Transformational leadership in healthcare: ICRE

@HelenBevan #ICRE2015
Helen Bevan
@HelenBevan
#ICRE2015
in healthcare
Source of image: http://cindyscott.org/so-what-is-the-big-deal-with-transformational-leadership-anyway/

@HelenBevan #ICRE2015@HelenBevan #ICRE2015
Learning outcomes
• Learn why transformational change is a
critical topic in leading improvement.
• Identify the future skills that healthcare
leaders need
• Understand how future methodologies,
models and frameworks for
transformational leadership can create
positive conditions for change in
healthcare

The NHS Five Year Forward View
• New care models
• Reinforcement of list-based
primary care
• Potential mismatch between
resources and patient needs of
nearly £30 billion a year by
2020/21
• Mentions “radical” 10 times, “transformation” 12
times and “change” 32 times
• Radical upgrade on prevention and public health
• Patients gain far greater control of their own care

New care models
• Viable smaller hospitals
• Maternity services
• Health of people in care
homes
• Multispecialty Community Provider
• Primary and Acute Care Systems
• Urgent and emergency care

“Pioneering
is the enemy of
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?

I amar prestar aen,
Han mathon ne nen,
Han mathon ne chae,
A han noston ned gwilith
The world is changed,
I feel it in the water,
I feel it in the Earth,
I smell it in the air
Galadriel’s prologue: The Lord of the Rings: The Fellowship of the Ring

SEISMIC SHIFTS

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

Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”

How does the NHS improvement community
prefer to communicate?

“In a connected world, power no
longer emanates from the top of
the heap, but the centre of the
network.”
Greg Satell, 2015
Greg Satell: http://www.digitaltonto.com/2015/how-power-is-shifting-from-
corporations-to-platforms/

SEISMIC SHIFTS
Change from the edge

http://www.slideshare.net/Openpolicymaking/policy-lab-slide-
share-introduction-final

Starts on the fringe
(at the edge)
Starts with the activists
Gary Hamel
always

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

Jeremy Heimens TED talk “What new power looks like”
https://www.youtube.com/watch?v=j-S03JfgHEA
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship

@HelenBevan #ICRE2015@HelenBevan #ICRE2015For more information/explanation visit: The Collaboration Pyramid revisited

Three types of levers 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

Three types of levers 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

Is your change process a cathedral or a bazaar?
http://www.unterstein.net/su/docs/CathBaz.pdf

We have a lot of cathedrals
Source: Sewell (2015) : Stop training our project managers to be process junkies

“In a world of mounting performance pressure,
[organisations and change processes] need to
evolve…the most successful will be those that
evolve into movements.
Success will be determined by their ability to
mobilise, inspire and support an
ever-expanding array of participants extending
far beyond their own four walls”
John Hagel, SXSW 2015
http://www2.deloitte.com/us/en/pages/center-for-the-edge/articles/john-hagel-at-
sxsw.html
@HelenBevan @TheEdgenhs #EdgeTalks@HelenBevan @Jodi Olden #EdgeTalks

The power of the platform
“Facebook, YouTube, Twitter and their lesser cousins have
proved the power of the platform. They have shown that if
your average 21st century citizen is given the tools to
connect and the freedom to create, they will do so with
enthusiasm, and often with an originality that blindsides
the so-called creative industries. …..
Good leadership is no longer about ‘taking charge’ or
imposing a strategic vision but about creating the
platforms that allow others to flourish and create”
Ashoka
http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in-
the-21st-century

• 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”

“A space (physical or virtual) that is created
so people get the choice and opportunity to
collaborate without boundaries to achieve a
common purpose, tackle a challenge or
improve a situation
Change platforms tackle silo thinking and
other barriers to the exchange of knowledge.
They enable a diverse group of people to
come to the table, share ideas, insight and
learned experience, co-create solutions and
launch experiments. Platforms thrive on
trust, relationships and the collisions of
minds. They build energy for change.
What is a change platform?
Definition by @JodiOlden & @HelenBevan 2015

“Change comes naturally when individuals
have a platform that allows them to
identify shared interests and to brainstorm
solutions.”
Gary Hamel & Michele Zanini, 2014
Build a change platform not a change program

Joy’s Law: No matter who you are, most of the smartest
people work for someone else
Bill Joy, Sun Microsystems
“It’s become a kind of ‘Joy’s Law’ for the
networked era—the best resources and
capabilities always lie somewhere else.”
Greg Satell
http://www.digitaltonto.com/2015/4-things-you-should-know-about-
platforms/?ct=t%28Why_Some_Movements_Succeed_5_31_2015%29
Platforms give access to resources

Evolving kinds of change platforms:
They overlap!
1. Connecting platforms
2. Mobilising platforms
3. Learning platforms
4. Knowledge platforms
5. Crowdsourcing platforms

Platform principles have long been part of
change practice
• Building on traditions in the field of
organisation development of communities of
interest and communities of practice
• Technology enables us to connect more widely
and at greater speed
Source of image:
Socialserviceinstitute.sg

Example platforms
Source of image: @JenniferClemo

Carousal:
shows all
active
challenges
open for
staff
participation
Live activity
feed
Click here to
submit an
idea
Gamification

A platform for system-wide transformation
Leeds Teaching Hospitals NHS Trust & Clever Together
WayFinder – a Crowdsourcing methodology and platform
• Step 1: 4,500 staff and stakeholders shared 45,000 contributions to
• co-create The Leeds Way – a redefinition of their vision and their
values
• co-design a five year strategy – a shared agreement of what needs
to happen to achieve their vision
• co-define a new behavioural framework – a new agreement of the
acceptable ways in which staff will live their values embedded into
recruitment, induction, training and appraisals
• Step 2: WayFinder local – every department trained to use its own
crowdsourcing platform
• 19 clinical service units trained
• A new way of working – online workshops – to ensure staff always
have a say in what’s happening in the Trust, bringing people
together to co-create solutions.
Examples of results:
• Staff satisfaction is up / buy-in to vision and values at an all time
high / complaints down 17% / 18weeks RTT down by 66% / CQC
acknowledgement of staff engagement and impact on quality and
safety

http://www.breakdengue.org/

www.newhcvoices.co.uk

The Academy of Fabulous NHS Stuff

Effective change platforms:
Gary Hamel & Michele Zanini (2014)
http://www.mckinsey.com/insights/organization/build
_a_change_platform_not_a_change_program
 Encourage people to tackle significant organisational challenges
 foster honest and forthright discussion of root causes and, in the
process, develop a shared view of the thorniest barriers
 elicit dozens (if not hundreds) of potential solutions rather than
seeking to coalesce prematurely around a single approach; the
goal is first to diverge, then to converge
 focus on generating a portfolio of experiments that can be
conducted locally to help prove or disprove the components of a
more general solution, as opposed to developing a single grand
design
 encourage people to take personal responsibility for initiating the
change they want to see and give them the resources and tools
necessary to spur their thinking and imaginations

@HelenBevan #ICRE2015 Source: IDEO: The Field Guide to Human-Centered Design

Knowledge platforms

Because there’s a problem….
Source of quote: Harold Jarche
Source of image: http://gotcll.com/about-2/
Getting
information off the
internet is like taking a
drink from a fire hydrant
Mitchell Kapor

What is the best way to spread new
knowledge?
Source of data: Nick Milton
http://www.nickmilton.com/2014/10
/why-knowledge-transfer-
through.html
Social connection/discussion is
14 times more effective
than
written word/best practice
databases/toolkits etc.
Source of image: www.happiness-one-quote-time.blogspot.com

Platforms as the new documentation
Source of image:
Flickr user acaben

@HelenBevan #ICRE2015 Source: Oliver Benson
If you’re a programmer, you don’t even
bother reading the manual, you simply
use stackoverflow to answer all your
questions”

Horizons Team:
All our work is via change platforms
Source of image: @JenniferClemo#Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

@HelenBevan #ICRE2015#Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

@HelenBevan #ICRE2015@HelenBevan #ICRE2015#Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

1. Being a health and care radical: change starts with me
• The differences between trouble-makers and radicals
• How to rock the boat and stay in it
• How to be a great change agent
2. Forming communities: building alliances for change
• The power of working together by exploring communities and social movements
• Techniques for connecting with own/others’ values and emotions to create a call
for action
3. Rolling with resistance
• Recognising behaviour, behaviour change and the importance of appreciating
where people are starting from in relation to change
4. Making change happen
• A range of tools, tactics and ways to make change happen
5. Moving beyond the edge
• Helping radicals to shape how they take their learning from The School forward
• What we can do next and where else we might get support and resources

The School is being formally evaluated by the Chartered
Institute for Personnel & Development
#EdgeTalks WebEx
http://theedge.nhsiq.nhs.uk/expert
/how-has-the-school-for-health-
and-care-radicals-made-a-
difference/
Or Google: #EdgeTalks School
How has the School for Health and Care
Radicals made a difference?

The School is being formally evaluated by the Chartered
Institute for Personnel & Development
• Change knowledge
• Sense of purpose & motivation to improve practice
• Ability to challenge the status quo
• Rocking the boat & staying in it
• Connecting with others to build support for change
Statistically significant positive effect on
EVERY dimension of impact at both individual
and organisational level

@HelenBevan #ICRE2015#Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
Activists from 120
countries
500,000+ Twitter impressions
@theedgenhs
21,000 active users

We have supported NHS Change Day for three years
• 800,000 pledges in 2014
• 6X the local
activity/connectivity in
2015 compared to 2014
• #nhschangeday: 130m
impressions
• Facebook impressions
253,999

“Top down is a
serious disease but
it can be treated”
Celine Schillinger

The Change Challenge
Tapping the collective brilliance
of the NHS

• The biggest-ever digital campaign for EMAP
(Health Service Journal and Nursing Times)
• 14,000 contributors to the joint campaign to
“challenge top down change”
• Ground-breaking: the first-ever crowd-sourced
theory of change in the NHS

Reach and scale:
• Contributors from 45 different
countries
• 13,895 ideas, comments and
votes shared - collectively
identifying:
Final outputs were
• 10 barriers
• 11 building blocks
• 16 solutions

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
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-fail-
don.aspx
Buy in from front line staff is critical for
improvements in quality and safety . Don’t
overload them
Buy in from front line staff is critical
for improvements in quality and safety
Don’t overload them
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

The power
of the
platform
“...demonstrates,
yet again, the
collective
brilliance of the
people who
work in the NHS
and wider care
system”
@HelenBevan

How to create a change platform #1
• Be clear about your intention or goal:
• Solve a problem?
• Learn from others?
• Create solutions?
• Mobilise for change?
• Spread innovation?
• Articulate your mission
• Design the stages in your process
• Sprints and hacks

How to create a change platform #2
• Identify the people you want in your community
• Identify how to reach them
• Find a platform
• Existing or new
• Free or paid for
• Virtual or face to face
• Measure the outcomes (all the way through)
• Engage your community
• Set their expectations
• Keep the connections flowing
• Convert ideas to actions
• Always, always follow up

Case study:
System redesign principles for care models
Source of image: @JenniferClemo#Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

CARE
DESIGN
2016
Systemredesign principles forcare models
#CareDesign
“Help us to capture redesign
principles for care models to get
better, quicker outcomes from
change”

What are design principles?
“Design principles are suggestions that are highly
likely to be effective, but they are not formulae
that guarantee success … The point remains,
however, that if one knows the design principles
in a field, he or she is much further along in
thinking and much more likely to be successful.”
Paul Bates

1. Distil a set of principles for redesign of care models that is globally
applicable
2. Organise the principles in a way that makes them accessible and
highly useable to people designing new systems for delivering care
3. Identify examples from across the world of the redesign principles in
action
4. Signpost tools, methods and resources that can help in the
implementation of the redesign principles
5. Demonstrate the power of design thinking for health and care
transformation
Our Care Design 2016 aims:

Our ‘starter-for-ten’

● Only 1% participate
fully so start with a big
crowd
● Inject thought
diversity to guard against
groupthink
● Mix high domain
knowledge with those
with high creativity
Choose the right
crowd
Choose the right
incentives
● Crowdsourcing cannot
happen without a
vibrant, committed
community
● Rewards must balance
intrinsic & extrinsic
motivators
Crowds do not
replace the team
● You’ll get volume &
diversity from the crowd
but be prepared to
match it with equal time
& effort to herd, sift &
identify contributions
Crowds need
love too!
● Crowds need
direction & guidance to
help them feel part of
their community & give
of their best
Keep it
simple
● Break complex tasks
down
● Tasks must be small,
simple & fun & fit into
your crowd’s spare time
Remember
Sturgeon’s Law
Communities are
always right!
Fulfilling self-
actualisation
● “90% of everything is
crap / 10% of everything
is not crap”
● Allow the crowd to
surface its best through
voting to the top
● Crowdsourcing
works because
creativity, spontaneity,
problem-solving &
affiliation achieve self-
actualisation (Maslow
/ Howe)
● Top-down
management style does
not work in crowds, nor
does grass-roots anarchy
● Lead with the moral
authority the crowd
allows
Adapted from: A Guide to Open Innovation and Crowdsourcing, Ed. Paul Sloane
The rules of crowdsourcing

https://nhsiq.crowdicity.com/

”If people give to a cause,
they expect a relationship,
not a transaction”
Nilofer Merchant
Once you start down this path, you
have to follow up and continue

Platforms are only as good as the people
leading them
Source of image: www.activationjourney.com

Four ways to connect!
1. Follow us on Twitter
@HelenBevan @TheEdgeNHS @School4Radicals
2. Subscribe to
theedge.nhsiq.nhs.uk
3. Get materials from
theedge.nhsiq.nhs.uk/school
…and sign up for our monthly #EdgeTalks
theedge.nhsiq.nhs.uk/edgetalks
4. Save the date for
theedge.nhsiq.nhs.uk/transformathon

@HelenBevan #ICRE2015@HelenBevan #ICRE2015#Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
4pm - 4pm, 27-28th January 2016

“Even the smallest
creature can
change the world”
Galadriel to Frodo
Lord of the Rings

Ashoka (2014) What does leadership mean in the 21st century?
Berg O (2014) The Collaboration Pyramid revisited
Briggs D (2015) The elements of council as a platform
Bromford P (2015) What’s the difference between a test and a pilot?
Dawson R (2015) The future of work and organisations
Deloitte University Press (2015) Business ecosystems come of age
Deloitte University Press (2014) The power of platforms
Hagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movements
Hagel J (2014) Platforms are not created equal: harnessing the full potential of platforms
Hamel G, Zanini J (2014) Build a change platform not a change program
Health Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’
interactive toolkit
Heimans J (2014) What new power looks like [YouTube]
Heimens J, Timms J (2014) Understanding “New Power”
Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers
Ivanov E (2013) The Strength Within
References cited in the slide deck (1/2)

Jarche H (2014) The Seek > Sense > Share Framework
Milton N (2014) Why knowledge transfer through discussion is 14 times more effective
than writing
O’Reilly T (2010) Government as a platform
Pearce D (2013) Social business discussions are the new documentation
Raymond E S (2001) The Cathedral and the Bazaar
Satell G (2015) 4 things you should know about platforms
Satell G (2012) How power is shifting from corporations to platforms
Satell G (2015) Leaders must do more than inspire – we must shape networks
Schillinger C (2015) Forget social networks, think social impact [YouTube]
Scrivens J (2015) Enabling the experience of wholeness within enterprise social networks
Sewell S (2015) Stop training our project managers to be process junkies
Shaw K (2015) Placing a digital platform at the heart of organisational change with Oxfam
Simon P (2011) The Age of the Platform
References cited in the slide deck (2/2)

Transformational leadership in healthcare: ICRE

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