School for Health and Care radicals - Slides for module four
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Transcript of School for Health and Care radicals - Slides for module four
#SHCR @School4Radicals
Module 4 Making change happen
Supported by:
http://www.theedge.nhsiq.nhs.uk/school/
Module
#SHCR @School4Radicals
• Please use the chat box to contribute continuously during the web seminar
• Please tweet using hashtag #SHCR and the handle @School4Radicals
• Request to join our Facebook group School for Health and Care Radicals
• We will produce summaries of each module discussion using Steller and put it on the website
• Join in the #SHCR Tweetchat each Tuesday at 1900 (GMT)
Joining in today…and beyond
#SHCR @School4Radicals
Session lead: Helen Bevan @HelenBevan
Learning lead: Pip Hardy@PilgrimPip
Session chair:Kate Pound@kateslater2
Twitter & chat monitor: Olly Benson@ollybenson
Storyteller:Rebecca Lacey@rebeccalacey76
Storyteller:Jas Atwal@jasjitkauratwal
Storyteller:Joyce Lee@joyclee
The team today
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Programme Study Guide: www.slideshare.net/TheEdgeNHS/school-for-health-and-care-radicals-iii-study-guide-2016?related=2
Module 4 Study Guide:http://www.slideshare.net/TheEdgeNHS/school-for-health-and-care-radicals-module-4-study-guide-2016
Study guides
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Modules
3rd March: Moving beyond the edge
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Our growing community
• The American College of Radiology• Macmillan nursing team growing
School news• Twitter chat for #SHCRmh today 20.00-21.00 (GMT)• Twitter chat for #SHCR6Cs Sunday 20.00-21.00 (GMT)• After school club north east on 7th April 1pm connect
with @markdavis272 or @maxine_craig
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Icebreaker: Making change happen
Which of these are you most interested in finding out about today?
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Today• Why change efforts often fail to achieve
their objectives• Leading large-scale change• Intrinsic and extrinsic motivators for
change • Building energy for change• Creating shared purpose• Discussion and reflection
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#SHCR @School4Radicals Source of image: Whatsthebigideascwartzy.blogspot.com
#SHCR @School4Radicals
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
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Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey
70%
25%5% Delivers and
sustains the change
Most change programmes fail to deliver their objectives
#SHCR @School4RadicalsSource: 2016 Chartered Institute of Management Quality of Working Life study
Across the UK, poorly managed change programmes are damaging morale and the performance of organisations
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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
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Change is not the goal; the goal is the goal
Peter Fuda
Source of image: timemanagementninja.com
@School4Radicals #SHCR
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
@School4Radicals #SHCR
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
@School4Radicals #SHCR
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
Buy in from front line staff is critical for improvements in quality and safety
Don’t overload themhttp
://healthaffairs.org/blog/2014/03/07/the-dangers-of-quality-improvement-overload-insights-from-the-field
/
@School4Radicals #SHCR
14,000 contributions identified 11 building blocks for change:
Inspiring & supportive leadershipCollaborative 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
@School4Radicals #SHCR @HelenBevan #NHSelect15
Types of motivation
Source of image: http://youearnedit.com/blog/intrinsic-vs-extrinsic-motivation/
@School4Radicals #SHCR @HelenBevan #NHSelect15
Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship
From
@School4Radicals #SHCR
14,000 contributions identified 11 building blocks for change:
Inspiring & supportive leadershipCollaborative 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
#SHCR @School4Radicals
Tapping into intrinsic motivation is critical to ongoing, large scale change
So while both extrinsic and intrinsic motivation have their place when implementing change, identifying underlying intrinsic motivation remains the differentiating factor between long-term success and failure. Every long-term, sustained extrinsic success
story has tapped into intrinsic motivation at its core……While extrinsic motivation can produce some initial success on its
own, people will move on from tasks that they no longer find personally challenging. So unless system leaders want to
continually increase the reward for the same task, they need to find a way to appeal to user’s values…..
.The Blog for Happy Workers: http://www.happymelly.com/why-intrinsic-motivation-is-the-key-to-change-management/
‘
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Intrinsic motivators
build energy and creativity
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Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
#SHCR @School4Radicals
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
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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
#SHCR @School4Radicals
Internal motivators
• connecting to shared purpose
•engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
Drivers of extrinsicmotivation
•System drivers & incentives•Performance management•Measurement for accountability
create & focus momentum for delivery
#SHCR @School4Radicals
The Change Model
Source: Zoe Lord
Priority area: Acute Kidney Injury (AKI) – NHS Kidney Care
What outcomes do we seek?Our Shared PurposeIs there a sense of shared purpose amongst our key stakeholders?
The shared purpose is to improve the prevention, detection and management of AKI across the whole NHS system
Leadership by all Do all our leaders have the skills to create transformational change?NHS Medical DirectorNHS Commissioning BoardClinical Commissioning GroupsNational Clinical LeadRoyal College of NursingNHS Nursing DirectorAKI Delivery GroupNational Vascular Society for Great Britain & IrelandClinical LeadsNetwork LeadsPatient Groups
Motivate and MobiliseAre we engaging and mobilising all the right people?
AKI London NetworkDeaneriesDirectors of NursingAKI Specialist Registrar NetworkAKI App
Spread and Adoption Are we designing for the active spread of innovation?
Acute Kidney Injury Resource PackHydration Matters CampaignAKI Audit in Acute Assessment Units in the North East of EnglandE-alerts SurveyMedicines Optimisation ToolkitHow to Guides
Project and performance ManagementDo we have an effective approach for delivery of change and monitoring of progress towards our planned objectives?Project Management OfficeRisk & Issues Log
Influencing factorsAre our processes, incentives and systems aligned to enable change? The Burdon of AKI – Health Economics StudyAKI Recording & CodingAKI Consensus ConferenceNICE (Guideline 50)NCEPOD
Improvement toolsAre we using an evidence-based quality improvement methodology?YES = quality improvement
MeasurementAre we measuring the outcome of the change continuously and transparently? National Confidential Enquiry into Patient Outcome and DeathAKI Markers in National Registrar Vascular DatabaseAtlas of Variation
“Without using the change model to undertake a gap analysis, we would have never have known many of our collective strengths and our challenges which would have had a direct impact on achieving our goal”
Beverley Matthews
http://www.londonaki.net/
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“Take your passion and
make it happen”
Source of image: www.zeelandtheaters.nl
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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/
#SHCR @School4Radicals
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
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
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Telling her story
Jas Atwal@jasjitkauratwal
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Dr Jasjit Kaur Atwal@jasjitkauratwal
General Practitioner on a career break. School Governor and Code Club volunteer.https://codewordblog.wordpress.com
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We built a computer…and it actually works!
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#SHCR @School4Radicals
https://scratch.mit.edu/projects/26818098/#editorhttps://scratch.mit.edu/
We have been using a language called Scratch to teach the children
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Amanda Coffey@adorescience
A qualified teacher, Amanda has extensive experience volunteering in her community and was instrumental in setting up a local Community Forum to enable disparate groups to work together. As a Process Co-ordinator working for a bank’s operations department, Amanda used her coding experience and networking skills to move from paper to a digital system.
#SHCR @School4Radicals
Creator of fetcheveryone.com, a free website for runners to log their exploits and share their passion for running. Bought by Hearst magazine in 2007 and now receiving 50,000 visitors per month, it is Ian’s full time occupation. In his spare time, he is a Parkrun event director and Code Club volunteer.
#SHCR @School4Radicals
#SHCR @School4Radicals
#SHCR @School4Radicals
What happens to large scale change efforts in reality?
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
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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
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Bruch and Vogel researchOrganisations with HIGH productive energy scored higher on: overall performance - 14% higher productivity – 17% efficiency – 14% customer satisfaction – 6% customer loyalty – 12%
#SHCR @School4Radicals
#SHCR @School4Radicals
Energy for change
The capacity and drive of a team, organisation or system to act and make the difference necessary to
achieve its goals
http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html
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Psychological
Physical
Spiritual
Social Intellectual
Energy for change
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Social energy
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”
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Spiritual energy
Energy of commitment to a common vision for the future, driven by shared
values and a higher purposeGives people the confidence to move towards a
different future that is more compelling than the status quo
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Psychological energy
Energy of courage, resilience and feeling safe to do things differently
Involves feeling supported to make a change and trust in leadership and direction
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Physical energy
Energy of action, getting things done and making progress
The flexible, responsive drive to make things happen
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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
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Low High
Social isolated solidarity
Spiritual uncommitted higher purpose
Psychological risky safe
Physical fatigue vitality
Intellectual Illogical reason
High and low ends of each energy domain
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Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)
Nearer to CEO, higher or lower energy scores?
Some questions
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• 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 profileSocial
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
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Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 1: what’s your assessment of their energy for change?
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Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 2: what’s your assessment of their energy for change?
#SHCR @School4Radicals
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Where is your team?
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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
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Telling her story
Rebecca Lacey@rebecccalacey76
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Shared purpose aligns.....
Shared purpose allows many communities to engage with us without us having to invest resourcesin controlling their actions Nilofer Merchant
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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 ...
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A 3-word concept
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[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
#SHCR @School4Radicals
“Matching Michigan” is a great example of the power of shared purpose
Perhaps the single most important influence on program response by individual units—either in promoting or resisting change—was the extent of consensus and
coalition among the senior medical and nursing staff on individual ICUs….
Transforming or boosting of efforts was most likely to occur when those locally charged with implementation were sincere in their beliefs about the value of the
program, were able to create transdisciplinary alliances, had local credibility among peers, were prepared to tolerate debate but exercise firmness, and used
multiple tactics including role modelling, persuasion, sanctioning, reminders, and constant feedback….
[Consultant says] ‘I think it’s been successful because it’s a unifying program, it’s one of the few things that we’ve done that hasn’t been just a doctor thing, or
just a nurse thing, it’s involved the doctors and the nurses together.’ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704826/
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As leaders, we are “signal generators”“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
Source of image: vintage-radio.com
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Avoiding “de facto” purpose 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
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....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
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How to make change happen Stop bribing Make people feel
something Emphasise progress Start a cult (a group
unified by a provocative idea)
Source: How to motivate people: four steps backed by science
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Telling her story
Joyce Lee@joyclee
#SHCR @School4Radicals http://ihavefoodallergies.tumblr.com
Patient as ExpertMaker
Collaborator
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Healthdesignby.us
Participatory Design = Maker Movement
Expert = DIYMaker = Learning by doing
Collaborator = Peer-to-Peer
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Design with and not for patients Integrate design into your daily workflowUser research as an educational opportunityMake the dream clinic happenDesign with members of a different tribe Identify your latent innovators
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Next opportunities for learning
• Next Tuesday, 1st March 1900-2000 GMT: Tweet chat #SHCR• Next Thursday 3rd March 1430-1600 GMT: Module 5:
Moving beyond the edge
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There’s still time to take part in an RCT!
• Randomised Coffee Trial!• Randomised Coffee Trial!
Randomised Coffee Trial!
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Questions for reflection
• How can I make the most of both intrinsic and extrinsic aspects of change?
• How can I build energy for change for the long haul?
• How can I ensure shared purpose throughout my change process?
Questions for reflection
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Questions for reflection
• Identify three ways in which I can ignite energy for change within my own groups and communities.
• Consider how I will build commitment to shared purpose in all my change efforts.
• Take one action tomorrow to accelerate change.
Call to action
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Goodbye and good luck!
‘There is a thread you follow. It goes among things that change. But it doesn’t change… while you hold it you cannot get lost.’
William Stafford
Goodbye and good luck!
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