SlideShare a Scribd company logo

2013 03-03 - large scale change for integrated care - r varnam (slideshare)

Robert Varnam Coaching
Robert Varnam Coaching
Robert Varnam CoachingDirector of general practice development at NHS England

2013 03-03 - large scale change for integrated care - r varnam (slideshare)

1 of 43
Download to read offline
Leading large scale change for integrated care
Dr Robert Varnam PhD MRCGP
Head of general practice development, NHS England
Clinical lead for CCG & primary care delivery, NHS Improving Quality
GP, Robert Darbishire Practice, Manchester
@robertvarnam
robert.varnam@nhs.net
Leading large scale change for integrated care
 The story so far
 Change in complexity
 Creating shared purpose
 Sequencing
 Top tips
Leading large scale change for integrated care
 The story so far
 Change in complexity
 Creating shared purpose
 Sequencing
 Top tips
The story so far
Structure + process = outcome
Structures
Infrastructure
ProcessesBehaviours

Recommended

The Theory of Change Approach
The Theory of Change ApproachThe Theory of Change Approach
The Theory of Change ApproachEric Graig
 
Chris pascal keynote_pp 11
Chris pascal keynote_pp 11Chris pascal keynote_pp 11
Chris pascal keynote_pp 11CREC_APT
 
Nudge theory
Nudge theoryNudge theory
Nudge theoryvikashita
 
Creating the culture for innovation - A guide for executives
Creating the culture for innovation - A guide for executivesCreating the culture for innovation - A guide for executives
Creating the culture for innovation - A guide for executivesNHS IQ legacy organisations
 
How Change Happens Webinar 08 June
How Change Happens Webinar 08 JuneHow Change Happens Webinar 08 June
How Change Happens Webinar 08 JuneJill Hinson
 
Communicating to decision makers karen wolfe
Communicating to decision makers karen wolfeCommunicating to decision makers karen wolfe
Communicating to decision makers karen wolfePenelope Toth
 
Releasing Individual Potential through Employee Wellbeing
Releasing Individual Potential through Employee WellbeingReleasing Individual Potential through Employee Wellbeing
Releasing Individual Potential through Employee WellbeingOPRA Psychology Group
 

More Related Content

What's hot

The hack day for the NHS Change Model
The hack day for the NHS Change ModelThe hack day for the NHS Change Model
The hack day for the NHS Change ModelNHS Improving Quality
 
An introduction to the NHS Change Model
An introduction to the NHS Change ModelAn introduction to the NHS Change Model
An introduction to the NHS Change ModelNHS Improving Quality
 
Major change within organisations has become the norm in the 21st century
Major change within organisations has become the norm in the 21st centuryMajor change within organisations has become the norm in the 21st century
Major change within organisations has become the norm in the 21st centuryAssentire Ltd
 
NHS Change Model hack day full report
NHS Change Model hack day full reportNHS Change Model hack day full report
NHS Change Model hack day full reportNHS Improving Quality
 
The Emergence of Strategic Doing
The Emergence of Strategic DoingThe Emergence of Strategic Doing
The Emergence of Strategic DoingEd Morrison
 
Using "solution space" to innovate and improve quality
Using "solution space" to innovate and improve qualityUsing "solution space" to innovate and improve quality
Using "solution space" to innovate and improve qualityBASPCAN
 
Facilitating change in health and social care
Facilitating change in health and social careFacilitating change in health and social care
Facilitating change in health and social careSurose Aryal
 
Hcvln assessment part 1 v4
Hcvln assessment part 1 v4Hcvln assessment part 1 v4
Hcvln assessment part 1 v4Mike Stoecklein
 
Special Interest Session 1: Safety, Collaboration and Spread Across Boundaries
Special Interest Session 1: Safety, Collaboration and Spread Across BoundariesSpecial Interest Session 1: Safety, Collaboration and Spread Across Boundaries
Special Interest Session 1: Safety, Collaboration and Spread Across BoundariesNHSScotlandEvent2013
 
Prevention; Wellness Practices In A 21st Century
Prevention; Wellness Practices In A 21st CenturyPrevention; Wellness Practices In A 21st Century
Prevention; Wellness Practices In A 21st CenturyUniversity of New Mexico
 
Stress busters – what helps social workers and why?
Stress busters – what helps social workers and why?Stress busters – what helps social workers and why?
Stress busters – what helps social workers and why?Jo Moriarty
 
Mechanisms of Collaboration and Engagement
Mechanisms of Collaboration and EngagementMechanisms of Collaboration and Engagement
Mechanisms of Collaboration and EngagementChristopher Wilson
 
Complexity aa sept2015
Complexity aa sept2015Complexity aa sept2015
Complexity aa sept2015BondUK
 
Contribution and Impact Tools - Iriss
Contribution and Impact Tools - IrissContribution and Impact Tools - Iriss
Contribution and Impact Tools - IrissIriss
 
To be or not to be: A systematic review and critique of safety leadership res...
To be or not to be: A systematic review and critique of safety leadership res...To be or not to be: A systematic review and critique of safety leadership res...
To be or not to be: A systematic review and critique of safety leadership res...Australian Institute of Health & Safety
 
Service design: why haven't we changed the world yet?
Service design: why haven't we changed the world yet?Service design: why haven't we changed the world yet?
Service design: why haven't we changed the world yet?ThePublicOffice
 
Hazards of Change - Lowering the risk of injury through intentional implement...
Hazards of Change - Lowering the risk of injury through intentional implement...Hazards of Change - Lowering the risk of injury through intentional implement...
Hazards of Change - Lowering the risk of injury through intentional implement...Australian Institute of Health & Safety
 
Thinking differently in the NHS - Zoe Lord - Change Management Institute
Thinking differently in the NHS - Zoe Lord - Change Management InstituteThinking differently in the NHS - Zoe Lord - Change Management Institute
Thinking differently in the NHS - Zoe Lord - Change Management InstituteZoe Lord
 

What's hot (20)

The hack day for the NHS Change Model
The hack day for the NHS Change ModelThe hack day for the NHS Change Model
The hack day for the NHS Change Model
 
An introduction to the NHS Change Model
An introduction to the NHS Change ModelAn introduction to the NHS Change Model
An introduction to the NHS Change Model
 
ISPIM-2017
ISPIM-2017ISPIM-2017
ISPIM-2017
 
Major change within organisations has become the norm in the 21st century
Major change within organisations has become the norm in the 21st centuryMajor change within organisations has become the norm in the 21st century
Major change within organisations has become the norm in the 21st century
 
NHS Change Model hack day full report
NHS Change Model hack day full reportNHS Change Model hack day full report
NHS Change Model hack day full report
 
The Emergence of Strategic Doing
The Emergence of Strategic DoingThe Emergence of Strategic Doing
The Emergence of Strategic Doing
 
T. vogus saturday the case for org
T. vogus saturday the case for orgT. vogus saturday the case for org
T. vogus saturday the case for org
 
Using "solution space" to innovate and improve quality
Using "solution space" to innovate and improve qualityUsing "solution space" to innovate and improve quality
Using "solution space" to innovate and improve quality
 
Facilitating change in health and social care
Facilitating change in health and social careFacilitating change in health and social care
Facilitating change in health and social care
 
Hcvln assessment part 1 v4
Hcvln assessment part 1 v4Hcvln assessment part 1 v4
Hcvln assessment part 1 v4
 
Special Interest Session 1: Safety, Collaboration and Spread Across Boundaries
Special Interest Session 1: Safety, Collaboration and Spread Across BoundariesSpecial Interest Session 1: Safety, Collaboration and Spread Across Boundaries
Special Interest Session 1: Safety, Collaboration and Spread Across Boundaries
 
Prevention; Wellness Practices In A 21st Century
Prevention; Wellness Practices In A 21st CenturyPrevention; Wellness Practices In A 21st Century
Prevention; Wellness Practices In A 21st Century
 
Stress busters – what helps social workers and why?
Stress busters – what helps social workers and why?Stress busters – what helps social workers and why?
Stress busters – what helps social workers and why?
 
Mechanisms of Collaboration and Engagement
Mechanisms of Collaboration and EngagementMechanisms of Collaboration and Engagement
Mechanisms of Collaboration and Engagement
 
Complexity aa sept2015
Complexity aa sept2015Complexity aa sept2015
Complexity aa sept2015
 
Contribution and Impact Tools - Iriss
Contribution and Impact Tools - IrissContribution and Impact Tools - Iriss
Contribution and Impact Tools - Iriss
 
To be or not to be: A systematic review and critique of safety leadership res...
To be or not to be: A systematic review and critique of safety leadership res...To be or not to be: A systematic review and critique of safety leadership res...
To be or not to be: A systematic review and critique of safety leadership res...
 
Service design: why haven't we changed the world yet?
Service design: why haven't we changed the world yet?Service design: why haven't we changed the world yet?
Service design: why haven't we changed the world yet?
 
Hazards of Change - Lowering the risk of injury through intentional implement...
Hazards of Change - Lowering the risk of injury through intentional implement...Hazards of Change - Lowering the risk of injury through intentional implement...
Hazards of Change - Lowering the risk of injury through intentional implement...
 
Thinking differently in the NHS - Zoe Lord - Change Management Institute
Thinking differently in the NHS - Zoe Lord - Change Management InstituteThinking differently in the NHS - Zoe Lord - Change Management Institute
Thinking differently in the NHS - Zoe Lord - Change Management Institute
 

Similar to 2013 03-03 - large scale change for integrated care - r varnam (slideshare)

"Signed, Sealed Delivered": leading improvement in a new era
"Signed, Sealed Delivered": leading improvement in a new era"Signed, Sealed Delivered": leading improvement in a new era
"Signed, Sealed Delivered": leading improvement in a new eraHelen Bevan
 
Scaling down and scaling up
Scaling down and scaling upScaling down and scaling up
Scaling down and scaling upHelen Bevan
 
Project Managers as instrument of change (change agents in action)
Project Managers as instrument of change (change agents in action)Project Managers as instrument of change (change agents in action)
Project Managers as instrument of change (change agents in action)PMI-Montréal
 
Sustainable change at scale and pace: How do we create change that sticks and...
Sustainable change at scale and pace: How do we create change that sticks and...Sustainable change at scale and pace: How do we create change that sticks and...
Sustainable change at scale and pace: How do we create change that sticks and...Helen Bevan
 
Seven-influence-strategies-session-8-2015.pptx
Seven-influence-strategies-session-8-2015.pptxSeven-influence-strategies-session-8-2015.pptx
Seven-influence-strategies-session-8-2015.pptxT.J. Elliott
 
The new era of change and transformation
The new era of change and transformationThe new era of change and transformation
The new era of change and transformationHelen Bevan
 
Strategy, Policy and Change Workshop May 2014
Strategy, Policy and Change Workshop May 2014 Strategy, Policy and Change Workshop May 2014
Strategy, Policy and Change Workshop May 2014 Brett Gardiner
 
ICWES15 - Workshop: Making Change Stick! - Systems for Sustaining Change. Pre...
ICWES15 - Workshop: Making Change Stick! - Systems for Sustaining Change. Pre...ICWES15 - Workshop: Making Change Stick! - Systems for Sustaining Change. Pre...
ICWES15 - Workshop: Making Change Stick! - Systems for Sustaining Change. Pre...Engineers Australia
 
Change transition management.....
Change transition management.....Change transition management.....
Change transition management.....Moch Kurniawan
 
Impact practice in the third sector for public health practitioners
Impact practice in the third sector   for public health practitionersImpact practice in the third sector   for public health practitioners
Impact practice in the third sector for public health practitionersCatherine A. Greaves
 
Creating Tomorrow Today: Unleashing Learning as a Power for Transformation
Creating Tomorrow Today: Unleashing Learning as a Power for Transformation Creating Tomorrow Today: Unleashing Learning as a Power for Transformation
Creating Tomorrow Today: Unleashing Learning as a Power for Transformation Zoe Lord
 
Waste Management Research Paper
Waste Management Research PaperWaste Management Research Paper
Waste Management Research PaperJennifer Ontiveros
 
Pennine acute trust and aqua celebration event fiona thow
Pennine acute trust and aqua celebration event   fiona thowPennine acute trust and aqua celebration event   fiona thow
Pennine acute trust and aqua celebration event fiona thowNHS Improving Quality
 
Aventus Partners on Organisation Behavior and Change
Aventus Partners on Organisation Behavior and ChangeAventus Partners on Organisation Behavior and Change
Aventus Partners on Organisation Behavior and ChangeMP Sriram
 
slidesforchangemanagement-141125085630-conversion-gate01
slidesforchangemanagement-141125085630-conversion-gate01slidesforchangemanagement-141125085630-conversion-gate01
slidesforchangemanagement-141125085630-conversion-gate01saroja sahadevan
 

Similar to 2013 03-03 - large scale change for integrated care - r varnam (slideshare) (20)

"Signed, Sealed Delivered": leading improvement in a new era
"Signed, Sealed Delivered": leading improvement in a new era"Signed, Sealed Delivered": leading improvement in a new era
"Signed, Sealed Delivered": leading improvement in a new era
 
Scaling down and scaling up
Scaling down and scaling upScaling down and scaling up
Scaling down and scaling up
 
Project Managers as instrument of change (change agents in action)
Project Managers as instrument of change (change agents in action)Project Managers as instrument of change (change agents in action)
Project Managers as instrument of change (change agents in action)
 
Sustainable change at scale and pace: How do we create change that sticks and...
Sustainable change at scale and pace: How do we create change that sticks and...Sustainable change at scale and pace: How do we create change that sticks and...
Sustainable change at scale and pace: How do we create change that sticks and...
 
Directing change
Directing changeDirecting change
Directing change
 
Seven-influence-strategies-session-8-2015.pptx
Seven-influence-strategies-session-8-2015.pptxSeven-influence-strategies-session-8-2015.pptx
Seven-influence-strategies-session-8-2015.pptx
 
The new era of change and transformation
The new era of change and transformationThe new era of change and transformation
The new era of change and transformation
 
Strategy, Policy and Change Workshop May 2014
Strategy, Policy and Change Workshop May 2014 Strategy, Policy and Change Workshop May 2014
Strategy, Policy and Change Workshop May 2014
 
ICWES15 - Workshop: Making Change Stick! - Systems for Sustaining Change. Pre...
ICWES15 - Workshop: Making Change Stick! - Systems for Sustaining Change. Pre...ICWES15 - Workshop: Making Change Stick! - Systems for Sustaining Change. Pre...
ICWES15 - Workshop: Making Change Stick! - Systems for Sustaining Change. Pre...
 
CCG transforming care programme
CCG transforming care programmeCCG transforming care programme
CCG transforming care programme
 
Change transition management.....
Change transition management.....Change transition management.....
Change transition management.....
 
Change management
Change managementChange management
Change management
 
Theory of Change
Theory of ChangeTheory of Change
Theory of Change
 
Impact practice in the third sector for public health practitioners
Impact practice in the third sector   for public health practitionersImpact practice in the third sector   for public health practitioners
Impact practice in the third sector for public health practitioners
 
Creating Tomorrow Today: Unleashing Learning as a Power for Transformation
Creating Tomorrow Today: Unleashing Learning as a Power for Transformation Creating Tomorrow Today: Unleashing Learning as a Power for Transformation
Creating Tomorrow Today: Unleashing Learning as a Power for Transformation
 
Waste Management Research Paper
Waste Management Research PaperWaste Management Research Paper
Waste Management Research Paper
 
Pennine acute trust and aqua celebration event fiona thow
Pennine acute trust and aqua celebration event   fiona thowPennine acute trust and aqua celebration event   fiona thow
Pennine acute trust and aqua celebration event fiona thow
 
Aventus Partners on Organisation Behavior and Change
Aventus Partners on Organisation Behavior and ChangeAventus Partners on Organisation Behavior and Change
Aventus Partners on Organisation Behavior and Change
 
Making sense of outcomes based commissioningv4
Making sense of outcomes based commissioningv4Making sense of outcomes based commissioningv4
Making sense of outcomes based commissioningv4
 
slidesforchangemanagement-141125085630-conversion-gate01
slidesforchangemanagement-141125085630-conversion-gate01slidesforchangemanagement-141125085630-conversion-gate01
slidesforchangemanagement-141125085630-conversion-gate01
 

More from Robert Varnam Coaching

Lead with why, Next Generation GP, Norfolk
Lead with why, Next Generation GP, NorfolkLead with why, Next Generation GP, Norfolk
Lead with why, Next Generation GP, NorfolkRobert Varnam Coaching
 
We're a primary care network - now what?
We're a primary care network - now what?We're a primary care network - now what?
We're a primary care network - now what?Robert Varnam Coaching
 
Time for Care. South & North Tandridge Network Group Training Event
Time for Care. South & North Tandridge Network Group Training EventTime for Care. South & North Tandridge Network Group Training Event
Time for Care. South & North Tandridge Network Group Training EventRobert Varnam Coaching
 
Leading improvement - lead with why, Pulse Live Liverpool
Leading improvement - lead with why, Pulse Live LiverpoolLeading improvement - lead with why, Pulse Live Liverpool
Leading improvement - lead with why, Pulse Live LiverpoolRobert Varnam Coaching
 
Improvement directors network - welcome
Improvement directors network - welcomeImprovement directors network - welcome
Improvement directors network - welcomeRobert Varnam Coaching
 
Primary care networks, realising the potential and avoiding the pitfalls
Primary care networks, realising the potential and avoiding the pitfallsPrimary care networks, realising the potential and avoiding the pitfalls
Primary care networks, realising the potential and avoiding the pitfallsRobert Varnam Coaching
 
Primary care networks - why and how (leaders' tips)
Primary care networks - why and how (leaders' tips)Primary care networks - why and how (leaders' tips)
Primary care networks - why and how (leaders' tips)Robert Varnam Coaching
 
The future of primary care and how to get there (Leeds CCG)
The future of primary care and how to get there (Leeds CCG)The future of primary care and how to get there (Leeds CCG)
The future of primary care and how to get there (Leeds CCG)Robert Varnam Coaching
 
Online consultations - why, what, how?
Online consultations - why, what, how?Online consultations - why, what, how?
Online consultations - why, what, how?Robert Varnam Coaching
 
Designing the future primary care workforce (SouthWest workshop 23/04/18)
Designing the future primary care workforce (SouthWest workshop 23/04/18)Designing the future primary care workforce (SouthWest workshop 23/04/18)
Designing the future primary care workforce (SouthWest workshop 23/04/18)Robert Varnam Coaching
 
Intro to online consultations, 17 Jan, Leeds
Intro to online consultations, 17 Jan, LeedsIntro to online consultations, 17 Jan, Leeds
Intro to online consultations, 17 Jan, LeedsRobert Varnam Coaching
 
Releasing time for care, Horsham and Mid Sussex and Crawley CCGs
Releasing time for care, Horsham and Mid Sussex and Crawley CCGsReleasing time for care, Horsham and Mid Sussex and Crawley CCGs
Releasing time for care, Horsham and Mid Sussex and Crawley CCGsRobert Varnam Coaching
 

More from Robert Varnam Coaching (20)

Lead with why, Next Generation GP, Norfolk
Lead with why, Next Generation GP, NorfolkLead with why, Next Generation GP, Norfolk
Lead with why, Next Generation GP, Norfolk
 
Improvement design - start at the end
Improvement design - start at the endImprovement design - start at the end
Improvement design - start at the end
 
We're a primary care network - now what?
We're a primary care network - now what?We're a primary care network - now what?
We're a primary care network - now what?
 
Time for Care. South & North Tandridge Network Group Training Event
Time for Care. South & North Tandridge Network Group Training EventTime for Care. South & North Tandridge Network Group Training Event
Time for Care. South & North Tandridge Network Group Training Event
 
Leading improvement - lead with why, Pulse Live Liverpool
Leading improvement - lead with why, Pulse Live LiverpoolLeading improvement - lead with why, Pulse Live Liverpool
Leading improvement - lead with why, Pulse Live Liverpool
 
Improvement directors network - welcome
Improvement directors network - welcomeImprovement directors network - welcome
Improvement directors network - welcome
 
190326 Redesign for integrated care
190326 Redesign for integrated care190326 Redesign for integrated care
190326 Redesign for integrated care
 
Primary care networks, realising the potential and avoiding the pitfalls
Primary care networks, realising the potential and avoiding the pitfallsPrimary care networks, realising the potential and avoiding the pitfalls
Primary care networks, realising the potential and avoiding the pitfalls
 
Primary care networks - why and how (leaders' tips)
Primary care networks - why and how (leaders' tips)Primary care networks - why and how (leaders' tips)
Primary care networks - why and how (leaders' tips)
 
Primary care networks - why? How?
Primary care networks - why? How?Primary care networks - why? How?
Primary care networks - why? How?
 
Why won't my innovation spread
Why won't my innovation spreadWhy won't my innovation spread
Why won't my innovation spread
 
So you're interested in leadership
So you're interested in leadershipSo you're interested in leadership
So you're interested in leadership
 
The future of primary care and how to get there (Leeds CCG)
The future of primary care and how to get there (Leeds CCG)The future of primary care and how to get there (Leeds CCG)
The future of primary care and how to get there (Leeds CCG)
 
Online consultations - why, what, how?
Online consultations - why, what, how?Online consultations - why, what, how?
Online consultations - why, what, how?
 
Designing the future primary care workforce (SouthWest workshop 23/04/18)
Designing the future primary care workforce (SouthWest workshop 23/04/18)Designing the future primary care workforce (SouthWest workshop 23/04/18)
Designing the future primary care workforce (SouthWest workshop 23/04/18)
 
Intro to online consultations, 17 Jan, Leeds
Intro to online consultations, 17 Jan, LeedsIntro to online consultations, 17 Jan, Leeds
Intro to online consultations, 17 Jan, Leeds
 
Support to implement change
Support to implement changeSupport to implement change
Support to implement change
 
Managing workload in general practice
Managing workload in general practiceManaging workload in general practice
Managing workload in general practice
 
Primary care - strengths and future
Primary care - strengths and futurePrimary care - strengths and future
Primary care - strengths and future
 
Releasing time for care, Horsham and Mid Sussex and Crawley CCGs
Releasing time for care, Horsham and Mid Sussex and Crawley CCGsReleasing time for care, Horsham and Mid Sussex and Crawley CCGs
Releasing time for care, Horsham and Mid Sussex and Crawley CCGs
 

2013 03-03 - large scale change for integrated care - r varnam (slideshare)

  • 1. Leading large scale change for integrated care Dr Robert Varnam PhD MRCGP Head of general practice development, NHS England Clinical lead for CCG & primary care delivery, NHS Improving Quality GP, Robert Darbishire Practice, Manchester @robertvarnam robert.varnam@nhs.net
  • 2. Leading large scale change for integrated care  The story so far  Change in complexity  Creating shared purpose  Sequencing  Top tips
  • 3. Leading large scale change for integrated care  The story so far  Change in complexity  Creating shared purpose  Sequencing  Top tips
  • 7. The story so far We have often focused on structures & provider-led change … and ended up with integration of providers (more than care) … made more improvements than transformations ... and found progress hard to sustain … which was entirely predictable
  • 8. So what are we dealing with?
  • 9. Improvement or transformation? Improvement Transformation Doing things better / differently Doing better / different things
  • 10. What is „large scale‟ change? Depth of change vis-à-vis current ways of thinking and doing; a.k.a cognitive-behavioural or paradigm shift Pervasiveness of change; does it affect whole or only portion of the system? Size of system experiencing change; e.g. geography, numbers of people Refs: Mohrman A. et. al. Large-Scale Organizational Change. Jossey-Bass, 1989 and Levy A. Second-order planned change: definitions and conceptualizations. Org. Dynamics. Summer 1986, 15:5-20
  • 11. Large scale change usually fails Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey of company executives 70% 25% 5%
  • 12. Leading large scale change for integrated care  The story so far  Change in complexity  Creating shared purpose  Sequencing  Top tips
  • 13. Levers for change What happens ...
  • 14. Levers for change What happens ...
  • 15. Levers for change What happens ...
  • 16. Levers for change What happens ...
  • 17. Levers for change What happens ...
  • 18. Levers for change Very few of our „wicked‟ problems will be addressed by believing the health and care system is a machine. Our experience shows that it behaves like a complex social organism. It is time for a different paradigm of large scale change…
  • 19. Complex Complicated Chaotic Simple Emergent practice Good practice Best practiceNovel practice Snowden D & Benford RD. The Cynefin Framework. Cause & effect relationships exist, are obvious to most people & predictable & repeatable. Can be known in advance. Cause & effect relationships exist, but not obvious, so require analysis/investigation +/- expert knowledge. Cause & effect only obvious in hindsight, with unpredictable, emergent outcomes. No cause & effect relationships can be determined. Probe. Sense. Respond. Sense. Analyse. Respond. Sense. Categorise. Respond.Act. Sense. Respond. Knowable Known Disorder Several options
  • 20. www.youtube.com/watch?v=ctMty7av0jc Coordinated, behaviour – thousands of birds moving ‘as one’ – with no external control How? A small number of simple rules, internalised: • Separation: steer to avoid crowding local flockmates, • Alignment: steer towards the average heading of local flockmates, and • Cohesion: steer to move toward the average position of local flockmates .
  • 21. Leading in complexity  A small number of simple rules  Acting within each unit  A few well-tested external influences & barriers
  • 22. Leading large scale change for integrated care  The story so far  Change in complexity  Creating shared purpose  Sequencing  Top tips
  • 24. What’s the financial incentive? Who is performance managing? What’s the project plan?
  • 25. “I have some KPIs for your” or “I have a dream”
  • 26. “You can’t impose anything on anyone and expect them to be committed to it” Edgar Schein Professor Emeritus, MIT Sloan School
  • 27. Drivers of extrinsic motivation  regulation  payment & incentive systems  performance management  measurement for accountability create focus & momentum for delivery Intrinsic motivators  connecting to shared purpose  engaging, mobilising and calling to action  motivational leadership build energy and creativity
  • 28. build energy and creativity Internal motivators  connecting to  shared purpose  engaging, mobilising and calling to action  motivational leadership Drivers of extrinsic motivation  System drivers & incentives  Performance management  Measurement for accountability create & focus momentum for delivery
  • 30. How do we create shared purpose? Identify shared values Create a safe space Create a vision for the future Describe why the change is urgent now Amended from work by Roffey Park
  • 31. [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 Garguilo
  • 32. Using shared purpose The „why‟ of your change A gravitational force for drivers The fuel that won‟t run out A uniting force for stakeholders
  • 33. Leading large scale change for integrated care  The story so far  Change in complexity  Creating shared purpose  Sequencing  Top tips
  • 34. Complex Complicated Chaotic Simple Emergent practice Good practice Best practiceNovel practice Snowden D & Benford RD. The Cynefin Framework. Cause & effect relationships exist, are obvious to most people & predictable & repeatable. Can be known in advance. Cause & effect relationships exist, but not obvious, so require analysis/investigation +/- expert knowledge. Cause & effect only obvious in hindsight, with unpredictable, emergent outcomes. No cause & effect relationships can be determined. Probe. Sense. Respond. Sense. Analyse. Respond. Sense. Categorise. Respond.Act. Sense. Respond. Disorder
  • 35. Sequencing in large scale change Identifying need for change Framing/ reframing the issues Engaging/ connecting others Making pragmatic change in multiple processes Attracting further interest After some time Settling in Possible outcomes 1. sustainable norm 2. plateau 3. run out of energy Living with results and consequences Maybe later Repeats many times in hard to predict ways Time delay
  • 36. Large Scale Change The emergent process of mobilising a large collection of individuals, groups and organisations toward a vision of a fundamentally new future state, by means of: • high-leverage key themes • a shift in power and a more distributed leadership • massive and active engagement of stakeholders • mutually reinforcing changes in multiple factors • a focus on changing patterns of behaviour, relationship & power
  • 37. Leading large scale change for integrated care  The story so far  Change in complexity  Creating shared purpose  Sequencing  Top tips
  • 38. Conclusions from the evidence Successful integration requires: • shared purpose & collaborative behaviours, more than new structures • overcoming silos through communication (leaders & staff talking, shared patient record, shared performance data) • much can be done within existing regimes (eg tariff, Caldicott) • no silver bullet bit.ly/RzENMB
  • 39. Conclusions from the evidence “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).
  • 40. Conclusions from the evidence • Eventually, successful commissioners have to adopt different approaches: • see the whole system, not just constituent services • more relational, less transactional • more clinically-led collaboration with providers, less finance-led negotiation • more provider-led innovation & improvement • less bound by annual & linear cycles, more flexible, long-term & iterative bit.ly/13Otdyq
  • 41. Top tips (NHS Academy for Large Scale Change) 1. Moving towards a new vision that is better and fundamentally different from the status quo 2. Identifying and communicating 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 5. Mutually reinforcing change across multiple processes/subsystems
  • 42. Top tips (NHS Academy for Large Scale Change) 1. Continually refreshing the story and attracting new, active supporters 2. Emergent planning and design, based on monitoring progress and adapting as you go 3. Enabling many people to contribute to the leadership of change, beyond organisational boundaries 4. Transforming mindsets, leading to inherently sustainable change 5. Maintaining and refreshing the leaders‟ energy over the long haul

Editor's Notes

  1. Acknowledgements & link to IQ CCGD
  2. SIMPLE – direct & obvious cause & effect
  3. SIMPLE (if you know it) - ?COMPLICATED – long chain of cause & effect
  4. COMPLICATED – it might take a while, but it’s still knowable. And reproducible.
  5. How knowable is it? How predictable? How reproducible?What if you did it repeatedly?
  6. How knowable is it? How predictable? How reproducible?What if you did it repeatedly?
  7. How knowable is it? How predictable? How reproducible?What if you did it repeatedly?
  8. The Cynefin (“kin-EV-in”) Framework. Useful for making sense of the ‘space’ you’re in and choosing a decision approach accordingly. www.youtube.com/watch?v=N7oz366X0-8 The framework was developed by Dave Snowdenden while working at IBM. Simple, in which the relationship between cause and effect is obvious to all, the approach is to Sense - Categorise - Respond and we can apply best practice.Complicated – good practice .. several options exist, experts should be allowed to choose from among them.Complex, - low control approach .. ‘agents modify the system’ (Dave Snowdenden). Probe-Sense-Respond = conduct experiments: “safe fail experiments, not fail-safe design” (Snowdenden). You can move towards order, but it emerges over time.Chaotic, Can be entered intentionally = innovation. If accidental = you need to “act” to stabilise situation quickly, using novel practice. Disorder = state of not knowing what type of causality exists, in which state people will revert to their own comfort zone in making a decisionthe boundary between simple and chaotic is seen as a catastrophic one: complacency leads to failure.
  9. VIDEO – flocking birds
  10. Examples of Social Movements: people doing something for a cause …The early psychosis declaration: Under the banner of IRIS a small group of people from around the UK gathered in Cheltenham in 2001 to discuss how they might generate a consensus on how services could be improved for young people with psychosis and their families. From those initial ideas the launch of the National Institute for Mental Health in England provided an ideal platform for further development.  40 people (service users, family members, and expert practitioners) met with representatives of the World Health Organisation (WHO), IRIS and Rethink to agree standards of care that those developing early psychosis and their families should expect. The IRA Hbloock/Armagh: IRA leaders detained in prison went on a dirty protest and refused to eat – Bobbly Sands was elected to the UK parliament whilst in prison and not allowed to take up his seat and died in prison. Greenpeace: surely everyone knows something about Greenpeace?100k lives campaign: in the USA from IHI, participating organizations agreed to provide monthly mortality statistics and adopt at least one of six interventions. These interventions included dispatching rapid response teams at the first sign of patient decline, following rigorous protocols to prevent infections caused by surgery, central venous catheters, and ventilators, giving heart attack patients recommended medications when they enter and leave the hospital, and checking to make sure all medications taken by a patient are appropriate. The 5 Million Lives Campaign calls for six additional interventions, including guidance on best practices to prevent pressure ulcers and to reduce Methicillin-Resistant Staphylococcus aureus (MRSA) infectionMarathon runners: City marathons for charity as well as elite athletes started in London on the 80s and have grown and spread all over the worldSuffragettesCND: peace marchers and peace camps against nuclear war British Heart Foundation – could have any number of charities
  11. Large scale action - Not requiring large leadership team or compliance frameworkDefinition used in “The Power of One, the Power of Many” = a voluntary collective of individuals committed to promoting or resisting change through co-ordinated activity.
  12. Connection is made with individuals by connecting with their values
  13. why shared purpose is a critical issue for NHS transformationhow shared purpose is different to organisational purposehow shared purpose underpins all other elements of the NHS Change Model how to build shared purpose
  14. Lots of evidence from around the world about how commissioners actually do their job. It’s worth reading.This is just one example, with key lessons here.This recent summary of several in-depth case studies shows that successful commissioners have to break out of some of the traditional moulds.
  15. Lots of evidence from around the world about how commissioners actually do their job. It’s worth reading.This is just one example, with key lessons here.This recent summary of several in-depth case studies shows that successful commissioners have to break out of some of the traditional moulds.