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Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013
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Building Contagious Commitment for Change - Workshop with Helen Bevan | April 9, 2013

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Helen Bevan delivered this full-day workshop, where we discussed, with about 80 health care leaders, how to build contagious commitment for change. …

Helen Bevan delivered this full-day workshop, where we discussed, with about 80 health care leaders, how to build contagious commitment for change.

Much of the redesign effort in health care is focused on the “anatomical” or technical aspects of improvement; how we transform processes, pathways and structures of care. There is growing recognition globally among leaders that we need to give more credence to the “physiological” aspects of redesign; how we capture the imagination and energy of frontline teams, leaders, and patients and families and mobilize them for system-wide transformation. Individuals and teams can weather the inevitable challenges presented by change, and they will sustain energy for change if they have an intrinsic sense of purpose, hope, and possibility about what the change will achieve.

At this one-day workshop, Helen Bevan – she is energy personified! - took us through some of the latest thinking and practice on how to build this ‘contagious commitment’ to change. She illustrated why energy is such a critical factor in successful change efforts. We learned about the different kinds of energy required for change, reviewed our Saskatchewan 'energy for change' profile, and built our skills for assessing and building energy levels in ourselves and in our team members.

The workshop took place in Regina, Saskatchewan, on Tuesday, April 9th, 2013.

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  • VIDEO – BRONZE AGE
  • 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.
  • This describes the group process for creating a driver diagram
  • Here’s one I prepared earlier. Note that the secondary drivers are measurable.
  • An example from a hospital provider. Things to note are the priority setting (i.e. quick wins) and the fact that a secondary driver can link to more than one primary driver.
  • Here is a real example – with some of the secondary drivers removed. Can you understand their logic? Note how they’ve thought very broadly about the issues (e.g. the local nightlife economy)Any thoughts on driver diagrams?
  • Transcript

    • 1. @helenbevanBuilding contagious commitment forimprovementHelen Bevan@helenbevan
    • 2. @helenbevanThemes for today1. Sensemaking about change2. Aligning aspects of change3. Building energy for change4. Shared purpose: change is not the goal,the goal is the goal
    • 3. @helenbevanMost large scale change fails toachieve its objectivesSource: McKinsey Performance Transformation Survey, 3000 respondents toglobal, multi-industry survey70%25%5%
    • 4. @helenbevanThe factors thatimpact the abilityto deliver Leantransformationare the same asthe factors inother large scalechange strategies
    • 5. @helenbevanGonna change my way of thinkingMake myself a different set of rulesGonna put my good foot forwardAnd stop being influenced by foolsFromGonna change my way of thinkingby Bob Dylanwith thanks to Jackie Lynton
    • 6. Leaders ask their staff to be ready for change,but do not engage enough insensemaking........Sensemaking is not done via marketing...orslogans but by emotional connection withemployeesRon Weil
    • 7. Anatomy of change Physiology of changeDefinition The shape and processes ofthe system; detailed analysis;how the components fittogether.The vitality and life-giving forces thatenable the system and its people todevelop, grow and change.FocusProcesses and structuresto deliver health andhealthcareEnergy/fuel for changeLeadershipactivitiesmeasurement andevidenceimproving clinical systemsreducing waste andvariation in healthcareprocessesredesigning pathwayscreating a higher purpose anddeeper meaning for the changeprocessbuilding commitment to changeconnecting with valuescreating hope and optimism aboutthe futurecalling to actionSource: Crump and Bevan
    • 8. Anatomy of change Physiology of changeDefinition The shape and processes ofthe system; detailed analysis;how the components fittogether.The vitality and life-giving forces thatenable the system and its people todevelop, grow and change.FocusProcesses and structuresto deliver health andhealthcareEnergy/fuel for changeLeadershipactivitiesmeasurement andevidenceimproving clinical systemsreducing waste andvariation in healthcareprocessesredesigning pathwayscreating a higher purpose anddeeper meaning for the changeprocessbuilding commitment to changeconnecting with valuescreating hope and optimism aboutthe futurecalling to actionSource: Crump and Bevan
    • 9. Anatomy of change Physiology of changeDefinition The shape and processes ofthe system; detailed analysis;how the components fittogether.The vitality and life-giving forces thatenable the system and its people todevelop, grow and change.FocusProcesses and structuresto deliver health andhealthcareEnergy/fuel for changeLeadershipactivitiesmeasurement andevidenceimproving clinical systemsreducing waste andvariation in healthcareprocessesredesigning pathwayscreating a higher purpose anddeeper meaning for the changeprocessbuilding commitment to changeconnecting with valuescreating hope and optimism aboutthe futurecalling to action
    • 10. “You can’t impose anythingon anyone and expect themto be committed to it”Edgar Schein, Professor EmeritusMIT Sloan School
    • 11. Source: Helen BevanFromComplianceStates a minimum performancestandard that everyone mustachieveUses hierarchy, systems andstandard procedures for co-ordination and controlThreat of penalties/ sanctions/shame creates momentum fordeliveryWhat is our approach to change?ToCommitmentStates a collective goal thateveryone can aspire toBased on shared goals, valuesand sense of purpose for co-ordination and controlCommitment to a commonpurpose creates energy fordelivery
    • 12. Intrinsicmotivatorsbuild energyand creativity
    • 13. Intrinsicmotivators•connecting toshared purpose•engaging, mobilising andcalling to action•motivational leadershipbuild energyand creativity
    • 14. Intrinsicmotivators•connecting toshared purpose•engaging, mobilising andcalling to action•motivational leadershipbuild energyand creativity create focus &momentum fordeliveryDriversof extrinsicmotivation
    • 15. Driversof extrinsicmotivationcreate focus &momentum fordeliveryIntrinsicmotivators•connecting toshared purpose•engaging, mobilising andcalling to action•motivational leadershipbuild energyand creativity•System drivers &incentives•Payment by results•Performancemanagement•Measurement foraccountability
    • 16. Internalmotivators•connecting toshared purpose•engaging, mobilising andcalling to action•motivational leadershipbuild energy andcreativityDrivers ofextrinsicmotivation•System drivers &incentives•Performancemanagement•Measurement foraccountabilitycreate & focusmomentum fordelivery
    • 17. @helenbevanTransformation is not a matter ofintent.........it is a matter of alignmentPeter Fuda
    • 18. @helenbevanNHS Change Modelwww.changemodel.nhs.uk
    • 19. @helenbevanTaskWith others at your table:• Identify the component that appeals to you themost/ that you feel the most connection with• Explain your reasons to your colleagues
    • 20. @helenbevan
    • 21. @helenbevanFive key principles in using theNHS Change Model1. Start with “shared purpose” but after that there is noprescribed linear or logical order2. It’s important to use the model to check if all eightcomponents are present but it’s more important to focuson whether they are aligned3. Use the model to build on what you are doing already4. Don’t “sell” the change model; “sell” theoutcomes you are seeking: change is notthe goal; the goal is the goal5. Build commitment to, not compliance with,the NHS Change Model
    • 22. @helenbevanIn terms of your current initiative• Where are you on a continuum between oneand ten in terms of how aligned the elementsare in your initiative?
    • 23. @helenbevanIn terms of your current initiative• Where are you on a continuum between oneand ten in terms of how aligned the elementsare in your initiative?• Move one step forward
    • 24. @helenbevanIn terms of your current initiative• Where are you on a continuum between oneand ten in terms of how aligned the elementsare in your initiative?• Move one step forward• Move one point higher on the continuum(i.e., if you are a five, move to a six)• What would it take to improve your score byone?
    • 25. @helenbevanWhat happens to large scalechange efforts in reality?In order of frequency:1. the effort effectively “runs out of energy” andsimply fades away2. the change hits a plateau at some level and nolonger attracts new supporters3. the change becomes reasonably well established;several levels across the system have changed toaccommodate or support it in a sustainable waySource: Leading Large Scale Change:a practical guide (2011), NHS Institute
    • 26. @helenbevanResearch shows that more than almostany other factor affecting anorganisation, organisational energy canlead to either a wellspring of corporatevitality or the destructionof its very coreSource: Bruch and Vogel
    • 27. @helenbevanBruch and Vogel researchOrganisations with HIGH productiveenergy scored higher on:• overall performance - 14% higher• productivity – 17%• efficiency – 14%• customer satisfaction – 6%• customer loyalty – 12%
    • 28. @helenbevan
    • 29. @helenbevanhttp://bit.ly/ZUCbfI
    • 30. @helenbevanthe capacity anddrive of ateam, organisation or system toact and makethe differencenecessary toachieve its goalsPsychologicalPhysicalSpiritualSocial IntellectualEnergy for change is:
    • 31. @helenbevanFive energies for changeEnergy DefinitionSocial energy of personal engagement, relationships and connectionsbetween 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, drivenby shared values and a higher purpose. It gives people theconfidence to move towards a different future that is morecompelling than the status quoPsychological energy of courage, resilience and feeling safe to do thingsdifferently. It involves feeling supported to make a change andtrust in leadership and directionPhysical energy of action, getting things done and making progress. It isthe flexible, responsive drive to make things happenIntellectual energy of analysis, planning and thinking. It involves gaininginsight as well as planning and supporting processes, evaluation,and arguing a case on the basis of logic/ evidence
    • 32. @helenbevanHigh and low ends of each energy domainLow HighSocial isolated solidaritySpiritual uncommitted higher purposePsychological risky safePhysical fatigue vitalityIntellectual Illogical reason
    • 33. @helenbevanKey conclusions from our work so far• Psychological energy is central• Dispersed leadership model• Explanation not judgement• Making explicit the issues thatremain hidden/unarticulated andthat really impact on teamperformance and achievement ofimprovement goalsPsychologicalPhysicalSpiritualSocial Intellectual
    • 34. @helenbevanThe energy for change index• The energy of any team, organisation or system – its capacity anddrive to act and make the difference necessary to achieve its goals– determines its agility for change• We have developed an online tool which is simple and rewarding asit provides an immediate insight into one’s own personal energy forchange• It is the first of a two-stage process for teams to identify areas thatneed a shift in focus in order to get wider engagement in changeand faster action towards achieving it• It is a powerful tool for organisations and teams undergoingperpetual change
    • 35. @helenbevanFacilitated questions -examples• Are particular energydomains more dominantthan others for our team atthe moment?• Is this the optimal energyprofile to help us achieveour change goals?• What would the optimalenergy profile look like forour team or community?PhysicalPsychologicalSpiritualSocialIntellectualEnergy for change profile
    • 36. @helenbevanFacilitated questions -examples• Are particular energydomains more dominantthan others for our team atthe moment?• Is this the optimal energyprofile to help us achieveour change goals?• What would the optimalenergy profile look like forour team or community?PhysicalPsychologicalSpiritualSocialIntellectualEnergy for change profileLOWHIGH
    • 37. @helenbevanTeam 1PhysicalPsychologicalSpiritualSocialIntellectual
    • 38. @helenbevanTeam 1PhysicalPsychologicalSpiritualSocialIntellectualTeam 1’s energy profile is characterised by an environment that has harnessedtheir interest and momentum for change, but which has failed to engage peoplefully. This imbalance results in their feeling some uncertainty regarding how theycan contribute fully to the change, and therefore a sense of risk and lack of hopefor the future. We can build energy by building team solidarity and developingshared purpose
    • 39. @helenbevanTeam twoPsychologicalSocial SpiritualPhysicalIntellectual
    • 40. @helenbevanTeam twoPsychologicalSocial SpiritualPhysicalIntellectualTeam 2 enables strong connections between people, a true senseof solidarity, which gives them enough hope for the future, but thisenergy is undirected, because the rational argument and sharedpurpose has not been agreed.
    • 41. @helenbevanSaskatchewan Energy for ChangeSSPPI Energy Index (V2)Analysis generated on 8th April 2013by Rosanna Hunt and Paul Woodley43 respondentsrosanna.hunt@nhsiq.nhs.uk+44 777 070 4056Energy for Change Model and SSPPI Energy Index by NHS Improving Quality is licensed under aCreative Commons Attribution-ShareAlike 2.0 UK: England & Wales License.
    • 42. @helenbevanThe following two slides show the SSPPI Energy Index, which is presented intwo parts.PART 1 is a psychometric profiling tool – it generates the group “energy forchange” profile.PART 2 asks individuals to self-evaluate their energy for change using theenergy definitions – it tells us whether there are any gaps between currentenergy levels, preferred energy levels and perceived energy levels in thework environment.The remaining slides show several perspectives on the results, from whichsome general conclusions are made, on the last slide.
    • 43. @helenbevanThe SSPPI Energy Index – V2, Part IThis questionnaire enables teams to measure their energy for change.Please agree the nature of the change context with your team before answering the following statements.Then answer all statements with your particular change context in mind.1 = Strongly disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly AgreeI am energised by the momentum of change____I have gained insight into the case for change____I feel a sense of solidarity with those I work with ____I am weary of change____I am able to keep expressing hope for the change when presented with setbacks_____The reasoning for the change is not compelling___I don’t feel appreciated by others at work_____I will be blamed if I try something new and it fails____I feel isolated from others____I feel depleted of energy when others express doubt about the change_____The case for change has stimulated my creativity_____I feel disconnected from others____I am committed to our common vision for the future____I feel safe enough to do things differently____I am driven by shared values____I am experiencing change fatigue____The change does not fit with my sense of purpose_____I am not driven by a shared purpose for change_____I think there is no rational argument for change____The case for change is interesting to me_____I feel that we are getting things done to achieve the change_____I feel the change may conflict with my values___I feel personally engaged in the change___Clear thinking and analysis underpins the change___I feel fearful about the change___I sense openness about the potential to change___
    • 44. @helenbevanSocial energy is the energy of personal engagement, relationshipsand connections between people. It reflects a “sense of us” and istherefore a collective concept that captures a situation wherepeople are drawn into an improvement or change because theyfeel a connection to it as part of the collective group.My social energy is ____The social energy of those I work with is____The importance of social energy to me is____Psychological energy is the energy of courage, trust and feelingsafe to do things differently. It involves feeling supported to makea change as well as belief in self and the team, organisation orsystem, and trust in leadership and direction.My psychological energy is ____The psychological energy of those I work with is____The importance of psychological energy to me is____Physical energy is the energy of action, getting things done andmaking progress. It is the flexible, responsive drive to makethings happen, with vitality and kinetic force (motion)My physical energy is ____The physical energy of those I work with is ____The importance of physical energy to me is____Intellectual energy is the energy of curiosity, analysis, thinking and cognition. It involves gaining insight, a thirst for new knowledge aswell as planning and supporting processes, evaluation, and arguing a case on the basis of logic and evidence.My intellectual energy is ____The intellectual energy of those I work with is____The importance of intellectual energy to me is____Complete these statements on a scale of 1 = low - 5 = highSpiritual energy is the energy of commitment to a common visionfor the future, driven by shared values and a higher purpose. Itinvolves giving people the confidence to move towards adifferent future that is more compelling than the status quo, byfinding the deep meaning in what they do.My spiritual energy is ____The spiritual energy of those I work with is____The importance of spiritual energy to me is____The SSPPI Energy Index – V2, Part 2
    • 45. @helenbevanmin max %Social 32 100 72Spiritual 47 100 80Psychological 47 97 75Physical 50 95 76Intellectual 48 100 82Total 45 98 771. The group’s Energy for ChangeprofileThe group’ energy for change is 77% (43 respondents). NHS groups previously analysedhave demonstrated energy levels between 54% and 84%.The table below shows that spiritual and intellectual energies are particularly high in thisgroup (82% and 80% respectively).Although social energy appears to be more depleted than the other energy types(72%), this may be skewed by a small number of individuals scoring particularly low(32%) on this energy type.
    • 46. @helenbevanProfiling data Self-EvaluationSocial 72 74Spiritual 80 80Psychological 75 72Physical 76 70Intellectual 82 82Total 77 76Overall, the two perspectives on energy support each otherThis indicates that respondents show good self-awareness of their energy forchange. The group may perceive its physical energy to be more depleted thanit is in reality (they self-evaluate their levels of physical energy to be at 70%whereas their profile indicates they have higher physical energy in reality(76%).2. How does your Energy for Changeprofile compare with your self-evaluated view of your energy?
    • 47. @helenbevan3. Gaps between current energy levels anddesired energy levelsThese results, taken from self-evaluations of energy for change (Part 2 of the questionnaire)indicate that there are large gaps (> 1) between the group’s perceived energy for change (on thegreen line) and its desired energy level (the red line) on the physical and psychological energies.The group would like to enhance its energy for change in these particular domains.On average, individuals within the group measure the energy of those they work with (the blueline) to be lower than their own energy to be lower than the energy of those around them.12345SocialSpiritualPsychologicalPhysicalIntellectual My Energy AverageThe Energy of those I work with AverageThe importance of this energy to me Average
    • 48. @helenbevan4. Frequency of high (>3) self-evaluatedcurrent and desired energy levelsSo far, we have used average (mean) scores to understand the group’s energylevels. However, since the mean can hide patterns in the data, it is important tolook at frequency data to gain another perspective and check conclusions.The bar chart above backs up the view that there is a particularly strong need tobuild an environment for change that enhances physical and psychological energyfor individuals.051015202530354045Social Spiritual Psychological Physical IntellectualMy EnergyThe Importance of this energyto me
    • 49. @helenbevan5. Is Energy for Change influenced by “distancefrom CEO” and “clinical/non-clinical” role?Our NHS dataset of 200 respondents showed that individuals in clinical roles have higherlevels of energy for change than those in non-clinical roles*, which is mostly influenced bytheir higher levels of spiritual energy** and may also be influenced by higher levels of socialenergy***.The NHS data also showed that individuals in roles that are closer to the CEO (in hierarchicalterms) have higher levels of energy for change**** in four out of the five energy domains(there were no differences in the physical energy levels of individuals at different levels ofthe hierarchy).In the Saskatchewan dataset there were no differences between individuals in clinical roles(n=13) compared with those in non-clinical roles (n=30). Interestingly, the only difference toemerge between the various levels of the hierarchy, was on Physical Energy: those closest tothe CEO had higher physical energy for change than those two steps away from the CEO++.However, caution should be exercised in the interpretation of these results. A largerSaskatchewan dataset would be required, as the groups are certainly too small to berepresentative (clinical = 13, proximity to the CEO = approximately 6 in each group).*t=2.1,df=190,p=0.03 ++F= 2.7,df=4,p=0.05**t=3.9,df=201,p<0.001***t=1.9, df=198,p=0.056****F=5.3,df=4,p<0.001
    • 50. @helenbevanConclusions• The group’s energy profile is 77%, but this varieswidely across energy domains and individuals• To build energy for change, the team should focuson the physical and psychological domains• Physical energy is enhanced by creatingopportunities for regular renewal, ensuringworkload is appropriate and investing in a healthywork environment• Psychological energy is enhanced by a safe, secureenvironment that provides role-models thatexhibit courage for, and trust in change
    • 51. @helenbevanResources for building and aligning energyTitle and source S S P P IQuality and Service Improvement Tools – NHS X X X X XEnergy Project tips – The Energy Project X X X XEmotional Resilience Toolkit – DH/Business inthe CommunityX X X XIHI Improvement Map – Institute for HealthcareImprovementX X X XP3M Resource Centre – NHS Connecting forHealthX X X Xi-resilience assessment – RobertsonCooper X X X XAppreciative Inquiry – Appreciative InquiryCommonsX X XGood Day at Work network – RobertsonCooper X X X
    • 52. @helenbevanResources for building and aligning energyTitle and source S S P P IQuality and Service Improvement Tools – NHS X X X X XEnergy Project tips – The Energy Project X X X XEmotional Resilience Toolkit – DH/Business inthe CommunityX X X XIHI Improvement Map – Institute for HealthcareImprovementX X X XP3M Resource Centre – NHS Connecting forHealthX X X Xi-resilience assessment – RobertsonCooper X X X XAppreciative Inquiry – Appreciative InquiryCommonsX X XGood Day at Work network – RobertsonCooper X X X
    • 53. @helenbevanburning platformversusburning ambition@PeterFuda
    • 54. @helenbevanLessons for transformational change1. In order to sustaintransformational change, we asleaders need to move from aburning platform (fear basedurgency) to a burning ambition(shared purpose for a betterfuture)2. We as leaders need to articulatepersonal reasons for change aswell as organisational reasons3. If the fire (the energy) goes out,all other factors are redundant@PeterFuda
    • 55. @helenbevanTaskTalk to the person next to you• What is “my burning ambition” for my service, mycommunity and /or my patients• Try to make it personal: tell others why this ambitionconnects with your personal motivations
    • 56. @helenbevanYou get the best efforts fromothers not by lighting a firebeneath them but by buildingSource: Bob Nelson
    • 57. @helenbevanThere has never been a time in the historyof healthcare when this advice has beenmore pertinent“Leadership is not about making cleverdecisions and doing bigger deals. It isabout helping release the positive energythat exists naturally within people”Henry Mintzberg
    • 58. @helenbevanFramingIs the process by which leaders construct, articulateand put across their message in a powerful andcompelling way in order to win people to their causeand call them to actionSnow D A and Benford R D (1992)
    • 59. @helenbevanIf we want people to take action, we have toconnect with their emotions through valuesactionvaluesemotionSource: Marshall Ganz
    • 60. @helenbevanWhat do we need to do?1. Tell a story
    • 61. @helenbevanWhat do we need to do?1. Tell a story2. Make it personal
    • 62. @helenbevanWhat do we need to do?1. Tell a story2. Make it personal3. Be authentic
    • 63. @helenbevanWhat do we need to do?1. Tell a story2. Make it personal3. Be authentic4. Create a sense of “us” (and be clear who the “us”is)
    • 64. @helenbevanWhat do we need to do?1. Tell a story2. Make it personal3. Be authentic4. Create a sense of “us” (and be clear who the “us”is)5. Build in a call for urgent action
    • 65. @helenbevanJames Croft
    • 66. @helenbevanOutwittedHe 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
    • 67. @helenbevanWhat’s our approach to change?Deficit based• what is wrong?• solving problems• identifying whatwe need toimprove• gaps anddeficiencies to befilledAsset based• what is right thatwe can build on?• working withexisting assets andresources• “positive deviants”• amplifying whatworks
    • 68. @helenbevan69Build on strengths or fix problems?To what extent did you balanceidentifying strengths withunderstanding problems?Focused exclusivelyon problems 83Focused mostly onproblems & a little onstrengths77Focused more onproblems than on strengths 61Equal focus on problemsand strengths 49x 3.0A study of two bowling teams atUniversity of Wisconsin showedthat the team that was coachedusing video tape of theirsuccesses improved twice asmuch as the team that wasshown only their mistakes51382317%, n = 2,043SOURCE: McKinsey Quarterly Transformational Change survey, January 2010
    • 69. @helenbevan“A shared sense ofcorporate purpose,grounded in universalvalues, is the highestoctane source of fuelfor organisationalaction.”Schwartz and Loehr (2004)
    • 70. @helenbevan“Money incentives do not create energyfor change; the energy comes fromconnection to meaningful goals”Ann-Charlott Norman, Talking about improvements: discursivepatterns and their conditions for learning, March 2012
    • 71. @helenbevanWe know that ...• Shared purpose is a common thread in successfulchange programmes*• Organisations and change initiatives with strongshared purpose consistently outperform thosewithout it.***What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)**Management Agenda 2013 Boury et al (Roffey Park Institute)
    • 72. @helenbevanShared purpose aligns.....Shared purpose allowsmany communities toengage with us without ushaving to invest resourcesin controlling their actionsNilofer Merchant
    • 73. @helenbevanA 3-word concept
    • 74. @helenbevanDiscretionary effortis contractualis personal
    • 75. @helenbevan[Shared] purpose goes way deeper thanvision and mission; it goes right into your gutand taps some part of your primal self. Ibelieve that if you can bring people withsimilar primal-purposes together and getthem all marching in the same direction,amazing things can be achieved.Seth Carguilo
    • 76. @helenbevanFrom compliance to commitment“We come from a culture of complianceand top down performance management,… It’s task-orientated to get things done. Itneeds to be much more aboutcooperation, about leading acrossboundaries … Being able to focus onshared purpose in those circumstances isabsolutely crucial.” NHS interviewee
    • 77. @helenbevanAvoiding “de facto” purpose• What leaders pay attention to matters to staff, and consequentlystaff 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 forsomething else to become a de facto purpose in the minds of theworkforceSource: Delivering Public Services That Work: The Vanguard Method in the Public Sector
    • 78. @helenbevan @SimonJGuilfoyle Police Inspector and systems thinker
    • 79. @helenbevan @SimonJGuilfoyle Police Inspector and systems thinker
    • 80. @helenbevanPolice@SimonJGuilfoyle Police Inspector and systems thinker
    • 81. @helenbevanEducation@SimonJGuilfoyle Police Inspector and systems thinker
    • 82. @helenbevanHealthcare@SimonJGuilfoyle Police Inspector and systems thinker
    • 83. @helenbevanHow de facto purpose is creeping into NHS improvementprojects: how 100 young and emerging clinical leaders framedtheir projects05101520251 2 3 4 5 6 7 8 9NoofprojectsProject ScoreMainly focussed onquality, safety &/orpatient experienceMainly focussedoncost, productivityor efficiencySource: project information from 100 young clinicaland managerial leaders taking part in nationalimprovement skills programme October 2012
    • 84. @helenbevanHow de facto purpose is creeping into NHS improvement projects: how 100young and emerging clinical leaders framed their projects05101520251 2 3 4 5 6 7 8 9NoofprojectsProject ScoreMainly focussed onquality, safety &/orpatient experienceMainly focussedoncost, productivityor efficiencyVery few framed theirprojects as quality, safetyor experience
    • 85. @helenbevanHow do we create shared purpose?
    • 86. @helenbevanCreate a safe space• This can be in small, medium or large groups• Online forums can also be used• Create a level playing field, free from hierarchy• Include patients and service users – they areexpert about their needs
    • 87. @helenbevanCreating a safe space“Just creating the space for people tocome together as individuals and feelsafe enough to share things … perhapstheir vulnerabilities; and how the groupbuilt as an entity and a supportingmechanism. I think the thing for me thatwas really important was that it wasacross what are conventionalboundaries. Focus group participant
    • 88. @helenbevanLook for commonalities• Start with each individual talking about theirown values and stories• Talk about the parts of the stories that unitethe group• Capture some statements that reflect yourshared understanding and ambitions
    • 89. @helenbevanFinding commonalities“The perspective of the patientmight be quite different than theperspective of the staff nurse onthe ward who looks after them ... Ithink it was really interesting for allthe participants to realise that theywere talking about the same thingsessentially.” Focus groupparticipant
    • 90. @helenbevanHow many of you have workedwith driver diagrams?
    • 91. @helenbevanCreating a driverdiagramThese directly affect the aim These directly affect one ormore primary driversPRIMARY DRIVERS SECONDARY DRIVERS?Write them as “We need to improve . ..”
    • 92. @helenbevanGetting Andy Murray to be Wimbledon championIncreaseskill levelBetterintelligence onrivalsImprove backhand accuracyDecrease double faultsIncrease staminaIncrease serve / volleyReserve challengesCreate top 50 dossiersWimbledonchampionIncreasefitnessImprovedtacticsImproved hydrationIncrease success rate for top3 tactics per player
    • 93. Turnround thedeficit inGeneralSurgeryReduce bedrequirements (andtherefore staffing)1. Reduce day before admissions5. Decrease bed capacity buffer6. Streamline elective demand7. Increase discharge timeliness (social factors)8. Increase discharge timeliness (weekend holdups)3. Improve recording and income capture10. Improve out-patient profitability9. Match staffing levels / mix to demand (via flexibility)11. Increase theatre utilisation2. Shift elective procedures to high margin day casesIncrease incomeImprove resourceusage (andtherefore reducestaffing)Decrease othercosts12. Decrease consumables costs4. Decrease controllable DNAsFrom a hospitalsystemQuick win Longer term
    • 94. To deliver harm freecare as defined by theabsence of pressureulcers, falls, UTI withCatheter and VTE byMarch 2013StrategicLeadershipAccountabilityIn CareFocus On CareEnabler To CareLeadershipWalk RoundsCommissioner VisitsRisk AssessmentIncidence95% Harm Free CareRoot Cause AnalysisCollaborativeLearning EventsPrimary Drivers Secondary DriversLarge ScaleChange TeamContractingAim Care PlanningAdult SafeguardingPatient StoriesChief Nurse 6Cs
    • 95. © NHS Institute for Innovation and Improvement, 2012Reduce the negativeimpact of alcohol onhealth, well-being, andsociety in the NorthWest.Increase opportunitiesto directly influenceindividual decisionmaking about alcohol Increase use of communication/messaging/campaigns etc.Create a grass roots social movement among thepublic (re: alcohol)Create leadership and mindset change amongprofessional groups to become advocates foralcohol awarenessCreating more leaders who can influence othersand lead the agendaAlign/create/enhance the performancemanagement system to promote alcohol relatedactivitiesCreate an alternatives for economicdevelopment (e.g. not nightlife based)Influence theenvironment thatdetermines alcoholconsumption andalcohol relatedservicesWork with alcohol industry to improve labellingand reduce instances of below cost salesFuture activitiesActivities currently underwayIncrease the number of targeted programmes forspecific groups of alcohol usersEducate directly-employed staff in the publicsector serve as role models/championsA large scale example . . .
    • 96. @helenbevanTask: stage oneAs a group or table, select one of the driverdiagrams to work on:• Familiarise yourself with the diagram• You are going to create a shared purpose to sit atthe beginning of the driver diagramme• Who needs to be involved in creating the sharedpurpose?• Can you “stand in the shoes” of these people andreframe the aims statement as a shared purpose?• How can you utilise spiritual and social energy aswell as intellectual and physical energy?• Can you create a shared purpose rather than ade-facto purpose?
    • 97. @helenbevanTask stage twoReview the entire driver diagram from the pointof view of the change model:• Are all eight components represented?• What should be added?• Are the components aligned?
    • 98. @helenbevanLevel 3: Keeping on trackHave we remainedtrue to our originalpurpose?Do we need to re-calibrate to ensurewe’re not just doing‘the wrong thingsrighter?’
    • 99. @helenbevanKeeping on track“It’s challenging sometimes tofind time and it’suncomfortable sometimes todiscover how far we havestrayed from [our sharedpurpose].” NHS interviewee.
    • 100. @helenbevanRe-energiseRe-visiting theoriginal purpose canhelp re-energisewhen a programmehas plateaued or runout of steam
    • 101. @helenbevanRe-energise“There is a need for change leaders tobe reminded about [shared purpose’s]centrality and therefore for it to becontinuallyrevisited, checked, refreshed, that evenif the value and the purpose stay thesame the messaging might need to berevisited and checked.” NHSInterviewee.
    • 102. @helenbevanWe need to build capability for knowing, doing, livingand being improvement
    • 103. @helenbevan 105
    • 104. @helenbevan‘Hurihia to aroaroki te ra, tukuna toatarangi kia taka kimuri i a koe’“Turn your face tothe sun and theshadows fallbehind you”Māori whakatauki

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