Being ready for change

@helenbevan
Being ready for change
Source of image: @voinonen
:

@helenbevan
The Horizons team:
Change agents and change agency
• A small, diverse team of people within
the English National Health Service
• We tune into the latest change thinking
and practice in healthcare and other
industries around the world –
translating this learning into practical
approaches to change
• The team has emerged through years of supporting
change in the NHS and the wider health and care system

@helenbevan
Change AGENCY definition:
The power, individually and collectively, to make
a positive difference. It is about pushing the
boundaries of what is possible, mobilising
others and making change happen more quickly
Change AGENT definition:
Someone who is actively developing the skills,
confidence, power, relationships and courage to
make a positive difference

@helenbevan
• Being a change agent in a fast-moving
world
• Networks AND hierarchies
• Structure AND agency
• Energy for change
• An unconference

@helenbevan
In the spirit of the session
How are YOU preparing for change?

@helenbevan
6
https://www.england.nhs.uk/wp-content/uploads/2017/09/practical-guide-large-scale-change-nov17.pdf

@helenbevan
Beware the chasm!
Source of image: @voinonen

@helenbevan
End of
Moore’s Law

@helenbevan
“Many times experts fail because
they are experts in the past version
of the world”
Vikram Khosia

@helenbevan
We need change agents to illuminate
the way!
We need more people willing to step outside of
expectations because our world is changing
exponentially, and if all we do is meet
expectations and the status quo - we will fall
behind as organisations, as teams, and as
societies.
David Bray
WE CAN DO IT

@helenbevan
We still organise healthcare like the
Tabulating Machine Co. of 1917
Source of image: @corp_rebels

@helenbevan
Three time points of collaboration among
cancer clinicians and researchers
from Braithwaite and colleagues 2017

@helenbevan
Source: World Economic Forum goo.gl/VDSnhA

@helenbevan
The skills for 2030
Nesta, Pearson and the Martin Oxford School: The future of skills: employment in 2030
Judgment and decision
making: Considering the
relative costs and benefits of
potential actions to choose
the most appropriate one.
Fluency of ideas: The
ability to come up with a
number of ideas about a
topic (the number of ideas
is important, not their
quality, correctness, or
creativity).
Active learning: Learning
strategies—selecting and
using training/instructional
methods and procedures
appropriate for the situation
when learning or teaching
new things.
Originality: The ability
to come up with unusual
or clever ideas about a
given topic or situation, or
to develop creative ways
to solve a problem
Learning strategies:
Understanding the
implications of new
information for both current
and future problem-solving
and decision-making.
Graphics by @scriberian

@helenbevan
Horizontal development:
• Adding more knowledge, skills, and
competencies
• It’s about what you think
• Transmitted through experts
Vertical development:
• Ability to think in more complex, systemic,
strategic and interdependent ways
• It’s about how you think
• Learnt through experience
In the era of disruption, we need to
focus on vertical development for
change agents as well as horizontal

@helenbevan
Stages of vertical development for change agents
Levelof
development
Time
 I’m a team player
 follow others
faithfully
 rely on formal
authority
 align with others
 stick to
methodologies
and/or project
management
approaches
Dependent /conformer
change agent
What I do:
Source: adapted from Center for Creative Leadership

@helenbevan
Levelof
development
Time
 follow others
faithfully
 rely on “old power”
authority
 stick to
methodologies
and/or project
management
approaches
 think in an
independent way
 I’m self-directed
 drive the agenda
 I’m guided by my
own values
 take a stand for
the things I
believe in
 spark and initiate
change
change agent
What I do:
Independent/achiever
change agent
What I do:

@helenbevan
Levelof
development
Time
 follow others
faithfully
 rely on “old power”
authority
 stick to
methodologies
and/or project
management
approaches
 think in an
independent way
 I’m self-directed
 drive the agenda
 I’m guided by my
own values
 take a stand for
the things I
believe in
 spark and initiate
change
 think in inter-
dependent ways
 see systems,
patterns and
connections
 think for the long
term
 hold multiple
perspectives at the
same time
 I’m comfortable with
tensions, paradox
and contradictions
 Lead transformation
change agent
What I do:
Independent/achiever
change agent
What I do:
Inter-dependent/collaborator
change agent
What I do:

@helenbevan
Connect with the 3%
Just 3% of people in the organisation or
system influence 85% of the other people
Source: research by Innovisor

@helenbevan
The 3% rule also appears true for
social media
Source: research by Graham MacKenzie using NodeXL
In health and
healthcare globally,
tweets by 3.3% of
tweeters accounted
for 85% of retweets

@helenbevan
Most social media operates within an
echo chamber
Source of image: Scriberia

@helenbevan
The powerful medical “superconnectors”
Source: NodeXL analysis:

@helenbevan
Collaborative innovation methods are
outpacing traditional R&D
Source: PWC Innovation benchmarking survey 2017

@helenbevan #ILN
It’s an issue of power
Power is one’s
ability to achieve
goals
Bertrand Russell

@helenbevan
Jeremy Heimens, Henry Timms New Power: How it’s changing the 21st Century and why you
need to know (2018)
new power
Current
Made by many
Pulled in
Shared
Open
Relationship
old power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction

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

@helenbevan #ILN
The Network Secrets of Great
Change Agents
Julie Battilana &Tiziana Casciaro
As a change agent, my centrality in
the informal network is more
important than my position in the
formal hierarchy

@helenbevan #ILN
People who are highly connected
have twice as much power to
influence change as people with
hierarchical power
Leandro Herrero
http://t.co/Du6zCbrDBC

@helenbevan
WHO will make the change happen?
List A
• The Delivery Board
• The senior sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Working Groups
• The Directors of
participating organisations
• The Change Facilitators
Source: adapted by Helen Bevan
from Leandro Herrera

@helenbevan
List A
• The senior sponsors
• The Programme
Management Office
streams
• The Working Groups
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who spread
behaviours, role model at a scale,
set mountains on fire and multiply
anything they get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
onesSource: adapted by Helen Bevan

@helenbevan
List A
• The programme sponsors
• The Programme
Management Office
streams
• The Clinical Leads
List B
• The mavericks and rebels
• The deviants (positive). Who do
things differently and succeed
• The nonconformists who see
things through glasses no one else
has
• The hyper-connected who spread
behaviours, role model at a scale,
set mountains on fire and multiply
anything they get their hands on
• The hyper-trusted. Multiple
reasons, doesn’t matter which
ones
Source: adapted by Helen Bevan

@helenbevan
What’s the evidence?
The failure of large scale
transformational change projects is
rarely due to the content or
structure of the plans that are put
into action
To make transformational change
happen we need to connect networks
of people who ‘want’ to contribute
http://iedp.com/articles/vertical-leadership/?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=13787-
257163-Campaign+-+01%2F09%2F2016
Source: David Dinwoodie (2015)
It’s much more about the role
of informal networks in the
organisations and systems
affected by change

@helenbevan
Do you remember that 3% of people in an
organisation influence 85% of other
people?
Most of them are NOT people on list A
Formal leaders typically make up 12% of an
organisation and drive conversations with
55% of other people
Source: Innovisor

#S4CA @Sch4Change
We need rebels!
•The principal champion of a change initiative,
cause or action
•Rebels don’t wait for permission to lead,
innovate, strategise
•They are responsible; they do what is right
•They name things that others
don’t see yet
•They point to new horizons
•Without rebels, the storyline never
changes
Source : @PeterVan http://t.co/6CQtA4wUv1

#S4CA @Sch4Change
If you put fences around people,
you get sheep. Give people the
room they need.
William L McKnight

#S4CA @Sch4Change
What happens to
rebels/heretics/radicals/mavericks
in organisations?
Source of image: thinglink.com
?

#S4CA @Sch4ChangeSource: Lois Kelly http://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out

#S4CA @Sch4Change
We need to be boatrockers!
Source: Debra Meyerson
• 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
perceived by others as a
destructive troublemaker

#S4CA @Sch4Change
Source: adapted from Rebels at Work

#S4CA @Sch4Change
“A cynic, after all, is a
passionate person who
does not want to be
disappointed again.”
Source of graphic: Benjamin Zander’s TED talk

#S4CA @Sch4Change
Source of image: Tord the Meme
by Marley Bryn
The world
feels terrible
if I choose to
distrust it
Marcella Bremer

#S4CA @Sch4Change
Reflection
• What are your insights around “boatrocking”
and “falling out”?
• What moves people from being “boatrockers”
to “falling out”?
• How do we protect against this?

#S4CA @Sch4Change
More reading
Source of graphic : Umair Haque
Lois Kelly and Carmen Medina The rebel at work
handbook
Harvey Schachter How to be a rebel, not a
troublemaker at work
Debra Meyerson Tempered radicals: how people use
difference to inspire change at work
Jane Watson A spotter’s guide to rebels and cynics
Umair Haque How to be more loving in a cynical world
Clark Quinn Skeptical optimist or hopeful cynic? A
science mindset
Marcella Bremer Cynicism or opticism?

#S4CA @Sch4Change
Change starts with me
Source of image: jasonkeath.com

#S4CA @Sch4Change
We are not outside of the
change:
we ARE the change
Source of graphic: Reos Partners

#S4CA @Sch4Change
The success of our actions as change-
makers does not depend on what we do or
how we do it, but on the inner place from
which we operate”
Otto Scharmer
Leading from the emerging future

#S4CA @Sch4Change
1. able to join forces with others to create
action
2. able to achieve small wins which create a
sense of hope, possibility and confidence
3. strong sense of agency
 belief that I am personally able/have the power
to create the change
4. more likely to view obstacles as
challenges to overcome
Four things we know about
successful boat rockers
Source: adapted from Debra E Meyerson

#S4CA @Sch4Change
Being a great change agent is about
doing, seeing and being change

#S4CA @Sch4Change
Avedis Donabedian
Ultimately, the secret
of quality is love…
If you have love, you
can then work
backward to monitor
and improve the
system

#S4CA @Sch4Change
Tactic for change agents:
Out-love everyone else
Source of image: Bradley Burgess

@helenbevan
Mark Jaben on the science behind resistance
What NOT to do
But what we do do
Engage
people here

@helenbevan
Mark Jaben on the science behind resistance to change
What NOT to do
(but what we usually do)
We don’t need buyers (who “buy-in” to change)
We need investors
What TO do
Engage
people here
Engage
people here

@helenbevan
A big debate in social science
Structure versus Agency

@helenbevan
The predominant approach in recent years has been STRUCTURE
but globally there is a big shift towards AGENCY
The design dilemma at the heart of change
Restructuring
Performance goals
Compliance
Regulation
Competition
Programme
Management
Incentive systems
Activation
Ability to make choices
Capability
Leaders everywhere
Social action
Solidarity
Social movements

@helenbevan
Power is linked to AGENCY
• The capacity of individuals to make their own
choices and to take action in a given environment
• Words that are connected to agency:
• Action
• Activity
• Effect
• Influence
• Power
• Choice

@helenbevan
Source: @NHSChangeDay
64

@helenbevan
65

@helenbevan
Problematic:
changing a
“permission
culture” can
take years
The good news:
we can usually
build agency
much more
quickly
66

@helenbevan
Making sure that only people
who should be in hospital are
in hospital
• The number of hospital beds occupied by
patients whose transfer of care has been delayed
should be reduced to 3.5%
• Less than 15% of assessments [for continuing
care] should take place in an acute hospital
setting;
• a standardised performance dashboard

@helenbevan
Royal Devon and Exeter Hospital

@helenbevan
University Hospitals Morecombe Bay

@helenbevan
East Sussex Healthcare

@helenbevan #ILN
“Because we want to, not because we have to”

@helenbevan #ILN
#endpjparalysis: connected social
communities

@helenbevan
Building agency: some tactics
1. Create change one small step at a time
2. Reframe your thinking:
• failed attempts are learning opportunities
• uncertainty becomes curiousity
3. Make change routine rather than an exceptional
activity
4. Get social support
5. Learn from the best

@helenbevan
Individual AND collective agency
Individual agency:
People get more power
and control in their own
lives: activation, shared
decision-making and self-
care
Collective agency:
People act together,
united by a common
cause, harnessing the
power and influence of
the group and building
mutual trust

@helenbevan
Building agency for large scale change
We do not become transformed alone, we
become transformed when we’re in relationship
with others
Hahrie Han
Source of image: Idahoc Community Action

@helenbevan Source: Jason Leitch and Derek Feeley

@helenbevan
New Public
Passion:
a growing
global
movement

@helenbevan
http://biggerboat.org/exploring-moodocs/
MOODOCs
(Massive, Online, Open, Disease Oriented Communities)
80

@helenbevan
Big drive to bring social movement thinking
and practice into delivery
81

@helenbevan
The capacity and drive of a team,
organisation or system to act and
make the differences necessary to
achieve its goals
In the new era, building energy for change
is a BIG priority
‘
“Energy for change” defined as
https://bcpsqc.ca/documents/sites/2/2013/07
/Further-Reading-Building-and-aligning-
energy-for-change-v2-Feb-131.pdf

@helenbevan
There is a relationship between high energy
and high performance
Teams with HIGH productive energy scored
higher on:
• overall performance - 14% higher
• productivity – 17%
• efficiency – 14%
• user satisfaction – 6%
• user loyalty – 12%
Research by Bruch and Vogel
@HelenBevan #improveUEC

@helenbevan
Psychological
Physical
Spiritual
Social Intellectual
Teams perform best when five energies
are high
Source: http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html

@helenbevan
Social energy
Energy of personal
engagement, relationships and
connections between people
It’s where people feel a sense of
“us and us”
rather than
“us and them”

@helenbevan
Spiritual energy
Energy of commitment to a common
vision for the future, driven by shared
values and a higher purpose
Gives people the confidence to move towards a
different future that is more compelling than
the status quo
@HelenBevan #Quality2017

@helenbevan@HelenBevan #improveUEC

@helenbevan
Psychological energy
Energy of courage, resilience and feeling
safe to do things differently
Involves feeling supported to make a change and
trust in leadership and direction

@helenbevan
Physical energy
Energy of action, getting
things done and making
progress
The flexible, responsive drive
to make things happen

@helenbevan
Intellectual energy
Energy of analysis, planning and thinking
Involves gaining insight as well as planning and
supporting processes, evaluation, and arguing a
case on the basis of logic/ evidence

@helenbevan
High and low ends of each energy domain
Social isolated solidarity
Spiritual uncommitted higher purpose
Psychological risky safe
Physical fatigue vitality
Intellectual Illogical reason
LOW
HIGH

@helenbevan
Some questions
• Which group likely to have
higher spiritual energy
scores:
– clinicians
– non clinicians
• Nearer to CEO in the
structure:
higher or lower overall
energy scores?
Source: Respondents to the energy for change questionnaire NHSIQ/Horizons team

@helenbevan
Some questions
• Which group likely to have
higher spiritual energy
scores:
– clinicians
– non clinicians
• Nearer to CEO in the
structure:
higher or lower overall
energy scores?
Source: Respondents to the energy for change questionnaire NHSIQ/Horizons team
Answers:

@helenbevan
1
2
3
4
5
Social
Spiritual
PsychologicalPhysical
Intellectual
Energy for change team profile 1:

@helenbevan
Energy for change team profile 2:

@helenbevan
The challenge of too much intellectual
energy
• Intellectual energy on
its own isn’t
transformational
• It keeps leaders in
their comfort zone
(intellect to intellect)
• Common values drive
behaviour change
more than data
http://www.newyorker.com/magazine/2017/02/27/why-facts-dont-change-our-minds
You can’t change fundamental behaviours without changing fundamental beliefs

@helenbevan
Where’s the energy for change in your team?

@helenbevan
The era of the PLATFORM
Platforms today power learning and innovation
at the speed of change by providing
collaborative and sometimes exponentially
productive spaces for people to create value
John Hagel
Source of image: Pinipa

@helenbevan
We are witnessing the collapse of expertise
and rise of collaborative sensemaking
David Holzmer
Source of image: ACCA

@helenbevan
The implosion of trust
Source: http://www.edelman.com/news/2017-edelman-trust-barometer-reveals-global-implosion /
102
Peers are now as credible as experts

@helenbevan
• 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”

@helenbevan
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

@helenbevan
http://www.nancydixonblog.com/2017/07/the-
hidden-knowledge-problem-in-organizations.html

@helenbevan
Source: Michael Arena, Rob Cross,
Jonathan Sims, and Mary Uhl-Bien (2017)
It’s about creating “adaptive spaces” that
allow ideas, information, and resources to
flow across the system and spur
improvement
Operational
system
Pockets of
improvement activity

@helenbevan
The NHS Continuing Healthcare Collaborative
approach
The Improvement
Community
200 local groups
The
Development
Group
10 local groups
1000 participants
£100,000 saved
per meeting cycle
1000 ideas and
contributions in 45
minutes
Designed to engage a mass of contributors
right from the start and make the process of
spread much easier
107

0
5
10
1 2 3 4 5 6 7 8 9 10
Your confidence in making changes
Before Now
0
2
4
6
1 2 3 4 5 6 7 8 9 10
How connected are you with other
people who work in this area?
Before Now

@helenbevan
#NurseFuture nhs70.crowdicity.com

@helenbevan
Google image
search using the
word ‘nurse’
Google image
search using the
word ‘doctor’

@helenbevan
The Change Challenge
Tapping the collective brilliance
of the NHS

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

@helenbevan
A global survey by Gallup into the reasons why
change initiatives fail, identified the same issue
Increasing number of messages
as information cascade through
the organisation
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-fail-
don.aspx

14,000 contributions identified
11 building blocks for change:
Inspiring & supportive
leadership
Collaborative 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

@helenbevan
After years of intensive analysis,
Google discovered that the key to high
performing teams that deliver change is
being nice
Project Aristotle:
https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja-
xoaZybvz9f0b1_6bJyG7zZO6L

@helenbevan
1. Frame issues in ways that will engage and mobilise the
imagination, energy and will of a lot of different people
2. Take steps to be social leaders, investing in digital skills and
social connections and leading through networks as well as
formal leadership systems
3. Align structure and agency
4. Find your B-listers and give them important tasks
5. Create spaces (“platforms”) for people to connect and take
action
6. Adopt emergent approaches to planning and design, based
on monitoring progress, learning and adapting as you go
7. Be the change
Ideas for
116

@helenbevan
Unconferences uncover tacit knowledge
Explicit
knowledge
Tacit
knowledge
Codified
knowledge
Found in documents,
databases, toolkits, quality
standards
Essential for transfer and
storage
Intuitive
knowledge and
know-how
Rooted in context, experience,
Practice and values
Hard to communicate
Most valuable kind of knowledge for
innovation and improvement
Most likely to lead to breakthroughs

@helenbevan
Our unconference process
• Given the issues we are addressing in this workshop,
what topic would you like to discuss further today?
• We want you to pitch for a topic and then explore it
with other people
• It should be a topic that we need to take action on over
the next twelve months
• Write your topic on a sheet of paper get ready to make
a 30 second pitch

@helenbevan
The unconference:
4 principles and a law
Principles:
1. Whoever comes are the right people
2. Whatever happens is the only thing that could
have happened.
3. When it starts is the right time
4. When it's over it's over
The Law is known as the Law of Two Feet:
"If you find yourself in a situation where you are not
contributing or learning, move somewhere where
you can."

@helenbevan
Our finale: “Snowstorm”
• Write down one key thing you have
learnt from this workshop on a sheet of
white paper

@helenbevan
white paper
• Screw the paper up

@helenbevan
white paper
• On the signal, throw your paper
snowball in the air

@helenbevan
• Write down one key thing you have learnt
from this workshop on a sheet of white
paper
• On the signal, throw your paper snowball in
the air
• Pick up a snowball that lands near you and
read it aloud to the rest of your table

Being ready for change

Recommandé

Recommandé

Contenu connexe

Similaire à Being ready for change

Similaire à Being ready for change (20)

Plus de Helen Bevan

Plus de Helen Bevan (20)

Dernier

Dernier (20)

Being ready for change

Notes de l'éditeur