Unleashing energy for change

@helenbevan #Quality2013
Unleashing energy
for change
Helen Bevan
@helenbevan
@NHSIQ
#Quality2013

@helenbevan@helenbevan #Quality2013@helenbevan #Quality2013
Most large scale change fails to
achieve its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey

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

© NHS Institute for Innovation and Improvement, 2011@helenbevan #Quality2013
Anatomy of change Physiology of change
Definition The shape and processes of
the system; detailed analysis;
how the components fit
together.
The vitality and life-giving forces that
enable the system and its people to
develop, grow and change.
Focus
Processes and structures
to deliver health and
healthcare
Energy/fuel for change
Leadership
activities
• measurement and
evidence
• improving clinical systems
• reducing waste and
variation in healthcare
processes
• redesigning pathways
• creating a higher purpose and
deeper meaning for the change
process
• building commitment to change
• connecting with values
• creating hope and optimism about
the future
• calling to action
Source: Crump and Bevan

Definition The shape and processes
of the system; detailed
analysis; how the
components fit together
Focus Processes and structures
to deliver health /healthcare
Leadership
activities
• measurement and
evidence
• improving clinical
systems
processes

Definition The shape and processes
of the system; detailed
analysis; how the
components fit together
The vitality and life-giving forces
that enable the system and its
people to develop, grow and
change
Focus Processes and structures
to deliver health /healthcare
Energy as a fuel for change
Leadership
activities
• measurement and
evidence
• improving clinical
systems
processes
• creating a higher purpose and
deeper meaning for the change
process
• building commitment to change
• connecting with values
• creating hope and optimism
about the future
• calling to action
Source: Crump and Bevan

Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising
and calling to action
•motivational leadership
build energy and
creativity

Intrinsic
motivators
•connecting to
shared purpose
build energy and
creativity create focus
&
momentum
for delivery
Drivers
of extrinsic
motivation

Drivers
of extrinsic
motivation
create focus
&
momentum
for delivery
Intrinsic
motivators
•connecting to
shared purpose
build energy and
creativity
•System drivers &
incentives
•Payment by results
•Performance
management
•Measurement for
accountability

Internal
motivators
•connecting to
shared purpose
•motivational
leadership
build energy and
creativity
Drivers of
extrinsic
motivation
•System drivers &
incentives
•Performance
management
•Measurement for
accountability
create & focus
momentum for
delivery

Transformation is not a matter of
intent.........
it is a matter of alignment
Peter Fuda

@helenbevan
NHS Change Model
www.changemodel.nhs.uk

@helenbevan@helenbevan #Quality2013
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?

Does fear motivate people
to change?

burning platform
versus
burning ambition
@PeterFuda

Show Peter Fuda film here

Lessons for transformational change
1. In order to sustain
transformational change we need
to move from a burning platform
(fear based urgency) to a burning
ambition (shared purpose for a
better future)
2. We need to articulate personal
reasons for change as well as
organisational reasons
3. If the fire (the compelling reason)
goes out, all other factors are
redundant
@PeterFuda

Task
Talk to the person next to you
• What is “my burning ambition” for my service,
my community and /or my patients?
• Try to make it personal: tell others why this
ambition connects with your personal
motivations

You get the best efforts from
others not by lighting a fire
beneath them but by building
Source: Bob Nelson

Show “energy for change” film
here

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:

The five energies for change

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

The SSPPI Energy Index – Part I
This questionnaire enables teams to measure their energy for change.
Please agree the nature of the change context with your team before answering the following statements.
Then answer all statements with your particular change context in mind.
1 = Strongly disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree
I am energised by the momentum of change____
I have gained insight into the case for change____
I feel a sense of solidarity with those I work with ____
I am weary of change____
I am able to keep expressing hope for the change when presented with setbacks_____
The reasoning for the change is not compelling___
I don’t feel appreciated by others at work_____
I will be blamed if I try something new and it fails____
I feel isolated from others____
I feel depleted of energy when others express doubt about the change_____
The case for change has stimulated my creativity_____
I feel disconnected from others____
I am committed to our common vision for the future____
I feel safe enough to do things differently____
I am driven by shared values____
I am experiencing change fatigue____
The change does not fit with my sense of purpose_____
I am not driven by a shared purpose for change_____
I think there is no rational argument for change____
The case for change is interesting to me_____
I feel that we are getting things done to achieve the change_____
I feel the change may conflict with my values___
I feel personally engaged in the change___
Clear thinking and analysis underpins the change___
I feel fearful about the change___
I sense openness about the potential to change___

@helenbevan
Social energy is the energy of personal engagement, relationships and
connections between people. It reflects a “sense of us” and is
therefore a collective concept that captures a situation where
people are drawn into an improvement or change because they feel
a connection to it as part of the collective group.
My social energy is ____
The social energy of those I work with is____
The importance of social energy to me is____
Psychological energy is the energy of courage, trust and feeling safe
to do things differently. It involves feeling supported to make a
change as well as belief in self and the team, organisation or
system, and trust in leadership and direction.
My psychological energy is ____
The psychological energy of those I work with is____
The importance of psychological energy to me is____
Physical energy is the energy of action, getting things done and
making progress. It is the flexible, responsive drive to make things
happen, with vitality and kinetic force (motion)
My physical energy is ____
The physical energy of those I work with is ____
The importance of physical energy to me is____
Intellectual energy is the energy of curiosity, analysis, thinking and cognition. It involves gaining insight, a thirst for new knowledge as well
as planning and supporting processes, evaluation, and arguing a case on the basis of logic and evidence.
My intellectual energy is ____
The intellectual energy of those I work with is____
The importance of intellectual energy to me is____
Complete these statements on a scale of 1 = low - 5 = high
Spiritual energy is the energy of commitment to a common vision for
the future, driven by shared values and a higher purpose. It involves
giving people the confidence to move towards a different future
that is more compelling than the status quo, by finding the deep
meaning in what they do.
My spiritual energy is ____
The spiritual energy of those I work with is____
The importance of spiritual energy to me is____
The SSPPI Energy Index – V2, Part 2

• 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

@helenbevan
Team 1: what’s your assessment of
their energy for change?

@helenbevan
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

@helenbevan

@helenbevan
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

@helenbevan
Resources for building and aligning energy
Title and source S S P P I
Quality and Service Improvement Tools – NHS X X X X X
Energy Project tips – The Energy Project X X X X
Emotional Resilience Toolkit – DH/Business in the CommunityX X X X
IHI Improvement Map – Institute for Healthcare ImprovementX X X X
P3M Resource Centre – NHS Connecting for HealthX X X X
i-resilience assessment – RobertsonCooper X X X X
Appreciative Inquiry – Appreciative Inquiry CommonsX X X
Good Day at Work network – RobertsonCooper X X X

@helenbevan #qs13@helenbevan #Quality2013
“Money incentives do not create energy
for change; the energy comes from
connection to meaningful goals”
Ann-Charlott Norman, Talking about improvements: discursive
patterns and their conditions for learning,
Clinical Microsystem Festival, Jönköping March 2012

[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

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

Purpose Obfuscation
O-meter

Police

Education

Healthcare

@helenbevan
What focus for our improvement projects?
Source: 100 improvement projects on national improvement
leadership programme October 2012

....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

Unleashing energy for change

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