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Leading large scale change                                                       Helen Bevan© NHS Institute for Innovation...
© NHS Institute for Innovation and Improvement, 2009
Data on transformation efforts  • Only one in three transformation efforts hit the    ball out of the park  • Only one in ...
Risk assessment: why do large scale change efforts fail?• They get designed using the same mindset, beliefs and rules as  ...
Risk assessment: why do large scale change effortsfail?• They fail to mobilise clinical and managerial leaders            ...
Risk assessment: why do large scale change effortsfail?• They fail to mobilise clinical and managerial leaders            ...
“Revolution                     begins with                                          transformation of                    ...
Different thinking for different resultsFirst order change  More of, or less of… the same thing    © NHS Institute for Inn...
Different thinking for different resultsFirst order change                                                            acr...
Different thinking for different resultsFirst order change                                                            acr...
Different thinking for different resultsSecond order change Stand back…........Reframe…...See the big picture…    © NHS In...
Different thinking for different resultsSecond order change                                                            un...
Different thinking for different resultsSecond order change                                                            un...
The large scale change model  • “All models are wrong, some           models are useful”           George E. P. Box, Stati...
How large scale change happens in reality:• There is a sufficiently well-defined topic area that people can  connect with ...
How large scale change happens in reality:• Momentum is created by the appearance of success       … that is communicated ...
How large scale change happens in reality:• The actual, full, measured results and unintended consequences  from a true la...
Our model of LSC         Identifying                                                 Maybe later             Living with  ...
Anatomy of change                       Physiology of changeDefinition                   The shape and structure of the   ...
The ten key principles of large scale change1.             Movement towards a new vision that is better and               ...
The ten key principles of large scale change6.            Continually refreshing the story and attracting new,            ...
How did the great transformational                     leaders change the world?    Strategy                              ...
Leaders ask their staff to be ready for   change, but do not engage enough in   sensemaking........ Sensemaking is not don...
A challenge     “What the leader cares about (and typically      bases at least 80% of his or her message to      others o...
mobilising                                                       versus                                                org...
“A cynic, after all, is a passionate person who does not want to be disappointed again” Zander R and Zander B (2000) The a...
Framing Is the process by which leaders construct, articulate and put across their message in a powerful and compelling wa...
If we want people to take action, we have                       to connect with their emotions through                    ...
© NHS Institute for Innovation and Improvement, 2009
But not all emotions are equal.........Action motivators                                                 Action inhibitors...
What the framing literature tells us           People are much more likely to embrace change if it           is framed as ...
Three components of  transformational change  (Fry 2002)    • Novelty / innovation    • Transition    • Continuity© NHS In...
“When you have gone as far that you              can‟t manage one more step, then you               have gone just half th...
What do we need to do?  1. Tell a story  2. Make it personal  3. Be authentic  4. Create a sense of “us” (and be clear who...
Public Narrative                                          story of                         story of                       ...
Public Narrative                                          story of                         story of                       ...
Telling your narrative    “A good narrative is drawn from the series of    choice points that have structured the “plot” o...
Show – don’t tell! • Specific moments • Specific people • Specific values • Specific challenges • Specific choices • Speci...
Task• Find a “partner” to work with• Spend two minutes quietly developing your story   – The challenge, choice and outcome...
Feedback  • Was the     – challenge     – choice     – outcome     explicit?  • Could you identify with the person‟s value...
© NHS Institute for Innovation and Improvement, 2009
Made in Dagenham  The main character, Sandra, seeks to convince her    audience to take action  • What is the call to acti...
We have a choice   “This is the true joy of life, the being used up for     a purpose recognised by yourself as a mighty  ...
Leading Large Scale Change: Web seminars for senior leadersSix free web seminars for senior leaders (60 minutes each) from...
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C7/D7 Leading Large-Scale Change - H. Bevan

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C7/D7 Leading Large-Scale Change - H. Bevan

  1. 1. Leading large scale change Helen Bevan© NHS Institute for Innovation and Improvement, 2009
  2. 2. © NHS Institute for Innovation and Improvement, 2009
  3. 3. Data on transformation efforts • Only one in three transformation efforts hit the ball out of the park • Only one in twenty clear the car park as well Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey of company executives© NHS Institute for Innovation and Improvement, 2009
  4. 4. Risk assessment: why do large scale change efforts fail?• They get designed using the same mindset, beliefs and rules as have been used before • they get designed as top down, often structural, solutions rather than transformation of complex adaptive systems • lack of a holistic model or perspective which links components together• A “voltage drop” occurs between radical change aspirations and the reality of implementation: • organisations are neither capable of, nor ready for, the breadth and depth of change • operational and financial reality gets in the way of re-inventing the system © NHS Institute for Innovation and Improvement, 2009
  5. 5. Risk assessment: why do large scale change effortsfail?• They fail to mobilise clinical and managerial leaders • Lack of emotional engagement and alignment of incentives with core values• Scale and pace: • it typically takes far longer than the planning horizons of leaders • diffusion approach does not go to plan - we are able to generate change (“pilots”), but unable to generalise it © NHS Institute for Innovation and Improvement, 2009
  6. 6. Risk assessment: why do large scale change effortsfail?• They fail to mobilise clinical and managerial leaders • Lack of emotional engagement and alignment of incentives with core values• Scale and pace: • it typically takes far longer than the planning horizons of leaders • diffusion approach does not go to plan - we are able to generate change (“pilots”), but unable to generalise itIn around 80% of cases, failure can be traced back to the early stages: change programmes are most likely to go wrong as a result of the way they are initially conceptualised and planned © NHS Institute for Innovation and Improvement, 2009
  7. 7. “Revolution begins with transformation of consciousness” Paul Bate© NHS Institute for Innovation and Improvement, 2009
  8. 8. Different thinking for different resultsFirst order change More of, or less of… the same thing © NHS Institute for Innovation and Improvement, 2009
  9. 9. Different thinking for different resultsFirst order change  across the board budget reductions  cost improvement goals are separate from quality improvement goals and are of primary importance  make the current system “leaner” and less wasteful  assess and understand performance  work harder  capture data More of, or less of… the same thing © NHS Institute for Innovation and Improvement, 2009
  10. 10. Different thinking for different resultsFirst order change  across the board budget reductions  cost improvement goals are separate from quality improvement goals and are of primary importance  make the current system “leaner” and less wasteful  assess and understand performance  work harder  capture data tighter control and scrutiny; management grip © NHS Institute for Innovation and Improvement, 2009
  11. 11. Different thinking for different resultsSecond order change Stand back…........Reframe…...See the big picture… © NHS Institute for Innovation and Improvement, 2009
  12. 12. Different thinking for different resultsSecond order change  unwarranted variation is driven out across the system  productivity and cost improvement goals are a subset of quality and patient goals  build meaning and understanding of the need for change, connected to higher purpose and NHS values  build commitment to take action across the organisation and the wider system  create the capacity and capability for change Stand back…........Reframe…...See the big picture… © NHS Institute for Innovation and Improvement, 2009
  13. 13. Different thinking for different resultsSecond order change  unwarranted variation is driven out across the system  productivity and cost improvement goals are a subset of quality and patient goals  build meaning and understanding of the need for change, connected to higher purpose and NHS values  build commitment to take action across the organisation and the wider system  create the capacity and capability for change Call to action to secure the future © NHS Institute for Innovation and Improvement, 2009
  14. 14. The large scale change model • “All models are wrong, some models are useful” George E. P. Box, Statistician, UK, 1919- • Practically speaking, how it tends to go Based on case study evidence from a variety of fields and settings© NHS Institute for Innovation and Improvement, 2009
  15. 15. How large scale change happens in reality:• There is a sufficiently well-defined topic area that people can connect with … on which there is a sufficient mix of pressure, will, incentive, attraction, consequences, etc … that it felt, by a small, but large-enough, group of people … … who find some means to exert some influences … … over systems at multiple levels (e.g. service delivery, hand- over processes, clinical decision-making, finance flow, public opinion, policy, etc) … … to initiate some changes in a sufficiently effective and visible way• This pattern of framing/re-framing, engaging others, and initiating changes at multiple levels repeats many times, in hard-to-predict ways © NHS Institute for Innovation and Improvement, 2009
  16. 16. How large scale change happens in reality:• Momentum is created by the appearance of success … that is communicated widely enough --- … to attract others who were previously neutral to join in actively in the process of change … … thereby creating another cycle of framing/re-framing, engaging others, and initiating changes at multiple levels• This momentum then continues for some time until either : 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 © NHS Institute for Innovation and Improvement, 2009
  17. 17. How large scale change happens in reality:• The actual, full, measured results and unintended consequences from a true large scale change are often not known until some time into the future, therefore, throughout most of the process of large scale change a certain amount of faith, intuition, judgement, and proceeding forward on incomplete evidence is inevitable © NHS Institute for Innovation and Improvement, 2009
  18. 18. Our model of LSC Identifying Maybe later Living with need for results and change Engaging/ consequences connecting Time delay others Repeats Framing/ many After some Settling in time Possible outcomes reframing times in hard to 1. sustainable norm the Making 2. plateau predict issues ways pragmatic 3. run out of energy change in Attracting multiple . further interest processes © NHS Institute for Innovation and Improvement, 2009
  19. 19. Anatomy of change Physiology of changeDefinition The shape and structure of the The vitality and life-giving forces that system; detailed analysis; how enable the system and its people to the components fit together. develop, grow and change. Processes and structuresFocus to deliver health and Energy/fuel for change. healthcare.  measurement and  creating a higher purpose and evidence deeper meaning for the changeLeadership  improving clinical systems process  reducing waste and  building commitment to changeactivities variation in healthcare  connecting with values processes  creating hope and optimism about  redesigning pathways the future  calling to action © NHS Institute for Innovation and Improvement, 2009
  20. 20. The ten key principles of large scale change1. Movement towards a new vision that is better and fundamentally different from the status quo2. Identification and communication of key themes that people can relate to and that will make a big difference3. Multiples of things („lots of lots‟)4. Framing the issues in ways that engage and mobilise a lot of different people5. Mutually reinforcing change across different parts of the system © NHS Institute for Innovation and Improvement, 2009
  21. 21. The ten key principles of large scale change6. Continually refreshing the story and attracting new, active supporters7. Emergent planning and design, based on monitoring progress and adapting as you go8. Enabling many people to contribute to the leadership of change, beyond organisational boundaries9. Transforming mindsets, leading to inherently sustainable change10. Maintaining and refreshing the leaders‟ energy over the long haul © NHS Institute for Innovation and Improvement, 2009
  22. 22. How did the great transformational leaders change the world? Strategy Narrative What? Why? Shared understanding leads to Action© NHS Institute for Innovation and Improvement, 2009 Source: Marshall Ganz
  23. 23. Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........ Sensemaking is not done via marketing...or slogans but by emotional connection with employees Ron Weil© NHS Institute for Innovation and Improvement, 2009
  24. 24. A challenge “What the leader cares about (and typically bases at least 80% of his or her message to others on) does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into the change programme” Scott Keller and Carolyn Aiken (2009) The Inconvenient Truth about Change Management© NHS Institute for Innovation and Improvement, 2009
  25. 25. mobilising versus organising© NHS Institute for Innovation and Improvement, 2009
  26. 26. “A cynic, after all, is a passionate person who does not want to be disappointed again” Zander R and Zander B (2000) The art of possibility. Harvard Business School Press. As quoted by Steve Onyett© NHS Institute for Innovation and Improvement, 2009
  27. 27. Framing Is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action Snow D A and Benford R D (1992)© NHS Institute for Innovation and Improvement, 2009
  28. 28. If we want people to take action, we have to connect with their emotions through values values emotion action© NHS Institute for Innovation and Improvement, 2009 Source: Marshall Ganz
  29. 29. © NHS Institute for Innovation and Improvement, 2009
  30. 30. But not all emotions are equal.........Action motivators Action inhibitors inertia Overcome urgency anger apathy hope fear solidarity isolation you can make Self- a difference doubt Source: Marshall Ganz© NHS Institute for Innovation and Improvement, 2009
  31. 31. What the framing literature tells us People are much more likely to embrace change if it is framed as something that builds positively on what they are familiar with than as something that seems far away and unachievable. “„a new idea must be at the least couched in the language of past ideas; often, it must be, at first, diluted with vestiges of the past” Saul Alinsky Rules for Radicals (1971)© NHS Institute for Innovation and Improvement, 2009
  32. 32. Three components of transformational change (Fry 2002) • Novelty / innovation • Transition • Continuity© NHS Institute for Innovation and Improvement, 2009
  33. 33. “When you have gone as far that you can‟t manage one more step, then you have gone just half the distance that you are capable of” Proverb of the Inuit people of the Arctic Circle© NHS Institute for Innovation and Improvement, 2009
  34. 34. What do we need to do? 1. Tell a story 2. Make it personal 3. Be authentic 4. Create a sense of “us” (and be clear who the “us” is) 5. Build in a call for urgent action © NHS Institute for Innovation and Improvement, 2009
  35. 35. Public Narrative story of story of Self PURPOSE Now call to Strategy leadership and action Why story of I am called to do this Us Shared values and our shared work shared experience EXPERIENCE reveals our shared VALUES© NHS Institute for Innovation and Improvement, 2009 Source: Marshall Ganz
  36. 36. Public Narrative story of story of Self PURPOSE Now call to Strategy leadership and action Why we frame the story of urgency and I am hopefulness called to do this Us necessary to secure commitment and build momentum Shared values and our shared shared towards our work shared experience EXPERIENCE goal reveals our shared VALUES© NHS Institute for Innovation and Improvement, 2009 Source: Marshall Ganz
  37. 37. Telling your narrative “A good narrative is drawn from the series of choice points that have structured the “plot” of your life – the challenges you faced; choices you made and outcomes you experienced” • Challenge: why did you feel it was a challenge? Why was it your challenge? • Choice: why did you make the choice you did? Where did you get the courage or hope? How did it feel? • Outcome: How did the outcome feel? Why did it feel that way? What do you want us to feel? © NHS Institute for Innovation and Improvement, 2009 Source: Marshall Ganz
  38. 38. Show – don’t tell! • Specific moments • Specific people • Specific values • Specific challenges • Specific choices • Specific outcomes …and well chosen vivid details!© NHS Institute for Innovation and Improvement, 2009 Source: Marshall Ganz
  39. 39. Task• Find a “partner” to work with• Spend two minutes quietly developing your story – The challenge, choice and outcomes should be explicit• A timekeeper will make sure that everyone sticks to timings• Share your story of self with your partner• Coach each other on the stories• Time allowed – two minutes per person to tell story – two minutes per person to feedback © NHS Institute for Innovation and Improvement, 2009
  40. 40. Feedback • Was the – challenge – choice – outcome explicit? • Could you identify with the person‟s values? Where did they come from? • Were the details vivid in ways that helped you to identify what the person was feeling? © NHS Institute for Innovation and Improvement, 2009
  41. 41. © NHS Institute for Innovation and Improvement, 2009
  42. 42. Made in Dagenham The main character, Sandra, seeks to convince her audience to take action • What is the call to action that she is making? • What fundamental values does she call on? • What are the shared experiences that revel shared values? • How does she create a sense of “us”?© NHS Institute for Innovation and Improvement, 2009
  43. 43. We have a choice “This is the true joy of life, the being used up for a purpose recognised by yourself as a mighty one, being a force of nature instead of a feverish, selfish little clot of ailments and grievances, complaining that the world will not devote itself to making you happy” George Bernard Shaw© NHS Institute for Innovation and Improvement, 2009
  44. 44. Leading Large Scale Change: Web seminars for senior leadersSix free web seminars for senior leaders (60 minutes each) from January 2012 to March2012. You can download the recordings These expert led seminars are designed to give you a rapid overview of the key ideas thatrepresent the latest thinking on leading large scale change.1.Delivering large scale change: the reality of how to make it happenSarah Fraser (13th January 2012) Fortnightly: 8:30am GMT Friday2.Creating energy to drive transformation (hosted by Director of Learning andHelen Bevan (27 th January 2012) Development, Julia RA Taylor)3.The leadership of large scale changeHelen Bevan & Karen Lynas (10th February 2012)4.Large scale change in action To register go to: www.institute.nhs.uk/LargeScaleChangeCase study site (24th February 2012)5.Building widespread commitment For more details contact:Julia RA Taylor (9th March 2012) LargeScaleChange@institute.nhs.uk6.Spreading and sustaining large scale change You can also get details of the latestSarah Fraser (23rd March 2012) virtual training programmes from this website © NHS Institute for Innovation and Improvement, 2009

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