being a change agent

@HelenBevan #womenlead

BEING a change agent

Helen Bevan

@HelenBevan

#womenlead

“New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)

Source of image: installation by the artist Adam Katzwww.thisiscolossal.com

Via @NeilPerkin

@HelenBevan #womenleadSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

@HelenBevan #womenleadImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

Functional thinking

(the things we do)

Change agents skills

Capability thinking

(our ability to do things)

Source of images: thenounproject.com

Peter Fuda’s Transformational Change Agent Framework

Skills and methods for creating change

Possibilities, opportunities, things in a different light

A role model first and a preacher second

Source: Peter Fuda (2012) 15 qualities of a transformational change agent

What is happening in the wider world that sets the context for change agents?

Change is changing

Kinthi Sturtevant, IBM 13th

annual Change Management Conference

June 2015

We rarely see two, three or four year change projects any more. Now it’s 30-60-90 day change

projects

@HelenBevan #womenleadSource: Bromford P (2015), ”What’s the difference between a test and a pilot?”

Pilots are being replaced by rapid tests and prototypes

Acceleration of connectedness

Change is changing

Digital skills are a critical capability for future leaders of improvement

How does the NHS improvement community prefer to communicate?

Digital

Non-digital

ProactiveReactive

Source: RAND evaluation data from the Q community of improvement leaders

How does the NHS improvement community prefer to communicate?

Digital

Non-digital

ProactiveReactive

Source: RAND evaluation data from the Q community of improvement leaders

Hierarchical power is diminishing

Change is changing

Hierarchical power is diminishing

The Challenges

Change is changing

Change is moving to the edge

Hierarchical Power is diminishing

An example from the Cabinet Office

http://www.slideshare.net/Openpolicymaking/060715-change-cardscollated?next_slideshow=1

@HelenBevan

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

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

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

WHO will make the change happen?

Source: adapted by Helen Bevan from Leandro Herrera

List A• The STP 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

WHO will make the change happen?

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

WHO will make the change happen?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

People who live and

perform in formal

organisation land and

people with the power to

make or break change are

two different lists (and

we need BOTH)

What’s the evidence?The failure of large scale

transformational change projects is rarely due to the content or

structure of the plans that are put into action

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)

It’s much more about the role of informal networks in the organisations and systems

affected by change

How well are we equipping NHS change leaders for this reality? Survey of 70 candidates for post of Head of Transformation, NHS Horizons team, July 2016:• Most candidates educated to at least Masters level• PRINCE 2 almost universal with Managing Successful Projects and

Lean methods well represented• Very few described strategic approaches to change or focussed on

social methods of change• Only limited descriptions of team /network based or facilitative

approaches to improvement • Most engaged in technostructure (technical advisory roles) – away from the locus of power in health organisations (Mintzberg typology)

• Old power/List A approaches predominated

Let’s think about resources for change inold/new power terms

Economic resourcesdiminish with use• money• materials• human resources

diminish

Natural resourcesgrow with use• relationships• commitment • community

Based on principles from Albert Hirschman and Marshall Ganz

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

Creating energy to enable transformation is a top priority

‘“Energy for change” defined as

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: http://www.nhsiq.nhs.uk/8530.aspx

Why is energy for change important?

Psychological

Physical

Spiritual

Social Intellectual

Change is most likely to happen when five energies are high

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

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

High and low ends of each energy domain

Social isolated solidarity

Spiritual uncommitted higher purpose

Psychological risky safe

Physical fatigue vitality

Intellectual Illogical reason

Some questions

• Which group likely to have higher spiritual energy scores:• clinicians• non clinicians

• Nearer to CEO in the structure:

higher or lower overall energy scores?

Source: Respondents to the energy for change questionnaire NHSIQ/Horizons team

Some questions

• Which group likely to have higher spiritual energy scores:• clinicians• non clinicians

• Nearer to CEO in the structure:

higher or lower overall energy scores?

Source: Respondents to the energy for change questionnaire NHSIQ/Horizons team

Answers:

Energy analysis of six STP plans

Source: energy for change discourse analysis of six draft STP plans by the Horizons team September 2016

The challenge of disproportionately high intellectual energy

• Intellectual energy on its own isn’t transformational

• It keeps leaders in their comfort zone (intellect to intellect)

Emotion is the fuel for change; data and information provide

direction Dan Heath

(author of Switch)

There has never been a time in the history of health and care 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

The Change Challenge

Tapping the collective brilliance of the NHS

@HelenBevan

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

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

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

@HelenBevan

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

Being a great change agent is about doing, seeing and being change

‘Avedis Donabedian

Ultimately, the secret of quality is love.…… If you have love, you can then work backward to monitor and improve the system

@HelenBevan #womenleadProject 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,

teams that deliver change is Being nice

Tactic for change agents:Out-love everyone else

Source of image: Bradley Burgess

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