"It's time to rewrite the rules of change in healthcare"

@HelenBevan #Quality2016

It’s time to rewrite the rules of

change in healthcare

Helen Bevan

@HelenBevan

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

What is happening in the field of change and transformation in the wider world?

Change is changing

What approaches to change are needed in this environment?

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?”

Acceleration of connectedness

Change is changing

How does the NHS improvement community prefer to communicate?

Digital

Non-digital

ProactiveReactive

Hierarchical Power is diminishing

Change is changingAcceleration of connectedness

The Challenges

Change is changing

Change is moving to the edge

Acceleration of connectedness

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

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

Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always

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

Relationship

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

“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”

“I have a dream”

Source: @RobertVarnam

@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

@HelenBevan

WHO makes change happen in healthcare?

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

@HelenBevan

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

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

@HelenBevan

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)

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

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

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

“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

• 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”

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

Evolving kinds of change platforms:

They overlap!

1. Connecting platforms

2. Mobilising platforms

3. Learning platforms

4. Knowledge platforms

5. Crowdsourcing platforms

Example platforms

Source of image: @JenniferClemo

http://biggerboat.org/exploring-moodocs/

MOODOCs(Massive, Online, Open, Disease Oriented Communities)

60,000 online diabetes communities and

around 80 million online patient communities

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

https://youtu.be/eUApgJBZU8M

Source: OpenIdeo https://challenges.openideo.com/challenge/end-of-life/refinement

Diane Smithdiane.smith2@swyt.nhs.uk@DianeCS9

Sue Bartonsue.barton@swyt.nhs.uk@barnsleybart

www.southwestyorkshire.nhs.uk

Paula RylattPaula.Rylatt@swyt.nhs.uk@rylatt_paula

Source: @NHSChangeDay

@HelenBevan #Quality2016Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

10,000Nearly

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?

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

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

Should we undertake routine radiology investigations overnight for all our inpatients?

How to build a change

platform in an hour

The Change Challenge

Tapping the collective brilliance of the NHS

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

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

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

Some lessons1. You can’t control the outputs of the crowd2. People want a relationship3. Always, always, follow up

The Natural Environment Research Council asked the crowd to name its new £200 million polar research vessel

TEN TIMES as many

votes as the next most popular answer

”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

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

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

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 helen.bevan2@nhs.net

Ways to connect!

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)

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)

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