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@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum Leading Radical A day of transformation Minicourse M5 Monday 8 th December Helen Bevan @HelenBevan Elaine Bayliss @Elaine_Bayliss Jon Hannah @JCHannah77 #IHI26Forum #Radicals
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Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Jul 07, 2015

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Healthcare

These are the slides from the Minicourse M5 that Helen Bevan led at the Institute for Healthcare Improvement National Forum, 8th December 2014

The aims of the day were to:
- Identify major themes and trends in the global world of change and transformation that are likely to shake the world of health care improvement
- Consider the opportunities and implications of these for their own practice as a leader of change and improvement
- Model new forms of collective learning, collaboration, and community building

You can follow Helen on Twittter at @HelenBevan

You can also sign up for The Edge, our free knowledge hub for change activists in health and care at TheEdge.nhsiq.nhs.uk
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Page 1: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Leading Radical

A day of transformationMinicourse M5

Monday 8th December

Helen Bevan @HelenBevanElaine Bayliss @Elaine_BaylissJon Hannah @JCHannah77

#IHI26Forum#Radicals

Page 2: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

We can’t drive into the future using only our rear view mirror

We will spend an inspiring day with like-minded individuals to consider the implications and opportunities for

transforming health care in a world where the power of hierarchy is diminishing in the face of complexity and

change is happening faster and becoming more disruptive

Join our new breed of change leaders who are rewriting the rules and leading change from the future

“Source of image: Abhishekshilpa.blogspot.com

Page 3: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Objectives of our minicourse

• Identify major themes and trends in the global world of change and transformation that are likely to shake the world of health care improvement

• Consider the opportunities and implications of these for their own practice as a leader of change and improvement

• Model new forms of collective learning, collaboration, and community building

Page 4: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

The Fundamental Law of Conventional Conferences

The sum of the expertise of the

people in the audience is greater

than the sum of expertise of the people on stage

Dave Winer

““

Source of image: www.citynet.com

Page 5: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Flipped classroom

Page 6: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Prework for our Minicourse

• Watch the film

• Read the White Paper “A new era of thinking and practice in change and transformation: a call to action for leaders of health and care” and watch the embedded films

• Complete your transformational profile

Page 7: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Today is based on two kinds of learningTransactional learning Transformational learning

A “toolkit” of ideas & approaches

Learning through motivation, practice &feedback

Seeks to transfer useful knowledge

Seeks to transform beliefs & underlying assumptions

Learning events, presentations & materials

Experiential, interactive & action-based

Generates understanding of “what to do”

Generates increased capacity in “how to do it”

Source: John Wenger https://medium.com/corporate-learning/3deb1bb2e865

Page 8: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Today we are part of a global community of change agents!

• We will monitor and synthesise tweets all day, including those from fellow change agents who are connecting virtually

• We will be using polling technology Poll Everywhere

• We will produce summaries of the minicourse:

– Storify

– Pinterest

• Please use both Twitter hashtags #IHI26Forum and #Radicals

Page 9: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Lunchtime Twitter clinic!

Page 10: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Design framework for our minicourse

Designed by M G Taylor

Page 11: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Design framework for our minicourse

• Understand everything that has happened to date

• Understand the opportunity to improve things

• Create a level starting point for change

• Imagine a different future

• Think the unthinkable

• Identify and test ideas

• Narrow down options

• Find creative solutions

• Make choices

• Uncover and remove barriers to change

• Build shared purpose around intention to act

• Make definitive decisions

• Establish action plans

• Agree review process

Page 12: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26ForumSource of image: www.freshnessmag.com

for today

Part 1:• Background to Minicourse• Our community

• Learning processes

• Context: emerging directions

in transformation and change

Part 2:• Applying the principles to our

own settings and challenges

• The 15 actions for leaders

• Mini talks and discussions

Part 3:• Background to the

“unconference”• First round of “unconference”

• Postcards from the future

Part 4:

• Second round of

“unconference”• Voting

• Next immediate steps

RCT

RCT

Page 13: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Four keys to collaboration

• Lean into discomfort

• Listen as an ally

• State your intent

• Share your “street corner”Source: Judith Katz and Fred Miller

Page 14: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Page 15: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

“I have some Key

Performance

Indicators

for you”

or

“I have a

dream”

Source: @RobertVarnam

Page 16: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Task

We are going to talk to others on our table about our goals and ambitions for radical change

• Pick a picture card from the pack that reflects your goals and dreams for improvement/change/transformation

• In turn each person at the table should take turns to:

• Introduce yourself to others

• talk about your goals and dreams (and why you picked the picture)

Time allowed (for whole table): 20 minutes

Page 17: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Page 18: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

What is transformational change?

Transformational change is a systems approach, deriving its power by attending equally to hearts & minds (the inner life of human beings), human behaviour, and the social systems and structures in which they exist. It therefore tends to be multi-disciplinary, integrating a range of approaches and methodologies. Transformational change aims to be irreversible and enduring.

Robert Gass, Rockwood Leadership Institute

““

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@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26ForumSource: Tim Stock http://www.slideshare.net/AnalyzingTrends/5-luxury-codes-stories

Page 20: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Leading change in a new era

Dominant approach Emerging direction

Page 21: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

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

society and business in the coming years

Jeremy Heimans and Henry Timms

Recommended reading: 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

Page 22: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Page 23: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26ForumSource: Gary Hamel

Page 24: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Gary Hamel’s 4 Ms for transformation

Page 25: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26ForumFor more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW

Page 26: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Some challenges:• Create organisations that are activist at their

core

• Find ways to:– marry innovation with complexity and scale

– balance control and freedom

• out-love everyone else

Source of image: rachelstivers.com

Page 27: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

What is a

RCT?

Page 28: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Randomized Coffee Trial!

Page 29: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Outcomes of randomised coffee trials

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Page 31: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

1. Change starts with me

Source of image: jasonkeath.com

Page 32: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Peter Fuda’s Transformational Change Agent framework

Skills and methods for creating change

Ability to make sense of, and reshape perceptions of ‘reality’

Personal characteristics and qualities

Page 33: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Peter Fuda’s Transformational Change Agent framework: my perspective

“Doing”• Where most change agents

in health and care put most of their effort and emphasis

• What others typically judge us on

• What we often perceive we need to do to add value

• What most change and improvement courses focus on

Page 34: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Peter Fuda’s Transformational Change Agent framework: my perspective

“Seeing ” and “Being”• We can only do effective

“doing” if we build on strong foundations of “seeing and being”

• Change begins with me• Hopeful futures, creative

opportunities and potential• Multiple lenses for change • See myself in the context of

my higher purpose

Page 35: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

“Being” as a change agent

Personal characteristics and qualities

Page 36: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

‘I do not think you can really deal with change without a person asking real

questions about who they are and how they belong in the world’

David Whyte, The Heart Aroused 1994

Source of image: fistfuloftalent.com

Page 37: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

"There’s only one corner of the

universe you can be certain of

improving, and that’s your own

self." Aldous Huxley

Source of image: timcoffeyart.wordpress.com

Page 38: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

1. able to join forces with others to create action

2. able to achieve small wins which create a sense of hope, self-efficacy and confidence

3. More likely to view obstacles as challenges to overcome

4. strong sense of “self-efficacy” belief that I am personally able to create the change

Four things we know about successful

boat rockers

Source: adapted from Debra E Meyerson

CHANGE

me

BEGINS WITH

Page 39: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Self-efficacy

There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change

and get good outcomes

Source of image:www.h3daily.com

Page 40: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source: @NHSChangeDay

Page 41: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source: @NHSChangeDay

What is the issue here?

“permission” ? (externally generated)

or

Self efficacy ? (internally generated)

Page 42: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

What’s the difference between

self efficacyand

self esteem,self belief,

self-confidence?

Page 43: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Building self-efficacy: some tactics

1. Create change one small step at a time

2. Reframe your thinking:

• failed attempts are learning opportunities

• uncertainty becomes curiousity

3. Make change routine rather than an exceptional

activity

4. Get social support

5. Learn from the best

Page 44: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

Page 45: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Page 46: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Page 47: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Page 48: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Page 49: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Make it a personal PERFORMANCE target.

Page 50: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

Page 51: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Research from the Sales industry:How many NOs should we be seeking to get?

• 2% of sales are made on the first contact

• 3% of sales are made on the second contact

• 5% of sales are made on the third contact

• 10% of sales are made on the fourth contact

• 80% of sales are made on the fifth to twelfthcontact

Source: http://www.slideshare.net/bryandaly/go-for-no

Page 52: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

“Papers that are more likely to contend against the status quo are more likely to find an opponent in the review system—and thus be rejected —but

those papers are also more likely to have an impact on people across the system, earning them

more citations when finally published”

V. Calcagno et al., “Flows of research manuscripts among scientific journals reveal hidden submission patterns,”

Science, doi:10.1126/science.1227833, 2012.

Page 53: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

2. Frame the issues in ways that connect with a wide group of

stakeholders

Source of image: www.nytimes.com

Page 54: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source of image: outskirtsbattledome.wikispaces.com

The easiest way to thrive as an outlier

...is to avoid being one

Seth Goodin

Page 55: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

“When we talk of social change, we talk of movements, a word that suggest vast

groups of people walking together, leaving behind one way and travelling towards

another”

Rebecca Solnit

Page 56: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Framing… is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action.

Snow D A and Benford R D (1992)

Page 57: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-crafting-visual-stories-with-data?sf3881865=1

Page 58: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Stories are a key part of the new improvement

Page 59: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

If we want people to take action, we have to connect with their emotions through values

action

values

emotion

Source: Marshall Ganz

Page 60: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

What’s the financial incentive?

Who is performance managing?

What’s the project plan?

Source: @RobertVarnam

Page 61: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

The reality

“What the leader cares about (and typically bases at least 80% of his or her message to others on) does

not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into the change

programme”Scott Keller and Carolyn Aiken (2009)

The Inconvenient Truth about Change Management

Source of image: swedenbourg-openlearning.org.uk

Page 62: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........

Sensemaking is not done via marketing...or slogans but by emotional connection with employees

Ron Weil

Page 63: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Effective framing: what do we need to do?

1. Tell a story

Page 64: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Effective framing: what do we need to do?

1. Tell a story

2. Make it personal

Page 65: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Effective framing: what do we need to do?

1. Tell a story

2. Make it personal

3. Be authentic

Page 66: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Effective framing: what do we need to do?

1. Tell a story

2. Make it personal

3. Be authentic

4. Create a sense of “us”

Page 67: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Effective framing: what do we need to do?

1. Tell a story

2. Make it personal

3. Be authentic

4. Create a sense of “us”

5. Build in a call for urgent action

Page 68: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Talk to the person next to you

• Tell your story about why the change you are involved in now is so important to you

• Relate it to a personal experience

You have:

• 2 minutes to prepare your story

• 2 minutes each to tell your story

Page 69: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

3. Build shared purpose

Page 70: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Leading change in a new era

Dominant approach Emerging direction

Page 71: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
Page 72: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Compliance

States a minimum standard of

performance or target that

everyone must achieve

Uses hierarchy, performance

management systems and

standardised procedures for co-

ordination and control

Threat of penalties/ sanctions/

shame creates momentum for

delivery

Focus on transaction

Commitment

States a collective, meaningful

goal that everyone can aspire to

Based on shared purpose and

shared goals (“us and us” rather

than “us and them”) for co-

ordination and control

Commitment to a common

purpose creates energy for

delivery

Focus on relationship

How are we leading?

Source: Helen Bevan

Page 73: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Leaders who focus on meaning also

get compliance, without focusing on it

@JeremyScrivens

Page 74: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

A 3-word concept

Page 75: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

[Shared] purpose goes way deeper than vision and mission; it 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.Seth Carguilo

@HelenBevan

Page 76: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

As leaders, we are “signal generators”

“As a leader, think of yourself as a “signal generator” whose words and actions are constantly being scrutinised and interpreted, especially by those below you” [in the hierarchy]

“Signal generators reduce uncertainty and ambiguity about what is important and how to act”

Charles O’Reilly,

Leaders in Difficult Times

Source of image: vintage-radio.com

Page 77: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Avoiding “de facto” purpose• What leaders pay attention to matters to staff, and consequently

staff pay attention to that too

• Shared purpose can easily be displaced by a “de facto” purpose:

hitting a target

reducing costs

reducing length of stay

eliminating waste

completing activities within a timescale

complying with an inspection regime

• If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce

Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector

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@SimonJGuilfoyle Police Inspector and systems thinker

Page 79: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

@SimonJGuilfoyle Police Inspector and systems thinker

Page 80: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Police

@SimonJGuilfoyle Police Inspector and systems thinker

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Education

@SimonJGuilfoyle Police Inspector and systems thinker

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Healthcare

@SimonJGuilfoyle Police Inspector and systems thinker

Page 83: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

6. Identify the heretics, disrupters and gamechangers in your organisation or system and engage them in your most

significant changes

@PeterVan http://t.co/6CQtA4wUv1 Source of image: scotteagan.blogspot.com

“Without rebels, the storyline never changes”

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Source : Lois Kelly www.rebelsatwork.com

There’s a big difference between a rebel and a troublemaker

Rebel

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Reflection• What are your insights around “rebels” and

“troublemakers”?

• What moves people from being “rebel” to “troublemaker”?

• How do we protect against this?

Page 86: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Source : Lois Kelly www.rebelsatwork.com

There’s a big difference between a rebel and a troublemaker

Rebel

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A disruptive case study:

Probably the biggest day of collective action for improvement in the history of the NHS

Creating a mass movement of people working together in and with the NHS demonstrating the difference they can

make, by one simple act for sustainable improvement

Page 88: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

2013 2014 2015

“The audacity to imagine……..”

Page 89: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

Change starts with me..

Maker

...Making a

difference

Anyone can pledge – it’s personal to you!

Change Activist

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‘Can I really make the change?’

Will ‘the system’ really ALLOW me?

Owned by the grassroots

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The more you do what you love the more energy you have Leadership Freak

Vs

Unleashing the energy

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Volunteers – leaders everywhere

98% of activity via volunteers

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Holding each other to account

rather than performance management

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13th March 2013

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189,000actions

13th March 2013

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more than 800,000 pledges to take action

• 81 separate Campaigns

• 86 million twitter impressions

• 35,400 video views

• 95,000 daily reach on Facebook

Change Day 2014:

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10. Build your extended network of weak ties

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The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy

2. If you want to create small scale change, work through a cohesive network

If you want to create big change, create

bridge networks between disconnected groups

Page 99: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

strong ties (cohesive)v.

weak ties (disconnected)

Source of image:brucemacvaresh.com

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When we spread change through strong ties:

• we interact with “people like us”, with the same life experiences, beliefs and values

• Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist

• Influence is spread through people who are strongly connected to each other, like and trust each other

Page 101: Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

When we spread change through strong ties:

• we interact with “people like us”, with the same life experiences, beliefs and values

• Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist

• Influence is spread through people who are strongly connected to each other, like and trust each other

IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied

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The pros and cons of strong ties

Pros Cons

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Strong and weak tiesWhen we seek to spread change

through strong ties:

• we interact with “people like us”, with the same life experiences, beliefs and values

• Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist

• Influence is spread through people who are strongly connected to each other, like and trust each other

When we seek to spread change through weak ties:

• we build bridges between groups and individuals who were previously different and separate

• we create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action

• our aim is to mobilise all the resources in our organisation, system or community that can help achieve our goals

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A great film that explains weak ties

http://www.youtube.com/watch?v=-Bm93gN1zJg

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Why we need to build weak ties AS WELL AS strong ties

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

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Why we need to build weak ties AS WELL AS strong ties

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

• In situations of uncertainty, we have a tendency to revert to our strong tie relationships

– yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity

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Why we need to build weak ties AS WELL AS strong ties

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

• In situations of uncertainty, we have a tendency to revert to our strong tie relationships

– yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity

• The most breakthrough innovations will come when we tap into our weak ties

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Why we need to build weak ties AS WELL AS strong ties

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

• In situations of uncertainty, we have a tendency to revert to our strong tie relationships

– yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity

• The most breakthrough innovations will come when we tap into our weak ties

History suggests that weak ties will probably give us the best chance to deliver large scale improvements in a challenging

timescale

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109

http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite

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Three components of a great narrative

• Diagnostic – what is the problem that we are addressing? What is the extent of the problem? What is the specific source or sources?

• Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan?

• Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of the audience?

Source: Benford and Snow

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Discussion

• What are our strong ties and weak ties?

• Is there a balance between diagnostic, prognostic and motivational aspects of our message for change?

• What might we do?

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14. Take steps to be a more social leader

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Source: http://www.digitalsherpa.com/blog/how-social-media-has-changed-in-the-last-few-years/

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“Social Media is a conversation.Between millions of people.Word of mouth on steroids. ”

@ FutureGP Dave Townsend

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48% of 18 to 34 year olds check Facebook right when they wake up...About 28% check their Facebook on their smartphones before getting out of bed...

OBSESSED WITH FACEBOOKENGAGING WITH GENERATION Y

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SOCIAL MEDIA IS JUST FOR YOUNG PEOPLE

The fastest growing age group on Facebook is 50+73% of business people visit it every dayLinkedIn - largest segment –45- 54 years (36%)Twitter – Largest segment – 45-54 years (35%)

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“Social media is so powerful because it taps into what makes us human… and we like it.”

Maddie Grant and James Notter.

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•Open – decentralised, systems thinking

•Trustworthy- transparency, truth, authenticity

•Generative- inclusion, collaboration, relationship building

•Courageous – learning, experimentation , personal development.

Four aspirational human elements (as seen through social media examples)

Maddie Grant and James Notter

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1. Have a cause2. Talk like a human3. Post interesting

links -inform, educate, entertain

4. Don’t wear a mask

10 Ways to be a digital influencer or super connector @PaulBromford

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Curating content

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My followers

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Source: @NHSChangeDay

Can I, dare I?

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Helen Bevan’s pledge for Change Day 2013

To support 500 leaders and activists

to develop their capability as radical change agents: to rock the boat and

stay in it

““

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1,900

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28,000

2,000

3,000

150

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Health and care radicals

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15. Take deliberate action to maintain energy for change over

the long haul

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Does fear motivate people to change?

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burning platform

versus

burning ambition

@PeterFuda

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Lessons for transformational change1. In order to sustain

transformational change we need to move from a burning platform (fear based urgency) to a burning ambition (shared purpose for a better future)

2. We need to articulate personal reasons for change as well as organisational reasons

3. If the fire (the compelling reason) goes out, all other factors are redundant

@PeterFuda

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What happens to large scale change efforts in reality?

In order of frequency:

1. the effort effectively “runs out of energy” and simply fades away

2. the change hits a plateau at some level and no longer attracts new supporters

3. the change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way

Source: Leading Large Scale Change:

a practical guide (2011), NHS Institute

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Bruch and Vogel research

Organisations with HIGH productive energy scored higher on:

• overall performance - 14% higher

• productivity – 17%

• efficiency – 14%

• customer satisfaction – 6%

• customer loyalty – 12%

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@HelenBevan

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the capacity and drive of a team, organisation or system to act and make the

difference necessary to

achieve its goals

Psychological

Physical

Spiritual

Social Intellectual

Energy for change is:

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Five energies for change Energy Definition

Social energy of personal engagement, relationships and connections between people. It’s where people feel a sense of “us and us” rather than “us and them”

Spiritual energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It gives people the confidence to move towards a different future that is more compelling than the status quo

Psychological energy of courage, resilience and feeling safe to do things differently. It involves feeling supported to make a change and trust in leadership and direction

Physical energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen

Intellectual energy of analysis, planning and thinking. It involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/ evidence

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High and low ends of each energy domain

Low High

Social isolated solidarity

Spiritual uncommitted higher purpose

Psychological risky safe

Physical fatigue vitality

Intellectual Illogical reason

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Some questions

• Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)

• Nearer to CEO, higher or lower energy scores?

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@HelenBevan

The SSPPI Energy Index – Part IThis questionnaire enables teams to measure their energy for change.

Please agree the nature of the change context with your team before answering the following statements.

Then answer all statements with your particular change context in mind.

1 = Strongly disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree

I am energised by the momentum of change____

I have gained insight into the case for change____

I feel a sense of solidarity with those I work with ____

I am weary of change____

I am able to keep expressing hope for the change when presented with setbacks_____

The reasoning for the change is not compelling___

I don’t feel appreciated by others at work_____

I will be blamed if I try something new and it fails____

I feel isolated from others____

I feel depleted of energy when others express doubt about the change_____

The case for change has stimulated my creativity_____

I feel disconnected from others____

I am committed to our common vision for the future____

I feel safe enough to do things differently____

I am driven by shared values____

I am experiencing change fatigue____

The change does not fit with my sense of purpose_____

I am not driven by a shared purpose for change_____

I think there is no rational argument for change____

The case for change is interesting to me_____

I feel that we are getting things done to achieve the change_____

I feel the change may conflict with my values___

I feel personally engaged in the change___

Clear thinking and analysis underpins the change___

I feel fearful about the change___

I sense openness about the potential to change___

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#IQTGOLD

Social energy is the energy of personal engagement,

relationships and connections between people. It reflects a

“sense of us” and is therefore a collective concept that

captures a situation where people are drawn into an

improvement or change because they feel a connection to it

as part of the collective group.

My social energy is ____

The social energy of those I work with is____

The importance of social energy to me is____

Psychological energy is the energy of courage, trust and

feeling safe to do things differently. It involves feeling

supported to make a change as well as belief in self and the

team, organisation or system, and trust in leadership and

direction.

My psychological energy is ____

The psychological energy of those I work with is____

The importance of psychological energy to me is____

Physical energy is the energy of action, getting things done

and making progress. It is the flexible, responsive drive to

make things happen, with vitality and kinetic force (motion)

My physical energy is ____

The physical energy of those I work with is ____

The importance of physical energy to me is____

Intellectual energy is the energy of curiosity, analysis, thinking and cognition. It involves gaining insight, a thirst for new

knowledge as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic and evidence.

My intellectual energy is ____

The intellectual energy of those I work with is____

The importance of intellectual energy to me is____

Complete these statements on a scale of 1 = low - 5 = high

Spiritual energy is the energy of commitment to a common

vision for the future, driven by shared values and a higher

purpose. It involves giving people the confidence to move

towards a different future that is more compelling than the

status quo, by finding the deep meaning in what they do.

My spiritual energy is ____

The spiritual energy of those I work with is____

The importance of spiritual energy to me is____

The SSPPI Energy Index – V2, Part 2

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• Are particular energy domains more dominant than others for our team at the moment?

• Is this the optimal energy profile to help us achieve our improvement goals?

Energy for change profile

1

2

3

4

5Social

Spiritual

PsychologicalPhysical

Intellectual

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• Are particular energy domains more dominant than others for our team at the moment?

• Is this the optimal energy profile to help us achieve our improvement goals?

Energy for change profile

1

2

3

4

5Social

Spiritual

PsychologicalPhysical

Intellectual

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#IQTGOLD

1

2

3

4

5Social

Spiritual

PsychologicalPhysical

Intellectual

Team 1: what’s your assessment of

their energy for change?

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#IQTGOLD

1

2

3

4

5Social

Spiritual

PsychologicalPhysical

Intellectual

Team 1: what’s your assessment of

their energy for change?This energy profile is characterised by an environment that has harnessed people’s interest and momentum for change, but which has failed to engage people fully. This imbalance results in their feeling some uncertainty regarding how they can contribute fully to the change, and therefore a sense of risk and lack of hope for the future. We can build energy by building team solidarity and developing shared purpose

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#IQTGOLD

1

2

3

4

5Social

Spiritual

PsychologicalPhysical

Intellectual

Team 2: what’s your assessment of

their energy for change?

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#IQTGOLD

1

2

3

4

5Social

Spiritual

PsychologicalPhysical

Intellectual

Team 2: what’s your assessment of

their energy for change?This energy profile shows strong connections between people, a true sense of solidarity, which gives them enough hope for the future, but this energy is undirected, because the rational argument and shared purpose has not been agreed. We can build energy by agreeing shared goals for change and using systematic approaches to thinking through and planning the change

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@HelenBevan

There has never been a time in the history of healthcare when this advice has been

more pertinent

“Leadership is not about making clever decisions and doing bigger deals. It is

about helping release the positive energy that exists naturally within people”

Henry Mintzberg

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Discussion

Which energies are most prevalent in your setting? How might you get more balance (if you need it?)

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@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

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@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

The Fundamental Law of Conventional Conferences

The sum of the expertise of the

people in the audience is greater

than the sum of expertise of the people on stage

Dave Winer

““

Source of image: www.citynet.com

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Traditional conference

The agenda is pre-set

One way learning style with Q&A

People sit in rows or round tables

Networking between sessions

Hard to leave the session once it starts

Absorbing information

Unconference

People set the agenda

Based on discussion

People sit in a circle with no chairs

Networking the whole time

Encouraged to find the right session

Connecting to action

Source: adapted from @BCPSQC

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The unconference: 4 principles and a law

Principles:1. Whoever comes are the right people2. Whatever happens is the only thing that could

have happened.3. When it starts is the right time4. When it's over it's over

The Law is known as the Law of Two Feet:"If you find yourself in a situation where you are not contributing or learning, move somewhere where you can."

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Our unconference process

• Think about a topic that you would like to explore with other people that will help you with your dreams and goals for change and improvement

• It should be a topic that you want to take action on over the next twelve months

• Come to the middle of the circle and write it on a sheet

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Four keys to collaboration

• Lean into discomfort

• Listen as an ally

• State your intent

• Share your “street corner”Source: Judith Katz and Fred Miller

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What’s our approach to change?

Deficit based

• what is wrong?• solve problems• identify what we

need to improve• fill gaps and

deficiencies

Strength based

• what is strong?• work with our

existing assets and resources

• amplify what works• “positive deviants”

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8th

Dec2015

8th December 2015

Topic:

Where did we start?

Where are we now?

How did we get there?

Who was mobilised?

*be as specific as possibleAdapted from British Columbia Patient Safety and Quality Council

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“Dotocracy”

• One person from each group to stand by their postcard/idea

• Each person has four dots• We are voting for the idea that offers the best

potential for radical/transformational change• You can give all your dots to one idea or one dot

each to four ideas• Switch the “standing” person half way so they

can vote• Time allowed 10 minutes

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Source: British Columbia Patient Safety and Quality Council

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The “two levels down” rule

What can I achieve in:

a year?

a month?

a week?

a day?

an hour?

If you think your improvement initiative will take a year to test and implement, consider what you could achieve in a week

If you think it will take a week, what you could achieve in an hour?

Source: Paul Plsek

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@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

1. Follow us on Twitter@HelenBevan@Elaine_Bayliss@JCHannah77@NHSIQ

2. Subscribe to

3. Enrol for The School for Health and Care Radicals: next term starts 30th January 2015 [email protected]

4. Engage with Change Day NHS Change Day 2015: 11th

March www.ChangeDay.nhs.uk

TheEdge.nhsiq.nhs.uk

Four ways to connect with us!

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A further “unconference”

session

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