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Moving to action:
new era thinking on spreading
and scaling change
04/09/19
#nhsspread @ExpoNHS #Expo19NHS
#nhsspread @ExpoNHS #Expo19NHS
Claire Roche
@claireroche19
Diane Ketley
@dianeketley
Ian Baines
@ihbaines
Helen Bevan
@helenbevan
What to expect in the next 60 minutes
• Polls via Slido
• 7 principles to increase spread and scale
• The 7 principles in practice
• Co-coaching
• Model of system convening
• System convening in practice
A poll
Do you know :
• The person to the right of you?
• The person to the left of you?
• The people on both sides?
• Neither of them?
Slido.com
A poll
To what extent is spreading change a
challenge in your role?
A very big
challenge
Not a
challenge
Slido.com
Question: describe your most
recent attempts to spread
change in a single phrase
The reality of spread
#nhsspread @ExpoNHS #Expo19NHS
“Isolated islands of
improvement effect”
(lack of spread)
Spread is a…
…dynamic, reciprocal
interacting, iterative and
evolving activity...not linear
and mechanistic
…developmental,
contextualised, adaptive,
learning and social process
#nhsspread @ExpoNHS #Expo19NHS
What is complexity?
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Complexity
7 interconnected principles
Complexity
Spread in health and care is a complex
activity occurring across a system
• Complexity around innovation, process,
context
• NHS is a complex adaptive system
• Match complexity of the approach to spread
with complexity of the situation
#nhsspread @ExpoNHS #Expo19NHS
Adaptive space an interface between innovations
and the business ‘as usual’
Source: Mary Uhl-Bien
Networks/information flows
7 interconnected principles
Complexity
Innovation development and spread are
interdependent
• How an innovation is developed influences
spread
• Early involvement increases commitment and
ownership
• Increased focus on role of adopters in
adaptation and spread
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Innovation Development
Focus on the value rather than the
innovation
• It’s about what others will value rather than
what you want to spread
• What problem of local priority will it solve?
• What benefit will it offer?
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Value
The perspective of the individual is pivotal
• Changing behaviours is hard
• The more work routines affected the greater
the spread challenge
• Generate energy for change and agency by
building motivation
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
The Individual
From an
inward to
an outward
mindset
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Leadership
Networks build communities, energising and
connecting individuals
• Create a “pull” for innovation by building communities
to energise individuals and maintain momentum
• Support networks and encourage connections with
other networks
• Support use of network building mechanisms; eg
platforms like WhatsApp, Slack, Facebook groups and
other social media
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Networks
Knowledge flows generate learning to
enable spread
• Collate and share local feedback and
evaluation of innovation adoption and impact
• Share knowledge through networks
• Build a culture of learning and transparency,
sharing and seeking knowledge from others
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Learning
Select three principles that resonate for you?
Complexity
Innovation Development
Value
The Individual
Leadership
Networks
Learning
Tweet your story of any of these principles at #nhsspread
#nhsspread @ExpoNHS #Expo19NHS
Applying 7 principles in practice
at the Welsh Ambulance Trust
Claire and Ian in conversation
#nhsspread @ExpoNHS #Expo19NHS
#nhsspread
@ExpoNHS
#Expo19NHS
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
#nhsspread @ExpoNHS #Expo19NHS
Please give Claire
one piece of advice
to inform the plans
for spreading the
WAST falls
framework across
Wales
#nhsspread @ExpoNHS #Expo19NHS
Table discussion
#nhsspread @ExpoNHS #Expo19NHS
Discuss your
thoughts on
what you have
heard about the
7 principles
• Matching approach to spread with
complexity of the situation
• Applying the seven principles in practice
• Providing enabling activities delivered by a
team or a number of people
• All levels in the system
#nhsspread @ExpoNHS #Expo19NHS
System Convening involves
An independent initiative An interdependent initiative
Improve needle
safety when taking
bloods
Improve
the emergency
response to people
in mental health
crisis
Police Voluntary
sector
Emergency
room
Mental
health
service
Supported by specific
tools & information
• Social and
collaborative
• Built on shared
purpose
• Multiple methods
Within a
clear
boundary
#nhsspread @ExpoNHS #Expo19NHS
System convening and
programme management
Interdependent
We need
both to
enable
spread
What system convening means
in practice
Claire and Ian in conversation
#nhsspread @ExpoNHS #Expo19NHS
#nhsspread @ExpoNHS #Expo19NHS
Discuss with the
person next to you
your thoughts on what
you have heard about
system convening
then share them on
Slido Interdependent
• Follow #nhsspread
• Horizons blogs https://nhshorizons.passle.net
• Spread publication early 2020
#nhsspread @ExpoNHS #Expo19NHS
Want to learn more about
this approach to spread?
Thank You
#nhsspread @HorizonsNHS
Diane.ketley@nhs.net
horizonsnhs.com

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Moving to Action: Spreading Change Across Complex Systems

  • 1. Moving to action: new era thinking on spreading and scaling change 04/09/19 #nhsspread @ExpoNHS #Expo19NHS
  • 2. #nhsspread @ExpoNHS #Expo19NHS Claire Roche @claireroche19 Diane Ketley @dianeketley Ian Baines @ihbaines Helen Bevan @helenbevan
  • 3. What to expect in the next 60 minutes • Polls via Slido • 7 principles to increase spread and scale • The 7 principles in practice • Co-coaching • Model of system convening • System convening in practice
  • 4. A poll Do you know : • The person to the right of you? • The person to the left of you? • The people on both sides? • Neither of them? Slido.com
  • 5. A poll To what extent is spreading change a challenge in your role? A very big challenge Not a challenge Slido.com
  • 6. Question: describe your most recent attempts to spread change in a single phrase
  • 7. The reality of spread #nhsspread @ExpoNHS #Expo19NHS “Isolated islands of improvement effect” (lack of spread)
  • 8. Spread is a… …dynamic, reciprocal interacting, iterative and evolving activity...not linear and mechanistic …developmental, contextualised, adaptive, learning and social process #nhsspread @ExpoNHS #Expo19NHS
  • 9. What is complexity? #nhsspread @ExpoNHS #Expo19NHS 7 interconnected principles Complexity
  • 10. 7 interconnected principles Complexity Spread in health and care is a complex activity occurring across a system • Complexity around innovation, process, context • NHS is a complex adaptive system • Match complexity of the approach to spread with complexity of the situation #nhsspread @ExpoNHS #Expo19NHS
  • 11. Adaptive space an interface between innovations and the business ‘as usual’ Source: Mary Uhl-Bien Networks/information flows 7 interconnected principles Complexity
  • 12. Innovation development and spread are interdependent • How an innovation is developed influences spread • Early involvement increases commitment and ownership • Increased focus on role of adopters in adaptation and spread #nhsspread @ExpoNHS #Expo19NHS 7 interconnected principles Innovation Development
  • 13. Focus on the value rather than the innovation • It’s about what others will value rather than what you want to spread • What problem of local priority will it solve? • What benefit will it offer? #nhsspread @ExpoNHS #Expo19NHS 7 interconnected principles Value
  • 14. The perspective of the individual is pivotal • Changing behaviours is hard • The more work routines affected the greater the spread challenge • Generate energy for change and agency by building motivation #nhsspread @ExpoNHS #Expo19NHS 7 interconnected principles The Individual
  • 15. From an inward to an outward mindset #nhsspread @ExpoNHS #Expo19NHS 7 interconnected principles Leadership
  • 16. Networks build communities, energising and connecting individuals • Create a “pull” for innovation by building communities to energise individuals and maintain momentum • Support networks and encourage connections with other networks • Support use of network building mechanisms; eg platforms like WhatsApp, Slack, Facebook groups and other social media #nhsspread @ExpoNHS #Expo19NHS 7 interconnected principles Networks
  • 17. Knowledge flows generate learning to enable spread • Collate and share local feedback and evaluation of innovation adoption and impact • Share knowledge through networks • Build a culture of learning and transparency, sharing and seeking knowledge from others #nhsspread @ExpoNHS #Expo19NHS 7 interconnected principles Learning
  • 18. Select three principles that resonate for you? Complexity Innovation Development Value The Individual Leadership Networks Learning Tweet your story of any of these principles at #nhsspread #nhsspread @ExpoNHS #Expo19NHS
  • 19. Applying 7 principles in practice at the Welsh Ambulance Trust Claire and Ian in conversation #nhsspread @ExpoNHS #Expo19NHS
  • 21. 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 #nhsspread @ExpoNHS #Expo19NHS
  • 22. Please give Claire one piece of advice to inform the plans for spreading the WAST falls framework across Wales #nhsspread @ExpoNHS #Expo19NHS
  • 23. Table discussion #nhsspread @ExpoNHS #Expo19NHS Discuss your thoughts on what you have heard about the 7 principles
  • 24. • Matching approach to spread with complexity of the situation • Applying the seven principles in practice • Providing enabling activities delivered by a team or a number of people • All levels in the system #nhsspread @ExpoNHS #Expo19NHS System Convening involves
  • 25. An independent initiative An interdependent initiative Improve needle safety when taking bloods Improve the emergency response to people in mental health crisis Police Voluntary sector Emergency room Mental health service Supported by specific tools & information • Social and collaborative • Built on shared purpose • Multiple methods Within a clear boundary
  • 26. #nhsspread @ExpoNHS #Expo19NHS System convening and programme management Interdependent We need both to enable spread
  • 27. What system convening means in practice Claire and Ian in conversation #nhsspread @ExpoNHS #Expo19NHS
  • 28. #nhsspread @ExpoNHS #Expo19NHS Discuss with the person next to you your thoughts on what you have heard about system convening then share them on Slido Interdependent
  • 29. • Follow #nhsspread • Horizons blogs https://nhshorizons.passle.net • Spread publication early 2020 #nhsspread @ExpoNHS #Expo19NHS Want to learn more about this approach to spread?