@helenbevan · @helenbevan kinthi sturtevant, ibm 13th annual change management conference june...

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What are the big themes for change in the world in which STPs are being

implemented?

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Change is changing

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What approaches to change are needed in this environment?

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Kinthi Sturtevant, IBM

13th annual Change Management Conference June 2015

We rarely see two, three or four year change projects anymore. Now it’s 30-60-90 day change

projects

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Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”

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Change is changing

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How does the NHS improvement community prefer to communicate?

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Change is changing

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Change is changing

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Change is changing

Change is moving to the edge

@HelenBevan http://www.slideshare.net/Openpolicymaking/policy-lab-slide-

share-introduction-final

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Why go to the edge?

“ Leading from the edge brings us 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

Aylet Baron

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Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

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The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro

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

than my position in the formal hierarchy

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WHO will make the change happen?

Source: adapted by Helen Bevan from Leandro Herrera

List A • The STP Transformation

Programme Board [or equivalent]

• The programme sponsors • The Programme Management

Office • The [insert number] STP

transformation work streams • The Clinical Leads of

workstreams • The Directors of participating

organisations • The Change Facilitators

@HelenBevan

WHO will make the change happen?

List A • The STP Transformation

Programme Board [or equivalent]

• The programme sponsors • The Programme Management

Office • The [insert number] STP

transformation work streams • The Clinical Leads of

workstreams • The Directors of participating

organisations • The Change Facilitators

List B • The mavericks and rebels

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

• The contrarians, because they can

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

• The hyper-connected. Good or bad, they 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

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WHO will make the change happen?

List B • The mavericks and rebels

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

• The contrarians, because they can

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

• The hyper-connected. Good or bad, they 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

List A • The STP Transformation

Programme Board [or equivalent]

• The programme sponsors • The Programme Management

Office • The [insert number] STP

transformation work streams • The Clinical Leads of

workstreams • The Directors of participating

organisations • The Change Facilitators

@HelenBevan

What’s the evidence? The failure of strategic change

projects is rarely due to the content or structure of the plans put into

action

It’s much more to do with the role of informal networks in the organisations/systems

affected by change

To make transformational change happen

we need to connect networks

of people who ‘want’ to

contribute

It therefore a critical ability for leaders of change to

‘craft’ informal networks of change agents to oil the

wheels to enable that change to emerge

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)

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Contrast this with current NHS situation Survey of 70 candidates for post of Head of Transformation, Horizons team, July 2016: • Most educated to at least Masters level

• PRINCE 2 almost universal with Managing Successful Projects and Lean methods well represented

• Very few described strategic approaches to change or focussed on social methods of change

• Only limited descriptions of team or network based or facilitative approaches to improvement

• Most engaged in technostructure (technical

advisory roles) - rarely the locus of power in

health organisations (Mintzberg typology)

• Old power/List A approaches predominated

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Which kind of activists are most successful at delivering change?

Lone wolves Build power by expertise and information — through advocacy, oversight , contributing to committees, public comments and other forms of consultation

Mobilisers Build power by mobilising people – being able to call on large numbers of people to contribute, engage in change and take action

Organisers Build power by growing leaders – identifying, recruiting and training future leaders in a distributed network: building a community and protecting its strength

Source: How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century Hahrie Han

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The capacity and drive of a team, organisation or system to act and make the difference necessary to

achieve its goals

http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html

Creating energy to drive transformation is a top priority

‘

@HelenBevan #Quality2015 #qfe1 @goranhenriks @HelenBevan

What happens to large scale change efforts in reality?

In order of frequency:

1. the effort effectively “runs out of energy” and simply fades away

2. the change hits a plateau at some level and no longer attracts new supporters

3. the change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way

Source: http://www.nhsiq.nhs.uk/8530.aspx

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Psychological

Physical

Spiritual

Social Intellectual

Energy for change

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Social energy

Energy of personal engagement, relationships and

connections between people

It’s where people feel a sense of

“us and us”

rather than

“us and them”

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Spiritual energy

Energy of commitment to a common vision for the future, driven by shared

values and a higher purpose

Gives people the confidence to move towards a different future that is more compelling than

the status quo

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Psychological energy

Energy of courage, resilience and feeling safe to do things differently

Involves feeling supported to make a change and trust in leadership and direction

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Project Aristotle: http://qz.com/625870/after-years-of-intensive-analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/

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

teams that deliver change is psychological safety

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Physical energy

Energy of action, getting things done and making progress

The flexible, responsive drive to make things happen

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Intellectual energy

Energy of analysis, planning and thinking

Involves gaining insight as well as planning and supporting processes, evaluation, and arguing a

case on the basis of logic/ evidence

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High and low ends of each energy domain

Low High

Social isolated solidarity

Spiritual uncommitted higher purpose

Psychological risky safe

Physical fatigue vitality

Intellectual Illogical reason

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Some questions

• Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)

• Nearer to CEO, higher or lower energy scores?

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The challenge of disproportionately high intellectual energy

• Intellectual energy isn’t transformational

• It keeps leaders in their comfort zone (intellect to intellect)

Emotion is the fuel for

change; data and information

provide direction Dan Heath

(author of Switch)

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Energy profile of 6 draft STP plans

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Energy profile of 6 draft STP plans

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There has never been a time in the history of health and care 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

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Is your STP change process a cathedral or a bazaar?

http://www.unterstein.net/su/docs/CathBaz.pdf

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We have a lot of cathedrals

Source: Sewell (2015) : Stop training our project managers to be process junkies

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The power of the platform

“Facebook, YouTube, Twitter and their lesser cousins have proved the power of the platform. They have shown that if

your average 21st century citizen is given the tools to connect and the freedom to create, they will do so with

enthusiasm, and often with an originality that blindsides the so-called creative industries. …..

Good leadership is no longer about ‘taking charge’ or imposing a strategic vision but about creating the platforms that allow others to flourish and create”

Ashoka http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in-

the-21st-century

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• 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”

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Why platforms?

Platforms 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

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Example platforms

Source of image: @JenniferClemo

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

MOODOCs (Massive, Online, Open, Disease Oriented Communities)

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The Academy of Fabulous Stuff

• Half a million page views • Over 700 fab shares • 1,500 to 4,000 page views

a day • Nottingham Safe staffing

app: 2,500 views • Dovetailing vaccinations

Scheme: 160 direct queries

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https://youtu.be/eUApgJBZU8M

@HelenBevan Source: OpenIdeo https://challenges.openideo.com/challenge/end-of-life/refinement

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The Change Challenge

Tapping the collective brilliance of the NHS

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14,000 contributions identified 10 barriers to change: Confusing strategies

Over controlling leadership

Perverse incentives Stifling innovation

Poor workforce planning

One way communication

Inhibiting environment

Undervaluing staff

Poor project management

Playing it safe

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14,000 contributions identified 11 building blocks for change:

Inspiring & supportive leadership

Collaborative working

Thought diversity Autonomy & 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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Some lessons

1. You can’t control the outputs of the crowd

2. People want a relationship

3. Always, always, follow up

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1. Frame the 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 a more social leaders, investing in your digital skills and social connections and leading through networks as well as formal leadership systems

3. Identify, develop and utilise all your local improvement resources

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

5. Consider what/where your equivalent of ‘the edge’ is, so that you incubate radical and disruptive ideas and lead health and care from the future

6. Purposefully build social and spiritual energy for the long haul

7. Build change platforms for important issues – create some bazaars alongside the cathedrals

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

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Coming soon: a new updated version

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Ways to connect!

1. Follow us on Twitter

@HelenBevan @TheEdgeNHS @School4Radicals

2. Subscribe to

theedge.nhsiq.nhs.uk

3. Get materials from

theedge.nhsiq.nhs.uk/school

…and sign up for our monthly #EdgeTalks theedge.nhsiq.nhs.uk/edgetalks

Or email me at helen.bevan2@nhs.net