Making transformation happen & creating the conditions

@helenbevan
Making transformation happen &
creating the conditions
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
3
The greatest
danger today is NOT
micro-managing:
it is MACRO-LEADING
Henry Mintzberg

@helenbevan
Change is changing

@helenbevan
Kinthi Sturtevant, IBM
13th annual Change Management
Conference
We rarely see two, three or
four year change projects
any more. Now it’s 30-60-90
day change projects

@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
Netnography
“Netnography is the branch of
ethnography that analyses the free
behaviour of individuals on the
Internet”
Paige Leidig

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

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

@helenbevan
We still organise the public sector 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
Collaborative innovation methods (“at the
edge”) are outpacing traditional R&D
Source: PWC Innovation benchmarking survey 2017

@helenbevan
Why go to the edge?
“ Leading from the edge brings us
into contact with a far wider range
of relationships, and in turn, this
increases our potential for diversity
in terms of thought, experience and
background. Diversity leads to more
disruptive thinking, faster change
and better outcomes
Aylet Baron

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

@helenbevan
Jeremy Heimens, Henry Timms
This is New Power
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship

@helenbevan
WHO will make the change happen?
List A
• The Delivery Board
• The Cabinet
• The Programme
Management Office
• The Delivery Board work
streams
• The Working Groups
• The Directors of
participating organisations
• The Change Facilitators
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
from Leandro Herrera

@helenbevan
WHO will make the change happen?
List A
• The Delivery Board
• The programme sponsors
• The Programme
Management Office
• The Delivery Board work
streams
• The Clinical Leads
• The Directors of
participating organisations
• The Change Facilitators
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
from Leandro Herrera

@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

@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
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
Systemic approaches
Performance goals
Regulation
Competition
Programme
Management
Incentive systems
Activation
Ability to make choices
Capability
Leaders everywhere
Social action
Solidarity
Social movements

@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
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
“Because we want to, not because we have to”

@helenbevan
#endpjparalysis: connected social
communities

@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)
41

@helenbevan
Big drive to bring social movement thinking
and practice into delivery
42

@helenbevan
COMPLIANT POWERFUL!
CHANGE AGENTS
WANT TO ROCK THE BOAT BUT NOT
FALL OUT?
• Starts 15th February 2018
• For 5 weeks
• Every Thursday 15.00-16.00 GMT
• Live webinar
• Recordings available
• Completely free and open to all
• Handbooks and study guides
• Meet fellow change agents from
across the globe
theedge.nhsiq.nhs.uk/school/
#S4Change
@SCH4Change
Join the

@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 /
46
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
“We learn when
we talk”
Nancy Dixon
https://t.co/t47VYkSSak
Source of image: @GraphicChange

@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
The NHS Continuing Healthcare Collaborative
approach
The Improvement
Community
All local groups
The
Development
Group
10 local groups The
Test and Scale
Group
16 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
50

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
Our latest collaboration will launch
tomorrow
Perceptions of Nursing #NurseFuture

@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
• Write down one key thing you have
learnt from this session on a sheet of
white paper
• Screw the paper up
• On the signal, throw your paper
snowball in the air
• Pick up a snowball that lands near you
and read it aloud to the people around
you
Our platform: a “Snowstorm”

Making transformation happen & creating the conditions

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