change in complex organisations – integrating support networked learning to enable sbc inverness 6...
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Change in complex organisations – integrating support
Networked Learning to enable SBC Inverness 6th April 2009
Dr. Guro HubySchool of Health in Social Science, University of Edinburgh
Centre for Integrated Healthcare Research,
Overview of presentation
Shifting the Balance of Care and High Impact Changes: ‘Whole System change’
Change in complex organisations: evidence, an evidence gap and a warning Headless Chickens, Total Gridlock or a modernised NHS?
Organisations learning about themselves: The right people, In the right place and at the right time Asking the right questions Tight project planning based on constant evaluation Collecting and interpreting the right information Producing learning which is disseminated and used
S B C and H I Cs; The Challenge of Whole Systems Change 8 SBC improvement areas are all existing policy initiatives and provide and
overall framework for change
All 48 HI8 SBC improvement areas are all existing policy initiatives and provide and overall framework for change
All 48 HICs can help SBC - but there are too many to be able to achieve change in all areas
The shortlist of 20 / 48 has been assessed to have the highest impact
Within the 19 HICs, CHPs and partners need to decide local community priorities and plans for change which will become part of LDPs, etc
Change needs to be monitored locally to deliver HEAT and SOA. No additional targets and measures
How ensure that changes work together for impact?
Change and innovation in Public services “[Innovation in service delivery and
organisation can be defined as] …a novel set of behaviours, routines and ways of working, which are directed at improving health outcomes, administrative efficiency, cost-effectiveness or the user experience, and which are implemented by means of planned and co-ordinated action”
(Greenhalgh et al, 2004).
Change and complexity
Non-linear change: no progression through distinct and predictable phases
Subject to a range of variables which interact to influence outcomes in often unpredictable ways.
Local context and organisational culture impact on direction of change
But..attributes of success are linear
Simplicity and clarity of goals and priorities
Quality and coherence of policy
Defined goals and milestones
Rigorous evaluation
Low complexity;
Trialability
Codifiability
Caught in the contradiction; a view from the middle manager positionFluid and shifting contexts
– Constant organisational change– Change in strategic direction– Change in personnel
Project goals and outcomes– Poorly defined – Shifting
Time pressure– On top of the day job– Unrealistic time scales and expectations
Information: – Too much but not enough
Evaluation and learning – What is evaluated?– What is learned?
Directions of Change?
No change The smoothly running modernised public
service Headless Chickens: lack of governance
Isolated changes, cancel each other out and work against each other
Total Gridlock: too much governance Litigation, rules, risk management: nothing
happens.Dunleavy and Hood 1994
‘Single loop’ and ‘double loop’ learning ‘Single loop’ learning: individuals change the way
they work when something goes wrong – Change in part of a system– Isolated processes and tasks – Sustainability?
‘Double loop’ learning: the system changes the way it works when something goes wrong– Individuals strategies pull together– Change is sustainable
(Argyris and Schon 1978)
Logics of complexity
The change process is not random,
It is shaped by an underlying organisational logic,
This logic has to be understood in order to manage the process
(Van de Van et al, 2008)
How do organisations learn about themselves?
The learning organisation
…organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together.
(Senge 1990)
Learning together: a way forward?
The right people, in the right place and at the right time
Asking the right questions: setting the right goals Collecting and interpreting the right information Tight project planning based on constant
monitoring and evaluation Producing learning which is disseminated and
used From Single to Double loop?