Creating contagious commitment
to change to deliver results in
challenging times
Helen Bevan
NHS Institute for Innovation and Improvement
© NHS Institute for Innovation and Improvement, 2011
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
© NHS Institute for Innovation and Improvement, 2011
A question
Where would you start if you wanted to
improve quality and reduce costs at
unprecedented scale and pace?
© NHS Institute for Innovation and Improvement, 2011
“
Revolution begins with
transformation of
consciousness”
Paul Bate
© NHS Institute for Innovation and Improvement, 2011
Which tradition of change?
Management
of change
© NHS Institute for Innovation and Improvement, 2011
Organising
and
mobilising
Which tradition of change?
•
•
•
•
•
Organisational behaviour
Leadership and management studies
Clinical/medical audit
Improvement “science”
Academic tradition(s) – 100 years
Management
of change
© NHS Institute for Innovation and Improvement, 2011
Which tradition of change?
• Community organising,
campaigns and social
movements
• Learning from popular, civic and
faith-based mobilisation efforts.
• Academic tradition– 100 years
Organising
and
mobilising
© NHS Institute for Innovation and Improvement, 2011
Which tradition of change?
• Organisational
behaviour
• Leadership and
management
studies
• Clinical/medical
audit
• Improvement
“science”
• Academic
tradition(s) – 100
years
Management
of change
© NHS Institute for Innovation and Improvement, 2011
• Community
organising,
campaigns and
social movements
• Learning from
popular, civic and
faith-based
mobilisation efforts
• Academic tradition –
100 years
Organising and
mobilising
Where would you start?
1. create a “burning platform” and imperative for
action around quality and cost improvement
© NHS Institute for Innovation and Improvement, 2011
Where would you start?
1. create a “burning platform” and imperative for
action around quality and cost improvement
2. develop a strong narrative (story) around how
cost improvement can be delivered through
quality
© NHS Institute for Innovation and Improvement, 2011
Where would you start?
1. create a “burning platform” and imperative for
action around quality and cost improvement
2. develop a strong narrative (story) around how
cost improvement can be delivered through
quality
3. make a clinically relevant case that makes
both a rational case for change and a
connection to emotions, through values
© NHS Institute for Innovation and Improvement, 2011
Where would you start?
1. create a “burning platform” and imperative for
action around quality and cost improvement
2. develop a strong narrative (story) around how
cost improvement can be delivered through
quality
3. make a clinically relevant case that makes
both a rational case for change and a
connection to emotions, through values
4. make it “real” for frontline staff (e.g., 200
patients and £5k per person per year)
© NHS Institute for Innovation and Improvement, 2011
Where would you start?
1. create a “burning platform” and imperative for
action around quality and cost improvement
2. develop a strong narrative (story) around how
cost improvement can be delivered through
quality
3. make a clinically relevant case that makes
both a rational case for change and a
connection to emotions, through values
4. make it “real” for frontline staff (e.g., 200
patients and £5k per person per year)
5. ask people to commit to specific actions
© NHS Institute for Innovation and Improvement, 2011
Definition
Anatomy of change
Physiology of change
The shape and structure of the
system; detailed analysis; how
the components fit together.
The vitality and life-giving forces that
enable the system and its people to
develop, grow and change.
Processes and structures
to deliver health and
healthcare.
Energy/fuel for change.
Focus

Leadership 

activities

measurement and
evidence
improving clinical systems
reducing waste and
variation in healthcare
processes
redesigning pathways





© NHS Institute for Innovation and Improvement, 2011
creating a higher purpose and
deeper meaning for the change
process
building commitment to change
connecting with values
creating hope and optimism about
the future
calling to action
The 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
© NHS Institute for Innovation and Improvement, 2011
The ten key principles of large scale change
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
© NHS Institute for Innovation and Improvement, 2011
© NHS Institute for Innovation and Improvement, 2011
From the old world to the new world
To
From
Commitment
Compliance
States a minimum performance
standard that everyone must
achieve
States a collective
everyone can aspire to
Uses hierarchy, systems
standard procedures for
ordination and control
and
co-
Based on shared goals, values and
sense of purpose for co-ordination
and control
Threat
of
penalties/sanctions/shame creates
momentum for delivery
Commitment to a common purpose
creates energy for delivery
Based
on
organisational
accountability (“if I don't deliver
this, I fail to meet my performance
objectives”)
Based on relational commitment (“If
I don’t deliver this, I let the group or
community and its purpose down”)
© NHS Institute for Innovation and Improvement, 2011
goal
that
Source: Helen Bevan
“Rules cannot substitute for
character”
Alan Greenspan
US Federal Reserve
© NHS Institute for Innovation and Improvement, 2011
mobilising
versus
organising
© NHS Institute for Innovation and Improvement, 2011
A cynic, after all, is a
passionate person
who does not want to
be disappointed again
Zander R and Zander B (2000) The
art of possibility. Harvard
Business School Press. As
quoted by Steve Onyett
© NHS Institute for Innovation and Improvement, 2011
How did the great social movement
leaders change the world?
Strategy
Narrative
what?
why?
Shared understanding leads to
Action
© NHS Institute for Innovation and Improvement, 2011
Source: Marshall Ganz
The challenge
”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
© NHS Institute for Innovation and Improvement, 2011
More than 80% of our ability to
save costs depends on clinical
decision making
Brent James,
Institute for Healthcare Delivery Research
Intermountain Healthcare
© NHS Institute for Innovation and Improvement, 2011
Copyright 2009 NHS Institute for Innovation and Improvement
If we want people to take action, we have to
connect with their emotions through values
values
emotion
action
© NHS Institute for Innovation and Improvement, 2011
Source: Marshall Ganz
© NHS Institute for Innovation and Improvement, 2011
But not all emotions are equal.........
urgency
anger
hope
solidarity
you can make
a difference
© NHS Institute for Innovation and Improvement, 2011
Action inhibitors
Overcome
Action motivators
inertia
apathy
fear
isolation
Self-doubt
What the framing literature tells us
“‘a new idea must be at the least couched in the language
of past ideas; often, it must be, at first, diluted with
vestiges of the past”
Saul Alinsky Rules for Radicals (1971)
© NHS Institute for Innovation and Improvement, 2011
What the framing literature tells us
In other words....
People are much more likely to embrace change if it is
framed as something that builds positively on what they
are familiar with than as something that seems far away
and unachievable.
© NHS Institute for Innovation and Improvement, 2011
Helen’s photo
© NHS Institute for Innovation and Improvement, 2011
© NHS Institute for Innovation and Improvement, 2011
“When you have gone as far that you can’t
manage one more step, then you have
gone just half the distance that you are
capable of”
Proverb of the Inuit people of the Arctic Circle
© NHS Institute for Innovation and Improvement, 2011
What do we need to do?
1. Tell a story
© NHS Institute for Innovation and Improvement, 2011
What do we need to do?
1. Tell a story
2. Make it personal
© NHS Institute for Innovation and Improvement, 2011
What do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
© NHS Institute for Innovation and Improvement, 2011
What do we need to do?
1.
2.
3.
4.
Tell a story
Make it personal
Be authentic
Create a sense of “us” (and be clear who the
“us” is)
© NHS Institute for Innovation and Improvement, 2011
What do we need to do?
1.
2.
3.
4.
Tell a story
Make it personal
Be authentic
Create a sense of “us” (and be clear who the
“us” is)
5. Build in a call for urgent action
© NHS Institute for Innovation and Improvement, 2011
Three components of a great
narrative (story)
• 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 the audience?
© NHS Institute for Innovation and Improvement, 2011
“The most common way people give
up their power is by thinking they don't
have any”
Alice Walker
© NHS Institute for Innovation and Improvement, 2011
The leader’s most basic role is to release
the human spirit that makes initiative,
creativity, and entrepreneurship possible
Bartlett and Ghoshal
© NHS Institute for Innovation and Improvement, 2011
“In everybody’s life, at some time, our inner fire
goes out. It is then burst into flame by an
encounter with another human being. We
should all be thankful for those people who
rekindle the human spirit”
Albert Schweitzer
© NHS Institute for Innovation and Improvement, 2011