Helen BevanChief Transformation

Officer

@HelenBevan #qf15

February 20 2015

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For those of you who attended the

Some learning reinforcement after a short space of time helps to retain learning

Casebourne I (2015)

Spaced Learning: An Approach to Minimize the Forgetting Curve

https://www.td.org/Publications/Blogs/Science-of-Learning-Blog/2015/01/Spaced-Learning-an-Approach-to-Minimize-the-Forgetting-Curve

The ideas in this presentation come from a new kind of improvement team:

the Horizons Group within NHS IQAim of the group: to stimulate new and ‘disruptive’ approaches in support of health and care transformation, operating at the edge of current thinking and practice:

• skipping a generation of thinking about how to create radical, system-wide change

• skipping a generation in a wider level of connection: working with emerging leaders, clinical trainees, students

• skipping a generation of methods for change: open innovation, open source, digital connection, social media, change platforms, hacking

“You

can’t cross a chasm in small

steps”David

Lloyd George

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The mindset of the past has a tendency to hijack the transformational potential of the future

“ The greatest

danger in times

of turbulence is

not the

turbulence…….

it is to act with

yesterday’s logic

Peter Drucker

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“ History, even if properly construed, can blind us to important possibilities. After all, it is not the

rhythms of the past that define us, but our dreams for the future

Greg Satell http://www.digitaltonto.com/2014/are-you-using-data-to-analyze-the-past-

or-to-create-a-new-future/

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SEISMIC SHIFTS

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SEISMIC SHIFTS

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SEISMIC SHIFTS

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SEISMIC SHIFTS

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SEISMIC SHIFTS

Change from the edge

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Leading change in a new era

Dominant approach Emerging direction

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Leading change in a new era

Dominant approach Emerging direction

Most healthcare transformation

efforts are driven from this side

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

Gary Hamel’’

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Curate rather than create knowledge for improvement

Source of image: John Curran designedforlearning.co.uk

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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 hydrant

Mitchell Kapor

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How do we know what to learn and absorb?

Source of image: Frits Ahlefeldt

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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

...but

The only way tacit

knowledge can be broadly shared…

…is to turn it into

explicit knowledge

VERY difficult

Few organisations succeed

Gray D (2012) The Connected Company

Source: Harold Jarche

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What is the best way to spread new knowledge?

Source of data: Nick Milton www.nickmilton.com/2/2tOjE

Social connection/discussion is

14 times more effective

than

written word/ best practice

databases/toolkits etc

Source of image: happiness-one-quote-time.blogspot.com

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Curating knowledge

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

“pushed” to us by trusted sources

Making 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

networksSource: Harold Jarche

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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

Moving to the edge

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What are the biggest opportunities for change agents in our system?

• As bridge builders between disconnected groups

• As curators and sharers of knowledge

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Improvement teams will move from “bench

scientists” (programme managers) to knowledge leaders and connectors

http://connect.forwardmetrics.com/business-management/the-

strength-within.html

Less change programmes More change platforms

Change Programmes:• utilise systematic “change

management” approaches• Too often, leaders prescribe

the outcome and the 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 Platforms• enable everyone in the

organisation/system (including service users) to help tackle the most challenging issues

• value diversity of thought• leadership attention on

creating an environment receptive to transformational change

http://www.hsj.co.uk/resource-centre/scrap-the-programme-successful-change-starts-with-a-change-platform/5078014.article?blocktitle=Blogs-and-videos&contentID=16031

What are the implications

regarding performance

goals?

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WHY were performance targets introduced?

• Public institutions were unwieldy, inefficient, with limited accountability

• Measures that did exist were mostly ad hoc and unsystematic

• Reformers had virtuous intentions

• Measurement based on specific quantified targets is easier than the alternatives

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Compliance

States a minimum standard of

performance or target that

everyone must achieve

Uses hierarchy, performance

management systems and

standardised procedures for co-

ordination and control

Threat of penalties/ sanctions/

shame creates momentum for

delivery

Focus on transaction

Commitment

States a collective, meaningful

goal that everyone can aspire to

Based on shared purpose and

shared goals (“us and us” rather

than “us and them”) for co-

ordination and control

Commitment to a common

purpose creates energy for

delivery

Focus on relationship

How are we leading?

Source: Helen Bevan

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Leaders who focus on meaning also

get compliance, without focusing on it

@JeremyScrivens

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As leaders, we are “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

Source of image: vintage-radio.com

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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 #qf15@SimonJGuilfoyle Police Inspector and systems thinker

@HelenBevan #qf15@SimonJGuilfoyle Police Inspector and systems thinker

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Police

@SimonJGuilfoyle Police Inspector and systems thinker

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Education

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Healthcare

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The future

1. The numerical goals are meaningful (intrinsic motivation)

2. Linked with shared purpose, not de facto purpose3. An investment in measurement capability4. The right performance indicators are selected in the

first place5. Understanding of naturally occurring variation

within the performance data produced6. Measurement for improvement, not just

judgement7. A wider systematic approach to measurement

and change where metrics are aligned

Source of image: salesshq.monster.com

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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 inspire

Dov Seidman

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Avedis Donabedian

“Ultimately, the secret of quality is love.

…… If you have love, you can then work backward to monitor and improve the system”.

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Tactic for success:

Source of image: Bradley Burgess

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Some challenges:• Create organisations that are activist at their

core

• Find ways to:– marry innovation with complexity and scale

– balance control and freedom

• out-love everyone else

Source of image: rachelstivers.com

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• Identify your own opportunities to move to the edge

• Think about how to ignite the disruptive innovators in your midst

• Connect this to your pledge for Change Day BC

• Consider how you can enable change at a faster rate than the outside world