1.
Moving to action:
new era thinking on spreading
and scaling change
04/09/19
#nhsspread @ExpoNHS #Expo19NHS

2.
#nhsspread @ExpoNHS #Expo19NHS
Claire Roche
@claireroche19
Diane Ketley
@dianeketley
Ian Baines
@ihbaines
Helen Bevan
@helenbevan

3.
What to expect in the next 60 minutes
• Polls via Slido
• 7 principles to increase spread and scale
• The 7 principles in practice
• Co-coaching
• Model of system convening
• System convening in practice

4.
A poll
Do you know :
• The person to the right of you?
• The person to the left of you?
• The people on both sides?
• Neither of them?
Slido.com

5.
A poll
To what extent is spreading change a
challenge in your role?
A very big
challenge
Not a
challenge
Slido.com

6.
Question: describe your most
recent attempts to spread
change in a single phrase

7.
The reality of spread
#nhsspread @ExpoNHS #Expo19NHS
“Isolated islands of
improvement effect”
(lack of spread)

8.
Spread is a…
…dynamic, reciprocal
interacting, iterative and
evolving activity...not linear
and mechanistic
…developmental,
contextualised, adaptive,
learning and social process
#nhsspread @ExpoNHS #Expo19NHS

9.
What is complexity?
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Complexity

10.
7 interconnected principles
Complexity
Spread in health and care is a complex
activity occurring across a system
• Complexity around innovation, process,
context
• NHS is a complex adaptive system
• Match complexity of the approach to spread
with complexity of the situation
#nhsspread @ExpoNHS #Expo19NHS

11.
Adaptive space an interface between innovations
and the business ‘as usual’
Source: Mary Uhl-Bien
Networks/information flows
7 interconnected principles
Complexity

12.
Innovation development and spread are
interdependent
• How an innovation is developed influences
spread
• Early involvement increases commitment and
ownership
• Increased focus on role of adopters in
adaptation and spread
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Innovation Development

13.
Focus on the value rather than the
innovation
• It’s about what others will value rather than
what you want to spread
• What problem of local priority will it solve?
• What benefit will it offer?
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Value

14.
The perspective of the individual is pivotal
• Changing behaviours is hard
• The more work routines affected the greater
the spread challenge
• Generate energy for change and agency by
building motivation
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
The Individual

15.
From an
inward to
an outward
mindset
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Leadership

16.
Networks build communities, energising and
connecting individuals
• Create a “pull” for innovation by building communities
to energise individuals and maintain momentum
• Support networks and encourage connections with
other networks
• Support use of network building mechanisms; eg
platforms like WhatsApp, Slack, Facebook groups and
other social media
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Networks

17.
Knowledge flows generate learning to
enable spread
• Collate and share local feedback and
evaluation of innovation adoption and impact
• Share knowledge through networks
• Build a culture of learning and transparency,
sharing and seeking knowledge from others
#nhsspread @ExpoNHS #Expo19NHS
7 interconnected principles
Learning

18.
Select three principles that resonate for you?
Complexity
Innovation Development
Value
The Individual
Leadership
Networks
Learning
Tweet your story of any of these principles at #nhsspread
#nhsspread @ExpoNHS #Expo19NHS

19.
Applying 7 principles in practice
at the Welsh Ambulance Trust
Claire and Ian in conversation
#nhsspread @ExpoNHS #Expo19NHS

20.
#nhsspread
@ExpoNHS
#Expo19NHS

21.
Complex systems are driven by the
quality of the interactions between
the parts, not the quality of the
parts. Working on discrete parts or
processes can properly bugger up
the performance at a system level.
Never fiddle with a part unless it
also improves the system
@ComplexWales
#nhsspread @ExpoNHS #Expo19NHS

22.
Please give Claire
one piece of advice
to inform the plans
for spreading the
WAST falls
framework across
Wales
#nhsspread @ExpoNHS #Expo19NHS

23.
Table discussion
#nhsspread @ExpoNHS #Expo19NHS
Discuss your
thoughts on
what you have
heard about the
7 principles

24.
• Matching approach to spread with
complexity of the situation
• Applying the seven principles in practice
• Providing enabling activities delivered by a
team or a number of people
• All levels in the system
#nhsspread @ExpoNHS #Expo19NHS
System Convening involves

25.
An independent initiative An interdependent initiative
Improve needle
safety when taking
bloods
Improve
the emergency
response to people
in mental health
crisis
Police Voluntary
sector
Emergency
room
Mental
health
service
Supported by specific
tools & information
• Social and
collaborative
• Built on shared
purpose
• Multiple methods
Within a
clear
boundary

26.
#nhsspread @ExpoNHS #Expo19NHS
System convening and
programme management
Interdependent
We need
both to
enable
spread

27.
What system convening means
in practice
Claire and Ian in conversation
#nhsspread @ExpoNHS #Expo19NHS

28.
#nhsspread @ExpoNHS #Expo19NHS
Discuss with the
person next to you
your thoughts on what
you have heard about
system convening
then share them on
Slido Interdependent

29.
• Follow #nhsspread
• Horizons blogs https://nhshorizons.passle.net
• Spread publication early 2020
#nhsspread @ExpoNHS #Expo19NHS
Want to learn more about
this approach to spread?

30.
Thank You
#nhsspread @HorizonsNHS
Diane.ketley@nhs.net
horizonsnhs.com