The NHS Change Model hack 14 October 2015

#CMhack

Change is changing…

…and so must the approaches we use to support and enable change. That is why we’ve held our first ever hack. We hacked the NHS Change Model to gain diverse and actionable insight into how it can be even better and more helpful to more people. Here’s our story…

About this report

This report is:

• A collection of the inputs and outputs of the day

• A record of what happened on the day

• A wealth of information, a lot of important voices and a starting point for considering next steps

• About capturing the feeling of the day

This report isn't:

• A commentary or analysis of the NHS Change Model

• A prioritisation of what matters the most

• A decision document about what happens next

All the slides used at the event can be accessed via SlideShare

All the pre-reading material is also available via The Edge

Why are we hacking the NHS Change Model?

The NHS Change Model has been one of the leading models of change used in the NHS over the past couple of years. We know that some improvement leaders would not be without it and use the model extensively, to underpin and structure all their change efforts. We also recognise that there are some that are not so keen on the NHS Change Model. They have found it hard to apply the model in a practical and useful way and there are others who think that it should be broadened out from just being an NHS-specific model. The way we lead change must always adapt and evolve with the times and as such, we feel it is timely and opportune to review and revise the NHS Change Model. Our starting point was to listen to and understand exactly what the people leading change in health and care said they needed to support them. We want to use methods that fly in the face of tradition and open up new, exciting and creative opportunities. So, we organised a hack day for about 80 people that we felt would bring diverse and wide-ranging perspectives to the table. Here’s what happened…

Dr. Helen Bevan, Chief Transformation Officer for the Horizons Team, NHS Improving Quality, opened the day.

Aims for the day

• 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

The 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

More information:

NHS Change Model

Helen Bevan talked about intrinsic and extrinsic motivators,

how they relate to the each other and the elements in the

NHS Change Model

Five key principles in using the NHS Change Model

1. Start with “shared purpose” but after that there is no prescribed linear

or logical order

2. 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 already

4. Don’t “sell” the change model; “sell” the outcomes you are seeking

5. Build commitment to, not compliance with, the NHS Change Model

Peter Fuda

“Change is not the goal, the goal is the goal”

Peter Fuda

Helen Bevan spoke about how less than 10% of the potential for improvement at system level can be delivered through type one change

Thinking about large scale change…

“Transformation is not a matter of intent... …it is a matter of alignment” Peter Fuda

Zoë Lord, Improvement Manager in the Horizons Team, NHS Improving Quality, presented insights gleaned from interviews and questionnaires completed by over 200 people.

This was invaluable in understanding people’s preference for leading change, how the NHS Change Model is currently being used and how people think it could be improved.

Feedback on the current NHS Change Model

Over 200 people were surveyed about how they currently undertook change and what they thought of the NHS Change Model. Here are some of the 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?

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

Activity 1: BINGO!

We kicked off the event with a game of bingo, so we could all get to know each other’s skills and experiences a little better.

Perry Timms is one the UK’s leading advocates of hackathon approaches for service transformation, so we were thrilled that he was involved with our hack. Here’s Perry explaining how it was all going to work.

We asked our hack participants to…

• Go with the flow and have faith in the process

• Unconference - self organise and follow your interests!

• Bring and voice your own perspective – that is why you are here!

• Collaborate, support and constructively challenge others

• Take collective responsibility for completing the task in the timescale

• Put yourself in other people’s shoes

• You have permission to create!

• Let reflectors reflect!

• Have fun!

What is a hackathon?

• Strategic

• Socialised

• Participative

• Fast

• Conclusive

Perry has written an article for us “Saving the world from mediocre ideas” which gives great insight into a non-technical hack.

TRIZ: Theory of Inventive Problem solving

For the first part of the hack process, delegates were asked to use the TRIZ method to think about the change model, why it should be improved and how it could be improved.

Stopping counter-productive activities and behaviours

Delegates were asked to answer three questions:

1. How could we create a framework that never gets used?

2. Are we currently doing anything that resembles the items on list 1?

3. What do we need to do to stop getting undesirable results?

How could we create a model that never gets used?

Here’s some of the responses we received… • Use lots of jargon • Tell people they must use it • Have 100s of different versions • Make it completely irrelevant • Make it extremely complicated to use • Exclude values • Make it really academic • Make sure it requires specific skill to

use • Make it long and complex. NO pictures,

just long text • Make it really complicated and complex • Do not be clear about what it is for

• Every time you use it you will get an electric shock!

• Obscure and unhelpful name • Keep it on the shelf • Make sure you need training to

understand it.

Are we currently doing anything that resembles the items on list 1? Yes!...

Here’s some of the responses we received… • Top down • Uses jargon and so people disengage • Feels academic • Published in an unattractive medium • In house language/ acronyms • Not sharing great work • Documents too long • Same people, using the same tools,

mechanisms and approaches • Needs training

• Don’t engage with a diverse audience

• Too hierarchical • Don’t have explicit practical

applications • No help available to use it. No ‘go to’

for help • It is hidden away: not easy to find • Ignoring other change models • We call it a ‘model’ • Doesn’t offer a simple process for

frontline staff

What do we need to do to stop and start doing?

Here’s some of the responses we received…

• Need to make it simpler to use it.

• Make it applicable by using outcomes it is in use.

• Need to put it into training and education

• Need to create a technique to remember the components.

• Need to market it using credible people with the goal at the heart of the sell.

• Need to build it with other sectors in mind.

• Be clear about how it is relevant/ can be relevant to your change.

• Careful use of language - Stop using jargon

• Need to consult with diverse and ‘expert’ reference group (the key people who are involved), using a variety of mediums.

• Need to tell people it exists. Engage, engage, engage. Tell the right people in the right way.

• Needs to be easy to access and use and adapt.

• Need to bring it to life with case studies. Keep them recent and applicable.

• Need to focus on outcomes. Nail the why. Confirm the real issue. Patients. Shared purpose.

Lets get hacking!

We ran a series of hacks to explore design a proof of concept to support and enable change across health and care. A number of hacks focused on:

• What’s it called? • Elements: language, in/out, what’s missing? • What does it look and feel like? • How is it underpinned? Resources and format • How do we engage people in spread and sustainability?

Here are some of the outputs from our hacks, starting with mini hack #1, “Who is the Change Model for?”

Who is our new Change Model for? Who is our customer?

Here’s some of the responses that came from our participants on the day: 1. Anyone who wants to make a change in health and care 2. Those who are directly leading the change e.g. policy

change 3. Those affected by or part of the change should be

involved 4. People at any level who want to make a difference 5. People with purpose and passion 6. People who don’t know where to start 7. People with ideas 8. Busy, practical people 9. People creating change, wanting leaders 10.Patients 11.For change makers whoever wants to reach an ultimate

goal

Mini hack #2: this team wanted to make the Change Model cool!

Mini hack #3: how do we support people to best use the Change Model?

Mini hack #4: using the ‘Oshry’ model to hack the Change Model

Mini hack #5: let’s strip the Change Model back (to basics)

Mini hack #6: our use of language This hack team focussed on language. There was extensive discussion about the language that should be used which in the Change Model. Questioning was a preferred approach

Mini hack #7: how can we include change (improvement) in education and training?

Mini hack #8: creating resources to support the Change Model

Mini hack #9: our un-model (a philosophy not a model)

The un-model continued…

Mini hack #10: how could we get it used? This hack team focussed on dissemination and how it could be used.

Mini hack #10: ‘Team Cool’…it’s more than a model…

Mini hack #10: ‘Team Cool’…it’s more than a model…

Possible designs for the new model

Early stats for #CMHack today: 6.7m impressions; 1K+ tweets; third healthcare worldwide trend - via @symplur

On the day we

were the third

trending

healthcare hashtag

in the world!

@symplur

Some feedback at the end of the day…

“It’s gone really quickly. Focus on outputs has been really worthwhile”

“Encouraged by diversity and depth of thinking. Also encouraged by alignment of thinking”

“Exciting discussions. Really respectful of each other’s opinions”

“Great day. Inspired and engaged. Let’s now involve more people and co-design”

“Thank you for taking us through the process. Thoroughly enjoyable”

To conclude…

It was a fantastic event that created more than we’d ever imagined!

There was energy, passion and strong desire to ensure change happens effectively across the whole of health and care (not just the NHS) and that people feel supported when undertaking change.

To conclude…

With your help, we will continue to synthesise and build on all the outputs, conversations and ideas to coproduce a prototype ready for further testing.

We are looking to prototype a ‘change space’, a change platform that will house a change model and all the relevant resources and conversations that are needed to support and shape the future of change in health and care.

If you would like to (continue to) provide input (and we really hope you do!) you can tweet us on #CMhack @ZoeLord1 or email: Zoe.Lord@NHSIQ.nhs.uk

@PerryTimms

Further reading:

• More information about the NHS Change Model

• Here’s the SlideShare from the event

• Read through the tweets of the day and continue with the conversation using #CMHack

• We took lots of pictures and shared on Pinterest as the day evolved

• Here is all the pre-reading material that we made available to our participants including information on hackathons and insight into the current NHS Change Model