shcr 2015 module 4

#SHCR @School4Radicals

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

Module 4:

Making change happen

Supported by

Joining in today and beyond Please use the chat box to contribute continuously during the

web seminar

Please tweet using hashtag #SHCR and the handle @School4Radicals

Join our Facebook group School for Health and Care Radicals

We will produce summaries of the discussions on each module using Storify and Pinterest and put on the website

Join in the Tweetchat each Wednesday at 4-5pm (GMT) using the hashtag #SHCR

The team today

Session lead: Helen Bevan @HelenBevan

Learning lead: Pip Hardy@PilgrimPip

Icebreaker and chat monitor:Dominic Cushman@domcushnan

Case study:Jenny Clarke@JennytheM

Twitter monitor:Kate Pound@kateslater2

Why change efforts often fail to achieve their objectives

Leading large scale change

The Change Model: aligning intrinsic and extrinsic motivators for change

Discussion on intrinsic/extrinsic motivators

Building energy for change

Creating shared purpose

Discussion and reflection

Source of image: www.freshnessmag.com

for today

Harvard researchers put a gorilla image on this lung scan

What proportion of the radiologists who reviewed this scan actually saw the gorilla?

25% 17%

What proportion of the radiologists who reviewed this scan actually saw the gorilla?

25% 17%

http://www.npr.org/blogs/health/2013/02/11/171409656/why-even-radiologists-can-miss-a-gorilla-hiding-in-plain-sight

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

Icebreaker: Making change happen

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

Most change programmes fail to deliver their objectives

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

Gets anywhere near achieving the change and

delivering the benefits

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

5% Delivers and sustains the change

Most change programmes fail to deliver their objectives

#SHCR @School4RadicalsImage from: @TheWorldStories

‘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 goal.’Peter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf

Source of image: Whatsthebigideascwartzy.blogspot.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 away

2. the change hits a plateau at some level and no longer attracts new supporters

3. 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

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

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/

“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

Ten key principles of large scale change

1. Movement towards a new vision that is better and fundamentally different from the status quo

2. Identification and communication of key themes that people can relate to and that will make a big difference

3. Multiples of things (‘lots of lots’)

4. Framing the issues in ways that engage and mobilise the imagination, energy and will of a large number of diverse stakeholders in order to create a shift in the balance of power and distribute the leadership

5. Mutually reinforcing change across multiple processes/subsystems

http://www.slideshare.net/NHSIQ/leading-large-scale-change-part-1

6. Continually refreshing the story and attracting new, active supporters

7. Emergent planning and design, based on monitoring progress and adapting as you go

8. Many people contribute to the leadership of change, beyond organisational boundaries

9. Transforming mindsets, leading to inherently sustainable change

10. Maintaining and refreshing the leaders’

energy over the long haul

Ten key principles of large scale change

http://www.slideshare.net/NHSIQ/leading-large-scale-change-part-1

Intrinsic motivationPeople engage in the activity for the pleasure and satisfaction of doing it

Invokes many positive behaviours

Extrinsic motivationPeople engage in the activity for the rewards or avoiding punishment

Any external influence is referred to as extrinsic motivation

Images: pixgood.com

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

create focus & momentum for delivery

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

Internal motivators

•connecting to shared purpose

Drivers of extrinsicmotivation

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

create & focusmomentum for delivery

An example

“Leaders and managers tasked with applying integrated care ‘at scale and pace’ might … focus on driving forward the organisational solution or introduce various financial inducements in the hope this will be more effective [than starting with values-based shared purpose]. Such an approach would be a mistake…

A values-driven approach should be a pre-requisite to the successful adoption of integrated care.”Goodwin, Nick. “Taking Integrated Care Forward: The Need for Shared Values.” International Journal of Integrated Care 13, no. 2 (June 24, 2013).

Transformation is not a matter of intent.........it is a matter of alignmentPeter Fuda

The Change Model

www.changemodel.nhs.uk

Which components appeal to you and why?

0123456789

Our shared purpose

Spread of innovation

Improvementmethodology

Rigorous delivery

Transparentmeasurement

System drivers

Engagement tomobilise

Leadership for change

What's our prognosis for this asthma pathway project?

The Change Model

www.changemodel.nhs.uk

You get the best effort from others not by lighting a fire beneath them, but by

building a fire within

Bob Nelson

“Take your passion and

make it happen.”

Source of image: www.zeelandtheaters.nl

Discussion

Reflecting on your change process:

how have you built both intrinsic and extrinsic motivators of change into your efforts?

How have you managed the tension between the two?

Any advice for other change agents on how to align intrinsic and extrinsic motivators?

What happens to large scale change efforts in reality?

In order of frequency:

1. the effort effectively “runs out of energy” and simply fades away

2. the change hits a plateau at some level and no longer attracts new supporters

3. 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

‘Research shows that more than almost any other factor affecting an

organisation, organisational energy can lead to either a wellspring of corporate

vitality or the destruction of its very core.’

Source: Bruch and Vogel

Bruch and Vogel research

Organisations with HIGH productive energy scored higher on:

overall performance - 14% higher

productivity – 17%

efficiency – 14%

customer satisfaction – 6%

customer loyalty – 12%

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

difference necessary to achieve its

Psychological

Physical

Spiritual

Social Intellectual

Energy for change is:

Five energies for change Energy Definition

Social 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 of commitment to a common vision for the future, driven by shared values and a higher purpose. It gives people the confidence to move towards a different future that is more compelling than the status quo

Psychological energy of courage, resilience and feeling safe to do things differently. It involves feeling supported to make a change and trust in leadership and direction

Physical energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen

Intellectual energy of analysis, planning and thinking. It 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

Low High

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, higher or lower energy scores?

@helenbevan@helenbevan #Quality2013

• 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 profile

5Social

Spiritual

PsychologicalPhysical

Intellectual

5Social

Spiritual

Intellectual

Team 1: what’s your assessment of

their energy for change?

5Social

Spiritual

Intellectual

their energy for change? This energy profile is characterised by an environment that has harnessed people’s interest and momentum for change, but which has failed to engage people fully. This imbalance results in their feeling some uncertainty regarding how they can contribute fully to the change, and therefore a sense of risk and lack of hope for the future. We can build energy by building team solidarity and developing shared purpose

5Social

Spiritual

Intellectual

their energy for change?

5Social

Spiritual

Intellectual

their energy for change?This energy profile shows strong connections between people, a true sense of solidarity, which gives them enough hope for the future, but this energy is undirected, because the rational argument and shared purpose has not been agreed. We can build energy by agreeing shared goals for change and using systematic approaches to thinking through and planning the change

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

#SHCR @School4Radicals Source: Helen Bevan

Compliance

States a minimum performance

standard that everyone must

achieve

Uses hierarchy, systems and

standard procedures for co-

ordination and control

Threat of penalties/ sanctions/

shame creates momentum for

delivery

What is our approach to change?

Commitment

States a collective goal that

everyone can aspire to

Based on shared goals, values

and sense of purpose for co-

ordination and control

Commitment to a common

purpose creates energy for

delivery

Shared purpose aligns.....

Shared purpose allows

many communities to

engage with us without us

having to invest resources

in controlling their actions

Nilofer Merchant

We know that ...

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)

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 wonderful 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/

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

#SHCR @School4Radicals @SimonJGuilfoyle Police Inspector and systems thinker

Police

@SimonJGuilfoyle Police Inspector and systems thinker

Education

Healthcare

“....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 inspire.”

Dov Seidman

Case study: Skin to skinJenny Clarke

Discussion

What is your experience as a change agent of:

Building energy for change?

Creating shared purpose?

Wednesday 25th February

16:00-17:00 Tweet chat #SHCRchat

Next Friday morning 27th February

module 4: Moving beyond the edge

You can start the process of applying to become a “certificated change agent”

Next opportunities for learning

The certification process

Take some actions to demonstrate your learning from the school and become a “certificated change agent”. If you complete the learning process you will:

• be recognised as a “certificated change agent” by the school and NHS Improving Quality

• be awarded a virtual badge that you can used on your email signature, personal website, etc.

• be invited to take part in one of our virtual graduation ceremonies

• receive a certificate.

Call to action

Reflect on how you can use both intrinsic and extrinsic motivators in your practice as a leader or agent of change.

Seek to ignite energy for change in everyone involved in your project.

Build commitment to shared purpose in all your change efforts.

Questions for reflection

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

2. How can I build energy for the long haul?

3. How can I ensure shared purpose throughout the change process?

4. What can I do tomorrow to accelerate change?

shcr 2015 module 4

change discussion

awaythe change

change happenwhich

changemost change programmes

new supportersthe change

large scale change efforts

school4radicals image

gorilla image

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