Transformational themes that will shake the world of healthcare improvement

Helen BevanChief Transformation Officer, Horizons Group

@HelenBevan #Quality2014 #f1

10 April 2014

The story

• Framing the future in the past and present story

• Five transformational forces that are changing the world

• Five ways to thrive and survive in the new world

• The future story

@@HelenBevan #Quality2014 #f1

Time present and time past Are both perhaps present in time future, And time future contained in time past. T. S. Eliot, Four Quartets 1936

What was once……A digital story for our time

Here between the hither and the farther shoreWhile time is withdrawn, consider the futureAnd the past with an equal mindT.S Eliot, The Dry Salvages (1941)

...to the person next to you

@@HelenBevan #Quality2014

Tell one of your own stories about change

How does your past experience impact on your view of the future?

WHAT IS HAPPENING IN THE WORLD OF CHANGE?

1. Change is happening at a faster rate

AND is becoming more disruptive

Source of image: nasu-dengaku.livejournal.com

2. New digital tools enable us to be in almost constant contact with almost everyone in the world

3. The increasingly complexity of the work environment is eroding hierarchical management structures/styles

4. Work is changing:Complex work is getting more complexThe pace of creative work is accelerating

5. Creative processes are moving to the

edges of our organisations

Whilst back in the world of health and care...

Many of the ways we go about improving health and care were designed in adifferent mindsetfor a different setof circumstances

@@HelenBevan #Quality2014 @@HelenBevan #Quality2014 #f1

Some warnings

The organizations that survive the future will be those that are capable of changing as fast as change itself

Gary Hamel

If the rate of change on the outside exceeds the change on the inside, the end is near Jack Welch

‘‘ ’’‘‘ ’’

In the near future, the edges will be where

almost all high-value work will be done in

organizations……. Organizational development and change

management need to move to the edges, and

quickly. Harold Jarche

(2014)

Moving to the edge

Source: @HelenBevan @@HelenBevan #Quality2014

Leading from the edge

From the centre From the edge

5 ways to lead from the edge - and thrive

1. Embrace disruption2. Curate knowledge3. Build bridges to connect

the disconnected4. Roll with resistance5. It starts with me

1. Embrace disruption

Source of image: nsight2success.com

Hierarchy alone won’t deliver the changes

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

Source of image:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community

Changing our mindset

From “have to” to “want to”

Head and heart, not just head

John Kotter: Accelerate!

is the new normal!“By questioning existing ideas,

by opening new fields for action, change agents actually help

organisations survive and adapt to the 21st Century.”

Céline Schillinger

Image by neilperkin.typepad.com

@chagwwchangeagentsworldwide.com

@corprebelscorporaterebelsunited.com

Across the world, the change agent movement Is exploding!

@rebelsatworkrebelsatwork.com

Valuing radicals

’s th

“New truths begin as heresies”

Rock the boat, but stay in it!Walk the fine line between difference and fit, inside and outside

Source: Debra Meyerson

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

Conform AND rebel

We need

boatro

ckers!

Rebel or troublemaker?

Troublemaker RebelComplain Create

Me-focused Mission-focusedAnger Passion

Pessimist OptimistEnergy-sapping Energy-generating

Alienate AttractProblems Possibilities

Alone Together

Source : Lois Kelly www.rebelsatwork.com

Discussion

• Are you are a rebel or a troublemaker?

• What moves people from being “radical” to “troublemaker”?

• How do we prevent people falling out of the boat?

Probably the largest simultaneous improvement initiative in the history of

healthcare

A disruptive case study

Aim:to create a mass movement of grass roots NHS staff and people who work with and use the NHS to pledge a simple act that can contribute to better patient care

It started with a tweet in June 2012!

Young clinical leaders and improvement leaders started to talk about how they could improve care

Damian RolandStuart Sutton Helen Bevan

Probably the only winner of a

global challenge to develop

leaders in the corporate world that names Saul

Alinsky and Marshall Ganz as major influencers

NHS Change Day: vital statistics

Nearly 750,000 pledges to take action

• 81 separate Campaigns• 86 million twitter impressions• 35,400 video views on YouTube and

Vimeo• 95,000 daily reach on Facebook

Insert Change Day film

Evaluating NHS Change Day

• We’re evaluating intention (pledging), initiation (doing) and their outcomes (delivering)

• We’re developing and testing new methods to show impact

• We want to build new theory of large scale change

Change Day is spreading…….

AustraliaSwedenN IrelandDenmarkCanadaNetherlandsSaudi ArabiaFinland…….and many more

2. Curate knowledge

Source of image: John Curran designedforlearning.co.uk

Finding things out and determining what’s valid from what’s just noise

CURATION

…It’s about identifying networks and communities and seeing where the nodes and amplifiers sit

…It’s about quality and coherence, not volume and mass

Julian Stodd

Because there’s a problem….

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

Gettinginformation off the

internet is like taking a drink from a fire

hydrantMitchell Kapor

A big challenge for improvement leaders

Tacit knowledge is where the action is….• It’s the people with tacit knowledge who deliver the results• Tacit knowledge is critical for large scale change

...butThe only way tacit knowledge can be broadly shared……is to turn it intoexplicit knowledgeVERY difficultFew organisations succeedGray D (2012) The Connected Company Source: Harold Jarche

Tacit knowledge...

“...is best developed through conversations and social

relationships”Source of image: northcentralcollege.edu

Harold Jarche

Curating knowledge from the edge

Finding things out and keeping up to date• “pulling” information, but also having

it “pushed” to us by trusted sourcesMaking sense and meaning of information• Reflecting and putting into practice

what we have learned• Plugging information into our own

mental models and turning it into knowledge

Connecting and collaborating• Sharing complex knowledge with our

own work teams• Testing new ideas with our own

networks• Increasing connections through social

networks

Source: Harold Jarche

3. Buildbridges to

connect the disconnected

The Network Secrets of Great Change Agents

As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy

If you want to create small scale change, work through a cohesive networkIf you want to create big change, create bridge networks between disconnected groups

Julie Battilana &Tiziana Casciaro

Diagnostic and

dialogic approaches

to “resistance to change”

Resistance: a diagnostic approach

• Change is something that happens “out there” in the organisation or system

• Resistance is a force to overcome• Resistance prevents change• Change agents must diagnose,

manage and/or overcome resistance • Resisters otherwise known as

“laggards”, “blockers”, “in denial”

Much of the resistance literature is “diagnostic”

Diagnostic: the role of the change agent

“The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to implement successfully and may not succeed at all”

David Stonehouse

The change agent: the manager’s role in changeBritish Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443

Resistance: a dialogic approach

• People make their own reality• Change results from transformational

conversations– involving more and different people in change

discussions– altering how and which people engage with

each other– by stimulating different perspectives to shape

how people think about things• Resistance is an inevitable consequence of a

complex change process (based on diversity)• Resistance should be embraced and worked

with @@HelenBevan #Quality2014 @@HelenBevan #Quality2014 #f1

Dialogic: the role of the change agent

1. Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system, and by being welcoming

2. Creat e opportunities for everyone to express their views, spot opportunities and build on each other’s ideas

3. Create ways for people to reflect together to find meaning, understanding and shared purpose in the change

Source: Peggy Holman

“The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities.”

Source of image: idsgn.org

Diversity: critical to innovation

“Do this before you start hiring consultants and rethinking your innovation process; there is no process that works without true diversity.”

Idris Moore

5.It starts

with me

Source of image: fistfuloftalent.com

‘I do not think you can really deal with change

without a person asking real

questions about who they are and how they belong

in the world’ David Whyte, The Heart

Aroused (1994)

Transformational Change Agent: Peter Fuda

Skills and methods for creating change

Ability to make sense of, and reshape perceptions of

‘reality’Personal characteristics and

qualities

Peter Fuda’s framework: my perspective

“Doing”• Where most change

agents in health and care put most of their effort and emphasis

• What others typically judge us on

• What we often perceive we need to do to add value

• What most change and improvement training focuses on

Peter Fuda’s framework: my perspective

“Seeing ” and “Being”• We can only do effective

“doing” if we build on strong foundations of “seeing and being”

• Change begins with me• Hopeful futures, creative

opportunities and potential

• Multiple lenses for change

• See myself in the context of my higher purpose

A case study in “it starts with me”:The School for Health and Care

Radicals

Source: @NHSChangeDay

Can I, dare I?

The School for Health and Care Radicals

• A virtual school• Anyone can join• Five weeks of virtual

lectures, study guides, materials, tweetchats

• Set up with three weeks notice

• Demonstrate learning to get a virtual badge

The School for Health and Care Radicals

More than 1,500 enrollees from 27 countries Around 150 people will complete full

certification 90 volunteer mentors Average weekly twitter reach 2.6 million Over 10,000 shares of the slides on

SlideShare More than 2,000 shares of the study guides More than 5,000 tweets using #SCHRchat Storify has been viewed 1,000 times

We learnt...

1. There is a massive untapped reservoir of energy and talent out there and the potential is outstanding

2. The core audience is different to that which we anticipated

3. The most important need is for connection and community

4. How to build the relationship between tacit and explicit knowledge

5. It’s early days but this is an efficient, high leverage way to build capability for motivated individuals

1. Embrace disruption2. Be a curator of knowledge3. Bridge bridges to connect

the disconnected4. Roll with resistance5. It starts with me

What might be… a digital story for the future It’s

2020… @@HelenBevan #Quality2014 #f1

A call to action

• Identify your own opportunities to move to the edge

• Think about the mindset, skills and relationships you need for the future

• Start changing at a faster rate of than the outside world

References

Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Change Agents Worldwide (2013) Moving forward with social collaboration SlideShareDiaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontierFeitler D (2014) The case for team diversity gets even betterFuda P (2012) 15 qualities of a transformational change agentGray D (2012) The Connected CompanyHamel G (2014) The busting bureaucracy hackathon: escaping the management taxJarche, H (2013) Rebels on the edgesJarche H (2014) Moving to the edgesLlopis G (2014) Every leader must be a change agent or face extinctionMeyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BPMoore I (2013) Diversity is the short cut to building an innovation cultureSchillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated Shinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadershipWilliams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activismVerjans S (2013) How social media changes the way we work together SlideShare

Transformational themes that will shake the world of healthcare improvement

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Transcript of Transformational themes that will shake the world of healthcare improvement

Transformational themes that will shake the world of healthcare improvement

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