Post on 11-Nov-2014
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@helenbevan
Leading change with big ambition
Helen BevanDelivery teamNHS Improving Quality@helenbevan@NHSIQ
@helenbevan
Themes for today
1. Sensemaking about change2. Aligning aspects of change3. Building energy for change4. Shared purpose: change is not the goal,
the goal is the goal
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Most large scale change fails to achieve its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey
70%
25%5%
Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........
Sensemaking is not done via marketing...or slogans but by emotional connection with employees
Ron Weil
Anatomy of change Physiology of change
Definition The shape and processes of the system; detailed analysis;
how the components fit together.
The vitality and life-giving forces that enable the system and its people to
develop, grow and change.
FocusProcesses and structures
to deliver health and healthcare
Energy/fuel for change
Leadership activities
measurement and evidence
improving clinical systems reducing waste and
variation in healthcare processes
redesigning pathways
creating a higher purpose and deeper meaning for the change process
building commitment to change connecting with values creating hope and optimism about
the future calling to action
Source: Crump and Bevan
Anatomy of change Physiology of change
Definition The shape and processes of the system; detailed analysis;
how the components fit together.
The vitality and life-giving forces that enable the system and its people to
develop, grow and change.
FocusProcesses and structures
to deliver health and healthcare
Energy/fuel for change
Leadership activities
measurement and evidence
improving clinical systems reducing waste and
variation in healthcare processes
redesigning pathways
creating a higher purpose and deeper meaning for the change process
building commitment to change connecting with values creating hope and optimism about
the future calling to action
Source: Crump and Bevan
Anatomy of change Physiology of change
Definition The shape and processes of the system; detailed analysis;
how the components fit together.
The vitality and life-giving forces that enable the system and its people to
develop, grow and change.
FocusProcesses and structures
to deliver health and healthcare
Energy/fuel for change
Leadership activities
measurement and evidence
improving clinical systems reducing waste and
variation in healthcare processes
redesigning pathways
creating a higher purpose and deeper meaning for the change process
building commitment to change connecting with values creating hope and optimism about
the future calling to action
Source: Crump and Bevan
Intrinsic motivators
build energy and creativity
Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity create focus &
momentum for delivery
Drivers of extrinsic motivation
Drivers of extrinsic motivation
create focus & momentum for delivery
Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
•System drivers & incentives•Payment by results•Performance management•Measurement for accountability
Internal motivators
• connecting to shared purpose
•engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
Drivers of extrinsicmotivation
•System drivers & incentives•Performance management•Measurement for accountability
create & focus momentum for delivery
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Transformation is not a matter of intent.........
it is a matter of alignmentPeter Fuda
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NHS Change Model
www.changemodel.nhs.uk
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TaskWith others at your table:• Identify the component that appeals to you the
most/ that you feel the most connection with• Explain your reasons to your colleagues
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TaskWith others at your table:• Identify the component that appeals to you the
least/ that you feel the least connection with• Explain your reasons to your colleagues
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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 already4. Don’t “sell” the change model; “sell” the outcomes you are seeking: change is not the goal; the goal is the goal5. Build commitment to, not compliance with, the NHS Change Model
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In terms of your current initiative
• Where are you on a continuum between one and ten in terms of how aligned the elements are in your initiative?
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In terms of your current initiative
• Where are you on a continuum between one and ten in terms of how aligned the elements are in your initiative?
• Move one step forward
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In terms of your current initiative
• Where are you on a continuum between one and ten in terms of how aligned the elements are in your initiative?
• Move one step forward• Move one point higher on the continuum (i.e.,
if you are a five, move to a six)• What would it take to improve your score by
one?
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0123456789
10Our shared purpose
Spread of innovation
Improvementmethodology
Rigorous delivery
Transparentmeasurement
System drivers
Engagement tomobilise
Leadership for change
What's our prognosis for this asthma pathway project?
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NHS Change Model
www.changemodel.nhs.uk
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What happens to large scale change efforts in reality?
In order of frequency:1. the effort effectively “runs out of energy” and
simply fades away2. the change hits a plateau at some level and no
longer attracts new supporters3. the change becomes reasonably well established;
several levels across the system have changed to accommodate or support it in a sustainable way
Source: Leading Large Scale Change: a practical guide (2011), NHS Institute
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Does fear motivate people to change?
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burning platformversus
burning ambition@PeterFuda
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Lessons for transformational change1. In order to sustain
transformational change we need to move from a burning platform (fear based urgency) to a burning ambition (shared purpose for a better future)
2. We need to articulate personal reasons for change as well as organisational reasons
3. If the fire (the compelling reason) goes out, all other factors are redundant
@PeterFuda
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TaskTalk to the person next to you• What is “my burning ambition” for my service, my
community and /or my patients?• Try to make it personal: tell others why this ambition
connects with your personal motivations
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Research shows that more than almost any other factor affecting an
organisation, organisational energy can lead to either a wellspring of corporate
vitality or the destruction of its very core
Source: Bruch and Vogel
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NHS Change Model
www.changemodel.nhs.uk
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Bruch and Vogel researchOrganisations with HIGH productive energy scored higher on:• overall performance - 14% higher• productivity – 17%• efficiency – 14%• customer satisfaction – 6%• customer loyalty – 12%
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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
Psychological
Physical
Spiritual
Social Intellectual
Energy for change is:
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Five energies for change Energy Definition
Social 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”
Spiritual energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It gives people the confidence to move towards a different future that is more compelling than the status quo
Psychological energy of courage, resilience and feeling safe to do things differently. It involves feeling supported to make a change and trust in leadership and direction
Physical energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen
Intellectual energy of analysis, planning and thinking. It 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
@helenbevan@helenbevan #Quality2013
The SSPPI Energy Index – Part I
This questionnaire enables teams to measure their energy for change. Please agree the nature of the change context with your team before answering the following statements. Then answer all statements with your particular change context in mind.
1 = Strongly disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly AgreeI am energised by the momentum of change____I have gained insight into the case for change____I feel a sense of solidarity with those I work with ____I am weary of change____I am able to keep expressing hope for the change when presented with setbacks_____The reasoning for the change is not compelling___I don’t feel appreciated by others at work_____ I will be blamed if I try something new and it fails____I feel isolated from others____I feel depleted of energy when others express doubt about the change_____The case for change has stimulated my creativity_____I feel disconnected from others____I am committed to our common vision for the future____I feel safe enough to do things differently____I am driven by shared values____I am experiencing change fatigue____The change does not fit with my sense of purpose_____I am not driven by a shared purpose for change_____I think there is no rational argument for change____The case for change is interesting to me_____I feel that we are getting things done to achieve the change_____I feel the change may conflict with my values___I feel personally engaged in the change___Clear thinking and analysis underpins the change___I feel fearful about the change___I sense openness about the potential to change___
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Social energy is the energy of personal engagement, relationships and connections between people. It reflects a “sense of us” and is therefore a collective concept that captures a situation where people are drawn into an improvement or change because they feel a connection to it as part of the collective group.
My social energy is ____The social energy of those I work with is____The importance of social energy to me is____
Psychological energy is the energy of courage, trust and feeling safe to do things differently. It involves feeling supported to make a change as well as belief in self and the team, organisation or system, and trust in leadership and direction.
My psychological energy is ____The psychological energy of those I work with is____The importance of psychological energy to me is____
Physical energy is the energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen, with vitality and kinetic force (motion)
My physical energy is ____The physical energy of those I work with is ____The importance of physical energy to me is____
Intellectual energy is the energy of curiosity, analysis, thinking and cognition. It involves gaining insight, a thirst for new knowledge as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic and evidence.
My intellectual energy is ____The intellectual energy of those I work with is____The importance of intellectual energy to me is____
Complete these statements on a scale of 1 = low - 5 = high
Spiritual energy is the energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It involves giving people the confidence to move towards a different future that is more compelling than the status quo, by finding the deep meaning in what they do.
My spiritual energy is ____The spiritual energy of those I work with is____The importance of spiritual energy to me is____
The SSPPI Energy Index – V2, Part 2
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• Are particular energy domains more dominant than others for our team at the moment?
• Is this the optimal energy profile to help us achieve our improvement goals?
Energy for change profileSocial
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
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• Are particular energy domains more dominant than others for our team at the moment?
• Is this the optimal energy profile to help us achieve our improvement goals?
Energy for change profileSocial
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
@helenbevan
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 1: what’s your assessment of their energy for change?
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Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 1: what’s your assessment of their energy for change?
This energy profile is characterised by an environment that has harnessed people’s interest and momentum for change, but which has failed to engage people fully. This imbalance results in their feeling some uncertainty regarding how they can contribute fully to the change, and therefore a sense of risk and lack of hope for the future. We can build energy by building team solidarity and developing shared purpose
@helenbevan
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 2: what’s your assessment of their energy for change?
@helenbevan
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 2: what’s your assessment of their energy for change?
This energy profile shows strong connections between people, a true sense of solidarity, which gives them enough hope for the future, but this energy is undirected, because the rational argument and shared purpose has not been agreed. We can build energy by agreeing shared goals for change and using systematic approaches to thinking through and planning the change
UOB01Energy for Change
SSPPI Energy Index (V2)
Analysis generated on 17th May 2013by Rosanna Hunt and Paul Woodley
50 respondents
rosanna.hunt@nhsiq.nhs.uk+44 777 070 4056
Energy for Change Model and SSPPI Energy Index by NHS Improving Quality is licensed under a Creative Commons Attribution-ShareAlike 2.0 UK: England & Wales License.
Energy for Change Profile
The group’ energy for change is 77% (50 respondents). NHS groups previously analysed have demonstrated energy levels between 54% and 84%.
The table below shows that intellectual energy is particularly high in this group (83%).
Social and Psychological energies are the lowest scoring energies (both 73%).
>20% variation between individuals on all energy domains
min max %
Social 40 92 73Spiritual 47 100 80Psychological 52 90 73Physical 50 100 78Intellectual 63 100 83Overall 50 96 77
Profiling data Self-Evaluation
Social 73 80Spiritual 80 85Psychological 73 77Physical 78 76Intellectual 83 86Total 77 81
The group tends to self-evaluate its energy levels to be slightly higher than they is revealed by the psychometric profiling data, on all but the physical energy domain
How much energy self-awareness does the group have?
Energy gaps
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5My Energy Average
The Energy of those I work with Average
The importance of this energy to me Average
This bar chart shows another perspective on the data – it uses frequencies of responses >3, rather than the mean (which can be misleading). It compares the data on current and desired energy for change.
The results displayed here confirm that there are very small gaps between current and desired energy levels on all five domains.
Current and desired energy for change
Social Spiritual Psychological Physical Intellectual0
5
10
15
20
25
30
35
40
45
50
My EnergyThe Importance of this energy to me
Conclusions
• The group’s energy profile (77%) is slightly higher than average levels across our NHS sample.
• However, individuals vary significantly in their energy levels, on all five domains
• The group could benefit from building its energy self-awareness - and their awareness of the energies of those they work with, too
Recommendations
• Individuals could use the Energy Index in smaller team settings, to enable those they work closely with, to develop a daily discourse around Energy for Change
• These smaller teams could benefit from facilitated feedback sessions – where they can question and share thoughts about their energy for change with each other
• The impact of these activities could be evaluated by re-administering the Energy Index at another time in the future
Where does team 1 go for help?Roadmap of resources for building energy for change
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There has never been a time in the history of healthcare 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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“You can’t impose anything on anyone and expect them
to be committed to it”Edgar Schein, Professor Emeritus
MIT Sloan School
@helenbevan Source: Helen Bevan
Compliance
States a minimum performance standard that everyone must achieve
Uses hierarchy, systems and standard procedures for co-ordination and control
Threat of penalties/ sanctions/ shame creates momentum for delivery
What is our approach to change?
Commitment
States a collective goal that everyone can aspire to
Based on shared goals, values and sense of purpose for co-ordination and control
Commitment to a common purpose creates energy for delivery
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From compliance to commitment
“We come from a culture of compliance and top down performance management, … It’s task-orientated to get things done. It needs to be much more about cooperation, about leading across boundaries … Being able to focus on shared purpose in those circumstances is absolutely crucial.” NHS interviewee
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“ The source of energy at work is not in control, it is in connection to purpose”
Don Berwick, 28th February 2012
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Shared purpose aligns.....
Shared purpose allows many communities to engage with us without us having to invest resourcesin controlling their actions Nilofer Merchant
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Leaders as “signal generators”
“As a leader, think of yourself as a “signal generator” whose words and actions are constantly being scrutinised and interpreted, especially by those below you [in the hierarchy]”
“Signal generators reduce uncertainty and ambiguity about what is important and how to act”
Charles O’Reilly, Leaders in Difficult Times, 2009
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Leading for shared purpose
“Leading effectively is less about mastering situations – or even mastering social skill sets –than about developing a positive interest in and
talent for fostering positive feelings in the people whose cooperation and support you
need”.Daniel Goleman and Richard Boyatzis
The Harvard Business Review
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“A shared sense of corporate purpose, grounded in universal values, is the highest octane source of fuel for organisational action.” Schwartz and Loehr (2004)
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We know that ...
• Shared purpose is a common thread in successful change programmes*
• Organisations and change initiatives with strong shared purpose consistently outperform those without it.**
*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)**Management Agenda 2013 Boury et al (Roffey Park Institute)
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A 3-word concept
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[Shared] purpose goes way deeper than vision and mission; it goes right into your gut
and taps some part of your primal self. I believe that if you can bring people with similar primal-purposes together and get them all marching in the same direction,
amazing things can be achieved.Seth Carguilo
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Feeling “primal”
Watch this film from James Calvert, Respiratory Physician from Bristol
http://t.co/qv59pMrvAZ
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Avoiding “de facto” purpose• What leaders pay attention to matters to staff, and consequently
staff pay attention to that too• Shared purpose can easily be displaced by a “de facto” purpose:
hitting a target reducing costs reducing length of stay eliminating waste completing activities within a timescale complying with an inspection regime
• If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce
Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector
@helenbevan @SimonJGuilfoyle Police Inspector and systems thinker
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Purpose
Obfuscation O-
meter
@SimonJGuilfoyle Police Inspector and systems thinker
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Police
@SimonJGuilfoyle Police Inspector and systems thinker
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Education
@SimonJGuilfoyle Police Inspector and systems thinker
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Healthcare
@SimonJGuilfoyle Police Inspector and systems thinker
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How de facto purpose is creeping into NHS improvement projects: how 100 young and emerging clinical leaders framed their projects
1 2 3 4 5 6 7 8 90
5
10
15
20
25
Project Score
No
of
pro
ject
s
Mainly focussed on quality, safety &/or patient experi-ence
Mainly focussed on cost, pro-
ductivity or effi-ciency
Source: project information from 100 young clinical and managerial leaders taking part in national improvement skills programme October 2012
@helenbevan
How de facto purpose is creeping into NHS improvement projects: how 100 young and emerging clinical leaders framed their projects
1 2 3 4 5 6 7 8 90
5
10
15
20
25
Project Score
No
of
pro
ject
s
Mainly focussed on quality, safety &/or patient experi-ence
Mainly focussed on cost, pro-
ductivity or effi-ciency
Very few framed their projects as quality, safetyor experience
Most framed their projects as cost and efficiency
@helenbevan
We have a particular challenge in creating shared purpose in a healthcare setting……
Source: Philip Hadridge Idenk.com
The noble purpose paradox
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Definition of a “noble purpose organisation”
An organisation where:• most people would answer the question “why
did you apply to work here?” with an answer that aligns their choice of job with the fundamental purpose of the organisation
• other motives (power, socialisation, rewards, personal achievement, fun, etc) are absent or hard to declare
Source: Philip Hadridge Idenk.com
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The noble purpose paradox
“Why is it that the more compelling the mission, the more tricky it can be to get the best collaborative behaviours and the necessary focused action? And how can some places that are trying to achieve the most crucial and needed changes to the world we live in be riven with petty politics and driven by individuals sometimes ruthlessly pursing their own agendas?”
Source: Philip Hadridge Idenk.com
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The noble purpose paradox: how it manifests itself
• office politics are the norm, often in a way that is perplexing to new recruits
• the motivations and actions of co-workers are regularly questioned and differences in point of view amplified
• personal interpretations of right and wrong, as well as what makes for a ‘noble purpose’, come to the fore
• alternative points of view can be hard to present without leading to arguments
• acknowledging the presence of other personal motivations (such as pay, profile or influence) is hard or impossible
• raising some of the issues at work about power or ambition is almost impossible. Source: Philip Hadridge Idenk.com
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What can we do?
• Listen to other people’s stories and understand their values and motivations
• reflect on the patterns and motivations you see in yourself and others
• Be aware of the gaming that can get in the way if leadership behaviours are not right; do all you can to counter it by identifying and living the values you believe are essential as a leadership group
• invest in and support insightful and strong leadersSource: Philip Hadridge Idenk.com
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How do we create shared purpose?
Create a safe space
Look for commonalities & understand
differences
Create a statement of
purpose
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From defacto purpose……
“Our job is to judge the effectiveness of urban gardens”
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To shared purpose
From“Our job is to judge the effectiveness of urban gardens”To “We’re here to figure out whether or not the free installation of urban gardens helps low-income families eat healthier or not. We’ve got nine months to come up with initial findings. It’s important because if the answer is no, then $500,000 of foundation money can go somewhere that it’s being better spent next year. If the answer is yes, it means we have a national model that other cities can learn from. So this is a huge opportunity to make a worthwhile contribution.”
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We need to build capability for knowing, doing, living and being improvement
@helenbevan 83
“You don’t need an engine when you have wind in your sails”
Paul Bate
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....the last era of management was about how much performance we could extract from people .....the next is all about how much humanity we can inspireDov Speidman