Implementing Change Workshop. #woncarural2015. Dubrovnik. 

Facilitator Martin London NZ / Scribe Jo Scott-Jones 

The workshop was well attended by people from South Africa who were effecting change for small rural communities, from Canada – who were facing government imposed changes and wanting to learn ways to change for others, from the USA seeking international perspective on change, from Ireland having undertaken significant change looking for more ideas, and from the UK  a work renowned expert able to share expertise about change through organisations. 

The process was one of “snowballing” discussion starting with pairs and building to larger groups, than sharing generated ideas to the whole group. 

To draw out initial ideas The facilitator made each pair speak to each other for two minutes without interruption starting each sentence with “One thing that has changed for the better in my practice has been… ” there were two iterations of this until the larger group feedback. 

Our workshop findings are below: 

Critical Landmarks on the Journey to Change 

There is a need for persistence, patience and time to enable change 

5-10-18 years is not uncommon. Be ready for rapid change because when it comes it will happen quickly. 

In terms of workforce problems train in rural for rural, a culture of learning is a fertile ground for change. 

Courage and Critical Mass 

Once there is opportunity there needs to be enough people in place to move with the cascade of change, face to face meetings work well, the people need a shared courage to make the move. Use IT resources to maintain conversations in between meetings, they can especially be helpful for the diaspora of people in rural communities. 

Demonstrate value

There will be barriers to change financial, or political keep the dream you have for your patient in focus. Cost effective change is a key to enabling change so you need to understanding “value” you can bring to the table. Resources go to what is measured. 

Cost effective discussions are hard, seek advice. 

Build on your strengths, we often circle the drain and focus on problems – celebrate what you do well. 

Opportunity prefers the prepared mind – having a vision and sharing it is important even if it is not implemented straight away it is part of the preparation for others. 

In South Africa, private practices often need to shift into government policy, a lightbulb moment has been that the private practice is demonstrating great care it can drive the government to change. 

Sometimes it is important to make a step change away over major structural barriers but sometimes major structural barriers can be changed if the right people understand. Elevate the conversations to the people above the barrier – use the organisations. 

Resistance is futile

You can always go up, down, round, or through – remember the shadow system in complexity theory – the shadowy power brokers if exposed can be extremely helpful. 

Identify the shadowy powerful people, get to know them, bring them into the rural areas, allow them to taste the vulnerability of distance, demonstrate hospitality and they will be friends for life.