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SHCR 2015 module 4

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These are the slides from Module 4: Making change happen
This module brings together themes from earlier modules and examines ways of bringing your aspirations for change to fruition. We will look at the NHS Change model and the energy model and consider the importance of balancing different types of energy and recognising the need for both extrinsic and intrinsic motivation.

Agenda:
Why change efforts often fail to achieve their objectives
What happens to large-scale change efforts in reality?
Leaders and their role as ‘signal generators’
10 key principles of large-scale change
Intrinsic vs extrinsic motivation and drivers
What is the NHS Change Model and how does it align with the above?
How can you build both intrinsic and extrinsic motivators of change into your efforts?
How can you managed the tension between the two?
Building energy for change
What is energy for change?
What are the five energies?
Characteristics of the high and low end of the energies
What is an energy for change profile?
Creating shared purpose
What is our approach to change?
What is the value of a shared purpose?
How to avoid de facto purpose?
Questions and call to action

Questions for reflection:
How can I make the most of both intrinsic and extrinsic aspects of change?
How can I build energy for change for the long haul?
How can I ensure shared purpose throughout my change process?
What can I do tomorrow to accelerate change?

Call to action:
Reflect on how you can use both intrinsic and extrinsic motivators in your practice as a leader or agent of change.
Seek to ignite energy for change in everyone involved in your project.
Build commitment to shared purpose in all your change efforts.

Published in: Healthcare

SHCR 2015 module 4

  1. 1. #SHCR @School4Radicals http://www.theedge.nhsiq.nhs.uk/school/ Module 4: Making change happen Supported by
  2. 2. #SHCR @School4Radicals Joining in today and beyond  Please use the chat box to contribute continuously during the web seminar  Please tweet using hashtag #SHCR and the handle @School4Radicals  Join our Facebook group School for Health and Care Radicals  We will produce summaries of the discussions on each module using Storify and Pinterest and put on the website  Join in the Tweetchat each Wednesday at 4-5pm (GMT) using the hashtag #SHCR
  3. 3. #SHCR @School4Radicals The team today Session lead: Helen Bevan @HelenBevan Learning lead: Pip Hardy @PilgrimPip Icebreaker and chat monitor: Dominic Cushman @domcushnan Case study: Jenny Clarke @JennytheM Twitter monitor: Kate Pound @kateslater2
  4. 4. #SHCR @School4Radicals  Why change efforts often fail to achieve their objectives  Leading large scale change  The Change Model: aligning intrinsic and extrinsic motivators for change  Discussion on intrinsic/extrinsic motivators  Building energy for change  Creating shared purpose  Discussion and reflection Source of image: www.freshnessmag.com for today
  5. 5. #SHCR @School4Radicals Harvard researchers put a gorilla image on this lung scan
  6. 6. #SHCR @School4Radicals Harvard researchers put a gorilla image on this lung scan
  7. 7. #SHCR @School4Radicals What proportion of the radiologists who reviewed this scan actually saw the gorilla? 90% 25% 17% 80% 9% 60%
  8. 8. #SHCR @School4Radicals What proportion of the radiologists who reviewed this scan actually saw the gorilla? 90% 25% 17% 80% 9% 60% http://www.npr.org/blogs/health/2013/02/11/171409656/why- even-radiologists-can-miss-a-gorilla-hiding-in-plain-sight
  9. 9. #SHCR @School4Radicals Source of image: Whatsthebigideascwartzy.blogspot.com
  10. 10. #SHCR @School4Radicals Icebreaker: Making change happen  Which of these are you most interested in finding out about today?
  11. 11. #SHCR @School4Radicals 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. #SHCR @School4Radicals Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey 70% 25% 5% Delivers and sustains the change Most change programmes fail to deliver their objectives
  13. 13. #SHCR @School4Radicals Image from: @TheWorldStories
  14. 14. #SHCR @School4Radicals Image from: @TheWorldStories
  15. 15. #SHCR @School4Radicals ‘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
  16. 16. #SHCR @School4Radicals 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 Source: Leading Large Scale Change: a practical guide (2011), NHS Institute
  17. 17. #SHCR @School4Radicals As leaders, we are “signal generators” “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 Source of image: vintage-radio.com
  18. 18. #SHCR @School4Radicals 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
  19. 19. #SHCR @School4Radicals 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 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/
  20. 20. #SHCR @School4Radicals “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
  21. 21. #SHCR @School4Radicals Ten key principles of large scale change 1. Movement towards a new vision that is better and fundamentally different from the status quo 2. Identification and communication of key themes that people can relate to and that will make a big difference 3. Multiples of things (‘lots of lots’) 4. Framing the issues in ways that engage and mobilise the imagination, energy and will of a large number of diverse stakeholders in order to create a shift in the balance of power and distribute the leadership 5. Mutually reinforcing change across multiple processes/subsystems http://www.slideshare.net/NHSIQ/leading-large-scale-change-part-1
  22. 22. #SHCR @School4Radicals 6. Continually refreshing the story and attracting new, active supporters 7. Emergent planning and design, based on monitoring progress and adapting as you go 8. Many people contribute to the leadership of change, beyond organisational boundaries 9. Transforming mindsets, leading to inherently sustainable change 10. Maintaining and refreshing the leaders’ energy over the long haul Ten key principles of large scale change http://www.slideshare.net/NHSIQ/leading-large-scale-change- part-1
  23. 23. #SHCR @School4Radicals Intrinsic motivation People engage in the activity for the pleasure and satisfaction of doing it Invokes many positive behaviours Extrinsic motivation People engage in the activity for the rewards or avoiding punishment Any external influence is referred to as extrinsic motivation Images: pixgood.com
  24. 24. #SHCR @School4Radicals Intrinsic motivators build energy and creativity
  25. 25. #SHCR @School4Radicals Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity
  26. 26. #SHCR @School4Radicals 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
  27. 27. #SHCR @School4Radicals 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
  28. 28. #SHCR @School4Radicals 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
  29. 29. #SHCR @School4Radicals An example “Leaders and managers tasked with applying integrated care ‘at scale and pace’ might … focus on driving forward the organisational solution or introduce various financial inducements in the hope this will be more effective [than starting with values-based shared purpose]. Such an approach would be a mistake… A values-driven approach should be a pre-requisite to the successful adoption of integrated care.” Goodwin, Nick. “Taking Integrated Care Forward: The Need for Shared Values.” International Journal of Integrated Care 13, no. 2 (June 24, 2013).
  30. 30. #SHCR @School4Radicals Transformation is not a matter of intent......... it is a matter of alignment Peter Fuda
  31. 31. #SHCR @School4Radicals The Change Model www.changemodel.nhs.uk
  32. 32. #SHCR @School4Radicals Which components appeal to you and why?
  33. 33. #SHCR @School4Radicals 0 1 2 3 4 5 6 7 8 9 10 Our shared purpose Spread of innovation Improvement methodology Rigorous delivery Transparent measurement System drivers Engagement to mobilise Leadership for change What's our prognosis for this asthma pathway project?
  34. 34. #SHCR @School4Radicals The Change Model www.changemodel.nhs.uk
  35. 35. #SHCR @School4Radicals You get the best effort from others not by lighting a fire beneath them, but by building a fire within Bob Nelson
  36. 36. #SHCR @School4Radicals “Take your passion and make it happen.” Source of image: www.zeelandtheaters.nl
  37. 37. #SHCR @School4Radicals Discussion Reflecting on your change process:  how have you built both intrinsic and extrinsic motivators of change into your efforts?  How have you managed the tension between the two?  Any advice for other change agents on how to align intrinsic and extrinsic motivators?
  38. 38. #SHCR @School4Radicals 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 Source: Leading Large Scale Change: a practical guide (2011), NHS Institute
  39. 39. #SHCR @School4Radicals ‘Research shows that more than almost any other factor affecting an organisation, organisational energy can lead to either a wellspring of corporate vitality or the destruction of its very core.’ Source: Bruch and Vogel
  40. 40. #SHCR @School4Radicals Bruch and Vogel research Organisations with HIGH productive energy scored higher on:  overall performance - 14% higher  productivity – 17%  efficiency – 14%  customer satisfaction – 6%  customer loyalty – 12%
  41. 41. #SHCR @School4Radicals
  42. 42. #SHCR @School4Radicals the capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals Psychological Physical Spiritual Social Intellectual Energy for change is:
  43. 43. #SHCR @School4Radicals Five energies for change Energy Definition Social 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” Spiritual energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It gives people the confidence to move towards a different future that is more compelling than the status quo Psychological energy of courage, resilience and feeling safe to do things differently. It involves feeling supported to make a change and trust in leadership and direction Physical energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen Intellectual energy of analysis, planning and thinking. It involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/ evidence
  44. 44. #SHCR @School4Radicals High and low ends of each energy domain Low High Social isolated solidarity Spiritual uncommitted higher purpose Psychological risky safe Physical fatigue vitality Intellectual Illogical reason
  45. 45. #SHCR @School4Radicals Some questions  Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)  Nearer to CEO, higher or lower energy scores?
  46. 46. @helenbevan@helenbevan #Quality2013 • Are particular energy domains more dominant than others for our team at the moment? • Is this the optimal energy profile to help us achieve our improvement goals? Energy for change profile 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual
  47. 47. #SHCR @School4Radicals 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 1: what’s your assessment of their energy for change?
  48. 48. #SHCR @School4Radicals 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 1: what’s your assessment of their energy for change? This energy profile is characterised by an environment that has harnessed people’s interest and momentum for change, but which has failed to engage people fully. This imbalance results in their feeling some uncertainty regarding how they can contribute fully to the change, and therefore a sense of risk and lack of hope for the future. We can build energy by building team solidarity and developing shared purpose
  49. 49. #SHCR @School4Radicals 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 2: what’s your assessment of their energy for change?
  50. 50. #SHCR @School4Radicals 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 2: what’s your assessment of their energy for change? This energy profile shows strong connections between people, a true sense of solidarity, which gives them enough hope for the future, but this energy is undirected, because the rational argument and shared purpose has not been agreed. We can build energy by agreeing shared goals for change and using systematic approaches to thinking through and planning the change
  51. 51. #SHCR @School4Radicals There has never been a time in the history of healthcare when this advice has been more pertinent “Leadership is not about making clever decisions and doing bigger deals. It is about helping release the positive energy that exists naturally within people.” Henry Mintzberg
  52. 52. #SHCR @School4Radicals
  53. 53. #SHCR @School4Radicals Source: Helen Bevan Compliance States a minimum performance standard that everyone must achieve Uses hierarchy, systems and standard procedures for co- ordination and control Threat of penalties/ sanctions/ shame creates momentum for delivery What is our approach to change? Commitment States a collective goal that everyone can aspire to Based on shared goals, values and sense of purpose for co- ordination and control Commitment to a common purpose creates energy for delivery
  54. 54. #SHCR @School4Radicals Shared purpose aligns..... Shared purpose allows many communities to engage with us without us having to invest resources in controlling their actions Nilofer Merchant
  55. 55. #SHCR @School4Radicals We know that ...  Shared purpose is a common thread in successful change programmes*  Organisations and change initiatives with strong shared purpose consistently outperform those without it.** *What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute) **Management Agenda 2013 Boury et al (Roffey Park Institute)
  56. 56. #SHCR @School4Radicals A 3-word concept
  57. 57. #SHCR @School4Radicals [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
  58. 58. #SHCR @School4Radicals “Matching Michigan” is a wonderful example of the power of shared purpose Perhaps the single most important influence on program response by individual units—either in promoting or resisting change—was the extent of consensus and coalition among the senior medical and nursing staff on individual ICUs…. Transforming or boosting of efforts was most likely to occur when those locally charged with implementation were sincere in their beliefs about the value of the program, were able to create transdisciplinary alliances, had local credibility among peers, were prepared to tolerate debate but exercise firmness, and used multiple tactics including role modelling, persuasion, sanctioning, reminders, and constant feedback…. [Consultant says] ‘I think it’s been successful because it’s a unifying program, it’s one of the few things that we’ve done that hasn’t been just a doctor thing, or just a nurse thing, it’s involved the doctors and the nurses together.’ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/
  59. 59. #SHCR @School4Radicals As leaders, we are “signal generators” “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 Source of image: vintage-radio.com
  60. 60. #SHCR @School4Radicals Avoiding “de facto” purpose  What leaders pay attention to matters to staff, and consequently staff pay attention to that too  Shared purpose can easily be displaced by a “de facto” purpose:  hitting a target  reducing costs  reducing length of stay  eliminating waste  completing activities within a timescale  complying with an inspection regime  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 Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector
  61. 61. #SHCR @School4Radicals @SimonJGuilfoyle Police Inspector and systems thinker
  62. 62. #SHCR @School4Radicals @SimonJGuilfoyle Police Inspector and systems thinker
  63. 63. #SHCR @School4Radicals Police @SimonJGuilfoyle Police Inspector and systems thinker
  64. 64. #SHCR @School4Radicals Education @SimonJGuilfoyle Police Inspector and systems thinker
  65. 65. #SHCR @School4Radicals Healthcare @SimonJGuilfoyle Police Inspector and systems thinker
  66. 66. #SHCR @School4Radicals “....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
  67. 67. #SHCR @School4Radicals Case study: Skin to skin Jenny Clarke
  68. 68. #SHCR @School4Radicals Case study: Skin to skin Jenny Clarke
  69. 69. #SHCR @School4Radicals Case study: Skin to skin Jenny Clarke
  70. 70. #SHCR @School4Radicals Discussion What is your experience as a change agent of:  Building energy for change?  Creating shared purpose?
  71. 71. #SHCR @School4Radicals  Wednesday 25th February 16:00-17:00 Tweet chat #SHCRchat  Next Friday morning 27th February module 4: Moving beyond the edge  You can start the process of applying to become a “certificated change agent” Next opportunities for learning
  72. 72. #SHCR @School4Radicals The certification process Take some actions to demonstrate your learning from the school and become a “certificated change agent”. If you complete the learning process you will: • be recognised as a “certificated change agent” by the school and NHS Improving Quality • be awarded a virtual badge that you can used on your email signature, personal website, etc. • be invited to take part in one of our virtual graduation ceremonies • receive a certificate.
  73. 73. #SHCR @School4Radicals Call to action  Reflect on how you can use both intrinsic and extrinsic motivators in your practice as a leader or agent of change.  Seek to ignite energy for change in everyone involved in your project.  Build commitment to shared purpose in all your change efforts.
  74. 74. #SHCR @School4Radicals Questions for reflection 1. How can I make the most of both intrinsic and extrinsic aspects of change? 2. How can I build energy for the long haul? 3. How can I ensure shared purpose throughout the change process? 4. What can I do tomorrow to accelerate change?

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