Leading Change into the Future

@HelenBevan #BPSconf
Leading change into
the future
Helen Bevan

The Horizons team
• A small team of people within
NHS England who support large scale change
• We tune into and engage with the best change
thinking and practice in healthcare and other
industries around the world and seek to translate
this learning into practical approaches to change
• The team has emerged through years of
supporting change in the NHS and wider health
and care system

“New truths begin as heresies”
(Huxley, defending Darwin’s theory of natural selection)
Source of image:
installation by the
artist Adam Katz
www.thisiscolossal.com
Via @NeilPerkin

Change is changing

Kinthi Sturtevant, IBM
13th annual Change Management
Conference June 2015
We rarely see two, three or
four year change projects
any more. Now it’s 30-60-90
day change projects

Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
Pilots are being replaced by rapid tests
and prototypes

How we communicate and connect

Hierarchy AND network

Change is changing
Change is moving to
the edge

An example from the
Cabinet Office
http://www.slideshare.net/Openpolicymaking/060715-change-
cardscollated?next_slideshow=1

Why go to the edge?
“ Leading from the edge brings us
into contact with a far wider range
of relationships, and in turn, this
increases our potential for diversity
in terms of thought, experience
and background. Diversity leads to
more disruptive thinking, faster
change and better outcomes
Aylet Baron

Power is one’s
ability to achieve
goals
Bertrand Russell

Jeremy Heimens, Henry Timms
This is New Power
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship

The Network Secrets of Great Change
Agents
Julie Battilana &Tiziana Casciaro
As a change agent, my centrality in the
informal network is more important
than my position in the formal
hierarchy

Power is linked to AGENCY
• The capacity of individuals to make their own
choices and to take action in a given environment
• Words that are connected to agency:
• Action
• Activity
• Effect
• Influence
• Power
• Choice

A big debate in social science
Structure versus Agency

Source: @NHSChangeDay

Source: @NHSChangeDay
Problematic:
changing a
“permission
culture” can
take years
The good news:
we can usually
build agency
much more
quickly

Individual AND collective agency
Individual agency:
People get more power
and control in their own
lives: patient activation,
shared decision-making
and self-care
Collective agency:
People act together,
united by a common
cause, harnessing the
power and influence of
the group and building
mutual trust

Building agency for large scale change
We do not become transformed alone, we
become transformed when we’re in relationship
with others
Hahrie Han
Source of image: Idahoc Community Action

http://biggerboat.org/exploring-moodocs/
MOODOCs
(Massive, Online, Open, Disease Oriented Communities)

WHO will make the change happen?
List A
• The Delivery Board
• The programme sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Clinical Leads
• The Directors of
participating organisations
• The Change Facilitators
Source: adapted by Helen Bevan
from Leandro Herrera

List A
• The Programme
Management Office
streams
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who spread
behaviours, role model at a scale,
set mountains on fire and multiply
anything they get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
onesSource: adapted by Helen Bevan

List A
• The Programme
Management Office
streams
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who spread
behaviours, role model at a scale,
set mountains on fire and multiply
anything they get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
ones
Source: adapted by Helen Bevan

What’s the evidence?
The failure of large scale
transformational change projects is
rarely due to the content or
structure of the plans that are put
into action
To make transformational change
happen we need to connect networks
of people who ‘want’ to contribute
http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-
257163-Campaign+-+01%2F09%2F2016
Source: David Dinwoodie (2015)
It’s much more about the role
of informal networks in the
organisations and systems
affected by change

The 3% rule for change
Just 3% of people
in the organisation
drive
conversations with
90% of other
people
Source: research by IC Kollectif

We are witnessing the collapse of expertise
and rise of collaborative sensemaking
David Holzmer
Source of image: ACCA

“Many times experts fail because
they are experts in the past version
of the world”
Vikram Khosia
@wellcometrust
#expertdebate

New Public
Passion:
a growing
global
movement

Which kind of activists are most successful at
delivering change?
Lone wolves
Build power by expertise and information — through
advocacy, oversight, contributing to committees, public
comments and other forms of consultation
Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

Patient leaders as “lone wolves”
“What I am ranting about is the way in which patients are
being streamed into advisory sub committees, the way we are
being used as tokens and to help tick off the right box…..
Where is the attitude that patients are part of the team in
healthcare, that we are partners? Why are we always asked
to participate inside a pre-determined frame? When will we
see co-design of new policies, and ultimately co-production?”
Annette McKinnon

Patient leaders as “lone wolves”
“What I am ranting about is the way in which patients are
being streamed into advisory sub committees, the way we are
being used as tokens and to help tick off the right box…..
Where is the attitude that patients are part of the team in
healthcare, that we are partners? Why are we always asked
to participate inside a pre-determined frame? When will we
see co-design of new policies, and ultimately co-production?”
Annette McKinnon
Structural issues encourage this
kind of participation

Which kind of activists are most successful at creating
agency & delivering results?
Lone wolves
Mobilisers
Build power by mobilising people – being able to call
on large numbers of people to contribute, engage in
change and take action

Which kind of activists are most successful at creating
agency & delivering results?
Lone wolves
Mobilisers
Organisers
Build power by growing leaders – identifying, recruiting
and training future leaders in a distributed network:
building a community and protecting its strength

More numbers
Centralised
responsibility
Independent
Marketing
pitches
What do they do differently?
Strategy for
power
Structure
Types of asks
Communication
Transformative
leaders
Decentralised
responsibility
Interdependent
Relationships
Mobilising Organising
Source: Hahrie Han (2016) Organising for transformational change

Which kind of activists are most successful at
delivering change?
Lone wolves
Mobilisers
Organisers
Build power by growing leaders – identifying, recruiting
and training future leaders in a distributed network:
building a community and protecting its strength

Focus on the “We”
“Great social movements get their
energy by growing a distributed
leadership”
Joe Simpson

“Resources” for change
Economic resources
diminish with use
• money
• materials
• technology
Social resources
grow with use
• relationships
• commitment
• community
Based on principles from Albert
Hirschman and Marshall Ganz

A problem
Strategic leaders don’t see the resources
that we see in the system as solutions to
the biggest problems
Don Berwick

• systematic “change
management”
• too often, leaders
prescribe outcome
and method of change
in a top-down way
• change is experienced
by people at the front
line as “have to”
(imposed) rather than
“want to” (embraced)
Change
Programmes
• everyone (including
service users and families)
can help tackle the most
challenging issues
• value diversity of thought
• connect people, ideas and
learning
• Role of formal leaders is to
create the conditions and
get out of the way
Change
Platforms
“Tear down the walls”

Why platforms?
Platforms today power learning and innovation
at the speed of change by providing
collaborative and sometimes exponentially
productive spaces for people to create value
John Hagel
Source of image: Pinipa

The Change Challenge
Tapping the collective brilliance
of the NHS

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

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

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
Don’t overload front line staff with
strategies if you want improvements
in quality and safety
http://healthaffairs.org/blog/2014/03/07/the-
dangers-of-quality-improvement-overload-insights-
from-the-field/

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

After years of intensive analysis,
Google discovered that the key to high
performing teams that deliver change is
Psychological safety
Project Aristotle:
https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-
xoaZybvz9f0b1_6bJyG7zZO6L

1. Frame the issues in ways that will engage and mobilise the
imagination, energy and will of a large number of diverse
stakeholders
2. Take steps to be social leaders, investing in digital skills and social
connections and leading through networks as well as formal
leadership systems
3. Consider what/where your equivalent of ‘the edge’ is, so that you
incubate radical and disruptive ideas and lead change from the
future
4. Find your B-listers and give them important tasks
5. Identify, develop and utilise all your local assets for improvement
6. Build change platforms for important issues
7. Adopt emergent approaches to planning and design, based on
monitoring progress, learning and adapting as you go
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Leading Change into the Future

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