Helen Bevan Chief Transformation...
Transcript of Helen Bevan Chief Transformation...
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@HelenBevan NFKH
Helen Bevan
Chief Transformation Officer @HelenBevan
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@HelenBevan NFKH
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@HelenBevan NFKH
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@HelenBevan NFKH
Everyone has gifts and strengths What superpower do you have?
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@helenbevan @HelenBevan
Peter Fuda’s Transformational Change Agent framework
Skills and methods for creating change
Ability to make sense of, and reshape perceptions of ‘reality’
Personal characteristics and qualities
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@helenbevan @HelenBevan
Peter Fuda’s Transformational Change Agent 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 courses focus on
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@helenbevan @HelenBevan
Peter Fuda’s Transformational Change Agent 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
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@helenbevan #NHSChangeDay #SHCRchat Source : Lois Kelly www.rebelsatwork.com
You can’t be a rebel on your own
Rebel
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@helenbevan @HelenBevan Source of image: outskirtsbattledome.wikispaces.com
The easiest way to thrive as an outlier
...is to avoid being one
Seth Goodin
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@helenbevan @HelenBevan
Leading change in a new era
Dominant approach Emerging direction
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@helenbevan @HelenBevan
Power in community “Power used to come largely through and from big institutions.
Today power can and does come from connected individuals in community.
When community invests in an idea, it co-owns its success.
Source of image: orton.org
Instead of trying to achieve scale all by ourselves, we have a new way to have scale. Scale can be in, with and through community.”
Nilofer Merchant
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@helenbevan
“When we talk of social change, we talk of movements, a word that suggest vast
groups of people walking together, leaving behind one way and travelling towards
another”
Rebecca Solnit
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@helenbevan @HelenBevan
Learning from social movement leaders
http://www.slideshare.net/NHSIQ/the-power-of-one-the-power-of-many?qid=97bb3464-07c2-4883-9531-c3d436a66aa1&v=qf1&b=&from_search=2
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@helenbevan @HelenBevan
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@helenbevan @HelenBevan
Six characteristics of people or groups within effective social movements
1. They share a sense of PURPOSE: There is purposefulness about
collaborations, discussions, actions, decisions and a sense of forward momentum
2. They are UNITED: They have learned to manage their differences well enough
that they can unite to accomplish their purpose. Differences are openly debated, discussed, and resolved.
3. They share UNDERSTANDING: There is a widely shared understanding of what's going on, what the challenges are and why what is being done has to be done
4. People PARTICIPATE: Lots of people and organisations in the system are active - not just in discussions and meetings, but getting the work done.
5. They take INITIATIVE: Rather than reacting to whatever happens in their
environment, they are proactive, and act upon their environment.
6. They ACT: People do the work they must do to
make the things happen that need to happen
Source: adapted from Wellstone Action
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@helenbevan @HelenBevan
Calls to Action
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@helenbevan @HelenBevan
Leadership is….
…the art of mobilising others to want to struggle for shared
aspirations Jim Kouzes
Source of image: environmentvictoria.org.au
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@helenbevan @HelenBevan
Framing … is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action.
Snow D A and Benford R D (1992)
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@helenbevan @HelenBevan
What’s the financial incentive?
Who is performance managing?
What’s the project plan?
Source: @RobertVarnam
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@helenbevan @HelenBevan
The reality “What the leader cares about (and typically bases at
least 80% of his or her message to others on) does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into the change
programme” Scott Keller and Carolyn Aiken (2009)
The Inconvenient Truth about Change Management
Source of image: swedenbourg-openlearning.org.uk
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@helenbevan @HelenBevan
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
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@helenbevan @HelenBevan
1. People speak intellectually but engage emotionally
2. Facts are hard to remember and easy to challenge
3. If we only talk about our success people won’t believe us
4. People don’t want more communication; they want meaningful communication
Source: Peter Fuda http://www.peterfuda.com/2014/10/30/traditional-comms-fail-engage/
Four gaps between how we
communicate change
how people engage with that communication
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@helenbevan #IQTGOLD @HelenBevan
“I have some Key
Performance
Indicators
for you”
or
“I have a
dream”
Source: @RobertVarnam
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@helenbevan
If we want people to take action, we have to connect with their emotions through values
action
values
emotion
Source: Marshall Ganz
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@helenbevan @HelenBevan
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@helenbevan #IQTGOLD @HelenBevan
But not all emotions are equal.........
inertia urgency
anger apathy
solidarity isolation
you can make a difference
Self-doubt
hope fear
Ov
erc
om
es
Action motivators Action inhibitors
Source: Marshall Ganz
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@helenbevan #SHCR @School4Radicals
‘‘Leaders must wake people out of inertia. They must get people excited about something they’ve never seen before, something that does not yet
exist”
Rosa Beth Moss Kanter
Source of image: www.linkedin.com/company/activate-brand-agency
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@helenbevan @HelenBevan
Effective framing: what do we need to do?
1. Tell a story
Source of image: woccdoc.org
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@helenbevan @HelenBevan
http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-crafting-visual-stories-with-data?sf3881865=1
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@helenbevan @HelenBevan
Effective framing: what do we need to do?
1. Tell a story
2. Make it personal
Source of image: woccdoc.org
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@helenbevan @HelenBevan
Effective framing: what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
Source of image: woccdoc.org
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@helenbevan @HelenBevan
Effective framing: what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us” is)
Source of image: woccdoc.org
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@helenbevan @HelenBevan
Effective framing: what do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the “us” is)
5. Build in a call for urgent action
Source of image: woccdoc.org
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@helenbevan #IQTGOLD @HelenBevan
Vivid details
Source: Marshall Ganz
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@helenbevan #IQTGOLD @HelenBevan
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@helenbevan #IQTGOLD @HelenBevan
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@helenbevan @HelenBevan
Talk to the person next to you
• Tell your story about why the change you are involved in now is so important to you
• Relate it to a personal experience
You have:
• 2 minutes to prepare your story
• 3 minutes each to tell your story
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@helenbevan @HelenBevan
What is a
RCT?
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@helenbevan @HelenBevan
Randomized Coffee Trial!
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@helenbevan @HelenBevan
Outcomes of randomised coffee trials
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@helenbevan #SHCR @School4Radicals
How do we create a sense of “us” to build momentum for
change?
Source of image: www.tannerfriedman.com
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@helenbevan @HelenBevan
Moving beyond us and them to us and us
Source of image: www.delta7.com
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@helenbevan
The Network Secrets of Great Change Agents Julie Battilana &Tiziana Casciaro
1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy
2. If you want to create small scale change, work through a cohesive network
If you want to create big change, create
bridge networks between disconnected groups
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@helenbevan @HelenBevan
strong ties (cohesive) v.
weak ties (disconnected)
Source of image: http://www.forbes.com/fdc/welcome_mjx.shtml
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@helenbevan
When we spread change through strong ties:
• we interact with “people like us”, with the same life experiences, beliefs and values
• Change is “peer to peer”; GP to GP, social worker to social worker, nurse to nurse, community leader to community leader
• Influence is spread through people who are strongly connected to each other, like and trust each other
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@helenbevan
When we spread change through strong ties:
• we interact with “people like us”, with the same life experiences, beliefs and values
• Change is “peer to peer”; GP to GP, social worker to social worker, nurse to nurse, community leader to community leader
• Influence is spread through people who are strongly connected to each other, like and trust each other
IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied
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@helenbevan
The pros and cons of strong ties
Pros Cons
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@helenbevan @HelenBevan
When we seek to spread change through weak ties • we build bridges between groups and individuals who were previously different and separate
• we create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action
• We can mobilise all the resources in our organisation, system or community to help achieve our goals
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@helenbevan @HelenBevan
Why we need to build weak ties AS WELL AS strong ties
• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers
More on weak ties: https://www.youtube.com/watch?v=w7AzRVxhEXA#t=45
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@helenbevan @HelenBevan
Why we need to build weak ties AS WELL AS strong ties
• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers
• In situations of uncertainty, we have a tendency to revert to our strong tie relationships
yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity
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@helenbevan @HelenBevan
Why we need to build weak ties AS WELL AS strong ties
• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers
• In situations of uncertainty, we have a tendency to revert to our strong tie relationships
yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity
• The most breakthrough innovations and most radical change will come when we tap into our weak ties
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@helenbevan @HelenBevan
Sources of weak ties
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@helenbevan @HelenBevan
Three components of a great narrative
• Diagnostic – what is the problem that we are addressing? What is the extent of the problem? What is the specific source or sources?
• Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan?
• Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of our audience?
Source: Benford and Snow Source of image: www.ecommercedefense.com
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@helenbevan @HelenBevan
Four keys to collaboration
• Lean into your discomfort
• Listen as an ally
• State your intent
• Share your “street corner” Source: Judith Katz and Fred Miller
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@helenbevan @HelenBevan
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@helenbevan @HelenBevan
Four keys to collaboration
• Lean into your discomfort
• Listen as an ally
• State your intent
• Share your “street corner” Source: Judith Katz and Fred Miller
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@helenbevan @HelenBevan 57
http://weneedsocial.com/blog/2013/8/25/disrupted-disruptors-unite
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@helenbevan @HelenBevan
Source of image: http://switchandshift.com/transactional-or-transformational-which-leadership-style-is-best
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@helenbevan #IQTGOLD @HelenBevan
“You don’t need an engine when you have
wind in your sails”
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@helenbevan @HelenBevan
Questions for reflection
1. What learning and inspiration can you take from social movement leaders to help you in your role as an agent of change in health and care?
2. How will you attract the attention of the people you want to call to action?
3. Who are the people who are currently disconnected that you want to unite in order to achieve your goal for change? How can you build a sense of “us” with them?
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@helenbevan @HelenBevan
What happens to large scale change efforts in reality?
In order of frequency:
1. the effort effectively “runs out of energy” and simply fades away
2. the change hits a plateau at some level and no longer attracts new supporters
3. 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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@helenbevan #SHCR @School4Radicals
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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@helenbevan @HelenBevan
Bruch and Vogel research
Organisations 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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@helenbevan #SHCR @School4Radicals
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@helenbevan @HelenBevan
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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@helenbevan @HelenBevan
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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@helenbevan @HelenBevan
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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@helenbevan @HelenBevan
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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@helenbevan
• 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 profile
1
2
3
4
5 Social
Spiritual
Psychological Physical
Intellectual
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@helenbevan #IQTGOLD @HelenBevan
1
2
3
4
5 Social
Spiritual
Psychological Physical
Intellectual
Team 1: what’s your assessment of
their energy for change?
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@helenbevan #IQTGOLD @HelenBevan
1
2
3
4
5 Social
Spiritual
Psychological Physical
Intellectual
Team 2: what’s your assessment of
their energy for change?
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@helenbevan @HelenBevan
Ten key principles of large scale change 1. Movement towards a new vision that is better and fundamentally
different from the status quo
2. Identification and communication of key themes that people can relate to and that will make a big difference
3. Multiples of things (‘lots of lots’)
4. Framing the issues in ways that engage and mobilise the imagination, energy and will of a large number of diverse stakeholders in order to create a shift in the balance of power and distribute the leadership
5. Mutually reinforcing change across multiple processes/subsystems
http://www.slideshare.net/NHSIQ/leading-large-scale-change-part-1
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@helenbevan @HelenBevan
6. Continually refreshing the story and attracting new, active supporters
7. Emergent planning and design, based on monitoring progress and adapting as you go
8. Many people contribute to the leadership of change, beyond organisational boundaries
9. Transforming mindsets, leading to inherently sustainable change
10. Maintaining and refreshing the leaders’
energy over the long haul
Ten key principles of large scale change
http://www.slideshare.net/NHSIQ/leading-large-scale-change-part-1
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@helenbevan #SHCR @School4Radicals
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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@helenbevan @HelenBevan
Employee resistance is the most common reason executives cite for the
failure of big organizational-change
efforts Scott Keller and Colin Price
(2011), Beyond Performance: How Great Organizations Build Ultimate
Competitive Advantage Source of image: Businessconjunctions.com
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@helenbevan @HelenBevan
“ Thousands of patients have died needlessly because of a
damaging reluctance amongst doctors and the
public to accept changes in the NHS, according to the country’s top emergency
doctor
“
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@helenbevan @HelenBevan
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
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@helenbevan
Resistant behaviour is a good indicator of missing relevance
Harald Schirmer http://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-role-of-hr-driving-social-adoption-and-change-in-the-enterprise
Source of image: driverlayer.com
‘ ‘
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@helenbevan
Cultural change is a million
subversive acts of resistance
Brene Brown
Source of image: zazzle.com
‘ ‘
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@helenbevan @HelenBevan
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@helenbevan @HelenBevan
“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
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@helenbevan @HelenBevan
• smoking cessation
• exercise adoption
• alcohol and drug use
• weight control
• fruit and vegetable intake
• domestic violence
• HIV prevention
• use of sunscreens to prevent skin cancer
• medication compliance
• mammography screening
The model is mostly used around health-related behaviours
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@helenbevan @HelenBevan
• smoking cessation
• exercise adoption
• alcohol and drug use
• weight control
• fruit and vegetable intake
• domestic violence
• HIV prevention
• use of sunscreens to prevent skin cancer
• medication compliance
• mammography screening
It works for organisational and service change too!
The model is mostly used around health-related behaviours
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@helenbevan @HelenBevan
“Stages of change” Smoking
I am not aware my smoking is a
problem – I have no intention to quit
Prochaska, DiClemente & Norcross (1992)
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@helenbevan @HelenBevan
“Stages of change” Smoking
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
Prochaska, DiClemente & Norcross (1992)
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@helenbevan @HelenBevan
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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@helenbevan @HelenBevan
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped smoking!
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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@helenbevan @HelenBevan
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped smoking!
I am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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@helenbevan @HelenBevan
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped smoking!
I am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
“Stages of change” Smoking
Prochaska, DiClemente & Norcross (1992)
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@helenbevan @HelenBevan
Prochaska, DiClemente & Norcross (1992)
“Stages of change” Transtheoretical model of behaviour change
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@helenbevan @HelenBevan
• Which stage do most change activities in health and care focus on?
• Which stage are most people actually at?
Some questions
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@helenbevan @HelenBevan
The reality of our change situation
• Our tools are often not effective at the stage of change that most people we work with are at
• It’s hard to engage people in change
• It’s hard to get people to make the changes we want them to make
• People get irritated, defensive, irrational
• We feel powerless in our ability to lead or facilitate the change
90% of the tools available for health and care change agents are designed for the “action” stage
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@helenbevan
• Designed for Stage 4 – ACTION!
• Mandated it through targets
• Despite compelling case for change – people resisted it – no values connection
• People did the task and missed the point
Example – WHO Surgical Safety Checklist
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@helenbevan @HelenBevan
IN A NUTSHELL
• Evidence from observational studies that the use of surgical safety checklists results in striking improvements in outcomes
• Led to rapid adoption of such checklists worldwide
• Researchers studied effect of mandatory adoption of checklists in Ontario, Canada
• Use of checklists not associated with significant reductions in operative mortality or complications
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@helenbevan @HelenBevan
• Lower our ambitions for improvement • Focus our energies on those who are
already in the “action” stage • Put negative labels on those who are
not yet at the action stage such as “blocker” or “resister” or “laggard”
• Blame “the management” for not enforcing change
So what do we TEND to do when people resist?
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@helenbevan @HelenBevan
The single biggest problem in communication is the illusion that it has taken
place
George Bernard Shaw
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@helenbevan @HelenBevan
• Listen and understand • appreciate the starting point
• elaborate interests
• Roll with resistance (Singh)
• Don’t argue against it • Encourage elaboration of resistance
• What makes it so hard? • What would help?
• Build meaning and conviction in the change
So what SHOULD we do?
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@helenbevan @HelenBevan
• The focus should be on creating awareness for me of the need to change
• Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation
• I am not thinking about changing my behaviours, actions or work processes
• The problem or issue is outside my frame of awareness or my perceived need
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@helenbevan @HelenBevan
Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model:
• What stage of change are some of the key people that you need to influence for your change initiative at?
• What actions can you take to help them move to the next stage?
Thinking about your own situation
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@helenbevan @HelenBevan
If your horse dies, get off it
Cherokee proverb
Source of image: fenwickgallery.co.uk
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@helenbevan #IQTGOLD @HelenBevan
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@helenbevan @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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@helenbevan @HelenBevan
Leaders who focus on meaning also
get compliance, without focusing on it
@JeremyScrivens
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@helenbevan @HelenBevan
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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@helenbevan #NHSChangeDay #SHCRchat
A 3-word concept
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@helenbevan #IQTGOLD @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
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@helenbevan @HelenBevan
The power of shared purpose:
Perhaps the single most important influence on program response by individual units—either in promoting or resisting change—was the extent of consensus and
coalition among the senior medical and nursing staff on individual Intensive Care Units….
[Consultant says] ‘I think it’s been successful because it’s a unifying program, it’s one of the few things that we’ve done that hasn’t been just a doctor thing, or just a nurse thing, it’s involved the doctors and the nurses together.’
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/
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@helenbevan @HelenBevan
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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@helenbevan @HelenBevan
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
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@helenbevan @HelenBevan @SimonJGuilfoyle Police Inspector and systems thinker
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@helenbevan @HelenBevan @SimonJGuilfoyle Police Inspector and systems thinker
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@helenbevan @HelenBevan
Police
@SimonJGuilfoyle Police Inspector and systems thinker
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@helenbevan @HelenBevan
Education
@SimonJGuilfoyle Police Inspector and systems thinker
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@helenbevan @HelenBevan
Healthcare
@SimonJGuilfoyle Police Inspector and systems thinker
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@helenbevan @HelenBevan
....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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@helenbevan #SHCR @School4Radicals