Most large scale change fails to achieve its objectives What happens to large scale change efforts in reality? In order of frequency: the effort effectively “runs out of energy” and simply fades away; the change hits a plateau at some level and no longer attracts new supporters; or the change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way. Money incentives do not create energy for change; the energy comes from connection to meaningful goals...

1. Unleashing energy
for change
Helen Bevan
@helenbevan
@NHSIQ
#Quality2013
@helenbevan #Quality2013

2. Most large scale change fails to
achieve its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
@helenbevan #Quality2013
@helenbevan
@helenbevan #Quality2013

3. 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
@helenbevan #Quality2013

4. Anatomy of change
Definition
Physiology of change
The shape and processes 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
Focus
•
Leadership •
•
activities
•
measurement and
evidence
improving clinical systems
reducing waste and
variation in healthcare
processes
redesigning pathways
@helenbevan #Quality2013
© NHS Institute for Innovation and Improvement, 2011
Energy/fuel for change
•
•
•
•
•
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
Source: Crump and Bevan

5. Anatomy of change
Definition
Focus
The shape and processes
of the system; detailed
analysis; how the
components fit together
Processes and structures
to deliver health /healthcare
• measurement and
evidence
Leadership • improving clinical
activities
systems
• reducing waste and
variation in healthcare
processes
• redesigning pathways
@helenbevan #Quality2013
© NHS Institute for Innovation and Improvement, 2011
Physiology of change

6. Anatomy of change
Definition
Focus
Physiology of change
The shape and processes
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 /healthcare
Energy as a fuel for change
• measurement and
evidence
Leadership • improving clinical
activities
systems
• reducing waste and
variation in healthcare
processes
• redesigning pathways
@helenbevan #Quality2013
© 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
Source: Crump and Bevan

7. Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising
and calling to action
•motivational leadership
build energy and
creativity
@helenbevan #Quality2013

8. Intrinsic
motivators
Drivers
of extrinsic
motivation
•connecting to
shared purpose
•engaging, mobilising
and calling to action
•motivational leadership
build energy and
creativity
@helenbevan #Quality2013
create focus
&
momentum
for delivery

9. Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising
and calling to action
•motivational leadership
build energy and
creativity
@helenbevan #Quality2013
Drivers
of extrinsic
motivation
•System drivers &
incentives
•Payment by results
•Performance
management
•Measurement for
accountability
create focus
&
momentum
for delivery

10. InternalDrivers of
extrinsic
motivators
motivation
•connecting to
shared purpose •System drivers &
incentives
•engaging, mobilising
•Performance
and calling to action
management
•motivational
•Measurement for
leadership
accountability
build energycreate & focus
and
creativity momentum for
delivery
@helenbevan #Quality2013

11. Transformation is not a matter of
intent.........
it is a matter of alignment
Peter Fuda

12. NHS Change Model
www.changemodel.nhs.uk
@helenbevan

13. What's our prognosis for this
asthma pathway project?
Our shared purpose
Leadership for change
Engagement to
mobilise
10
9
8
7
6
5
4
3
2
1
0
System drivers
@helenbevan
@helenbevan #Quality2013
Spread of innovation
Improvement
methodology
Rigorous delivery
Transparent
measurement

14. NHS Change Model
www.changemodel.nhs.uk
@helenbevan

15. Does fear motivate people
to change?
@helenbevan #Quality2013

16. burning platform
versus
burning ambition
@PeterFuda
@helenbevan #Quality2013

17. Show Peter Fuda film here
@helenbevan #Quality2013

18. Lessons for transformational change
1. In order to sustain
transformational change we need
to move from a burning platform
(fear based urgency) to a burning
ambition (shared purpose for a
better future)
2. We need to articulate personal
reasons for change as well as
organisational reasons
3. If the fire (the compelling reason)
goes out, all other factors are
redundant
@PeterFuda
@helenbevan #Quality2013

19. Task
Talk to the person next to you
• What is “my burning ambition” for my service,
my community and /or my patients?
• Try to make it personal: tell others why this
ambition connects with your personal
motivations
@helenbevan #Quality2013

20. You get the best efforts from
others not by lighting a fire
beneath them but by building
Source: Bob Nelson
@helenbevan
@helenbevan #Quality2013

21. @helenbevan
@helenbevan #Quality2013

22. Show “energy for change” film
here
@helenbevan
@helenbevan #Quality2013

23. Energy for change is:
the capacity and
drive of a team,
organisation or
system to act
and make the
difference
necessary to
achieve its goals
Spiritual
Social
Psychological
Physical
@helenbevan
@helenbevan #Quality2013
Intellectual

24. The five energies for change
@helenbevan
@helenbevan #Quality2013

25. 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
@helenbevan
@helenbevan #Quality2013

26. The SSPPI Energy Index – Part I
This questionnaire enables teams to measure their energy for change.
Please agree the nature of the change context with your team before answering the following statements.
Then answer all statements with your particular change context in mind.
1 = Strongly disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree
I am energised by the momentum of change____
I have gained insight into the case for change____
I feel a sense of solidarity with those I work with ____
I am weary of change____
I am able to keep expressing hope for the change when presented with setbacks_____
The reasoning for the change is not compelling___
I don’t feel appreciated by others at work_____
I will be blamed if I try something new and it fails____
I feel isolated from others____
I feel depleted of energy when others express doubt about the change_____
The case for change has stimulated my creativity_____
I feel disconnected from others____
I am committed to our common vision for the future____
I feel safe enough to do things differently____
I am driven by shared values____
I am experiencing change fatigue____
The change does not fit with my sense of purpose_____
I am not driven by a shared purpose for change_____
I think there is no rational argument for change____
The case for change is interesting to me_____
I feel that we are getting things done to achieve the change_____
I feel the change may conflict with my values___
I feel personally engaged in the change___
Clear thinking and analysis underpins the change___
I feel fearful about the change___
I sense openness about the potential to change___
@helenbevan
@helenbevan #Quality2013

27. The SSPPI Energy Index – V2, Part 2
Complete these statements on a scale of 1 = low - 5 = high
Social energy is the energy of personal engagement, relationships and
connections between people. It reflects a “sense of us” and is
therefore a collective concept that captures a situation where
people are drawn into an improvement or change because they feel
a connection to it as part of the collective group.
Psychological energy is the energy of courage, trust and feeling safe
to do things differently. It involves feeling supported to make a
change as well as belief in self and the team, organisation or
system, and trust in leadership and direction.
My social energy is ____
The social energy of those I work with is____
The importance of social energy to me is____
My psychological energy is ____
The psychological energy of those I work with is____
The importance of psychological energy to me is____
Spiritual energy is the energy of commitment to a common vision for
the future, driven by shared values and a higher purpose. It involves
giving people the confidence to move towards a different future
that is more compelling than the status quo, by finding the deep
meaning in what they do.
Physical energy is the energy of action, getting things done and
making progress. It is the flexible, responsive drive to make things
happen, with vitality and kinetic force (motion)
My spiritual energy is ____
The spiritual energy of those I work with is____
The importance of spiritual energy to me is____
My physical energy is ____
The physical energy of those I work with is ____
The importance of physical energy to me is____
Intellectual energy is the energy of curiosity, analysis, thinking and cognition. It involves gaining insight, a thirst for new knowledge as well
as planning and supporting processes, evaluation, and arguing a case on the basis of logic and evidence.
My intellectual energy is ____
The intellectual energy of those I work with is____
The importance of intellectual energy to me is____
@helenbevan

28. Energy for change profile
• 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?
@helenbevan
@helenbevan #Quality2013

29. Energy for change profile
• 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?
@helenbevan
@helenbevan #Quality2013

30. Team 1: what’s your assessment of
their energy for change?
@helenbevan

31. Team 1: what’s your assessment of
their energy for change?
@helenbevan
This energy profile is
characterised by an
environment that has
harnessed people’s
interest and momentum
for change, but which has
failed to engage people
fully. This imbalance
results in their feeling
some uncertainty
regarding how they can
contribute fully to the
change, and therefore a
sense of risk and lack of
hope for the future. We
can build energy by
building team solidarity
and developing shared
purpose

32. Team 2: what’s your assessment of
their energy for change?
@helenbevan

33. Team 2: what’s your assessment of
their energy for change?
@helenbevan
This energy profile shows
strong connections
between people, a true
sense of solidarity, which
gives them enough hope
for the future, but this
energy is undirected,
because the rational
argument and shared
purpose has not been
agreed. We can build
energy by agreeing shared
goals for change and
using systematic
approaches to thinking
through and planning the
change

34. Resources for building and aligning energy
Title and source
Quality and Service Improvement Tools – NHS
S
X
S
X
Energy Project tips – The Energy Project
X
P
X
X
P
X
I
X
X
X
Emotional Resilience Toolkit – DH/Business in the Community X
X X X
IHI Improvement Map – Institute for Healthcare Improvement X
X X
X
P3M Resource Centre – NHS Connecting for Health
X
X
X
i-resilience assessment – RobertsonCooper
X
X
X
X
X
Appreciative Inquiry – Appreciative Inquiry Commons X
X
X
Good Day at Work network – RobertsonCooper
X
@helenbevan
X
X

35. “Money incentives do not create energy
for change; the energy comes from
connection to meaningful goals”
Ann-Charlott Norman, Talking about improvements: discursive
patterns and their conditions for learning,
Clinical Microsystem Festival, Jönköping March 2012
@helenbevan #Quality2013
@helenbevan #qs13

36. [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
@helenbevan
@helenbevan #Quality2013

37. 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 #Quality2013
@helenbevan #qs13

38. @helenbevan #Quality2013
@helenbevan #qs13

39. io n
at
usc
bf
e O e t er
pos -m
ur
P
O
@helenbevan #Quality2013
@helenbevan #qs13

40. Police
@helenbevan #Quality2013
@helenbevan #qs13

41. Education
@helenbevan #Quality2013
@helenbevan #qs13

42. Healthcare
@helenbevan #Quality2013
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43. What focus for our improvement projects?
Source: 100 improvement projects on national improvement
leadership programme October 2012
@helenbevan

44. ....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
@helenbevan #Quality2013
@helenbevan #qs13