4. @robertvarnam@robertvarnam
Leading improvement
Being an improver is a noble calling with a
guarantee of challenge after challenge.
Whether it’s successful or rewarding is mostly
down to how you approach it.
Learning objectives
Challenge our thinking about leadership and hierarchies
Apply key lessons from the social movement paradigm of
change to our own attempts to lead change
6. @robertvarnam@robertvarnam
One of the earliest experiences every improver has
is of trying to get people to do what you want.
It’s also one of the hardest.
Leading improvement
13. @robertvarnam
From compliance to commitment
From Compliance To commitment
States a minimum performance
standard that everyone must achieve
States a collective goal that everyone
can aspire to
Uses hierarchy, systems and
standard procedures for coordination
and control
Based on shared goals, values and
sense of purpose for co-ordination and
control
Threat of penalties/sanctions/shame
creates momentum for delivery
Commitment to a common purpose
creates energy for delivery
Extrinsic motivators
Mechanistic approach to change
Intrinsic motivators
Values-based approach to change
18. @robertvarnam
The NHS has been instructed to improve access to general
practice.
Far-reaching changes are required in every local community,
including new patient pathways, extended opening hours,
changes to the workforce and greater use of technology.
By March 2019, every part of the country is expected to be
providing improved access, supported by a new investment of
£6 / patient and monitored through measurement of
appointment activity and patient satisfaction.
Extrinsic motivators
Mechanistic approach to change
Intrinsic motivators
Values-based approach to change
22. @robertvarnam
Developing the art…
You need to know:
• what the important shared values are
• which ones are most likely to drive action
• how to tap into the emotions most likely to lead to
positive action
• what the most common misconceptions will be
• what the most pernicious defacto purposes are
24. @robertvarnam
Resources
• The power of one, the power of many.
bit.ly/powerofonemanypdf
• Start with why. youtu.be/IPYeCltXpxw [short]
youtu.be/qp0HIF3SfI4 [long]
• Leading with purpose. vimeo.com/103429228
• Motivation at work. bit.ly/12g66zh
• The Edge. theedge.nhsiq.nhs.uk
• School for Change Agents. theedge.nhsiq.nhs.uk/school/
SETUP
Audio
PEV for Flipchart (wordcloud)
Volunteer for coaching in the room
- specific thing you'd like to improve / have been involved in - hard / failed
My aims. Career.
So much about CHANGE – so many failures!
How about YOU…
ever thought something could be improved?
tried? found it hard?
Think about LEADERSHIP
Reflect + share – where are you?
Where SHOULD a leader be?
Hold those thoughts …
2 wards PW …
Delays rising, sickness rising. Worst staff survey in hospital / region.
Improvements (small no.) designed & planned
3/12 … everything worse
Discuss: list every possible reason
VOLUNTEER: your topic / improvement
What do you want people to do?
in the absence of central control, how is this working?
DISCUSS - What’s different about 2nd?
Extrinsic – Intrinsic
Mechanistic – Values based
Set scene …
She’s come to tell them what they should do
Already knows they don’t want to
Q : what has she done? How has she told them what to do?
Successful SM leaders start with WHY – then the WHAT / PLAN
Having a CLEAR and ATTRACTIVE PURPOSE is essential
My visit to the ward… DE FACTO PURPOSE
Shotton Walk woman
Good access is at the heart of good general practice. Yet too many efforts to improve access have been rather one dimensional, focusing on speed often at the cost of other aspects of quality such as continuity. The Prime Minister’s GP Access Fund (originally called the “Challenge Fund”) involved 2,500 practices collaborating in 57 schemes across England to improve access and care. Their approach was very different.
Patients and professionals have always recognised the central importance of access in providing good care. Yet getting the right model for access is more complex than is often acknowledged. Access is a multifaceted aspect of value, but initiatives to improve it have often been rather one dimensional, focusing for example on speed alone or promoting a one-size-fits-all solution.
Schemes in the GP Access Fund can be seen to have worked on introducing ‘right access’, ensuring patients get access to the right care from the right person at the right time and through the right channel. This is more holistic than just focusing on providing rapid appointments, and it acknowledges that there is no “one size fits all” approach – in particular, some patients place high value on speedy access to an appointment, whereas others prefer to wait to see their own GP. A ‘right access’ appointment system allows for both.
GPAF schemes often made wide-ranging improvements to the model of care for patients. They considered the whole patient journey, starting before someone becomes ill. Innovations were introduced to help prevent ill-health and educate people about how to use health services wisely. When patients contacted their practices, new systems and staff training helped to actively signpost them to the most appropriate source of advice or help. Consultations themselves were undertaken in innovative ways including online and on the phone, and using text messages and group consultations to help people manage their longterm conditions better. Access was also improved by broadening skillmix, incorporating pharmacists, advanced nurses, physiotherapists, paramedics and care navigators into the practice team.
YOUR TURN – TRY IT
Hierarchies … SJP explaining talent Mx form
Where are you?
How does it feel now?
What next for you?
TRY IT