leading change into the future

@helenbevan #2017congress

Leading change into the futureThemes and trends in the wider world of

change and implications for healthcare leaders


The Horizons team:Change agents and change agency

• A small, diverse team of people within the English National Health Service

• We tune into the latest change thinking and practice in healthcare and other industries around the world –translating this learning into practical approaches to change

• The team has emerged through years of supporting change in the NHS and the wider health and care system

@helenbevan #2017congress3

The greatestdanger today is NOT

micro-managing: it is MACRO-LEADING

Henry Mintzberg


Change is changing


Kinthi Sturtevant, IBM

13th annual Change Management Conference

We rarely see two, three or four year change projects

any more. Now it’s 30-60-90 day change projects

http://www.innovationexcellence.com/blog/2015/07/09/13th-annual-change-management-conference-highlights/?utm_source=hs_email&utm_medium=email&utm_content=20535245&_hsenc=p2ANqtz--W0963q5vEUgL7ecueQKfQ5nK0QPbROyo7BwHs10orC8Mhs-KVEWZbwEyxXf1c8rSQahhkhUXAPaEFtqlTzK5nEygUTw&_hsmi=20535245


Change is changing


We still organise health and care like the Tabulating Machine Co. of 1917

Source of image: @corp_rebels


Source: Innovisor


Three time points of collaboration among cancer clinicians and researchers

from Braithwaite and colleagues 2017

https://www.dropbox.com/s/mluhmam41vijrso/Braithwaite 2017 - Complexity Science in Healthcare - A White Paper.pdf?dl=0


Power is shifting

Power is one’s ability to achieve goals

Bertrand Russell


Jeremy Heimens, Henry TimmsThis is New Power

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

http://thisisnewpower.com/


To make change happen, connect with the 3%

Just 3% of people in the organisation or

system typically drive conversations

with 90% of the other people

Source: research by Innovisor


WHO will make the change happen?List A

• The Delivery Board

• The programme sponsors

• The Programme Management Office

• The Delivery Board work streams

• The Clinical Leads

• The Directors of participating organisations

• The Change Facilitators

Source: adapted by Helen Bevan from Leandro Herrera

http://leandroherrero.com/people-who-perform-and-live-in-formal-org-land-and-people-who-have-makebreak-power-two-different-lists










List B• The mavericks and rebels

• The deviants (positive). Who do things differently and succeed

• The nonconformists who see things through glasses no one else has

• The hyper-connected who 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 onesSource: adapted by Helen Bevan

from Leandro Herrera











List B• The mavericks and rebels

• The deviants (positive). Who do things differently and succeed

• The nonconformists who see things through glasses no one else has

• The hyper-connected who 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



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

http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-257163-Campaign+-+01/09/2016


Mark Jaben on the science behind resistance

What NOT to do

But what we do do

Engage people here


Mark Jaben on the science behind resistance to change

What NOT to do (but what we usually do)

We don’t need buyers (who “buy-in” to change)We need investors

What TO do

Engage people here

Engage people here


The design dilemma at the heart of change

The predominant approach in recent years has been STRUCTUREbut globally there is a big shift towards AGENCY


Source: @NHSChangeDay


Source: @NHSChangeDay

Problematic: changing a

“permission culture” can take years

The good news: we can usually build agency much more

quickly


Individual AND collective agency

Individual agency:People get more power and control in their own lives: patient activation, shared decision-making

and self-care

Collective agency: People act together, united by a common cause, harnessing the

power and influence of the group and building

mutual trust


Building agency for large scale change

We do not become transformed alone, we become transformed when we’re in relationship

with others

Hahrie Han

Source of image: Idahoc Community Action


http://biggerboat.org/exploring-moodocs/MOODOCs(Massive, Online, Open, Disease Oriented Communities)

http://biggerboat.org/exploring-moodocs/


Big drive to bring social movement thinking and practice into delivery


New Public

Passion:

a growing

global

movement


The era of the PLATFORMPlatforms today power learning and innovation

at the speed of change by providing collaborative and sometimes exponentially

productive spaces for people to create value

John Hagel

Source of image: Pinipa


Platform-based, collaborative innovation methods are outpacing traditional R&D

Source: PWC Innovation benchmarking survey 2017


• 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”


The Change Challenge

Tapping the collective brilliance of the NHS

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


A global survey by Gallup into the reasons why change initiatives fail, identified the same issue

Increasing number of messages as information cascade through

the organisation

Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx

http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx

14,000 contributions identified 11 building blocks for change:

Inspiring & supportive leadership

Collaborative 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

http://www.hsj.co.uk/leadership/change-challenge/


After years of intensive analysis, Google discovered that the key to high

performing teams that deliver change is being nice

Project Aristotle: https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-

xoaZybvz9f0b1_6bJyG7zZO6L

https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-xoaZybvz9f0b1_6bJyG7zZO6L


... 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

A changing world


1. Frame issues in ways that will engage and mobilise the imagination, energy and will of a large number of diverse stakeholders

2. Take steps to be social leaders, investing in digital skills and social connections and leading through networks as well as formal leadership systems

3. Align structure and agency

4. Find your B-listers and give them important tasks

5. Make space for collective sensemaking: build change platforms for important issues

6. Harness the power of advanced analytics

7. Adopt emergent approaches to planning and design, based on monitoring progress, learning and adapting as you go

Ideas for