denmark shcr 1 day, april 2015 jackie lynton & kate pound

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs

(in one day!)

Jackie Lynton – Head of transformation Kate Pound –Transformation Fellow

@HelenBevan #SHCR #QF15

The Horizons Group within NHS Improving Quality

Aim of the group: to stimulate new and ‘disruptive’ approaches in support of health and care transformation, operating at the edge of current thinking and practice:

1. how to create radical, system-wide change

2. working with emerging leaders, clinical trainees, students

3. open innovation, open source, digital connection, social media, change platforms, hacking

“You can’t cross a

chasm in small

steps”David

Lloyd George

Community

Call to attention Stay with the process

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs

Agenda for the day Time Subject Speaker09.00 – 09.10 Introduction Britt Wendelboe09.10 – 10.00 M1: Being a health and care radical:

change begins with me10.00 – 10.30 M2: Building alliances for change10.30 – 11.00 BREAK 11.00 – 11.30 (Continuation) M2: Building alliances

for change

11.30 – 11.50 Change agent story Camilla Noelle Rathcke11.50 – 12.30 M3: Rolling with resistance12.30 – 13.30 LUNCH 13.30 – 13. 50 (Continuation) M3: Rolling with

resistance

13.50 – 14.50 M4: Making change happen14.50 – 15.30 M5: Moving beyond the edge15.30 – 16.00 Ending the day Britt Wendelboe


Welcome to the School for Health and Care Radicals – a global community of change agents

• More than 5,000 change agents in health and care have taken part in The School for Health and Care Radicals

• From more than 60 countries, including:

Australia, Belgium, Canada, Czech Republic, Denmark, England, France, Germany, Ireland, Netherlands, New Zealand, Norway, Northern

Ireland, Philippines, Saudi Arabia, Scotland, Spain, Sweden, Ukraine, United Arab Emirates,

USA, Wales


1. Follow on Twitter

@JackieLynton @KateSlater2

@School4Radicals @TheEdgeNHS

2. Subscribe to

3. Get materials from The School for Health and Care Radicals: www.theedge.nhsiq.nhs.uk/school

4. htts://www.facebook.com/groups/15170225286921/?fref=ts

TheEdge.nhsiq.nhs.uk

Four ways to connect!

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


• Being an effective change activist

• Transformational leadership

• Thought diversity and disruptive

innovation• Scale and spread of

change• The new methods

for change

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhswww.nhsiq.nhs.uk/ImprovementFundamentals

• Delivered entirely online to study at your own time and pace

• Features live knowledge exchange events with experts and other participants

• Gives you the tools to put improvement ideas into practice

• Connect with a global improvement community• Free to ANYONE interested in improving health and care

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs #SHCR #Patient15 @JackieLynton @KateSlater2 @School4Radicals @TheEdgeNHS


Five enabling themes in change and transformation www.nhsiq.nhs.uk/whitepaper

http://www.nhsiq.nhs.uk/whitepaper


Everyone has gifts and strengthsEveryone has gifts and strengthsWhat’s your superpower ?What’s your superpower ?

#SHCR #Patient15 @JackieLynton @KateSlater2 @School4Radicals @TheEdgeNHS

@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5

Activity

Introduce yourself to others at your table. Tell a quick story that demonstrates what your super power is and why you came to the workshop today.

Time allowed: 10 minutes for the whole table

#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchatImage from: @TheWorldStories

Change the world

ENGAGEMENTCOMMITMENT ENERGY

• Creating a space for getting ready for change

• Invitation to thinking differently about change

• Share the collective wisdom of people in the room – 5 minutes of wisdom

Overview

Strong sense public service and community

1986

1. I did not feel heard, supported

2. Let down by my profession

3. I was part of a hierarchical system

that didn’t protect vulnerable

people

Nurse

Checked

Out!

Always fighting for change and speaking out

This picture was taken from the window of my hotel room in Scotland when I asked myself one of the most important questions

Knowing your purpose

It was about trying to move the mountain it was about climbing it

Together/WeAlone/Me

30 years on

1. Staff didn’t feel heard – ‘checked out’

2. Compliance over commitment

3. Staff not feeling ‘permission’ to make to make changes

‘Can I really make the change?’

Will ‘the system’ really ALLOW me?

As a radical its not just about me, its about how I work with others

1. Cut on the dotted line2. Rotate 180 degrees

Creating change through connections and building relationships

#NHSChangeDay #SHCRchat

Now I don’t!I bring my authentic self to work

I had to be someone else

to fit in

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5

Reconnected with my values


Change starts with me


NHS Change Day - Making a difference

@HelenBevan @JackieLynton #mixmashup

Quote from ChloeI was inspired by the caring,

creative and committed individuals I met in the NHS and realised I need to fulfil a sense of

purpose in using my skills and passion in helping others.

I want ……


Call to action

¨The more you share your story, you create hope, and the more you create hope, the more you can create change.¨

Jackie Lynton

Share your story


The history of the School

2002

20142013

2010 2012

2003

NHS Change Day 2013

“A school for healthcare radicals”

Applying social movement

thinking to healthcare

improvement

“The School for Health and Care

Radicals”

“A one day school for organisational

radicals”

Applying community organising

principles to healthcare

improvement

2015

#SHCR #Patient15 @JackieLynton @KateSlater2 @School4Radicals @TheEdgeNHS


So why do we keep reinventing the past and calling it the future?

Image used under Creative Commons licence: Kicki

@HelenBevan #SHCR #QF15

Resources to improve health and care

Economic resourcesdiminish with use•money•materials•technology

Natural resourcesgrow with use•relationships•commitment•community

Based on principles from Albert Hirschman, Against Parsimony

diminish grow


http://www.theedge.nhsiq.nhs.uk/school/ Module 1:

Being a health and care radical:

Change starts with me

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



Starts on the fringe

(at the edge)

Starts with the activistsGary Hamel

always


DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity

Change from the edge


Leading change in a new eraDominant approach Emerging direction


Leading change in a new eraDominant approach Emerging direction

Most healthcare transformation

efforts are driven from this side

Most healthcare transformation

efforts are driven from this side


DiscussionWhat are the implications of the “emerging direction” for the way

change agents work?

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: Gary Hamel

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource:@Alfacarlo


John Kotter, the most influential thought leader globally, recognises new approaches are needed

FROM


John Kotter: “Accelerate!”

• We won’t create big change through hierarchy on its own

• We need hierarchy AND network• Many change agents, not just a

few, with many acts of leadership

• At least 50% buy-in required• Changing our mindset

– From “have to” to “want to”

TO


Must do

Want to do

Kotter: From “have to” to “want to”


From “have to” to “want to”

Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community


Managers know how to command obedience and diligence, but most are clueless when it

comes to galvanizing the sort of volunteerism that animates life on the social web.

Initiative, imagination and passion can’t be commanded—they’re gifts.

Gary Hamel http://www.mixmashup.org/blog/reinventing-management-mashup-architecture-ideology

‘

http://www.mixmashup.org/blog/reinventing-management-mashup-architecture-ideology


People who are highly connected have twice as much power to

influence change as people with hierarchical power

Leandro Herrero

http://t.co/Du6zCbrDBC

http://t.co/Du6zCbrDBC


is the new normal!

“By questioning existing ideas, by opening new fields for action, change

agents actually help organisations survive and adapt to the 21st Century.”

Céline Schillinger Image by neilperkin.typepad.com


What does it mean to be a rebel or a radical?


We need rebels!•The principal champion of a change initiative, cause or action

•Rebels don’t wait for permission to lead, innovate, strategise

•They are responsible; they do what is right•They name things that others don’t see yet

•They point to new horizons

•Without rebels, the storyline never changes

Source : @PeterVan http://t.co/6CQtA4wUv1

http://t.co/6CQtA4wUv1


What happens to heretics/radicals/rebels/mavericks

in organisations?

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out


We need to be boatrockers!

• Walk the fine line between difference and fit, inside and outside, rock the boat but manage to stay in it• Able to challenge the status

quo when we see that there could be a better way• Conform AND rebel• Capable of working with others

to create success NOT a destructive troublemaker Source: Debra Meyerson

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: Rebelsatwork.com


What are the risks for a boat rocker?

1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice we surrender a part of ourselves, and silence

our commitment, in order to survive1. leave the organisation

we cannot find a way to be true to our values and commitments and still survive

1. stridently challenge the status quo in a manner which is increasingly radical and self-defeating this just confirms what we already know – that

we don’t belong Source: adapted from Debra E Meyerson

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource : Lois Kelly www.foghound.com

There’s a big difference between a rebel and a troublemaker

Rebel

http://www.foghound.com/


Reflection• What are your insights around “rebels” and

“troublemakers”?• What moves people from being “rebel” to

“troublemaker”?• How do we protect against this?


If your horse dies, get off it

Cherokee proverb

Source of image: fenwickgallery.co.uk

‘‘‘‘


"There’s only one corner of the

universe you can be certain of

improving, and that’s your own

self." Aldous Huxley

Source of image: timcoffeyart.wordpress.com


1. Change starts with me

Source of image: jasonkeath.com


‘I do not think you can really deal with change without a person asking real

questions about who they are and how they belong in the world’

David Whyte, The Heart Aroused 1994

Source of image: fistfuloftalent.com


History tells us that personal transformation comes before

organisational or system transformationIf we want to play our role, we have to focus deeply on our own perspective and the ways

http://blogs.bmj.com/quality/2013/08/19/a-call-to-action-helen-bevans-blog-2/

we interact with and influence others. The more that we can unleash that powerful reservoir of energy for change, the more our influence and impact will grow.

Image from novamagazine.com




1. able to join forces with others to create action2. able to achieve small wins which create a sense

of hope, possibility and confidence3. More likely to view obstacles as challenges to

overcome4. strong sense of “self-efficacy”

belief that I am personally able to create the change

Four things we know about successful boat rockers

Source: adapted from Debra E Meyerson

CHANGE

me

BEGINS WITH


What’s the difference between

self efficacyand

self esteem,self belief,

self-confidence?


Source: @NHSChangeDay


Source: @NHSChangeDay

What is the issue here?

“permission” ? (externally generated)

or

Self efficacy ? (internally generated)


Building self-efficacy: some tactics

1. Create change one small step at a time

2.Reframe your thinking:• failed attempts are learning opportunities• uncertainty becomes curiousity

3. Make change routine rather than an exceptional

activity

4. Get social support

5. Learn from the best


The most effective change agents:

•don’t waste their time and energy blaming and complaining

•take calculated risks to achieve the outcomes they sought

Now is the time to plan steps to keep moving myself forward, with positive momentum, as a health and care radical


Avedis Donabedian

“Ultimately, the secret of quality is love.

…… If you have love, you can then work backward to monitor and improve the system”.


Tactic for radicals:Out-love everyone else

Source of image: Bradley Burgess



Building alliances for change

Supported by




Often as radicals, we feel different to other people

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource of image: outskirtsbattledome.wikispaces.com

The easiest way to thrive as an outlier

...is to avoid being oneSeth Goodin


strong ties (cohesive)v.

weak ties (disconnected)

Source of image:brucemacvaresh.com


Why we need to build weak ties AS WELL AS strong ties

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

• In situations of uncertainty, we have a tendency to revert to our strong tie relationships– yet the evidence tells us that weak ties are much more

important than strong ties when it comes to searching out resources in times of scarcity

• The most breakthrough innovations will come when we tap into our weak ties

History suggests that weak ties will probably give us the best chance to deliver large scale improvements in a challenging

timescale


Four keys to collaboration• Lean into your discomfort• Listen as an ally• State your intent • Share your “street corner”

Source: Judith Katz and Fred Miller


Call to action1. Identify which communities you

are currently part of and how you can utilise your existing communities for change

2. Reflect on who else you would like to be part of your community for change and take action to connect with them

3. Create your narrative or “call to action” to win other people to your cause

Source of image: marymagdalen.blogspot.com


What is a

RCT?


Randomized Coffee Trial!


Outcomes of randomised coffee trials


Harvard researchers put a gorilla image on this lung scan


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

90%

25% 17%

80%

9%

60%


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

90%

25% 17%

80%

9%

60%

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

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


Change Agents need to know how to tell their story. Effective framing:

1. Tell a story

2. Make it personal

3. Be authentic

4. Create a sense of “us” (and be clear who the “us” is)

5. Build in a call for urgent action

Camilla Noelle Rathcke story


Vivid details

Source: Marshall Ganz


Talk to the person next to you ACTIVITY

• Tell your story about why the change you are involved in now is so important to you

• Relate it to a personal experience

You have:• 2 minutes to prepare your story• 3 minutes each to tell your story



Rolling with resistance




What do we mean by

?

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource of image: sport-fitness-advisor.com

Any force that stops or slows movement

Resistance


Employee resistance is the most common reason executives cite for the failure of big organizational-

change effortsScott Keller and Colin Price (2011), Beyond

Performance: How Great Organizations Build Ultimate Competitive Advantage

Source of image: Businessconjunctions.com


In module 1, we talked about:


Let’s think about this in the context of “resistance”


Leading change in a new eraDominant approach

Emerging direction

• Change can be planned and managed through a rigorous process

• Resistance is a force to overcome

• Resistance prevents change• Change agents must

diagnose, manage and/or overcome resistance

• Resisters can otherwise be known as “laggards”, “blockers”, “in denial”


Resistance to change: the dominant approach


“The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to

implement successfully and may not succeed at all”

David Stonehouse The change agent: the manager’s role in change

British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445

Dominant approach: the role of the change agent

http://www.bjhcm.co.uk/cgi-bin/go.pl/library/contents.html?uid=4973;journal_uid=22


Leading change in a new era

• Change in human systems is often emergent and hard to predict

• Change results from connections/interactions stimulating different perspectives, shaping how people think about things

• Resistance is an inevitable consequence of a complex change process

• Resistance should be embraced and rolled with

Dominant approach

Emerging direction

• Change can be planned and managed through a rigorous process

• Resistance is a force to overcome

• Resistance prevents change• Change agents must diagnose,

manage and/or overcome resistance

• Resisters can otherwise be known as “laggards”, “blockers”, “in denial”


“Change doesn’t rain down on us from on high. Rather, its stories are co-created and co-owned by the community. Or, at least they

are if you want the change to stick”Julian Stodd

https://julianstodd.wordpress.com/2013/11/29/the-co-creation-and-co-ownership-of-organisational-change/

https://julianstodd.wordpress.com/2013/11/29/the-co-creation-and-co-ownership-of-organisational-change/


Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........

Sensemaking is not done via marketing...or slogans but by emotional connection with employees

Ron Weil


Resistant behaviour is a good indicator of missing relevance

Harald Schirmerhttp://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-

role-of-hr-driving-social-adoption-and-change-in-the-enterprise

Source of image: driverlayer.com

‘‘‘‘


What’s the financial incentive?

Who is performance managing?

What’s the project plan?

Source: @RobertVarnam


“I have some Key Performance

Indicators

for you”

oror

“I have a dream”

Source: @RobertVarnam


1. Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system and by being welcoming

2. Creat-e opportunities for everyone to express their views, spot opportunities and build on each other’s ideas

3. Create ways for people to reflect together to find meaning, understanding and shared purpose in the change

Source: Peggy Holman

Emerging direction: the role of the change agent

Source of image: rachtalks.pressprestige.com


“Leaders and organisations must let go of the idea that there is “one right way” and instead focus on creating a learning culture where people feel accepted, are comfortable contributing ideas, and actively seek to learn from each other”

Diaz_Uda, Medina and Schill (2013)

Source of image:fineartamerica.com

As health and care radicals, we should be champions of diversity for change


In the context of “rolling with resistance”•What are the implications of embracing diversity of thought, experience and background in our change efforts?•What skills and perspectives do health and care radicals need to work effectively with diverse teams for change?

Source of image:fineartamerica.com

Discussion


Stop talkingAT ME

Start talkingTO ME

Source of image: prepbeijing.com

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/


C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively


Make it a personal PERFORMANCE target.


Research from the sales industry:How many NOs should we be seeking to get?

• 2% of sales are made on the first contact

• 3% of sales are made on the second contact• 5% of sales are made on the third contact• 10% of sales are made on the fourth contact• 80% of sales are made on the fifth to twelfth contact

Source: http://www.slideshare.net/bryandaly/go-for-no


“Papers that are more likely to contend against the status quo are more likely to find an opponent in the review system—and thus be rejected —but

those papers are also more likely to have an impact on people across the system, earning them more

citations when finally published”V. Calcagno et al., “Flows of research manuscripts among

scientific journals reveal hidden submission patterns,” Science, doi:10.1126/science.1227833, 2012.

—


“Stages of change” Transtheoretical model of behaviour

change

Prochaska, DiClemente & Norcross (1992)


The reality of our change situation• Our tools are often not effective at the stage of change

that most people we work with are at• It’s hard to engage people in change• It’s hard to get people to make the changes we want

them to make• People get irritated, defensive, irrational• We feel powerless in our ability to lead or facilitate the

change

90% of the tools available for health and care change agents are designed for the “action”

stage


• Designed for Stage 4 – ACTION!

• Mandated it through targets

• Despite compelling case for change – people resisted it – no values connection

• People did the task and missed the point

Example – WHO Surgical Safety Checklist


IN A NUTSHELL

•Evidence from observational studies that the use of surgical safety checklists results in striking improvements in outcomes

•Led to rapid adoption of such checklists worldwide

•Researchers studied effect of mandatory adoption of checklists in Ontario, Canada

•Use of checklists not associated with significant reductions in operative mortality or complications


• Lower our ambitions for improvement• Focus our energies on those who are

already in the “action” stage• Put negative labels on those who are

not yet at the action stage such as “blocker” or “resister” or “laggard”• Blame “the management” for not

enforcing change

So what do we TEND to do when people resist?


The single biggest problem in communication is the illusion that it has taken

place

George Bernard Shaw

‘‘‘‘


• Listen and understand• appreciate the starting point• elaborate interests

• Roll with resistance (Singh) • Don’t argue against it• Encourage elaboration of resistance•What makes it so hard?•What would help?

• Build meaning and conviction in the change

So what SHOULD we do?


“Tomorrow’s management systems

will need to value diversity, dissent and

divergence as highly as conformance, consensus

and cohesion.”

Gary Hamel

Source of image: www.fastcompany.com


Call to action

• Reflect deeply on how you operate as an agent for change

• Consider the impact of your communication and behaviour beyond your intent

• Listen to others’ views, engage others in change and help others through the stages of change



Module 4:

Making change happen


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 goalPeter 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 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: Leading Large Scale Change: a practical guide (2011), NHS Institute


Bruch and Vogel researchOrganisations with HIGH productive energy scored higher on:• overall performance - 14% higher• productivity – 17%• efficiency – 14%• customer satisfaction – 6%• customer loyalty – 12%


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

http://healthaffairs.org/blog/2014/03/07/the-dangers-of-quality-improvement-overload-insights-from-the-field/


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


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 extrinsic

motivation•System drivers &

incentives•Performance management

•Measurement for accountability

create & focus momentum for

delivery


The Change Model

www.changemodel.nhs.uk


Which components appeal to you and why?


0123456789

10Our 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?


[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


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


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

building a fire withinBob Nelson


What lights the ‘fire in your belly’ and makes you feel passionate and determined to make change happen?


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?

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: 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


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)


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


Police


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


Discussion

What is your experience as a change agent of:•Building energy for change?•Creating shared purpose?


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.



Module 5:

Moving beyond the edge


“From the edge”

Source of image:hoodlinghole.blogspot.com

#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SHCR @school4radicals

What do we mean by “the edge”?• Working at the edge of organisations

so we can see the potential and make connections that we couldn’t do if we were at the centre

• At the edge of current practice and knowledge about change

• Taking risks and demonstrating courage to think and do things in new ways

• On the edge of ?


Why do we go to the edge?The edge is where those who want to

challenge are able to unite, share, support and grow together as

change activist. Leading from the edge brings you 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 outcomes

“


Peter Fuda’s Transformational Change Agent framework

Skills and methods for creating change

Ability to make sense of, and reshape perceptions of ‘reality’

Personal characteristics and qualities


Peter Fuda’s Transformational Change Agent framework: my commentary

“Doing”•Where most change agents in health and care put most of

their effort and emphasis•What others typically judge

us on•What we often perceive we

need to do to add value•What most change and

improvement courses focus on•The “de facto” purpose of a

health and care radical


Peter Fuda’s Transformational Change Agent framework: my commentary

“Seeing ” and “Being”•We can only do effective

“doing” if we build on strong foundations of “seeing and

being”•Give us the potential for:

• better outcomes• more engagement• self-fufillment and connection with our bigger purpose as an

agent of change


“Seeing” as a health and care radical• The big picture• Multiple perspectives• Reframing situations:

• failed attempts are learning opportunities• uncertainty becomes curiosity

• The positive intentions of others• Possibility of bad change processes rather than

resistors, blockers and laggards• Hopeful futures, creative opportunities and potential• See myself in the context of my higher purpose


“Doing” as a health and care radical

• Create the conditions where everyone can contribute and do their best

• Join forces with others to create action• Achieve small wins which create a sense of hope,

self-efficacy and confidence• Appeal to both the head (logic/planning/data) and

the heart (shared values/purpose, framing, relationships)

• Make change (and learning cycles from change) routine rather than an exceptional activity

• Use models, theories and frameworks effectively


“Being an effective Change Agent involves demonstrating what you

teach as much as pontificating from the mountaintops. Any behaviour we

ask others to adopt, we must consistently represent in our own

work, and share the positive outcomes.

Bryce WilliamsWorking Out Loud


• We must activate the mavericks, radicals, rebels and heretics

• There is a massive untapped reservoir of energy and talent out there and the

potential is outstanding

SO GO OUT AND CAUSE TROUBLE!

SUMMARY

NHS Change DayNHS Change Day

Making a change for Making a change for better together.better together.

Disruptive Case Study

Do something better together…. Do something better together….

Audacity to imagine we could mobilise the 1.3m people in the NHS

Must do

Want to do

Shared purposeGoal – 65,000 (500k)

pledgesCore leadership team

Personal pledgeSet a dateWebsite

Social media Took risks

Courage & belief Kept it simple!

Holding each other to account rather than performance management

Change Day pledges and stories

‘…the floodgates of change open’from front line to senior leaders


Change starts with me..

Maker

...Making a

difference

Anyone can pledge – it’s personal to you!

Change Activist


Volunteers – leaders everywhere

98% of activity via volunteers

My pledge/action…..Not let hierarchy get in the way of patient care

What I didWorked with the hierarchy at an early stage. Seeking their support with an explicit understanding that they respected the grassroots nature of Change Day.

Bottom up approach with top down support

I urge as many people as possible to give their support“

"NHS Change Day is a fantastic opportunity to join a movement of young leaders who want to make a

difference in the NHS

Jeremy Hunt Health Secretary

Chief Nursing Officer - England

Professor Sir Bruce Keogh National Medical Director

It's especially an opportunity for the next generation of junior doctors to effect change

in a practical and sustainable way"

Fun day for children Support group with a stomas

NHS CEO personal National pledge campaign

30% shift in staff survey: ‘Would you feel confident your hospital

would address your concern?’

Ashley Brooks Patient Champion

‘Change Day gave me the permission to use my energy in the direction I wanted to use it’

Students swap places with patients in mock ward

Change in University nursing curriculum

Louise Trowse – Second year student

Tasting common medicine for children

Discussing pharmacy methods of improving the taste

Dr Damian Roland

“The single most important skill I learned from improvement leaders was narrative. It connects us to the reasons we were called to work forthe NHS. It will stay with me the rest of my career.”

Jeharna sings for children’s ward to say thank you

‘I wanted to say thank you to NHS staff for the way my brother was looked after when he got knocked over,’

Staff feel appreciated

Smile Feedback Wednesday

Ellie Milner


2013 2014 2015

Google Searches Twitter

Google Searches and Twitter posts tell the same story: 50% bigger than last year at peakOnline mentions: 4x bigger than last year (Source — OLR) 9,274 vs 1,869 in 2014

Changeathon:

Changeathon peaked on Twitter around 09:00 and 11:00

46 Million Twitter Impressions14 Thousand Tweets9 Thousand online mentions4,859 individuals tweeting200 events flagged on Twitter60 events notified to team

Biggest ever

Events acrossEngland

Twitter:

50% bigger than 2014(tweets & searches — online is 400% bigger)

CHANGEATHON

#NHSChangeDay #SHCRchat


A global movement was born

https://www.youtube.com/watch?v=inHc1NgohuA

@helenbevan #IQTGOLD#SHCR @School4Radicals

“You don’t need an engine when you have wind in your sails”


1. Follow on Twitter

@JackieLynton @KateSlater2

@School4Radicals @TheEdgeNHS

2. Subscribe to

3. Get materials from The School for Health and Care Radicals: www.theedge.nhsiq.nhs.uk/school

4. htts://www.facebook.com/groups/15170225286921/?fref=ts

TheEdge.nhsiq.nhs.uk

Four ways to connect!

References and links

Baron A (2014) Preparing for a changing world: the power of relationships Battilano J, Casciaro T (2013) The network secrets of the great change agents Harvard Business Review, July-August Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Bevan H, Fairman S (2014) The new era of thinking and practice in change and transformation, NHS Improving Quality Change Agents Worldwide (2013) Moving forward with social collaboration SlideShareDiaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontierFuda P (2012) 15 qualities of a transformational change agentGrant, M (2014) Humanize: How people centric organisations succeed in a social world http://prezi.com/usju20i0nzhd/humanize-how-people-centric-organizations-succeed-in-a-social-world/ Hamel G (2014)Why bureaucracy must dieJarche, H (2013) Rebels on the edges


Jarche H (2014) Moving to the edgesKotter J (2014) Accelerate! Harvard Business Review PressMerchant N (2013) eleven rules for creating value in the social era Llopis G (2014) Every leader must be a change agent or face extinctionMeyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BPPerkins N (2014) Bats and pizzas (agility and organisational change) Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated School for health and Care radicals (2014) www.changeday.nhs.uk/healthcareradicalsShinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadershipWilliams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activismVerjans S (2013) How social media changes the way we work together

References and links

denmark shcr 1 day, april 2015 jackie lynton & kate pound

Health & Medicine

change happen14

care radicalsfrom

building alliances

northern ireland

new zealand

improvement ideas

continuation m2

continuation m3