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Transforming End of Life Care in Acute Hospitals PM Workshop 4: Achieving Transformational and Large Scale Change

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Transforming End of Life Care in Acute Hospitals PM Workshop 4: Achieving Transformational and Large Scale Change presented by Susie Peachey, NHS England

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Transforming End of Life Care in Acute Hospitals PM Workshop 4: Achieving Transformational and Large Scale Change

  1. 1. Creating the environment for  transformation‐ leadership & culture  for innovation Susie Peachey‐ November 2015
  2. 2. “Without innovation, public services costs tend to rise faster than the rest of the economy. Without innovation the inevitable pressure to contain costs can only be met by forcing already stretched staff to work harder.” Mulgan G. & Albury D.  (2003) Innovation in the public sector. Strategy Unit, London. “Changing the way people think about situations is, in fact, the most powerful and useful way to ultimately change behaviour and thereby affect organisational results” Pfeffer J.  (2005‐p125)
  3. 3. Leading Transformational Change YouInfluencer &  communicator Innovator &  designer Scientist &   systems  thinker Strategist &  decision maker Deliverer &  adaptor Coach &  connector Culture shaper  & enabler
  4. 4. First follower: leadership lessons from  dancing  guy http://www.bing.com/videos/search?q=man+ dancing+in+a+crowd&qs=n&form=QBVR&pq= man+dancing+in+a+crowd&sc=0‐15&sp=‐ 1&sk=#view=detail&mid=5F6EEAAAD88C0C7F 841E5F6EEAAAD88C0C7F841E
  5. 5. A culture for innovation • Leading change in a complex environment – the culture needs to support change – 7 dimensions identified to assess culture – work on the culture in your team (any collection  of individuals where innovative output is required) • Culture is hard to change – work on the culture within your project/change  (create a bubble for change to happen in)
  6. 6. Accompanied by 29 questions across these dimensions to visualise your culture and create a ‘portal chart’ that needs to be wide open for the free flow of ideas. Scored from -5 to +5
  7. 7. Dimensions of Innovation Culture
  8. 8. Risk Taking 1. My direct supervisor supports me if I want to  try something new 2. If I suggest a new idea and it fails, I know that  I  will not be made to feel humiliated 3. In my dept, the general tendency is to try  new things rather than hold onto the status  quo 4. Senior leadership is willing to take a risk on  new ideas that might make things better
  9. 9. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor  hinder innovation Positive scores‐ behaviours and practices tend to  aid innovation Negative scores‐ behaviours and practices tend to  hinder innovation
  10. 10. Resources 5. My direct supervisor provides me the time to  work on a promising new idea 6. In my dept, we seem to find the resources we  need to fund innovative ideas 7. I feel that I have reasonable authority to try  out an innovative new idea 8. Senior leadership makes sure that there is  both the availability of time and money to  support innovation
  11. 11. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor  hinder innovation Positive scores‐ behaviours and practices tend to  aid innovation Negative scores‐ behaviours and practices tend to  hinder innovation
  12. 12. Knowledge 9. If I don’t have the information I need, I feel  comfortable asking my direct supervisor for it 10.We are generally kept informed of activities  in other depts that affect our work 11.There  is a lot of information available to me  about what organisations are doing to meet  the same sort of challenges we face 12.Senior leadership openly shares information  that is important to me and the work I do
  13. 13. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor  hinder innovation Positive scores‐ behaviours and practices tend to  aid innovation Negative scores‐ behaviours and practices tend to  hinder innovation
  14. 14. Goals 13.I know what the priorities or goals are in my  dept 14.My direct supervisor makes it clear that  innovative new ideas are highly desirable 15.Priorities come down to me without pre‐ determined solutions, leaving me plenty of  room to contribute my own ideas 16.Senior leadership has made it clear that  innovative new thinking is required to meet  some of our organisational goals
  15. 15. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor  hinder innovation Positive scores‐ behaviours and practices tend to  aid innovation Negative scores‐ behaviours and practices tend to  hinder innovation
  16. 16. Rewards 17.I am certain that I would receive recognition or  praise from my direct supervisor if I put an  innovative idea forward 18.The recognition that we get here for coming up  with new ideas does motivate me personally to  be more innovative 19.We celebrate and say thanks when someone  tries out a new idea, even when it is not  successful in the traditional sense 20. Senior leadership actively seeks out and  recognises innovative thinking
  17. 17. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor  hinder innovation Positive scores‐ behaviours and practices tend to  aid innovation Negative scores‐ behaviours and practices tend to  hinder innovation
  18. 18. Tools 21.My organisation has trained me in methods  to support creative, new ways of thinking 22.My dept uses specific methods to generate  creative ideas around the challenges we face 23.I am capable of generating creative ideas 24.Senior leadership actively demonstrates  innovative new thinking in its own work
  19. 19. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor  hinder innovation Positive scores‐ behaviours and practices tend to  aid innovation Negative scores‐ behaviours and practices tend to  hinder innovation
  20. 20. Relationships 25.In my organisation, people who think  differently are respected for their point of  view 26.The teams that I work on tend to have people  with a diverse mix of skills and styles 27.In general, there is a high degree of honest  and open communication between depts 28.Senior leadership models high levels of   cooperation and trust among colleagues
  21. 21. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor  hinder innovation Positive scores‐ behaviours and practices tend to  aid innovation Negative scores‐ behaviours and practices tend to  hinder innovation
  22. 22. Overall 29. My department has an underlying culture that  supports innovation Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor hinder  innovation Positive scores‐ behaviours and practices tend to aid  innovation Negative scores‐ behaviours and practices tend to hinder  innovation
  23. 23. What areas need addressing?
  24. 24. Relationships‐ tips for improving  this dimension • Trusting, open environment to identify problems  and share ideas • Honouring everyone’s input, not just those most  senior, and exploring new ideas‐ not immediately  arguing against use the ‘fresh eyes’ exercise • Create opportunities for diverse individuals to  come together to create true team based  working‐ job shadowing, work rotations • Explore personal styles and preferences‐ Myers‐ Briggs, Merrill‐Reid
  25. 25. • revealing your  values • connecting to the  values of others • gaining  commitment to the  change sought Professor  Marshall  Ganz  identified  the  power of  story  telling in:  “an appropriately told story  has the power to …..  communicate  a strange  new idea easily and  naturally, and quickly gets  people into enthusiastic  positive action” Denning S. (2007): The  Secret  Language of Leadership, Jossey Bass “You can’t impose anything  on anyone and expect them  to be committed to it” Edgar Schein, Professor Emeritus  MIT Sloan School “You can’t impose anything  on anyone and expect them  to be committed to it” Edgar Schein, Professor Emeritus  MIT Sloan School “You can’t impose anything  on anyone and expect them  to be committed to it” Edgar Schein, Professor Emeritus  MIT Sloan School
  26. 26. Goals • The ‘Why’‐ leaders speaking about what they care  about‐create a compelling vision for a new future‐ WOW • Create a clear case for need‐ NOW • Specific call for innovation‐ HOW • Tie to strategic plan‐ define, align and clarify goals • ‘Stretch’‐set aspirational goals that encourage new  thinking and do something that seems impossible  today e.g. NASA, keyhole surgery
  27. 27. “What a leader cares  about  does not tap  into roughly 80% of the  workforce’s primary  motivators for putting  extra energy into a  change programme”  Scott Keller & Carolyn Aiken  (2009)‐ The Inconvenient Truth  about Change Management “What a leader cares  about  does not tap  into roughly 80% of the  workforce’s primary  motivators for putting  extra energy into a  change programme”  Scott Keller & Carolyn Aiken  (2009)‐ The Inconvenient Truth  about Change Management “What a leader cares  about  does not tap  into roughly 80% of the  workforce’s primary  motivators for putting  extra energy into a  change programme”  Scott Keller & Carolyn Aiken  (2009)‐ The Inconvenient Truth  about Change Management Feedback from NHS senior leaders  development programme showed: • 57% created a climate which is  ‘demotivating’ • Only 12% created a climate that is  ‘inspiring’
  28. 28. Why are you here? What’s your burning ambition? “Leaders of successful  large scale change are  more likely to have built  their efforts on a  platform of commitment  to change, setting the  conditions, creating a  shared purpose and  deeper meaning for the  change”.  NHS Change Model “If you want people to act on  your vision you need to create  a burning ambition: a fire  from within”. Peter Fuda
  29. 29. Burning Ambition‐ Peter Fuda http://www.peterfuda.com/2012/06/28/from‐ burning‐platform‐to‐burning‐ambition/ http://viralvideos.mobi/video/Tfn6vD4yyC4/Fire ‐Metaphor‐‐From‐‐Burning‐Platform‐‐to‐‐ Burning‐Ambition‐.html
  30. 30. Why are we doing this? Dell • We make computers  (what) • They have fast processors  and great features (how) • We want you to buy our  computers (why) Apple • Everything we do we  believe in challenging the  status quo. We believe in  thinking differently (why) • Our products are  beautifully designed,  simple to use… (how) • We happen to make great  computers (what)
  31. 31. Creating your Vision Wow • needs to create a  ‘pull’ to engage  others Now • should create a  sense of urgency  for moving to the  new future How • creating  alignment to core  values
  32. 32. Risk Taking • Emotional support‐ learning from failure, not   punishing • Balanced assessment‐ not over‐estimation of  risk (intelligent risk‐taking)‐ challenge to take  an idea forward • Create a climate of trying new things‐ After  Action Reviews • Don’t use humour‐ we told her we are sure  she can find work elsewhere if it doesn’t work
  33. 33. Resources • Authority to act‐ not always having to ask  permission‐ remove perceived barriers to act • Funding‐ change is not free! – Link innovation efforts to waste reduction techniques • Seek resources from non‐traditional channels‐ become a test site, third sector/charities/  universities/ local industry • Turn strategically important innovation into  formal organisational projects
  34. 34. Knowledge • Wide scope search‐ avoid ‘not invented here’  to prevent re‐inventing the wheel • Encourage ideas from outside the health  service • Uncensored, unfiltered, unsummarised • Get information flowing freely and quickly‐ share board info widely and use knowledge  from the workforce to support the board
  35. 35. Rewards • Intrinsic motivation‐ make change personally  rewarding • Recognition‐ peer and patient • Aligned with organisational goal (use  performance reviews) • Individualised‐ ‘thank you’
  36. 36. Tools • Deliberate process, with strategic focus • Develop a pool of people who can facilitate  and develop creative thinking‐training in  change techniques (SI) • Encouragement for skills development • Provide tools needed for change‐ introduce  periodically NB Thinking Differently
  37. 37. Thinking Differently Creativity‐ a structured process 1. Stop before you start 2. Generate lots of ideas with stakeholders – First burst‐ brainstorm – Second burst‐ more structured 3. Harvest ideas and narrow selection‐ what  criteria 4. Stretch and enhance ideas 5. Test and implement final choices …………….loop back through the process
  38. 38. Tools for generating ideas Fresh eyes‐ think like another person or make links to  another industry Constraints‐ too much freedom can actually overwhelm  teams trying to find solutions   Breaking the rules‐ identify assumptions, mental models,  unwritten rules and deliberately think around them Random word, picture or object‐ activate thoughts we  don’t usually associate with the topic Stepping stones‐ start with the outrageous, suspend  judgment, emerging concept, practical suggestions That’s impossible‐ think of impossible things that have  been solved in the past‐ surgery without incision etc and think  how it could be made possible Mental benchmarking‐ ideas applied in a not so obvious  way in a different context
  39. 39. Using creativity and innovation to drive transformation - experiencing a technique Fresh Eyes
  40. 40. Thinking Differently…. • Fresh eyes • Stepping stones • Breaking the rules and many more ways of generating lots of ideas…
  41. 41. Thinking Differently… the tools Fresh  Eyes‐ p70 Breaking  the rules‐ p78 Random  word/ picture/  object‐ p86 Stepping  Stones‐ p94 That’s  impossible‐ p102 Mental  benchmarking‐ p108 Harvesting by Criteria or Dot  Voting‐ p120 Others’ point of view‐ p40 Reframing by word play‐ p46 Pause, Notice, Observe p50 Phase 1: stop before you start Phase 2: generating lots of ideas Phase 3: selecting & testing ideas to make a difference Six Thinking Hats‐ p128 Enhancement checklist‐ p136 Testing new ideas on a small  scale‐ p141
  42. 42. Fresh Eyes Since others have different ways of looking or approaching challenges, Fresh Eyes is about thinking or exploring the challenge in the mindset of another, with Fresh Eyes. Without birds, would we have sought to fly? This can be looking at things through other companies’ eyes or other peoples’ eyes, that may have tackled or looked at this challenge differently. Remember: this exercise is not just for new ideas for services but for any challenge you face in the changes you are making e.g. for maintaining momentum as team members change
  43. 43. Fresh eyes • In a moment, each person will be given a picture of a person or organisation. We will also give you a challenge to consider. • Individually (and silently) take five minutes to note down how the person or organisation would view the challenge – what would they pay attention to? (2 minutes) – what kinds of solutions would they consider? (3 minutes)
  44. 44. Fresh eyes – Example only Challenge • Reducing the waiting times in A&E Person or organisation • Disney Controlled environment, distracting people with fun, different zones for attractions, parades, lots of guides etc. What do they pay attention to? What kinds of solution would they consider? •Guides to help navigate A&E •Creating treatment zones •Dressing all the consultants as Mickey!
  45. 45. Fresh eyes Reducing A&E waits . . . by dressing all the consultants in Mickey Mouse outfits! What a stupid idea! Or is it?
  46. 46. Fresh eyes Reducing A&E waits . . . by dressing all the consultants in Mickey Mouse outfits! Should we make it easier for patients to tell who the staff are? Should we make staff more approachable? Are the consultants front of house enough, seeing more people? Treat ‘stupid’ ideas as a springboard for new insights and ideas
  47. 47. Fresh eyes • In a moment, each person will be given a picture of a person or organisation. We will also give you a challenge to consider. • Individually (and silently) take five minutes to note down how the person or organisation would view the challenge – what do they would pay attention to? (2 minutes) – what kinds of solutions would they consider? (3 minutes)
  48. 48. Your challenge How would these people or organisations tackle . . . Getting health and local government to coordinate their support for individuals more effectively 5 minutes, individually and silently 2 minutes on: What do they pay attention to? 3 minutes on: What kinds of solution would they consider?
  49. 49. Building on your individual thoughts Rules for idea generation Criticism is ruled out Go for quantity Encourage wild ideas Build on the ideas of others Every person and every idea has equal worth One conversation at a time .  Go round the table – one ‘solution’ each One solution = one breath and no more! As they speak, note down builds or new ideas Pause to think when everyone ‘passes’ then go  again 5 minutes
  50. 50. Your challenge How would these people or organisations tackle . . . Getting health and local government to coordinate their support for individuals more effectively Feedback • Top innovative idea that has potential • Most thought provoking (or wishful thinking) idea

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