Leading change into the future

1. @helenbevan #2017congress Leading change into the future Themes and trends in the wider world of change and implications for healthcare leaders

2. @helenbevan #2017congress The Horizons team: Change agents and change agency • A small, diverse team of people within the English National Health Service • We tune into the latest change thinking and practice in healthcare and other industries around the world – translating this learning into practical approaches to change • The team has emerged through years of supporting change in the NHS and the wider health and care system

3. @helenbevan #2017congress 3 The greatest danger today is NOT micro-managing: it is MACRO-LEADING Henry Mintzberg

4. @helenbevan #2017congress Change is changing

5. @helenbevan #2017congress Kinthi Sturtevant, IBM 13th annual Change Management Conference We rarely see two, three or four year change projects any more. Now it’s 30-60-90 day change projects

7. @helenbevan #2017congress

9. @helenbevan #2017congress We still organise health and care like the Tabulating Machine Co. of 1917 Source of image: @corp_rebels

10. @helenbevan #2017congress Source: Innovisor

11. @helenbevan #2017congress Three time points of collaboration among cancer clinicians and researchers from Braithwaite and colleagues 2017

12. @helenbevan #2017congress Power is shifting Power is one’s ability to achieve goals Bertrand Russell

13. @helenbevan #2017congress Jeremy Heimens, Henry Timms This is New Power old power new power Currency Held by a few Pushed down Commanded Closed Transaction Current Made by many Pulled in Shared Open Relationship

14. @helenbevan #2017congress To make change happen, connect with the 3% Just 3% of people in the organisation or system typically drive conversations with 90% of the other people Source: research by Innovisor

15. @helenbevan #2017congress WHO will make the change happen? List A • The Delivery Board • The programme sponsors • The Programme Management Office • The Delivery Board work streams • The Clinical Leads • The Directors of participating organisations • The Change Facilitators Source: adapted by Helen Bevan from Leandro Herrera

16. @helenbevan #2017congress WHO will make the change happen? List A • The Delivery Board • The programme sponsors • The Programme Management Office • The Delivery Board work streams • The Clinical Leads • The Directors of participating organisations • The Change Facilitators List B • The mavericks and rebels • The deviants (positive). Who do things differently and succeed • The nonconformists who see things through glasses no one else has • The hyper-connected who spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on • The hyper-trusted. Multiple reasons, doesn’t matter which onesSource: adapted by Helen Bevan from Leandro Herrera

17. @helenbevan #2017congress WHO will make the change happen? List A • The Delivery Board • The programme sponsors • The Programme Management Office • The Delivery Board work streams • The Clinical Leads • The Directors of participating organisations • The Change Facilitators List B • The mavericks and rebels • The deviants (positive). Who do things differently and succeed • The nonconformists who see things through glasses no one else has • The hyper-connected who spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on • The hyper-trusted. Multiple reasons, doesn’t matter which ones Source: adapted by Helen Bevan from Leandro Herrera

18. @helenbevan #2017congress What’s the evidence? The failure of large scale transformational 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

19. @helenbevan #2017congress Mark Jaben on the science behind resistance What NOT to do But what we do do Engage people here

20. @helenbevan #2017congress Mark Jaben on the science behind resistance to change 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

21. @helenbevan #2017congress The design dilemma at the heart of change The predominant approach in recent years has been STRUCTURE but globally there is a big shift towards AGENCY

22. @helenbevan #2017congress Source: @NHSChangeDay

23. @helenbevan #2017congress Source: @NHSChangeDay

24. @helenbevan #2017congress Source: @NHSChangeDay Problematic: changing a “permission culture” can take years The good news: we can usually build agency much more quickly

25. @helenbevan #2017congress Individual AND collective agency Individual agency: People get more power and control in their own lives: patient activation, shared decision-making and self-care Collective agency: People act together, united by a common cause, harnessing the power and influence of the group and building mutual trust

26. @helenbevan #2017congress Building agency for large scale change We do not become transformed alone, we become transformed when we’re in relationship with others Hahrie Han Source of image: Idahoc Community Action

27. @helenbevan #2017congress http://biggerboat.org/exploring-moodocs/ MOODOCs (Massive, Online, Open, Disease Oriented Communities)

28. @helenbevan #2017congress Big drive to bring social movement thinking and practice into delivery

29. @helenbevan #2017congress New Public Passion: a growing global movement

30. @helenbevan #2017congress The era of the PLATFORM Platforms today power learning and innovation at the speed of change by providing collaborative and sometimes exponentially productive spaces for people to create value John Hagel Source of image: Pinipa

31. @helenbevan #2017congress Platform-based, collaborative innovation methods are outpacing traditional R&D Source: PWC Innovation benchmarking survey 2017

32. @helenbevan #2017congress • systematic “change management” • too often, leaders prescribe outcome and method of change in a top-down way • change is experienced by people at the front line as “have to” (imposed) rather than “want to” (embraced) Change Programmes • everyone (including service users and families) can help tackle the most challenging issues • value diversity of thought • connect people, ideas and learning • Role of formal leaders is to create the conditions and get out of the way Change Platforms “Tear down the walls”

33. @helenbevan #2017congress The Change Challenge Tapping the collective brilliance of the NHS

34. 14,000 contributions identified 10 barriers to change: Confusing strategies Over controlling leadership Perverse incentivesStifling innovation Poor workforce planning One way communication Inhibiting environment Undervaluing staff Poor project management Playing it safe

35. @helenbevan #2017congress A global survey by Gallup into the reasons why change initiatives fail, identified the same issue Increasing number of messages as information cascade through the organisation Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail- don.aspx

36. 14,000 contributions identified 11 building blocks for change: Inspiring & supportive leadership Collaborative working Thought diversityAutonomy & trust Smart use of resources Flexibility & adaptability Long term thinking Nurturing our people Fostering an open culture A call to action Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015 Challenging the status quo

37. @helenbevan #2017congress After years of intensive analysis, Google discovered that the key to high performing teams that deliver change is being nice Project Aristotle: https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja- xoaZybvz9f0b1_6bJyG7zZO6L

38. @helenbevan #2017congress ... 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 A changing world

39. @helenbevan #2017congress 1. Frame issues in ways that will engage and mobilise the imagination, energy and will of a large number of diverse stakeholders 2. Take steps to be social leaders, investing in digital skills and social connections and leading through networks as well as formal leadership systems 3. Align structure and agency 4. Find your B-listers and give them important tasks 5. Make space for collective sensemaking: build change platforms for important issues 6. Harness the power of advanced analytics 7. Adopt emergent approaches to planning and design, based on monitoring progress, learning and adapting as you go Ideas for