Radical thinking and practice about change and transformation

@HelenBevanSource of image:

Buildingchangetrust.org

Helen Bevan@HelenBevan

Radical thinking and practice about change and

transformation

@HelenBevan @HelenBevan

Learning outcomes• Get a sense of hope, potential and possibility about the future

of change in health and care• Identify major themes and trends in the global world of

change and transformation that are likely to shake our world of health and care improvement

• Learn how “change platforms” (approaches to change that allow everyone to have a voice, to connect and collaborate and socially create the future ) will lead to the demise of “change programmes” as we know them

• Consider the opportunities and implications of the above for our own practice as leaders or activists in health and care

• Model new forms of collective learning, collaboration and community building and bring the future forward

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

@HelenBevan

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

DIGITALCONNECTION

SEISMIC SHIFTS

Work complexity

SEISMIC SHIFTS

DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

Work complexity

@HelenBevan

“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/

DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

Work complexityChange from the edge

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

Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always

@HelenBevan@HelenBevan

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 outcomesAylet Baron

Research by IBM

200841% of leaders considered they were successful in managing change

201420% of leaders considered they were successful in managing change

Source: Jorgensen, Bruel & Franke, Making change work….while the work keeps changing” quoted in Foster F (2015) “Using crowdsourcing to deliver transformational change

@HelenBevan@HelenBevan

Source : Ross Dawson (2015)

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

Relationship

The battle and balancing between the old and new power will be a defining feature

of society and business in the coming yearsJeremy Heimans and Henry Timms

Understanding new power, Harvard Business Review, December 2014 https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet

The battle and balancing between the old and new power will be a defining feature

of society and business in the coming yearsJeremy Heimans and Henry Timms

Understanding new power, Harvard Business Review, December 2014 https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet

The battle and balancing between old and new power will also be the defining feature of the

health and care system in the coming years

@HelenBevan @HelenBevanFor 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 contractsprofessional 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 contractsprofessional 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

@HelenBevan

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

@HelenBevan

“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 2015http://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

@HelenBevan

• 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 situationChange 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, 2014Build a change platform not a change program

#Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

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 Satellhttp://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:

1. Connecting platforms

2. Mobilising platforms

3. Learning platforms

4. Knowledge platforms

5. Crowdsourcing platforms They overlap!

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

@HelenBevan

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

@HelenBevan

Example platforms

Source of image: @JenniferClemo

@HelenBevan

Case study: Giff Gaff“The mobile network run by you”

@HelenBevan

Carousal: shows all active challenges open for staff participation

Live activity feed

Click here to submit an idea

Gamification

A platform for Trust-wide transformationLeeds 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

@HelenBevan

https://www.youtube.com/watch?v=CMDKkTuLUHw

http://www.breakdengue.org/

@HelenBevan

www.newhcvoices.co.uk

The Academy of Fabulous NHS Stuff

@HelenBevan

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

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 Source: UXthink

@HelenBevan

Knowledge platforms

Because there’s a problem….

Source of quote: Harold JarcheSource of image: http://gotcll.com/about-2/

Gettinginformation 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 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”

@HelenBevan

Horizons Team: All our work is via change platforms

Source of image: @JenniferClemo #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

@HelenBevan #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

Stephen Downes, 2011Connectivism & Personal Learning

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 #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

• 4 X the local activity/connectivity in 2015 compared to 2014

• #nhschangeday: 130m impressions

• Facebook impressions 253,999

The power of th

e platform #MatExp

The power of the platform

#NHSChangeDay + #MatExp

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

Celine Schillinger

Source of image: Leadershipfreak.wordpress.com

@HelenBevan

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

• Build bridges between disconnected groups• Activate radicals and engage them in action for

change• Change the story of how we undertake large

scale and transformational change in the NHS• Lead from the edge using new era methodology

Objectives to:

The process:

Step 1 :The build-upSetting the right foundation for campaign launch

Step 2:Launch campaign, explore barriers and enablersWeeks 1-4Launch the campaign for bottom up change and questions to the crowd to develop the barriers and building blocks for change.

Step 3Propose solutions Weeks 5-6Crowd invited to share, build and validate list of potential solutions

Step 4Develop toolkitWeek 7 best ideas selected by crowd and panel selectsWeeks 8-9 crowd develops best ideas into toolsWeeks 9-11 works on key outputs

Step 5:Spread and EmbedWeek 12Publication of interactive guide / ‘new era’ toolkit / manifesto for change / celebrated cases

Development of the process, questions, objectives and communication plan

Questions:-What things block or help you from delivering bottom-up change:· inside your organisation, to improve or transform services, and· across organisations to improve the health and wellbeing of a local population?

Questions:- What solutions work? What approaches have you used or observed that others could learn from and copy? Please share your stories and learning about what did and didn't work. What solutions should we test? What ideas do you have that we could test out? Share ideas (these can be completely new) that you believe could support bottom-up change in the NHS, if we gave them a chance.

47 ideas selected for the crowd to develop. Crowd asked to develop these into workable tools; tangible and practical enough to be used widely across health and care organisations to deliver bottom up change for patients, staff and the public. To do this, please tell us: - what steps need to be taken, - who needs to be involved, and - what commitments…

The HSJ and Nursing Times share outputs :• project overview,• ‘how to’ guides for

application of crowdsourcing

• ‘how to’ toolkit of prioritised ‘hacks’/ solutions

Result: a foundation for a social movement of bottom up change

Project over 12 weeks

Reach and scale:

• 3,595 people involved - from 45 different countries

• 13,895 ideas, comments and votes shared - collectively identifying:

Final outputs were • 10 barriers• 11 building blocks• 16 solutions

@HelenBevan

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

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

@HelenBevan

14,000 contributions identified 11 building blocks for change:

Inspiring & supportive leadershipCollaborative 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

@HelenBevan

The power of the platform

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

@HelenBevan

Use the “barriers” and “building blocks” to analyse a change initiative

that you are currently working on

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

@HelenBevan

Case study: System redesign principles for care models

Source of image: @JenniferClemo #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

@HelenBevan

A call to action!“Help us to capture system redesign

principles for care models to get better, quicker outcomes from change”

#CareDesign

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

Aims• Distil a new set of design principles to accelerate the

implementation of care models that are truly based on the wants and needs of people who use the care system, patients and families.

• Organise the principles in a way that makes them accessible and highly useable to people designing new care models

• Identify examples from across the world of the design principles in action

• Signpost tools, methods and resources that can help in the implementation of the design principles

• Demonstrate the power of design thinking for health and care transformation

@HelenBevan

Design a platform methodology to test, adapt and validate the design principles and make them useable/accessible

• Think about using ‘sprints’ to break the challenge down into manageable, simple ‘chunks’

• You might like to consider:• Identification of methods and resources to support implementation

of the design principles• Capturing examples of the design principles in action• Encouraging people to build the principles into their change efforts

and build capabilities in the methods underpinning the design principles

● 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 needlove too!

● Crowds need direction & guidance to help them feel part of their community & give of their best

Keep itsimple

● 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

Design a platform methodology to test, adapt and validate the design principles and make them useable/accessible

• Think about using ‘sprints’ to break the challenge down into manageable, simple ‘chunks’

• You might like to consider:• Identification of methods and resources to support implementation

of the design principles• Capturing examples of the design principles in action• Encouraging people to build the principles into their change efforts

and build capabilities in the methods underpinning the design principles

Platform methodology for our design principlesPre-sprint Sprint 1 Sprint 2 Sprint 3

Expert group sense-check of design principles & crowdsourcing process

“Have we got the right design principles?”

“Tell us about the design principles in action”

“How do we make the principles happen?”

V1.0 of design principles paper to be shared with expert group of “systems engineers” both from within and outside the NHS

The ten design principles will be presented via the crowdsourcing platform to our collaborators (widespread engagement)

Invite practical examples and case studies that demonstrate the refined ten design principles working and in action

Invite collaborators to signpost us to tools, methods, resources and methodologies that can help in the implementation of the design principles

Output from each sprint becomes a new version of the paper. The socially derived design principles are then open for the next sprint and round of crowdsourcing

How you can get involved:

• Look out for our tweets• Email: jodi.brown@nhsiq.nhs.uk to receive updates

& an invite to join the collaboration platform

@HelenBevan

”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

@HelenBevan

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 #EdgeTalkstheedge.nhsiq.nhs.uk/edgetalks

4. Save the date for theedge.nhsiq.nhs.uk/transformathon

4pm - 4pm, 27-28th January 2016

“Even the smallest creature can

change the world”Galadriel to FrodoLord of the Rings

Ashoka (2014) What does leadership mean in the 21st century?Berg O (2014) The Collaboration Pyramid revisitedBriggs D (2015) The elements of council as a platformBromford 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 ageDeloitte University Press (2014) The power of platformsHagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movementsHagel J (2014) Platforms are not created equal: harnessing the full potential of platformsHamel G, Zanini J (2014) Build a change platform not a change programHealth Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’ interactive toolkitHeimans 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 writingO’Reilly T (2010) Government as a platformPearce D (2013) Social business discussions are the new documentationRaymond E S (2001) The Cathedral and the BazaarSatell G (2015) 4 things you should know about platformsSatell G (2012) How power is shifting from corporations to platformsSatell G (2015) Leaders must do more than inspire – we must shape networksSchillinger C (2015) Forget social networks, think social impact [YouTube]Scrivens J (2015) Enabling the experience of wholeness within enterprise social networksSewell S (2015) Stop training our project managers to be process junkiesShaw K (2015) Placing a digital platform at the heart of organisational change with OxfamSimon P (2011) The Age of the Platform

References cited in the slide deck (2/2)

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