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Valenzuela City, Metro Manila

DOCTOR OF PHILOSOPHY IN NURSING


Major in Nursing Administration

PhDN 310
HUMAN BEHAVIOR IN NURSING ADMINISTRATION
FIRST SEMESTER – SY 2018 – 2019

Submitted to:
MA. VIRGINIA M. ALARILLA, Ph.D.

In Partial Fulfillment of the


Requirements for the Degree in
DOCTOR OF PHILOSOPHY IN NURSING
Major in Nursing Administration

Submitted by:
FELIPE A. MERANO, MSN, RN
CHED SCHOLAR: Nominee ID No. 2017a-0405915
October 2017

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REPORTS:

ORGANIZATIONAL DEVELOPMENT & CHANGE MANAGEMENT

ORGANIZATIONAL DEVELOPMENT

Organization development is an effort (1) planned, (2) organization-wide, and (3)


managed from the top, to (4) increase organization effectiveness and health
through (5) planned interventions in the rganization’s “processes,” using
behavioral-science knowledge.

1. It is a planned change effort.


An OD program involves a systematic diagnosis of the organization, the
development of a strategic plan for improvement, and the mobilization of
resources to carry out the effort.

2. It involves the total “system.”


An organization-development effort is related to a total organization change such
as a change in the culture or the reward systems or the total managerial strategy.
There may be tactical efforts which work
with subparts of the organization but the “system” to be changed is a total,
relatively autonomous organization. This is not necessarily a total corporation,
or an entire government, but refers to a system which is relatively free to
determine its own plans and future within very general constraints from the
environment.

3. It is managed from the top.


In an organization-development effort, the top management of the system has a
personal investment in the program and its outcomes. They actively participate
in the management of the effort. This does not mean they must participate in the
same activities as others, but it does mean that they must have both knowledge
and commitment to the goals of the program and must actively support the
methods used
to achieve the goals.

4. It is designed to increase organization effectiveness and health.


To understand the goals of organization development, it is necessary to have
some picture of what an “ideal” effective, healthy organization would look like.
What would be its characteristics? Numbers of writers and practitioners in the
field have proposed definitions which, although they differ in detail, indicate a
strong consensus of what a healthy operating organization is. Let me start with
my own definition.

An effective organization is one in which:

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a. The total organization, the significant subparts, and individuals manage
their work against goals and plans for achievement of these goals.
b. Form follows function (the problem, or task, or project determines how the
human resources are organized).
c. Decisions are made by and near the sources of information regardless of
where these sources are located on the organization chart.
d. The reward system is such that managers and supervisors are rewarded
(and punished) comparably for: short-term profit or production
performance, growth and development of their subordinates, creating a
viable working group.
e. Communication laterally and vertically is relatively undistorted. People are
generally open and confronting. They share all the relevant facts including
feelings.
f. There is a minimum amount of inappropriate win/lose activities between
individuals and groups. Constant effort exists at all levels to treat conflict
and conflict-situations as problems subject to problem-solving methods.
g. There is high “conflict” (clash of ideas) about tasks and projects, and
relatively little energy spent in clashing over interpersonal difficulties
because they have been generally worked through.
h. The organization and its parts see themselves as interacting with each
other and with a larger environment. The organization is an “open system.”
i. There is a shared value and management strategy to support it, of trying
to help each person (or unit) in the organization maintain his (or its)
integrity and uniqueness in an interdependent environment.
j. The organization and its members operate in an “action research” way.
General practice is to build in feedback mechanisms so that individuals
and groups can learn from their own experience.

Another definition is found in John Gardner’s set of rules for an effective


organization. He describes an effective organization as one which is self-
renewing and then lists the rules:
 The first rule is that the organization must have an effective program for
the recruitment and development of talent.
 The second rule for the organization capable of continuous renewal is
that it must be a hospitable environment for the individual.
 The third rule is that the organization must have built-in provisions for
self-criticism.
 The fourth rule is that there must be fluidity in the internal structure.
 The fifth rule is that the organization must have some means ofcombating
the process by which men become prisoners of their procedures
(Gardner, 1965).

• Organization development differs from other planned change efforts, such


as project management or innovation, because the focus is on building the
organization’s ability to assess its current functioning and to achieve its
goals.
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• Moreover, OD is oriented to improving the total system—the organization
and its parts in the context of the larger environment that affects them.
(Cummings & Worley, 2008)

Definitions of Organization Development

1. Organization development is a planned process of change in an


organization’s culture through the utilization of behavioral science
technology, research, and theory. (Warner Burke)
2. Organization development refers to a long-range effort to improve an
organization’s problem-solving capabilities and its ability to cope with
changes in its external environment with the help of external or internal
behavioral-scientist consultants, or change agents, as they are sometimes
called. (Wendell French)
3. . Organization development is an effort

(1) planned,

(2) organization-wide, and

(3) managed from the top, to

(4) increase organization effectiveness and health through

(5) planned interventions in the organization’s “processes,” using


behavioral science knowledge. (Richard Beckhard)

4. Organization development is a system wide process of data collection,


diagnosis, action planning, intervention, and evaluation aimed at (1)
enhancing congruence among organizational structure, process, strategy,
people, and culture; (2) developing new and creative organizational
solutions; and (3) developing the organization’s self renewing capacity.
It occurs through the collaboration of organizational members working
with a change agent using behavioral science theory, research, and
technology. (Michael Beer)
5. Is based on
(1) a set of values, largely humanistic;
(2) application of the behavioral sciences; and
(3) open systems theory,

6. Organization Development is a system wide process of planned change


aimed toward improving overall organization effectiveness by way of
enhanced congruence of such key organization dimensions as external
environment, mission, strategy, leadership, culture, structure,
information and reward systems, and work policies and procedures.
(Warner Burke and David Bradford).
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The following definitions reveal the heart of the practice of OD, which is to
improve the functioning of individuals, teams and the total organization:
 OD is a systematic process for applying behavioural science principles and
practices in organizations to increase individual and organization
effectiveness (French and Bell, 1999).
 OD is a process (and its associated technology) directed at organization
improvement (Margulies, 1978).
 OD is all the planned interventions to increase organization effectiveness
and health (Beckhard, 1969).
 OD is about building and maintaining the health of the organization as a
total system (Schein, 1988).
 Organization revitalization is achieved through synthesizing individual,
group and organizational goals so as to provide effective service to the
client and community while furthering quality of product and work life
(Lippitt and Lippitt, 1975).
 The goal of OD is to enhance organizational effectiveness by attending to
both human and organizational needs (Rainey Tolbert and Hanafin, 2006).
 OD is an organizational process for understanding and improving any and
all substantive processes an organization may develop for performing any
tasks and pursuing any objectives (Vaill, 1989).
 OD is all the activities engaged in by managers, employees and helpers
that are directed towards building and maintaining the health of the
organization as a total system (Schein, 1988).
 OD is a long-range effort to improve an organization’s problem solving and
renewal processes... with the assistance of a change agent, or catalyst, and
the use of the theory and technology of applied behavioural science,
including action research (French and Bell, 1999).

Characteristic of OD

1. We are ‘process’ experts to improve any substantive organization processes


(eg planning, group meetings and relationships, superior–subordinate
communication).
2. We focus on the ‘total system’ even if we are asked to look at a specific
organization issue.
3. We aim to improve an organization’s problem solving and renewal
processes.
4. The primary practitioners of OD are the organization’s managers, not
HR/OD professionals.
5. OD practitioners are ‘helpers and catalysts’ to the leaders of the
organization (the primary practitioners).
6. We use the technology of applied behavioral science to support the
organization towards healthy development.
7. We are theory based, process focused, value driven.

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Critical founders who shaped the OD field

• Kurt Lewin (critical founder of OD): Lewin gave the field some of its most
essential theoretical roots – action research theory, group theories and
change theories. Schein commented that there is little question that Lewin
is the intellectual father of contemporary theories of applied behavioural
science, action research and planned change.

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He was the first to write about group dynamics and the importance of the
group in shaping the behavior of its members. Also, his commitment to
extending democratic values in society through his work created a most
pervasive impact on Organization Development.
• Ron Lippitt: Lippitt was on Lewin’s original staff at the Research
Center for Group Dynamics at MIT and was also a member of the first
group of trainers for T group in 1946. In 1947, he was one of the founders
of National Training Laboratory in Group
• Edgar Schein: Schein, a professor at the MIT Sloan School of
Management, made a notable mark on the field in many areas including
career development, group process consultation and organizational
culture. His career anchoring concepts and tools are forerunners in
helping organizations to think of combining unconditional motivation and
an organization way of managing staff career structure. He is generally
credited with inventing the term ‘corporate culture’. Schein showed us that
process consultation is an essential philosophy underlying OD, not just a
tool. Development, which started holding a three-week session in Bethel,
Maine. The summer event evolved into the birth of the NTL Institute for
Applied Behavioural Science. Together with Lee Bradford, he invented flip
chart paper in 1946 as a convenient way to record, retrieve and display
data in OD activities and in training.
• Douglas McGregor: McGregor is mostly known for his classic work,
The Human Side of Enterprise, which has had a great impact on mangers
since its publication in 1960. He was one of the first professor-consultants
and one of the first behavioural scientists working with corporations to
help implement the application of T group skills in complex organizations.
• Rensis Likert: Likert showed the importance of holding up a mirror
for the organization to reflect how its members think about themselves
and how to strengthen their relationships. His early work on this gave rise
to the use of organization survey. Later on, his research provided
overwhelming data on the superiority of a democratic leadership style in
which the leader is group oriented, goal oriented and shares decision
making with the work group. This leadership style was contrasted with an
authoritarian, one-on-one leadership style (1961, 1967).
• Chris Argyris: Argyris was one of the first (following Bob Tannerbaum)
to conduct team building sessions in 1957. He has made extensive
contributions to theory and research on laboratory training, OD and
organizational learning. One of his several books on OD, Intervention
Theory and Method (1970), stands as a classic in the field. He asserted that

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it is important to gather valid information and give clients choice to secure
commitment (1957).
• Bob Tannerbaum: Tannerbaum received his PhD in Industrial
Relations from the School of Business at the University of Chicago. He is
known for being the first researcher to conduct the earliest ‘team building’
activities in 1952–53 at the US Naval Ordinance Test Station at China
Lake, California. Subsequently, he published such team building work in
Harvard Business Review in 1955. He and Art Shedline started the first
non-degree training programme on OD at UCLA.
• Richard Beckhard: Beckhard was a major figure in the emergence and
extension of the field of OD. He started from a career in the theatre. He
was interested in improving the effectiveness of communications in large
meetings, and his first major job after his career change was to stage the
1950 White House conference on children and youth, which involved 6,000
people. He started to pay attention to how to stage a large convention and
enable participative discussion. He developed one of the first major non-
degree training programmes in OD – the NTL’s Programme for Specialists
in Organizational Training and Development (PSOTD).
• Herbert Shepard: Shepard completed his doctorate at MIT and then
went to join the employee relations department of Esso Standard Oil as a
research associate. He was to have a major impact on the emergence of
OD through his extensive practice in the corporate world as well as his
involvement with the NTL work. In 1960, he founded the first doctoral
programme devoted to training OD specialists at the Case Institute of
Technology. His continuous experiments in OD at major Esso refineries
resulted in significant learning for us; two particular lessons that emerged
from his work are: a) the requirement for top management’s active
involvement in the leadership of the programme; b) the importance of the
need for on-the-job application.
• Robert Blake: During World War II, Blake served in the Psychological
• Research Unit of the Army Air Force and concluded that looking at the
system rather than the individuals within the system on an isolated
individual basis is a much more robust approach in identifying how best
to help. Later, he spent 16 months in Tavistock and was deeply influenced
by family group therapy. Upon returning to the USA, he took up an
appointment at Harvard but joined the NTL programmes at Bethel to staff
T groups for six years and was significant in shaping the changes in T
group

OD PROCESS

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• Burke and Bradford’s definition broadens the range and interests of OD.
Worley and Feyerherm suggested that for a process to be called
organization development,
(1) it must focus on or result in the change of some aspect of the
organizational system;
(2) there must be learning or the transfer of knowledge or skill to the client
system; and
(3) there must be evidence of improvement in or an intention to improve the
effectiveness of the client system.

• First, OD applies to changes in the strategy, structure, and/or processes


of an entire system, such as an organization, a single plant of a multiplant
firm, a department or work group, or individual role or job.
• A change program aimed at modifying an organization’s strategy, for
example, might focus on how the organization relates to a wider
environment and on how those relationships can be improved.
• It might include changes both in the grouping of people to perform tasks
(structure) and in methods of communicating and solving problems
(process) to support the changes in strategy.
• Second, OD is based on the application and transfer of behavioral science
knowledge and practice, including microconcepts, such as leadership,
group dynamics, and work design, and macroapproaches, such as
strategy, organization design, and international relations.
• Third, OD is concerned with managing planned change, but not in the
formal sense typically associated with management consulting or project
management, which tends to comprise programmatic and expert-driven
approaches to change. Rather, OD is more an adaptive process for
planning and implementing change than a blueprint for how things should
be done.
• Fourth, OD involves the design, implementation, and the subsequent
reinforcement of change. It moves beyond the initial efforts to implement
a change program to a longer-term concern for appropriately
institutionalizing new activities within the organization.
• Finally, OD is oriented to improving organizational effectiveness.

Effectiveness is best measured along three dimensions:


 First, OD affirms that an effective organization is adaptable; it is able to solve
its own problems and focus attention and resources on achieving key goals.
OD helps organization members gain the skills and knowledge necessary to
conduct these activities by involving them in the change process.
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• Second, an effective organization has high financial and technical
performance, including sales growth, acceptable profits, quality products
and services, and high productivity. OD helps organizations achieve these
ends by leveraging social science practices to lower costs, improve products
and services, and increase productivity.
• Third, an effective organization has satisfied and loyal customers or other
external stakeholders and an engaged, satisfied, and learning workforce. The
organization’s performance responds to the needs of external groups, such
as stockholders, customers, suppliers, and government agencies, which
provide the organization with resources and legitimacy.
• Moreover, it is able to attract and motivate effective employees, who then
perform at higher levels.
• “Organization development is a response to change, a complex educational
strategy intended to change beliefs, attitudes, values, and structures of
organizations so that they can better adapt to new technologies, markets,
and challenges, and the dizzying rate of change itself” (p. 2).
• Bennis used four words that are seen today as key components of
organizational culture: beliefs, attitudes, values, and structures. This view
was later expanded by Edgar Schein (1980), who developed the idea of a
cultural iceberg

Introduction to Change Management

ADKAR process
ADKAR individual change assessment

Employees Have Found Meaning in Their Work.


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• Most employees feel their work matters -- that they’re contributing to
something larger than themselves. The majority of our employees have
found a sense of meaning in the work they do today.
• Comfort with the current state
• Do not underestimate the power of “comfort” with how things are today
• The natural reaction to change is pause and reflection
• “Many change agents are surprised by the reaction to change, when
in fact they should plan for many reactions.”

• Three Phases of Change

Current State Transition State Future State

LET’S GET STARTED


• How many people take pride in the way you do your work today?
• How many people believe that the work you do everyday directly
contributes to PURSUE success?
• Look to the person next to you and thank them for a job well done.

Employees Have Found Meaning in Their Work.


• Most employees feel their work matters -- that they’re contributing to
something larger than themselves. The majority of our employees have
found a sense of meaning in the work they do today.

Change Readiness and Comfort


• Comfort with the current state
o Do not underestimate the power of “comfort” with how things are
today
o The natural reaction to change is pause and reflection
“Many change agents are surprised by the reaction to change, when in fact
they should plan for many reactions.”

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Three Phases of Change

Current Transition Future


State State State

Current State
• Employees generally prefer the current state

Current Transition Future


State State State

Future State
• The future state is unknown to the employee.

Current Transition Future


State State State

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Transition State
• The transition state creates stress and anxiety

Current Transition Future


State State State

Change Management is:


Change
management is a
system used to
anticipate,
activate and
accelerate
engagement

The process, tools and techniques to manage the


people-side of change to achieve the required business
outcome.
Adapted from Prosci 2008

Primary reasons for change Management

• Manage resistance to change


• Increase probability of success
• Reduce transition time

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Organizational change can be represented
as three states of change

Current Transition Future


state state state

How things are done How to move from How things will be
today? current to future? done tomorrow?

Adapted from Prosci 2008

The organization’s future state is actually


the collection of many individual future
states

Organization

Future

Adapted from Prosci 2008

Consequences of Not managing the people side of change>


• Lower productivity
• Passive resistance
• Active resistance
• Turnover of valued employees
• Disinterest in the current or future state
• Arguing about the need for change
• More sick days
• Change not fully implemented
• People finding work arounds
• People revert to the old way of doing things
• The change being totally scrapped
• Divides are created between ‘us’ and ‘them’

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Change is not always easy!

Adapted from Prosci 2008

Composite Organizational Change Model


for the Learning Organization

Individual-
Organizational
Psychological

56

Necessary Conditions for Successful Change:


1. Leadership for the Change
2. Capabilities that are weaved into the fabric of the organization

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Implementing Process: Managing Change

Eight Stages of Leading Change by John Kotter’s 8 Model of Change


1. Create Sense of Urgency
2. Create Guiding Coalition
3. Develop a Change Vision & Strategy
4. Communicate the Change Vision
5. Empower Broad-based Action
6. Generate Short-term Wins
7. Consolidate Gains and Produce more Wins
8. Anchor New Approaches in the Culture

Desire does NOT mean 100% acceptance rate


20 – 60 – 20 rule

The ADKAR Model


ADKAR describes the required phases that an individual will go through
when faced with change.

ADKAR is a foundational tool for understanding “how, why and when” to


use different change management tools.

The five building blocks of successful change

Awareness of the need for change


Desire to participate and support the change
Knowledge on how to change
Ability to implement required skills and behaviors
Reinforcement to sustain the change

• The ADKAR Model is an individual change management model describing


how one person makes a successful change.
• Effective change management requires a change management model as
its foundation to encourage effective organizational change.

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Awareness of the need for change.
 What is the nature of the change?
 Why is the change happening?
 What is the risk of not changing?

Awareness is often equated to communication; however, the act of


communicating does not always produce the result of awareness.
This is where you should start seeing:
 what the change is,
 why the change is being made,
 and what the risks of not changing from the current state are.

Think about the change your team is working on currently. Write a


number 1 – 5 on the Post-It note to indicate your Awareness of this
change.

Desire to support the change.


• Personal motivation to support the change
• Organizational drivers to support change

Ultimately, desire is about personal choice. It is often due to uncertainty


and lack of control during the change process that causes a person’s
motivation for the change to put them at odds with the change.
This can create ‘reactive management’ – fire fighting and damage control.
Instead of introducing change and then identifying those who are
resistant. The ultimate goal is not to drag you along unwillingly, but to
create energy and engagement around the change that produces
momentum and support from you. This is sometimes referred to as the
“what’s in it for me” stage

Think about the change your team is working on currently. Write a


number 1 – 5 on the Post-It note to indicate your Desire for this change.

Knowledge on how to change.


• Knowledge, skills and behaviors required during and after the change
• Understanding how to change

Think about the change your team is working on currently. Write a


number 1 – 5 on the Post-It note to indicate your Knowledge needed to
implement this change.

Ability to implement new skills.


• Demonstrated ability to implement the change
• Barriers that may inhibit implementing the change

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Think about the change your team is working on currently. Write a
number 1 – 5 on the Post-It note to indicate your Ability to implement this
change

Reinforcement to sustain the change.

• Mechanisms to keep the change in place


• Recognition, rewards, incentives, successes

Think about the change your team is working on currently. Write a


number 1 – 5 on the Post-It note to indicate your feeling of Reinforcement
for this change.

Connecting ADKAR and the current,


transition and future states.

Current Transition Future

A D K A R

Adapted from Prosci 2008

ADKAR Gap Model

Change

Confusion

Resistance

Fear/
Anxiety

Frustration

Backsliding

Adapted from Prosci 2008

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Developing corrective actions with
ADKAR
If the gap is: Corrective actions:

Awareness Management communicates about the


business reasons f or change (why, risk of not
changing, drivers of change); Face-to-f ace
communications with immediate supervisors
about how the change impacts you directly is
what should occur.
Desire Look f or pockets of resistance and identif y the
root cause; discuss your desire f or resisting
the change

Adapted from Prosci 2008

Developing
Developingcorrective actions
corrective with
actions
ADKAR
with ADKAR
If the gap is: Corrective actions:
Knowledge Training on how to change and the skills
needed af ter the change

Ability On-the-job training and job aides to support


the new behaviors; Coaching by
supervisors; Troubleshooting

Reinforcement Messages by senior leaders and


supervisors that the change is here to stay;
Individual coaching sessions to identity
gaps

Adapted from Prosci 2008

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Managing Resistance

Applying ADKAR:
Not everyone moves through change
at the same pace
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Adapted from Prosci 2008

Involve Stakeholders During Planning


Often projects fall into the trap of, “if we build it, they will come”

How the customer How the project How the analyst How the programmer What the customer
explained it. leader understood it. designed it. wrote it. really wanted.

Key Stakeholders (e.g. other Offices, front -line employees, etc.) should actively be involved in:
o Developing the case for change
o Defining project success in terms of outcomes, outputs, and associated metrics
o Creating the project plan
o Ongoing project decisions and status reports (e.g. via a working group, weekly status email,
meeting, etc.)

Engaging Front-Line Employees early builds buy-in and proactively avoids unintended consequences

86

Obstacles to Change
66% of change initiatives fail to achieve desired
business outcomes
0% 40% 80%
Staff Resistan ce 76%
Co mmun ication
Breakd o wn 72%

In sufficient time
d evo ted to training 44%

Staff turn o ver 36%

Co sts exceed s 32%


bud g et
Harvard Business Review.

88
Sirken, Keenan, Jackson. “The Hard Side of Change Management,” Harvard Business Review, October 2006.

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Commitment Curve
The objective of change management activities is to move individuals along the
commitment curve. During the stakeholder analysis it’s therefore important to
determine where stakeholders currently are along the commitment curve and
where they ultimately need to be.
Ownership (5)
Level of Commitment

Buy-in (4)

Acceptance (3)

Understanding (2)

Awareness (1)

Time
Individuals Individuals can explain Individuals have a positive Individuals champion
become aware of the impact of the attitude regarding the the change, taking
the change and a change on themselves change and can ‘see accountability and
vision of the future and on the themselves’ in the new ownership for the
is introduced. organization. state. They begin to feel success of the
accountable for making it transformation.
happen.
90

Engaging Supervisors and Managers

“It is not the strongest of the species that survive, nor the most
intelligent, but the one most responsive to change.”

Charles Darwin

21 / 61
Importance of Supervisors and Managers

95

Five Roles of Supervisors & Managers


1) Communicator
2) Advocate
3) Coach
4) Liaison
5) Resistance Manager

22 / 61
Sponsorship Strategy

“Progress is impossible without change, and those who cannot change


their minds cannot change anything.”
George Bernard Shaw (1856-1950) Irish writer.

23 / 61