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@helenbevan
Leading transformational change
Presentation to the Swedish Society of Medicine
5th December 2013
Helen BevanNHS Horizons Group
@helenbevan
@helenbevan
Most large scale change fails to achieve its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey
@helenbevan
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 actionSource: Crump and Bevan
@helenbevan
Anatomy of change Physiology of change
Definition The shape and processes of the system; 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 actionSource: Crump and Bevan
@helenbevan
Anatomy of change Physiology of change
Definition The shape and processes of the system; 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 care 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
@helenbevan #Staffschange
Emerging themes in large scale change
Organisation Community
Power through hierarchy Power through connection
Mission and vision Shared purpose
Making sense through rational argument
Making sense through emotional connection
Leadership-driven (top down) innovation
Viral (grass-roots driven) creativity
Tried and tested, based on experience
“ Open” approaches , sharing ideas & data, co-creating change
Transactions Relationships
Dominantapproach
Emerging direction
@helenbevan #Staffschange
John Kotter: “Accelerate!”
• We won’t create big change through hierarchy on its own
• We need hierarchy AND network• Many change agents, not just the usual few • Changing our mindset
• From “have to” to “want to”• Head and heart, not just head
and
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The Network Secrets of Great Change Agents
As a change agent, my centrality in the informal network is far more important
than my position in the formal hierarchy
Julie Battilana &Tiziana Casciaro
@helenbevan #Staffschange
A challengeThe way that leaders put messages across
does not tap into roughly 80% of the primary motivators of the workforce for
putting energy into the change programme”
Scott Keller and Carolyn Aiken (2009) The Inconvenient Truth about Change Management
@helenbevan
If we want people to take action, we have to connect with their emotions through values
actionaction
valuesvalues
emotionemotion
Source: Marshall Ganz
@helenbevan #Staffschange
Learning from leaders of social movements:Framing
Is the process by which leaders construct, articulate & put across their message in a powerful & compelling way in order to win people to their cause & call them
to action
Snow D A & Benford R D (1992)
@helenbevan #Staffschange 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
@helenbevan
[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
@helenbevan
The largest simultaneous improvement initiative in the history of the NHS
@helenbevan #NHSChangeDay#NHSChangeDay
Its started with a tweet!
Trainee doctors and improvement leaders started to talk about how they could build a social movement to improve care
Damian RolandStuart Sutton Helen Bevan
@helenbevan #NHSChangeDay#NHSChangeDay
A 189,000 pledge mountain!
16
“As Director of Safety and Risk, my pledge is to spend more time listening to patients and staff and to act upon their concerns.” Moira Durbridge
“We pledge to invite all individuals who make a complaint about our services to be involved in one of our 15 Steps Quality Challenge panels.” Bradford District Care Trust, Yorkshire, 3001
“We pledge to introduce a test for values and behaviour for recruitment into our universities and into employment.” Health Education England, West Yorkshire
“I pledge each month to contact a front line staff member within my team who demonstrates inspirational clinical practice.” East of England Ambulance Service NHS Trust
“I pledge to make sure every person with a learning disability at Turning Point has a health action plan.” Fiona Ritchie
“I pledge to visit an elderly gentleman with dementia in his own home to help him build his life story on our Digital Reminiscence Therapy Software.” Jo Samuels.
Example pledges
@helenbevan #NHSChangeDay#NHSChangeDay
People took action all over the country
#NHSChangeDay
@helenbevan #NHSChangeDay#NHSChangeDay
@helenbevan #NHSChangeDay#NHSChangeDay
Change Day 2013 was an extraordinary moment in the history of the NHS. It taught us that large-scale improvement is possible in the NHS and that the best way to do it is through collective commitment, action and by keeping
it simple.
@helenbevan #NHSChangeDay#NHSChangeDay
3rd March 2014www.changeday.nhs.uk
@helenbevan #NHSChangeDay#NHSChangeDay
@helenbevan #NHSChangeDay#NHSChangeDay
What happens to heretics/radicals/rebels/mavericks
in organisations?
@helenbevan #NHSChangeDay#NHSChangeDay
@helenbevan #NHSChangeDay#NHSChangeDay
Valuing radicals
• “New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)
• big things only happen in organisations because of heretics and radicals
@helenbevan #NHSChangeDay#NHSChangeDay
We need boatrockers!
• Rock the boat but manage to stay in it
• Able to challenge the status quo when we see that there could be a better way• Capable of working with
others to create success NOT a destructive troublemaker
Source: Debra Meyerson
@helenbevan #NHSChangeDay#NHSChangeDay Source : Lois Kelly www.foghound.com
Sometimes leaders see radicals as troublemakers
@helenbevan #NHSChangeDay
www.changeday.nhs.uk/healthcare radicals
@helenbevan #NHSChangeDay#NHSChangeDay
....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