Rewrite rules of change in healthcare

It’s time to rewrite the rules
of change in healthcare
Source of image: www.ohiolibertycoalition.org
Based on the talk that
Helen Bevan
gave at
Yale New Haven Hospital
Grand Rounds
10th
June 2014
@HelenBevan

“New truths begin as heresies”
(Huxley, defending Darwin’s theory of natural selection)
Source of image:
installation by the
artist Adam Katz
www.thisiscolossal.com
Via @NeilPerkin

Our new White Paper
• Examines leading trends in
change and transformation
globally
• How to make change happen at
a faster rate and be more
disruptive
• Join the new breed of healthcare
leaders across the world,
rewriting the rules of change and
leading change from the future
for different results
Release date: 4th
July 2014
www.nhsiq.nhs.uk/whitepaper

@HelenBevan
SEISMIC SHIFTS
Causing us to rethink the
very nature of change and
how to enable it in the
future

@HelenBevan
DIGITALCONNECTION
SEISMIC SHIFTS

@HelenBevan
Facebook didn’t exist,
Twitter was still a sound,
the cloud was still in the sky,
4G was a parking place,
LinkedIn was a prison,
applications were what you sent to college,
Skype was a typo Thomas Friedman,
World Economic Forum,
Quoted by http://ayeletbaron.com

@HelenBevan
….creates additional challenges
Source of quote: Harold Jarche
Source of image: http://gotcll.com/about-2/
Getting
information off the
internet is like taking
a drink from a fire
hydrant
Mitchell Kapor

@HelenBevan
Work
complexity
SEISMIC SHIFTS

@HelenBevan
DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work
complexity

@HelenBevan
DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work
complexity
Change from the edge

@HelenBevan
Whilst back in the world of health and care...
Many of the ways we go
about improving health
and care were designed
in a different mindset
for a different set of
circumstances
We are operating with
20th
century change
practice in a 21st
century
world Source of image:
Bain top ten management
tools
http://www.bain.com/management_tools/BainTop

@HelenBevan
Some warnings
‘‘The organizations that survive
the future will be those that
are capable of changing as
fast as change itself
Gary Hamel’’

@HelenBevan
Leading change in a new era
Dominant approach Emerging direction

@HelenBevan
‘If people give to a cause, they expect a
relationship, not a transaction.’
Nilofer Merchant

@HelenBevan
“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

@HelenBevan
John Kotter, the most influential thought leader
globally, recognises new approaches are needed
FROM

@HelenBevan
John Kotter: “Accelerate!”
• We won’t create big change
through hierarchy on its own
• We need hierarchy AND network
• Many change agents, not just a
few, with many acts of
leadership
• At least 50% buy-in required
• Changing our mindset
• From “have to” to “want to”
TO

@HelenBevan
From “have to” to “want to”
Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-
of-the-cipd-online-community

@HelenBevan
Unleashing the spirit of the volunteer
You may be able to ‘buy’ a person’s back
with a paycheck, position, power or fear but a
human being’s genius, loyalty and tenacious
creativity are volunteered only.
The world’s greatest problems will be solved
by passionate, unleashed ‘volunteers’
Stephen Covey, Turn the ship around, via @MarkGraban
Source of image: www.volunteerweekly.org
‘‘
’’

@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

@HelenBevan
5 ways to lead from the edge - and thrive
1. Embrace disruption
2. Curate knowledge
3. Build bridges to
connect the
disconnected
4. Roll with resistance
5. It starts with me

@HelenBevan
is the new normal!
“By questioning existing ideas, by
opening new fields for action,
change agents actually help
organisations survive and adapt
to the 21st
Century.”
Céline Schillinger
Image by neilperkin.typepad.com

@HelenBevan
@corprebels
corporaterebelsunited.com
Across the world,
the change
agent
movement
Is exploding!
@rebelsatwork
rebelsatwork.com
@chagwwchangeagentsworldwide.com

@HelenBevan
What happens to
heretics/radicals/rebels/mavericks
in organisations?
Source of image: findingmyself.net

@HelenBevan
The 90/30 conundrum
of senior leaders say
that to create more
innovation, they need to
activate the radicals/
disruptive innovators in
their organisations or
systems
of senior leaders are
very satisfied that
radicals/innovators
can provide this value
in their organisations
or systems
Source: rebelsatwork.com

@HelenBevan
We need boatrockers!
• Rock the boat but manage to
stay in it
• Walk the fine line between
difference and fit, inside and
outside
• Able to challenge the status
quo when we see that there
could be a better way
• Conform AND rebel
• Capable of working with others
to create success NOT a
destructive troublemaker
Source: Debra Meyerson

@HelenBevan
Source : Lois Kelly www.rebelsatwork.com
There’s a big difference between a rebel
and a troublemaker
Rebel

@HelenBevan
Reflection
• What are your insights around “rebels” and
“troublemakers”?
• What moves people from being “rebel” to
“troublemaker”?
• How do we protect against this?

@HelenBevan
Probably the largest simultaneous improvement initiative in the history of healthcare
A disruptive case study
@HelenBevan #Quality2014 #f1

@HelenBevan
NHS Change Day
Aim:
to create a mass movement of grass roots NHS staff and
people who work with and use the NHS to pledge a
simple act that can contribute to better patient care

@HelenBevan
NHS Change Day 2014
More than 700,000 pledges to take action
• 81 separate Campaigns
• 86 million twitter
impressions
• 35,400 video views
• 95,000 daily reach on
Facebook
• More than 98% of the
activity through volunteers

@HelenBevan
It started with a tweet in June 2012!
Young clinical leaders
and improvement
leaders decided to start
a social movement to
improve care
Damian Roland
Stuart Sutton
Helen Bevan

@HelenBevan
Probably the only
winner of a global
challenge to develop
leaders in the
corporate world that
names Saul Alinsky
and Marshall Ganz as
major influencers

@HelenBevan
Evaluating NHS Change Day
• We’re evaluating intention
(pledging), initiation
(doing) and outcomes
(delivering)
• We’re having a celebration
day on 4th
July
• We’re developing and
testing new methods to
show impact
• We want to build new
theory of large scale
change

@HelenBevan
Change Day is spreading…….
Australia
Sweden
N Ireland
Denmark
Canada
Netherlands
Saudi Arabia
USA
Finland…….and many more

@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

@HelenBevan
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

@HelenBevan
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

@HelenBevan
Source: @NHSChangeDay
Can I, dare I?

@HelenBevan
• A virtual school
• Anyone can join
• All the resources are
completely open
• Five weeks of virtual
lectures, study guides,
materials, tweetchats
• Demonstrate learning to
earn a virtual badge
The School for Health and Care
Radicals

@HelenBevan
The School for Health and Care Radicals
More than 1,600 enrollees from 40 countries
90 volunteer mentors
Average weekly twitter reach 2.6 million
Over 25,000 shares of the slides on SlideShare
More than 10,000 shares of the study guides
More than 10,000 tweets using #SCHRchat
Storify has been viewed 2,000 times
150 people have completed full certification
so far

@HelenBevan
We learnt...
1. The core audience is different to that
which we anticipated
2. The most important need is for
connection and community
3. How to build the relationship between
tacit and explicit knowledge
4. There is a massive untapped reservoir
of energy and talent out there and the
potential is outstanding
www.changeday.nhs.uk/healthcareradicals

@HelenBevan
Leading change
from the edges
Go out to your edges.
Explore the possibilities.
Because you will find more opportunity
in the edges, where you will be able to
imagine, invent and thrive
Ayelet Baron

@HelenBevan
• Identify your own opportunities to move to
the edge
• Think about the mindset, skills and
relationships you need for the future
• Consider how you are going to enable change
at a faster rate than the outside world

@HelenBevan
References
Baron A (2014) Preparing for a changing world: the power of relationships
Bate P, Robert G, Bevan H.
The next phase of healthcare improvement: what can we learn from social mov
Quality and Safety in Health Care. 2004 Feb;13(1):62-6.
Battilano J, Casciaro T (2013)
The network secrets of the great change agents Harvard Business Review,
July-August
Bevan H, Plsek P, Winstanley (2011)
Leading Large Scale Change - Part 1, A Practical Guide
Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript
Change Agents Worldwide (2013) Moving forward with social collaboration
SlideShare
Diaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontier
Fuda P (2012) 15 qualities of a transformational change agent
Hamel G (2014)Why bureaucracy must die
Jarche, H (2013) Rebels on the edges
Jarche H (2014) Moving to the edges

@HelenBevan
References
Kotter J (2014) Accelerate! Harvard Business Review Press
Merchant N (2013) eleven rules for creating value in the social era
Llopis G (2014) Every leader must be a change agent or face extinction
Meyerson D (2001) Tempered Radicals: how people use differences to
inspire change at work Harvard
Meyerson D (2008) Rocking the boat: how to effect change without making
trouble Harvard BP
Perkins N (2014) Bats and pizzas (agility and organisational change)
Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated
Shinners C (2014) New Mindsets for the Workplace Web
Stoddard J (2014)The future of leadership
Williams B (2014) Working Out Loud: When You Do That… I Do This
Weber Shandwick (2014) Employees rising: seizing the opportunity in
employee activism
Verjans S (2013) How social media changes the way we work together

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