Making Change Happen: Tips for Delivering Change Initiatives

NHS IQ Webinar (UKNHSI0903A)
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[Remi.Coordinator is Live]
HELEN BEVAN:
Good afternoon, everyone, and welcome to module four of the School for Change Agents, and
our focus today is making change happen.
My name is Helen Bevan, and I'm going to be the lead for today's module.
It's fantastic to welcome such a diverse group of people. We have people taking part here with
us live from all over the world, and I know that many, many more people will be watching the
recording of this session, so a great welcome to all of you.
So, let's see who we have got on the team today.
Hello, my name is Helen Bevan, and I am going to be looking after things. I am very happy to
have Pip Hardy alongside me, who is the lead facilitator. We always get a fantastic response to
Twitter on school days, so Leigh and Louis will be keeping an eye on Twitter.
With so many of you taking part, we hope the chat room will go crazy with engagement as
usual, and Kate, Catherine and Ollie are helping us in the chat room.
Behind-the-scenes, we have our extremely able and important technical support colleagues, Jo
and Paul.
Welcome to the team and everybody taking part.
Just as usual, a note to say please join in today and beyond today.
For those of you taking part live, please use the chat box to continue to contribute. Put your
views across, create your links. We would love to have your contribution.
Also, we would like you to tweet, if you can do three things at the same time, using the hashtag,
hashtag School for Change Agents, and the handle is @Sch4Change. Our Facebook group is
becoming very active, and we would love you to join it.
You just need to send a request, and we will produce a summary of each module, as usual, and
we will put it on the website.
What are we going to do today?
Well, each week, what we have been doing is covering different change agent capabilities.
This is week four already. I can't believe how quickly it has gone. The first week, we looked at
how change begins with me. The second week, we looked at from me to we. Last week we
looked at Rolling with Resistance and some different ways of thinking about resistance to

change.
Today is a session around practical things, around making change happen.
Again, just to emphasise that it's possible to use your contribution to the School to build your
professional development.
Nurses, midwives and allied health professionals can use this experience as part of your
reflective account for revalidation for your CPD. For doctors, there will be a process for getting
credits for the School, and for everyone, what we will be doing at the beginning of next week is
giving you all the information about how you apply to become a certificated change agent of the
School for Change Agents.
It is a really straightforward process, and it is free so we hope lots of you will want to do that.
A final announcement: loads of you have been signing up for randomised coffee trials, and
some of you have been having some really fantastic conversations, so how to sign up if you
haven't yet – we will send you the information in our newsletter, but basically you just email, and
we will randomly match you with someone else from the School who could be in the same city
or across the world, and over the next four weeks, you need to arrange to have a conversation
over Skype or FaceTime or a phone call – however you want to do it – over a cup of coffee.
That is the end of the notices.
What we normally do at this point is we have some sort of warmup activity, and usually it
involves arrows and pens, but after last week we had a request for some more polls. In this
session we have a number of them.
Let me tell you what the first one is. The topic that we will be talking about first is to what extent
did the last change initiative you were engaged with deliver its objectives? We will be talking
about this shortly.
To start with, we will put a poll up. I will hand over to Jo. Not necessarily the initiative you're
working on at the moment, which is still happening, but the last one you kind of finished.
Somewhere between 1-10, give it a score. If it hardly delivered anything, give it one. If it's
delivered all of its objectives, give it 10. If it delivered some of it, give it five. Are you there, Jo?
JOANNA HEMMING:
Yes, I am here now.
HELEN BEVAN:
OK, let's see the poll. Here it comes.
The last change initiative you were engaged with and that has finished, to what extent did it
deliver all of its objectives? I will ask our chat room monitors to be ready in a moment to tell us
the results. We have got just about 30 seconds to go.

It is completely anonymously. Nobody will know what you said.
I have just done this, too. Just another 20 seconds.
How are we doing, Jo?
OK. The poll has now ended, and we are just waiting to see what we get.
So, Kate and Catherine, are you there?
KATE POUND:
Yes. I'm just waiting for the result to come up. Here we go.
So, it looks like we have got a really good standard distribution curve that is slightly weighted
towards the positive.
The most popular answers are the six and seven.
HELEN BEVAN:
The mean looks like a seven. The median looks like a seven and about 6.5, we reckon.
KATE POUND:
In the chat box, there are some comments about it is like thinking about... 6.5, someone has just
corrected me on that. I'm glad we have mathematicians!
Some people are thinking about the sustainability, which is also important.
HELEN BEVAN:
Yes. Very good. There are 185 people logged in. There are many, many more than that taking
part now because many of you are taking part as groups, but of those people logged in, 145 of
you took part in that, so that is fantastic.
Let's talk a little bit about the capabilities that we want to build in our hour together today.
First of all, we are looking at why many change efforts fail to deliver the intended benefits. We
want to think about some of the barriers and building blocks to making change happen.
We are going to look at the need to align both the intrinsic and extrinsic motivators for change,
and we will talk a little bit about those. We will talk little bit about building joy for work, and many
of the people who are here taking part are connected to public service so we will touch on this
idea of the joyful public servant.
We will have a section on appreciating energy for change.
And finally we want to look at what is the de facto purpose, which is something we do want to
have.

So, let's get going.
Going back to the chat box, very often, when you look at the literature and research and the
ideas that people are proposing around change, there's this kind of mythical figure of 70% that
gets quoted all over the place, constantly, in the change literature.
Can we have a go at putting this in the box? Why is that mythical 70% figure often quoted in the
field of change leadership?
What are we getting, Kate and Catherine? That's right. Yeah.
KATHRYN PERERA:
Some people are suggesting it is the rate of failure.
HELEN BEVAN:
That is absolutely right. If you look at what was being written in the 1970s about large-scale
change and the extent to which it succeeds, that figure is used.
If you look at things that are being written recently about large-scale change, it's the same
figure. I took this from Deloitte and their document, demystifying change management, and they
are saying that despite significant investment and literature on the subject, most studies still
show a 60-70% failure rate for organisational change projects, a statistic that has stayed
constant right the way from the 1970s to the present.
Let's look at some McKinsey data on this. This comes from the McKinsey performance
transformation survey, and what they showed was only about 25% of change projects of a
reasonable complexity get anywhere near achieving the change and delivering the benefits that
are sought.
Actually, the reality is that it's probably nearer 5% – someone in the chat box was talking about
sustainability. In terms of those programs that actually make the change happen and deliver it
and sustain it over time, it's probably nearer to 5%.
It's interesting looking at some of this McKinsey data and the research which shows what the
reasons for failure are. Those of us who have been around in the field of change for a while, we
see all of these things.
Failure to launch the change properly, being stuck in diagnostic, or leaders not being held
accountable, or employees being resistant. Again, that word "Sustainability". We have
implemented the change but we haven't seen it in the day to day behaviour, and the people
leading the change are not those responsible for the service, it is still being run by change
agents or we haven't built the skills. The final set of reasons given here are about failure to
scale.
We can create pilots and demonstration sites, but we haven't actually got a process to scale it
out and make it happen everywhere.
It's interesting because when you look at this data, it talks about things that happen down the

road, 1-3 years, but what strikes me about all of these factors is these are factors right at the
beginning of the change programme. Things will be happening not 1-3 years on but they are all
about what we do right at the beginning of the change process.
There's a lot of discussion going on. There is a number of researchers and authors who
question the 70% figure and say that is not right. Here is an example here from David Wilkinson
from Oxford Review, and there are quite a lot of them about.
So much of this depends on how do you define success? How do you define failure? Is it such a
black and white issue?
It is probably much more complex.
However, it is fair to say that what we see consistently are change programmes that don't
deliver or don't give us the outcomes that we want, and again this is some more recent research
that was carried out by the Chartered Institute of Management.
You can see all kinds of factor and change. What people are being asked is do you agree or
disagree with this statement as a result of your change project.
To what extent is decision-making faster. Agree or strongly agree is pink or bright pink. Most of
those different factors the pink or the bright pink is in the minority which is the thing we are
trying to do so decision-making, employee participation, customer service.
The only ones where you see the pink is in the majority of the things you don't want to happen.
If you go four up from the bottoms, key skills and experience have been lost. The majority of
people agree or strongly agree. Employee turnover has increased. More people agree or
strongly agree. And so on and so on.
We really need to think about what the factors are that we need to think about as change agents
to make change happen.
I like the stuff that Peter Fuda has done. He wrote a nice paper called Why Change Efforts Fail.
He says our research shows the reason most change efforts fail to achieve their objectives is
because they are built on five flawed assumptions. The first is that change is a logical, rational
process we can manage. The second one is that people are very objective and rational when it
comes to change. The third one is that there are eight steps or 10 steps to change and if we
follow them, we will deliver.
The fourth one is that there is a neutral starting point for change so no history, nothing has gone
on before we are doing this change process.
He says change isn't the goal, the goal is the goal. We get focused on change programs where
you are so focused on the change that we forget what we are actually trying to do.
One of the issues that comes up a lot is have we got resources for change. Again, last week
when we spoke about resistance to change, we looked at looking at things through a lens. The
model we have used the most in the School for Change Agents has been old power, new

power. We have looked at this in a different context.
Let's look at resources. In a world where there is a battle going on between old power and new
power constantly and where we have to be as change agents is operating in that difficult place
in the middle.
When we talk about old power, it is like a currency, money. A few people have a lot and most
people haven't got very much. The other thing about a currency is the resources we have
available to us are finite. When we have used those resources, there is none left. When we
think about new power, it's more like a current, and energy and the more we see the energy by
more people engaging, by more shared purpose, then the more we can build.
I thought this was really helpful in terms of thinking about making change happen And resources
for change. If we think about resources in an old power way, essentially, we are talking about
economic resources. We have this finite set of resources and for our project... We have got this
level of materials, technology to assist us.
The more we use it, the more it diminishes. When we start to think as change agents in new
ways we think about natural resources that grow with use. The more we build new power, the
more we build a wider set of relationships, the more we build commitment to a common
purpose, the more that we are part of a broader community for change, then those resources
grow.
When we think about making change happen, the starting point, let's think about the lens
through which we consider resources. I like this approach very much. We see it a lot in
community development. Many of the people who have taken part in school are practitioners of
asset-based community development. What I've got here is an example of an asset map.
What you can see is when we are trying to make change happen, we are thinking about assets
we have that can help us. We need to think more broadly. I think it's much nicer to think about
the people in the communities and the networks that can support us as assets rather than
resources.
Thinking about making change happen and what are the opportunities? What are the
blockages? What are some of the builders?
A little while ago, my team, Horizons, we did a collaboration with the Health Service Journal and
the Nursing Times. It was about a response from a very wide group of people around how we
can make change happen.
We asked about the biggest barriers to change. It is interesting to look at these 10 barriers. The
one that interested me the most and surprised me but actually reflecting on it, shouldn't be a
surprise is the issue of confusing strategies.
When we asked our frontline colleagues, what are the biggest barriers, this issue of confusing
strategies.
When you're at a senior level, you have 10 or 11 priorities and they are very clear. When that

strategy goes down several levels and it goes to people who are operating at the front line of
care, it's confusing.
This is a new priority but is it more important than the previous priority? Do they connect? Do
they make sense? If you want us to do that, what should we stop doing? It's interesting because
the Gallup organisation did a study about this issue around why do so many change projects
fail. Again they found the same thing.
Every day, people on the front line are getting inundated with these high priority messages and
it is really hard to know the actual things that we should be focusing on. I see this sometimes as
someone who works in the National Health Service in England because a team nationally might
be working on a certain priority and when you are a national leader of change, that's the most
important thing in the world to you.
When you are trying to make people locally adopt a change, your priority is fighting with many,
many other priorities. This was a study from the Gallup organisation but actually there has been
other studies that have shown this is really pertinent in terms of the world of health and care.
This is some work that appeared in Health Affairs. It is an eminent global policy report. If we
want change to happen, getting action from front-line staff is critical if we want quality and safety
to happen consistently. We must stop overloading people.
We thought what would be fun is to give you a poll which is looking at the blocks that came out
of this poll is these are the biggest blocks to change. To what extent in the work that you have
been doing in the last 12 months has each of these things been a block?
What you can do, if all of them have been blocks, you can put all of them. Jo, can we move to
the second poll?
Thinking about yourself as a change agent, take as many of these as have been an issue for
you. Let's see what we come up with. We've only got one minute. We may need to work quickly.
Click as few or as many as you would like to.
Again if Kate and Kathryn can be on standby to analyse the results. This one will take a little bit
longer to analyse because it is more complicated but the poll is ending now. We are waiting for
the results.
While this is happening, Kate and Kathryn, do you want to say anything about what we are
seeing in the chat box?
KATE POUND:
The chat box has disappeared. Really interesting results. Confusing strategy is the top one.
Those are two of the top ones. It has disappeared again.
In the chat box, some people were putting things like they like the demonstration of what this is.
It is resonating with a lot of people.
HELEN BEVAN:

Isn't it interesting? Looking at this, the confusing strategies is the top one. Undervaluing staff
and inhibiting environments. Over controlling leadership. What is great about that is those are
the kind of things we are going to talk about today. That's really interesting.
163 of you took part in that. That's really fantastic.
Shall we look at the other side of things. Thank you Jo.
The 14,000 contributions that we got from our colleagues across health and care, what did they
say was the main building blocks for change? I don't think any of these are surprising that we
start with inspiring and supportive leadership and collaborative working.
Lots of these are things that we have talked about during the last four weeks. We talked about
challenging the status quo, calling to action. We talked about the final one, around thought
diversity and thinking in different ways.
If Jo can set the next poll up. Which of these factors are present in your situation now? In terms
of the changes that you are undertaking currently, which of these are there for you?
The poll is now up and we only have a minute. In terms of your situation now and the change
that you are working with and trying to make happen, which of these factors are present for you
now?
And Kate or Catherine, whenever you are ready to chip in. We are just waiting for the poll to
end. OK, it has now ended. Anything interesting in the chat box while we are waiting?
KATE POUND:
You go!
KATHRYN PERERA:
There are a lot of interesting reading suggestions. A comment that was widely appreciated was
that the best change is network driven. There is a lot of shared experiences happening in the
chat box at the moment.
HELEN BEVAN:
Yeah, and the results have appeared. Again, just to get you to reflect on them, the thing that
strikes me is far fewer numbers than we saw in terms of the negative things that were present.
Kate, do you want to say what we are seeing?
KATE POUND:
Yeah, that sums it up nicely, Helen.
There is more of a spread as well across the selection. The highest one is the collaborative
working, which is great because it is obviously people are saying that is really important to get a
more diverse opinion or view and being more creative with how we can do that.

I feel that there is hope there, things are changing, but it is taking its time.
HELEN BEVAN:
Yeah, that is great. Again, we will make the outcomes from the polls available.
So, let's go ahead and talk about some of these factors.
This module is about making change happen. So how do we make change happen?
I want to suggest four things.
Firstly, we have to make people feel something, and that goes back to what Kathryn was talking
about in module two, where if we can engage at a level of emotions and values that connect
what is important to people, that is where we need to go.
The second point here, which I think is really interesting, is about emphasising progress, and
this is a point that gets forgotten sometimes.
I just wanted to quote this research, this Harvard research from Theresa Amabile. She got 238
professionals to keep a diary of their inner work life and how they were feeling and what
happened, and what was interesting was these professionals reported the very best days for
them at work were when they were able to make progress and move forward in their work.
It really ties in with the kind of things we have been saying in the School around the importance
of small-scale, incremental change, even if it is very small, just making some things happen,
how important they are.
That was reiterated. If people can make progress, however small, it makes a massive difference
at work.
What Teresa and her colleagues did was they asked 700 managers to rank factors for
employee motivation, things they thought that were most important, and what happened was the
managers rated things like recognition and incentives, and they ranked progress last.
What the actual professionals said, "The days when I make progress are my best days." Yet the
managers didn't seem to think it was an important issue.
The third point here around making change happen is stop bribing. I want to talk about the
relationship between intrinsic and extrinsic change because we need both.
But really, I love this way of describing things. What do we need to do? We need to start a cult.
What do we mean by that? A group that is unified by a provocative idea that can make a
difference.
Let's talk about intrinsic/extrinsic motivation and bribery.
When we are trying to engage people in change and make things happen, we need to think
about both extrinsic and intrinsic motivation.

So, extrinsic motivation is motivation that comes from outside, so when we as a system want
people to do something, the kind of factors we are talking about are rewarding people,
mandating people with quality standards, having incentive systems, competition, compliance,
award systems, recognition and putting people under pressure to perform. Those are classic
factors of extrinsic motivation.
Intrinsic motivation is when I connect with the things that are inside people and the factors that
really make them want to do things, so being able to be autonomous, having a sense of
purpose, being able to master things, connecting with passion, belonging to a community or a
bigger group, love, fun, building my own self-knowledge, learning – those are factors for intrinsic
motivation.
Now, what we know is that we need both, and I will talk about that shortly, but actually if we
want ongoing large-scale change, we have to work with both.
What do we know about extrinsic motivation? It works best – it is the carrot and stick approach.
When we want people to do straightforward, repetitive tasks they don't need to think about, that
is when extrinsic motivation works best.
If you want extrinsic motivation to work well, because it is linked to performance and improving
performance, it is very important people understand what performance means.
We need to tie the extrinsic motivators, the reward or award or scheme, closely to the specific
performance we want, and if we focus on rewarding teams rather than individuals, often it helps.
Let's look at intrinsic motivation, where we connect with the things in people's hearts. This works
best for complex tasks that need personal investment, as not to do repetitive tasks but to absorb
and focus on quality.
The kind of people who work in health and care.
We can increase that intrinsic motivation by making people feel competent and self efficacious,
which we looked at in module one, and by giving them autonomy.
The evidence clearly tells us that people who are internally motivated, who are enjoying what
they do, barely perform poorly in organisations.
When we think about it in our world, if we want to make change happen, we want to connect
with intrinsic motivators because they build energy and creativity.
[Anne.Captioner is Live]
Actually, we want to change the whole system so that care is better for everybody, where all our
customers get a better deal. On its own, intrinsic motivation is not enough.
How can we drive extrinsic motivation? It drives a sense of focus and momentum for delivery.
The kind of factors we are talking about our systems drivers and the kind of incentives that we
put in the bigger system to get people to perform in a different way. Payment for quality,

performance management systems, the kind of management systems that hold people to
account.
We need to look for and design an effective model of a combination of the two. However, we
live in a world, many of us, where what has happened over the past period is that we over focus
on extrinsic motivation and under focus on intrinsic motivation. The extrinsic motivation comes
along and spits out the energy and creativity. We need to find ways to work with both.
This is a model that I think is really helpful. It was designed in the health care system and it is
called the change model.
When we think about a change process or program, let's think about the multiple factors we can
take account of and build and align them. Some of these factors are for intrinsic motivation.
Having a really clear shared purpose, right at the heart of the model. Motivating leadership.
Motivating and mobilising people for change.
Those are all factors that are around intrinsic motivation.
There are also factors around extrinsic motivation.
Project and performance management, how we build those in.
Measurement is interesting because it can be either. A lot of the time, we are using
measurement in an intrinsic way to understand the improvements in performance and hold
people to account, but when I see really fantastic improvement projects going on, where people
are so joyful and excited about what they are doing, they love to measure because they want to
know how well they are doing for their patients or service users. Measurement can be either.
We need to have a working with improvement tools approach and think about spread and
adoption right from the start.
I find this incredibly useful model to think through. We need to look at whether these factors are
aligned with each other, and here is an example from a local organisation within the NHS that
supports people with learning disabilities.
They were looking at how they can reduce inappropriate use of antipsychotic drugs for people
with learning disabilities.
As a team, they looked at each of these factors and said, "How are we doing?" Everybody did it
to start with and looked at their score out of 10.
We are doing really well on shared purpose and having a clear shared purpose that we have all
developed.
We have a really strong project and performance management system, too, to back up what we
are doing, and we have strong measures.

We're also doing quite well on improvement tools, and we are thinking about how we will spread
and get adoption of this beyond the current unit.
However, we haven't necessarily got all our leaders on board, and we haven't thought through
some of the bigger system drivers.
What it helps us to do is to think about these factors and make sure we are building them
in right from the start, and even more importantly it helps us to align our intrinsic and extrinsic
factors.
This is the parent of James, one of the people on the ward, who was part of the team that co-
produced this work, just saying that this model is a structure that helps us to understand what
we are trying to achieve, where we need to focus, and it helped us to work together.
All of the resources for that are available for free.
Let's talk about two different kinds of people at work.
This comes from a study that was the biggest study in the world around engagement at work.
What it identified was different types of people at work, and I want to talk about two of them.
One kind of person is the compliant, and compliant people come to work, they work diligently.
They don't necessarily feel connected to the bigger purpose. And their work is controlled and
coordinated in extrinsic ways, through performance management and standardised procedures.
Very often, compliant people will hold back, they will not take risks.
Often, they like to work in a standardised way. They know what the job is, they are comfortable
and they do not like change, and they want to work to a role specification.
When someone comes along and talks to the endoscopy nurse, for example, about "How can
we extend your role?" he or she will say, "I don't want to take that risk. I would rather stick to the
job I have got."
[Anne.Captioner is Live]
Contributors are people who are highly intrinsically motivated. They feel connected to the higher
purpose. They don't need a lot of standardisation and compliance because they start from a
place of shared values and goals which makes the control and coordination happen.
They are very collaborative with other people. They are willing to embrace and lead to change.
The thing that is important or different about contributors compared to compliant people is that
they work to who they are. I work to who I am and what I want to be and the contribution that I
want to make in the world.
I think that many of us work in organisations that force people to be compliant. The wider
environment that we find ourselves in is that the compliant people have an easier life and they
get along. To be a contributor is really tough.
I wanted to show you the other part of this data. This was a study that was carried out by the

Gallup organisation. They found that only 13% of the overall workforce looked at were fully
engaged i.e. contributors. They also found that contributors create six times the value to an
organisation compared to compliant people. We are in a system that often forces us to be
compliant.
We need to be thinking as change agents, what do we need to be doing to be fully contributing
and to support other people to be contributors? When we look at the way the world is going, it
becomes even more important.
I took this diagram from Harry Burns who was the Chief Medical Officer of Scotland and he is
looking into the future and talks about the third curve of change. I can see this coming as well. If
we look at the three different curves the first one is public management. We saw that from the
late 1990s onwards which is about holding people to account and putting proper measures in
place and getting a grip.
What we have seen since then is a move much more towards quality improvement and working
in collective teams and finding ways of sharing power.
When we look at where public service needs to go or health and care needs to go, we need to
move into a phase of mobilising, social action where we cede power, we give it away to
communities and families and patients and frontline staff.
Having contributors is key to that. We can see this happening all over the world. We can see
this growing global movement, more and more people are talking about the new public passion.
If you look on this page on the top left-hand side, this is a document that came from Singapore.
How do we move from the new public management which is here on the left-hand side to the
new public passion which is this mobilising for social action?
We see being a facilitator of joy, is that a new line on the job description for the 21st-century
public servant? We have Henry Kippin writing about 2017 being the year of new public passion.
Unless you can connect with the intrinsic motivation of our workforce, then we are not going to
see the changes that we need to see.
Many of us particularly working in the UK, USA, a lot of our goals for improvement are framed
as a triple aim around patient care and experience. And reducing costs. We are seeing the
move from the triple aim to the quadruple aim which is about how do we build meaning and
passion in work and for our health and care workforce. Being an equal issue.
This focus on intrinsic motivation is absolutely coming.
I wanted to talk to you now about energy for change. At the heart of this, at the heart of the idea
of the new public passion is our ability to build energy for change.
What do I mean by that? Here I am defining it as the capacity at the level of a team to take
action to make the difference necessary to achieve its goals. When we think about the new
public passion, we think about the 21st-century public servant. Energy for changes underpinning
these ideas.

It is a really important idea because when we look at the change literature, it shows us that
energy for change is a very important factor. If we look at the reality of change across multiple
sectors, we see the thing that is least likely to happen is the thing we want to happen. This is
implementing the change and it becomes reasonably well-established at multiple levels across
the system to accommodate it and it is supported and sustained. That's what we most want to
happen and that is the thing that is least likely to happen.
The thing most likely to happen as the change ever fizzles out, runs out of energy and fades
away. As change agents and leaders, our ability to create energy for the long haul seems to be
a pretty critical factor.
I like this quote from Tara Paluck. Her research shows around any change effort, there is an
initial spate of tangible energy and change, but when leaders lose interest, when those priorities
change, the momentum of change slows down drastically. I think many of us have seen that
happen.
People want to see the data. This comes from a group who published the most on energy for
change. Their studies show that if you have teams and organisations with high-energy score,
they will do better on virtually every dimension of improvement.
I want to show your model of the building energy for change that comes from the work that our
team did with the York Health Economics Consortium and Landmark. We developed a
framework for the energy of change and it focuses on five different types of energy for change.
We are high on all five. I want to take you through the five now. I want you to think about the
environment you are in and how the energies are where you are at the moment. The first is
social energy. When social energy is strong, we have an idea of us and us rather than us and
them. Spiritual energy is the commitment to a different vision for the future that connects with
what is in our hearts. When spiritual energy is high, people are more likely to be willing to move
towards a different future that is better than the status quo.
The third energy is psychological energy. Very important. This sense of psychological safety
that people feel that enables them to try new things and innovate and fail. Psychological energy
is the energy of having the courage to do different things, feeling resilient and feeling safe to
innovate and do things differently. It is about feeling part of a strong team that is supportive and
having trust in the leadership of the organisation and the direction.
The next energy is physical energy. This is the energy of action, implementation, getting things
done. The final energy is intellectual energy. This is the energy of standing back and looking at
things rationally. Planning, evaluating, chunking things down, holding people to account in very
rational ways.
Let's have a look at these energies. Let's go back to social energy. If social energy is low,
people feel isolated on their own. When social energy is high, there is a sense of solidarity.
When spiritual energy is low, people feel uncommitted to the organisation or the system and its
direction. When it is high, there is a real sense of higher purpose. When psychological energy is
low, people won't try things out. They won't innovate because there is too much risk. It may fail.
When psychological energy is high, people feel safe to do new things.

When physical energy is low, people feel a real sense of fatigue, burnout, weariness. When
physical energy is high, there is a sense of vitality, spring in the step. When intellectual energy
is low, there is a sense of why on earth are we doing that, it's completely illogical. When it is
high, there is a strong sense of reason. It is obvious why we are doing this.
I want you to think. We have more than 2000 data points in the health care system around
energy for change. What we see particularly in senior leadership teams is that one of those
energies is disproportionate.
We won't do a poll. Write down in the chat box which of those five energies you think is more
disproportionately high than any of the others.
Yes, most of you are getting it.
The issue that we see time and time again is an over focus on intellectual energy. How that
manifests itself as he reserved big planning system. Here is our decision-making, here are our
actions, he was holding to account.
The problem is disproportionately high intellectual energy… On its own, intellectual energy is
not transformational. We see leaders all over our country trying to create radical
transformational plans based on intellectual energy. The problem with it is that it keeps leaders
and their comfort zones. It doesn't change the world.
Which group do you think are more likely to have higher spiritual energy scores? Clinicians or
non-clinicians? Do you think clinicians tend to have higher spiritual energy scores?
That's interesting. It's split. Actually, clinicians have higher spiritual energy scores to a
statistically significant level.
The nearer you are to the chief exec in the structure - if you're a vice president or something like
that - do you have a higher or lower energy score?
Lots of you are saying lower but it is higher. I think that is to do with all power and people in the
system feeling they have got more control around making things happen.
Clinicians tend to have higher energy scores and the nearer you are in the structure to the chief
exec, the more likely you are to have a higher score.
This is a simplified version but we help teams to analyse where their energy is. If you look at
this, if your physical energy was low, you would be down there at one. If your social energy was
high, you would be at five.
Some work that my team did was discourse analysis of six large-scale transformation plans in
the health and care system, and you will see the six.
It will kind of look like this. There are six of them like that on a sheet. Let's look at it. Here we go.

What is really interesting about this... These are really large-scale transformation plans.
Obviously, the first thing we see is a very, very strong focus on intellectual energy on all of
them.
What you are seeing on at least three of them is quite a toxic mix.
We see this time and time again. When you have high intellectual and physical energy but lower
social and spiritual energy, this is the context where people talk about burnout, change fatigue,
you know, a complete lack of energy for change.
It's often that combination, and it's interesting because people say it is bound to have higher
intellectual energy, but these plans are so different. Even though they are written to the same
guidance.
If you look at this red one here, that is in a locality that coproduces with patients and families
and the wider community. When they wrote their plan, they wrote it together, and you get such a
sense of coproduction.
With the lower spiritual and social scores, the plans are written through by very, very clever
people and thinking in very logical ways.
At the very heart of the change we are making, we have to build social and spiritual energy. Of
course, we also want high intellectual and high physical energy.
There is a relationship between social and spiritual energy and psychological energy which
basically is if we want psychological energy to be high, then we have to build social and spiritual
energy.
I know I'm overrunning a bit, and I'm very sorry, but I will just keep going and hopefully you can
stay. There is not much more to go.
What happens when we don't build a proportionate amount of social and spiritual energy in our
efforts? As leaders and change agents, we are signal generators. All the time, we are sending
out signals to people in our system around what is important, what we ought to do, and people
are reading our signals all the time, and we completely underestimate the extent to which those
signals get amplified.
What leaders pay attention to matters to staff, and then staff and up taking their signals from
their leaders.
What we end up with many, many times is instead of a focus on shared purpose, we end up
with a focus on de facto purpose.
Shared purposes where we have got a purpose, and it is not an organisational purpose which is
written down, but a real shared purpose that everyone who has a stake in the change and
improvement we are seeking to create owns.

But often what happens is we haven't made that explicit, and we haven't shared it, and we
haven't co-produced it.
When we don't do that, it's very easy for something else to become the purpose instead, and
what we see in a lot of public-sector settings is that shared purpose gets overtaken by a de
facto purpose because often, as leaders and change agents, we are telling colleagues what we
need to do, so what they hear is not the shared purpose.
If we are not creating a narrative and we are not having conversations about a bigger shared
purpose, it creates a very, very toxic environment in our organisations.
When we talk about making change happen, we need to think about how we build social energy
and spiritual energy. I have just put a couple of quotes in here. the first one comes from Seth,
and he says it goes way deeper than the kind of vision and mission that we write for our
organisational system. True shared purpose 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.
I believe that, too. When you look at the work that has been done around the change model we
looked at earlier that had shared purpose right at the heart of it, when we have done
retrospective analysis and we have asked change agents about what they would have done
differently, they say, "We would have spent so much more time focusing on shared purpose
right at the beginning and coproducing a purpose."
If you remember last week when we looked at the work that Mark Jaben did around the science
of resistance to change, he's saying the same thing. It isn't enough to talk about getting people
to buy into your change. If you are asking people to buy in, it is too late. We do not need buyers
but investors.
We need to be collective investors, building shared purpose from the start. I promise this is my
very last slide. I love this quote. When you look at the way the world is going at Harry Burns'
third curve of change, you look at what is happening in terms of passionate public management,
this quote is so spot on.
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.
As change agents, we are at the front of this move.
It has overrun, and I apologise for that. I know we are biting into the time for the breakouts. Can
I just really, really quickly ask Kate and/or Catherine to sum up the chat in less than one
minute? Can I call on Leigh as well to tell us what has been happening on Twitter? Are you
there, Kate?
KATE POUND:
Yes, I'm here. It is kind of where do I start? The chat has been flooding through today. We have

had so much discussion about the session and so much supporting each other to explore the
discussions further as well as directing people to good resources to read. It would be wrong of
me to summarise it by pulling points out but it has been phenomenal today. I look forward to
reading the transcripts.
It has been hard keeping up with it!
HELEN BEVAN:
Great. Leigh, you there?
LEIGH KENDALL:
Yes. It is similar on Twitter. There has been so much conversation, and there will be some
soreness from people nodding to say, "Yes, we agree," and how inspired they are. Lots of
words and evidence to back up what people believe. Lots of excitement out there.
HELEN BEVAN:
Fantastic, thank you so much. Again, the final thing I would say is most of us live in a world
that's about doing change, and what we get judged on is doing change.
And we need to be focused on being change. Because actually by being change the doing will
be so much easier.
I think that is the best advice that any of us can give when it comes to making change happen.
For those of you who are watching the recording, we are going to sign off now. For those of you
who are staying, and hopefully most of you will be, taking part in the live session, I will now hand
over to Ollie, who is going to explain what is going to happen in the breakout rooms.

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