• Editors' Summary
• Credits

1. Overview
2. Getting Started
3. Define Desired Performance
4. Describe Actual Performance
5. Measure/Describe Performance Gaps
6. Find the Root Causes
7. Select Interventions
8. Implement Interventions
9. Monitor and Evaluate Performance
10. Managing Change
• Creative Leadership Needed

• Figures
• Tables
• Side-bars
• Bibliography

• PI approach offers many benefits
• Pilot project holds lessons
• Helping people do their best
• Burkina Faso: Assessing needs
• India: PI helps private providers
• Using the “Why Tree” in Ghana

• POPLINE
• Media/Materials Clearinghouse
• Other issues
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• CCP Home Page

Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA

Managing Change

Improving performance requires people and organizations to learn and change. For example, providers learn new procedures for sterilizing equipment or change attitudes toward clients. In a decentralizing organization employees learn to handle more authority and to make decisions that their managers previously made for them. Carrying out the PI process itself involves managing change.

Change is stressful. It provokes fear, anxiety, and resentment in many people. Without a compelling reason to change, people resist change because they fear that they will have to adopt unfamiliar routines (148), be forced to do more work without more pay, or lose their jobs because they will be judged by a higher standard that they cannot meet (22). Some people are unwilling to take on more responsibility (119, 148). Others dislike change imposed by outsiders (29), or they dislike their working conditions and resist change in protest (4, 22, 112, 144, 147).

Leaders of an organization using the PI process need to take into account and plan for the varying responses of staff members to change. Most people change slowly and in stages. One theory of behavior change identifies a five-step process: precontemplation, contemplation, preparation, action, and maintenance (160). People vary in their response to change, falling into groups of innovators, early adopters, early majority, late majority, and late adopters. The rate of adoption depends on the perceived advantages of the change, how difficult it is to adopt, and the skill with which it is introduced, among other factors (77, 138).

Starting and sustaining institutional change requires strong and creative leaders. They need to inspire and persuade employees to complete a sometimes difficult and lengthy process. Leaders committed to change can emerge at any level of an organization, not only from top management. To start the change process, leaders:

• Articulate and communicate an urgent reason to change. Urgency usually comes from a change outside the organization, such as a funding cut or a change in clientele (104). In the Dominican Republic, for example, as more women took jobs in the early 1990s, the Social Security Institute (IDSS) began serving more women than men, and the women were dissatisfied with the reproductive health services offered by the institute (91).
• Include a broad spectrum of employees in planning the changes. In the PI process, involving all stakeholders creates a nucleus of people who support the changes and reduces the likelihood of resistance to change. Experience in US industry suggests that organizations can change when at least one-quarter of employees are committed to change (77).
• Create a vision of the organization. Leaders communicate a vision for the organization and link the changes to the vision so that employees see the reason for change.

Communicating the vision demands persistence and creativity. Leaders set examples of the new ways of working. They must emphasize the vision repeatedly in many forms —presentations, informal discussions, letters, memos, and newsletters—to make it the guiding principle for employees (77). Changes become permanent when employees change the way they think about and do their work (77, 84).

Performance Improvement promises to do for reproductive health organizations and programs in developing countries what it has done for corporations around the world: improve services with well-designed solutions to performance problems. The PI process helps organizations inspire, guide, equip, and enable employees to fulfill the mission of their organization and perform at their highest level. The result can be more productive employees, more effective reproductive health programs, and more satisfied clients.