Transformational themes that will shake the world of healthcare improvement

Helen Bevan
Chief Transformation
Officer,
Horizons Group
@HelenBevan #Quality2014 #f1
10 April 2014

The story
• Framing the future in the past and
present story
• Five transformational forces that are
changing the world
• Five ways to thrive and survive in the
new world
• The future story
@@HelenBevan #Quality2014 #f1

Time present and time past
Are both perhaps present in time
future,
And time future contained in time
past.
T. S. Eliot, Four Quartets 1936

What was once……
A digital story for our time

Here between the hither and the
farther shore
While time is withdrawn, consider the
future
And the past with an equal mind
T.S Eliot, The Dry Salvages (1941)

...to the
person next
to you
@@HelenBevan #Quality2014
Tell one of your
own stories
about change
How does your past experience impact on
your view of the future?

WHAT IS HAPPENING IN THE WORLD OF CHANGE?
1. Change is happening at a faster rate
AND
is
becoming
more
disruptive
Source of image: nasu-dengaku.livejournal.com

2. New digital tools
enable us to be in
almost constant
contact with
almost everyone in
the world

3. The increasingly
complexity of the
work environment is
eroding hierarchical
management
structures/styles

4. Work is changing:
Complex work is
getting more complex
The pace of creative
work is accelerating

5. Creative processes
are moving to the
edges of our
organisations

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
@@HelenBevan #Quality2014@@HelenBevan #Quality2014 #f1

Some warnings
The organizations that survive the future
will be those that are capable of
changing as fast as change itself
Gary Hamel
If the rate of change on the outside
exceeds the change on the inside, the
end is near Jack Welch
‘‘
’’
‘‘
’’@@HelenBevan #Quality2014 #f1

In the near future, the
edges will be where almost
all high-value work will be
done in organizations…….
Organizational
development and change
management need to
move to the edges, and
quickly.
Harold Jarche (2014)
Moving to the edge

Source: @HelenBevan @@HelenBevan #Quality2014
Leading from the edge
From the centre From the edge

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

lc
Source of image: nsight2success.com

Hierarchy alone won’t deliver the changes
Source of image:
www.slideshare.net/mexicanwave/champ
ions-trolls-10-years-of-the-cipd-online-
community
John Kotter: Accelerate!

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

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

Valuing radicals
Huxley,defendingDarwin‟s
theoryofnaturalselection
“New truths begin as heresies”

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

Rebel or troublemaker?
Troublemaker Rebel
Complain Create
Me-focused Mission-focused
Anger Passion
Pessimist Optimist
Energy-sapping Energy-generating
Alienate Attract
Problems Possibilities
Alone Together
Source : Lois Kelly www.rebelsatwork.com

Discussion
• Are you are a rebel or a
troublemaker?
• What moves people from
being “radical” to
“troublemaker”?
• How do we prevent people
falling out of the boat?

Probably the largest simultaneous
improvement initiative in the history of
healthcare
A disruptive case study

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

It started with a tweet in June 2012!
Young clinical leaders and
improvement leaders
started to talk about how
they could improve care
Damian Roland
Stuart Sutton
Helen Bevan

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

NHS Change Day: vital statistics
Nearly 750,000 pledges to take
action
• 81 separate Campaigns
• 86 million twitter impressions
• 35,400 video views on YouTube and
Vimeo
• 95,000 daily reach on Facebook

Evaluating NHS Change Day
• We‟re evaluating
intention
(pledging), initiation
(doing) and their
outcomes (delivering)
• We‟re developing and
testing new methods
to show impact
• We want to build new
theory of large scale
change

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

2. Curate knowledge
Source of image: John Curran designedforlearning.co.uk

Finding things out and determining
what’s valid from what’s just noise
CURATION
…It’s about identifying networks
and communities and seeing
where the nodes and ampliﬁers sit
…It’s about quality and
coherence, not volume and mass
Julian Stodd

Because there’s a problem….
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

A big challenge for improvement leaders
Tacit knowledge is where the action is….
• It‟s the people with tacit knowledge who deliver the results
• Tacit knowledge is critical for large scale change
...but
The only way tacit
knowledge can be broadly
shared…
…is to turn it into
explicit knowledge
VERY difficult
Few organisations succeed
Gray D (2012) The Connected
Company
Source: Harold Jarche

Tacit knowledge...
“...is best developed through
conversations and social relationships”
Source of image: northcentralcollege.edu
Harold Jarche

Curating knowledge from the edge
Finding things out and keeping up to date
• “pulling” information, but also having it
“pushed” to us by trusted sources
Making sense and meaning of information
• Reflecting and putting into practice
what we have learned
• Plugging information into our own
mental models and turning it into
knowledge
Connecting and collaborating
• Sharing complex knowledge with our
own work teams
• Testing new ideas with our own networks
• Increasing connections through social
networks Source: Harold Jarche

3. Build
bridges to
connect the
disconnected

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

Diagnostic
and
dialogic
approaches
to
“resistance to change”

Resistance: a diagnostic approach
• Change is something that happens
“out there” in the organisation or
system
• Resistance is a force to overcome
• Resistance prevents change
• Change agents must diagnose,
manage and/or overcome resistance
• Resisters otherwise known as
“laggards”, “blockers”, “in denial”

Much of the resistance literature is “diagnostic”

Diagnostic: the role of the change agent
“The role of the change agent is to
recognise the causes of resistance and
address each one. If this is not
done, then the change will be much
harder to implement successfully and
may not succeed at all”
David Stonehouse
The change agent: the manager‟s role in change
British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445

Resistance: a dialogic approach
• People make their own reality
• Change results from transformational conversations
– involving more and different people in change
discussions
– altering how and which people engage with
each other
– by stimulating different perspectives to shape
how people think about things
• Resistance is an inevitable consequence of a
complex change process (based on diversity)
• Resistance should be embraced and worked with

Dialogic: the role of the change agent
1. Create the conditions for transformational
conversations by asking questions that are
focussed on future possibilities, by inviting diversity
into the system, and by being welcoming
2. Creat-e opportunities for everyone to express their
views, spot opportunities and build on each
other‟s ideas
3. Create ways for people to reflect together to find
meaning, understanding and shared purpose in
the change
Source: Peggy Holman

“The most basic not-so-secret formula for building an innovation
culture is pretty simple - embrace diversity and start to attract,
retain and promote a diverse workforce that looks differently,
works differently, dress differently, speaks differently and is
inclusive of the full spectrum of human sexual orientation and
gender identities.”
Source of image: idsgn.org
Diversity: critical to innovation
“Do this before you start hiring consultants and rethinking your
innovation process; there is no process that works without true
diversity.”
Idris Moore

5.
It starts
with me

Source of image: fistfuloftalent.com
„I do not think you
can really deal
with change
without a person
asking real
questions about
who they are and
how they belong
in the world‟
David Whyte, The Heart
Aroused (1994)

Transformational Change Agent: Peter Fuda
Skills and methods for creating
change
Ability to make sense of, and
reshape perceptions of „reality‟
Personal characteristics and
qualities

Peter Fuda’s 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 training
focuses on

Peter Fuda’s 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

A case study in “it starts with me”:
The School for Health and Care
Radicals

Source: @NHSChangeDay
Can I, dare I?

The School for Health and Care Radicals
• A virtual school
• Anyone can join
• Five weeks of virtual
lectures, study
guides, materials, tweet
chats
• Set up with three weeks
notice
• Demonstrate learning
to get a virtual badge

The School for Health and Care Radicals
 More than 1,500 enrollees from 27 countries
 Around 150 people will complete full
certification
 90 volunteer mentors
 Average weekly twitter reach 2.6 million
 Over 10,000 shares of the slides on SlideShare
 More than 2,000 shares of the study guides
 More than 5,000 tweets using #SCHRchat
 Storify has been viewed 1,000 times

We learnt...
1. There is a massive untapped reservoir of energy and
talent out there and the potential is outstanding
2. The core audience is different to that which we
anticipated
3. The most important need is for connection and
community
4. How to build the relationship between tacit and
explicit knowledge
5. It‟s early days but this is an efficient, high leverage
way to build capability for motivated individuals

2. Be a curator of knowledge
3. Bridge bridges to connect
the disconnected
4. Roll with resistance
5. It starts with me

What might be… a
digital story for the
future It’s 2020…

A call to action
• Identify your own opportunities to
move to the edge
• Think about the mindset, skills and
relationships you need for the future
• Start changing at a faster rate of than
the outside world

References
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
Feitler D (2014) The case for team diversity gets even better
Fuda P (2012) 15 qualities of a transformational change agent
Gray D (2012) The Connected Company
Hamel G (2014) The busting bureaucracy hackathon: escaping the management tax
Jarche, H (2013) Rebels on the edges
Jarche H (2014) Moving to the edges
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
Moore I (2013) Diversity is the short cut to building an innovation culture
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 SlideShare

Transformational themes that will shake the world of healthcare improvement

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Transformational themes that will shake the world of healthcare improvement