Knowledge driven change management

Nature of change management in social development sector 

Popularized by some of the big consulting firms, change management is one of the most growing ‘industry’ in the world today! Big consulting firms made it as a lucrative career opportunity for high profile consultants. 

Change management related services are mainly bought by the corporate giants to re-engineer their organizations and to prepare staff to accept new ideas and technologies introduced to catalyze big changes in organizational strategies and structures. 

Some philanthropic organisations, mainly INGOs also avail their services. This article is not exactly about such internal change management processes at the organizational level. Changes can also be introduced in development programs, through amendments made in the scope, strategies or approaches to enhance project impact, improve quality of services or help programs to adapt with changing external environment. 

This article is mostly about induced changes at service delivery level, community level and/or at societal level. The broad principles behind change management in both the above cases could be the same, but the approach, processes and methods used in the latter and the expected results in the external environment are significantly different.

Essential ingredients of knowledge driven change management 

Knowledge driven change management processes are based not only on information, data and evidence but also on skills, experience and wisdom embedded within and beyond organizations and their stakeholders. Development programs/projects should be able to fully understand the ecosystem within which they are being operated, dominant perceptions including apprehensions of key stakeholders, internal strengths and weaknesses, external opportunities and threats, and demonstrated outcomes of any existing strategies similar to what is going to be implemented.

The key players involved in the change process might need capacity building inputs in terms of training, mentoring and/or exposure visits. They would also need evidence gathered about similar changes being introduced in local and global contexts. There should be a live platform (either online or physical) to aid problem solving and experience sharing while change management is being introduced. Change management also needs a robust monitoring and evaluation plan. All these processes could be brought in under an integrated Knowledge Management framework to maximize the impact.

All change management processes involve a logical sequence of planning, implementation, evaluation and modifications based on evaluation findings and continuing the change process till they sustain in organizations or communities where these have been implemented.

Knowledge driven change planning 

Change management needs informed preparation based on clear understanding of issues involved, evaluating various options, and developing appropriate strategies.

Understanding key issues

Desire for change starts from discontentment about the existing situation. Understanding the root of this discontentment or finding out why we are not getting the results we had expected through existing systems and processes is the beginning of any change management process. An analysis to understand the current situation in communities or facilities is an important first step. For example, people in a district or state might be dissatisfied with the health services they are offered thanks to the poor quality. Finding out why the expected quality is not available at the service delivery level is a natural first step.

At macro level, one could start with a detailed study. At micro level one can sit with service providers in the facility to conduct a root cause analysis using the ‘5-why technique’ in which we keep on answering the question ‘why’ five times or till the fundamental reason is found. The required quality may not be available because of lack of trained personnel. Why trained personnel are not available could be because of no recruitment for several months, because of non-availability of funds, because of non-use of budget allocated and so on. A possible solution for poor quality of services at the health facility level could finally be found through analysis of budget allocation or fund utilization process.

Understanding issues through appropriate assessments will enable change managers to address the real issue, which may not necessarily a training quality issue as widely perceived initially.

Understanding the Environment

Change management should acknowledge the specific nature of the context within which a change process is introduced. For example, introduction of flush toilets without considering non availability of water in villages or promotion of home based Oral Re-hydration Therapy without considering the poor quality of water available in the community etc. will not yield the expected impact.

Sourcing change ideas ‘from within’

Change ideas could be ‘donor driven’ or could emanate from priorities identified by the board members of the organization or as identified by key stakeholders like the government. They can be sourced from data, studies, research experiences and documented best practices from similar projects. 

Change ideas are also sourced from the community themselves through processes such as ‘Participatory Rural Appraisal’. In the context of health care, change ideas could come from patients, staff, communities, or other stakeholders. Ideal source for change ideas are the people who are based within the project or service delivery process. As the Chinese proverb says: Go to the people, live with them, start with what they have, change and finally enable them to say “we have changed it”. Changes that came from within are more sustainable than those imposed from outside.

Appropriate change approaches

Once we clearly understood all the major issues, it is easier to develop appropriate change approaches. For example, the poor quality issue at the facility level could be addressed through 'policy advocacy' and facilitating changes in the national, and state level guidelines, policies and regulations and simultaneously organize cascade model training at national and state levels. 

Alternatively one could adopt a ‘bottom up’ approach in which a series of capacity building and quality improvement processes may be unleashed at facility level and then documenting and disseminating the changes demonstrated at micro level to key stakeholders like the government and thereby advocating scaling up of similar changes in the larger system.

Deciding the specific goal

Change planning starts with clarity on what is it that you want to change or achieve. You may want to improve the quality of services delivered by your program or you may want your project beneficiaries to use a new product or technology. You will have to express your clear goal in a goal statement which is well defined, specific, measurable, and time bound. Here is a smart goal statement: “In our hospital, we will reduce post-partum hemorrhage rates among women delivering at our facility by 60% within 3 months by ensuring oxytocin administration within one minute of delivery.”

Shared vision for change

By now, most of us are familiar with the vision statement of SONY in 1960s – “We will change the poor quality image of Japanese products” which was a compelling vision shared by the staff of SONY Company in Japan. It excited and even emotionally charged the employees and this shared vision turned around the company’s fortunes for several decades to come. Everyone in the project including the security guards and sweepers in the organization should know the vision of your change project.

Knowledge driven change implementation 

Feasibility assessment/Pilot project

It is always advisable to introduce change in a small location and do an operations research to see the impact and then scale up it to the entire project area or service delivery system based on lessons learned. Operations Research, Implementation Science, Process documentation, cost effective analysis etc. are useful methods during this stage.

Scale up

Solutions proven to be effective could be scaled up in all the project districts or in the whole clinic or department. We may have to effectively advocate findings and lessons learned from the pilot phase to key stakeholders. For example, experiences from introducing a new clinical product or process may be shared with senior government officials and present them with a plan for scale up in certain specified geographical/administrative units.

Forming change teams

Changes happen better in teams. For example we may create community associations or health care teams in health facilities. Changes made in participatory contexts are more effective as participation improves ideas, increases buy-in, and reduces resistance to change. Moreover accomplishing things together increases the confidence of team members, and empowers organizations.

Effective advocacy/Communication channels

The change project may use appropriate channels of communication to take the general public along with the change process. Change ideas may be resisted by a variety of influential people including the general public. Educating both the public as well as key decision makers who would influence the change process is important. One may even use ‘good will ambassadors’ and ‘celebrity endorsements’ to raise awareness on change processes. Identifying ‘champions’ for the cause among the stakeholders and utilizing their influence is also important.

Sustainability

Changes made at community or service delivery level need to continue as part of the organizational or community culture. Repeated visits and assessments may be necessary to gauge whether the change introduced has made sustained impact.

Change assessments and learning platforms 

At every stage of the planning and implementation of change, systematic assessments are essential to understand progress of change processes, to make course corrections and to understand the real impact. An important goal of such assessments is to influence decision-making or policy formulation through the provision of empirical feedback. Distinguishing change assessments as ‘formative’ and ‘summative’ may be useful to understand appropriate applications of these methods.

Formative assessments

Formative assessments are conducted to strengthen or improve the program. It may be conducted prior to or during the change implementation. Examples are:

• Needs Assessment (to determine who needs the change, how great the change is, and what might work to meet the need for change),

• Implementation Evaluation (which monitors the fidelity of the change implementation), and

• Process Evaluation (to investigate the process of delivering the change including alternative delivery procedures).

Summative assessments

Summative assessments are conducted to assess whether the change process has caused the desired outcome and may also determine overall impact of the change process. This is to be conducted at the end of the program, but may involve collection of data before, during, and after the change implementation. Examples of summative assessments are:

• Outcome evaluations to investigate whether the change process caused demonstrable effects on specifically defined target outcomes,

• Impact evaluation (to assesses the overall or net effects – intended or unintended – of the change management process or as a whole) and

• Cost-effectiveness and cost-benefit analysis.

Learning platforms

A recent trend in development organizations is to combine the above assessment process along with a learning platform by calling the unit as an integrated Monitoring, Evaluation and Learning platform. Such projects enable change processes to have an integrated framework to monitor, evaluate and share lessons from change processes implementation to key stakeholders within and outside the project with the help of a team of KM professionals.

Change management activities are tracked regularly using a set of monitoring tools and reporting formats which are developed based on pre-defined process and input indicators. Learning Plans for change teams are usually developed through Learning Needs Assessment or using a Learning Plan Worksheet. In some cases, change managers establish technology driven platforms for learning and knowledge sharing and also to facilitate dialogue and problem solving around change management themes and issues.

Concluding remarks

Irrespective of the knowledge products or processes used in the change management process, the knowledge management platform should constantly be asking or answering some key questions while driving the change management. These questions are:

• Relevance: Are the change management activities relevant and well-conceived? Can the existing change strategy be improved?

• Efficiency and Effectiveness: Are the activities implemented in a timely and cost-effective manner? Have resources been used cost effectively? Do the quantitative and qualitative results justify the resources expended? In relation to the change goal, what changes in knowledge, attitudes, behaviors, relationships or activities of service providers is the change project generating; what is the evidence? To what extent have the planned outputs been achieved and are contributing to the change? What supports and barriers have affected the achievement of outputs and contribution towards outcomes? What are we learning from our experience and how can we further improve?

• Impact: What evidence is there that the intervention is potentially contributing to change?

• Replicability: To what extent is the program is replicable in other places/facilities? How the intervention’s approaches, methods and have potential value in other districts, states or regions?

• Scalability: To what extent the inputs such as training, human and material resources etc. are used in such a way that learning from the project will be used for scaling up the intervention without additional costs.

• Sustainability: To what extent is the intervention contributing to building an enabling environment for continued capacity development by making the suggested processes and products by the project are becoming part of the system and culture within and beyond intervention points? Are they leading to changes in national, state level guidelines, policies and regulations?

(About the Author: Kandathil Sebastian is a Social Scientist and Knowledge Management expert based in Delhi. He is also a novelist. His best selling novels include WISDOM OF THE WHITE MOUNTAIN and DDOLMENS IN THE BLUE MOUNTAIN)