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Buildingchangetrust.org
Helen Bevan@HelenBevan
Masterclass: engagement for transformation
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Learning outcomes
• Identify major themes and trends in the global world of change and transformation that are likely to shake our world of health and care improvement
• Learn how “change platforms” (approaches to change that allow everyone to have a voice, to connect and collaborate and socially create the future ) will lead to the demise of “change programmes” as we know them
• Consider the opportunities and implications of the above for our own practice as leaders or activists in health and care
• Model new forms of collective learning, collaboration and community building and bring the future forward
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I amar prestar aen, Han mathon ne nen, Han mathon ne chae,
A han noston ned gwilith
The world is changed,I feel it in the water, I feel it in the Earth,I smell it in the air
Galadriel’s prologue: The Lord of the Rings: The Fellowship of the Ring
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SEISMIC SHIFTS
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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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DIGITALCONNECTION
SEISMIC SHIFTS
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Work complexity
SEISMIC SHIFTS
DIGITALCONNECTION
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DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work complexity
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“In a connected world, power no longer emanates from the top of the heap, but the centre of the
network.”Greg Satell, 2015
Greg Satell: http://www.digitaltonto.com/2015/how-power-is-shifting-from-corporations-to-platforms/
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DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work complexityChange from the edge
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http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final
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Starts on the fringe (at the edge)
Starts with the activistsGary Hamel
always
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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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Research by IBM
200841% of leaders considered they were successful in managing change
201420% of leaders considered they were successful in managing change
Source: Jorgensen, Bruel & Franke, Making change work….while the work keeps changing” quoted in Foster F (2015) “Using crowdsourcing to deliver transformational change
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Source : Ross Dawson (2015)
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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 battle and balancing between the old and new power will be a defining feature
of society and business in the coming yearsJeremy Heimans and Henry Timms
Understanding new power, Harvard Business Review, December 2014 https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet
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The battle and balancing between the old and new power will be a defining feature
of society and business in the coming yearsJeremy Heimans and Henry Timms
Understanding new power, Harvard Business Review, December 2014 https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet
The battle and balancing between old and new power will also be the defining feature of the
health and care system in the coming years
@HelenBevan #aquatransform @HelenBevan #aquatransformFor more information/explanation visit: The Collaboration Pyramid revisited
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Three types of levers for large scale change
‘Prod mechanisms’ targets
performance management
price & payment incentives regulation
competition
‘Proactive support’
relies on building ‘intrinsic motivation’ in
staff to make the right changes to
improve
‘People focused’ education and training
national contractsprofessional regulation
clinical quality standards
Type one:
Type two: Type three:
Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015
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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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“In a world of mounting performance pressure, [organisations and change processes] need to evolve…the most successful will be those that
evolve into movements.
Success will be determined by their ability to mobilise, inspire and support an
ever-expanding array of participants extending far beyond their own four walls”
John Hagel, SXSW 2015http://www2.deloitte.com/us/en/pages/center-for-the-edge/articles/john-hagel-at-sxsw.html
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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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• 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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“A space (physical or virtual) that is created so people get the choice and opportunity to collaborate without boundaries to achieve a common purpose, tackle a challenge or improve a situationChange platforms tackle silo thinking and other barriers to the exchange of knowledge. They enable a diverse group of people to come to the table, share ideas, insight and learned experience, co-create solutions and launch experiments. Platforms thrive on trust, relationships and the collisions of minds. They build energy for change.
What is a change platform?
Definition by @JodiOlden & @HelenBevan 2015
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“Change comes naturally when individuals have a platform that allows them to identify shared interests and to brainstorm solutions.”
Gary Hamel & Michele Zanini, 2014Build a change platform not a change program
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Joy’s Law: No matter who you are, most of the smartest people work for someone else
Bill Joy, Sun Microsystems
“It’s become a kind of ‘Joy’s Law’ for the networked era—the best resources and capabilities always lie somewhere else.”
Greg Satellhttp://www.digitaltonto.com/2015/4-things-you-should-know-about-platforms/?
ct=t%28Why_Some_Movements_Succeed_5_31_2015%29
Platforms give access to resources
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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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Platform principles have long been part of change practice
• Building on traditions in the field of organisation development of communities of interest and communities of practice
• Technology enables us to connect more widely and at greater speed
Source of image: Socialserviceinstitute.sg
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Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
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Example platforms
Source of image: @JenniferClemo
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Case study: Giff Gaff“The mobile network run by you”
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Carousal: shows all active challenges open for staff participation
Live activity feed
Click here to submit an idea
Gamification
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A platform for Trust-wide transformationLeeds Teaching Hospitals NHS Trust & Clever Together
WayFinder – a Crowdsourcing methodology and platform • Step 1: 4,500 staff and stakeholders shared 45,000 contributions to
• co-create The Leeds Way – a redefinition of their vision and their values
• co-design a five year strategy – a shared agreement of what needs to happen to achieve their vision
• co-define a new behavioural framework – a new agreement of the acceptable ways in which staff will live their values embedded into recruitment, induction, training and appraisals
• Step 2: WayFinder local – every department trained to use its own crowdsourcing platform • 19 clinical service units trained • A new way of working – online workshops – to ensure staff always
have a say in what’s happening in the Trust, bringing people together to co-create solutions.
Examples of results:• Staff satisfaction is up / buy-in to vision and values at an all time
high / complaints down 17% / 18weeks RTT down by 66% / CQC acknowledgement of staff engagement and impact on quality and safety
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https://www.youtube.com/watch?v=CMDKkTuLUHw
http://www.breakdengue.org/
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www.newhcvoices.co.uk
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The Academy of Fabulous NHS Stuff
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Effective change platforms:
Gary Hamel & Michele Zanini (2014)http://www.mckinsey.com/insights/organization/build_a_change_platform_not_a_change_program
Encourage people to tackle significant organisational challenges foster honest and forthright discussion of root causes and, in the
process, develop a shared view of the thorniest barriers elicit dozens (if not hundreds) of potential solutions rather than
seeking to coalesce prematurely around a single approach; the goal is first to diverge, then to converge
focus on generating a portfolio of experiments that can be conducted locally to help prove or disprove the components of a more general solution, as opposed to developing a single grand design
encourage people to take personal responsibility for initiating the change they want to see and give them the resources and tools necessary to spur their thinking and imaginations
@HelenBevan #aquatransform Source: IDEO: The Field Guide to Human-Centered Design
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Knowledge platforms
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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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What is the best way to spread new knowledge?
Source of data: Nick Milton http://
www.nickmilton.com/2014/10/why-knowledge-transfer-through.html
Social connection/discussion is 14 times more effective
than written word/best practice
databases/toolkits etc.
Source of image: www.happiness-one-quote-time.blogspot.com
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Platforms as the new documentation
Source of image:Flickr user acaben
@HelenBevan #aquatransform Source: Oliver Benson
If you’re a programmer, you don’t even bother reading the manual, you simply
use stackoverflow to answer all your questions”
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Horizons Team: All our work is via change platforms
Source of image: @JenniferClemo #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
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Stephen Downes, 2011Connectivism & Personal Learning
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The School is being 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/
Or Google: #EdgeTalks School
How has the School for Health and Care Radicals made a difference?
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The School is being 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 EVERY dimension of impact at both individual
and organisational level
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Activists from 120 countries
500,000+ Twitter impressions@theedgenhs
21,000 active users
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We have supported NHS Change Day for three years
• 800,000 pledges in 2014
• 4 X the local activity/connectivity in 2015 compared to 2014
• #nhschangeday: 130m impressions
• Facebook impressions 253,999
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The power of th
e platform #MatExp
The power of the platform
#NHSChangeDay + #MatExp
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“Top down is a serious disease but it can be treated”
Celine Schillinger
Source of image: Leadershipfreak.wordpress.com
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The Change Challenge
Tapping the collective brilliance of the NHS
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• The biggest-ever digital campaign for EMAP (Health Service Journal and Nursing Times)
• 14,000 contributors to the joint campaign to “challenge top down change”
• Ground-breaking: the first-ever crowd-sourced theory of change in the NHS
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• Build bridges between disconnected groups• Activate radicals and engage them in action for
change• Change the story of how we undertake large
scale and transformational change in the NHS• Lead from the edge using new era methodology
Objectives to:
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The process:
Step 1 :The build-upSetting the right foundation for campaign launch
Step 2:Launch campaign, explore barriers and enablersWeeks 1-4Launch the campaign for bottom up change and questions to the crowd to develop the barriers and building blocks for change.
Step 3Propose solutions Weeks 5-6Crowd invited to share, build and validate list of potential solutions
Step 4Develop toolkitWeek 7 best ideas selected by crowd and panel selectsWeeks 8-9 crowd develops best ideas into toolsWeeks 9-11 works on key outputs
Step 5:Spread and EmbedWeek 12Publication of interactive guide / ‘new era’ toolkit / manifesto for change / celebrated cases
Development of the process, questions, objectives and communication plan
Questions:-What things block or help you from delivering bottom-up change:· inside your organisation, to improve or transform services, and· across organisations to improve the health and wellbeing of a local population?
Questions:- What solutions work? What approaches have you used or observed that others could learn from and copy? Please share your stories and learning about what did and didn't work. What solutions should we test? What ideas do you have that we could test out? Share ideas (these can be completely new) that you believe could support bottom-up change in the NHS, if we gave them a chance.
47 ideas selected for the crowd to develop. Crowd asked to develop these into workable tools; tangible and practical enough to be used widely across health and care organisations to deliver bottom up change for patients, staff and the public. To do this, please tell us: - what steps need to be taken, - who needs to be involved, and - what commitments…
The HSJ and Nursing Times share outputs :• project overview,• ‘how to’ guides for
application of crowdsourcing
• ‘how to’ toolkit of prioritised ‘hacks’/ solutions
Result: a foundation for a social movement of bottom up change
Project over 12 weeks
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Reach and scale:
• 3,595 people involved - from 45 different countries
• 13,895 ideas, comments and votes shared - collectively identifying:
Final outputs were • 10 barriers• 11 building blocks• 16 solutions
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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
Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015
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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
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The power of the platform
“...demonstrates, yet again, the collective brilliance of the people who work in the NHS and wider care system”
@HelenBevan
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Task
Use the “barriers” and “building blocks” to analyse a change initiative
that you are currently working on
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How to create a change platform #1• Be clear about your intention or goal:• Solve a problem?• Learn from others?• Create solutions?• Mobilise for change?• Spread innovation?
• Articulate your mission• Design the stages in your process• Sprints and hacks
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How to create a change platform #2• Identify the people you want in your community• Identify how to reach them• Find a platform • Existing or new • Free or paid for• Virtual or face to face
• Measure the outcomes (all the way through)• Engage your community• Set their expectations• Keep the connections flowing• Convert ideas to actions• Always, always follow up
#Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
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Case study: System redesign principles for care models
Source of image: @JenniferClemo #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
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CAREDESIGN2016System redesign principles for care models
#CareDesign
“Help us to capture redesign principles for care models to get better, quicker outcomes from
change”
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What are design principles?
“Design principles are suggestions that are highly likely to be effective, but they are not formulae that guarantee success … The point remains, however, that if one knows the design principles in a field, he or she is much further along in thinking and much more likely to be successful.”
Paul Bates
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1. Distil a set of principles for redesign of care models that is globally applicable
2. Organise the principles in a way that makes them accessible and highly useable to people designing new systems for delivering care
3. Identify examples from across the world of the redesign principles in action
4. Signpost tools, methods and resources that can help in the implementation of the redesign principles
5. Demonstrate the power of design thinking for health and care transformation
Our Care Design 2016 aims:
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Our ‘starter-for-ten’
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Be the crowd for the first sprint“What do you think of our ‘starter-for-ten’? Tell us your thoughts and ideas and collaborate with others via our online platform”
We are working face to face, not virtually but if you will give your email addresses, we will load your content onto the platform when it launches
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● Only 1% participate fully so start with a big crowd● Inject thought diversity to guard against groupthink● Mix high domain knowledge with those with high creativity
Choose the right crowd
Choose the right incentives
● Crowdsourcing cannot happen without a vibrant, committed community ● Rewards must balance intrinsic & extrinsic motivators
Crowds do not replace the team
● You’ll get volume & diversity from the crowd but be prepared to match it with equal time & effort to herd, sift & identify contributions
Crowds needlove too!
● Crowds need direction & guidance to help them feel part of their community & give of their best
Keep itsimple
● Break complex tasks down● Tasks must be small, simple & fun & fit into your crowd’s spare time
Remember Sturgeon’s Law
Communities are always right!
Fulfilling self-actualisation
● “90% of everything is crap / 10% of everything is not crap”● Allow the crowd to surface its best through voting to the top
● Crowdsourcing works because creativity, spontaneity, problem-solving & affiliation achieve self-actualisation (Maslow / Howe)
● Top-down management style does not work in crowds, nor does grass-roots anarchy● Lead with the moral authority the crowd allows
Adapted from: A Guide to Open Innovation and Crowdsourcing, Ed. Paul Sloane
The rules of crowdsourcing
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Platform methodology for our design principlesPre-sprint Sprint 1 Sprint 2 Sprint 3
Expert group sense-check of design principles & crowdsourcing process
“Have we got the right design principles?”
“Tell us about the design principles in action”
“How do we make the principles happen?”
V1.0 of design principles paper to be shared with expert group of “systems engineers” both from within and outside the NHS
The ten design principles will be presented via the crowdsourcing platform to our collaborators (widespread engagement)
Invite practical examples and case studies that demonstrate the refined ten design principles working and in action
Invite collaborators to signpost us to tools, methods, resources and methodologies that can help in the implementation of the design principles
Output from each sprint becomes a new version of the paper. The socially derived design principles are then open for the next sprint and round of crowdsourcing
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How you can get involved:
• Look out for our tweets• Email: [email protected] to receive updates
& an invite to join the collaboration platform
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”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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Platforms are only as good as the people leading them
Source of image: www.activationjourney.com
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Four 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
4. Save the date for theedge.nhsiq.nhs.uk/transformathon
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4pm - 4pm, 27-28th January 2016
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“Even the smallest creature can
change the world”Galadriel to FrodoLord of the Rings
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Ashoka (2014) What does leadership mean in the 21st century?Berg O (2014) The Collaboration Pyramid revisitedBriggs D (2015) The elements of council as a platformBromford P (2015) What’s the difference between a test and a pilot?Dawson R (2015) The future of work and organisations Deloitte University Press (2015) Business ecosystems come of ageDeloitte University Press (2014) 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]Heimens J, Timms J (2014) Understanding “New Power”Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers Ivanov E (2013) The Strength Within
References cited in the slide deck (1/2)
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Jarche H (2014) The Seek > Sense > Share Framework Milton 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 Platform
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