Rewrite rules of change in healthcare


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"It's time to rewrite the rules of change in healthcare" - a presentation that Helen Beven, Chief Transformation Officer with the Horizons group, NHS Improving Quality, made at Yale on 10 June 2014.

This is the summary of the talk:
As leaders of health and care, we are seeking to create change in a world where the power of hierarchy is diminishing and change is happening faster and becoming more disruptive. Many of the ways we have traditionally gone about improving health and care were designed in a different mindset for a different set of circumstances and increasingly, they won't work. This means a fundamental rethink about what organisational change means; who does it (many change agents, not just a few) where it happens (increasingly 'at the edge' of organisations and the skills and mindsets that change agents need. This also means embracing disruption and 'disruptors' in our health and care organisations so that innovation happens; no longer seeking to 'overcome resistance to change' but welcoming difference, diversity and dissent as core operating principles in our approach to change. The slides end with a call to action: join the movement of health and care leaders across the world who are rewriting the rules of change and leading change from the future for different results.

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Rewrite rules of change in healthcare

  1. 1. It’s time to rewrite the rules of change in healthcare Source of image: Based on the talk that Helen Bevan gave at Yale New Haven Hospital Grand Rounds 10th June 2014 @HelenBevan
  2. 2. “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection) Source of image: installation by the artist Adam Katz Via @NeilPerkin
  3. 3. @HelenBevan
  4. 4. Our new White Paper • Examines leading trends in change and transformation globally • How to make change happen at a faster rate and be more disruptive • Join the new breed of healthcare leaders across the world, rewriting the rules of change and leading change from the future for different results Release date: 4th July 2014
  5. 5. @HelenBevan SEISMIC SHIFTS Causing us to rethink the very nature of change and how to enable it in the future
  6. 6. @HelenBevan SEISMIC SHIFTS
  8. 8. @HelenBevan Facebook didn’t exist, Twitter was still a sound, the cloud was still in the sky, 4G was a parking place, LinkedIn was a prison, applications were what you sent to college, Skype was a typo Thomas Friedman, World Economic Forum, Quoted by
  9. 9. @HelenBevan ….creates additional challenges Source of quote: Harold Jarche Source of image: Getting information off the internet is like taking a drink from a fire hydrant Mitchell Kapor
  10. 10. @HelenBevan Work complexity SEISMIC SHIFTS
  11. 11. @HelenBevan DIGITALCONNECTION SEISMIC SHIFTS Hierarchical power Work complexity
  12. 12. @HelenBevan DIGITALCONNECTION SEISMIC SHIFTS Hierarchical power Work complexity Change from the edge
  13. 13. @HelenBevan Whilst back in the world of health and care... Many of the ways we go about improving health and care were designed in a different mindset for a different set of circumstances We are operating with 20th century change practice in a 21st century world Source of image: Bain top ten management tools
  14. 14. @HelenBevan Some warnings ‘‘The organizations that survive the future will be those that are capable of changing as fast as change itself Gary Hamel’’
  15. 15. @HelenBevan Leading change in a new era Dominant approach Emerging direction
  16. 16. @HelenBevan ‘If people give to a cause, they expect a relationship, not a transaction.’ Nilofer Merchant
  17. 17. @HelenBevan “A cynic, after all, is a passionate person who does not want to be disappointed again.” Zander R and Zander B (2000) The art of possibility. Harvard Business School Press. As quoted by Steve Onyett
  18. 18. @HelenBevan John Kotter, the most influential thought leader globally, recognises new approaches are needed FROM
  19. 19. @HelenBevan John Kotter: “Accelerate!” • We won’t create big change through hierarchy on its own • We need hierarchy AND network • Many change agents, not just a few, with many acts of leadership • At least 50% buy-in required • Changing our mindset • From “have to” to “want to” TO
  20. 20. @HelenBevan From “have to” to “want to” Source of image of-the-cipd-online-community
  21. 21. @HelenBevan Unleashing the spirit of the volunteer You may be able to ‘buy’ a person’s back with a paycheck, position, power or fear but a human being’s genius, loyalty and tenacious creativity are volunteered only. The world’s greatest problems will be solved by passionate, unleashed ‘volunteers’ Stephen Covey, Turn the ship around, via @MarkGraban Source of image: ‘‘ ’’
  22. 22. @HelenBevan The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro 1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy 2. If you want to create small scale change, work through a cohesive network If you want to create big change, create bridge networks between disconnected groups
  23. 23. @HelenBevan 5 ways to lead from the edge - and thrive 1. Embrace disruption 2. Curate knowledge 3. Build bridges to connect the disconnected 4. Roll with resistance 5. It starts with me
  24. 24. @HelenBevan is the new normal! “By questioning existing ideas, by opening new fields for action, change agents actually help organisations survive and adapt to the 21st Century.” Céline Schillinger Image by
  25. 25. @HelenBevan @corprebels Across the world, the change agent movement Is exploding! @rebelsatwork
  26. 26. @HelenBevan What happens to heretics/radicals/rebels/mavericks in organisations? Source of image:
  27. 27. @HelenBevan
  28. 28. @HelenBevan The 90/30 conundrum of senior leaders say that to create more innovation, they need to activate the radicals/ disruptive innovators in their organisations or systems of senior leaders are very satisfied that radicals/innovators can provide this value in their organisations or systems Source:
  29. 29. @HelenBevan We need boatrockers! • Rock the boat but manage to stay in it • Walk the fine line between difference and fit, inside and outside • Able to challenge the status quo when we see that there could be a better way • Conform AND rebel • Capable of working with others to create success NOT a destructive troublemaker Source: Debra Meyerson
  30. 30. @HelenBevan Source : Lois Kelly There’s a big difference between a rebel and a troublemaker Rebel
  31. 31. @HelenBevan Reflection • What are your insights around “rebels” and “troublemakers”? • What moves people from being “rebel” to “troublemaker”? • How do we protect against this?
  32. 32. @HelenBevan Probably the largest simultaneous improvement initiative in the history of healthcare A disruptive case study @HelenBevan #Quality2014 #f1
  33. 33. @HelenBevan NHS Change Day Aim: to create a mass movement of grass roots NHS staff and people who work with and use the NHS to pledge a simple act that can contribute to better patient care
  34. 34. @HelenBevan NHS Change Day 2014 More than 700,000 pledges to take action • 81 separate Campaigns • 86 million twitter impressions • 35,400 video views • 95,000 daily reach on Facebook • More than 98% of the activity through volunteers
  35. 35. @HelenBevan It started with a tweet in June 2012! Young clinical leaders and improvement leaders decided to start a social movement to improve care Damian Roland Stuart Sutton Helen Bevan @HelenBevan #Quality2014 #f1
  36. 36. @HelenBevan Probably the only winner of a global challenge to develop leaders in the corporate world that names Saul Alinsky and Marshall Ganz as major influencers @HelenBevan #Quality2014 #f1
  37. 37. @HelenBevan
  38. 38. @HelenBevan Evaluating NHS Change Day • We’re evaluating intention (pledging), initiation (doing) and outcomes (delivering) • We’re having a celebration day on 4th July • We’re developing and testing new methods to show impact • We want to build new theory of large scale change
  39. 39. @HelenBevan Change Day is spreading……. Australia Sweden N Ireland Denmark Canada Netherlands Saudi Arabia USA Finland…….and many more @HelenBevan #Quality2014 #f1
  40. 40. @HelenBevan Peter Fuda’s Transformational Change Agent framework Skills and methods for creating change Ability to make sense of, and reshape perceptions of ‘reality’ Personal characteristics and qualities
  41. 41. @HelenBevan Peter Fuda’s Transformational Change Agent framework: my perspective “Doing” •Where most change agents in health and care put most of their effort and emphasis •What others typically judge us on •What we often perceive we need to do to add value •What most change and improvement courses focus on
  42. 42. @HelenBevan Peter Fuda’s Transformational Change Agent framework: my perspective “Seeing ” and “Being” •We can only do effective “doing” if we build on strong foundations of “seeing and being” •Change begins with me •Hopeful futures, creative opportunities and potential •Multiple lenses for change •See myself in the context of my higher purpose
  43. 43. @HelenBevan Source: @NHSChangeDay Can I, dare I?
  44. 44. @HelenBevan • A virtual school • Anyone can join • All the resources are completely open • Five weeks of virtual lectures, study guides, materials, tweetchats • Demonstrate learning to earn a virtual badge The School for Health and Care Radicals
  45. 45. @HelenBevan The School for Health and Care Radicals More than 1,600 enrollees from 40 countries 90 volunteer mentors Average weekly twitter reach 2.6 million Over 25,000 shares of the slides on SlideShare More than 10,000 shares of the study guides More than 10,000 tweets using #SCHRchat Storify has been viewed 2,000 times 150 people have completed full certification so far
  46. 46. @HelenBevan
  47. 47. @HelenBevan
  48. 48. @HelenBevan We learnt... 1. The core audience is different to that which we anticipated 2. The most important need is for connection and community 3. How to build the relationship between tacit and explicit knowledge 4. There is a massive untapped reservoir of energy and talent out there and the potential is outstanding
  49. 49. @HelenBevan Leading change from the edges Go out to your edges. Explore the possibilities. Because you will find more opportunity in the edges, where you will be able to imagine, invent and thrive Ayelet Baron
  50. 50. @HelenBevan • Identify your own opportunities to move to the edge • Think about the mindset, skills and relationships you need for the future • Consider how you are going to enable change at a faster rate than the outside world
  51. 51. @HelenBevan References Baron A (2014) Preparing for a changing world: the power of relationships Bate P, Robert G, Bevan H. The next phase of healthcare improvement: what can we learn from social mov Quality and Safety in Health Care. 2004 Feb;13(1):62-6. Battilano J, Casciaro T (2013) The network secrets of the great change agents Harvard Business Review, July-August Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Change Agents Worldwide (2013) Moving forward with social collaboration SlideShare Diaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontier Fuda P (2012) 15 qualities of a transformational change agent Hamel G (2014)Why bureaucracy must die Jarche, H (2013) Rebels on the edges Jarche H (2014) Moving to the edges
  52. 52. @HelenBevan References Kotter J (2014) Accelerate! Harvard Business Review Press Merchant N (2013) eleven rules for creating value in the social era Llopis G (2014) Every leader must be a change agent or face extinction Meyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BP Perkins N (2014) Bats and pizzas (agility and organisational change) Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated Shinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadership Williams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activism Verjans S (2013) How social media changes the way we work together