Creating the conditions
for improvement
(in a changing world)
Helen Bevan
@HelenBevan
#NHS_QIHub
@HelenBevan
Source of image:
Buildingchangetrust.org
I will cover
• The changing environment for leading
improvement
• Intrinsic and extrinsic motivation
• From change programmes to change
platforms
• Tapping the collective brilliance of people who
work in and use services
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SEISMIC SHIFTS
Change from the edge
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old power
Currency
new power
Current
Held by a few
Made by many
Pushed down
Pulled in
Commanded
Shared
Closed
Transaction
Open
Relationship
Jeremy Heimens TED talk “What new power looks like”
https://www.youtube.com/watch?v=j-S03JfgHEA
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Intrinsic
motivators
build energy
and creativity
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@HelenBevan
Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy
and creativity
@HelenBevan#NHS_QIHub
@HelenBevan
Intrinsic
motivators
Drivers
of extrinsic
motivation
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy
and creativity
@HelenBevan#NHS_QIHub
@HelenBevan
create focus &
momentum for
delivery
Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy
and creativity
@HelenBevan#NHS_QIHub
@HelenBevan
Drivers
of extrinsic
motivation
•System drivers &
incentives
•Payment by results
•Performance
management
•Measurement for
accountability
create focus &
momentum for
delivery
InternalDrivers of
extrinsic
motivators
•connectingmotivation
to
shared purpose •System drivers &
incentives
•engaging, mobilising and
•Performance
calling to action
management
•motivational leadership
•Measurement for
accountability
build energy and
create & focus
creativity
momentum for
delivery
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@HelenBevan
The power of extrinsic drivers
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@HelenBevan
Three types of levers for large scale change
Type one:
‘Prod mechanisms’
targets
performance
management
price & payment incentives
regulation
competition
Type two:
‘Proactive support’
relies on building
‘intrinsic motivation’ in
staff to make
the right changes to
improve
Type three:
‘People focused’
education and training
national contracts
professional
regulation
clinical
quality standards
Source: Health Foundation report Constructive
comfort: accelerating change in the NHS 2015
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@HelenBevan
Three types of levers for large scale change
Type one:
‘Prod mechanisms’
targets
performance
management
price & payment incentives
regulation
competition
Type two:
‘Proactive support’
relies on building
‘intrinsic motivation’ in
staff to make
the right changes to
improve
Type three:
‘People focused’
education and training
national contracts
professional
regulation
clinical
quality standards
Less than 10%
of the potential
for
improvement
at system level
can be
delivered
through type
one change
Source: Health Foundation report Constructive
comfort: accelerating change in the NHS 2015
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We rarely see two, three or four
year change projects anymore.
Now it’s 30-60-90 day change
projects
Kinthi Sturtevant, IBM
13th annual Change Management
Conference June 2015
@HelenBevan
Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
@HelenBevan
Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”
@HelenBevan
Is your change process a cathedral or a bazaar?
@HelenBevan
http://www.unterstein.net/su/docs/CathBaz.pdf
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 2015
http://www2.deloitte.com/us/en/pages/center-for-the-edge/articles/john-hagel-atsxsw.html
@HelenBevan
@TheEdgenhs
#EdgeTalks
@HelenBevan
@Jodi
Olden #EdgeTalks
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-inthe-21st-century
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Change
Programmes
• 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)
@HelenBevan
Change
Platforms
• 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
“Tear down the walls”
What is a change platform?
“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 situation
Change 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.
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Definition by @JodiOlden & @HelenBevan 2015
“Change comes naturally when individuals
have a platform that allows them to
identify shared interests and to brainstorm
solutions.”
Gary Hamel & Michele Zanini, 2014
Build a change platform not a change program
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Platforms give access to resources
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 Satell
http://www.digitaltonto.com/2015/4-things-you-should-know-aboutplatforms/?ct=t%28Why_Some_Movements_Succeed_5_31_2015%29
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Evolving kinds of change platforms:
1. Connecting platforms
2. Mobilising platforms
3. Learning platforms
4. Knowledge platforms
5. Crowdsourcing platforms
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They overlap!
Carousal:
shows all
active
challenges
open for
staff
participation
Click here to
submit an
idea
Live activity
feed
@HelenBevan
Gamification
A platform for Trust-wide transformation
Leeds 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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@HelenBevan
http://www.breakdengue.org/
@HelenBevan
www.newhcvoices.co.uk
@HelenBevan
The Academy of Fabulous NHS Stuff
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Effective change platforms:
 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
Gary Hamel & Michele Zanini (2014)
http://www.mckinsey.com/insights/organization/build
_a_change_platform_not_a_change_program
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Source: IDEO: The Field Guide to Human-Centered Design
The Change Challenge
Tapping the collective brilliance
of the NHS
@HelenBevan
• 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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Objectives to:
• 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
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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
#Expo15NHS
#EdgeTalks
@HelenBevan
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#NHS_QIHub
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@JodiOlden
14,000 contributions identified
10 barriers to change:
Confusing strategies
Playing it safe
Over controlling
leadership
One way
communication
Poor project
management
Poor workforce
planning
Inhibiting
environment
Stifling innovation
Perverse incentives
Undervaluing staff
Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015
@HelenBevan
Front line teams get inundated with high priority
messages from leaders each day, making it difficult
for them to know what to focus on
Increasing number of messages
as information cascade through
the organisation
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-faildon.aspx
@HelenBevan
Front line teams get inundated with high priority messages
from leaders each day, making it difficult for them to know
what to focus on
Increasing number of messages
as information cascade through
the organisation
Buy in from front line staff is critical for
improvements in quality and safety . Don’t
overload them
Buy in from front line staff is critical
for improvements in quality and safety
Source: adapted from
Don’t overload them
http://businessjournal.gallup.com/content/162707/change-initiatives-failhttp://healthaffairs.org/blog/2014/03/07/thedon.aspx
dangers-of-quality-improvement-overload-insightsfrom-the-field/
@HelenBevan
14,000 contributions identified
11 building blocks for change:
Inspiring & supportive
leadership
A call to action
Collaborative working
Fostering an open
culture
Flexibility &
adaptability
Nurturing our people
Smart use of resources
Long term thinking
Autonomy & trust
Thought diversity
Challenging the
status quo
@HelenBevan
Source: Health Service Journal, Nursing Times, NHS Improving
Quality, “Change Challenge” March 2015
Typically, around any change effort, there is an
initial spike of tangible energy, and change, but
when leadership loses interest, the momentum
of change slows down drastically.”
Tara Paluck
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@HelenBevan
The power
of the
platform
“...demonstrates,
yet again, the
collective
brilliance of the
people who
work in the NHS
and wider care
system”
@HelenBevan
@HelenBevan
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
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@HelenBevan
CARE
DESIGN
2016
System redesign principles for care models
#CareDesign
@HelenBevan
“Help us to capture redesign
principles for care models to get
better, quicker outcomes from
change”
Our Care Design 2016 aims:
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
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@HelenBevan
Our ‘starter-for-ten’
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@HelenBevan
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Once you start down this path, you
have to follow up and continue
”If people give to a cause,
they expect a relationship,
not a transaction”
Nilofer Merchant
@HelenBevan
Where do we need to focus our improvement
activities for the future?
Source of basic framework:
Charlie Leadbetter
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Where most improvement activity is currently
focussed
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Where much of the change thinking and practice
that could most benefit the NHS ends up
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@HelenBevan
Where we need to focus additionally to
achieve our improvement goals
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@HelenBevan
4pm - 4pm, 27-28th January 2016
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References cited in the slide deck (1/2)
Ashoka (2014) What does leadership mean in the 21st century?
Berg O (2014) The Collaboration Pyramid revisited
Briggs D (2015) The elements of council as a platform
Bromford 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 age
Deloitte University Press (2014) The power of platforms
Hagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movements
Hagel J (2014) Platforms are not created equal: harnessing the full potential of platforms
Hamel G, Zanini J (2014) Build a change platform not a change program
Health Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’
interactive toolkit
Heimans 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
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References cited in the slide deck (2/2)
Jarche H (2014) The Seek > Sense > Share Framework
Milton N (2014) Why knowledge transfer through discussion is 14 times more effective
than writing
O’Reilly T (2010) Government as a platform
Pearce D (2013) Social business discussions are the new documentation
Raymond E S (2001) The Cathedral and the Bazaar
Satell G (2015) 4 things you should know about platforms
Satell G (2012) How power is shifting from corporations to platforms
Satell G (2015) Leaders must do more than inspire – we must shape networks
Schillinger C (2015) Forget social networks, think social impact [YouTube]
Scrivens J (2015) Enabling the experience of wholeness within enterprise social networks
Sewell S (2015) Stop training our project managers to be process junkies
Shaw K (2015) Placing a digital platform at the heart of organisational change with Oxfam
Simon P (2011) The Age of the Platform
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