transforming end of life care in acute hospitals pm workshop 4: achieving transformational and large...

Creating the environment for transformation‐ leadership & culture

for innovationSusie Peachey‐ November 2015

“Without innovation, public services costs tend to rise faster than the rest of the economy.Without innovation the inevitable pressure to contain costs can only be met by forcing already stretched staff to work harder.” Mulgan G. & Albury D. (2003) Innovation in the public sector. Strategy Unit, London.

“Changing the way people think about situations is, in fact, the most powerful and useful way to ultimately change behaviour and thereby affect organisational results” Pfeffer J. (2005‐p125)

Leading Transformational Change

YouInfluencer & communicator

Innovator & designer

Scientist & systems thinker

Strategist & decision maker

Deliverer & adaptor

Coach & connector

Culture shaper & enabler

First follower: leadership lessons from dancing guy

http://www.bing.com/videos/search?q=man+dancing+in+a+crowd&qs=n&form=QBVR&pq=man+dancing+in+a+crowd&sc=0‐15&sp=‐1&sk=#view=detail&mid=5F6EEAAAD88C0C7F841E5F6EEAAAD88C0C7F841E

A culture for innovation• Leading change in a complex environment

– the culture needs to support change– 7 dimensions identified to assess culture– work on the culture in your team (any collection of individuals where innovative output is required)

• Culture is hard to change– work on the culture within your project/change (create a bubble for change to happen in)

Accompanied by 29 questions across these dimensions to visualise your culture and create a ‘portal chart’ that needs to be wide open for the free flow of ideas.

Scored from -5 to +5

Dimensions of Innovation Culture

Risk Taking

1. My direct supervisor supports me if I want to try something new

2. If I suggest a new idea and it fails, I know that I will not be made to feel humiliated

3. In my dept, the general tendency is to try new things rather than hold onto the status quo

4. Senior leadership is willing to take a risk on new ideas that might make things better

Scoring

Scores from ‐5 to +50 ‐ behaviours and practices neither aid nor hinder innovationPositive scores‐ behaviours and practices tend to aid innovationNegative scores‐ behaviours and practices tend to hinder innovation

Resources

5. My direct supervisor provides me the time to work on a promising new idea

6. In my dept, we seem to find the resources we need to fund innovative ideas

7. I feel that I have reasonable authority to try out an innovative new idea

8. Senior leadership makes sure that there is both the availability of time and money to support innovation

Scoring


Knowledge

9. If I don’t have the information I need, I feel comfortable asking my direct supervisor for it

10.We are generally kept informed of activities in other depts that affect our work

11.There is a lot of information available to me about what organisations are doing to meet the same sort of challenges we face

12.Senior leadership openly shares information that is important to me and the work I do

Scoring


Goals

13.I know what the priorities or goals are in my dept

14.My direct supervisor makes it clear that innovative new ideas are highly desirable

15.Priorities come down to me without pre‐determined solutions, leaving me plenty of room to contribute my own ideas

16.Senior leadership has made it clear that innovative new thinking is required to meet some of our organisational goals

Scoring


Rewards

17.I am certain that I would receive recognition or praise from my direct supervisor if I put an innovative idea forward

18.The recognition that we get here for coming up with new ideas does motivate me personally to be more innovative

19.We celebrate and say thanks when someone tries out a new idea, even when it is not successful in the traditional sense

20. Senior leadership actively seeks out and recognises innovative thinking

Scoring


Tools

21.My organisation has trained me in methods to support creative, new ways of thinking

22.My dept uses specific methods to generate creative ideas around the challenges we face

23.I am capable of generating creative ideas24.Senior leadership actively demonstrates

innovative new thinking in its own work

Scoring


Relationships

25.In my organisation, people who think differently are respected for their point of view

26.The teams that I work on tend to have people with a diverse mix of skills and styles

27.In general, there is a high degree of honest and open communication between depts

28.Senior leadership models high levels of cooperation and trust among colleagues

Scoring


Overall

29.My department has an underlying culture that supports innovation


What areas need addressing?

Relationships‐ tips for improving this dimension

• Trusting, open environment to identify problems and share ideas

• Honouring everyone’s input, not just those most senior, and exploring new ideas‐ not immediately arguing against use the ‘fresh eyes’ exercise

• Create opportunities for diverse individuals to come together to create true team based working‐ job shadowing, work rotations

• Explore personal styles and preferences‐Myers‐Briggs, Merrill‐Reid

• revealing your values

• connecting to the values of others

• gaining commitment to the change sought

Professor Marshall Ganz

identified the

power of story

telling in:

“an appropriately told story has the power to ….. communicate a strange new idea easily and naturally, and quickly gets people into enthusiastic positive action”Denning S. (2007): The Secret Language of Leadership, Jossey Bass

“You can’t impose anything on anyone and expect them to be committed to it”Edgar Schein, Professor Emeritus MIT Sloan School



Goals

• The ‘Why’‐ leaders speaking about what they care about‐create a compelling vision for a new future‐WOW

• Create a clear case for need‐ NOW• Specific call for innovation‐ HOW• Tie to strategic plan‐ define, align and clarify goals• ‘Stretch’‐set aspirational goals that encourage new thinking and do something that seems impossible today e.g. NASA, keyhole surgery

“What a leader cares about does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into a change programme” Scott Keller & Carolyn Aiken (2009)‐ The Inconvenient Truth about Change Management



Feedback from NHS senior leaders development programme showed:

• 57% created a climate which is ‘demotivating’

• Only 12% created a climate that is ‘inspiring’

Why are you here?What’s your burning ambition?

“Leaders of successful large scale change are more likely to have built their efforts on a platform of commitment to change, setting the conditions, creating a shared purpose and deeper meaning for the change”. NHS Change Model

“If you want people to act on your vision you need to create a burning ambition: a fire from within”.Peter Fuda

Burning Ambition‐ Peter Fuda

http://www.peterfuda.com/2012/06/28/from‐burning‐platform‐to‐burning‐ambition/

http://viralvideos.mobi/video/Tfn6vD4yyC4/Fire‐Metaphor‐‐From‐‐Burning‐Platform‐‐to‐‐Burning‐Ambition‐.html

Why are we doing this?

Dell• We make computers

(what)• They have fast processors

and great features (how)• We want you to buy our

computers (why)

Apple• Everything we do we

believe in challenging the status quo. We believe in thinking differently (why)

• Our products are beautifully designed, simple to use… (how)

• We happen to make great computers (what)

Creating your Vision

Wow• needs to create a ‘pull’ to engage others

Now• should create a sense of urgency for moving to the new future

How• creating alignment to core values

Risk Taking

• Emotional support‐ learning from failure, not punishing

• Balanced assessment‐ not over‐estimation of risk (intelligent risk‐taking)‐ challenge to take an idea forward

• Create a climate of trying new things‐ After Action Reviews

• Don’t use humour‐ we told her we are sure she can find work elsewhere if it doesn’t work

Resources

• Authority to act‐ not always having to ask permission‐ remove perceived barriers to act

• Funding‐ change is not free!– Link innovation efforts to waste reduction techniques

• Seek resources from non‐traditional channels‐become a test site, third sector/charities/ universities/ local industry

• Turn strategically important innovation into formal organisational projects

Knowledge

• Wide scope search‐ avoid ‘not invented here’ to prevent re‐inventing the wheel

• Encourage ideas from outside the health service

• Uncensored, unfiltered, unsummarised• Get information flowing freely and quickly‐share board info widely and use knowledge from the workforce to support the board

Rewards

• Intrinsic motivation‐ make change personally rewarding

• Recognition‐ peer and patient• Aligned with organisational goal (use performance reviews)

• Individualised‐ ‘thank you’

Tools

• Deliberate process, with strategic focus• Develop a pool of people who can facilitate and develop creative thinking‐training in change techniques (SI)

• Encouragement for skills development• Provide tools needed for change‐ introduce periodically

NB Thinking Differently

Thinking DifferentlyCreativity‐ a structured process1. Stop before you start2. Generate lots of ideas with stakeholders

– First burst‐ brainstorm– Second burst‐more structured

3. Harvest ideas and narrow selection‐ what criteria

4. Stretch and enhance ideas5. Test and implement final choices…………….loop back through the process

Tools for generating ideasFresh eyes‐ think like another person or make links to another industryConstraints‐ too much freedom can actually overwhelm teams trying to find solutions Breaking the rules‐ identify assumptions, mental models, unwritten rules and deliberately think around themRandom word, picture or object‐ activate thoughts we don’t usually associate with the topicStepping stones‐ start with the outrageous, suspend judgment, emerging concept, practical suggestionsThat’s impossible‐ think of impossible things that have been solved in the past‐ surgery without incision etc and think how it could be made possibleMental benchmarking‐ ideas applied in a not so obvious way in a different context

Using creativity and innovation to drive transformation

- experiencing a technique

Fresh Eyes

Thinking Differently….

• Fresh eyes• Stepping stones• Breaking the rulesand many more ways of generating lots of ideas…

Thinking Differently… the tools

Fresh Eyes‐ p70

Breaking the rules‐p78

Random word/ picture/ object‐ p86

Stepping Stones‐p94

That’s impossible‐p102

Mental benchmarking‐p108

Harvesting by Criteria or Dot Voting‐ p120

Others’ point of view‐ p40 Reframing by word play‐ p46 Pause, Notice, Observe p50

Phase 1: stop before you start

Phase 2: generating lots of ideas

Phase 3: selecting & testing ideas to make a difference

Six Thinking Hats‐ p128

Enhancement checklist‐p136

Testing new ideas on a small scale‐ p141

Fresh Eyes

Since others have different ways of looking or approaching challenges, Fresh Eyes is about thinking or exploring the challenge in the mindset of another, with Fresh Eyes.

Without birds, would we have sought to fly?

This can be looking at things through other companies’ eyes or other peoples’ eyes, that may have tackled or looked at this challenge differently.

Remember: this exercise is not just for new ideas for services but for any challenge you face in the changes you are making e.g. for maintaining momentum as team members change

Fresh eyes

• In a moment, each person will be given a picture of a person or organisation. We will also give you a challenge to consider.

• Individually (and silently) take five minutes to note down how the person or organisation would view the challenge– what would they pay attention to?

(2 minutes)– what kinds of solutions would they

consider? (3 minutes)

Fresh eyes – Example onlyChallenge• Reducing the waiting times

in A&E

Person or organisation• Disney

Controlled environment, distracting people with fun, different zones for attractions, parades, lots of guides etc.

What do they pay attention to?

What kinds of solution would they consider?

•Guides to help navigate A&E•Creating treatment zones•Dressing all the consultants as Mickey!

Fresh eyes

Reducing A&E waits . . . by dressing all the consultants

in Mickey Mouse outfits!

What a stupid idea!Or is it?

Fresh eyes

Reducing A&E waits . . . by dressing all the consultants

in Mickey Mouse outfits!

Should we make it easier for patients to tell who the staff

are?

Should we make staff more

approachable?

Are the consultants front of house enough,

seeing more people?

Treat ‘stupid’ ideas as a springboard for new insights and ideas

Fresh eyes

• In a moment, each person will be given a picture of a person or organisation. We will also give you a challenge to consider.

• Individually (and silently) take five minutes to note down how the person or organisation would view the challenge– what do they would pay attention

to? (2 minutes)– what kinds of solutions would they

consider? (3 minutes)

Your challenge

How would these people or organisations tackle . . .

Getting health and local government to coordinate their support for individuals more effectively

5 minutes, individually and silently2 minutes on: What do they pay attention to?3 minutes on: What kinds of solution would they consider?

Building on your individual thoughtsRules for idea generation

Criticism is ruled outGo for quantityEncourage wild ideasBuild on the ideas of othersEvery person and every idea has equal worthOne conversation at a time

.

Go round the table – one ‘solution’ eachOne solution = one breath and no more!As they speak, note down builds or new ideasPause to think when everyone ‘passes’ then go again 5 minutes

Your challenge

How would these people or organisations tackle . . .

Getting health and local government to coordinate their support for individuals more effectivelyFeedback• Top innovative idea that has potential• Most thought provoking (or wishful thinking) idea

transforming end of life care in acute hospitals pm workshop 4: achieving transformational and large...

Healthcare