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The hack day for the NHS Change Model
This document summarizes discussions from a hackathon event focused on improving models for change in healthcare. Participants reviewed how change currently happens, examined the existing NHS Change Model, and designed concepts to better support change across health and care. The group engaged in various hacks and discussions to reimagine change frameworks. They developed a refreshed model framework and explored elements in more depth through "mini hacks". The goal was to scope how an improved change model could be spread more widely.
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The hack day for the NHS Change Model
- 1. #CMhack#CMhack Improving the waywe do change! Hacking the NHS Change Model 14 October 2015 #CMhack @HelenBevan @PerryTimms @ZoeLord1
- 2. #CMhack Housekeeping and survival! Breaks… Firealarms and exits… Mobile technology Toilet location…Security… Password: HubWest1 #CMhack 2
- 3. #CMhack We are adiverse group Diversity leads to more disruptive thinking, faster change and better outcomes Aylet Baron
- 4. #CMhack Joining in todayand beyond • Please tweet using the hashtag #CMhack • We will produce summaries of the discussions using Storify and Pinterest • A report is being produced in real time and will be emailed to everyone by next Monday, 19th October
- 5. #CMhack Aims for today • Reviewhow change currently happens in health and care • Review the NHS Change Model • Design a proof of concept to support and enable change across health and care • Scope how a change model can be spread across health and care
- 6. #CMhack Aims for today • Reviewhow change currently happens in health and care • Review the NHS Change Model • Design a proof of concept to support and enable change across health and care • Scope how a change model can be spread across health and care
- 7. #CMhack How we willdo this • Self-directed, not told • Communal, not siloed • Blocks, not agendas • Creative, not forced • Exploratory , not prescribed
- 8. #CMhack “Pioneering is the enemyof transformative and systematic change” David Albury The Innovation Centre Why, after nearly two decades, haven’t we created an unstoppable, system-wide drive for improvement?
- 9. #CMhack There have beenmany attempts to introduce change models and frameworks
- 10. #CMhack NHS Change Model Developedin 2012 with inputs from hundreds of people, to distil twenty years of learning from change in the NHS into a useable model to accelerate and get better outcomes from improvement
- 11.
- 12. #CMhack Drivers of extrinsic motivation create focus& momentum for delivery Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity •System drivers & incentives •Payment by results •Performance management •Measurement for accountability
- 13. #CMhack Internal motivators •connecting to shared purpose •engaging,mobilising and calling to action •motivational leadership build energy and creativity Drivers of extrinsic motivation •System drivers & incentives •Performance management •Measurement for accountability create & focus momentum for delivery
- 14. #CMhack The power ofextrinsic drivers
- 15. #CMhack Three types oflevers for large scale change ‘Prod mechanisms’ targets performance management price & payment incentives regulation competition ‘Proactive support’ relies on building ‘intrinsic motivation’ in staff to make the right changes to improve ‘People focused’ education and training national contracts professional regulation clinical quality standards Type one: Type two: Type three: Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015
- 16. #CMhack Three types oflevers for large scale change ‘Prod mechanisms’ targets performance management price & payment incentives regulation competition ‘Proactive support’ relies on building ‘intrinsic motivation’ in staff to make the right changes to improve ‘People focused’ education and training national contracts professional regulation clinical quality standards Type one: Type two: Type three: Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015 Less than 10% of the potential for improvement at system level can be delivered through type one change
- 17. #CMhack#CMhack Transformation is nota matter of intent......... it is a matter of alignment Peter Fuda
- 18.
- 19. #CMhack Shared purpose aligns..... Sharedpurpose allows many communities to engage with us without us having to invest resources in controlling their actions Nilofer Merchant
- 20. #CMhack 0 1 2 3 4 5 6 7 8 9 10 Our shared purpose Spreadof innovation Improvement methodology Rigorous delivery Transparent measurement System drivers Engagement to mobilise Leadership for change Where are we currently?
- 21. #CMhack Priority area: What outcomesdo we seek? Our Shared Purpose Is there a sense of shared purpose amongst our key stakeholders? Leadership for change Do all our leaders have the skills to create transformational change? Engagement to mobilise Are we engaging and mobilising all the right people? Spread for innovation Are we designing for the active spread of innovation? Rigorous delivery Do we have an effective approach for delivery of change and monitoring of progress towards our planned objectives? System drivers Are our processes, incentives and systems aligned to enable change? Improvement methodology Are we using an evidence-based quality improvement methodology? Transparent measurement Are we measuring the outcome of the change continuously and transparently? People with dementia Deliver goals of the National Dementia Strategy
- 22. #CMhack What’s strong? Whereare the gaps? How can we align? Political, clinical, voluntary and private sector leadership for change Multiple projects and initiatives at multiple levels not necessarily aligned Don’t consider any component of change in isolation (eg, broad perspective on CQUIN scheme re people with dementia in hospital) Strong sense of shared purpose and will for change Lack of transparent measures in terms of how well NHS is playing its part Support Clinical Commissioning Groups to act as enablers/aligners at local level Key stakeholders engaged and mobilised Not exploiting the potential for spread and adoption of innovation Link to local initiatives such as “Dementia Friendly Communities” Multiple system drivers to support change Sporadic use of quality improvement methodologies Align with other strategies to support older people across health and social care and building broad common commitment to change Clarity of immediate programme Building energy and engagement for the long haul Build all the components into design of future strategies
- 23. #CMhack Five key principlesin using the NHS Change Model 1. Start with “shared purpose” but after that there is no prescribed linear or logical order 2. It’s important to use the model to check if all eight components are present but it’s more important to focus on whether they are aligned 3. Use the model to build on what you are doing already 4. Don’t “sell” the change model; “sell” the outcomes you are seeking 5. Build commitment to, not compliance with, the NHS Change Model
- 24. #CMhack#CMhack Peter Fuda “Change isnot the goal, the goal is the goal” Peter Fuda
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- 26. #CMhack Insights • Interviewed andsurveyed 200 + people
- 27. #CMhack What did wefind Similarities and Polarities!!!
- 28. #CMhack What does theNHS workforce think? 14,000 contributors recently 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 Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015
- 29. #CMhack What does theNHS workforce think? 14,000 contributors recently 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
- 30. #CMhack Insights • Use: – Itis used for many different purposes -Projects, events, meetings • Knowledge: – The more people know, the more they find it useful – Easy accessible information on practical application is required • Language: – Some of the language is inhibiting • Name: – NHS brand brings prestige – NHS brand is hindering the uptake from other care providers – Is it a model or framework?
- 31. #CMhack Going forward… • Bringon board the people who don’t like it and keep hold of the people who do like it • Enhance the positives – rather than change for change sake • Address what ‘it’ should be called • Think about spread and implementation • How we frame it so that we focus on the goals not the model.
- 32. #CMhack Bingo sheets areon your table. Keep hold of your bingo card. Find people who match the words below and ask them to write their name in one relevant box. Once you’ve completed the whole grid, shout “bingo!” There’s a prize for the winner.
- 33. #CMhack#CMhack We’re here to Hack…but what’s a hack?
- 34. #CMhack A true hackathon •Strategic • Socialised • Participative • Fast • Conclusive
- 35. #CMhack Plan for theday • Series of hacks to explore design a proof of concept to support and enable change across health and care: – Problem solving – Framework hacks – Mini Hacks – Spread and sustainability hacks
- 36. #CMhack How today willwork This is not your usual conference or workshop, it is a specially designed process which enables a depth and quality of output that would usually be unachievable in such a short timeframe... “ “ 36
- 37. #CMhack We ask youto… • Go with the flow and have faith in the process • Unconference - self organise and follow your interests! • You have permission to create! • Take collective responsibility for completing the task in the timescale • Collaborate, support and constructively challenge others • Put yourself in other people’s shoes • Bring and voice your own perspective – that is why you are here! • Let reflectors reflect!
- 38. #CMhack We ask youto… • Go with the flow and have faith in the process • Unconference - self organise and follow your interests! • You have permission to create! • Take collective responsibility for completing the task in the timescale • Collaborate, support and constructively challenge others • Put yourself in other people’s shoes • Bring and voice your own perspective – that is why you are here! • Let reflectors reflect!
- 39. #CMhack#CMhack TRIZ: Theory of Inventive Problemsolving Stopping counter-productive activities and behaviours “Every act of creation is first an act of destruction” Pablo Picasso
- 40. #CMhack There have beenmany attempts to introduce change models and frameworks
- 41. #CMhack There have beenmany attempts to introduce change models and frameworks
- 42. #CMhack TRIZ: our schedulefor the next 30 minutes Step 1: Make a list of everything we could reliably do to create/promote a change model or framework that never gets used for any useful purpose in our world of health and care Step 3: Go through the items on your second list and decide what first steps will help us stop what we know creates undesirable results?” Step 2: Go down this list item by item & ask ‘Is there anything that we are currently doing that in any way, shape or form resembles this item?’ Be brutally honest to make a second list of all our counterproductive activities & processes TRIZ
- 43. #CMhack Our TRIZ topic… Howcould we could reliably create/promote a change model or framework that NEVER gets used for any useful purpose in our world of health and care? TRIZ
- 44. #CMhack Step 1 As atable group make a list of “to-dos” on the first paper sheet in answer to the question: How could we could reliably create/promote a change model or framework that NEVER gets used for any useful purpose in our world of health and care? • Go wild! • 10 minutes TRIZ
- 45. #CMhack Step 2 As atable group, go down your first list and ask: ‘Is there anything that we are currently doing that in any way, shape or form resembles any of the items on list one?’ • Make a second list on sheet 2 • Be unforgiving about these items and talk about their impact • 10 minutes TRIZ
- 46. #CMhack Step 3 As atable group, go down your second list from step 2 and ask: “what are the first steps that will help us stop getting undesirable results?” • Make a list of actions on sheet 3 • Be prepared to share some of your content from lists 2 and 3 with the wider group • 10 minutes TRIZ
- 47. #CMhack Lets have awarm up hack! Who is this model for? Who is our customer?
- 48. #CMhack Lets get hacking! Twoparallel hacks: • Framework Hack: Big Picture • Mini Hack: Elements & bright ideas
- 49. #CMhack Framework Hack: BigPicture • Remit: – Refreshed, revolutionary, reimagined – looks like a framework/model. • Starting point is up to you - Scrap the current model and start afresh - Start with the model and look what is missing, what could be improved • Bring the frameworks together to make one framework!
- 50. #CMhack Mini Hacks • Remit: –Depth – Ideas and activities • Examples of mini hacks: – What is the detail under the elements? E.g. leadership – How do you move from idea to reality? Story telling? – What’s it going to be called? – What’s it going to look like? Design? • Pitch your hack A3 paper – and set up your stall! • Ideas, synthesise and come up with some very useful things!
- 51.
- 52. #CMhack Remember: - Unconference - Followyour interests - Self organising - Go for it!!!!
- 53. #CMhack Lets get hacking! Twoparallel hacks: • Framework Hack: Big Picture • Mini Hack: Elements & bright ideas
- 54. #CMhack Feedback • Framework Hack:Big Picture • Mini Hack: Elements & bright ideas
- 55. #CMhack Final Sprint: TwoHacks 1) Design team - refining the design of the model 2) Diffusion – spread of our new model
- 56.
- 57. #CMhack Feedback 1) Design team- refining the design of the model 2) Diffusion – spread of our new model
- 58.
Editor's Notes
- #3 Helen
- #6 Helen
- #7 Helen
- #8 Helen
- #10 Zoe Haphazard Only achieved by the people involved – not because of the process, just imagine what chage would be like if those people were supported with an effecive change process. Accelerated change
- #11 Helen Talk about how it was developed – How we developed the NHS Change Model • Looking at best practice from across the world • Learning from what’s gone before to create a common approach • Consulting with people in the service – using their ideas, experiences and words – c500 people • Building on all we’ve learned about large scale change • Sharing progress – descriptors and design • Making sense at every level
- #26 Helen
- #27 Helen Some people who lead improvement love the model and use it to underpin all their improvement activities. Other improvement leaders dislike the model or find it hard to apply it in practical ways or think it should be broadened from just an NHS model. There are also issues about the way that the model is used. It creates a danger of change being driven by a model or method, rather than driven by goals for improvement that everyone can buy into.
- #29 Helen Thinking widely about change
- #30 Helen Thinking widely about change
- #31 Helen
- #32 Helen This needs some more expansion.
- #33 Helen Word bingo to get people introducing themselves
- #34 Perry Its not a workshop, it’s a hack because…
- #36 Perry
- #37 Perry
- #38 Perry
- #39 Perry
- #40 Zoe
- #41 Zoe Haphazard Only achieved by the people involved – not because of the process, just imagine what chage would be like if those people were supported with an effecive change process. Accelerated change
- #42 Zoe Haphazard Only achieved by the people involved – not because of the process, just imagine what chage would be like if those people were supported with an effecive change process. Accelerated change
- #43 Zoe
- #45 Zoe implemented/used
- #46 Zoe
- #47 Zoe
- #48 Perry
- #49 Perry
- #50 Perry
- #51 Perry
- #53 Perry
- #54 Perry
- #55 Perry
- #56 Perry How is our new model/framework going to be spread to all the right people and places? You may want to think about using personas… (Explain Personas) - Millie student nurse - George the Trust improvement manager **If required some people can complete previous exercise **
- #58 Perry How is our new model/framework going to be spread to all the right people and places? You may want to think about using personas… (Explain Personas) - Millie student nurse - George the Trust improvement manager **If required some people can complete previous exercise **
- #59 Helen and Perry Show new model