Leading effectively in a world that is increasingly volatile and uncertain

@horizonsnhs #civilservicelive
Gearing up for a world that is
increasingly volatile and uncertain

The Horizons team:
Change agents and change agency
• A small, diverse team of people within
NHS England that supports change
agents and builds change agency
• We tune into the latest change thinking and
practice in healthcare and other industries
around the world –translating this learning
into practical approaches to change
• The team has emerged through years of supporting
change in the NHS and the wider health and care
system
• Currently in the process of spinning out to become
a public sector mutual (PSM) owned by the staff

The seeds of radically different futures are
in the margins of the present
FORECASTING
Focus on expected future
Future is an extension of
the present
Surprises come from
changes in the value of
known variables
Focus on range of futures
The present contains the
seeds of radically different
futures
Surprises come from
changes that disrupt the
system
FORESIGHT
Source: CoLab Alberta

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

Tabulating Machine Co. of 1917
Source of image: @corp_rebels

Source: Innovisor

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

The implosion of trust
”A person like yourself (60 percent) is now just as
credible a source of information about an
organisation as is a technical (60 percent) or
academic (60 percent) expert, and far more credible
than a CEO (37 percent) and government official (29
percent)”
http://www.edelman.com/news/2017-edelman-trust-barometer-reveals-global-implosion/

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

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

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

Mark Jaben on the science behind resistance
What NOT to do
But what we do do
Engage
people here

Mark Jaben on the science behind resistance
What NOT to do
Instead of buyers (who “buy-in”),
we need investors
What TO do
Engage
people here
Engage
people here

The predominant approach in recent years has been STRUCTURE
but globally there is a big shift towards AGENCY
The design dilemma at the heart of policy
implementation

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

Source: @NHSChangeDay

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

Change agency and change agents
illuminate the way
We need more people willing to step outside of
expectations because our world is changing
exponentially, and if all we do is meet
expectations and the status quo - we will fall
behind as organisations, as teams, and as
societies.
David Bray
WE CAN DO IT

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)

Big drive to bring social movement thinking
and practice into delivery

New Public
Passion:
a growing
global
movement

• 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”

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 where to focus
Increasing number of messages
as information cascade through
the organisation
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-fail-
don.aspx

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 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. Align structure and agency
4. Find your B-listers and give them important tasks
5. Make space for collective sensemaking: build change
platforms for important issues
6. Harness the power of advanced analytics
7. Adopt emergent approaches to planning and design, based
on monitoring progress, learning and adapting as you go
Ideas for

... 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
A changing world

Leading effectively in a world that is increasingly volatile and uncertain

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