Create a Supportive Context: Principles of Fostering and Leading Change

The principles presented in this section of the Guide are applicable to all actors in the change process. Much of the thinking behind these principles is influenced by John Kotter, whose writings present a wealth of information and ideas that offer a solid context for organizational and structural change. His Eight Steps for Organizational Change are widely viewed as the framework for successful change at all levels of an organization.

Principle 1: Change must matter to those making the change.

To foster change and create a sense of ownership among staff, those leading the process must clearly convey how the innovation will benefit the implementers of change—those who must actually alter the way they do their work at a service delivery site—and the clients they serve.

Principle 2: A credible, committed change agent is critical for change in health practices.

Change agents facilitate the develop­ment, application and advocacy for new practices. They transmit their commitment and enthu­siasm to those who do the day-to-day work, resulting in the implementation and institutionalization of new practices. Successful change agents work with management to support staff in the change effort. Their skills and temperament lead teams to achieve results.

An effective change agent is well respected inside the system so that the new practice is linked with someone credible and familiar with the organization’s staff and operations. Studies of suc­cessful change show that early adopters possess the characteristics and credibility to influence others. Early adopters are typically the most effective internal change agents.

Change agents cannot succeed alone; implementing change requires a team approach. Change agents are more successful when they are embedded in a team that is well supported by leaders and decision makers to work with a unified purpose and clear direction.

Principle 3: Supporting the change agent gives the agent the credibility and confidence to lead.

Those who are in positions to foster change can strengthen the efforts of local change agents by providing them with data and resources that support the innovation. They can also share knowledge about pathways to successful change, including the necessity of planning for sustainability and future scaling up from the beginning of the program.

Principle 4: Change is more likely to succeed when leadership at each organi­zational level supports it and when it is introduced into an environment where change is an ongoing practice.

Studies and experience show that successful adoption of new practices occurs most often in organizations or work groups with five characteristics:

  1. Senior managers and leaders at all levels readily share information and knowledge and encourage their staff to do the same. They give a clear message: “This change is impor­tant and we stand behind it.”
  2. Leading change is part of ongoing practice: staff are encouraged to make small, practical improvements, not just to undertake big changes in a crisis.
  3. Working teams are designed to bring together people with varied and complementary perspectives.
  4. Staff are rewarded or acknowledged for asking questions, taking risks and challenging the status quo in order to better fulfill the organization’s mission.
  5. Staff members trust the people who are promoting change.

Change is an ongoing process, and building these characteristics can help with current and future initiatives.

Principle 5: Clarity about the purpose, benefits and results of the change is necessary.

Those implementing the change should ensure that it meets the CORRECT criteria described in the section of this guide titled Consider Perceptions of the Innovation. Early success reinforces motivation for continued investment and energy.

Measurement and data will help staff see evidence of improvement. Small-scale trials lessen risk and influence adoption by individuals, especially if the demonstrator is an opinion leader. In ongoing measurement and course corrections, it has often been observed that failing on a small scale leads to greater success than starting with large, expensive, untested programs.

Principle 6: Motivating and supporting staff throughout the change process will help maintain their dedication and create a support network for the change agent.

Too often, we underestimate the effort and support needed to make change permanent. Supporting the implementers throughout the change process, including scale-up, can significantly increase their motivation and the likelihood of institutionalizing the change. Interpersonal communi­cation is critical to the adoption of new practices and be­haviors.

Principle 7: Clearly assigned and accepted responsibility for implementing the change increases the chances of sustaining the change as a part of ongoing work.

When roles and responsibilities for instituting change are laid out clearly, and measures are put in place to monitor progress, accountability for continuing progress is maintained. One obstacle to successful change is failure to incorporate new behaviors into regular work routines and systems. If staff are to be held accountable for making the change happen, they need to:

  • Be encouraged to recognize the urgency and priority of the proposed change.
  • Be provided with the information, resources and skills they need to take on their new responsibilities.
  • Integrate new responsibilities into their performance expectations and be held accountable for achieving their part of the change effort.

Principle 8: Start where you can, and start now.

Top-level leadership must be supportive for change to succeed. This is especially true in scaling up change throughout and beyond an organization. But many successful changes have started in a small corner of a hospital, health or community center, district or province with a committed change agent and team.

Your task is to help the change agent persevere even if support is not readily forthcoming at all levels. Documented evidence of success is often what convinces higher-level decision makers to support institutionalization. If you cannot begin with top-level support, it is useful to progressively enroll people at higher levels as you demonstrate success.