change and innovation: it's time to rewrite the rules
TRANSCRIPT
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@HelenBevan
Change and innovation:
It’s time to rewrite the rules
Helen Bevan
@HelenBevan
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@HelenBevan
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
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@HelenBevan
Change is changing
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@HelenBevan
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
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@HelenBevan
Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
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@HelenBevan
Acceleration of connectedness
Change is changing
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@HelenBevan
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@HelenBevan
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@HelenBevan
How does the NHS improvement community prefer to communicate?
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@HelenBevan
Hierarchical power
Change is changing
Acceleration of connectedness
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@HelenBevan
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@HelenBevan
Change is changing
Hierarchical power
Acceleration of connectedness
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@HelenBevan
The Challenges
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@HelenBevan
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@HelenBevan
Change is changing
Hierarchical power
Change from the edge
Acceleration of connectedness
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@HelenBevan
http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final
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@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
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@HelenBevan
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
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@HelenBevan
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
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@HelenBevan
People who are highly connected have twice as much power to
influence change as people with hierarchical power
Leandro Herrerohttp://t.co/Du6zCbrDBC
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@HelenBevan
Is your change process a cathedral or a bazaar?
http://www.unterstein.net/su/docs/CathBaz.pdf
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@HelenBevan
We have a lot of cathedrals
Source: Sewell (2015) : Stop training our project managers to be process junkies
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@HelenBevan
WHO makes change happen in health and care?
Source: adapted by Helen Bevan from Leandro Herrera
List A• The Transformation Programme
Board• The programme sponsor• The Programme Management
Office• The leads of the [insert number]
transformation work streams • The Clinical Director• The Team Leader /Unit Manager• The Change Facilitator
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@HelenBevan
WHO makes change happen in health and care?
List A• The Transformation Programme
Board• The programme sponsor• The Programme Management
Office• The leads of the [insert number]
transformation work streams • The Clinical Director• The Team Leader /Unit Manager• The Change Facilitator
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
Source: adapted by Helen Bevan from Leandro Herrera
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@HelenBevan
WHO makes change happen in health and care?
List A• The Transformation Programme
Board• The programme sponsor• The Programme Management
Office• The leads of the [insert number]
transformation work streams • The Project Manager• The Team Leader /Unit Manager• The Change Facilitator
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
Source: adapted by Helen Bevan from Leandro Herrera
People who perform and live
in formal organisation land and
people who have make or break
power for change are two different
lists
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@HelenBevan
We need to change the role and skills of improvement leadersSurvey of 70 candidates for post of Head of Transformation, Horizons team:• Most educated to at least Master’s 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 based and facilitative
approaches to improvement • Most engaged in technostructure (technical advisory roles) -
rarely the locus of power in health organisations (Mintzberg typology)
• Old power/List A predominates
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@HelenBevan
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
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@HelenBevan
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
We need to focus on a different kind of energy for change
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@HelenBevan
Psychological
Physical
Spiritual
Social Intellectual
Energy for change
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@HelenBevan
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”
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@HelenBevan
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
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@HelenBevan
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
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@HelenBevan
Physical energy
Energy of action, getting things done and making progress
The flexible, responsive drive to make things happen
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@HelenBevan
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
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@HelenBevan
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
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@HelenBevan
Some questions
• Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)
• Nearer to CEO, higher or lower energy scores?
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@HelenBevan
• 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
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@HelenBevan
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 1: what’s your assessment of their energy for change?
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@HelenBevan
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 2: what’s your assessment of their energy for change?
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@HelenBevan
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
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@HelenBevan
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
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@HelenBevan
• 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”
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@HelenBevan
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 valueJohn Hagel
Source of image: Pinipa
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@HelenBevan
Evolving kinds of change platforms:
They overlap!
1. Connecting platforms
2. Mobilising platforms
3. Learning platforms
4. Knowledge platforms
5. Crowdsourcing platforms
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@HelenBevan
Example platforms
Source of image: @JenniferClemo
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@HelenBevanhttp://biggerboat.org/exploring-moodocs/
MOODOCs(Massive, Online, Open, Disease Oriented Communities)
60,000 online diabetes communities and
around 80 million online patient communities
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@HelenBevan
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
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@HelenBevanSource: OpenIdeo https://challenges.openideo.com/challenge/end-of-life/refinement
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@HelenBevan
Source: @NHSChangeDay
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@HelenBevan
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@HelenBevanSource: http://www.slideshare.net/alwynlau/learning-theories-learner-needs
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@HelenBevan
Nearly 10,000
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@HelenBevan
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?
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@HelenBevan
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
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@HelenBevan
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
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@HelenBevan
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@HelenBevan
Should we undertake routine radiology investigations overnight for all our inpatients?
How to build a change
platform in an hour
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@HelenBevan
• Platform established and presented to global audience in less than three days
• 60 minute sprint followed by a two week window for further ideas and discussion
• 3,000+ connections• good level of support for a 24/7 service for inpatients• consensus that the decision to receive a scan during
unsocial hours was patient led• yet many participants commented that it should be a joint
decision between clinician and patient• Panel at Nottingham University Hospitals is reviewing
findings, ideas and agreeing next steps for implementation
Help create a change platform in an hourRather than a consultation exercise that can take weeks, we set up a crowdsourcing platform to get an answer in an hour
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@HelenBevan
The Change Challenge
Tapping the collective brilliance of the NHS
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@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
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@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
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@HelenBevanProject 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
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@HelenBevan
Some lessons
1. You can’t control the outputs of the crowd2. People want a relationship3. Always, always, follow up
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@HelenBevan
The Natural Environment Research Council asked the crowd to name its new £200 million polar research vessel
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@HelenBevan
TEN TIMES as
many votes as the next
most popular answer
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@HelenBevan
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@HelenBevan
”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
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@HelenBevan
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@HelenBevan
Ways to connect!
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 [email protected]
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@HelenBevan
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)
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@HelenBevan
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)