Transforming End of Life Care in Acute Hospitals PM Workshop 4: Achieving Transformational and Large Scale Change
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Transforming End of Life Care in Acute Hospitals PM Workshop 4: Achieving Transformational and Large Scale Change presented by Susie Peachey, NHS England
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Transforming End of Life Care in Acute Hospitals PM Workshop 4: Achieving Transformational and Large Scale Change
- 2. “Without innovation, public services costs tend to rise faster than the rest of the economy. Without innovation the inevitable pressure to contain costs can only be met by forcing already stretched staff to work harder.” Mulgan G. & Albury D. (2003) Innovation in the public sector. Strategy Unit, London. “Changing the way people think about situations is, in fact, the most powerful and useful way to ultimately change behaviour and thereby affect organisational results” Pfeffer J. (2005‐p125)
- 7. A culture for innovation • Leading change in a complex environment – the culture needs to support change – 7 dimensions identified to assess culture – work on the culture in your team (any collection of individuals where innovative output is required) • Culture is hard to change – work on the culture within your project/change (create a bubble for change to happen in)
- 8. Accompanied by 29 questions across these dimensions to visualise your culture and create a ‘portal chart’ that needs to be wide open for the free flow of ideas. Scored from -5 to +5
- 10. Risk Taking 1. My direct supervisor supports me if I want to try something new 2. If I suggest a new idea and it fails, I know that I will not be made to feel humiliated 3. In my dept, the general tendency is to try new things rather than hold onto the status quo 4. Senior leadership is willing to take a risk on new ideas that might make things better
- 11. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor hinder innovation Positive scores‐ behaviours and practices tend to aid innovation Negative scores‐ behaviours and practices tend to hinder innovation
- 12. Resources 5. My direct supervisor provides me the time to work on a promising new idea 6. In my dept, we seem to find the resources we need to fund innovative ideas 7. I feel that I have reasonable authority to try out an innovative new idea 8. Senior leadership makes sure that there is both the availability of time and money to support innovation
- 13. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor hinder innovation Positive scores‐ behaviours and practices tend to aid innovation Negative scores‐ behaviours and practices tend to hinder innovation
- 15. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor hinder innovation Positive scores‐ behaviours and practices tend to aid innovation Negative scores‐ behaviours and practices tend to hinder innovation
- 17. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor hinder innovation Positive scores‐ behaviours and practices tend to aid innovation Negative scores‐ behaviours and practices tend to hinder innovation
- 19. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor hinder innovation Positive scores‐ behaviours and practices tend to aid innovation Negative scores‐ behaviours and practices tend to hinder innovation
- 21. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor hinder innovation Positive scores‐ behaviours and practices tend to aid innovation Negative scores‐ behaviours and practices tend to hinder innovation
- 23. Scoring Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor hinder innovation Positive scores‐ behaviours and practices tend to aid innovation Negative scores‐ behaviours and practices tend to hinder innovation
- 24. Overall 29. My department has an underlying culture that supports innovation Scores from ‐5 to +5 0 ‐ behaviours and practices neither aid nor hinder innovation Positive scores‐ behaviours and practices tend to aid innovation Negative scores‐ behaviours and practices tend to hinder innovation
- 26. Relationships‐ tips for improving this dimension • Trusting, open environment to identify problems and share ideas • Honouring everyone’s input, not just those most senior, and exploring new ideas‐ not immediately arguing against use the ‘fresh eyes’ exercise • Create opportunities for diverse individuals to come together to create true team based working‐ job shadowing, work rotations • Explore personal styles and preferences‐ Myers‐ Briggs, Merrill‐Reid
- 27. • revealing your values • connecting to the values of others • gaining commitment to the change sought Professor Marshall Ganz identified the power of story telling in: “an appropriately told story has the power to ….. communicate a strange new idea easily and naturally, and quickly gets people into enthusiastic positive action” Denning S. (2007): The Secret Language of Leadership, Jossey Bass “You can’t impose anything on anyone and expect them to be committed to it” Edgar Schein, Professor Emeritus MIT Sloan School “You can’t impose anything on anyone and expect them to be committed to it” Edgar Schein, Professor Emeritus MIT Sloan School “You can’t impose anything on anyone and expect them to be committed to it” Edgar Schein, Professor Emeritus MIT Sloan School
- 28. Goals • The ‘Why’‐ leaders speaking about what they care about‐create a compelling vision for a new future‐ WOW • Create a clear case for need‐ NOW • Specific call for innovation‐ HOW • Tie to strategic plan‐ define, align and clarify goals • ‘Stretch’‐set aspirational goals that encourage new thinking and do something that seems impossible today e.g. NASA, keyhole surgery
- 29. “What a leader cares about does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into a change programme” Scott Keller & Carolyn Aiken (2009)‐ The Inconvenient Truth about Change Management “What a leader cares about does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into a change programme” Scott Keller & Carolyn Aiken (2009)‐ The Inconvenient Truth about Change Management “What a leader cares about does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into a change programme” Scott Keller & Carolyn Aiken (2009)‐ The Inconvenient Truth about Change Management Feedback from NHS senior leaders development programme showed: • 57% created a climate which is ‘demotivating’ • Only 12% created a climate that is ‘inspiring’
- 32. Why are we doing this? Dell • We make computers (what) • They have fast processors and great features (how) • We want you to buy our computers (why) Apple • Everything we do we believe in challenging the status quo. We believe in thinking differently (why) • Our products are beautifully designed, simple to use… (how) • We happen to make great computers (what)
- 33. Creating your Vision Wow • needs to create a ‘pull’ to engage others Now • should create a sense of urgency for moving to the new future How • creating alignment to core values
- 34. Risk Taking • Emotional support‐ learning from failure, not punishing • Balanced assessment‐ not over‐estimation of risk (intelligent risk‐taking)‐ challenge to take an idea forward • Create a climate of trying new things‐ After Action Reviews • Don’t use humour‐ we told her we are sure she can find work elsewhere if it doesn’t work
- 35. Resources • Authority to act‐ not always having to ask permission‐ remove perceived barriers to act • Funding‐ change is not free! – Link innovation efforts to waste reduction techniques • Seek resources from non‐traditional channels‐ become a test site, third sector/charities/ universities/ local industry • Turn strategically important innovation into formal organisational projects
- 36. Knowledge • Wide scope search‐ avoid ‘not invented here’ to prevent re‐inventing the wheel • Encourage ideas from outside the health service • Uncensored, unfiltered, unsummarised • Get information flowing freely and quickly‐ share board info widely and use knowledge from the workforce to support the board
- 37. Rewards • Intrinsic motivation‐ make change personally rewarding • Recognition‐ peer and patient • Aligned with organisational goal (use performance reviews) • Individualised‐ ‘thank you’
- 38. Tools • Deliberate process, with strategic focus • Develop a pool of people who can facilitate and develop creative thinking‐training in change techniques (SI) • Encouragement for skills development • Provide tools needed for change‐ introduce periodically NB Thinking Differently
- 39. Thinking Differently Creativity‐ a structured process 1. Stop before you start 2. Generate lots of ideas with stakeholders – First burst‐ brainstorm – Second burst‐ more structured 3. Harvest ideas and narrow selection‐ what criteria 4. Stretch and enhance ideas 5. Test and implement final choices …………….loop back through the process
- 40. Tools for generating ideas Fresh eyes‐ think like another person or make links to another industry Constraints‐ too much freedom can actually overwhelm teams trying to find solutions Breaking the rules‐ identify assumptions, mental models, unwritten rules and deliberately think around them Random word, picture or object‐ activate thoughts we don’t usually associate with the topic Stepping stones‐ start with the outrageous, suspend judgment, emerging concept, practical suggestions That’s impossible‐ think of impossible things that have been solved in the past‐ surgery without incision etc and think how it could be made possible Mental benchmarking‐ ideas applied in a not so obvious way in a different context
- 41. Using creativity and innovation to drive transformation - experiencing a technique Fresh Eyes
- 42. Thinking Differently…. • Fresh eyes • Stepping stones • Breaking the rules and many more ways of generating lots of ideas…
- 43. Thinking Differently… the tools Fresh Eyes‐ p70 Breaking the rules‐ p78 Random word/ picture/ object‐ p86 Stepping Stones‐ p94 That’s impossible‐ p102 Mental benchmarking‐ p108 Harvesting by Criteria or Dot Voting‐ p120 Others’ point of view‐ p40 Reframing by word play‐ p46 Pause, Notice, Observe p50 Phase 1: stop before you start Phase 2: generating lots of ideas Phase 3: selecting & testing ideas to make a difference Six Thinking Hats‐ p128 Enhancement checklist‐ p136 Testing new ideas on a small scale‐ p141
- 44. Fresh Eyes Since others have different ways of looking or approaching challenges, Fresh Eyes is about thinking or exploring the challenge in the mindset of another, with Fresh Eyes. Without birds, would we have sought to fly? This can be looking at things through other companies’ eyes or other peoples’ eyes, that may have tackled or looked at this challenge differently. Remember: this exercise is not just for new ideas for services but for any challenge you face in the changes you are making e.g. for maintaining momentum as team members change
- 45. Fresh eyes • In a moment, each person will be given a picture of a person or organisation. We will also give you a challenge to consider. • Individually (and silently) take five minutes to note down how the person or organisation would view the challenge – what would they pay attention to? (2 minutes) – what kinds of solutions would they consider? (3 minutes)
- 46. Fresh eyes – Example only Challenge • Reducing the waiting times in A&E Person or organisation • Disney Controlled environment, distracting people with fun, different zones for attractions, parades, lots of guides etc. What do they pay attention to? What kinds of solution would they consider? •Guides to help navigate A&E •Creating treatment zones •Dressing all the consultants as Mickey!
- 47. Fresh eyes Reducing A&E waits . . . by dressing all the consultants in Mickey Mouse outfits! What a stupid idea! Or is it?
- 48. Fresh eyes Reducing A&E waits . . . by dressing all the consultants in Mickey Mouse outfits! Should we make it easier for patients to tell who the staff are? Should we make staff more approachable? Are the consultants front of house enough, seeing more people? Treat ‘stupid’ ideas as a springboard for new insights and ideas
- 49. Fresh eyes • In a moment, each person will be given a picture of a person or organisation. We will also give you a challenge to consider. • Individually (and silently) take five minutes to note down how the person or organisation would view the challenge – what do they would pay attention to? (2 minutes) – what kinds of solutions would they consider? (3 minutes)
- 50. Your challenge How would these people or organisations tackle . . . Getting health and local government to coordinate their support for individuals more effectively 5 minutes, individually and silently 2 minutes on: What do they pay attention to? 3 minutes on: What kinds of solution would they consider?
- 51. Building on your individual thoughts Rules for idea generation Criticism is ruled out Go for quantity Encourage wild ideas Build on the ideas of others Every person and every idea has equal worth One conversation at a time . Go round the table – one ‘solution’ each One solution = one breath and no more! As they speak, note down builds or new ideas Pause to think when everyone ‘passes’ then go again 5 minutes
- 52. Your challenge How would these people or organisations tackle . . . Getting health and local government to coordinate their support for individuals more effectively Feedback • Top innovative idea that has potential • Most thought provoking (or wishful thinking) idea