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School for Health and Care radicals - Slides for module four

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Making change happen: 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.

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School for Health and Care radicals - Slides for module four

  1. 1. #SHCR @School4Radicals Module 4 Making change happen Supported by: http://www.theedge.nhsiq.nhs.uk/school/ Module
  2. 2. #SHCR @School4Radicals • Please use the chat box to contribute continuously during the web seminar • Please tweet using hashtag #SHCR and the handle @School4Radicals • Request to join our Facebook group School for Health and Care Radicals • We will produce summaries of each module discussion using Steller and put it on the website • Join in the #SHCR Tweetchat each Tuesday at 1900 (GMT) Joining in today…and beyond
  3. 3. #SHCR @School4Radicals Session lead: Helen Bevan @HelenBevan Learning lead: Pip Hardy @PilgrimPip Session chair: Kate Pound @kateslater2 Twitter & chat monitor: Olly Benson @ollybenson Storyteller: Rebecca Lacey @rebeccalacey76 Storyteller: Jas Atwal @jasjitkauratwal Storyteller: Joyce Lee @joyclee The team today
  4. 4. #SHCR @School4Radicals Programme Study Guide: www.slideshare.net/TheEdgeNHS/school- for-health-and-care-radicals-iii-study- guide-2016?related=2 Module 4 Study Guide: http://www.slideshare.net/TheEdgeNHS/ school-for-health-and-care-radicals- module-4-study-guide-2016 Study guides
  5. 5. #SHCR @School4Radicals Modules 3rd March: Moving beyond the edge
  6. 6. #SHCR @School4Radicals Our growing community • The American College of Radiology • Macmillan nursing team growing School news • Twitter chat for #SHCRmh today 20.00-21.00 (GMT) • Twitter chat for #SHCR6Cs Sunday 20.00-21.00 (GMT) • After school club north east on 7th April 1pm connect with @markdavis272 or @maxine_craig
  7. 7. #SHCR @School4Radicals Icebreaker: Making change happen Which of these are you most interested in finding out about today?
  8. 8. #SHCR @School4Radicals Today • Why change efforts often fail to achieve their objectives • Leading large-scale change • Intrinsic and extrinsic motivators for change • Building energy for change • Creating shared purpose • Discussion and reflection Sourceofimage:www.freshnessmag.com
  9. 9. #SHCR @School4Radicals Source of image: Whatsthebigideascwartzy.blogspot.com
  10. 10. #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
  11. 11. #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
  12. 12. #SHCR @School4Radicals Source: 2016 Chartered Institute of Management Quality of Working Life study Across the UK, poorly managed change programmes are damaging morale and the performance of organisations
  13. 13. #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
  14. 14. #SHCR @School4Radicals Change is not the goal; the goal is the goal Peter Fuda Source of image: timemanagementninja.com
  15. 15. @School4Radicals #SHCR 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
  16. 16. @School4Radicals #SHCR 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
  17. 17. @School4Radicals #SHCR 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/
  18. 18. @School4Radicals #SHCR 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
  19. 19. @School4Radicals #SHCR@HelenBevan #NHSelect15 Types of motivation Source of image: http://youearnedit.com/blog/intrinsic-vs-extrinsic-motivation/
  20. 20. @School4Radicals #SHCR@HelenBevan #NHSelect15 Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA old power new power Currency Held by a few Pushed down Commanded Closed Transaction Current Made by many Pulled in Shared Open Relationship From
  21. 21. @School4Radicals #SHCR 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
  22. 22. #SHCR @School4Radicals Tapping into intrinsic motivation is critical to ongoing, large scale change So while both extrinsic and intrinsic motivation have their place when implementing change, identifying underlying intrinsic motivation remains the differentiating factor between long-term success and failure. Every long-term, sustained extrinsic success story has tapped into intrinsic motivation at its core…… While extrinsic motivation can produce some initial success on its own, people will move on from tasks that they no longer find personally challenging. So unless system leaders want to continually increase the reward for the same task, they need to find a way to appeal to user’s values….. . The Blog for Happy Workers: http://www.happymelly.com/why-intrinsic-motivation-is-the-key-to-change-management/ ‘
  23. 23. #SHCR @School4Radicals Intrinsic motivators build energy and creativity
  24. 24. #SHCR @School4Radicals Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership 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 create focus & momentum for delivery Drivers of extrinsic motivation
  26. 26. #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
  27. 27. #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
  28. 28. #SHCR @School4Radicals The Change Model Source: Zoe Lord
  29. 29. Priority area: Acute Kidney Injury (AKI) – NHS Kidney Care 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 prevention, detection and management of AKI across the whole NHS system Leadership by all Do all our leaders have the skills to create transformational change? NHS Medical Director NHS Commissioning Board Clinical Commissioning Groups National Clinical Lead Royal College of Nursing NHS Nursing Director AKI Delivery Group National Vascular Society for Great Britain & Ireland Clinical Leads Network Leads Patient Groups Motivate and Mobilise Are we engaging and mobilising all the right people? AKI London Network Deaneries Directors of Nursing AKI Specialist Registrar Network AKI App Spread and Adoption Are we designing for the active spread of innovation? Acute Kidney Injury Resource Pack Hydration Matters Campaign AKI Audit in Acute Assessment Units in the North East of England E-alerts Survey Medicines Optimisation Toolkit How to Guides Project and performance Management Do we have an effective approach for delivery of change and monitoring of progress towards our planned objectives? Project Management Office Risk & Issues Log Influencing factors Are our processes, incentives and systems aligned to enable change? The Burdon of AKI – Health Economics Study AKI Recording & Coding AKI Consensus Conference NICE (Guideline 50) NCEPOD Improvement tools Are we using an evidence-based quality improvement methodology? YES = quality improvement Measurement Are we measuring the outcome of the change continuously and transparently? National Confidential Enquiry into Patient Outcome and Death AKI Markers in National Registrar Vascular Database Atlas of Variation
  30. 30. “Without using the change model to undertake a gap analysis, we would have never have known many of our collective strengths and our challenges which would have had a direct impact on achieving our goal” Beverley Matthews http://www.londonaki.net/
  31. 31. #SHCR @School4Radicals “Take your passion and make it happen” Source of image: www.zeelandtheaters.nl
  32. 32. #SHCR @School4Radicals 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/
  33. 33. #SHCR @School4Radicals 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 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/wor ldwide-employees-engaged-work.aspx
  34. 34. #SHCR @School4Radicals Telling her story Jas Atwal @jasjitkauratwal
  35. 35. #SHCR @School4Radicals Dr Jasjit Kaur Atwal @jasjitkauratwal General Practitioner on a career break. School Governor and Code Club volunteer. https://codewordblog.wordpress.com
  36. 36. #SHCR @School4Radicals We built a computer… and it actually works!
  37. 37. #SHCR @School4Radicals
  38. 38. #SHCR @School4Radicals https://scratch.mit.edu/projects/26818098/#editor https://scratch.mit.edu/ We have been using a language called Scratch to teach the children
  39. 39. #SHCR @School4Radicals Amanda Coffey @adorescienc e A qualified teacher, Amanda has extensive experience volunteering in her community and was instrumental in setting up a local Community Forum to enable disparate groups to work together. As a Process Co- ordinator working for a bank’s operations department, Amanda used her coding experience and networking skills to move from paper to a digital system.
  40. 40. #SHCR @School4Radicals Ian Williams @ www.fetcheveryone.com Creator of fetcheveryone.com, a free website for runners to log their exploits and share their passion for running. Bought by Hearst magazine in 2007 and now receiving 50,000 visitors per month, it is Ian’s full time occupation. In his spare time, he is a Parkrun event director and Code Club volunteer.
  41. 41. #SHCR @School4Radicals
  42. 42. #SHCR @School4Radicals
  43. 43. #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
  44. 44. #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
  45. 45. #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%
  46. 46. #SHCR @School4Radicals
  47. 47. #SHCR @School4Radicals Energy for change The capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals http://www.institute.nhs.uk/tools/energ y_for_change/energy_for_change_.html
  48. 48. #SHCR @School4Radicals Psychological Physical Spiritual Social Intellectual Energy for change
  49. 49. #SHCR @School4Radicals Social energy 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”
  50. 50. #SHCR @School4Radicals Spiritual energy 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
  51. 51. #SHCR @School4Radicals Psychological energy Energy of courage, resilience and feeling safe to do things differently Involves feeling supported to make a change and trust in leadership and direction
  52. 52. #SHCR @School4Radicals Physical energy Energy of action, getting things done and making progress The flexible, responsive drive to make things happen
  53. 53. #SHCR @School4Radicals 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. #SHCR @School4Radicals Low High Social isolated solidarity Spiritual uncommitted higher purpose Psychological risky safe Physical fatigue vitality Intellectual Illogical reason High and low ends of each energy domain
  55. 55. #SHCR @School4Radicals  Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)  Nearer to CEO, higher or lower energy scores? Some questions
  56. 56. #SHCR @School4Radicals • 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
  57. 57. #SHCR @School4Radicals 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 1: what’s your assessment of their energy for change?
  58. 58. #SHCR @School4Radicals 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Team 2: what’s your assessment of their energy for change?
  59. 59. #SHCR @School4Radicals 1 2 3 4 5 Social Spiritual PsychologicalPhysical Intellectual Where is your team?
  60. 60. #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
  61. 61. #SHCR @School4Radicals Telling her story Rebecca Lacey @rebecccalacey76
  62. 62. #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
  63. 63. #SHCR @School4Radicals  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) We know that ...
  64. 64. #SHCR @School4Radicals A 3-word concept
  65. 65. #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
  66. 66. #SHCR @School4Radicals “Matching Michigan” is a great 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/
  67. 67. #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
  68. 68. #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
  69. 69. #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
  70. 70. #SHCR @School4Radicals How to make change happen  Stop bribing  Make people feel something  Emphasise progress  Start a cult (a group unified by a provocative idea) Source: How to motivate people: four steps backed by science
  71. 71. #SHCR @School4Radicals Telling her story Joyce Lee @joyclee
  72. 72. #SHCR @School4Radicals http://ihavefoodallergies.tumblr.com Patient as Expert Maker Collaborator
  73. 73. #SHCR @School4Radicals Healthdesignby.us Participatory Design = Maker Movement Expert = DIY Maker = Learning by doing Collaborator = Peer-to-Peer
  74. 74. #SHCR @School4Radicals Design with and not for patients Integrate design into your daily workflow User research as an educational opportunity Make the dream clinic happen Design with members of a different tribe Identify your latent innovators
  75. 75. #SHCR @School4Radicals Next opportunities for learning • Next Tuesday, 1st March 1900-2000 GMT: Tweet chat #SHCR • Next Thursday 3rd March 1430-1600 GMT: Module 5: Moving beyond the edge
  76. 76. #SHCR @School4Radicals There’s still time to take part in an RCT! • Randomised Coffee Trial! • Randomised Coffee Trial! Randomised Coffee Trial!
  77. 77. #SHCR @School4Radicals 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? Questions for reflection
  78. 78. #SHCR @School4Radicals Questions for reflection • Identify three ways in which I can ignite energy for change within my own groups and communities. • Consider how I will build commitment to shared purpose in all my change efforts. • Take one action tomorrow to accelerate change. Call to action
  79. 79. #SHCR @School4Radicals Goodbye and good luck! ‘There is a thread you follow. It goes among things that change. But it doesn’t change… while you hold it you cannot get lost.’ William Stafford Goodbye and good luck!
  80. 80. #SHCR @School4Radicals

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