1. NHS England and NHS Improvement
to make
Helen Bevan
@HelenBevan
#CollaborativeNW
Taking the
Power is the ability to
produce intended effects
Bertrand Russell
change happen

2. 2 |2 |
Our agenda
0945: Welcome to the masterclass
1000: Meet your small group
1010: The main session
• Old and new power
• How we make change happen using both
• Investors not buyers
• Building shared purpose
• A model for change
1050: Break
1100: Our case study: virtual ICTs and MDTs with
Warrington Together
1145: Reflections and close
@HelenBevan #CollaborativeNW

3. Rachel Mellor
Programme Manager
Carole Hugall
Director of Clinical Integration

4. New ways of working
Virtual working in integrated care teams – Phase 1
• Using WebEx to dial in – morning, lunch and afternoon handovers
• From home, car or other convenient location
• Occasional physical office presence for wellbeing purposes
Virtual multi-disciplinary teams – Phase 2
• Plan to rollout to MDTs in near future – currently suspended due to pandemic
• PCNs not all geographically aligned so will save considerably on travel
• Primary Care are now doing more virtual consultations so are keen to explore other
opportunities

5. Finding your way around Zoom
To join the chat:
1. Click on Chat
2. Add your views and comments with the
'everyone' or click on the drop down to respond
to an individual privately
To mute or share video:
To raise your hand:
1. Click on Participants
2. Click on 'Raise Hand
3. Remember to lower your
hand afterwards too
To add sub titles
Click on Closed Caption

6. 6 |
In the main
virtual room
• Unless you are a speaker
you will be muted
• Having your camera on is
optional
• Use the chat box as the
main method of
communication
• Raise your virtual hand if
you have a technical
problem
In the breakout
room
• You mute and unmute
yourself: please mute
unless you are speaking
• Have your camera on so
others can see you
• Raise your virtual hand if
you want to vote

7. 7 |
We will now move to your small
group in a breakout room
• Unmute yourself and turn on your camera
• Introduce yourself to others in your group
• Identify something that unites you: one thing that everyone in your group has
in common
• Nominate someone to make a few comments in the chat box when you get
back to the main room later
• Be ready to come back to the main room after 10 minutes
(we will give you time warnings)
• Don’t type your comments into the breakout room chat box as they will be
lost
• Remember your room number
#CollaborativeNW

8. 8 |
Welcome back from the
breakout rooms
Please can one person from each room add “what unites
us” from your conversations to the chat box
#CollaborativeNW

9. Jeremy Heimens, Henry Timms New Power: How it’s changing the 21st Century and why you need to know (2018)
new power
Current
Made by many
Pulled in
Shared
Open
Relationship
old power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
@HelenBevan #CollaborativeNW

10. 10 |10 |
The power of relationships, united by purpose
Joseph Gremy
and David
Maxfield
• Crisis leadership is relational
• Virtual working needs to be relational
• The community response is relational
Samer Araabi
@HelenBevan #CollaborativeNW

11. 11 |
Covid-19 metaphors and power
Sources:
Ella Saltmarshe: https://medium.com/@ellasaltmarshe/8-tips-for-framing-covid-19-f3c897c1ffa6
Public Interest Research Centre: https://publicinterest.org.uk/part-4-metaphors/
The Workshop: https://mcusercontent.com/b0185015163b8400982fe50f3/files/5b54ba18-e698-4ee5-8c68-
9d950d81b6db/The_Workshop_Covid19_Digital.01.pdf?mc_cid=620d8519d0&mc_eid=f7b8a6dd7c
Old power
• The war, the fight, the
battle against Covid-19
• Crime: “lockdown”;
“curfew”; social
isolation “transgressors”
• Doctors and nurses as
“superheroes”, “troops in
battle”, “frontline”
• “Battening down”
• Needs command &
control, top down
leadership
New power
• A journey with challenges and a hopeful
destination
• Positive human actions based on shared
purpose: “Building”, “forging”
“reconstruction”
• Many people working together, each playing
their part - interdependence
• Creating resilient, connected communities

12. Across the globe, people are questioning the
old power model of system change
Pilot project Rolling out
“If we opened our eyes we would see the wonderful irony. Trying
to manage human change through pilot and roll-out has actually
grown something. A proliferation of project managers”.
John Atkinson
@HelenBevan #CollaborativeNW

13. 13 |
WHO will make the change happen?
Source: adapted by Helen Bevan from Leandro
Herrera
List A
• The Delivery Board
• The programme sponsors
• The CEOS of participating
organisations
• The Programme Management Office
• The Delivery Board work streams
• The Clinical Directors
• The Change Facilitators

14. 14 |
WHO will make the change happen?
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see things
differently
• The hyper-connected who spread
behaviours, role model at a scale, set
mountains on fire and multiply
anything they get their hands on
Source: adapted by Helen Bevan from Leandro
Herrera
List A
• The Delivery Board
• The programme sponsors
• The CEOS of participating
organisations
• The Programme Management Office
• The Delivery Board work streams
• The Clinical Directors
• The Change Facilitators

15. Who do we need to mobilise for our change initiative?
The failure of large scale change projects
is rarely due to the content or structure of
the plans that are put into action
To make transformational change happen
we need to connect networks of people
who ‘want’ to contribute
http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-
257163-Campaign+-+01%2F09%2F2016
Source: David Dinwoodie (2015)
It’s much more about the role of
informal networks in the
organisations and systems affected
by change
#OurNHSPeople
#WeAreTheNHS
#OurNHSPeople
#WeAreTheNHS

16. People who are highly connected have
twice as much power to influence
change as people with hierarchical
power
Leandro Herrero
http://t.co/Du6zCbrDBC
@HelenBevan #CollaborativeNW

17. Find the 3% “super-connectors”!
Source: Organisational Network Analysis by Innovisor
Just 3% of
people in the
organisation or
system typically
influence 85% of
the other people
.Influencers
@HelenBevan #CollaborativeNW

18. Why superconnectors?
A major cause of change failure is poor dialogue with
the informal organisation
The 3% informal influencers:
• Have the relationships, networks, content and context
• drive the perceptions of other people
• are the go-to people for advice
• make sense of things and reduce ambiguity for others
• Are trusted by peers more than formal leaders are trusted
• Are often unknown to formal leaders
Source: Innovisor
Source of graphic:
The Strategy Group
Even more important at a time of ambiguity and uncertainty
@HelenBevan #CollaborativeNW

19. The 3% rule also appears true for social
media
Source: research by Graham MacKenzie using NodeXL
In health and
healthcare globally,
tweets by 3.3% of
tweeters accounted
for 85% of retweets
@HelenBevan #CollaborativeNW

20. The superconnectors become even more important at
times of ambiguity and uncertainty
@davemorgan_NEAS
@trishgreenhalgh @doctor_oxford
@HelenBevan #CollaborativeNW

21. Innovisor Evidence-based change
McKinsey Tapping the power of hidden influencers
Mike Klein Internal influencers: actionable and no longer optional
How do you find your superconnectors?
Ask other people!
Who do you
go to for information
when you have concerns
at work?
Who’s advice do you
trust and resect?

22. What does this mean for me?
- Build your connections
and relationships
- Be a model of trust and
positive behaviours
- Always, always follow up
Be a
superconnector
- Get their insights
- Engage them in
change
- Stay connected for the
long haul
Find your
superconnectors
@HelenBevan

23. As senior leaders, we may be less
influential than we think
If we want to get the same
level of influence through
top down change as the 3% get,
we need four times more people
Source:
Jeppe
Hansgaard,
Innovisor

24. Mark Jaben on the neuroscience of resistance to change
What NOT to do
(but what we usually do)
Engage
people here

25. What NOT to do
(but what we usually do)
We don’t need buyers (who “buy-in” to change)
We need investors
What TO do
Engage
people here
Engage
people here
Mark Jaben on the neuroscience of resistance to change

26. Complex systems are driven by the quality
of the interactions between the parts, not the
quality of the parts. Working on discrete parts
or processes can properly bugger up the
performance at a system level. Never fiddle
with a part unless it also improves the system
@ComplexWales
Source of image: Eclipse

27. An independent initiative An inter-dependent initiative
Improve
the response to
someone presenting
to primary care in a
mental health crisis
Primary
care
Emergency
Department
Mental
health
service
Supported by specific
tools & information
• Social and
collaborative
• Built on shared
purpose
• Multiple methods
Within a
clear
boundary
Improve
smoking cessation rates
amongst people living
with asthma and COPD

28. My organisation/group
My interests
Silos
Tunnel vision
Behaviours that protect
and advance me or my
group
The bigger system
Our shared purpose
Collaboration
Awareness
Behaviours that
advance the collective
result
Inward mindset Outward mindset
Source: The Arbinger Institute@HelenBevan #CollaborativeNW

29. Why shared purpose?
[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

30. Improvement is
anchored in purpose
@HelenBevan #CollaborativeNW

31. Where do we start?
• In improvement methodology, our first question is “What is our
aim”?
• In social movement and community organising practice, our first
question is “who are our people?”
Who are our people?
What unites us (our shared purpose)?
What is our aim?
@HelenBevan #CollaborativeNW

32. Who do we need to mobilise for change?
The first question a community organiser asks is “Who are my
people?” not “What is my issue?”
Organising is about enabling the people with the problem to
mobilise their own resources to solve it (and keep it solved).
Marshall Ganz
https://d3n8a8pro7vhmx.cloudfront.net/themes/52e6e37401925b6f9f000002/attachments/
original/1423171411/Organizers_Handbook.pdf?1423171411

33. The model for improvement
Source: IHI
@HelenBevan #CollaborativeNW

34. The model for improvement
Who are our people?
What unites us (our shared purpose?)
@HelenBevan #CollaborativeNW

35. Don’t confuse PURPOSE with
AIM
• An aim is setting a determined course in order to
achieve a set goal within a specific timescale
• Purpose seeks to make explicit the reason behind
something that is being done. Purpose defines WHY we
are doing what we are doing, and WHAT we hope to
achieve from it
@HelenBevan #CollaborativeNW
We need BOTH but shared purpose comes before aim

36. Avoiding “de facto” purpose
Source: Delivering Public
Services That Work: The
Vanguard Method in the
Public Sector
• Shared purpose can easily be displaced by a “de
facto” purpose:
 hitting targets, standards or key performance indicators
 reducing costs
 reducing time in hospital
 complying with regulators
 completing activities within a timescale and budget
• 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
• De facto purpose is toxic, leads to burn out and
blocks engagement
“de facto” means
that something
exists in reality even
if it isn’t intended

37. “I have some key performance
indicators for the next 12
months” “I have a dream”
Source: @RobertVarnam
@HelenBevan #CollaborativeNW

38. “I have some key performance
indicators for the next 12
months”
or
“I have a dream”
Source: @RobertVarnam
@HelenBevan #CollaborativeNW

39. @HelenBevan #CollaborativeNW

40. Our shared purpose:
#EndPJParalysis
@HelenBevan #CollaborativeNW

42. Our approach to change
STARTING
POINT
THE
FUTURE
XXXX has
demonstrated
new, flexible
ways of working
in its Covid-19
response and we
want to move
forward with
these, not go
back to the old
ways of working
 Change the discussion
that shapes everyday
thinking and
behaviour
 Engage the whole
organisation
 Rewrite the “rules”
that govern how
things operate
• Create a big
conversation
based on three
questions
• Make the
conversation
part of the
change, not a
“diagnostic”
• Work across
boundaries
• New
connections,
collaboration
• Energy for
change
• Stronger
alignment
but sense of
autonomy
Agile, flexible,
responsive,
value-driven
ways of
working in
achieving our
goals for our
patients,
population &
people

43. Our approach to change
STARTING
POINT
THE
FUTURE

44. The leaders who succeed in the future will be those who develop the
ability to operate in new power ways
Building skills
Making change happen
Information flows
Networks and connections
Modified from Donella Meadows adaptation of leverage points in
OECD ‘A brief history of systems approaches’ 44
Leadership thinking

45. Rachel Mellor
Programme Manager
Carole Hugall
Director of Clinical Integration

46. About Warrington Together
Warrington
 Population of 207,000, equidistant between Manchester and Liverpool
 Top decile for economic prosperity and educational attainment outside London
 Deprivation vs affluence – 12 year difference in life expectancy between most affluent and most
deprived areas of the town
Warrington Together
 Integrated Care Partnership – health, care, 3rd sector,
housing…
 Reports to Health and Wellbeing Board
 Asset based population model integrating care in
communities
 Integrated Community Teams – a workstream focused on
delivering integrated care closer to home to our frail
population. Includes co-location of health and social care
staff, working together for more seamless care

47. New ways of working
Virtual working in integrated care teams – Phase 1
• Using WebEx to dial in – morning, lunch and afternoon handovers
• From home, car or other convenient location
• Occasional physical office presence for wellbeing purposes
Virtual multi-disciplinary teams – Phase 2
• Plan to rollout to MDTs in near future – currently suspended due to pandemic
• PCNs not all geographically aligned so will save considerably on travel
• Primary Care are now doing more virtual consultations so are keen to explore other
opportunities

48. New ways of working
Our aims
• Reinstated MDTs to be held virtually by August 2020
• Nominated GP to be in attendance at 80% of MDTs
• Attendance of all professionals to be 80% at MDTs
• Reduction in travel time to MDTs by 100%
• Reduction in travel costs to MDTs by 100%
Key questions
• How do we ensure patient care is not compromised by
holding virtual MDTs?
• How can we measure success?
• How can we ensure relationships are maintained?
• How can we encourage a continuous cycle of innovation?

50. Reflections