1.
theedge.nhsiq.nhs.uk/school/
Module 4: Making Change Happen
@Sch4Change #S4CA
team
Brought to you by the

2.
The team today
School Lead:
Helen Bevan
@HelenBevan
Lead
facilitator:
Pip Hardy
@PilgrimPip
Technical Support
Joanna Hemming
@JoannaHemming
Paul Woodley
@PaulWoodley4
Olly Benson
@OllyBenson
Kate Pound
@KateSlater2
Chat Room Monitors
Kathryn Perera
@Kathrynperera
Twitter Monitors
Louis Warner
@LouisWHorizons
Leigh Kendall
@leighakendall

3.
• Please use the chat box to contribute continuously during the talk
• Please tweet using hashtag #S4CA and the handle @Sch4Change
• Send a request to join our Facebook group School for Change Agents
https://www.facebook.com/sch4change/
• We will produce summaries of each module discussion using Steller and
put on the website
Joining in today…and beyond

4.
16th February: Being a change agent: change
begins with me
23rd February: From me to we: making
connections and building communities
2nd March: Rolling with resistance
9th March: Making change happen
16th March: Moving beyond the edge
Each week we’ll cover different
change agent capabilities
Source of image: thenounproject.com

5.
Nurses, Midwives and Allied Health Professionals
Use the school experience as part of your CPD reflective account
for revalidation
Doctors
We have applied for CPD credits for the school
Certification and Continuing
Professional Development
Everyone
If you watch all five of the talks and
demonstrate you have applied the
learning, you can apply to become a
certificated change agent (and it’s free).

6.
• Email to join the RCT england.si-
horizons@nhs.net
• We will randomly match you with
another participant in the School
for Change Agents from
anywhere in the world
• At some time in the next four
weeks, arrange to have a
conversation over Skype (or other
communication system) with a
cup of coffee!
Randomised Coffee Trials
Image source: Pinterest

7.
7
To what extent did the last change
initiative you were engaged with
deliver all its objectives?
1 = delivered very little
10 = delivered all its objectives

8.
• understanding why many change efforts fail to
deliver their intended benefits
• considering barriers and building blocks to change
• recognising the need to align intrinsic and extrinsic
motivators for change
• building joy at work
• appreciating energy for change
• avoiding “de facto” purpose
Change agent capabilities in
module 4
Source of image: thenounproject.com

9.
Source of image: Whatsthebigideascwartzy.blogspot.com
Why is
often quoted in the field of change
leadership?

10.
From Deloitte
“Demystifying change management”

11.
Most change programmes fail to
deliver their objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
70%
25%
5%
Gets anywhere near
achieving the
change and
delivering the
benefits

12.
Most change programmes fail to
deliver their objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
70%
25%
5% Delivers and
sustains the change

13.
Source: McKinsey Performance Transformation Survey
Reasons for failure in large scale
improvement programmes

14.
Some authors question
the 70% figure

15.
Source: 2016 Chartered Institute of Management Quality of Working Life study
Across the UK, poorly led change
programmes are damaging morale and the
performance of organisations

16.
It is our contention that most change efforts are built upon
the shaky foundation of five flawed assumptions; that
change can be managed, that human beings are objective,
that there are ‘X’ steps to change, that we have a neutral
starting point for change, and that change, itself, is the goal
Peter Fuda
http://www.peterfuda.com/wp-content/themes/peterfuda-
bootstrap/content/Why-Change-Efforts-Fail.pdf
Source of image: Whatsthebigideascwartzy.blogspot.com

17.
The old power/new power
framework has been a thread
through every module so far:
Jeremy Heimens, Henry Timms
This is New Power

18.
Economic resources
diminish with use
• money
• materials
• technology
Natural resources
grow with use
• relationships
• commitment
• community
Based on principles from Albert
Hirschman and Marshall Ganz
Let’s think about resources for
change inold/new power terms

19.
Source: How can asset mapping improve community health?
An asset map from the Institute
for Healthcare Improvement

20.
Change is not the goal;
the goal is the goal
Peter Fuda
Source of image:
timemanagementninja.com

21.
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
Source: Health Service Journal, Nursing Times, NHS Improving
Quality, “Change Challenge” March 2015

22.
Front line teams get inundated with high priority
messages from leaders each day, making it
difficult for them to know what to focus on
Increasing number of messages
as information cascade through
the organisation
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-fail-
don.aspx

23.
Front line teams get inundated with high priority
messages from leaders each day, making it
difficult for them to know what to focus on
Increasing number of messages
as information cascade through
the organisation
Source: adapted from
http://businessjournal.gallup.com/content/162707/change-initiatives-fail-
don.aspx
Buy in from front line staff is critical
for improvements in quality and safety
Don’t overload them
http://healthaffairs.org/blog/2014/03/07/the-
dangers-of-quality-improvement-overload-insights-
from-the-field/

24.
Poll: Which of these have been blocks
for you in the last 12 months?
Confusing strategies
Over controlling
leadership
Perverse incentivesStifling innovation
Poor workforce
planning
One way
communication
Inhibiting
environment
Undervaluing staff
Poor project
management
Playing it safe
Source: Health Service Journal, Nursing Times, NHS Improving
Quality, “Change Challenge” March 2015

25.
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
14,000 contributions identified
11 building blocks for change:

26.
Poll: Which of these factors are
present in your situation now?
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

27.
How to make change happen
• Make people feel
something
• Emphasise progress
• Stop bribing
• Start a cult (a group
unified by a provocative
idea)
Source: How to motivate people: four steps backed by science

28.
• Teresa Amabile, Harvard
Business School: studied the
"inner work life" diaries of 238
professionals
• Best days were when they were
able to move forward in their
work
• 700 managers were asked to
rank five employee motivators,
including recognition and
incentives. They ranked
progress last
Emphasise progress
Source: The Progress Principle: Using Small Wins to
Ignite Joy, Engagement, and Creativity at Work

29.
Rewards
Mandated
quality
standards
Incentive
systems
Pressure
to perform
Compliance
Recognition
Awards
Source: adapted from commons.grd.msu.ed
Competition
Extrinsic versus intrinsic
motivation

30.
Tapping into intrinsic motivation
is critical to ongoing, large scale
change
Emilia Wietrak External incentives and internal motivation – a perfect
pairing to boost work performance!
• Works best for straightforward,
repetitive tasks
• Build meaning and understanding
of performance, tie extrinsic
motivators closely to specific
performance and reward teams
• Works best for complex tasks that
need personal investment,
absorption and focus on quality
• Increase intrinsic motivation by
making people feel competent/self-
efficacious (module1) and giving
them more autonomy
Internally motivated people who enjoy what they do RARELY
perform poorly
Joy at work /intrinsic motivation RARELY appear in isolation

31.
Intrinsic
motivators
build energy
and creativity

32.
Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy
and creativity

33.
Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy
and creativity create focus &
momentum for
delivery
Drivers
of extrinsic
motivation

34.
Drivers
of extrinsic
motivation
create focus &
momentum for
delivery
Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy
and creativity
•System drivers &
incentives
•Payment by results
•Performance
management
•Measurement for
accountability

35.
Internal
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy and
creativity
Drivers of
extrinsic
motivation
•System drivers &
incentives
•Performance
management
•Measurement for
accountability
create & focus
momentum for
delivery

36.
The Change Model
Source: The
Change Model
Zoe Lord

37.
Priority area: Reducing inappropriate use of anti-psychotic drugs for people
with Learning Disabilities in our inpatient unit
What outcomes do we seek?
Our Shared Purpose
Is there a sense of shared
purpose amongst our key
stakeholders?
The shared purpose is to
improve the quality of life
for people with learning
disabilities by reducing the
over reliance on
antipsychotic drugs.
Leadership by all
Do all our leaders have the skills
to create transformational
change?
Psychiatrists
Lead commissioner
Clinical Lead
Managers
Clinical staff
Support staff /carers
Therapies
Patients, families, carers,
advocates
Motivate and Mobilise
Are we engaging and mobilising
all the right people?
Patient , carer and family groups,
related charities
Medication group
Psychiatrists
Local improvement group
Local patient advocate group
Therapies staff
Commissioners
Spread and Adoption
Are we designing for the active
spread of innovation?
Medicines Optimisation Toolkit
Induction pack
National campaigns
How to Guides – benefits and
practical application
Project and performance
Management
Do we have an effective
approach for delivery of change
and monitoring of progress
towards our planned objectives?
Inclusion in all team meetings
Risk & Issues Log
System Drivers
Are our processes, incentives
and systems aligned to enable
change?
National Guidance
National Publication
Improvement tools
Are we using an evidence-based
quality improvement
methodology?
YES. Using the Trust’s quality
improvement tools package
Measurement
Are we measuring the outcome
of the change continuously and
transparently?
Baseline data re number on
medication, medication used
and why medication is being
used.
Regular data collection
Regional and national data.

38.
“The change model is a structure that helped the
team to understand what we are all trying to
achieve, where we needed to focus more of our
attention and how to achieve it. It helped the team
to work together. I encourage more teams to use
the change model to achieve successful change.”
Parent of James

39.
Two kinds of people at work
• Feel connected to a higher
purpose
• Controlled & coordinated
through shared goals & values
• Collaborate
• Embrace change
• Work to who they are
The contributors The compliant
• Feel disconnected from purpose
• Controlled & coordinated through
performance management &
standardised procedures
• Hold back
• Resist change
• Work to a role specification
Adapted from The Emotional Economy
http://emotionaleconomy.com.au/papers-articles/why-the-winners-
in-business-are-taking-the-time-to-build-a-positive-kind-social-
culture/

40.
Two kinds of people at work
The compliant
• Feel connected to a higher
purpose
• Controlled & coordinated
through shared goals & values
• Collaborate
• Embrace change
• Work to who they are
The contributors
Gallup global research:
• Only 13% of the workforce are
engaged (contributors)
• Contributors create six times the
value to an organisation
compared to the compliant
http://www.gallup.com/poll/165269/worldwide-
employees-engaged-work.aspx

41.
The 3rd curve of change

42.
New Public
Passion:
a growing
global
movement

43.
The capacity and drive of a team,
organisation or system to act and
make the difference necessary to
achieve its goals
Energy for change
http://www.institute.nhs.uk/tools/energ
y_for_change/energy_for_change_.html

44.
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
Why is energy for change important?
Source: http://www.nhsiq.nhs.uk/8530.aspx

45.
Typically, around any change effort, there is an
initial spike of tangible energy, and change, but
when leadership loses interest, the momentum
of change slows down drastically.”
Tara Paluck

46.
Overall performance - 14% higher
• productivity – 17%
• efficiency – 14%
• customer satisfaction – 6%
• customer loyalty – 12%
Teams and organisations with high energy score
higher on every dimension of performance
Source: Bruch and Vogel

47.
Change is most likely to happen
when five energies are high
Psychologic
al
Physical
Spiritual
Social Intellectual
Source: http://www.institute.nhs.uk/tools/
energy_for_change/energy_for_change_.html

48.
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”
Social energy

49.
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
Spiritual energy

50.
Energy of courage, resilience and feeling
safe to do things differently
Involves feeling supported to make a change and
trust in leadership and direction
Psychological energy

51.
Project Aristotle: http://qz.com/625870/after-years-of-
intensive-analysis-google-discovers-the-key-to-good-
teamwork-is-being-nice/
After years of intensive analysis, Google
discovers that the key to high performing,
teams that deliver change is
psychological safety

52.
Energy of action, getting things done and
making progress
The flexible, responsive drive to make things
happen
Physical energy

53.
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

54.
Social isolated solidarity
Spiritual uncommitted higher purpose
Psychological risky safe
Physical fatigue vitality
Intellectual Illogical reason
High and low ends of each
energy domain
LOW
HIGH

55.
Which one of these energies do you
think is disproportionately high
(compared to the other energies) in
senior leadership teams in health
and care?
56
• Social
• Spiritual
• Psychological
• Physical
• Intellectual

56.
• Intellectual energy on its own isn’t
transformational
• It keeps leaders in their comfort zone (intellect
to intellect)
The challenge of disproportionately
high intellectual energy
Emotion is the fuel for change;
data and information provide
direction
Dan Heath
(author of Switch)

57.
• Which group likely to have
higher spiritual energy
scores:
• clinicians
• non clinicians
• Nearer to CEO in the
structure:
higher or lower overall
energy scores?
Some more questions
Source: Respondents to the energy for change questionnaire NHSIQ/Horizons team

58.
Energy analysis of six large scale
transformation plans

59.
Energy analysis of six large scale
transformation plans
Source: energy for change discourse analysis of six STP plans by the Horizons team

60.
Energy analysis of six large scale
transformation plans
Source: energy for change discourse analysis of six STP plans by the Horizons team

61.
What happens when we don’t build a
proportionate amount of social and
spiritual energy in our change efforts?

62.
“As a leader, think of yourself as a “signal generator” whose
words and actions are constantly being scrutinised and
interpreted, especially by those below you” [in the
hierarchy]…..
Signal generators reduce uncertainty and ambiguity about what
is important and how to act”
Charles O’Reilly, Leaders in Difficult Times
As leaders and change agents, we
are “signal generators”
Source of image:
vintage-radio.com
What leaders pay attention to
matters to staff, and
consequently staff pay attention
to that too

63.
Avoiding “de facto” purpose
• hitting a target
• reducing costs
• reducing length of stay
• eliminating waste
• completing activities within a
timescale
• complying with regulators
Source: Delivering Public Services That Work: The Vanguard
Method in the Public Sector
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
PURPOSE
The difference between
having a purpose and a shared
purpose is that shared purpose
is owned everyone who has a
stake in the change and
improvement we are seeking
to create
SHARED
PURPOSE

64.
[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
We need to go beyond “buy-in”. We
don’t need buyers, we need
investors
Mark Jaben
We can build shared purpose
through social and spiritual energy

65.
....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

66.
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number, you will be transferred there
• If you haven’t registered with a room, we are offering
a separate phone conference that you can join:
0800 917 1950
33136606#
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67.
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