Module 4 - Making change happen

The School for Health and Care
Radicals
www.changeday.nhs.uk/healthcareradicals

Module 4:
Making change happen
Supported by
#NHSChangeDay #SHCRchat

www.changeday.nhs.uk

Joining in today and beyond
• Please use the chat box to contribute continuously
during the web seminar
• Please tweet using hashtags #NHSChangeDay and
#SHCRchat
• We will produce summaries of the discussions of today’s
module using Storify.com and Pinterest and put these
on the website
• The conversation continues on the live chat forum at
www.changeday.nhs.uk/healthcareradicalsforum


Modules
31st January:

Being a health and care radical:
change starts with me
7th February: Forming communities: building
alliances for change
14th February: Rolling with resistance
21st February: Making change happen
28th February: Moving beyond the edge

Almost…
1,300 learners
8,000 Slideshare views
1,000 study guide views

And over…
4,500 tweets
#SHCRchat

6,500,000 potential
reach!

for
today
• Why change efforts often fail to achieve their
objectives
• Leading large scale change
• The NHS Change Model: aligning intrinsic and
extrinsic motivators for change
• Discussion on intrinsic/extrinsic motivators
• Building energy for change
• Creating shared purpose
• Panel case studies

Source of image: www.freshnessmag.com

Most large scale change doesn’t fully
deliver its objectives
5%
Gets anywhere near
achieving the
change and
delivering the
benefits

25%
70%

Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey

Most large scale change doesn’t fully
deliver its objectives
5%

Delivers and
sustains the change

25%
70%

Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey


Image from: @TheWorldStories

It is our contention that most change efforts are built upon
the shaky foundation of five flawed assumptions; that
change can be managed, that human beings are objective,
that there are ‘X’ steps to change, that we have a neutral
starting point for change, and that change, itself, is the goal
Peter Fuda
http://www.peterfuda.com/wp-content/themes/peterfudabootstrap/content/Why-Change-Efforts-Fail.pdf

Source of image: Whatsthebigideascwartzy.blogspot.com

What happens to large scale change efforts in
reality?
In order of frequency:
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
Source: Leading Large Scale Change:
a practical guide (2011), NHS Institute

Leaders as “signal generators”
“As a leader, think of yourself as a “signal generator”
whose words and actions are constantly being
scrutinised and interpreted, especially by those
below you *in the hierarchy+”
“Signal generators reduce uncertainty and ambiguity
about what is important and how to act”
Charles O’Reilly, Leaders in Difficult Times, 2009

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-faildon.aspx

Typically, around any change effort, there is an
initial spike of tangible energy, and change, but
when leadership loses interest, the momentum
of change slows down drastically.”
Tara Paluck


Ten key principles of large scale change
1.

Movement towards a new vision that is better and
fundamentally different from the status quo

2.

Identification and communication of 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 in order to create a shift in the balance of power
and distribute the leadership

5.

Mutually reinforcing change across multiple
processes/subsystems


Ten key principles of large scale change
6.

Continually refreshing the story and attracting new, active
supporters

7.

Emergent planning and design, based on monitoring progress
and adapting as you go

8.

Many people contribute to the leadership of change, beyond
organisational boundaries

9.

Transforming mindsets, leading to inherently sustainable
change

10.

Maintaining and refreshing the leaders’
energy over the long haul


Intrinsic
motivation

Extrinsic
motivation

People engage in the
activity for the
pleasure and
satisfaction of doing it

People engage in the
activity for the
rewards or avoiding
punishment

Invokes many positive
behaviours

Any external
influence is referred
to as extrinsic
motivation

Source:
http://www.slideshare.net/JeremyStephens103/coaches-as-extrinsic-motivatorsand-supporter-of-intrinsic-development


Intrinsic
motivators

build energy
and creativity


Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership

build energy
and creativity


Intrinsic
motivators

Drivers
of extrinsic
motivation

•connecting to
shared purpose
calling to action

build energy
and creativity


create focus &
momentum for
delivery

Intrinsic
motivators
•connecting to
shared purpose
calling to action

build energy
and creativity


Drivers
of extrinsic
motivation
•System drivers &
incentives
•Payment by results
•Performance
management
•Measurement for
accountability

create focus &
momentum for
delivery

InternalDrivers of
extrinsic
motivators
motivation
•connecting to
shared purpose •System drivers &
incentives
•Performance
calling to action
management
•Measurement for
accountability
build energy and
create & focus
creativity
momentum for
delivery

An example
“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).


Transformation is not a matter of
intent.........
it is a matter of alignment
Peter Fuda


NHS Change Model

www.changemodel.nhs.uk

Which components appeal to you and
why?

What's our prognosis for this
asthma pathway project?
Our shared purpose
Leadership for change

Engagement to
mobilise

10
9
8
7
6
5
4
3
2
1
0

System drivers

Improvement
methodology

Rigorous delivery
Transparent
measurement


Spread of innovation

You get the best effort from others not by
lighting a fire beneath them, but by
building a fire within
Bob Nelson


“Take your
passion and
make it
happen”
Source of image: www.zeelandtheaters.nl

Discussion
Reflecting on your change process:
• how have you built both intrinsic and extrinsic
motivators of change into your efforts?
• How have you managed the tension between
the two?
• Any advice for other change agents on how to
align intrinsic and extrinsic motivators?


Research shows that more than almost
any other factor affecting an
organisation, organisational energy can
lead to either a wellspring of corporate
vitality or the destruction
of its very core
Source: Bruch and Vogel


Bruch and Vogel research
Organisations with HIGH productive
energy scored higher on:
• overall performance - 14% higher
• productivity – 17%
• efficiency – 14%
• customer satisfaction – 6%
• customer loyalty – 12%


Energy for change is:
Spiritual

the capacity and
drive of a
team, organisati
on or system to
act and make
the difference
necessary to
achieve its goals

Social

Psychological

Physical


Intellectual

Five energies for change
Energy

Definition

Social

energy of personal engagement, relationships and connections
between people. It’s where people feel a sense of “us and us”
rather than “us and them”

Spiritual

energy of commitment to a common vision for the future, driven
by shared values and a higher purpose. It gives people the
confidence to move towards a different future that is more
compelling than the status quo

Psychological

energy of courage, resilience and feeling safe to do things
differently. It involves feeling supported to make a change and
trust in leadership and direction

Physical

energy of action, getting things done and making progress. It is
the flexible, responsive drive to make things happen

Intellectual

energy of analysis, planning and thinking. It involves gaining
insight as well as planning and supporting processes, evaluation,
and #SHCRchat
#NHSChangeDayarguing a case on the basis of logic/ evidence

High and low ends of each
Low

High

Social

isolated

solidarity

Spiritual

uncommitted

higher purpose

Psychological

risky

safe

Physical

fatigue

vitality

Intellectual

Illogical

reason


Energy for change profile
Social
5

4
3

Intellectual

2
1

Physical


• Are particular
energy domains
more dominant
than others for
Spiritual
our team at the
moment?
• Is this the
optimal energy
profile to help
us achieve our
Psychological
improvement
goals?

Team 1: what’s your assessment of
their energy for change?
Social
5
4
3

Intellectual

2

Spiritual

1

Physical

Psychological

This energy profile is
characterised by an

Social
5
4

3

Intellectual

2
1

Physical

environment that has
harnessed people’s
interest and momentum
for change, but which has
failed to engage people
fully. This imbalance
results in their feeling
some uncertainty
regarding how they can
Spiritual contribute fully to the
change, and therefore a
sense of risk and lack of
hope for the future. We
can build energy by
building team solidarity
and developing shared
Psychological purpose

Social
5
4
3

Intellectual

2

Spiritual

1

Physical

Psychological

This energy profile

Social
5
4

3

Intellectual

2
1

Physical

shows strong
connections between
people, a true sense of
solidarity, which gives
them enough hope for
the future, but this
energy is
undirected, because the
rational argument and
Spiritual shared purpose has not
been agreed. We can
build energy by agreeing
shared goals for change
and using systematic
approaches to thinking
through and planning
Psychological the change

“Leadership is not about making clever
decisions and doing bigger deals. It is
about helping release the positive energy
that exists naturally within people”
Henry Mintzberg

There has never been a time in the history
of healthcare when this advice has been
more pertinent

“You can’t impose anything
on anyone and expect them
to be committed to it”
Edgar Schein, Professor Emeritus
MIT Sloan School


What is our approach to change?
Compliance

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 coordination and control

Threat of penalties/ sanctions/
shame creates momentum for
delivery

Commitment to a common
purpose creates energy for
delivery


Source: Helen Bevan

Shared purpose aligns.....
Shared purpose allows
many communities to
engage with us without us
having to invest resources
in controlling their actions
Nilofer Merchant


We know that ...
• Shared purpose is a common thread in successful
change programmes*
• Organisations and change initiatives with strong
shared purpose consistently outperform those
without it.**
*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)
**Management Agenda 2013 Boury et al (Roffey Park Institute)


A 3-word concept


[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 Carguilo


Avoiding “de facto” purpose
• What leaders pay attention to matters to staff, and consequently
staff pay attention to that too
• Shared purpose can easily be displaced by a “de facto” purpose:
 hitting a target
 reducing costs
 reducing length of stay
 eliminating waste
 completing activities within a timescale
 complying with an inspection regime
• If purpose isn’t explicit and shared, then it is very easy for
something else to become a de facto purpose in the minds of the
workforce
Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector

#NHSChangeDay #SHCRchat @SimonJGuilfoyle Police Inspector and systems thinker

Police


Education


Healthcare


....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


Panel discussion
What is your experience as a change agent of:
• Building energy for change?
• Creating shared purpose?


Calls to action campaigns for this week
Post these or similar actions as a pledge on the NHS
Change Day pledge wall
http://changeday.nhs.uk/campaign
• I will reflect on how I can use both intrinsic and
extrinsic motivators in my practice as a leader or
agent of change
• I will seek to ignite energy for change in everyone
involved in my project
• I will build commitment to shared purpose in all
my change efforts

Next opportunities for learning

• Wednesday 26th February
16:00-17:00 Tweet chat #SHCRchat
• Next Friday morning 28st February
module 4: Moving beyond the edge
• You can start the process of applying to
become a “certificated change agent”


Gain a certificate as a health and care change
agent AND claim your continuing professional
development points
Take some actions to demonstrate your learning from the school
and become a “certified change agent”. If you complete the
learning process you will:
• Be recognised as a “certified change agent” by the school and
NHS Improving Quality
• Be awarded a virtual badge that you can used on your email
signature, personal website, etc
• Be invited to take part in one of our virtual graduation
ceremonies
• Receive a framed certificate (UK residents only)
More details will be sent out in Naomi’s News today!

Get
certified!

Questions for reflection
1. How can I make the most of both intrinsic
and extrinsic aspects of change?
2. How can I build energy for the long haul?
3. How can I ensure shared purpose
throughout the change process?
4. What can I do tomorrow to accelerate
change?


Module 4 - Making change happen

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