School for Health and Care Radicals; International Forum on Quality and Safety in Healthcare 2014

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These are the slides from minicourse M5 "The School for Health and Care Radicals" held at the International Forum on Quality and Safety in Health Care, 8th April 2014

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  • Examples form the NHS of social movements often called a call to action
  • Large scale action - Not requiring large leadership team or compliance frameworkDefinition used in “The Power of One, the Power of Many” = a voluntary collective of individuals committed to promoting or resisting change through co-ordinated activity.
  • So Emotions help us understand what we value in the world. Why did the story of Alice work ?So why was this story powerful?Why do we respond differently when we hear about Alice rather than when we see the policy data and financial balance sheet?So public narrative when used intentionally for a purpose to connect with others to move to action is a powerful skills set and leadership gift. When we hear stories that make us feel a certain way those stories remind us of our core values. We experience our values through emotions. Then we are prepared to take action on those values. Through our emotions we are more likely to take action Research by Martha Nussbaum a Moral philosopher, tells us that people who have a damaged (a-mig-da- la) Amygadla the part of the brain which controls emotions, when faced with decisions can come up with many options from which to choose but cannot make a decision because the decision rests upon judgements of value. If we cannot feel emotion we cannot experience values that orient us to the choices we must make Shortly we will be thinking about the lived experiences that have moved you to action…we’ll be drawing on those a few minutes as you start to craft your own stories.
  • LIST some emotions
  • Try to include a challenge , choice and outcome in your story when you write it.We will ask you to provide feedback to your colleagues as they tell their stories later on whether these are obvious to you.
  • Remember the power of “Killer Facts”Have one that really illustrates this for you.JG – I often use one from Kath Evans. If we had the health care system in England that matched the best in Europe 1500 children a year, would not die in our care.
  • School for Health and Care Radicals; International Forum on Quality and Safety in Healthcare 2014

    1. 1. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 The School for Health and Care Radicals Helen Bevan, @Helen Bevan NHS Improving Quality, England Boel Andersson Gäre @BoelGare Jönköping County Council and the Jönköping Academy , Sweden; Jackie Lynton @jackieLynton NHS Improving Quality, England
    2. 2. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Why the School for Health & Care Radicals? It’s tough being a change agent in health and care, particularly when other people don’t always get it or want to change. Yet big change happens in health and care only because of heretics and radicals: passionate people who are willing to take responsibility for change. We are people who support the goals of our health and care systems, but also want to change existing thinking and practice and improve care for patients and people who use services. The School for Health and Care Radicals provides tools, ideas and connections with a community of radicals to help us thrive and survive as agents of positive change
    3. 3. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 We are a learning community • We encourage you to tweet during the day using the hashtags #Quality2014 and #M5 • We hope other radicals will join in virtually during the day • We will produce a summary of the day using Storify.com and send it to you
    4. 4. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 What is community? 1. Locality 2. Interest or shared purpose 3. Sense of belonging: “community spirit” “There is no power for change greater than a community discovering what it cares about.” ~ Margaret Wheatley Source of image: rootedincommunity.org
    5. 5. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Power in community “Power used to come largely through and from big institutions. Today power can and does come from connected individuals in community. When community invests in an idea, it co-owns its success. Source of image: orton.org Instead of trying to achieve scale all by ourselves, we have a new way to have scale. Scale can be in, with and through community.” Nilofer Merchant
    6. 6. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Why am I a radical?
    7. 7. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Task Today you will be working as a community with others on your table so it’s important to find out who is in your community. Introduce yourself to others at your table. Tell a quick story that demonstrates why you chose to come to this course today. Time allowed: 15 minutes for the whole table
    8. 8. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 The genesis of the School 2002 2014 2013 2010 2012 2003 NHS Change Day 2013 “A school for healthcare radicals” Applying social movement thinking to healthcare improvement “The School for Health and Care Radicals” “A one day school for organisational radicals” Applying community organising principles to healthcare improvement
    9. 9. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Pledge today! http://changeday.nhs.uk
    10. 10. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Source: @NHSChangeDay
    11. 11. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
    12. 12. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 The school is based on two kinds of learning Transactional learning Transformational learning A “toolkit” of ideas & approaches Learning through motivation, practice & feedback Seeks to transfer useful knowledge Seeks to transform beliefs & underlying assumptions Learning event, presentations & materials Experiential, interactive & action-based Generates understanding of “what to do” Generates increased capacity in “how to do it” Source: Based on John Wenger https://medium.com/corporate-learning/3deb1bb2e865
    13. 13. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 What is happening in the world of change? Source of image: from guardiansprayerwarrior.com
    14. 14. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Emerging themes in change and transformation Source: @HelenBevan
    15. 15. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 John Kotter: “Accelerate!” • We won’t create big change through hierarchy on its own • We need hierarchy AND network • Many change agents, not just the usual few • Changing our mindset • From “have to” to “want to” • Head and heart, not just head Source of image:www.slideshare.net/m exicanwave/champions-trolls- 10-years-of-the-cipd-online- community
    16. 16. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 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
    17. 17. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 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 neilperkin.typepad.com
    18. 18. @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 ACROSS THE WORLD, THE CHANGE AGENT MOVEMENT IS EXPLODING! @rebelsatwork rebelsatwork.com @chagww changeagentsworldwide.com @corprebels corporaterebelsunited.com
    19. 19. @helenbevan #1000LivesPlusImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
    20. 20. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 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
    21. 21. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 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
    22. 22. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 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
    23. 23. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 “Being” as a health and care radical Personal characteristics and qualities
    24. 24. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 What happens to heretics/radicals/rebels/mavericks in organisations?
    25. 25. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
    26. 26. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 We need to be boatrockers! • Walk the fine line between difference and fit, inside and outside, rock the boat but manage to stay in it • 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
    27. 27. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 What are the risks for a boat rocker? 1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice  we surrender a part of ourselves, and silence our commitment, in order to survive 2. leave the organisation  we cannot find a way to be true to our values and commitments and still survive 3. stridently challenge the status quo in a manner which is increasingly radical and self-defeating  this just confirms what we already know – that we don’t belong Source: adapted from Debra E Meyerson
    28. 28. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5Source: Rebelsatwork.com
    29. 29. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5Source of image: quote.lifehack.org
    30. 30. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Source : Lois Kelly www.rebelsatwork.com Sometimes other people see radicals/rebels as troublemakers Rebel
    31. 31. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Discussion • What are your insights around “rebels/radicals” and “troublemakers”? • What moves people from being “rebel” to “troublemaker”? • How do we protect against this?
    32. 32. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Valuing radicals • “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection) • Big things only happen in organisations because of heretics and radicals. GALILEO DESCRIBES HIS DISCOVERIES TO THE CHURCH ESTABLISHMENT
    33. 33. #NHSChangeDay #SHCRchat "There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley Source of image: timcoffeyart.wordpress.com
    34. 34. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Source: via @NeilWigg
    35. 35. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 History tells us that personal transformation comes before organisational or system transformation If we want to play our role, we have to focus deeply on our own perspective and the ways http://blogs.bmj.com/quality/2013/08/19/a-call-to-action-helen-bevans-blog-2/ we interact with and influence others. The more that we can unleash that powerful reservoir of energy for change, the more our influence and impact will grow. Image from novamagazine.com
    36. 36. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Change begins with me "I wanted to win minds. Now I win hearts. I used to find difficult doctors. Now I find doctors in difficulty” Dr Umesh Prabhu Source: @WhoseShoes
    37. 37. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 1. Driven by conviction and values 2. strong sense of “self-efficacy”  belief that I am personally able to create the change 3. able to join forces with others to create action 4. able to achieve small wins which create a sense of hope, self-efficacy and confidence 5. More likely to view obstacles as challenges to overcome Five things we know about successful boat rockers Source: adapted from Debra E Meyerson CHANGE me BEGINS WITH
    38. 38. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Self-efficacy There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change and get good outcomes Source of image:www.h3daily.com
    39. 39. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 What’s the difference between self efficacy and self esteem, self belief, self-confidence?
    40. 40. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Source: @NHSChangeDay
    41. 41. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Source: @NHSChangeDay What is the issue here? “permission” ? (externally generated) or Self efficacy ? (internally generated)
    42. 42. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Brainstorm at the table What are some ways that health and care radicals can build self-efficacy?
    43. 43. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Building self-efficacy: some tactics 1. Invest in your own change agent development • create the conditions where success is more likely to happen 2. Create change one small step at a time 3. Reframe your thinking: • failed attempts are learning opportunities • uncertainty becomes curiousity 4. Make change (and learning cycles from change) routine rather than an exceptional activity 5. Get social support 6. Learn from the best 7. Get people whose opinions you value to encourage you (mentor?)
    44. 44. #NHSChangeDay #SHCRchat “Being an effective Change Agent involves demonstrating what you teach as much as pontificating from the mountaintops. Any behaviour we ask others to adopt, we must consistently represent in our own work, and share the positive outcomes.” Bryce Williams Working Out Loud Source of image: leighellis.net
    45. 45. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 1. Driven by conviction and values 2. strong sense of “self-efficacy”  belief that I am personally able to create the change 3. able to join forces with others to create action 4. able to achieve small wins which create a sense of hope, self-efficacy and confidence 5. More likely to view obstacles as challenges to overcome Five things we know about successful boat rockers Source: adapted from Debra E Meyerson CHANGE me BEGINS WITH
    46. 46. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Source of image: outskirtsbattledome.wik ispaces.com The easiest way to thrive as an outlier ...is to avoid being one Seth Goodin
    47. 47. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 “if you want to go fast, go alone. If you want to go far, go together.” African proverb quoted by Al Gore
    48. 48. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Learning from social movement leaders
    49. 49. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Call to Action Source: @RobertVarnam
    50. 50. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 How do we create change at scale? Source: Marshall Ganz Shared understanding leads to Action Narrative why? Strategy what?
    51. 51. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 What is strategy? Strategy is the process of turning the you have into the you need to win the you want Source: Marshall Ganz
    52. 52. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Resources to improve health and care Economic resources diminish with use • money • materials • technology Natural resources grow with use • relationships • commitment • community Based on principles from Albert Hirschman, Against Parsimony
    53. 53. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Framing … is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action. Snow D A and Benford R D (1992)
    54. 54. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 What’s the financial incentive? Who is performance managing? What’s the project plan? Source: @RobertVarnam
    55. 55. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 The reality “What the leader cares about (and typically bases at least 80% of his or her message to others on) does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into the change programme” Scott Keller and Carolyn Aiken (2009) The Inconvenient Truth about Change Management Source of image: swedenbourg-openlearning.org.uk
    56. 56. #NHSChangeDay #SHCRchat “I have some Key Performance Indicators for you” or “I have a dream” Source: @RobertVarnam
    57. 57. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........ Sensemaking is not done via marketing...or slogans but by emotional connection with employees Ron Weil
    58. 58. #NHSChangeDay #SHCRchat How the world of work is shifting • The organisation as a collective • Leaders seek to build the allegiance of the workforce to the goals, culture and ethos of the organisation • The network as a connective • We share and identify with a deeper, extra- corporate work culture and the structure is subordinated to that Source:stoweboyd.com Source of image: www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community
    59. 59. #NHSChangeDay #SHCRchat If we want people to take action, we have to connect with their emotions through values action values emotion Source: Marshall Ganz
    60. 60. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
    61. 61. #NHSChangeDay #SHCRchat But not all emotions are equal......... inertiaurgency anger apathy solidarity isolation you can make a difference Self-doubt hope fear Overcomes Action motivators Action inhibitors Source: Marshall Ganz
    62. 62. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Effective framing: what do we need to do? 1. Tell a story 2. Make it personal 3. Be authentic 4. Create a sense of “us” (and be clear who the “us” is) 5. Build in a call for urgent action
    63. 63. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Creating our narrative • Challenge: What was the challenge? Why was it a challenge? • Choice: What were the choices? Why did you make the choice you did? Where did you get the courage or hope? How did it feel? • Outcome: How did the outcome feel? Why did it feel that way? What do you want us to feel? Source: Marshall Ganz
    64. 64. #NHSChangeDay #SHCRchat Vivid details Source: Marshall Ganz
    65. 65. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Talk to the person next to you • Tell your story about why the change you are involved in now is so important to you • Relate it to a personal experience You have: • 2 minutes to prepare your story • 2 minutes each to tell your story
    66. 66. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Talk to the person next to you Have a further discussion • In terms of the people you want to get on board with your change project, what will create a sense of “us” rather than “us and them”? • How could telling your story help create the “us”? You have three minutes for further discussion as a pair
    67. 67. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Talk to the rest of the table What insight did you get from that exercise? You have five minutes for a whole table discussion
    68. 68. #NHSChangeDay #SHCRchat How do we create a sense of “us” to build momentum for change? Source of image: studentblognmaestics.blogspot.com
    69. 69. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 strong ties (cohesive) v. weak ties (disconnected) Source of image:brucemacvaresh.com
    70. 70. #NHSChangeDay #SHCRchat When we spread change through strong ties: • we interact with “people like us”, with the same life experiences, beliefs and values • Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist • Influence is spread through people who are strongly connected to each other, like and trust each other
    71. 71. #NHSChangeDay #SHCRchat When we spread change through strong ties: • we interact with “people like us”, with the same life experiences, beliefs and values • Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist • Influence is spread through people who are strongly connected to each other, like and trust each other IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied
    72. 72. #NHSChangeDay #SHCRchat The pros and cons of strong ties Pros Cons
    73. 73. #NHSChangeDay #SHCRchat Strong and weak ties When we seek to spread change through strong ties: • we interact with “people like us”, with the same life experiences, beliefs and values • Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist • Influence is spread through people who are strongly connected to each other, like and trust each other When we seek to spread change through weak ties: • we build bridges between groups and individuals who were previously different and separate • we create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action • our aim is to mobilise all the resources in our organisation, system or community that can help achieve our goals
    74. 74. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Why we need to build weak ties AS WELL AS strong ties • Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers
    75. 75. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Why we need to build weak ties AS WELL AS strong ties • Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers • In situations of uncertainty, we have a tendency to revert to our strong tie relationships • yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity
    76. 76. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Why we need to build weak ties AS WELL AS strong ties • Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers • In situations of uncertainty, we have a tendency to revert to our strong tie relationships • yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity • The most breakthrough innovations will come when we tap into our weak ties
    77. 77. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Why we need to build weak ties AS WELL AS strong ties • Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers • In situations of uncertainty, we have a tendency to revert to our strong tie relationships • yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity • The most breakthrough innovations will come when we tap into our weak ties History suggests that weak ties will probably give us the best chance to deliver large scale improvements in a challenging timescale
    78. 78. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Three components of a great narrative • Diagnostic – what is the problem that we are addressing? What is the extent of the problem? What is the specific source or sources? • Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan? • Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of the audience? Source: Benford and Snow
    79. 79. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 ‘If people give to a cause, they expect a relationship, not a transaction.’ Nilofer Merchant
    80. 80. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 “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
    81. 81. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Who are your communities? Source: Celine Schillinger http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite • In your role: through relationships and social networks • Through external social networks such as Twitter and LinkedIn • Through communities of practice and learning groups
    82. 82. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 82 http://weneedsocial.com/blog/2013/8/25/disr upted-disruptors-unite
    83. 83. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
    84. 84. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 The most effective change agents: • don’t waste their time and energy blaming and complaining • take calculated risks to achieve the outcomes they sought Now is the time to plan steps to keep moving myself forward, with positive momentum, as a health and care radical
    85. 85. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Three assumptions for health and care radicals 1. Assume that everyone has a noble intention. 2. When people “resist” change is it more likely to be a result of their interpersonal interaction with the change process than their innate character traits (“a bad change process not a difficult person”). 3. My role as a change agent is about alignment, not judgement. Source of image:help.adobe.com
    86. 86. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Being a great change agent is about knowing, doing, living and being improvement
    87. 87. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Being a great change agent is about knowing, doing, living and being improvement
    88. 88. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 “Being” as a health and care radical CHANGE me BEGINS WITH • Living my conviction and values • Strong sense of “self-efficacy”  belief that I am personally able to create the change • Shared purpose, not de facto purpose • Stepping outside my comfort zone • A “rebel” rather than a “troublemaker” • Learning not judging
    89. 89. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Outwitted He drew a circle that shut me out - Heretic, rebel, a thing to flout. But Love and I had the wit to win: We drew a circle that took him in. Edward Markham
    90. 90. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 “Seeing” as a health and care radical Ability to make sense of, and reshape perceptions of ‘reality’
    91. 91. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 ‘En este muno traidor No hay verdad ni mentira, Que todo esta en el color Del cristal con que se mira’ In this world of many mazes There is nothing false or true: All depends upon the hue Of the glass through which one gazes (Sixteenth-century Spanish quatrain)
    92. 92. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Seeing “Seeing, looking, monitoring, listening, perceiving and especially the indefinite concept of intuitive feeling ” Aubrey Jango
    93. 93. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Task Have a table discussion: What are some of the different ways of “seeing” change?
    94. 94. #NHSChangeDay #SHCRchat What do we mean by resistance to change?
    95. 95. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat Source of image: sport-fitness-advisor.com Any force that stops or slows movement Resistance
    96. 96. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat Employee resistance is the most common reason executives cite for the failure of big organizational-change efforts Scott Keller and Colin Price (2011), Beyond Performance: How Great Organizations Build Ultimate Competitive Advantage Source of image: Businessconjunctions.com
    97. 97. #NHSChangeDay #SHCRchat Change can either challenge or threaten us……. Your beliefs pave your way to success or block you Marsha Sinetar Source of image: Creatememe.chucklesnetwork.com
    98. 98. #NHSChangeDay #SHCRchat Diagnostic and dialogic approaches to resistance to change
    99. 99. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat • Change is something that happens “out there” in the organisation or system • Resistance is a force to overcome • Resistance prevents change • Change agents must diagnose, manage and/or overcome resistance • Resisters may be otherwise known as “laggards”, “blockers”, “in denial” Resistance: a “diagnostic” approach
    100. 100. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat Resistance to change
    101. 101. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat “The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to implement successfully and may not succeed at all” David Stonehouse The change agent: the manager’s role in change British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445 Diagnostic: the role of the change agent
    102. 102. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat • People make their own reality • Change results from transformational conversations  involving more and different people in change discussions  altering how and which people engage with each other  by stimulating different perspectives to shape how people think about things • Resistance is an inevitable consequence of a complex change process (based on diversity) • Resistance should be embraced and worked with Resistance: a “dialogic” approach
    103. 103. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat 1. Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system, and by being welcoming 2. Creat-e opportunities for everyone to express their views, spot opportunities and build on each other’s ideas 3. Create ways for people to reflect together to find meaning, understanding and shared purpose in the change Source: Peggy Holman Dialogic: the role of the change agent
    104. 104. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat “The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities. Do this before you start hiring consultants and rethinking your innovation process, there is no process that works without true diversity.” Idris Moore Source of image: idsgn.org Diversity is critical to innovation and change
    105. 105. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat “Leaders and organisations must let go of the idea that there is “one right way” and instead focus on creating a learning culture where people feel accepted, are comfortable contributing ideas, and actively seek to learn from each other” Diaz_Uda, Medina and Schill (2013) Source of image:fineartamerica.com Health and care radicals should be champions of diversity for change
    106. 106. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat In the context of “rolling with resistance” • What are the implications of embracing diversity of thought, experience and background in our change efforts? • What skills and perspectives do health and care radicals need to work effectively with diverse teams for change? Source of image:fineartamerica.com Discussion
    107. 107. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat The effectiveness of change agents is not a matter of intention; it’s a matter of impact
    108. 108. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat • Helen’s intent was to give people quick solutions, help them do their work faster and get on to the next problem at hand • However, her impact was that people did not know how to solve their own problems so that Helen’s style was impeding their development Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee Source of image: thedigitalawards.com
    109. 109. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat Stop talking AT ME Start talking TO ME Source of image: prepbeijing.com
    110. 110. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat • Build a trusting and supportive work environment • Listen with an open heart and open mind • Commit to the change 100% • Seek common purpose and common interests • Take time to build relationships • Be open with my intent • Take responsibility for my own actions What should I do to manage intent and impact?
    111. 111. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
    112. 112. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat If your horse dies, get off it Cherokee proverb Source of image: fenwickgallery.co.uk
    113. 113. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat Have a discussion with others at your table: • How can I manage my intent and impact? Task
    114. 114. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
    115. 115. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)
    116. 116. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 The model is mostly used around health-related behaviours • smoking cessation • exercise adoption • alcohol and drug use • weight control • fruit and vegetable intake • domestic violence • HIV prevention • use of sunscreens to prevent skin cancer • medication compliance • mammography screening
    117. 117. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 The model is mostly used around health-related behaviours • smoking cessation • exercise adoption • alcohol and drug use • weight control • fruit and vegetable intake • domestic violence • HIV prevention • use of sunscreens to prevent skin cancer • medication compliance • mammography screening It works for organisational and service change too!
    118. 118. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit Prochaska, DiClemente & Norcross (1992)
    119. 119. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet Prochaska, DiClemente & Norcross (1992)
    120. 120. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
    121. 121. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
    122. 122. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! I am continuing to not smoke. I sometimes miss it – but I am still not smoking “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
    123. 123. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! I am continuing to not smoke. I sometimes miss it – but I am still not smoking “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)
    124. 124. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat Prochaska, DiClemente & Norcross (1992) “Stages of change” Transtheoretical model of behaviour change
    125. 125. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat • Which stage do most change activities in health and care focus on? • Which stage are most people actually at? Some questions
    126. 126. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat The reality of our change situation • Our tools are often not effective at the stage of change that most people we work with are at • It’s hard to engage people in change • It’s hard to get people to make the changes we want them to make • People get irritated, defensive, irrational • We feel powerless in our ability to lead or facilitate the change 90% of the tools available for health and care change agents are designed for the “action” stage
    127. 127. #NHSChangeDay #SHCRchat • Designed for Stage 4 – ACTION! • Mandated it through targets • Despite compelling case for change – people resisted it – no values connection • People did the task and missed the point Example - Surgical Checklist
    128. 128. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat • Lower our ambitions for improvement • Focus our energies on those who are already in the “action” stage • Put negative labels on those who are not yet at the action stage such as “blocker” or “resister” or “laggard” • Blame “the management” for not enforcing change So what do we TEND to do?
    129. 129. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat The single biggest problem in communication is the illusion that it has taken place George Bernard Shaw
    130. 130. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat • Listen and understand  appreciate the starting point  elaborate interests • Build meaning and conviction in the change • Roll with resistance (Singh)  Don’t argue against it  Encourage elaboration of resistance • What makes it so hard? • What would help? • Build shared purpose So what SHOULD we do?
    131. 131. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat • The focus should be on creating awareness for me of the need to change • Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation • I am not thinking about changing my behaviours, actions or work processes • The problem or issue is outside my frame of awareness or my perceived need
    132. 132. #NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model: • What stage of change are some of the key people that you need to influence for your change initiative at? • What actions can you take to help them move to the next stage? Reflection
    133. 133. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 “Seeing” as a health and care radical • The big picture • Multiple perspectives • The positive intentions of others • Possibility of bad change processes rather than resistors, blockers and laggards • Hopeful futures, creative opportunities and potential • Multiple paradigms for change (eg, diagnostic and dialogic) • See myself in the context of my higher purpose
    134. 134. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 “Doing” as a health and care radical Skills and methods for creating change
    135. 135. #NHSChangeDay #SHCRchat Most large scale change doesn’t fully deliver its objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey 70% 25% 5% Gets anywhere near achieving the change and delivering the benefits @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
    136. 136. #NHSChangeDay #SHCRchat Most large scale change doesn’t fully deliver its objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey 70% 25% 5% Delivers and sustains the change
    137. 137. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Image from: @TheWorldStories
    138. 138. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 It is our contention that most change efforts are built upon the shaky foundation of five flawed assumptions; that change can be managed, that human beings are objective, that there are ‘X’ steps to change, that we have a neutral starting point for change, and that change, itself, is the goal Peter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda- bootstrap/content/Why-Change-Efforts-Fail.pdf Source of image: Whatsthebigideascwartzy.blogspot.com
    139. 139. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 What happens to large scale change efforts in reality? In order of frequency: 1. the effort effectively “runs out of energy” and simply fades away 2. the change hits a plateau at some level and no longer attracts new supporters 3. the change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way Source: Leading Large Scale Change: a practical guide (2011), NHS Institute
    140. 140. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Leaders as “signal generators” “As a leader, think of yourself as a “signal generator” whose words and actions are constantly being scrutinised and interpreted, especially by those below you *in the hierarchy+” “Signal generators reduce uncertainty and ambiguity about what is important and how to act” Charles O’Reilly, Leaders in Difficult Times, 2009
    141. 141. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on Increasing number of messages as information cascade through the organisation Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail- don.aspx
    142. 142. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on Increasing number of messages as information cascade through the organisation Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail- don.aspx Buy in from front line staff is critical for improvements in quality and safety . Don’t overload them Buy in from front line staff is critical for improvements in quality and safety Don’t overload them http://healthaffairs.org/blog/2014/03/07/the- dangers-of-quality-improvement-overload-insights- from-the-field/
    143. 143. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Typically, around any change effort, there is an initial spike of tangible energy, and change, but when leadership loses interest, the momentum of change slows down drastically.” Tara Paluck
    144. 144. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Ten key principles of large scale change 1. Movement towards a new vision that is better and fundamentally different from the status quo 2. Identification and communication of key themes that people can relate to and that will make a big difference 3. Multiples of things (‘lots of lots’) 4. Framing the issues in ways that engage and mobilise the imagination, energy and will of a large number of diverse stakeholders in order to create a shift in the balance of power and distribute the leadership 5. Mutually reinforcing change across multiple processes/subsystems
    145. 145. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 6. Continually refreshing the story and attracting new, active supporters 7. Emergent planning and design, based on monitoring progress and adapting as you go 8. Many people contribute to the leadership of change, beyond organisational boundaries 9. Transforming mindsets, leading to inherently sustainable change 10. Maintaining and refreshing the leaders’ energy over the long haul Ten key principles of large scale change
    146. 146. #NHSChangeDay #SHCRchat Intrinsic motivation People engage in the activity for the pleasure and satisfaction of doing it Invokes many positive behaviours Extrinsic motivation People engage in the activity for the rewards or avoiding punishment Any external influence is referred to as extrinsic motivation Source: http://www.slideshare.net/JeremyStephens103/coaches-as-extrinsic-motivators- and-supporter-of-intrinsic-development
    147. 147. #NHSChangeDay #SHCRchat Transformation is not a matter of intent......... it is a matter of alignment Peter Fuda
    148. 148. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 You get the best effort from others not by lighting a fire beneath them, but by building a fire within Bob Nelson
    149. 149. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 “Take your passion and make it happen” Source of image: www.zeelandtheaters.nl
    150. 150. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Discussion Reflecting on your change process: • how have you built both intrinsic and extrinsic motivators of change into your efforts? • How have you managed the tension between the two? • Any advice for other change agents on how to align intrinsic and extrinsic motivators?
    151. 151. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 What happens to large scale change efforts in reality? In order of frequency: 1. the effort effectively “runs out of energy” and simply fades away 2. the change hits a plateau at some level and no longer attracts new supporters 3. the change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way Source: Leading Large Scale Change: a practical guide (2011), NHS Institute
    152. 152. #NHSChangeDay #SHCRchat Research shows that more than almost any other factor affecting an organisation, organisational energy can lead to either a wellspring of corporate vitality or the destruction of its very core Source: Bruch and Vogel
    153. 153. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Bruch and Vogel research Organisations with HIGH productive energy scored higher on: • overall performance - 14% higher • productivity – 17% • efficiency – 14% • customer satisfaction – 6% • customer loyalty – 12%
    154. 154. #NHSChangeDay #SHCRchat
    155. 155. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 the capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals Psychological Physical Spiritual Social Intellectual Energy for change is:
    156. 156. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Five energies for change Energy Definition Social energy of personal engagement, relationships and connections between people. It’s where people feel a sense of “us and us” rather than “us and them” Spiritual energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It gives people the confidence to move towards a different future that is more compelling than the status quo Psychological energy of courage, resilience and feeling safe to do things differently. It involves feeling supported to make a change and trust in leadership and direction Physical energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen Intellectual energy of analysis, planning and thinking. It involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/ evidence
    157. 157. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 High and low ends of each energy domain Low High Social isolated solidarity Spiritual uncommitted higher purpose Psychological risky safe Physical fatigue vitality Intellectual Illogical reason
    158. 158. #NHSChangeDay #SHCRchat • Are particular energy domains more dominant than others for our team at the moment? • Is this the optimal energy profile to help us achieve our improvement goals? Energy for change profile 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual
    159. 159. #NHSChangeDay #SHCRchat 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 1: what’s your assessment of their energy for change?
    160. 160. #NHSChangeDay #SHCRchat 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 1: what’s your assessment of their energy for change? This energy profile is characterised by an environment that has harnessed people’s interest and momentum for change, but which has failed to engage people fully. This imbalance results in their feeling some uncertainty regarding how they can contribute fully to the change, and therefore a sense of risk and lack of hope for the future. We can build energy by building team solidarity and developing shared purpose
    161. 161. #NHSChangeDay #SHCRchat 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 2: what’s your assessment of their energy for change?
    162. 162. #NHSChangeDay #SHCRchat 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 2: what’s your assessment of their energy for change? This energy profile shows strong connections between people, a true sense of solidarity, which gives them enough hope for the future, but this energy is undirected, because the rational argument and shared purpose has not been agreed. We can build energy by agreeing shared goals for change and using systematic approaches to thinking through and planning the change
    163. 163. #NHSChangeDay #SHCRchat There has never been a time in the history of healthcare when this advice has been more pertinent “Leadership is not about making clever decisions and doing bigger deals. It is about helping release the positive energy that exists naturally within people” Henry Mintzberg
    164. 164. #NHSChangeDay #SHCRchat “You can’t impose anything on anyone and expect them to be committed to it” Edgar Schein, Professor Emeritus MIT Sloan School
    165. 165. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Source: Helen Bevan Compliance States a minimum performance standard that everyone must achieve Uses hierarchy, systems and standard procedures for co- ordination and control Threat of penalties/ sanctions/ shame creates momentum for delivery What is our approach to change? Commitment States a collective goal that everyone can aspire to Based on shared goals, values and sense of purpose for co- ordination and control Commitment to a common purpose creates energy for delivery
    166. 166. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Shared purpose aligns..... Shared purpose allows many communities to engage with us without us having to invest resources in controlling their actions Nilofer Merchant
    167. 167. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 We know that ... • Shared purpose is a common thread in successful change programmes* • Organisations and change initiatives with strong shared purpose consistently outperform those without it.** *What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute) **Management Agenda 2013 Boury et al (Roffey Park Institute)
    168. 168. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 A 3-word concept @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
    169. 169. #NHSChangeDay #SHCRchat [Shared] purpose goes way deeper than vision and mission; it goes right into your gut and taps some part of your primal self. I believe that if you can bring people with similar primal-purposes together and get them all marching in the same direction, amazing things can be achieved. Seth Carguilo @HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
    170. 170. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Avoiding “de facto” purpose • What leaders pay attention to matters to staff, and consequently staff pay attention to that too • Shared purpose can easily be displaced by a “de facto” purpose:  hitting a target  reducing costs  reducing length of stay  eliminating waste  completing activities within a timescale  complying with an inspection regime • If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector
    171. 171. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 @SimonJGuilfoyle Police Inspector and systems thinker
    172. 172. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 @SimonJGuilfoyle Police Inspector and systems thinker
    173. 173. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Police @SimonJGuilfoyle Police Inspector and systems thinker
    174. 174. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Education @SimonJGuilfoyle Police Inspector and systems thinker
    175. 175. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 Healthcare @SimonJGuilfoyle Police Inspector and systems thinker
    176. 176. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 ....the last era of management was about how much performance we could extract from people .....the next is all about how much humanity we can inspire Dov Seidman
    177. 177. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 “Doing” as a health and care radical • Create the conditions where everyone can contribute and do their best • Join forces with others to create action • Achieve small wins which create a sense of hope, self-efficacy and confidence • Appeal to both the head (logic/planning/data) and the heart (shared values/purpose, framing, relationships) • Make change (and learning cycles from change) routine rather than an exceptional activity • Use models, theories and frameworks effectively
    178. 178. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 ‘I do not think you can really deal with change without a person asking real questions about who they are and how they belong in the world’ David Whyte, The Heart Aroused 1994 Source of image: fistfuloftalent.com
    179. 179. #NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 We have a choice “This is the true joy of life, the being used up for a purpose recognised by yourself as a mighty one, being a force of nature instead of a feverish, selfish little clot of ailments and grievances, complaining that the world will not devote itself to making you happy.” George Bernard Shaw

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