denmark shcr 1 day, april 2015 jackie lynton & kate pound
TRANSCRIPT
#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
#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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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!
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
• 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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Five enabling themes in change and transformation www.nhsiq.nhs.uk/whitepaper
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
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
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
This picture was taken from the window of my hotel room in Scotland when I asked myself one of the most important questions
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
As a radical its not just about me, its about how I work with others
1. Cut on the dotted line2. Rotate 180 degrees
#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
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
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 ……
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
http://www.theedge.nhsiq.nhs.uk/school/ Module 1:
Being a health and care radical:
Change starts with me
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Starts on the fringe
(at the edge)
Starts with the activistsGary Hamel
always
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work complexity
Change from the edge
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Leading change in a new eraDominant approach Emerging direction
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
DiscussionWhat are the implications of the “emerging direction” for the way
change agents work?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
John Kotter, the most influential thought leader globally, recognises new approaches are needed
FROM
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Must do
Want to do
Kotter: From “have to” to “want to”
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
From “have to” to “want to”
Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
‘
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
People who are highly connected have twice as much power to
influence change as people with hierarchical power
Leandro Herrero
http://t.co/Du6zCbrDBC
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
What does it mean to be a rebel or a radical?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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 @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Reflection• What are your insights around “rebels” and
“troublemakers”?• What moves people from being “rebel” to
“troublemaker”?• How do we protect against this?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
If your horse dies, get off it
Cherokee proverb
Source of image: fenwickgallery.co.uk
‘‘‘‘
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
"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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
1. Change starts with me
Source of image: jasonkeath.com
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
‘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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
What’s the difference between
self efficacyand
self esteem,self belief,
self-confidence?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Source: @NHSChangeDay
What is the issue here?
“permission” ? (externally generated)
or
Self efficacy ? (internally generated)
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Avedis Donabedian
“Ultimately, the secret of quality is love.
…… If you have love, you can then work backward to monitor and improve the system”.
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Tactic for radicals:Out-love everyone else
Source of image: Bradley Burgess
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
http://www.theedge.nhsiq.nhs.uk/school/ Module 2:
Building alliances for change
Supported by
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
strong ties (cohesive)v.
weak ties (disconnected)
Source of image:brucemacvaresh.com
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Outcomes of randomised coffee trials
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Harvard researchers put a gorilla image on this lung scan
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Harvard researchers put a gorilla image on this lung scan
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
What proportion of the radiologists who reviewed this scan actually saw the gorilla?
90%
25% 17%
80%
9%
60%
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Vivid details
Source: Marshall Ganz
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
http://www.theedge.nhsiq.nhs.uk/school/ Module 3:
Rolling with resistance
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
In module 1, we talked about:
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Let’s think about this in the context of “resistance”
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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”
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Resistance to change: the dominant approach
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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”
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“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/
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
‘‘‘‘
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
What’s the financial incentive?
Who is performance managing?
What’s the project plan?
Source: @RobertVarnam
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“I have some Key Performance
Indicators
for you”
oror
“I have a dream”
Source: @RobertVarnam
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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/
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: 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.
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“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.
—
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“Stages of change” Transtheoretical model of behaviour
change
Prochaska, DiClemente & Norcross (1992)
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
• 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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
• 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?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
The single biggest problem in communication is the illusion that it has taken
place
George Bernard Shaw
‘‘‘‘
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
• 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?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
http://www.theedge.nhsiq.nhs.uk/school/
Module 4:
Making change happen
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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%
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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/
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Intrinsic motivators
build energy and creativity
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Intrinsic motivators •connecting to shared purpose
•engaging, mobilising and calling to action
•motivational leadership
build energy and creativity
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Drivers of extrinsic motivation
create focus & momentum for
delivery
Intrinsic motivators •connecting to shared purpose
•engaging, mobilising and calling to action
•motivational leadership
build energy and creativity
•System drivers & incentives
•Payment by results•Performance management
•Measurement for accountability
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Internal motivators •connecting to shared purpose
•engaging, mobilising and calling to action
•motivational leadership
build energy and creativity
Drivers of extrinsic
motivation•System drivers &
incentives•Performance management
•Measurement for accountability
create & focus momentum for
delivery
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
The Change Model
www.changemodel.nhs.uk
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Which components appeal to you and why?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
[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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
You get the best effort from others not by lighting a fire beneath them, but by
building a fire withinBob Nelson
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
What lights the ‘fire in your belly’ and makes you feel passionate and determined to make change happen?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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)
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
....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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
Discussion
What is your experience as a change agent of:•Building energy for change?•Creating shared purpose?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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.
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
http://www.theedge.nhsiq.nhs.uk/school/
Module 5:
Moving beyond the edge
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“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 ?
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
“
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
“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
#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5
• 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!
@HelenBevan @JackieLynton #mixmashup
Change starts with me..
Maker
...Making a
difference
Anyone can pledge – it’s personal to you!
Change Activist
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"
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
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
@HelenBevan @JackieLynton #mixmashup
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”
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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
#SCHR #Patient15 @jackielynton @KateSlater2 @School4Radicals @theedgenhs
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