leading transformational change

@helenbevan

Leading transformational change

Presentation to the Swedish Society of Medicine

5th December 2013

Helen BevanNHS Horizons Group

@helenbevan

@helenbevan

Most large scale change fails to achieve its objectives

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

@helenbevan

Anatomy of change Physiology of change

Definition The shape and processes of the system; detailed analysis;

how the components fit together.

The vitality and life-giving forces that enable the system and its people to

develop, grow and change.

FocusProcesses and structures

to deliver health and healthcare

Energy/fuel for change

Leadership activities

measurement and evidence

improving clinical systems reducing waste and

variation in healthcare processes

redesigning pathways

creating a higher purpose and deeper meaning for the change process

building commitment to change connecting with values creating hope and optimism about

the future calling to actionSource: Crump and Bevan

@helenbevan


Definition The shape and processes of the system; how the

components fit together.

The vitality and life-giving forces that enable the system and its people to

develop, grow and change.

FocusProcesses and structures

to deliver health and healthcare

Energy/fuel for change



improving clinical systems reducing waste and

variation in healthcare processes



building commitment to change connecting with values creating hope and optimism about

the future calling to actionSource: Crump and Bevan

@helenbevan


Definition The shape and processes of the system; how the components fit together

The vitality and life-giving forces that enable the system and its people to develop, grow and

change

FocusProcesses and structures to deliver health and care Energy/fuel for change



improving clinical systems

reducing waste and variation in healthcare processes



building commitment to change connecting with values creating hope and optimism

about the future calling to action

Source: Crump and Bevan

@helenbevan #Staffschange

Emerging themes in large scale change

Organisation Community

Power through hierarchy Power through connection

Mission and vision Shared purpose

Making sense through rational argument

Making sense through emotional connection

Leadership-driven (top down) innovation

Viral (grass-roots driven) creativity

Tried and tested, based on experience

“ Open” approaches , sharing ideas & data, co-creating change

Transactions Relationships

Dominantapproach

Emerging direction


John Kotter: “Accelerate!”

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

• We need hierarchy AND network• Many change agents, not just the usual few • Changing our mindset

• From “have to” to “want to”• Head and heart, not just head

and

@helenbevan

The Network Secrets of Great Change Agents

As a change agent, my centrality in the informal network is far more important

than my position in the formal hierarchy

Julie Battilana &Tiziana Casciaro


A challengeThe way that leaders put messages across

does not tap into roughly 80% of the primary motivators of the workforce for

putting energy into the change programme”

Scott Keller and Carolyn Aiken (2009) The Inconvenient Truth about Change Management

@helenbevan

If we want people to take action, we have to connect with their emotions through values

actionaction

valuesvalues

emotionemotion

Source: Marshall Ganz


Learning from leaders of social movements:Framing

Is the process by which leaders construct, articulate & put across their message in a powerful & compelling way in order to win people to their cause & call them

to action

Snow D A & Benford R D (1992)

@helenbevan #Staffschange 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

@helenbevan

[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

@helenbevan

The largest simultaneous improvement initiative in the history of the NHS

@helenbevan #NHSChangeDay#NHSChangeDay

Its started with a tweet!

Trainee doctors and improvement leaders started to talk about how they could build a social movement to improve care

Damian RolandStuart Sutton Helen Bevan


A 189,000 pledge mountain!

16

“As Director of Safety and Risk, my pledge is to spend more time listening to patients and staff and to act upon their concerns.” Moira Durbridge

“We pledge to invite all individuals who make a complaint about our services to be involved in one of our 15 Steps Quality Challenge panels.” Bradford District Care Trust, Yorkshire, 3001

“We pledge to introduce a test for values and behaviour for recruitment into our universities and into employment.” Health Education England, West Yorkshire

“I pledge each month to contact a front line staff member within my team who demonstrates inspirational clinical practice.” East of England Ambulance Service NHS Trust

“I pledge to make sure every person with a learning disability at Turning Point has a health action plan.” Fiona Ritchie

“I pledge to visit an elderly gentleman with dementia in his own home to help him build his life story on our Digital Reminiscence Therapy Software.” Jo Samuels.

Example pledges


People took action all over the country

#NHSChangeDay


Change Day 2013 was an extraordinary moment in the history of the NHS. It taught us that large-scale improvement is possible in the NHS and that the best way to do it is through collective commitment, action and by keeping

it simple.


3rd March 2014www.changeday.nhs.uk


What happens to heretics/radicals/rebels/mavericks

in organisations?


Valuing radicals

• “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)

• big things only happen in organisations because of heretics and radicals


We need boatrockers!

• 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• Capable of working with

others to create success NOT a destructive troublemaker

Source: Debra Meyerson

@helenbevan #NHSChangeDay#NHSChangeDay Source : Lois Kelly www.foghound.com

Sometimes leaders see radicals as troublemakers

@helenbevan #NHSChangeDay

www.changeday.nhs.uk/healthcare radicals


....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 inspireDov Speidman

leading transformational change

Health & Medicine

values creating hope

deliver health

giving forces

components fit

future calling

change connecting

deeper meaning

action source