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The power of one: the power of many: what healthcare improvement can learn from social movements

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Slides from the presentation that Helen Bevan made at the International Forum on Quality and Safety in Healthcare, 24th August 2017. #Quality2017

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The power of one: the power of many: what healthcare improvement can learn from social movements

  1. 1. @HelenBevan #Quality2017 The power of one: the power of many What healthcare improvement can learn from social movements Dr Helen Bevan, OBE @HelenBevan @HorizonsNHS #Quality2017
  2. 2. @HelenBevan #Quality2017 The Horizons team: Change agents and change agency • A small, diverse team of people within the English National health Service that supports change agents and builds change agency • We tune into the latest change thinking and practice in healthcare and other industries around the world • The team has emerged through years of supporting change in the NHS and the wider health and care system
  3. 3. @HelenBevan #Quality2017 “When we talk of social change, we talk of movements, a word that suggest vast groups of people walking together, leaving behind one way and travelling towards another” Rebecca Solnit
  4. 4. @HelenBevan #Quality2017 What do successful social movements do? • Define the change they want to see • Identify the pillars of power • Create a spectrum of allies • Seek to attract not overpower • Build a plan to survive victory Source: Satell G (2017) How to create transformational change, according to the world’s most successful social movements
  5. 5. @HelenBevan #Quality2017 “We must act with all due alacrity [speed/swiftness], yet also with the thoughtfulness and seriousness of purpose appropriate to meaningful action” Dr Martin Luther King Jr.
  6. 6. @HelenBevan #Quality2017
  7. 7. @HelenBevan #Quality2017 If we want people to take action, we have to connect with their emotions through values action values emotion Source: Marshall Ganz
  8. 8. @HelenBevan #Quality2017 “I have some KPIs for you” or “I have a dream” Source: @RobertVarnam
  9. 9. @HelenBevan #Quality2017 Makin sure that only people who should be in hospital are in hospital • The number of hospital beds occupied by patients whose transfer of care has been delayed should be reduced to 3.5% • Less than 15% of assessments [for continuing care] should take place in an acute hospital setting; • a performance dashboard is being introduced
  10. 10. @HelenBevan #Quality2017
  11. 11. @HelenBevan #Quality2017
  12. 12. @HelenBevan #Quality2017 Royal Devon and Exeter Hospital
  13. 13. @HelenBevan #Quality2017 East Sussex Healthcare
  14. 14. @HelenBevan #Quality2017 “Because we want to, not because we have to”
  15. 15. Starts on the fringe (at the edge) Starts with the activists Gary Hamel always
  16. 16. 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 Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge”
  17. 17. @HelenBevan #Quality2017 Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on Increasing number of messages as information cascade through the organisation Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail- don.aspx
  18. 18. @HelenBevan #Quality2017 Identify the pillars of power
  19. 19. @HelenBevan #Quality2017 We still organise health and care like the Tabulating Machine Co. of 1917 Source of image: @corp_rebels
  20. 20. @HelenBevan #Quality2017 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
  21. 21. @HelenBevan #Quality2017 Create a spectrum of allies Source of image: Greg Satell
  22. 22. @HelenBevan #Quality2017 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
  23. 23. @HelenBevan #Quality2017 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
  24. 24. @HelenBevan #Quality2017 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
  25. 25. @HelenBevan #Quality2017 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
  26. 26. @HelenBevan #Quality2017 Mark Jaben on the science behind resistance What NOT to do But what we do do Engage people here
  27. 27. @HelenBevan #Quality2017 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
  28. 28. @HelenBevan #improvedischarge Seek to attract not overpower
  29. 29. @HelenBevan #Quality2017 To enable change, connect with the 3% Just 3% of people in the organisation or system typically drive conversations with 85% of the other people Source: research by Innovisor
  30. 30. @HelenBevan #Quality2017 • Did we accomplish the goal we were trying to accomplish? • Did our community grow stronger? (create capacity; new power – power we didn’t have before) • Did individuals involved in the whole effort learn, grow and develop their capacity to organise with others? How would we know if our digital transformation efforts were successful from a social movement perspective?
  31. 31. 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
  32. 32. @HelenBevan #Quality2017 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
  33. 33. @HelenBevan #improvedischarge “If we take care of the relationships, the results will follow” Chip Bell Bridge building leaders

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