@HelenBevan

Change and innovation:

It’s time to rewrite the rules

Helen Bevan

@HelenBevan

@HelenBevan

This talk is bought to you by the Horizons team

We tune into and engage with the best change thinking and practice in healthcare and other industries around the world

and seek to translate this learning into practical approaches to change

The team has emerged through years of supporting change in

the NHS and wider health and care system

A small team of people within the English NHS who support improvement and change

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Change is changing

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Kinthi Sturtevant, IBM 13th

annual Change Management Conference

June 2015

We rarely see two, three or four year change projects anymore. Now it’s 30-60-90 day change

projects

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Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”

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Acceleration of connectedness

Change is changing

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How does the NHS improvement community prefer to communicate?

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Hierarchical power

Change is changing

Acceleration of connectedness

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Change is changing

Hierarchical power

Acceleration of connectedness

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The Challenges

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Change is changing

Hierarchical power

Change from the edge

Acceleration of connectedness

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http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final

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Why go to the edge?

“Leading from the edge brings us into contact with a far wider range

of relationships, and in turn, this increases our potential for diversity in terms of thought, experience and

background. Diversity leads to more disruptive thinking, faster

change and better outcomesAylet Baron

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Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

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The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

As a change agent, my centrality in the informal network is more important

than my position in the formal hierarchy

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People who are highly connected have twice as much power to

influence change as people with hierarchical power

Leandro Herrerohttp://t.co/Du6zCbrDBC

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Is your change process a cathedral or a bazaar?

http://www.unterstein.net/su/docs/CathBaz.pdf

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We have a lot of cathedrals

Source: Sewell (2015) : Stop training our project managers to be process junkies

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WHO makes change happen in health and care?

Source: adapted by Helen Bevan from Leandro Herrera

List A• The Transformation Programme

Board• The programme sponsor• The Programme Management

Office• The leads of the [insert number]

transformation work streams • The Clinical Director• The Team Leader /Unit Manager• The Change Facilitator

@HelenBevan

WHO makes change happen in health and care?

List A• The Transformation Programme

Board• The programme sponsor• The Programme Management

Office• The leads of the [insert number]

transformation work streams • The Clinical Director• The Team Leader /Unit Manager• The Change Facilitator

List B• The mavericks and rebels• The deviants (positive). Who do

things differently and succeed• The contrarians, because they can• The nonconformists who see things

through glasses no one else has• The hyper-connected. Good or bad,

they spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on

• The hyper-trusted. Multiple reasons, doesn’t matter which ones

Source: adapted by Helen Bevan from Leandro Herrera

@HelenBevan

WHO makes change happen in health and care?

List A• The Transformation Programme

Board• The programme sponsor• The Programme Management

Office• The leads of the [insert number]

transformation work streams • The Project Manager• The Team Leader /Unit Manager• The Change Facilitator

List B• The mavericks and rebels• The deviants (positive). Who do

things differently and succeed• The contrarians, because they can• The nonconformists who see things

through glasses no one else has• The hyper-connected. Good or bad,

they spread behaviours, role model at a scale, set mountains on fire and multiply anything they get their hands on

• The hyper-trusted. Multiple reasons, doesn’t matter which ones

Source: adapted by Helen Bevan from Leandro Herrera

People who perform and live

in formal organisation land and

people who have make or break

power for change are two different

lists

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We need to change the role and skills of improvement leadersSurvey of 70 candidates for post of Head of Transformation, Horizons team:• Most educated to at least Master’s level• PRINCE 2 almost universal with Managing Successful Projects

and Lean methods well represented• Very few described strategic approaches to change or focussed

on social methods of change• Only limited descriptions of team based and facilitative

approaches to improvement • Most engaged in technostructure (technical advisory roles) -

rarely the locus of power in health organisations (Mintzberg typology)

• Old power/List A predominates

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The essential flaw of quality improvement approaches

The essential flaw of [quality improvement ] is that, when

implemented, it tends to reinforce the mechanistic and hierarchical

models that are consistent with the mental maps of most managers Chris Argyris, Flawed advice and

the management trap

Source of image: www.biblicalcreation.org.uk

Read more at: http://www.slideshare.net/jurgenappelo/management-30-workout

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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

http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html

We need to focus on a different kind of energy for change

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Psychological

Physical

Spiritual

Social Intellectual

Energy for change

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Social energy

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”

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Spiritual energy

Energy of commitment to a common vision for the future, driven by shared

values and a higher purposeGives people the confidence to move towards a

different future that is more compelling than the status quo

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Psychological energy

Energy of courage, resilience and feeling safe to do things differently

Involves feeling supported to make a change and trust in leadership and direction

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Physical energy

Energy of action, getting things done and making progress

The flexible, responsive drive to make things happen

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Intellectual energy

Energy of analysis, planning and thinking

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

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Some questions

• Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)

• Nearer to CEO, higher or lower energy scores?

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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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Social

Spiritual

PsychologicalPhysical

Intellectual

1

2

3

4

5

Team 1: 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?

@HelenBevan

The power of the platform“Facebook, YouTube, Twitter and their lesser cousins have proved the power of the platform. They have shown that if

your average 21st century citizen is given the tools to connect and the freedom to create, they will do so with

enthusiasm, and often with an originality that blindsides the so-called creative industries. …..

Good leadership is no longer about ‘taking charge’ or imposing a strategic vision but about creating the

platforms that allow others to flourish and create” Ashoka

http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in-the-21st-century

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There has never been a time in the history of health and care 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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• systematic “change management”

• too often, leaders prescribe outcome and method of change in a top-down way

• change is experienced by people at the front line as “have to” (imposed) rather than “want to” (embraced)

Change Programmes

• everyone (including service users and families) can help tackle the most challenging issues

• value diversity of thought• connect people, ideas and

learning• Role of formal leaders is to

create the conditions and get out of the way

Change Platforms

“Tear down the walls”

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Why platforms?Platforms today power learning and innovation

at the speed of change by providing collaborative and sometimes exponentially

productive spaces for people to create valueJohn Hagel

Source of image: Pinipa

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Evolving kinds of change platforms:

They overlap!

1. Connecting platforms

2. Mobilising platforms

3. Learning platforms

4. Knowledge platforms

5. Crowdsourcing platforms

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Example platforms

Source of image: @JenniferClemo

@HelenBevanhttp://biggerboat.org/exploring-moodocs/

MOODOCs(Massive, Online, Open, Disease Oriented Communities)

60,000 online diabetes communities and

around 80 million online patient communities

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The Academy of Fabulous Stuff

• Half a million page views • Over 700 fab shares• 1,500 to 4,000 page views

a day• Nottingham Safe staffing

app: 2,500 views• Dovetailing vaccinations

Scheme: 160 direct queries

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https://youtu.be/eUApgJBZU8M

@HelenBevanSource: OpenIdeo https://challenges.openideo.com/challenge/end-of-life/refinement

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Source: @NHSChangeDay

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@HelenBevanSource: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

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Nearly 10,000

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The School was formally evaluated by the Chartered Institute for Personnel & Development

#EdgeTalks WebEx

http://theedge.nhsiq.nhs.uk/expert/how-has-the-school-for-health-and-care-radicals-made-a-difference/

How has the School for Health and Care Radicals made a difference?

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The School was formally evaluated by the Chartered Institute for Personnel & Development

• Change knowledge• Sense of purpose & motivation to improve

practice• Ability to challenge the status quo• Rocking the boat & staying in it• Connecting with others to build support for

change

Statistically significant positive effect on at both individual and organisational level

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Nearly 100,000

connections(defined as a viewing, a download of material or

an original tweet)

• Latest no-cost solutions

• 150 speakers• 28 topics

• Live broadcast and on-demand

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@HelenBevan

Should we undertake routine radiology investigations overnight for all our inpatients?

How to build a change

platform in an hour

@HelenBevan

• Platform established and presented to global audience in less than three days

• 60 minute sprint followed by a two week window for further ideas and discussion

• 3,000+ connections• good level of support for a 24/7 service for inpatients• consensus that the decision to receive a scan during

unsocial hours was patient led• yet many participants commented that it should be a joint

decision between clinician and patient• Panel at Nottingham University Hospitals is reviewing

findings, ideas and agreeing next steps for implementation

Help create a change platform in an hourRather than a consultation exercise that can take weeks, we set up a crowdsourcing platform to get an answer in an hour

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The Change Challenge

Tapping the collective brilliance of the NHS

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14,000 contributions identified 10 barriers to change:

Confusing strategies

Over controlling leadership

Perverse incentivesStifling innovation

Poor workforce planning

One way communication

Inhibiting environment

Undervaluing staff

Poor project management

Playing it safe

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14,000 contributions identified 11 building blocks for change:

Inspiring & supportive leadershipCollaborative working

Thought diversityAutonomy & trust

Smart use of resources

Flexibility & adaptability

Long term thinking

Nurturing our people

Fostering an open culture

A call to action

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

Challenging the status quo

@HelenBevanProject Aristotle: http://qz.com/625870/after-years-of-intensive-analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/

After years of intensive analysis, Google discovers that the key to high performing, innovative teams is psychological safety

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Some lessons

1. You can’t control the outputs of the crowd2. People want a relationship3. Always, always, follow up

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The Natural Environment Research Council asked the crowd to name its new £200 million polar research vessel

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TEN TIMES as

many votes as the next

most popular answer

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@HelenBevan

”If people give to a cause, they expect a relationship, not a transaction”

Nilofer Merchant

Once you start down this path, you have to follow up and continue

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Ways to connect!

1. Follow us on Twitter@HelenBevan @TheEdgeNHS @School4Radicals

2. Subscribe to theedge.nhsiq.nhs.uk

3. Get materials from theedge.nhsiq.nhs.uk/school

…and sign up for our monthly #EdgeTalkstheedge.nhsiq.nhs.uk/edgetalks

Or email me at helen.bevan2@nhs.net

@HelenBevan

Ashoka (2014) What does leadership mean in the 21st century?Berg O (2014) The Collaboration Pyramid revisitedBevan H (2015) From change programmes to platformsBriggs D (2015) The elements of council as a platformBromford P (2015) What’s the difference between a test and a pilot?Chesbrough H et al (2016) Why does open innovation work?Choudray P (2015) The platform manifesto: 16 principles for digital transformationDawson R (2015) The future of work and organisations Deloitte University Press (2014) A movement in the makingDeloitte University Press (2015) Business ecosystems come of ageHagel J (2015) The power of platformsHagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movementsHagel J (2014) Platforms are not created equal: harnessing the full potential of platformsHamel G, Zanini J (2014) Build a change platform not a change programHealth Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’ interactive toolkitHeimans J (2014) What new power looks like [YouTube]

References cited in the slide deck (1/2)

@HelenBevan

Heimens J, Timms J (2014) Understanding “New Power”Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers Little J (2016) Change management is deadMilton N (2014) Why knowledge transfer through discussion is 14 times more effective than writingO’Reilly T (2010) Government as a platformPearce D (2013) Social business discussions are the new documentationRaymond E S (2001) The Cathedral and the BazaarSatell G (2015) 4 things you should know about platformsSatell G (2012) How power is shifting from corporations to platformsSatell G (2015) Leaders must do more than inspire – we must shape networksSchillinger C (2015) Forget social networks, think social impact [YouTube]Scrivens J (2015) Enabling the experience of wholeness within enterprise social networksSewell S (2015) Stop training our project managers to be process junkiesShaw K (2015) Placing a digital platform at the heart of organisational change with OxfamSimon P (2011) The Age of the PlatformVan Alstyne et al (2016) Pipelines, platforms, and the new rules of strategy

References cited in the slide deck (2/2)