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School for Change Agents - Module 4 Slides

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This module will help us create and sustain the energy we need to make change happen. We will look at a number of practical ideas, tools and resources to help us change the way we do change. We’ll look at why change fails and how you can minimise the risk of it failing by creating a shared purpose and understanding the different energies needed to bring teams with you.
To find out more about the School, please visit the website http://theedge.nhsiq.nhs.uk/school/

Published in: Health & Medicine

School for Change Agents - Module 4 Slides

  1. 1. theedge.nhsiq.nhs.uk/school/ Module 4: Making Change Happen @Sch4Change #S4CA team Brought to you by the
  2. 2. The team today School Lead: Helen Bevan @HelenBevan Lead facilitator: Pip Hardy @PilgrimPip Technical Support Joanna Hemming @JoannaHemming Paul Woodley @PaulWoodley4 Olly Benson @OllyBenson Kate Pound @KateSlater2 Chat Room Monitors Kathryn Perera @Kathrynperera Twitter Monitors Louis Warner @LouisWHorizons Leigh Kendall @leighakendall
  3. 3. • Please use the chat box to contribute continuously during the talk • Please tweet using hashtag #S4CA and the handle @Sch4Change • Send a request to join our Facebook group School for Change Agents https://www.facebook.com/sch4change/ • We will produce summaries of each module discussion using Steller and put on the website Joining in today…and beyond
  4. 4. 16th February: Being a change agent: change begins with me 23rd February: From me to we: making connections and building communities 2nd March: Rolling with resistance 9th March: Making change happen 16th March: Moving beyond the edge Each week we’ll cover different change agent capabilities Source of image: thenounproject.com
  5. 5. Nurses, Midwives and Allied Health Professionals Use the school experience as part of your CPD reflective account for revalidation Doctors We have applied for CPD credits for the school Certification and Continuing Professional Development Everyone If you watch all five of the talks and demonstrate you have applied the learning, you can apply to become a certificated change agent (and it’s free).
  6. 6. • Email to join the RCT england.si- horizons@nhs.net • We will randomly match you with another participant in the School for Change Agents from anywhere in the world • At some time in the next four weeks, arrange to have a conversation over Skype (or other communication system) with a cup of coffee! Randomised Coffee Trials Image source: Pinterest
  7. 7. 7 To what extent did the last change initiative you were engaged with deliver all its objectives? 1 = delivered very little 10 = delivered all its objectives
  8. 8. • understanding why many change efforts fail to deliver their intended benefits • considering barriers and building blocks to change • recognising the need to align intrinsic and extrinsic motivators for change • building joy at work • appreciating energy for change • avoiding “de facto” purpose Change agent capabilities in module 4 Source of image: thenounproject.com
  9. 9. Source of image: Whatsthebigideascwartzy.blogspot.com Why is often quoted in the field of change leadership?
  10. 10. From Deloitte “Demystifying change management”
  11. 11. Most change programmes fail to deliver their objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey 70% 25% 5% Gets anywhere near achieving the change and delivering the benefits
  12. 12. Most change programmes fail to deliver their objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey 70% 25% 5% Delivers and sustains the change
  13. 13. Source: McKinsey Performance Transformation Survey Reasons for failure in large scale improvement programmes
  14. 14. Some authors question the 70% figure
  15. 15. Source: 2016 Chartered Institute of Management Quality of Working Life study Across the UK, poorly led change programmes are damaging morale and the performance of organisations
  16. 16. It is our contention that most change efforts are built upon the shaky foundation of five flawed assumptions; that change can be managed, that human beings are objective, that there are ‘X’ steps to change, that we have a neutral starting point for change, and that change, itself, is the goal Peter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda- bootstrap/content/Why-Change-Efforts-Fail.pdf Source of image: Whatsthebigideascwartzy.blogspot.com
  17. 17. The old power/new power framework has been a thread through every module so far: Jeremy Heimens, Henry Timms This is New Power
  18. 18. Economic resources diminish with use • money • materials • technology Natural resources grow with use • relationships • commitment • community Based on principles from Albert Hirschman and Marshall Ganz Let’s think about resources for change inold/new power terms
  19. 19. Source: How can asset mapping improve community health? An asset map from the Institute for Healthcare Improvement
  20. 20. Change is not the goal; the goal is the goal Peter Fuda Source of image: timemanagementninja.com
  21. 21. 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” March 2015
  22. 22. 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
  23. 23. 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 Buy in from front line staff is critical for improvements in quality and safety Don’t overload them http://healthaffairs.org/blog/2014/03/07/the- dangers-of-quality-improvement-overload-insights- from-the-field/
  24. 24. Poll: Which of these have been blocks for you in the last 12 months? 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” March 2015
  25. 25. 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 14,000 contributions identified 11 building blocks for change:
  26. 26. Poll: Which of these factors are present in your situation now? 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
  27. 27. How to make change happen • Make people feel something • Emphasise progress • Stop bribing • Start a cult (a group unified by a provocative idea) Source: How to motivate people: four steps backed by science
  28. 28. • Teresa Amabile, Harvard Business School: studied the "inner work life" diaries of 238 professionals • Best days were when they were able to move forward in their work • 700 managers were asked to rank five employee motivators, including recognition and incentives. They ranked progress last Emphasise progress Source: The Progress Principle: Using Small Wins to Ignite Joy, Engagement, and Creativity at Work
  29. 29. Rewards Mandated quality standards Incentive systems Pressure to perform Compliance Recognition Awards Source: adapted from commons.grd.msu.ed Competition Extrinsic versus intrinsic motivation
  30. 30. Tapping into intrinsic motivation is critical to ongoing, large scale change Emilia Wietrak External incentives and internal motivation – a perfect pairing to boost work performance! • Works best for straightforward, repetitive tasks • Build meaning and understanding of performance, tie extrinsic motivators closely to specific performance and reward teams • Works best for complex tasks that need personal investment, absorption and focus on quality • Increase intrinsic motivation by making people feel competent/self- efficacious (module1) and giving them more autonomy Internally motivated people who enjoy what they do RARELY perform poorly Joy at work /intrinsic motivation RARELY appear in isolation
  31. 31. Intrinsic motivators build energy and creativity
  32. 32. Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity
  33. 33. Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity create focus & momentum for delivery Drivers of extrinsic motivation
  34. 34. Drivers of extrinsic motivation create focus & momentum for delivery Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity •System drivers & incentives •Payment by results •Performance management •Measurement for accountability
  35. 35. Internal motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity Drivers of extrinsic motivation •System drivers & incentives •Performance management •Measurement for accountability create & focus momentum for delivery
  36. 36. The Change Model Source: The Change Model Zoe Lord
  37. 37. Priority area: Reducing inappropriate use of anti-psychotic drugs for people with Learning Disabilities in our inpatient unit What outcomes do we seek? Our Shared Purpose Is there a sense of shared purpose amongst our key stakeholders? The shared purpose is to improve the quality of life for people with learning disabilities by reducing the over reliance on antipsychotic drugs. Leadership by all Do all our leaders have the skills to create transformational change? Psychiatrists Lead commissioner Clinical Lead Managers Clinical staff Support staff /carers Therapies Patients, families, carers, advocates Motivate and Mobilise Are we engaging and mobilising all the right people? Patient , carer and family groups, related charities Medication group Psychiatrists Local improvement group Local patient advocate group Therapies staff Commissioners Spread and Adoption Are we designing for the active spread of innovation? Medicines Optimisation Toolkit Induction pack National campaigns How to Guides – benefits and practical application Project and performance Management Do we have an effective approach for delivery of change and monitoring of progress towards our planned objectives? Inclusion in all team meetings Risk & Issues Log System Drivers Are our processes, incentives and systems aligned to enable change? National Guidance National Publication Improvement tools Are we using an evidence-based quality improvement methodology? YES. Using the Trust’s quality improvement tools package Measurement Are we measuring the outcome of the change continuously and transparently? Baseline data re number on medication, medication used and why medication is being used. Regular data collection Regional and national data.
  38. 38. “The change model is a structure that helped the team to understand what we are all trying to achieve, where we needed to focus more of our attention and how to achieve it. It helped the team to work together. I encourage more teams to use the change model to achieve successful change.” Parent of James
  39. 39. Two kinds of people at work • Feel connected to a higher purpose • Controlled & coordinated through shared goals & values • Collaborate • Embrace change • Work to who they are The contributors The compliant • Feel disconnected from purpose • Controlled & coordinated through performance management & standardised procedures • Hold back • Resist change • Work to a role specification Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners- in-business-are-taking-the-time-to-build-a-positive-kind-social- culture/
  40. 40. Two kinds of people at work The compliant • Feel connected to a higher purpose • Controlled & coordinated through shared goals & values • Collaborate • Embrace change • Work to who they are The contributors Gallup global research: • Only 13% of the workforce are engaged (contributors) • Contributors create six times the value to an organisation compared to the compliant http://www.gallup.com/poll/165269/worldwide- employees-engaged-work.aspx
  41. 41. The 3rd curve of change
  42. 42. New Public Passion: a growing global movement
  43. 43. The capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals Energy for change http://www.institute.nhs.uk/tools/energ y_for_change/energy_for_change_.html
  44. 44. What happens to large scale change efforts in reality In order of frequency: 1. the effort effectively “runs out of energy” and simply fades away 2. the change hits a plateau at some level and no longer attracts new supporters 3. the change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way Why is energy for change important? Source: http://www.nhsiq.nhs.uk/8530.aspx
  45. 45. Typically, around any change effort, there is an initial spike of tangible energy, and change, but when leadership loses interest, the momentum of change slows down drastically.” Tara Paluck
  46. 46. Overall performance - 14% higher • productivity – 17% • efficiency – 14% • customer satisfaction – 6% • customer loyalty – 12% Teams and organisations with high energy score higher on every dimension of performance Source: Bruch and Vogel
  47. 47. Change is most likely to happen when five energies are high Psychologic al Physical Spiritual Social Intellectual Source: http://www.institute.nhs.uk/tools/ energy_for_change/energy_for_change_.html
  48. 48. Energy of personal engagement, relationships and connections between people It’s where people feel a sense of “us and us” rather than “us and them” Social energy
  49. 49. Energy of commitment to a common vision for the future, driven by shared values and a higher purpose Gives people the confidence to move towards a different future that is more compelling than the status quo Spiritual energy
  50. 50. Energy of courage, resilience and feeling safe to do things differently Involves feeling supported to make a change and trust in leadership and direction Psychological energy
  51. 51. Project Aristotle: http://qz.com/625870/after-years-of- intensive-analysis-google-discovers-the-key-to-good- teamwork-is-being-nice/ After years of intensive analysis, Google discovers that the key to high performing, teams that deliver change is psychological safety
  52. 52. Energy of action, getting things done and making progress The flexible, responsive drive to make things happen Physical energy
  53. 53. Intellectual energy Energy of analysis, planning and thinking Involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/ evidence
  54. 54. Social isolated solidarity Spiritual uncommitted higher purpose Psychological risky safe Physical fatigue vitality Intellectual Illogical reason High and low ends of each energy domain LOW HIGH
  55. 55. Which one of these energies do you think is disproportionately high (compared to the other energies) in senior leadership teams in health and care? 56 • Social • Spiritual • Psychological • Physical • Intellectual
  56. 56. • Intellectual energy on its own isn’t transformational • It keeps leaders in their comfort zone (intellect to intellect) The challenge of disproportionately high intellectual energy Emotion is the fuel for change; data and information provide direction Dan Heath (author of Switch)
  57. 57. • Which group likely to have higher spiritual energy scores: • clinicians • non clinicians • Nearer to CEO in the structure: higher or lower overall energy scores? Some more questions Source: Respondents to the energy for change questionnaire NHSIQ/Horizons team
  58. 58. Energy analysis of six large scale transformation plans
  59. 59. Energy analysis of six large scale transformation plans Source: energy for change discourse analysis of six STP plans by the Horizons team
  60. 60. Energy analysis of six large scale transformation plans Source: energy for change discourse analysis of six STP plans by the Horizons team
  61. 61. What happens when we don’t build a proportionate amount of social and spiritual energy in our change efforts?
  62. 62. “As a leader, think of yourself as a “signal generator” whose words and actions are constantly being scrutinised and interpreted, especially by those below you” [in the hierarchy]….. Signal generators reduce uncertainty and ambiguity about what is important and how to act” Charles O’Reilly, Leaders in Difficult Times As leaders and change agents, we are “signal generators” Source of image: vintage-radio.com What leaders pay attention to matters to staff, and consequently staff pay attention to that too
  63. 63. Avoiding “de facto” purpose • hitting a target • reducing costs • reducing length of stay • eliminating waste • completing activities within a timescale • complying with regulators Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector 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 PURPOSE The difference between having a purpose and a shared purpose is that shared purpose is owned everyone who has a stake in the change and improvement we are seeking to create SHARED PURPOSE
  64. 64. [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 We need to go beyond “buy-in”. We don’t need buyers, we need investors Mark Jaben We can build shared purpose through social and spiritual energy
  65. 65. ....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
  66. 66. • If you pre-registered with your Break out room number, you will be transferred there • If you haven’t registered with a room, we are offering a separate phone conference that you can join: 0800 917 1950 33136606# What happens next
  67. 67. • If you get stuck, ask for help here • Your facilitator will be in the room. They can be identified with the presenter ball next to them. • You can mute and unmute yourself using the Mute button We’ve occasionally seen instances where screenshare appears. We therefore strongly recommend you close other windows you have open on your computer. In the breakout room

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