Module 4 - Making change happen

#NHSChangeDay #SHCRchat

The School for Health and Care Radicals

www.changeday.nhs.uk/healthcareradicals

Module 4: Making change happen

Supported by

#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat

www.changeday.nhs.uk

http://www.changeday.nhs.uk/


Please use the chat box to contribute continuously during the web seminarPlease tweet using hashtags #NHSChangeDay and #SHCRchatWe will produce summaries of the discussions of today’s module using Storify.com and Pinterest and put these on the websiteThe conversation continues on the live chat forum at www.changeday.nhs.uk/healthcareradicalsforum

Joining in today and beyond

http://www.changeday.nhs.uk/healthcareradicalsforum


Modules31st January: Being a health and care radical: change starts with me7th February: Forming communities: building alliances for change14th February: Rolling with resistance21st February: Making change happen28th February: Moving beyond the edge


Almost…1,300 learners8,000 Slideshare

views1,000 study guide

views

And over…4,500 tweets

#SHCRchat 6,500,000 potential

reach!

#NHSChangeDay #SHCRchat Source of image: www.freshnessmag.com

for today

Why change efforts often fail to achieve their objectivesLeading large scale changeThe NHS Change Model: aligning intrinsic and extrinsic motivators for change Discussion on intrinsic/extrinsic motivatorsBuilding energy for changeCreating shared purposePanel case studies


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

Most large scale change doesn’t fullydeliver its objectives


Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey

70%

25%5% Delivers and

sustains the change

Most large scale change doesn’t fullydeliver its objectives

#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchatImage from: @TheWorldStories


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 goalPeter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf Source of image: Whatsthebigideascwartzy.blogspot.com

http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf




In order of frequency:1. the effort effectively “runs out of energy” and

simply fades away2. the change hits a plateau at some level and no

longer attracts new supporters3. the change becomes reasonably well established;

several levels across the system have changed to accommodate or support it in a sustainable way

Source: Leading Large Scale Change: a practical guide (2011), NHS Institute

What happens to large scale change efforts in reality?


“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, 2009

Leaders as “signal generators”


Increasing number of messages as information cascade through

the organisation

Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx

Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on

http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx

http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx


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


1. Movement towards a new vision that is better and fundamentally different from the status quo

2. Identification and communication of key themes that people can relate to and that will make a big difference

3. Multiples of things (‘lots of lots’)

4. Framing the issues in ways that engage and mobilise the imagination, energy and will of a large number of diverse stakeholders in order to create a shift in the balance of power and distribute the leadership

5. Mutually reinforcing change across multiple processes/subsystems

Ten key principles of large scale change


6. Continually refreshing the story and attracting new, active supporters

7. Emergent planning and design, based on monitoring progress and adapting as you go

8. Many people contribute to the leadership of change, beyond organisational boundaries

9. Transforming mindsets, leading to inherently sustainable change

10. Maintaining and refreshing the leaders’

energy over the long haul

Ten key principles of large scale change


Intrinsic motivationPeople engage in the activity for the pleasure and satisfaction of doing it

Invokes many positive behaviours

Extrinsic motivationPeople engage in the activity for the rewards or avoiding punishment

Any external influence is referred to as extrinsic motivation

Source: http://www.slideshare.net/JeremyStephens103/coaches-as-extrinsic-motivators-and-supporter-of-intrinsic-development

http://www.slideshare.net/JeremyStephens103/coaches-as-extrinsic-motivators-and-supporter-of-intrinsic-development





Intrinsic motivators

build energy and creativity


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


Drivers of extrinsic motivation

create focus & momentum for delivery





•System drivers & incentives•Payment by results•Performance management•Measurement for accountability


Internal motivators

• connecting to shared purpose

•engaging, mobilising and calling to action



Drivers of extrinsicmotivation

•System drivers & incentives•Performance management•Measurement for accountability

create & focus momentum for delivery


“Leaders and managers tasked with applying integrated care ‘at scale and pace’ might … focus on driving forward the organisational solution or introduce various financial inducements in the hope this will be more effective [than starting with values-based shared purpose]. Such an approach would be a mistake…A values-driven approach should be a pre-requisite to the successful adoption of integrated care.”Goodwin, Nick. “Taking Integrated Care Forward: The Need for Shared Values.” International Journal of Integrated Care 13, no. 2 (June 24, 2013).

An example


Transformation is not a matter of intent.........

it is a matter of alignmentPeter Fuda


NHS Change Model

www.changemodel.nhs.uk

http://www.changemodel.nhs.uk/


Which components appeal to you and why?


0123456789

10Our shared purpose

Spread of innovation

Improvementmethodology

Rigorous delivery

Transparentmeasurement

System drivers

Engagement tomobilise

Leadership for change

What's our prognosis for this asthma pathway project?


NHS Change Model

www.changemodel.nhs.uk


You get the best effort from others not by lighting a fire beneath them, but by

building a fire withinBob Nelson


“Take your passion and

make it happen”

Source of image: www.zeelandtheaters.nl

http://www.zeelandtheaters.nl/


Reflecting on your change process:• how have you built both intrinsic and extrinsic

motivators of change into your efforts?• How have you managed the tension between

the two?• Any advice for other change agents on how to

align intrinsic and extrinsic motivators?

Discussion


In order of frequency:1. the effort effectively “runs out of energy” and

simply fades away2. the change hits a plateau at some level and no

longer attracts new supporters3. the change becomes reasonably well established;

several levels across the system have changed to accommodate or support it in a sustainable way

Source: Leading Large Scale Change: a practical guide (2011), NHS Institute

What happens to large scale change efforts in reality?


Research shows that more than almost any other factor affecting an

organisation, organisational energy can lead to either a wellspring of corporate

vitality or the destruction of its very core

Source: Bruch and Vogel


Organisations with HIGH productive energy scored higher on:• overall performance - 14% higher• productivity – 17%• efficiency – 14%• customer satisfaction – 6%• customer loyalty – 12%

Bruch and Vogel research


the capacity and drive of a team, organisation or system to act and make the

difference necessary to

achieve its goals

Psychological

Physical

Spiritual

Social Intellectual

Energy for change is:


Energy Definition

Social 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”

Spiritual energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It gives people the confidence to move towards a different future that is more compelling than the status quo

Psychological

energy of courage, resilience and feeling safe to do things differently. It involves feeling supported to make a change and trust in leadership and direction

Physical energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen

Intellectual

energy of analysis, planning and thinking. It involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/ evidence

Five energies for change


Low High

Social isolated solidarity

Spiritual uncommitted higher purpose

Psychological risky safe

Physical fatigue vitality

Intellectual Illogical reason

High and low ends of each


Social

Spiritual

PsychologicalPhysical

Intellectual

1

2

3

4

5 • Are particular energy domains more dominant than others for our team at the moment?

• Is this the optimal energy profile to help us achieve our improvement goals?

Energy for change profile


Social

Spiritual


Intellectual

1

2

3

4

5

Team 1: what’s your assessment of their energy for change?


Social

Spiritual


Intellectual

1

2

3

4

5

This energy profile is characterised by an environment that has harnessed people’s interest and momentum for change, but which has failed to engage people fully. This imbalance results in their feeling some uncertainty regarding how they can contribute fully to the change, and therefore a sense of risk and lack of hope for the future. We can build energy by building team solidarity and developing shared purpose



Social

Spiritual


Intellectual

1

2

3

4

5



Social

Spiritual


Intellectual

1

2

3

4

5

This energy profile shows strong connections between people, a true sense of solidarity, which gives them enough hope for the future, but this energy is undirected, because the rational argument and shared purpose has not been agreed. We can build energy by agreeing shared goals for change and using systematic approaches to thinking through and planning the change



There has never been a time in the history of healthcare when this advice

has been more pertinent

“Leadership is not about making clever decisions and doing bigger deals. It is

about helping release the positive energy that exists naturally within people”

Henry Mintzberg


“You can’t impose anything on anyone and expect them

to be committed to it”Edgar Schein, Professor Emeritus

MIT Sloan School

#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat Source: Helen Bevan

Compliance

States a minimum performance standard that everyone must achieve

Uses hierarchy, systems and standard procedures for co-ordination and control

Threat of penalties/ sanctions/ shame creates momentum for delivery

Commitment

States a collective goal that everyone can aspire to

Based on shared goals, values and sense of purpose for co-ordination and control

Commitment to a common purpose creates energy for delivery

What is our approach to change?


Shared purpose allows many communities to engage with us without us having to invest resourcesin controlling their actions Nilofer Merchant

Shared purpose aligns.....


• Shared purpose is a common thread in successful change programmes*

• Organisations and change initiatives with strong shared purpose consistently outperform those without it.**

*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)

**Management Agenda 2013 Boury et al (Roffey Park Institute)

We know that ...


A 3-word concept


[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


• What leaders pay attention to matters to staff, and consequently staff pay attention to that too

• Shared purpose can easily be displaced by a “de facto” purpose: hitting a target reducing costs reducing length of stay eliminating waste completing activities within a timescale complying with an inspection regime

• 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

Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector

Avoiding “de facto” purpose

#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat@SimonJGuilfoyle Police Inspector and systems thinker

https://twitter.com/SimonJGuilfoyle



Purpose

Obfuscation O-

meter

@SimonJGuilfoyle Police Inspector and systems thinker




Police




Education




Healthcare




....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 inspireDov Seidman


What is your experience as a change agent of:• Building energy for change?• Creating shared purpose?

Panel discussion


Post these or similar actions as a pledge on the NHS Change Day pledge wall http://changeday.nhs.uk/campaign• I will reflect on how I can use both intrinsic and

extrinsic motivators in my practice as a leader or agent of change

• I will seek to ignite energy for change in everyone involved in my project

• I will build commitment to shared purpose in all my change efforts

Calls to action campaigns for this week

http://changeday.nhs.uk/

http://changeday.nhs.uk/


• Wednesday 26th February 16:00-17:00 Tweet chat #SHCRchat

• Next Friday morning 28st February module 4: Moving beyond the edge• You can start the process of applying to

become a “certificated change agent”

Next opportunities for learning


Gain a certificate as a health and care change agent AND claim your continuing professional development points

Get certified!

Take some actions to demonstrate your learning from the school and become a “certified change agent”. If you complete the learning process you will: • Be recognised as a “certified change agent” by the school and

NHS Improving Quality • Be awarded a virtual badge that you can used on your email

signature, personal website, etc• Be invited to take part in one of our virtual graduation

ceremonies• Receive a framed certificate (UK residents only)

More details will be sent out in Naomi’s News today!


1. How can I make the most of both intrinsic and extrinsic aspects of change?

2. How can I build energy for the long haul?3. How can I ensure shared purpose

throughout the change process?4. What can I do tomorrow to accelerate

change?

Questions for reflection

Module 4 - Making change happen

Health & Medicine

Transcript of Module 4 - Making change happen