Guide to Successful Change Management

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Initial challenges

Immediately a number of challenges arose for the Institute. One key issue was where it was to be located - in the system, more than geographically. The Republic and Northern Ireland had different jurisdictions, different cultures, different health structures organizationally, different budgetary regimes and time periods and clearly different political institutions.

The Institute was to be housed literally and metaphorically within the Royal College of Physicians in Dublin. It was a beautiful building with porticos and marble. However, the Institute hadn't been allocated any space - it had to work from what amounted to a broom cupboard with no windows and a redundant PC.

One possibility was to be further absorbed into the Royal College but the College was focused on standards, training and exams. It was steeped in history, some might say rather archaic. Jane conceived of the Institute as being modern, transparent and permeable, facultative and enabling rather than imposing and laying down the law.

For the first six months she went out meeting people all over the island, initially those in the more obvious public health roles. She saw her job as going out and meeting, asking people what they were doing and reassuring them that the Institute was not in competition with them. Her endeavours were generally met with support and warmth. The timing was right as over 80 per cent of the Republic's population had voted for the Belfast Agreement and there was a strong feeling of wanting this North-South process to begin. Health was a relatively non-contentious issue so it had the possibility of progression.

Although the Director initially knew only a few key people in the Republic the Chief Medical Officer acted as her chief sponsor, engaging her in conversations and meetings. She had had a credible track record and indeed, first by listening to people and then explaining what they were willing and able to do, people became interested and wanted to be involved.

Concurrently the organization's infrastructure was developed. Technology, web and internet, e-mail and other lines of communication were established. Recruitment processes were set in motion, and budgetary, purchasing and financial systems established. It became clear that the future of the Institute required independence to set its own direction.

During this initial time people were recruited based on what they could contribute and deliver on certain things, rather than from what profession they came. It was during this period also that the Director and her emerging team began to shift the focus away from just providing advice and information towards tackling health inequalities, though not straying from the original remit. There was a certain nervousness at having it as a main aim but the Institute was convinced that its focus should be on the wider determinants of health, highlighting the inter-connections between transport, housing, education and social networks, and how these are intimately connected with health and well-being. Initially radical, the approach is now more widely accepted. This set the scene for the Institute to be involved in areas outside the usual health arenas. It was going beyond the disease model, using systems thinking and seeing its place in the whole system.

It recognized that it had a small place in the system, with little responsibility or executive power. It had its ambitions for influencing and impacting health inequalities without becoming a gigantic bureaucratic institution.

Of course the more you start to become successful the greater the demands on your limited resources. One of the key philosophies of the IoPH was to be innovative and light many fires across the health scene. That suggested there would always be this tension between concentrating on running the successful projects and continuing to develop and implement new ideas and initiatives.

Strategy implementation

The strategy development process involved a lot of time together with the new team. It involved stakeholder mapping and brainstorming, and shaping the future possibilities within the context of understanding future needs and possible scenarios. These were then shaped up into work programmes, which were generally cross-cutting themes rather than one or two specialist areas - such as developing a diabetes register - which might have been too limiting. This was partly looking at the longer term and positioning the Institute in the context of the wider health picture - it could easily have got bogged down in just one important time-consuming initiative. It decided to operate more at a 'meta-leveP and wanted to start out as it planned to continue.

Soon people were seeing the Institute as a resource that could be utilized. For example, the Department of Health in Ireland saw it as really useful in developing the National Anti-Poverty Strategy specifically to produce health targets. This in turn developed into a wonderful networking opportunity to better connect with the web of people and institutions absolutely essential for the IoPH to realize its aims.

The Institute works at a whole systems level providing some resource and expertise, supporting and influencing through facilitation via its networks. Its aims include building capacity and capability within its own organization to do the same for all organizations involved in the all-Ireland health agenda.

Vision and values

Jane Wilde had a very clear take on the importance of the vision and values to the organization and its way of working:

The vision and values are crucial, even more important than a clear set of objectives. At the top are the vision and values, at the bottom is the infrastructure - accounting, systems, processes - both very worked out and clear and effective. In the middle is the room to juggle and be flexible - we don't need to fight for our existence, we fight for our vision.

The Institute has its work plan developed from its strategy process but it recognizes that things will come up or it'll spot things and need to decide whether to factor them into the ongoing work. It has its flagship programmes which are the core of its work, and are quite responsive at taking on additional things during the year, mobilizing resources and spending additional funding quickly and easily and in a very focused manner.

It is more interested in things being achieved than being precious about keeping ownership of things or about who controls the resources. It's not about being territorial, more about effective deployment of resources.

Vision and values come out all the time, whether it's the way the offices are furnished or how the senior management team and management board minutes are published. Keeping communication open between the Belfast and Dublin offices can sometimes be problematical though regular video conferences are organized and face-to-face 'programme' days are scheduled. It can be difficult to get people who have no reason to go to the South, say, to get to know about the South, though the ethos is to constantly reiterate the need for an all-Ireland focus.

A very cosmopolitan staff group have been recruited, drawn from many countries. They operate with a belief that says tensions are more about where they should invest their energies rather where there's conflict to be avoided. They try to do everything to a high standard, with a real attention to both the task and people process, ensuring clarity of agendas and outcomes and that all staff are supported. They support and look after each other with team days designed to allow time for creativity, reflection, de-stressing, growth and development.

Leadership style

The leadership style exhibited by the Director and her senior management team on the one hand reflect the personalities and values of the managers themselves, and on the other hand, mirror the requirements of the Institute from formation through to being a successful player in the Irish health field.

A balance was struck between being affiliative, democratic and authoritative. The Institute needed to get close to all of its stakeholders, build trust and discover what the needs and ideas were of all of these bodies and the constituencies that they represented. It then had to craft a vision and a strategy that would command respect, be authoritative and encourage engagement.

Core values which permeate the leadership are:

* being determined to stand up for what they believe (ie, tackling health inequalities in an inclusive way);

* setting out a motivating vision;

* setting consistently high standards;

* being collaborative, building relationships and fostering networks wherever and whenever it's possible; and

* building and maintaining momentum on a number of fronts with a number of initiatives.

A key leadership competency for the senior management team is being politically astute, with no game-playing whilst watching and managing the political and organizational boundaries.

In the top team the Director's style is very facilitative; occasionally she needs to remember - or be told - that she has to take the lead and make the final decision. As a matter of course there is a collaborative and consensual approach to strategy making, problem solving and decision taking.

Management board

The non-executive management board had the ultimate responsibility for directing the Institute, though in reality the process seemed to be one of collaboration and negotiation. The Director and senior team would go to them with ideas and get approval for the agenda. Initially more directive, the board evolved a way of working that is rather low key, but open, honest and transparent. The relationship between the non-executive management board and the executive senior management team has developed over the years. A lot depended on the differing states of maturity of the board as opposed to the senior management team (maturity in terms of knowledge and experience of the organization, its agenda and its place within the health arena).

The Institute tended to be senior management-led within the broad parameters laid down by the board. In some ways this reflects the confidence the board had in the senior management, though in other ways it probably needed to demonstrate greater critical challenge.

Working across the border

A key challenge was the need to work across the border with both the political sensitivities and cultural differences that implied. The line across the border proved to be a very big line indeed. The two governments had different ways of transacting and different priorities. The Institute acted as facilitators between the two in an attempt to better align the different health agendas and priorities. For example, at one stage there was restructuring in the South, another time budget cuts in the North. At both these times people outside of the Institute tended to look more inward and take their eyes off the collective agenda. It was for the Institute to hold firm to its vision and work with what and who was available. Indeed it found that rather than wait for a total agreement on any one initiative it would start things off in one area and other areas would pick it up if they saw any value in it.

Leadership programme

The leadership programme is a good case in point as its aim was to build leadership capability and capacity across all organizations working on the island. This innovative programme focused on personal development, systems change and collaborative leadership, addressing individual leadership challenges whilst promoting and developing networks. In addition to the individual and group learning there have also been two specific products created by the participants - an imaginative book, Reflecting Leadership, and an advocacy toolkit which is being further developed as a web-based resource. Four programmes have been run with 100 people from all health sectors nominated or self-selected to attend. These include academics, public health doctors, community health workers as well as managers from local government.

The programme didn't just focus on individual leadership development but also on the impact on their respective organizations - creating a cadre of leaders, making wider connections and operating in an all-Ireland system. The ongoing peace process has helped - creating more porous borders, being more fluid and less threatening. Likewise this increased level of communication and understanding has helped the peace process.

A key symbolic act on the Director's part was to enrol in the first leadership programme along with some of her associate directors. She recognized that full and wide participation on the leadership programme was important. By acknowledging that she was prepared to show her vulnerabilities, address her weaknesses and further develop her strengths she set a particular tone for the Institute itself and for all leaders and would-be leaders across the health arena in Ireland. This was one of the factors that ensured other high profile people attended, and the programme became something which others wanted to attend.


The key lessons from this change process are as follows.

Good sponsorship

It was imperative to have a good level of sponsorship from someone who was already respected and had power and authority in the field. The Chief Medical Officers played this role during the birth of the organization and its crucial first few months and this role has now been adopted by members of the management board.

The importance of inclusivity - looking after your stakeholders This means identifying all of the stakeholders, discovering their needs and wants and factoring them into your strategic deliberations and demonstrating that they have been listened to.

Appropriate influencing skills

The Institute was a legitimate entity but was operating without specific powers. It adopted an influencing style based on drawing people into discussions and deliberations and offering knowledge, experience and resource as away of gaining commitment and engagement.

Features of this style would typically be building on others' ideas, testing understanding, seeking information, being democratic and sharing power, being involved and building trust. Interestingly this works best when one has no formal power.

The importance of vision and values

The 'what' of the vision and the 'how' of the values provided a compass en route to achieving the objectives. They were used as a crucial part of the decision-making process and provided a raison d'être for the organization rather than having to concern itself with ideas of growth and acquiring and monopolizing resources.

Developing a lean, agile, responsive organization

As a consequence of clarity of vision the organization didn't need to demonstrate success by growth, assets or size but by how well it enabled the health inequalities agenda to be moved on. To do this it need to develop a lean, agile and responsive organization which it did through recruitment of the right people (professionally and attitudinally); particularly good influencing and enabling skills; demonstrating value through building flagship projects and programmes; investing time in research and reflection; spotting the right opportunities in the myriad of issues and initiatives; and harnessing the power and influence of the networks around it.

Transformational leadership style

The senior management team adopted more of a transformation leadership style. Some of the qualities associated with this style include:

* setting out and working towards a longer-term vision;

* creation of a facilitating environment, enabling people to operate in an environment of trust, openness and empowerment;

* working towards changing the status quo and not being afraid to confront (in skilful ways) situations or people that are not committed to this process;

* recognizing that building overall capacity and capability rather than being directive and hierarchical is a means towards the end; and

* seeing and demonstrating that authority comes from the ability to influence through a network of relationships and a relationship of networks.

The use of reflection as an aid to action

Partly because the organization is involved in research and reflection, partly due to the personalities of the senior management team, there is a great emphasis placed on individual and team reflection and addressing the group process. The organization recognizes the need (as demonstrated in its leadership programme) to invest in leadership processes that pay due regard to individual and team development and dynamics as a prelude to taking action.

Non-executive board and senior management team

For an organization to be operating at full effectiveness there needs to be a stronger relationship between the non-executive board and its senior management team. Healthy relationships need to be brokered between these two groups to ensure clarity of goals and effective operating processes.

Biogen Idee

Biogen Idee Incorporated is a global biotechnology company which develops products and capabilities in oncology, neurology and immunology. Its two major drugs are used in the treatment of Non-Hodgkin's lymphomas, a type of cancer, and multiple sclerosis. Its core capabilities are drug discovery, research, development, biomanufacturing, and commercialization of its products. The company is one of just a few biotechnology companies that have biological bulkmanufacturing facilities, with one of the world's largest cell culture facilities.

Biogen Idee has headquarters in Cambridge, Massachusetts, and was formed in 2003 from the merger of two of the world's leading biotechnology companies - Biogen, founded in Switzerland in 1978, and Idee, founded in San Francisco, California, in 1985. Biogen Idec's history has been one of developing partnerships and achieving mergers with strategic fit, for example same location different drugs, different presences in different markets. In 2005 Biogen Idee invested $684 million - 31 per cent of revenues - in continued research.

The company has research centres of excellence in San Diego, California, and Cambridge, Massachusetts, and additional offices in Canada, Australia, Japan and throughout Europe, including the international commercial and administrative centre of excellence in Zug, Switzerland. In 2006, the company employed approximately 3,400 people worldwide.

For more than 25 years the company has grown through the discovery, development and commercialization of its own innovative products and through its strategic alliances.

Biogen Idee vision and values


With passion, purpose and partnerships, we transform scientific discoveries into advances in human healthcare.


We create new standards of care in oncology and immunology through our pioneering research, and our global development, manufacturing and commercial capabilities.

Core Values

Courageous Innovation

We apply our knowledge, talent and resources to yield new insights and bold ideas. We confront challenge and uncertainty with zeal, tenacity and vision and seize opportunities to excel.

Quality, Integrity, Honesty

Our products are of the highest quality. Our personal and corporate actions are rooted in mutual trust and responsibility. We are truthful, respectful and objective in conducting business and in building relationships.

Team as a Source of Strength

Our company is strong because our employees are diverse, skilful and collaborative. We pursue our fullest potential as individual contributors, team members and team leaders.

Commitment to Those We Serve

We measure our success by how well we enable people to achieve and to thrive. Patients, caregivers, shareholders and colleagues deserve our best.

Growth, Transformation and Renewal

Consistent with our core values, we as individuals and as a corporation are dedicated to creative and constructive growth, transformation and renewal as a source of inspiration and vitality.

Up until recently the international headquarters were based in Paris. However, following a strategic benchmarking review, the decision was made to establish a number of centres of excellence across Europe, moving from France and basing the new commercial and administrative headquarters in Zug, Switzerland, where most of the international functions reside.

What were the thought processes that led to this decision and how well was this restructuring and cultural shift managed?

The Paris headquarters had responsibility for all finance, legal, HR and commercial activities. Other international functions like regulatory affairs, drug safety and logistics were locally divided. The prevailing culture in the European operation was one of a relatively centralized controlling style with many decisions being made in the headquarters.

Due to the bureaucratic process, decision making was seen as rather slow and onerous and perhaps not totally aligned with the business culture the company wanted to live across its European operations.

While the company had direct presence in most West European countries, it operated via distributors in Latin America, Central and Eastern Europe and the Middle East. In 2003, the company was revisiting its business strategy while it was striving to launch new products and to grow its direct presence in emerging markets.

The change

A project team was appointed to conduct the reassessment of the business strategy. The key objective was to conduct a benchmarking study for the best location, in order to optimize the organizational structure and processes and develop more effective relationships with the European affiliate companies on the one hand and the corporate headquarters in the United States on the other. The head of the international business was appointed to be the project leader, supported by the directors of commercial operations, human resources and international legal affairs. The first stage was pure data gathering of internal and external information. The company was intent on following best industry practice. If, for example, staff were to be relocated or made redundant, the team needed to base its decisions on industry and regional best practices. Data gathered here related, for instance, to relocation and outplacement.

The second stage was to look at future options regarding distribution of functions and allocation of resources across Europe. In principle it was decided to create three 'centres of excellence', by moving commercial and administrative functions to Switzerland (international headquarters), regulatory affairs and drug safety to the UK, where the European Regulatory Authority is based, and logistics to Holland, where the packaging operations was based.

Part of the discussion was the role of the international headquarters as opposed to the affiliate companies. As mentioned before, there was always the possibility of tension between the two and the potential for conflict, as long as roles had not clearly been defined, in particular due to the fact that the former international headquarters and the various affiliates had grown their resources simultaneously.

As part of the move towards empowering the affiliates it was decided to redefine the role of the HQ as primarily sharing best practice, voicing local/international needs to corporate and ensuring alignment between the various operations Therefore, the affiliates had to become self-sufficient: additional resources were allocated on a local level while resources on the international level were reduced. As an example, the HR function was designed to no longer primarily report into headquarters, but into the managing directors of the affiliates, with a 'dotted line' relationship to the Vice President Human Resources. Actions such as these reflected the empowerment of the affiliates and the local managing directors. There was some resistance to change in the reporting Unes but this was remedied by groups and individuals relinquishing a direct reporting line for at least a dotted line. In this manner, some connections were retained, but looser. This reinforced the notion of a move away from a largely centralized web culture to a more networked one, based on a matrix. From an early stage and to comply with employment legislation, follow best practice and to be true to the company's 'Team as a source of strength' corporate value, the team actively involved staff representatives through the representatives of the Works Council.

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