Knowledge exchange 2015 QSIR leading transformational change. Presented by Dr Julia RA Taylor at the QSIR knowledge exchange, January 2015.

1. NHS Improving Quality
Knowledge Exchange 2015
Quality, Service Improvement & Redesign (QSIR)
Leading Transformational Change
Dr Julia RA Taylor
National Programme Director
Advancing Change Team

3. An event based on
sharing learning
Leading Transformational Change
• A programme for teams leading large scale change
• Additional support for Advanced Practitioners and
combined with a development programme for new
trainers
• Mainly focused on change across multiple
organisations
Quality, Service Improvement and Redesign
• A programme for individuals leading improvements
and redesign
• Includes the involvement of project sponsors to
support participants
• Mainly focused on change within single organisations
Applying the core skills, tools and
techniques of leading change

4. The purpose of today
is to share learning
• Peer to peer
• From NHS IQ
An event based on
sharing learning
What are some of key concepts & techniques?
How have people used them?
What have they learnt?
× What have they achieved?
The greatest glory in living
lies not in never falling, but in
rising every time we fall.
Nelson Mandela
I have not failed. I've just
found 10,000 ways that won't
work.
Thomas A Edison

5. The purpose of today
is to share learning
• Peer to peer
• From NHS IQ
An event based on
sharing learning 10.00 Welcome and programme highlights
Julia R A Taylor, Stephanie Reid & Andrew Singfield
10.35 Presentations by participants from both programmes
11.05 Meeting the challenges of the Five Year Forward View
– an NHS Improving Quality perspective
Steve Fairman, Interim Managing Director – NHS Improving Quality
11.20 Break
11.35 Parallel breakout sessions
12.30 Lunch & poster viewing (to include voting)
13.30 How do you engage clinicians in transformational change and service
improvement?
Professor Moira Livingston, Clinical Director – NHS Improving Quality
13.55 Parallel Breakout sessions
14.50 Break
15.05 Measurement in service improvement and transformation
Matt Tite, QSIR Faculty member and measurement expert
16.05 Prize giving for best posters
16.30 Close

6. The purpose of today
is to share learning
• Peer to peer
• From NHS IQ
An event based on
sharing learning 10.00 Welcome and programme highlights
Julia R A Taylor, Stephanie Reid & Andrew Singfield
10.35 Presentations by participants from both programmes
11.05 Meeting the challenges of the Five Year Forward View
– an NHS Improving Quality perspective
Steve Fairman, Interim Managing Director – NHS Improving Quality
11.20 Break
11.35 Parallel breakout sessions
12.30 Lunch & poster viewing (to include voting)
13.30 How do you engage clinicians in transformational change and service
improvement?
Professor Moira Livingston, Clinical Director – NHS Improving Quality
13.55 Parallel Breakout sessions
14.50 Break
15.05 Measurement in service improvement and transformation
Matt Tite, QSIR Faculty member and measurement expert
16.05 Prize giving for best posters
16.30 Close

7. The purpose of today
is to share learning
• Peer to peer
• From NHS IQ
An event based on
sharing learning 10.00 Welcome and programme highlights
Julia R A Taylor, Stephanie Reid & Andrew Singfield
10.35 Presentations by participants from both programmes
11.05 Meeting the challenges of the Five Year Forward View
– an NHS Improving Quality perspective
Steve Fairman, Interim Managing Director – NHS Improving Quality
11.20 Break
11.35 Parallel breakout sessions
12.30 Lunch & poster viewing (to include voting)
13.30 How do you engage clinicians in transformational change and service
improvement?
Professor Moira Livingston, Clinical Director – NHS Improving Quality
13.55 Parallel Breakout sessions
14.50 Break
15.05 Measurement in service improvement and transformation
Matt Tite, QSIR Faculty member and measurement expert
16.05 Prize giving for best posters
16.30 Close
1pm
Leading
Transformational
Change
QSIR
Please vote for your favourite two
posters from each programme by the
end of lunchtime.
You have four votes in total:
• Allocate each red star to a
different Leading Transformational
Change poster
• Allocate each blue star to a
different QSIR poster
No voting for a poster from your team
or locality!
Wall sideWindow side

8. The purpose of today
is to share learning
• Peer to peer
• From NHS IQ
An event based on
sharing learning 10.00 Welcome and programme highlights
Julia R A Taylor, Stephanie Reid & Andrew Singfield
10.35 Presentations by participants from both programmes
11.05 Meeting the challenges of the Five Year Forward View
– an NHS Improving Quality perspective
Steve Fairman, Interim Managing Director – NHS Improving Quality
11.20 Break
11.35 Parallel breakout sessions
12.30 Lunch & poster viewing (to include voting)
13.30 How do you engage clinicians in transformational change and service
improvement?
Professor Moira Livingston, Clinical Director – NHS Improving Quality
13.55 Parallel Breakout sessions
14.50 Break
15.05 Measurement in service improvement and transformation
Matt Tite, QSIR Faculty member and measurement expert
16.05 Prize giving for best posters
16.30 Close

9. The purpose of today
is to share learning
• Peer to peer
• From NHS IQ
An event based on
sharing learning 10.00 Welcome and programme highlights
Julia R A Taylor, Stephanie Reid & Andrew Singfield
10.35 Presentations by participants from both programmes
11.05 Meeting the challenges of the Five Year Forward View
– an NHS Improving Quality perspective
Steve Fairman, Interim Managing Director – NHS Improving Quality
11.20 Break
11.35 Parallel breakout sessions
12.30 Lunch & poster viewing (to include voting)
13.30 How do you engage clinicians in transformational change and service
improvement?
Professor Moira Livingston, Clinical Director – NHS Improving Quality
13.55 Parallel Breakout sessions
14.50 Break
15.05 Measurement in service improvement and transformation
Matt Tite, QSIR Faculty member and measurement expert
16.05 Prize giving for best posters
16.30 Close

10. The purpose of today
is to share learning
• Peer to peer
• From NHS IQ
An event based on
sharing learning 10.00 Welcome and programme highlights
Julia R A Taylor, Stephanie Reid & Andrew Singfield
10.35 Presentations by participants from both programmes
11.05 Meeting the challenges of the Five Year Forward View
– an NHS Improving Quality perspective
Steve Fairman, Interim Managing Director – NHS Improving Quality
11.20 Break
11.35 Parallel breakout sessions
12.30 Lunch & poster viewing (to include voting)
13.30 How do you engage clinicians in transformational change and service
improvement?
Professor Moira Livingston, Clinical Director – NHS Improving Quality
13.55 Parallel Breakout sessions
14.50 Break
15.05 Measurement in service improvement and transformation
Matt Tite, QSIR Faculty member and measurement expert
16.05 Prize giving for best posters
16.30 Close

11. The purpose of today
is to share learning
• Peer to peer
• From NHS IQ
An event based on
sharing learning 10.00 Welcome and programme highlights
Julia R A Taylor, Stephanie Reid & Andrew Singfield
10.35 Presentations by participants from both programmes
11.05 Meeting the challenges of the Five Year Forward View
– an NHS Improving Quality perspective
Steve Fairman, Interim Managing Director – NHS Improving Quality
11.20 Break
11.35 Parallel breakout sessions
12.30 Lunch & poster viewing (to include voting)
13.30 How do you engage clinicians in transformational change and service
improvement?
Professor Moira Livingston, Clinical Director – NHS Improving Quality
13.55 Parallel Breakout sessions
14.50 Break
15.05 Measurement in service improvement and transformation
Matt Tite, QSIR Faculty member and measurement expert
16.05 Prize giving for best posters
16.30 Close
4:30pm

12. Who is here today? (choose one)
I’ve been part of a project in the Leading
Transformational Change programme
I’ve been part of a project in the Quality,
Service Improvement & Redesign programme
I’m not part of these programmes but here to
share and learn
Oops! I’m in the wrong room, I should be next
door
A
B
C
D

13. Of these which do you feel is the
biggest challenge in major
change? (choose one)
Getting clinicians involved and on board
Getting the public involved and on board
Designing and planning the right services
Delivering the changes with limited resources
A
B
C
D

14. NHS Improving Quality
Is all change the same?
Andrew Singfield
Senior Manager
Advancing Change Team

15. What do we mean by large
scale and small scale change?
A genuine difference?
or a matter of perspective?

16. What do we mean by large
scale and small scale change?
QSIR
How to deliver small(er)
scale change
Leading
Transformational Change
How to deliver larg(er)
scale change

17. What do we mean by large
scale and small scale change?
Quality, Service
Improvement and
Redesign
Leading
Transformational Change
Large scale (transformational change)
will involve lots of smaller scale
changes or improvement activities

18. What do we mean by large
scale and small scale change?
Quality, Service
Improvement and
Redesign
Leading
Transformational Change
?
In larger scale change you tend to have:
•  diversity (and less clarity) of goals
•  stakeholders and less control
•  uncertainty and emergence
 Multiple goals
 Competing goals (cost v quality)
 Vague goals (‘better’ outcomes)
 Emerging goals (from new
policy, new stakeholders etc.)

19. What do we mean by large
scale and small scale change?
Quality, Service
Improvement and
Redesign
Leading
Transformational Change
?
In larger scale change you tend to have:
•  diversity (and less clarity) of goals
•  stakeholders and less control
•  uncertainty and emergence
 Span organisational boundaries
 Complex governance
 Limited levers to enforce
compliance with the changes

20. What do we mean by large
scale and small scale change?
Quality, Service
Improvement and
Redesign
Leading
Transformational Change
?
In larger scale change you tend to have:
•  diversity (and less clarity) of goals
•  stakeholders and less control
•  uncertainty and emergence
 Longer timescales – more can
change
 Less clarify about cause and
effect (‘messy’ systems)
 More stakeholder to react to any
changes you make

21. What do we mean by large
scale and small scale change?
A thought experiment . . .
How might organising a
school sports day . . .
. . . from organising the
Olympics?

22. Where is the focus and energy?
1. The project & deliverables
2. The plan & Gantt chart
3. Efficiency of processes
4. Allocation of tasks
5. Risks & mitigation
6. PDSA cycles to refine the solution
7. The ‘blueprint’ vision
8. The measurable goal
9. Descriptions of the change
10. Selling the end point
11. Watching for project issues
12. Competence in change management
13. Role modelling objectivity
14. The ‘best’ solution
15. Getting compliance
16. Knowing the problems
17. Rigour of delivery
18. Culture as an issue to work around
19. The leadership hierarchy
20. Known unknowns (quantified risks)
21. Governance as checking solutions
22. Debates and decisions
23. Linear cause and effect
24. Facts and measures
1. The outcomes
2. Cycles & evolving activities
3. Structure, process and patterns
4. Supporting others to lead
5. Working with emergence
6. Experimentation with multiple solutions
7. The inspiring vision
8. Shared purpose encompassing many goals
9. Multiple framings of the change
10. Building trust and understanding
11. Scanning for system reactions
12. Being authentic with a burning ambition
13. Role modelling the change
14. The most resilient solution
15. Seeking commitment
16. Making sense of the system with others
17. Opportunism
18. Culture as something to change
19. The leadership network
20. Unknown unknowns (unpredictable occurrences)
21. Governance as managing uncertainty
22. Dialogues and ambiguity
23. Messy feedback loops
24. Intuition and stories
Small scale improvement Transformational change

23. Where is the focus and energy?
1. The project & deliverables
2. The plan & Gantt chart
3. Efficiency of processes
4. Allocation of tasks
5. Risks & mitigation
6. PDSA cycles to refine the solution
7. The ‘blueprint’ vision
8. The measurable goal
9. Descriptions of the change
10. Selling the end point
11. Watching for project issues
12. Competence in change management
13. Role modelling objectivity
14. The ‘best’ solution
15. Getting compliance
16. Knowing the problems
17. Rigour of delivery
18. Culture as an issue to work around
19. The leadership hierarchy
20. Known unknowns (quantified risks)
21. Governance as checking solutions
22. Debates and decisions
23. Linear cause and effect
24. Facts and measures
1. The outcomes
2. Cycles & evolving activities
3. Structure, process and patterns
4. Supporting others to lead
5. Working with emergence
6. Experimentation with multiple solutions
7. The inspiring vision
8. Shared purpose encompassing many goals
9. Multiple framings of the change
10. Building trust and understanding
11. Scanning for system reactions
12. Being authentic with a burning ambition
13. Role modelling the change
14. The most resilient solution
15. Seeking commitment
16. Making sense of the system with others
17. Opportunism
18. Culture as something to change
19. The leadership network
20. Unknown unknowns (unpredictable occurrences)
21. Governance as managing uncertainty
22. Dialogues and ambiguity
23. Messy feedback loops
24. Intuition and stories
Small scale improvement Transformational change
Focus on . . .
organising races,
refreshments, parking,
first aid etc.
Focus on . . .
an Olympics that
showcases the best of
GB in how we . . .
organising races,
refreshments, parking,
first aid etc.

24. Where is the focus and energy?
1. The project & deliverables
2. The plan & Gantt chart
3. Efficiency of processes
4. Allocation of tasks
5. Risks & mitigation
6. PDSA cycles to refine the solution
7. The ‘blueprint’ vision
8. The measurable goal
9. Descriptions of the change
10. Selling the end point
11. Watching for project issues
12. Competence in change management
13. Role modelling objectivity
14. The ‘best’ solution
15. Getting compliance
16. Knowing the problems
17. Rigour of delivery
18. Culture as an issue to work around
19. The leadership hierarchy
20. Known unknowns (quantified risks)
21. Governance as checking solutions
22. Debates and decisions
23. Linear cause and effect
24. Facts and measures
1. The outcomes
2. Cycles & evolving activities
3. Structure, process and patterns
4. Supporting others to lead
5. Working with emergence
6. Experimentation with multiple solutions
7. The inspiring vision
8. Shared purpose encompassing many goals
9. Multiple framings of the change
10. Building trust and understanding
11. Scanning for system reactions
12. Being authentic with a burning ambition
13. Role modelling the change
14. The most resilient solution
15. Seeking commitment
16. Making sense of the system with others
17. Opportunism
18. Culture as something to change
19. The leadership network
20. Unknown unknowns (unpredictable occurrences)
21. Governance as managing uncertainty
22. Dialogues and ambiguity
23. Messy feedback loops
24. Intuition and stories
Small scale improvement Transformational change
Focus on efficiency . . .
• Start and end on time
• Keep costs down
• Have safe events
Focus on . . .
• Start and end on time
• Keep costs down
• Have safe events
And structural changes
• Re-use of each stadium
And change how we think about
• Volunteering
• Participation in sport
• Disability
• GB as a world leader

25. Where is the focus and energy?
1. The project & deliverables
2. The plan & Gantt chart
3. Efficiency of processes
4. Allocation of tasks
5. Risks & mitigation
6. PDSA cycles to refine the solution
7. The ‘blueprint’ vision
8. The measurable goal
9. Descriptions of the change
10. Selling the end point
11. Watching for project issues
12. Competence in change management
13. Role modelling objectivity
14. The ‘best’ solution
15. Getting compliance
16. Knowing the problems
17. Rigour of delivery
18. Culture as an issue to work around
19. The leadership hierarchy
20. Known unknowns (quantified risks)
21. Governance as checking solutions
22. Debates and decisions
23. Linear cause and effect
24. Facts and measures
1. The outcomes
2. Cycles & evolving activities
3. Structure, process and patterns
4. Supporting others to lead
5. Working with emergence
6. Experimentation with multiple solutions
7. The inspiring vision
8. Shared purpose encompassing many goals
9. Multiple framings of the change
10. Building trust and understanding
11. Scanning for system reactions
12. Being authentic with a burning ambition
13. Role modelling the change
14. The most resilient solution
15. Seeking commitment
16. Making sense of the system with others
17. Opportunism
18. Culture as something to change
19. The leadership network
20. Unknown unknowns (unpredictable occurrences)
21. Governance as managing uncertainty
22. Dialogues and ambiguity
23. Messy feedback loops
24. Intuition and stories
Small scale improvement Transformational change
Energy into . . .
Organising who will do
what and allocating tasks
• Mr Smith – refreshments
• Mrs Jones – car parking
Energy into . . .
Creating enthusiasm and
getting others to lead
• Games-makers
• On site construction firms
working together
• TfL, tourism board etc.

26. Where is the focus and energy?
1. The project & deliverables
2. The plan & Gantt chart
3. Efficiency of processes
4. Allocation of tasks
5. Risks & mitigation
6. PDSA cycles to refine the solution
7. The ‘blueprint’ vision
8. The measurable goal
9. Descriptions of the change
10. Selling the end point
11. Watching for project issues
12. Competence in change management
13. Role modelling objectivity
14. The ‘best’ solution
15. Getting compliance
16. Knowing the problems
17. Rigour of delivery
18. Culture as an issue to work around
19. The leadership hierarchy
20. Known unknowns (quantified risks)
21. Governance as checking solutions
22. Debates and decisions
23. Linear cause and effect
24. Facts and measures
1. The outcomes
2. Cycles & evolving activities
3. Structure, process and patterns
4. Supporting others to lead
5. Working with emergence
6. Experimentation with multiple solutions
7. The inspiring vision
8. Shared purpose encompassing many goals
9. Multiple framings of the change
10. Building trust and understanding
11. Scanning for system reactions
12. Being authentic with a burning ambition
13. Role modelling the change
14. The most resilient solution
15. Seeking commitment
16. Making sense of the system with others
17. Opportunism
18. Culture as something to change
19. The leadership network
20. Unknown unknowns (unpredictable occurrences)
21. Governance as managing uncertainty
22. Dialogues and ambiguity
23. Messy feedback loops
24. Intuition and stories
Small scale improvement Transformational change
Transformational change is qualitatively
and quantitatively different from smaller
scale change . . .
. . . but involves the successful delivery
of lots of smaller scale change!
Quality, Service
Improvement and
Redesign
Leading
Transformational Change


27. NHS Improving Quality
What have we learnt?
Stephanie Reid
Senior Manager
Advancing Change Team

28. What have we learned?
Faculty reflections
Value the wisdom in the room (beyond the faculty!)…
“Meeting with colleagues from other
organisations…felt motivated to put plans
into action” (QSIR participant)
Most valuable part of the workshop was
…”open and interesting group discussions
around leadership qualities and values.”
(QSIR participant)
Most valuable part of the workshop…”Time
together as a team to learn, network
develop our project perhaps in a new light”
(LTC participant)

29. What have we learned?
Faculty reflections
“This is the interesting concept of a team, a
whole raft of people who I am working with
and we don’t have one mother ship, I met
them all individually prior to start and I know
them all, but they didn’t know each other..”
The teams working on transformational change rarely meet as a
team…it’s an add-on to the job
“I don’t know how formally people work in
teams now, people move in and out of
meetings, and people need to formally
commit themselves to being a team - its
quite rare’”

30. What have we learned?
Faculty reflections
Participants value the
investment in them…
“It is unfortunate however, that it is not
compulsory for Strategic Managers from CCGs to
attend and learn
how programme redesign can be effectively,
consistently and professionally undertaken.”
(QSIR participant)
‘I think this sort of development isn’t
on anyone’s radar as a priority at the
moment, should be no limits and no
barriers, use as an opportunity for
team building, Is the priority the day
job or other learning – priority is the
day job. Thoughts are not in a
coordinated way about the skills
and competencies in this emerging
NHS, not thinking 2-5 years hence,
what skills and behaviours we will
need to do at scale’
(LTC participant)
‘I think there is something about having a weeks
commitment, if it truly is transformation than
should be dedicated time, In that five days you
work out how to make it the day job otherwise
nothing will fly. If it’s not the day it won’t cross
the start line’. (LTC participant)

31. What have we learned?
Our challenges to you…

2. Pay attention to how the change team functions –
• Teams struggle if they rarely meet
• Treat the time allocated to the project as a
signal of the importance of the change
1. Value the wisdom in the room –
• Take this opportunity to listen to, talk to and
learn from as many people as possible
3. Change projects are more likely to succeed if we
build committed and competent change leaders
with the time and resource to make a difference
• Create space for teams to practice and use
their new skills
• Role model willingness to adopt new tools
and techniques to shape your approach to
change