Directions in

Helen Bevan Chief Transformation Officer

@HelenBevan #VHAevents

@HelenBevan #VHAevents

SEISMIC SHIFTS

Change from the edge

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

share-introduction-final

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Starts on the fringe (at the edge)

Starts with the activists Gary Hamel

always

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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 battle and balancing between the old and new power will be a defining feature of

society and business in the coming years Jeremy Heimans and Henry Timms

Understanding new power, Harvard Business Review, December 2014 https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet

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

People who are highly connected have twice as much power to

influence change as people with positional power

Leandro Herrero http://t.co/Du6zCbrDBC

“I have some Key Performance

Indicators for you”

or

“I have a dream”

Source: @RobertVarnam

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is the new normal! “Tomorrow’s management systems will need to value

diversity, dissent and divergence as highly as

conformance, consensus and cohesion.”

Gary Hamel

Image by neilperkin.typepad.com

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What is a rebel? •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

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We need to create more boatrockers! • Rock the boat but manage to

stay in it • Walk the fine line between

difference and fit, inside and outside

• 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

@HelenBevan Source : Lois Kelly www.rebelsatwork.com

There’s a big difference between a rebel and a troublemaker

Rebel

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Reflection • What are your insights around “rebels” and

“troublemakers”? • What moves people from being “rebel” to

“troublemaker”? • How do we protect against this?

@HelenBevan Source : Lois Kelly www.rebelsatwork.com

There’s a big difference between a rebel and a troublemaker

Rebel

@HelenBevan #VHAevents For more information/explanation visit: http://linkis.com/www.oscarberg.net/20/QwGqW

@HelenBevan

Is your change process a cathedral or a bazaar?

Source of image: http://www.slideshare.net/djinoz/the-cathedral-and-the-bazaar-musings-on-iphone-and-android?related=1

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We have a lot of cathedrals

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

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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• 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 & get out of the way

Change Platforms

“Tear down the walls”

@HelenBevan

What is a platform? Some simple definitions…

“A raised level surface on which people or things can stand.”

“A raised floor or stage used by public speakers or performers so that they can be seen by their audience.”

“A raised structure standing in the sea from which oil or gas wells can be drilled or regulated.”

“A raised structure or orbiting satellite from which rockets or missiles may be launched.”

“The declared policy of a political party or group”

…flattening hierarchies

…new ideas and

discoveries

…diversity of thought

…with shared purpose

Definitions from Oxford Dictionary @HelenBevan @TheEdgenhs #EdgeTalks Source of content: Jodi Brown

What do these four have in common? They have: • excelled via their superior use of technology • embraced partnerships and external innovation • built interactive communities • embraced an entirely new way of doing business: the

platform.

Adapted from: http://www.philsimon.com/books/the-age-of-the-platform/

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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

@HelenBevan

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“Piloting” new approaches: close

d o

pe

n

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

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Evolving kinds of change platforms:

1. Connecting platforms

2. Mobilisation platforms

3. Learning platforms

4. Knowledge platforms

5. Crowdsourcing platforms They overlap!

Knowledge platforms

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Because there’s a problem….

Source of quote: Harold Jarche Source of image: http://gotcll.com/about-2/

Getting information off the

internet is like taking a drink from a fire hydrant

Mitchell Kapor

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What is the best way to spread new knowledge?

Source of data: Nick Milton http://www.nickmilton.com/2014/10

/why-knowledge-transfer-through.html

Social connection/discussion is 14 times more effective

than written word/best practice

databases/toolkits etc.

Source of image: www.happiness-one-quote-time.blogspot.com

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Platforms as the new documentation

Source of image: Flickr user acaben

Source: Oliver Benson

If you’re a programmer, you don’t even bother reading the manual, you simply

use stackoverflow to answer all your questions”

21,000 active users Activists from 120

countries @theedgenhs:

500,000+ Twitter impressions

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Platform principles have long been part of change practice

• Building on traditions in the field of organisation development of communities of interest and communities of practice

• Technology enables us to connect more widely and at greater speed

Source of image: Socialserviceinstitute.sg

The Horizons team

We have abandoned change programmes and we only work

through platforms

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http://www.slideshare.net/Downes/connectivism-and-personal-learning?next_slideshow=1

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100,000

2,000

20,000 65

348

25,000+

120 14,000

inc

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The school is being formally evaluated by the Chartered Institute for Personnel and Development

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We have supported NHS Change Day for three years

• 800,000 pledges in 2014 • 5 X the local activity/connectivity in 2015 compared

to 2014 • #nhschangeday: 130m impressions • Support Change Day Australia

Our change platforms

Identified as one of the most significant “stealth revolutionaries”

in healthcare (source: Social Media in the NHS)

“Probably the most widely read, impactful NHS paper globally,

challenging the “Five Year Forward View””

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“Top down is a serious disease but it can be treated”

Celine Schillinger

Source of image: Leadershipfreak.wordpress.com

The Change Challenge

Tapping the collective brilliance of the NHS

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• The biggest-ever digital campaign for EMAP (Health Service Journal and Nursing Times)

• 14,000 contributors to the joint campaign to “challenge top down change”

• Ground-breaking: the first-ever crowd-sourced theory of change in the NHS

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• Build bridges between disconnected groups

• Activate radicals and engage them in action for change

• Change the story of how we undertake large scale and transformational change in the NHS

• Lead from the edge using new era methodology

Objectives to:

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The process

Step 1 : Build foundations for campaign launch

Step 2: Weeks 1-4 Launch the campaign and questions to the crowd to develop the barriers and building blocks for change.

Step 3 Weeks 5-6 Invite the crowd to share, build and validate list of potential solutions

Step 4 Week 7 best ideas selected Weeks 8-9 crowd develops best ideas into tools Weeks 9-11 work on key outputs

Step 5: Week 12 Publication of interactive guide / toolkit / manifesto for change / celebrated cases

Develop the process, questions, comms plan

Questions:- What things block or help you from delivering bottom-up change: · inside your organisation, to improve or transform services, and/or · across organisations to improve the health and wellbeing of a local population?

Questions:- What solutions work? What approaches have you used or observed that others could learn from and copy? What solutions should we test?

47 ideas selected for the crowd to develop. . To do this, please tell us: - what steps need to be taken, - who needs to be involved, and - what commitments

The HSJ and Nursing Times share outputs : • project overview, • ‘how to’ guides

for application of crowdsourcing

• ‘how to’ toolkit of prioritised ‘hacks’/ solutions

Project over 12 weeks

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Reach and scale

• 3,595 people involved - from 45 different countries

• 13,895 ideas, comments and

votes shared - collectively identifying:

Final outputs were

• 10 barriers • 11 building blocks • 16 solutions

14,000 contributors 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

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

14,000 contributors 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

http://www.insme.org/files/open-innovation-handbook

@HelenBevan

Platforms are only as good as the people leading them

Source of image: www.activationjourney.com

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● Only 1% participate fully so start with a big crowd ● Inject thought diversity to guard against groupthink ● Mix high domain knowledge with those with high creativity

Choose the right crowd

Choose the right incentives

● Crowdsourcing cannot happen without a vibrant, committed community ● Rewards must balance intrinsic & extrinsic motivators

Crowds do not replace the team

● You’ll get volume & diversity from the crowd but be prepared to match it with equal time & effort to herd, sift & identify contributions

Crowds need love too!

● Crowds need direction & guidance to help them feel part of their community & give of their best

Keep it simple

● Break complex tasks down ● Tasks must be small, simple & fun & fit into your crowd’s spare time

Remember Sturgeon’s Law

Communities are always right!

Fulfilling self-actualisation

● “90% of everything is crap / 10% of everything is not crap” ● Allow the crowd to surface its best through voting to the top

● Crowdsourcing works because creativity, spontaneity, problem-solving & affiliation achieve self-actualisation (Maslow / Howe)

● Top-down management style does not work in crowds, nor does grass-roots anarchy ● Lead with the moral authority the crowd allows

Adapted from: A Guide to Open Innovation and Crowdsourcing, Ed. Paul Sloane

The rules of crowdsourcing

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Case study

Design principles for new care models

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The old order of health and care is broken.

Across the globe, leaders of health and care

systems are designing and implementing new care

models that fly in the face of the orthodoxy of how care should be delivered.

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New care models in England

• Viable smaller hospitals • Maternity services • Health of people in care

homes

• Multispecialty Community Provider

• Primary and Acute Care Systems

• Urgent and emergency care

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What are design principles?

“Design principles are suggestions that are highly likely to be effective, but they are not formulae that guarantee success … The point remains, however, that if one knows the design principles in a field, he or she is much further along in thinking and much more likely to be successful.”

Paul Bates

“Help us to capture design principles for new care models to get better, quicker outcomes from change”

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Aims • Distil a new set of design principles to accelerate the

implementation of models for care that are truly based on the wants and needs of people who use the care system, patients and families.

• Organise the principles in a way that makes them accessible and highly useable to people designing new care models

• Identify examples from across the world of the design principles in action

• Signpost tools, methods and resources that can help in the implementation of the design principles

• Demonstrate the power of design thinking for health and care transformation

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Ten draft design principles: We have identified 10 draft design principles that we see consistently in the new care models that are being developed globally

#1 Understand the health of the population and segment by need #2 Mobilise the assets of the wider community #3 Manage for complexity #4 Focus on flow: align the different parts of the system and the pace at which they work #5 The network as a key organising principle #6 Share information across the network #7 Design a platform rather than a “vending machine” #8 Purposefully focus on the design and improvement of the system #9 Design new care models and pathways of care more on a model

of living systems than a machine #10 Measure outcomes and key processes across the network of care

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Design a platform methodology to test, adapt and validate the design principles and make them useable/accessible • Think about using ‘sprints’ to break the challenge down into

manageable, simple ‘chunks’ • You might like to consider:

• Identification of methods and resources to support implementation of the design principles

• Capturing examples of the design principles in action • Encouraging people to build the principles into their change

efforts and build capabilities in the methods underpinning the design principles

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Platform methodology for our design principles Pre-sprint Sprint 1 Sprint 2 Sprint 3

Expert group sense-check of design principles & crowdsourcing process

“Have we got the right design principles?”

“Tell us about the design principles in action”

“How do we make the principles happen?”

V1.0 of design principles paper to be shared with expert group of “systems engineers” both from within and outside the NHS

The ten design principles will be presented via the crowdsourcing platform to our collaborators (widespread engagement)

Invite practical examples and case studies that demonstrate the refined ten design principles working and in action

Invite collaborators to signpost us to tools, methods, resources and methodologies that can help in the implementation of the design principles

Output from each sprint becomes a new version of the paper. The socially derived design principles are then open for the next sprint and round of crowdsourcing

”If people give to a cause, they expect a relationship, not

a transaction” Nilofer Merchant

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@HelenBevan

“Even the smallest creature can

change the world” Galadriel to Frodo Lord of the Rings

@HelenBevan

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