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Shaking up the world of healthcare improvement

  1. @HelenBevan #hsemasterclass
  2. @HelenBevan #hsemasterclass This talk is bought to you by the Horizons team We tune into and engage with the best change thinking and practice in healthcare and other industries around the world and seek to translate this learning into practical approaches to change The team has emerged through years of supporting change in the NHS and wider health and care system A small team of people within the English NHS who support improvement and change
  3. @HelenBevan #hsemasterclass Change is changing
  4. @HelenBevan #hsemasterclass After World War 2, it took Japanese companies three decades to seize leadership roles in car making and electronics from their global competitors Source: P Choudray
  5. @HelenBevan #hsemasterclass In contrast, Uber, a little over five years old, competes around the world Source: P Choudray
  6. @HelenBevan #hsemasterclass Kinthi Sturtevant, IBM 13th annual Change Management Conference June 2015 We rarely see two, three or four year change projects anymore. Now it’s 30-60-90 day change projects
  7. @HelenBevan #hsemasterclass Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
  8. @HelenBevan #hsemasterclass Change is changing
  9. @HelenBevan #hsemasterclass Change is changing
  10. @HelenBevan #hsemasterclass “In a connected world, power no longer emanates from the top of the heap, but the centre of the network.” Greg Satell, 2015 Greg Satell: corporations-to-platforms/
  11. @HelenBevan #hsemasterclass Change is changing
  12. @HelenBevan #hsemasterclass Change is changing Change from the edge
  13. @HelenBevan #hsemasterclass share-introduction-final
  14. @HelenBevan #hsemasterclass Why go to the edge? “ Leading from the edge brings us into contact with a far wider range of relationships, and in turn, this increases our potential for diversity in terms of thought, experience and background. Diversity leads to more disruptive thinking, faster change and better outcomes Aylet Baron
  15. @HelenBevan #hsemasterclass Jeremy Heimens TED talk “What new power looks like” old power new power Currency Held by a few Pushed down Commanded Closed Transaction Current Made by many Pulled in Shared Open Relationship
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  17. @HelenBevan #hsemasterclass The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy
  18. @HelenBevan #hsemasterclass People who are highly connected have twice as much power to influence change as people with hierarchical power Leandro Herrero
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  21. @HelenBevan #hsemasterclass How does the NHS improvement community prefer to communicate?
  22. @HelenBevan #hsemasterclass Is your change process a cathedral or a bazaar?
  23. @HelenBevan #hsemasterclass We have a lot of cathedrals Source: Sewell (2015) : Stop training our project managers to be process junkies
  24. @HelenBevan #hsemasterclass The power of the platform “Facebook, YouTube, Twitter and their lesser cousins have proved the power of the platform. They have shown that if your average 21st century citizen is given the tools to connect and the freedom to create, they will do so with enthusiasm, and often with an originality that blindsides the so-called creative industries. ….. Good leadership is no longer about ‘taking charge’ or imposing a strategic vision but about creating the platforms that allow others to flourish and create” Ashoka the-21st-century
  25. @HelenBevan #hsemasterclass • 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”
  26. @HelenBevan #hsemasterclass Why platforms? 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
  27. @HelenBevan #hsemasterclass Evolving kinds of change platforms: They overlap! 1. Connecting platforms 2. Mobilising platforms 3. Learning platforms 4. Knowledge platforms 5. Crowdsourcing platforms
  28. @HelenBevan #hsemasterclass Platform principles have long been part of change practice • Building on traditions in the field of organisation development of communities of interest and communities of practice • Technology enables us to connect more widely and at greater speed Source of image:
  29. @HelenBevan #hsemasterclass Example platforms Source of image: @JenniferClemo
  30. @HelenBevan #hsemasterclass MOODOCs (Massive, Online, Open, Disease Oriented Communities)
  31. @HelenBevan #hsemasterclass The Academy of NHS Fabulous Stuff • Half a million page views • Over 700 fab shares • 1,500 to 4,000 page views a day • Nottingham Safe staffing app: 2,500 views • Dovetailing vaccinations Scheme: 160 direct queries
  32. @HelenBevan #hsemasterclass
  33. @HelenBevan #hsemasterclass A platform for system-wide transformation Leeds Teaching Hospitals NHS Trust & Clever Together WayFinder – a Crowdsourcing methodology and platform • Step 1: 4,500 staff and stakeholders shared 45,000 contributions to • co-create The Leeds Way – a redefinition of their vision and their values • co-design a five year strategy – a shared agreement of what needs to happen to achieve their vision • co-define a new behavioural framework – a new agreement of the acceptable ways in which staff will live their values embedded into recruitment, induction, training and appraisals • Step 2: WayFinder local – every department trained to use its own crowdsourcing platform • 19 clinical service units trained • A new way of working – online workshops – to ensure staff always have a say in what’s happening in the Trust, bringing people together to co-create solutions. Examples of results: • Staff satisfaction is up / buy-in to vision and values at an all time high / complaints down 17% / 18weeks RTT down by 66% / CQC acknowledgement of staff engagement and impact on quality and safety
  34. @HelenBevan #hsemasterclass Knowledge platforms
  35. @HelenBevan #hsemasterclass Because there’s a problem…. Source of quote: Harold Jarche Source of image: Getting information off the internet is like taking a drink from a fire hydrant Mitchell Kapor
  36. @HelenBevan #hsemasterclass
  37. @HelenBevan #hsemasterclass What is the best way to spread new knowledge? Source of data: Nick Milton /why-knowledge-transfer- through.html Social connection/discussion is 14 times more effective than written word/best practice databases/toolkits etc. Source of image:
  38. @HelenBevan #hsemasterclass Platforms as the new documentation Source of image: Flickr user acaben
  39. @HelenBevan #hsemasterclass Source: Oliver Benson If you’re a programmer, you don’t even bother reading the manual, you simply use stackoverflow to answer all your questions”
  40. @HelenBevan #hsemasterclass
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  42. @HelenBevan #hsemasterclass Source: @NHSChangeDay
  43. @HelenBevan #hsemasterclass 8,000
  44. @HelenBevan #hsemasterclass Source:
  45. @HelenBevan #hsemasterclass 1. Being a health and care radical: change starts with me 2. Forming communities: building alliances for change 3. Rolling with resistance 4. Making change happen 5. Moving beyond the edge
  46. @HelenBevan #hsemasterclass The School is being formally evaluated by the Chartered Institute for Personnel & Development /how-has-the-school-for-health- and-care-radicals-made-a- difference/ How has the School for Health and Care Radicals made a difference?
  47. @HelenBevan #hsemasterclass The School is being formally evaluated by the Chartered Institute for Personnel & Development • Change knowledge • Sense of purpose & motivation to improve practice • Ability to challenge the status quo • Rocking the boat & staying in it • Connecting with others to build support for change Statistically significant positive effect on EVERY dimension of impact at both individual and organisational level
  48. @HelenBevan #hsemasterclass Nearly 100,000 connections (defined as a viewing, a download of material or an original tweet) • Latest no-cost solutions • 150 speakers • 28 topics • Live broadcast and on-demand
  49. @HelenBevan #hsemasterclass NHS Transformathon: the maker movement
  50. @HelenBevan #hsemasterclass Should we undertake routine radiology investigations overnight for all our inpatients? How to build a change platform in an hour
  51. @HelenBevan #hsemasterclass • Platform established and presented to global audience in less than three days • 60 minute sprint followed by a two week window for further ideas and discussion • 3,000+ connections • good level of support for a 24/7 service for inpatients • consensus that the decision to receive a scan during unsocial hours was patient led • yet many participants commented that it should be a joint decision between clinician and patient • Panel at Nottingham University Hospitals is reviewing findings, ideas and agreeing next steps for implementation Help create a change platform in an hour Rather than a consultation exercise that can take weeks, we set up a crowdsourcing platform to get an answer in an hour
  52. @HelenBevan #hsemasterclass Activists from 120 countries 21,000 active users Used by 5,000 people each month
  53. @HelenBevan #hsemasterclass The Change Challenge Tapping the collective brilliance of the NHS
  54. @HelenBevan #hsemasterclass 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
  55. @HelenBevan #hsemasterclass 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
  56. @HelenBevan #hsemasterclass Project Aristotle: analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/ After years of intensive analysis, Google discovers that the key to high performing, innovative teams is psychological safety
  57. @HelenBevan #hsemasterclass Some lessons 1. You can’t control the outputs of the crowd 2. People want a relationship 3. Always, always, follow up
  58. @HelenBevan #hsemasterclass The Natural Environment Research Council asked the crowd to name its new £200 million polar research vessel
  59. @HelenBevan #hsemasterclass TEN TIMES as many votes as the next most popular answer
  60. @HelenBevan #hsemasterclass
  61. @HelenBevan #hsemasterclass ”If people give to a cause, they expect a relationship, not a transaction” Nilofer Merchant Once you start down this path, you have to follow up and continue
  62. @HelenBevan #hsemasterclass Three ways to connect! 1. Follow us on Twitter @HelenBevan @TheEdgeNHS @School4Radicals 2. Subscribe to 3. Get materials from …and sign up for our monthly #EdgeTalks
  63. @HelenBevan #hsemasterclass Ashoka (2014) What does leadership mean in the 21st century? Berg O (2014) The Collaboration Pyramid revisited Bevan H (2015) From change programmes to platforms Briggs D (2015) The elements of council as a platform Bromford P (2015) What’s the difference between a test and a pilot? Chesbrough H et al (2016) Why does open innovation work? Choudray P (2015) The platform manifesto: 16 principles for digital transformation Dawson R (2015) The future of work and organisations Deloitte University Press (2014) A movement in the making Deloitte University Press (2015) Business ecosystems come of age Hagel J (2015) The power of platforms Hagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movements Hagel J (2014) Platforms are not created equal: harnessing the full potential of platforms Hamel G, Zanini J (2014) Build a change platform not a change program Health Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’ interactive toolkit Heimans J (2014) What new power looks like [YouTube] References cited in the slide deck (1/2)
  64. @HelenBevan #hsemasterclass Heimens J, Timms J (2014) Understanding “New Power” Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers Little J (2016) Change management is dead Milton N (2014) Why knowledge transfer through discussion is 14 times more effective than writing O’Reilly T (2010) Government as a platform Pearce D (2013) Social business discussions are the new documentation Raymond E S (2001) The Cathedral and the Bazaar Satell G (2015) 4 things you should know about platforms Satell G (2012) How power is shifting from corporations to platforms Satell G (2015) Leaders must do more than inspire – we must shape networks Schillinger C (2015) Forget social networks, think social impact [YouTube] Scrivens J (2015) Enabling the experience of wholeness within enterprise social networks Sewell S (2015) Stop training our project managers to be process junkies Shaw K (2015) Placing a digital platform at the heart of organisational change with Oxfam Simon P (2011) The Age of the Platform Van Alstyne et al (2016) Pipelines, platforms, and the new rules of strategy References cited in the slide deck (2/2)