Leading real change from the front line –what can you do tomake a difference for your patients?

Steve Fairman

Managing Director, NHS Improving Quality

To start,a short story

about a fridge

Image from: @TheWorldStories

• Creating a space for getting ready for change

• Invitation to thinking differently about change

• Share the collective wisdom of people in the room – 5 minutes of wisdom

Overview

Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

…your organisation may not be ‘change friendly’…

Research from the sales industry:

• 2% of sales are made on the first contact

• 3% of sales are made on the second contact

• 5% of sales are made on the third contact

• 10% of sales are made on the fourth contact

• 80% of sales are made on the fifth to twelfthcontact

Source: http://www.slideshare.net/bryandaly/go-for-no

Source: @NHSChangeDay

Employee resistance is the most common

reason executives cite for the failure

of big organizational-change efforts

Scott Keller and Colin Price (2011), Beyond Performance: How Great Organizations Build

Ultimate Competitive Advantage Source of image: Businessconjunctions.com

The NHS Change Challenge

• The World’s first mass crowd-sourcing event focused on improving healthcare

• 14,000 contributions

• 10 Barriers to change identified

• 11 Building Blocks for change identified

• 17 practical solutions built by contributors

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

The 10 barriers to change identified by 14,000 contributions from front line staff

The 11 building blocks for change identified by 14,000 contributions from front line staff

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

A Solution:Everybody’s ideas on board

• Simple and easy

• A place to pose questions about delivery of your service, or staff or patient experience

• A place anyone can post responses

• Locally owned improvement plans!

Everybody’s ideas on board (2)

A Solution:Use a Change Model

• No one model has all the answers

• A mental framework and a process that can help

• Use evidence of what makes change successful

• Helpful to see the change through different lenses

Use a Change Model (2)

Bigger picture / longer term thinking

Poor workforce planning

Poor project management

A Solution:An online NHS Forum

• The NHS is terrible at shouting about its successes

• More wheels are reinvented by the NHS than by Ford

• Share!

An online NHS Forum (2)

Inhibiting environment

A Solution:Empower everyone to be a change agent

• It’s easy to feel isolated if you want to change things

• Build everyone’s QI skills and confidence and willingness to take on a challenge as an antidote

• Resistance to change will fall…

Empower everyone to be a change agent (2)

Flexibility and adaptability Playing it safe

Poor workforce planning

Source: @NHSChangeDay

Source: @NHSChangeDay

What is the issue here?

“permission” ? (externally generated)

or

Self efficacy ? (internally generated)

Building self-efficacy: some tactics

1. Create change one small step at a time

2. Reframe your thinking: failed attempts are learning opportunities

3. Make change routine rather

than an exceptional activity

4. Get social support

5. Learn from the best

Self-efficacy

There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change

and get good outcomes

Source of image:www.h3daily.com

“Thousands of patients have died

needlessly because of a damaging reluctance amongst doctors and the public to accept changes in the NHS,

according to the country’s top emergency doctor

“

5 Questions for to take away for reflection

1. What are the opportunities for me to build my perspectives and skills as an agent of change?

2. How can I build self efficacy as a change agent?

3. How do I move beyond skills and knowledge of change to live and be change?

4. Who can help and support me as a change agent?

5. What are the implications for the way I work?

Thank you