@HelenBevan #Quality2016 It’s time to rewrite the rules of change in healthcare Helen Bevan @HelenBevan
@HelenBevan #Quality2016
It’s time to rewrite the rules of
change in healthcare
Helen Bevan
@HelenBevan
@HelenBevan #Quality2016
Joining in this session• The theme of the session is
connectivity and platforms for change
• Please tweet using hashtag #Quality2016
• A challenge: make our Twitter conversational
• We will get some feedback on Twitter activity during the session
@HelenBevan #Quality2016
What is happening in the field of change and transformation in the wider world?
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Change is changing
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What approaches to change are needed in this environment?
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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
@HelenBevan #Quality2016Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
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Acceleration of connectedness
Change is changing
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How does the NHS improvement community prefer to communicate?
Digital
Non-digital
ProactiveReactive
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Hierarchical Power is diminishing
Change is changingAcceleration of connectedness
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@HelenBevan #Quality2016
Change is changingAcceleration of connectedness
Hierarchical Power is diminishing
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The Challenges
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Change is changing
Change is moving to the edge
Acceleration of connectedness
Hierarchical Power is diminishing
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http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final
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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
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Starts on the fringe (at the edge)
Starts with the activistsGary Hamel
always
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Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA
old power new powerCurrency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship
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The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro
As a change agent, my centrality in the informal network is more important than my
position in the formal hierarchy
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“People who are highly connected have twice
as much power to influence change as
people with hierarchical power”
Leandro Herrerohttp://t.co/Du6zCbrDBC
@HelenBevan #ngdpcohort17
“I have some Key Performance
Indicatorsfor you”
or
“I have a dream”
Source: @RobertVarnam
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WHO makes change happen in healthcare?
Source: adapted by Helen Bevan from Leandro Herrera
List A• The Transformation Programme
Board [or equivalent]• The programme sponsors• The Programme Management
Office• The [insert number] work streams • The Clinical Director• The Quality Improvement team
@HelenBevan
WHO makes change happen in healthcare?
Source: adapted by Helen Bevan from Leandro Herrera
List A• The Transformation Programme
Board [or equivalent]• The programme sponsors• The Programme Management
Office• The [insert number] work streams • The Clinical Director• The Quality Improvement team
List B• The mavericks and rebels• The deviants (positive). Who do things
differently and succeed• The contrarians, because they can• The nonconformists who see things
through glasses no one else has• The hyper-connected. Good or bad, they
spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on
• The hyper-trusted. Multiple reasons, doesn’t matter which ones
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WHO makes change happen in healthcare?List B
• The mavericks and rebels• The deviants (positive). Who do things
differently and succeed• The contrarians, because they can• The nonconformists who see things
through glasses no one else has• The hyper-connected. Good or bad, they
spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on
• The hyper-trusted. Multiple reasons, doesn’t matter which ones
Source: adapted by Helen Bevan from Leandro Herrera
List A• The Transformation Programme Board
[or equivalent]• The programme sponsors• The Programme Management Office• The [insert number] STP
transformation work streams • The Clinical Leads of workstreams• The Directors of participating
organisations• The Change Facilitators
People who live and
perform in formal
organisation land and
people with the power who
have make or break change
are two different lists
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What’s the evidence?The failure of strategic change
projects is rarely due to the content or structure of the plans that are put
into action
It’s much more about the role of informal networks in the
organisations/systems affected by change
To make transformational change happen we need to connect networks of
people who ‘want’ to contribute
http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-257163-Campaign+-+01%2F09%2F2016
Source: David Dinwoodie (2015)
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The essential flaw of quality improvement approaches
The essential flaw of [quality improvement ] is that, when implemented, it tends to
reinforce the mechanistic and hierarchical models that are consistent with the
mental maps of most managers Chris Argyris, Flawed advice and the
management trap Source of image:
www.biblicalcreation.org.uk Read more at: http://www.slideshare.net/jurgenappelo/management-30-workout
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Is your change process a cathedral or a bazaar?
http://www.unterstein.net/su/docs/CathBaz.pdf
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We have a lot of cathedrals
Source: Sewell (2015) : Stop training our project managers to be process junkies
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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
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“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
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• 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”
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Why platforms?“Platforms today power learning and innovation at the speed of change by providing collaborative and sometimes exponentially productive spaces
for people to create value”John Hagel
Source of image: Pinipa
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Evolving kinds of change platforms:
They overlap!
1. Connecting platforms
2. Mobilising platforms
3. Learning platforms
4. Knowledge platforms
5. Crowdsourcing platforms
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Example platforms
Source of image: @JenniferClemo
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http://biggerboat.org/exploring-moodocs/
MOODOCs(Massive, Online, Open, Disease Oriented Communities)
60,000 online diabetes communities and
around 80 million online patient communities
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The Academy of Fabulous Stuff• Half a million page views • Over 700 fab shares• 1,500 to 4,000 page views
a day• Nottingham Safe staffing
app: 2,500 views• Dovetailing vaccinations
Scheme: 160 direct queries
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https://youtu.be/eUApgJBZU8M
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Source: OpenIdeo https://challenges.openideo.com/challenge/end-of-life/refinement
Diane [email protected]@DianeCS9
Sue [email protected]@barnsleybart
www.southwestyorkshire.nhs.uk
Paula [email protected]@rylatt_paula
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Source: @NHSChangeDay
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@HelenBevan #Quality2016Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs
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10,000Nearly
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The School was 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/
How has the School for Health and Care Radicals made a difference?
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The School was 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 at both individual and organisational level
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Nearly 100,000
connections(defined as a viewing, a
download of material or an original tweet)
• Latest no-cost solutions
• 150 speakers• 28 topics
• Live broadcast and on-demand
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Should we undertake routine radiology investigations overnight for all our inpatients?
How to build a change
platform in an hour
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The Change Challenge
Tapping the collective brilliance of the NHS
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14,000 contributions identified 10 barriers to change:
Confusing strategiesOver controlling leadership
Perverse incentivesStifling innovation
Poor workforce planning
One way communication
Inhibiting environment
Undervaluing staff
Poor project management
Playing it safe
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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
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Project Aristotle: http://qz.com/625870/after-years-of-intensive-analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/
After years of intensive analysis, Google discovers that the key to high performing, innovative teams is psychological safety
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Some lessons1. You can’t control the outputs of the crowd2. People want a relationship3. Always, always, follow up
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The Natural Environment Research Council asked the crowd to name its new £200 million polar research vessel
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TEN TIMES as many
votes as the next most popular answer
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”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
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1. Frame the issues in ways that will engage and mobilise the imagination, energy and will of diverse stakeholders
2. Take steps to be more social leaders, invest in digital skills & social connections & lead through networks as well as formal leadership systems
3. Find your B-list people & give them important tasks
4. Consider what/where your equivalent of ‘the edge’ is, so that you incubate radical & disruptive ideas & lead healthcare from the future
5. Build change platforms for important issues – create bazaars alongside the cathedrals
6. Adopt emergent approaches to planning & design, based on monitoring progress, learning & adapting as you go
SIX
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This talk is bought to you by the Horizons team
We tune into and engage with the best change thinking and practice in healthcare and other industries around the world and seek to
translate this learning into practical approaches to change
The team has emerged through years of supporting change in the NHS and wider health and care system
A small team of people within the English NHS who support improvement and
change
@HelenBevan #Quality2016
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
Or email me at [email protected]
Ways to connect!
@HelenBevan #Quality2016
Ashoka (2014) What does leadership mean in the 21st century?Berg O (2014) The Collaboration Pyramid revisitedBevan H (2015) From change programmes to platformsBriggs D (2015) The elements of council as a platformBromford P (2015) What’s the difference between a test and a pilot?Chesbrough H et al (2016) Why does open innovation work?Choudray P (2015) The platform manifesto: 16 principles for digital transformationDawson R (2015) The future of work and organisations Deloitte University Press (2014) A movement in the makingDeloitte University Press (2015) Business ecosystems come of ageHagel J (2015) 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]
References cited in the slide deck (1/2)
@HelenBevan #Quality2016
Heimens J, Timms J (2014) Understanding “New Power”Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers Little J (2016) Change management is deadMilton 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 PlatformVan Alstyne et al (2016) Pipelines, platforms, and the new rules of strategy
References cited in the slide deck (2/2)