@helenbevan · @helenbevan kinthi sturtevant, ibm 13th annual change management conference june...
TRANSCRIPT
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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
@HelenBevan
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
@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!
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@HelenBevan @TheEdgeNHS @School4Radicals
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Or email me at [email protected]