involved in this project within its first year and contributed to its continuing growth and improving motivation of team members involved.
Why do we need to consider personal factors when implementing change ideas.
Change projects are often planned and initiated by a smaller group of people but can involve the actions of a larger workforce, often not initially involved in the planning of the idea. For any change idea to succeed beyond planning those people directly impacted need to accept and believe in its long-term value. Yet, in large institutions such as the NHS there is often a gap in the communication between leaders of change and the change makers.
Initially, success may be measured on agreeing funding for a project or presenting concepts to senior management. However, for change to become permanent it must outlast the leaders that initiate the idea. Many improvement projects can offer great promise but lose momentum when key figures leave a workforce or take on different roles. People may return to former practices or loose sight of the vision outlined by its former leaders. It is therefore paramount that change involves consideration of all team members impacted in improving delivery of care. Despite external pressures for short term results, clearly communicating a vision and motivating people should therefore be prioritised. This improvement project evidences this statement. It has progressed over three years with multiple patients now accessing community employment through the course. Team members involved understand the clear benefits it can provide. They have become committed to thinking of new ways to adapt and engage patients in the program during periods when attendance has decreased.
What challenges do we face to enforcing and sustaining change.
“Leadership is the capacity to translate vision into reality.” - Warren Bennis (2008)
Understanding personal resistance to change is therefore imperative when delivering service improvement projects. Common emotive reactions to enforced change include fear, hesitation, and scepticism for new ideas. People may find comfort in continuity, or they might not feel assertive to challenge a workplace culture that is avoidant of innovation. When change is enacted in a superficial manner, authoritative leaders direct people to act differently. In the short term this action can lead to new results and externally appear to provide success. However, this strategy is limited because it is overly reliant on the constant influence of a specific leader. Within this model people follow instructions but are not empowered to apply their own thinking. In fact, this authoritative leadership fails to communicate a vision or instil belief in its purpose.
How can transformational leadership implement genuine change.
“The function of leadership is to produce more leaders, not more followers.” - Ralph Nader (2017)
Transformational leadership offers a separate approach that considers the volition of a work force and gives precedence to belief in its cause. This leadership approach is defined by influencing people to change by inspiring and motivating them to transform from followers to leaders. Transformational leaders identify the personalities within their teams and recognise the individual drivers that influence performance. Understanding a person’s attributes enables leaders to inspire people to trust in their change idea.
Staff in Mental Health services work in highly pressured environments, where motivation can be impacted by a range of stressors. Due to responsibilities and increasing demands people may not feel they have the time to consider ways to change practice. Transformational leadership offers a way of breaking this cycle. Rather than increasing demands on staff it enables them to enrich the process with their expertise and experience. Within a transformational model the leader does not attempt to direct staff to carry out specific duties and monitor each process. They convey an idea and intrust the skills of their staff to deliver. This process is not just empowering it is long lasting and is more likely to sustain positive change.
Quality improvement projects are invaluable in modernising care and ensuring that practices respond to the needs of the patient population. However, it is important to recognise the large number of these projects that exist for a short period or fail to change the way in which we work. Reflecting on these limitations enables us to identify the key components to achieve sustained, meaningful change amongst a more motivated work force. The following recommendations have been proven effective through the achievements of the vocational project and are transferable to service improvement work:
- Clearly communicate the rationale for innovation, why is change necessary and what problem is being addressed.
- Validate and recognise success within the process of change.
- Apply reflective thinking to overcome unforeseen challenges and avoid disillusionment.
- Grant authority to empower team members to take autonomy and enrich the project with innovative ideas.
About the author
Michael McManus is a Clinical Specialist Occupational Therapist working in Forensic services. He provides patients with skills based therapeutic interventions to support their transition from hospital to community. Michael has experience delivering service improvement projects across a range of prison, rehabilitation, and acute services. Recently his involvement in a Virtual Reality therapeutic programme was published in OT news.
References
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Berson, Y., Halevi, M. Y., & Shamir, B. (2015) 'The Impact of Transformational Leadership on Followers’ Character Strengths, Spirituality, and Organizational Citizenship Behavior', Journal of Management, Spirituality & Religion, 12(3), pp. 247-277. Available at: https://doi.org/10.1080/14766086.2014.907400 (Accessed: 2ndJanuary 2023
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