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Improving the way we do change! Hacking the NHS Change Model

14 October 2015

#CMhack@HelenBevan @PerryTimms

@ZoeLord1

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Housekeeping and survival!

Breaks…

Fire alarms and exits…

Mobile technology

Toilet location…Security…

Password: HubWest1 #CMhack

2

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We are a diverse group

Diversity leads to more disruptive thinking, faster change and better

outcomesAylet Baron

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Joining in today and beyond

• Please tweet using the hashtag #CMhack • We will produce summaries of the discussions

using Storify and Pinterest• A report is being produced in real time and

will be emailed to everyone by next Monday, 19th October

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Aims for today

• Review how change currently happens in health and care

• Review the NHS Change Model• Design a proof of concept to support

and enable change across health and care

• Scope how a change model can be spread across health and care

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Aims for today

• Review how change currently happens in health and care

• Review the NHS Change Model• Design a proof of concept to support

and enable change across health and care

• Scope how a change model can be spread across health and care

A re-imagined

model and a

plan for spread

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How we will do this

• Self-directed, not told• Communal, not siloed• Blocks, not agendas• Creative, not forced• Exploratory , not prescribed

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“Pioneering is the enemy of

transformative and systematic change”

David AlburyThe Innovation Centre

Why, after nearly two decades, haven’t we created an

unstoppable, system-wide drive for improvement?

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There have been many attempts to introduce change models and frameworks

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NHS Change Model

Developed in 2012 with inputs from hundreds of people, to distil twenty years of learning from

change in the NHS into a useable model to accelerate

and get better outcomes from improvement

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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

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Internal motivators

• connecting to shared purpose

•engaging, mobilising and calling to action

• motivational leadership

build energy and creativity

Drivers of extrinsicmotivation

•System drivers & incentives•Performance management•Measurement for accountability

create & focus momentum for delivery

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The power of extrinsic drivers

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Three types of levers for large scale change

‘Prod mechanisms’ targets

performance management

price & payment incentives regulation

competition

‘Proactive support’

relies on building ‘intrinsic motivation’ in

staff to make the right changes to

improve

‘People focused’ education and training

national contractsprofessional regulation

clinical quality standards

Type one:

Type two: Type three:

Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015

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Three types of levers for large scale change

‘Prod mechanisms’ targets

performance management

price & payment incentives regulation

competition

‘Proactive support’

relies on building ‘intrinsic motivation’ in

staff to make the right changes to

improve

‘People focused’ education and training

national contractsprofessional regulation

clinical quality standards

Type one:

Type two: Type three:

Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015

Less than 10%of the potential

for improvement

at system level can be

delivered through type one change

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Transformation is not a matter of intent.........

it is a matter of alignmentPeter Fuda

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The NHS Change Model aligns

intrinsic and

extrinsic aspects

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Shared purpose aligns.....

Shared purpose allows many communities to engage with us without us having to invest resourcesin controlling their actions Nilofer Merchant

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Our shared purpose

Spread of innovation

Improvement methodology

Rigorous delivery

Transparent measurement

System drivers

Engagement to mobilise

Leadership for change

0

5

10

Where are we currently?

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Priority area:

What outcomes do we seek?

Our Shared PurposeIs there a sense of shared purpose amongst our key stakeholders?

Leadership for changeDo all our leaders have the skills to create transformational change?

Engagement to mobiliseAre we engaging and mobilising all the right people?

Spread for innovationAre we designing for the active spread of innovation?

Rigorous deliveryDo we have an effective approach for delivery of change and monitoring of progress towards our planned objectives?

System driversAre our processes, incentives and systems aligned to enable change?

Improvement methodologyAre we using an evidence-based quality improvement methodology?

Transparent measurementAre we measuring the outcome of the change continuously and transparently?

People with dementia

Deliver goals of the National Dementia Strategy

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What’s strong? Where are the gaps? How can we align?

Political, clinical, voluntary and private sector leadership for

change

Multiple projects and initiatives at multiple levels

not necessarily aligned

Don’t consider any component of change in isolation (eg, broad

perspective on CQUIN scheme re people with dementia in hospital)

Strong sense of shared purpose and

will for change

Lack of transparent measures in terms of how well NHS is

playing its part

Support Clinical Commissioning Groups to act as enablers/aligners

at local level

Key stakeholders engaged and

mobilised

Not exploiting the potential for spread and adoption of

innovation

Link to local initiatives such as “Dementia Friendly Communities”

Multiple system drivers to support

change

Sporadic use of quality improvement methodologies

Align with other strategies to support older people across health and social care and building broad common commitment to change

Clarity of immediate programme

Building energy and engagement for the long haul

Build all the components into design of future strategies

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Five key principles in using the NHS Change Model1. Start with “shared purpose” but after that there is no

prescribed linear or logical order2. It’s important to use the model to check if all eight

components are present but it’s more important to focus on whether they are aligned

3. Use the model to build on what you are doing already4. Don’t “sell” the change model; “sell” the outcomes you

are seeking 5. Build commitment to, not compliance with, the NHS

Change Model

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Peter Fuda“Change is not the goal,

the goal is the goal”Peter Fuda

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Insights…

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Insights• Interviewed and surveyed 200 + people

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What did we find

Similarities and Polarities!!!

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What does the NHS workforce think? 14,000 contributors recently 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

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

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What does the NHS workforce think? 14,000 contributors recently identified 11 building blocks for change:

Inspiring & supportive leadershipCollaborative 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

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Insights• Use: – It is used for many different purposes -Projects, events, meetings

• Knowledge:– The more people know, the more they find it useful– Easy accessible information on practical application is required

• Language:– Some of the language is inhibiting

• Name:– NHS brand brings prestige– NHS brand is hindering the uptake from other care providers– Is it a model or framework?

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Going forward…

• Bring on board the people who don’t like it and keep hold of the people who do like it

• Enhance the positives – rather than change for change sake

• Address what ‘it’ should be called• Think about spread and implementation• How we frame it so that we focus on the goals

not the model.

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Bingo sheets are on your table.

Keep hold of your bingo card.

Find people who match the words below and ask them to write their name in one relevant box.

Once you’ve completed the whole grid, shout “bingo!” There’s a prize for the winner.

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We’re here to Hack… but what’s

a hack?

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A true hackathon

• Strategic • Socialised • Participative• Fast • Conclusive

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Plan for the day

• Series of hacks to explore design a proof of concept to support and enable change across health and care:

– Problem solving – Framework hacks – Mini Hacks – Spread and

sustainability hacks

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How today will workThis is not your usual conference or workshop, it is a specially designed process which enables

a depth and quality of output that would usually be unachievable in such a short

timeframe...

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We ask you to…• Go with the flow and have faith in the process• Unconference - self organise and follow your interests! • You have permission to create!• Take collective responsibility for completing the task in the

timescale• Collaborate, support and constructively challenge others• Put yourself in other people’s shoes• Bring and voice your own perspective – that is why you are

here!• Let reflectors reflect!

#CMhack

We ask you to…• Go with the flow and have faith in the process• Unconference - self organise and follow your interests! • You have permission to create!• Take collective responsibility for completing the task in the

timescale• Collaborate, support and constructively challenge others• Put yourself in other people’s shoes• Bring and voice your own perspective – that is why you are

here!• Let reflectors reflect!

Have fun!

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TRIZ: Theory of Inventive

Problem solving

Stopping counter-productive

activities and behaviours

“Every act of creation is first an act of destruction”Pablo Picasso

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There have been many attempts to introduce change models and frameworks

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There have been many attempts to introduce change models and frameworks

Whilst there are great examples of

their use, none of them have been

used consistently across the whole

system

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TRIZ: our schedule for the next 30 minutes

Step 1:Make a list of everything we

could reliably do to create/promote a change model or framework that

never gets used for any useful purpose

in our world of health and care

Step 3:Go through the items on your second list and

decide what first steps will help us

stop what we know creates undesirable

results?”

Step 2:Go down this list item by item & ask ‘Is there anything that we are

currently doing that in any way, shape or

form resembles this item?’ Be brutally honest to make a

second list of all our counterproductive

activities & processes

TRIZ

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Our TRIZ topic…

How could we could reliably create/promote a change model or framework that NEVER gets used for any useful purpose in our world of health

and care?

TRIZ

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Step 1As a table group make a list of “to-dos” on the first paper sheet in answer to the question:

How could we could reliably create/promote a change model or framework that NEVER gets used for any useful purpose in our world of health and care?

• Go wild!• 10 minutes

TRIZ

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Step 2As a table group, go down your first list and ask:

‘Is there anything that we are currently doing that in any way, shape or form resembles any of the items on list one?’

• Make a second list on sheet 2• Be unforgiving about these items and talk

about their impact• 10 minutes

TRIZ

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Step 3As a table group, go down your second list from step 2 and ask:“what are the first steps that will help us stop

getting undesirable results?”• Make a list of actions on sheet 3• Be prepared to share some of your content

from lists 2 and 3 with the wider group• 10 minutes

TRIZ

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Lets have a warm up hack!

Who is this model for? Who is our customer?

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Lets get hacking! Two parallel hacks:• Framework Hack: Big Picture• Mini Hack: Elements & bright ideas

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Framework Hack: Big Picture

• Remit:– Refreshed, revolutionary, reimagined – looks like a framework/model.

• Starting point is up to you- Scrap the current model and start

afresh - Start with the model and look what is

missing, what could be improved

• Bring the frameworks together to make one framework!

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Mini Hacks

• Remit:– Depth– Ideas and activities

• Examples of mini hacks: – What is the detail under the elements? E.g. leadership – How do you move from idea to reality? Story telling?– What’s it going to be called?– What’s it going to look like? Design?

• Pitch your hack A3 paper – and set up your stall!

• Ideas, synthesise and come up with some very useful things!

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Remember:

- Unconference - Follow your interests - Self organising

- Go for it!!!!

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Lets get hacking! Two parallel hacks:• Framework Hack: Big Picture• Mini Hack: Elements & bright ideas

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Feedback

• Framework Hack: Big Picture• Mini Hack: Elements & bright ideas

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Final Sprint: Two Hacks

1) Design team - refining the design of the model 2) Diffusion – spread of our new model

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Feedback

1) Design team - refining the design of the model 2) Diffusion – spread of our new model

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Review of the day….