School for Health and Care radicals - Slides for module four

#SHCR @School4Radicals

Module 4 Making change happen

Supported by:

http://www.theedge.nhsiq.nhs.uk/school/

Module


• Please use the chat box to contribute continuously during the web seminar

• Please tweet using hashtag #SHCR and the handle @School4Radicals

• Request to join our Facebook group School for Health and Care Radicals

• We will produce summaries of each module discussion using Steller and put it on the website

• Join in the #SHCR Tweetchat each Tuesday at 1900 (GMT)

Joining in today…and beyond


Session lead: Helen Bevan @HelenBevan

Learning lead: Pip Hardy@PilgrimPip

Session chair:Kate Pound@kateslater2

Twitter & chat monitor: Olly Benson@ollybenson

Storyteller:Rebecca Lacey@rebeccalacey76

Storyteller:Jas Atwal@jasjitkauratwal

Storyteller:Joyce Lee@joyclee

The team today


Programme Study Guide: www.slideshare.net/TheEdgeNHS/school-for-health-and-care-radicals-iii-study-guide-2016?related=2

Module 4 Study Guide:http://www.slideshare.net/TheEdgeNHS/school-for-health-and-care-radicals-module-4-study-guide-2016

Study guides

http://www.slideshare.net/TheEdgeNHS/school-for-health-and-care-radicals-iii-study-guide-2016?related=2



http://www.slideshare.net/TheEdgeNHS/school-for-health-and-care-radicals-module-4-study-guide-2016





Modules

3rd March: Moving beyond the edge


Our growing community

• The American College of Radiology• Macmillan nursing team growing

School news• Twitter chat for #SHCRmh today 20.00-21.00 (GMT)• Twitter chat for #SHCR6Cs Sunday 20.00-21.00 (GMT)• After school club north east on 7th April 1pm connect

with @markdavis272 or @maxine_craig


Icebreaker: Making change happen

Which of these are you most interested in finding out about today?


Today• Why change efforts often fail to achieve

their objectives• Leading large-scale change• Intrinsic and extrinsic motivators for

change • Building energy for change• Creating shared purpose• Discussion and reflection

Sour

ce o

f im

age:

ww

w.fr

eshn

essm

ag.c

om

#SHCR @School4Radicals Source of image: Whatsthebigideascwartzy.blogspot.com


Most change programmes fail to deliver their objectives

Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey

70%

25%5%

Gets anywhere near achieving the change and

delivering the benefits


Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey

70%

25%5% Delivers and

sustains the change

Most change programmes fail to deliver their objectives

#SHCR @School4RadicalsSource: 2016 Chartered Institute of Management Quality of Working Life study

Across the UK, poorly managed change programmes are damaging morale and the performance of organisations


It is our contention that most change efforts are built upon the shaky foundation of five flawed assumptions; that change can be managed, that human beings are objective, that there are ‘X’ steps to change, that we have a neutral starting point for change, and that change, itself, is the goalPeter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf Source of image: Whatsthebigideascwartzy.blogspot.com

http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf




Change is not the goal; the goal is the goal

Peter Fuda

Source of image: timemanagementninja.com

@School4Radicals #SHCR

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

http://www.hsj.co.uk/leadership/change-challenge/


Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on

Increasing number of messages as information cascade through

the organisation

Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx

http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx



Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on

Increasing number of messages as information cascade through

the organisation

Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx

Buy in from front line staff is critical for improvements in quality and safety . Don’t overload them

Buy in from front line staff is critical for improvements in quality and safety

Don’t overload themhttp

://healthaffairs.org/blog/2014/03/07/the-dangers-of-quality-improvement-overload-insights-from-the-field

/



http://healthaffairs.org/blog/2014/03/07/the-dangers-of-quality-improvement-overload-insights-from-the-field/





14,000 contributions identified 11 building blocks for change:

Inspiring & supportive 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


Challenging the status quo


@School4Radicals #SHCR @HelenBevan #NHSelect15

Types of motivation

Source of image: http://youearnedit.com/blog/intrinsic-vs-extrinsic-motivation/

http://youearnedit.com/blog/intrinsic-vs-extrinsic-motivation/

http://youearnedit.com/blog/intrinsic-vs-extrinsic-motivation/

@School4Radicals #SHCR @HelenBevan #NHSelect15

Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

From

https://www.youtube.com/watch?v=j-S03JfgHEA

https://www.youtube.com/watch?v=j-S03JfgHEA


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


Challenging the status quo



Tapping into intrinsic motivation is critical to ongoing, large scale change

So while both extrinsic and intrinsic motivation have their place when implementing change, identifying underlying intrinsic motivation remains the differentiating factor between long-term success and failure. Every long-term, sustained extrinsic success

story has tapped into intrinsic motivation at its core……While extrinsic motivation can produce some initial success on its

own, people will move on from tasks that they no longer find personally challenging. So unless system leaders want to

continually increase the reward for the same task, they need to find a way to appeal to user’s values…..

.The Blog for Happy Workers: http://www.happymelly.com/why-intrinsic-motivation-is-the-key-to-change-management/

‘

http://www.happymelly.com/why-intrinsic-motivation-is-the-key-to-change-management/


Intrinsic motivators

build energy and creativity


Intrinsic motivators • connecting to shared purpose

• engaging, mobilising and calling to action

• motivational leadership






build energy and creativity create focus &

momentum for delivery

Drivers of extrinsic motivation


Drivers of extrinsic motivation

create focus & momentum for delivery





•System drivers & incentives•Payment by results•Performance management•Measurement for accountability


Internal motivators

• connecting to shared purpose

•engaging, mobilising and calling to action



Drivers of extrinsicmotivation

•System drivers & incentives•Performance management•Measurement for accountability

create & focus momentum for delivery


The Change Model

Source: Zoe Lord

Priority area: Acute Kidney Injury (AKI) – NHS Kidney Care

What outcomes do we seek?Our Shared PurposeIs there a sense of shared purpose amongst our key stakeholders?

The shared purpose is to improve the prevention, detection and management of AKI across the whole NHS system

Leadership by all Do all our leaders have the skills to create transformational change?NHS Medical DirectorNHS Commissioning BoardClinical Commissioning GroupsNational Clinical LeadRoyal College of NursingNHS Nursing DirectorAKI Delivery GroupNational Vascular Society for Great Britain & IrelandClinical LeadsNetwork LeadsPatient Groups

Motivate and MobiliseAre we engaging and mobilising all the right people?

AKI London NetworkDeaneriesDirectors of NursingAKI Specialist Registrar NetworkAKI App

Spread and Adoption Are we designing for the active spread of innovation?

Acute Kidney Injury Resource PackHydration Matters CampaignAKI Audit in Acute Assessment Units in the North East of EnglandE-alerts SurveyMedicines Optimisation ToolkitHow to Guides

Project and performance ManagementDo we have an effective approach for delivery of change and monitoring of progress towards our planned objectives?Project Management OfficeRisk & Issues Log

Influencing factorsAre our processes, incentives and systems aligned to enable change? The Burdon of AKI – Health Economics StudyAKI Recording & CodingAKI Consensus ConferenceNICE (Guideline 50)NCEPOD

Improvement toolsAre we using an evidence-based quality improvement methodology?YES = quality improvement

MeasurementAre we measuring the outcome of the change continuously and transparently? National Confidential Enquiry into Patient Outcome and DeathAKI Markers in National Registrar Vascular DatabaseAtlas of Variation

“Without using the change model to undertake a gap analysis, we would have never have known many of our collective strengths and our challenges which would have had a direct impact on achieving our goal”

Beverley Matthews

http://www.londonaki.net/

http://www.londonaki.net/


“Take your passion and

make it happen”

Source of image: www.zeelandtheaters.nl

http://www.zeelandtheaters.nl/


Two kinds of people at work

Feel connected to a higher purpose

Controlled & coordinated through shared goals & values

Collaborate Embrace change Work to who they are

The contributors The compliant

• Feel disconnected from purpose• Controlled & coordinated

through performance management & standardised procedures

• Hold back• Resist change• Work to a role specification

Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/

http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/

http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/


Two kinds of people at work

Feel connected to a higher purpose

Controlled & coordinated through shared goals & values

Collaborate Embrace change Work to who they are

The contributors The compliant

• Feel disconnected from purpose• Controlled & coordinated

through performance management & standardised procedures

• Hold back• Resist change• Work to a role specification

Gallup global research:• Only 13% of the workforce are

engaged (contributors)• Contributors create six times the

value to an organisation compared to the compliant

http://www.gallup.com/poll/165269/worldwide-employees-engaged-work.aspx





Telling her story

Jas Atwal@jasjitkauratwal


Dr Jasjit Kaur Atwal@jasjitkauratwal

General Practitioner on a career break. School Governor and Code Club volunteer.https://codewordblog.wordpress.com


We built a computer…and it actually works!



https://scratch.mit.edu/projects/26818098/#editorhttps://scratch.mit.edu/

We have been using a language called Scratch to teach the children

https://scratch.mit.edu/projects/26818098/#editor


Amanda Coffey@adorescience

A qualified teacher, Amanda has extensive experience volunteering in her community and was instrumental in setting up a local Community Forum to enable disparate groups to work together. As a Process Co-ordinator working for a bank’s operations department, Amanda used her coding experience and networking skills to move from paper to a digital system.


Ian [email protected]

Creator of fetcheveryone.com, a free website for runners to log their exploits and share their passion for running. Bought by Hearst magazine in 2007 and now receiving 50,000 visitors per month, it is Ian’s full time occupation. In his spare time, he is a Parkrun event director and Code Club volunteer.

http://www.fetcheveryone.com/

http://fetcheveryone.com/




What happens to large scale change efforts in reality?

In order of frequency:1. the effort effectively “runs out of energy” and

simply fades away2. the change hits a plateau at some level and no

longer attracts new supporters3. 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


Typically, around any change effort, there is an initial spike of tangible energy, and change, but when leadership loses interest, the momentum

of change slows down drastically.”Tara Paluck


Bruch and Vogel researchOrganisations with HIGH productive energy scored higher on: overall performance - 14% higher productivity – 17% efficiency – 14% customer satisfaction – 6% customer loyalty – 12%



Energy for change

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

achieve its goals

http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html





Psychological

Physical

Spiritual

Social Intellectual

Energy for change


Social energy

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

Energy of commitment to a common vision for the future, driven by shared

values and a higher purposeGives people the confidence to move towards a

different future that is more compelling than the status quo


Psychological energy

Energy of courage, resilience and feeling safe to do things differently

Involves feeling supported to make a change and trust in leadership and direction


Physical energy

Energy of action, getting things done and making progress

The flexible, responsive drive to make things happen


Intellectual energy

Energy of analysis, planning and thinking

Involves gaining insight as well as planning and supporting processes, evaluation, and arguing a

case on the basis of logic/ evidence


Low High

Social isolated solidarity

Spiritual uncommitted higher purpose

Psychological risky safe

Physical fatigue vitality

Intellectual Illogical reason

High and low ends of each energy domain


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

Nearer to CEO, higher or lower energy scores?

Some questions


• 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 profileSocial

Spiritual

PsychologicalPhysical

Intellectual

1

2

3

4

5


Social

Spiritual


Intellectual

1

2

3

4

5

Team 1: what’s your assessment of their energy for change?


Social

Spiritual


Intellectual

1

2

3

4

5

Team 2: what’s your assessment of their energy for change?


Social

Spiritual


Intellectual

1

2

3

4

5

Where is your team?


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


Telling her story

Rebecca Lacey@rebecccalacey76


Shared purpose aligns.....

Shared purpose allows many communities to engage with us without us having to invest resourcesin controlling their actions Nilofer Merchant


Shared purpose is a common thread in successful change programmes*

Organisations and change initiatives with strong shared purpose consistently outperform those without it.**

*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)

**Management Agenda 2013 Boury et al (Roffey Park Institute)

We know that ...


A 3-word concept


[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


“Matching Michigan” is a great example of the power of shared purpose

Perhaps the single most important influence on program response by individual units—either in promoting or resisting change—was the extent of consensus and

coalition among the senior medical and nursing staff on individual ICUs….

Transforming or boosting of efforts was most likely to occur when those locally charged with implementation were sincere in their beliefs about the value of the

program, were able to create transdisciplinary alliances, had local credibility among peers, were prepared to tolerate debate but exercise firmness, and used

multiple tactics including role modelling, persuasion, sanctioning, reminders, and constant feedback….

[Consultant says] ‘I think it’s been successful because it’s a unifying program, it’s one of the few things that we’ve done that hasn’t been just a doctor thing, or

just a nurse thing, it’s involved the doctors and the nurses together.’ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/




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


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


....the last era of management was about how much performance we could extract from people .....the next is all about how much humanity we can inspireDov Seidman


How to make change happen Stop bribing Make people feel

something Emphasise progress Start a cult (a group

unified by a provocative idea)

Source: How to motivate people: four steps backed by science

http://www.bakadesuyo.com/2014/04/how-to-motivate-people/

http://www.bakadesuyo.com/2014/04/how-to-motivate-people/


Telling her story

Joyce Lee@joyclee

https://twitter.com/joyclee

https://twitter.com/joyclee

#SHCR @School4Radicals http://ihavefoodallergies.tumblr.com

Patient as ExpertMaker

Collaborator


Healthdesignby.us

Participatory Design = Maker Movement

Expert = DIYMaker = Learning by doing

Collaborator = Peer-to-Peer


Design with and not for patients Integrate design into your daily workflowUser research as an educational opportunityMake the dream clinic happenDesign with members of a different tribe Identify your latent innovators


Next opportunities for learning

• Next Tuesday, 1st March 1900-2000 GMT: Tweet chat #SHCR• Next Thursday 3rd March 1430-1600 GMT: Module 5:

Moving beyond the edge


There’s still time to take part in an RCT!

• Randomised Coffee Trial!• Randomised Coffee Trial!

Randomised Coffee Trial!


Questions for reflection

• How can I make the most of both intrinsic and extrinsic aspects of change?

• How can I build energy for change for the long haul?

• How can I ensure shared purpose throughout my change process?




• Identify three ways in which I can ignite energy for change within my own groups and communities.

• Consider how I will build commitment to shared purpose in all my change efforts.

• Take one action tomorrow to accelerate change.

Call to action


Goodbye and good luck!

‘There is a thread you follow. It goes among things that change. But it doesn’t change… while you hold it you cannot get lost.’

William Stafford

Goodbye and good luck!


School for Health and Care radicals - Slides for module four

Healthcare