Creating the

Strategic

Conditions

Rebecca Joyce

Service Improvement Director

Mark Cobb

Clinical Director,

Therapeutics & Palliative Care

Leadership

Culture

Strategy

A future of uncertainty,

complexity, ambiguity

Increasing

expectations and

need

£22 bn funding

gap

A need to do things differently

Emerging themes in large scale change

Organisation Community

Power through hierarchy Power through connection

Mission and vision Shared purpose

Making sense through

rational argument

Making sense through

emotional connection

Leadership-driven (top

down) innovation

Viral (grass-roots

driven) creativity

Tried and tested,

based on experience

“ Open” approaches , sharing

ideas & data, co-creating

change

Transactions Relationships

Dominant

approach Emerging

direction

From Helen Bevan, 2013

A polarity (not either/or)

From Helen Bevan, 2013

To support MND research on donate via

justgiving.com/IceBucket4MND or Text ICED55 £5 to 70070.

To support MND research on donate via

justgiving.com/IceBucket4MND or Text ICED55 £5 to 70070.

The Ice Bucket Challenge…

• Origins unclear – US “cold water challenge”

– Celebrities

– Ease of spread

– Fun

– Mid July – Aug 14

• > 2.4 m Facebook videos (end Aug 14)

• 1 in 6 people in UK participated

• Estimated that $150,000,000 extra donations

Leadership

Culture

Strategy

Strategy Strategy as

orientation

Strategy as animation

Differentiation:

fixed position

Emergence:

evolving pattern

Strategy as a specialist

skill

Strategy as a shared

process

Leader as visionary Leader as orchestrator

Divergent thinking Divergent and convergent

thinking

Revolutionary change Evolutionary change

Fixed position,

perfect fit

Many positions,

changing shape

Chris Bilton (2007)

o set bold aims to improve

o establish transparent metrics of progress

o invite patients, carers, communities into

every single part of the system

o empower staff to be the leaders and

activists of change

o cease fear and blame; develop pride and

joy

o develop collaborative learning

Donald Berwick,

IHI/BMJ International Forum on Quality and Safety in Health Care, London 2015

Strategy

Culture Lawton et al (2011) BMJ Quality & Safety

The myopic focus on errors, harm and near misses

has been sending negative messages for a long

time. Politicians, bureaucrats, managers, the

media and those leading enquiries as far back as

Bristol Royal Infirmary… have essentially indicated

to clinicians:

you are prone to making mistakes, and we must

insist that you reduce the harm or potential harm

you cause; and if you do not, we will regulate your

activities, tightening the rules over time.

Culture

Culture In most organizations and communities

there are people or groups of people who

solve problems better than colleagues with

the exact same resources, who display

uncommon but successful behaviours or

strategies: these are the positive deviants

Culture Marra et al (2011) Am J Infection Control

• Positive deviants: HCWs who wanted to

change, to think, and to develop new ideas

for improving hand hygiene and who

stimulated other HCWs to use the alcohol gel

product.

• There was a statistically significant reduction

in the incidence density of all HAIs and

device-associated infections.

What do they all

have in common? Culture

….. Experimentation &

creativity… Culture

Culture

1. Doing the right things

2. Doing things right

3. Doing things better

4. Doing away with things

5. Doing things that other people are doing

6. Doing things no one else is doing

7. Doing things that cannot be done

(Smith/Plsek)

lean translation

and adoption

invention

innovation

research

“Collective leadership cultures are

characterised by all staff focusing on

continual learning and through this,

the improvement of patient care.”

Michael West et al, Developing Collective Leadership for HealthCare, King’s

Fund, 2015

Culture

Development of the

Surgical Checklist

• 8 hospital test

• 36% reduction in major complications

• Deaths fell 47%

• Post-op complications reduced 25%

• Correlation between teamwork scores

& reduction in complications

• Incorporates strategy to foster team work

& communication – ie, team huddle

• “activation phenomenon”

Atul Gawande, The Checklist Manifesto, 2011

Culture

Meet the anti-coagulation team

Reduced overtime

Reduced referral turnaround

time

Increased staff satisfaction

Increased patient satisfaction

Increased fun

How does the team feel now?

““Although work seems as difficult as ever on

some days, there are more days where I think ...I

have actually enjoyed today!!”

“Lots of hard work so far from

the team - and it has yielded

improvements! Remember

to think about what has been

achieved”

“I feel more empowered”

“Actually getting involved

and having a say about

how we are going to

change things, I must say I

have really enjoyed it”

Leadership

Leadership • We are part of the system we are

seeking to change.

• Build you own and others’ capabilities

to see the bigger picture, to be

inquisitive, to hear the voice of

patients, and to continually learn.

• Practice climate control: create the

conditions necessary for change and to

enable collective wisdom &

intelligence to emerge.

Leadership

Quality

Initiative

Directorate Ecology for Improvement

How are your team’s improvement

skills?….

RHH

S

WPH

JW

OSSCA Spec Med &

Rehabilitation

Diagnostics &

Therapeutics Head &

Neck

Emergency

Care

Corporate

Surgical Services

Emergency

Care

Surgical

Services

Spec Med &

Rehabilitation

SYRS

Diagnostics &

Therapeutics

Corporate

Community

Opportunity to

aggregate gains or

help prompt a

cultural shift?

o hear the voice of the patient as person

o Spread of change – innovation,

messiness, network, but united with

strategic intent

o strategy as “animation”, leader as

enabler/ orchestrator

o a culture which encourages the

creative and positive deviants

o improved ownership, team work and

engagement gets better performance

Culture

Strategy

Leadership

o grow an ecology in which

improvement and innovation can

flourish

o explicitly value and prioritise

improvement activity

o use the resource around you – skill up

your people

o make improvement and innovation

ubiquitous through events, learning,

permissive culture, business

agendas…

Culture

Strategy

Leadership

Table Exercise

Seven success factors for change in the NHS

Allcock et al (2015) Constructive comfort: accelerating change in the NHS

http://www.health.org.uk/sites/default/files/ConstructiveComfortAcceleratingChangeInTheNHS.pdf

Things to celebrate What you can do to help

improvement flourish

Committed and respected

leadership that engages staff

A culture hospitable to, and

supportive of, change

Management practices that

ensure rigorous execution and

implementation.

Data and analytics that

measure and communicate

impact

Capabilities and skills to

identify and solve problems

Resources and support for

change

An enabling environment

which supports and drives

change.

References

Allcock et al (2015) Constructive comfort: accelerating change in the NHS. [Available to

download from the Health Foundation]

Donald Berwick, IHI/BMJ International Forum on Quality and Safety in Health Care,

London 2015

From Helen Bevan, Slide Pack from STH Presentation 2013

Chris Bilton (2007) Management and Creativity. Oxford: Blackwell

Atul Gawande, The Checklist Manifesto, 2011

Lawton et al (2011) BMJ Quality & Safety

Marra et al (2011) Am J Infection Control

Paul Plsek (2014) Accelerating Health Care Transformation with Lean and Innovation.

Florida: CRC/Taylor Francis

Michael West et al, Developing Collective Leadership for HealthCare, King’s Fund, 2015

John Whitmore(2002) Coaching for Performance