SHCR 2015 module 4
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Transcript of SHCR 2015 module 4
#SHCR @School4Radicals
http://www.theedge.nhsiq.nhs.uk/school/
Module 4:
Making change happen
Supported by
#SHCR @School4Radicals
Joining in today and beyond Please use the chat box to contribute continuously during the
web seminar
Please tweet using hashtag #SHCR and the handle @School4Radicals
Join our Facebook group School for Health and Care Radicals
We will produce summaries of the discussions on each module using Storify and Pinterest and put on the website
Join in the Tweetchat each Wednesday at 4-5pm (GMT) using the hashtag #SHCR
#SHCR @School4Radicals
The team today
Session lead: Helen Bevan @HelenBevan
Learning lead: Pip Hardy@PilgrimPip
Icebreaker and chat monitor:Dominic Cushman@domcushnan
Case study:Jenny Clarke@JennytheM
Twitter monitor:Kate Pound@kateslater2
#SHCR @School4Radicals
Why change efforts often fail to achieve their objectives
Leading large scale change
The Change Model: aligning intrinsic and extrinsic motivators for change
Discussion on intrinsic/extrinsic motivators
Building energy for change
Creating shared purpose
Discussion and reflection
Source of image: www.freshnessmag.com
for today
#SHCR @School4Radicals
Harvard researchers put a gorilla image on this lung scan
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Harvard researchers put a gorilla image on this lung scan
#SHCR @School4Radicals
What proportion of the radiologists who reviewed this scan actually saw the gorilla?
90%
25% 17%
80%
9%
60%
#SHCR @School4Radicals
What proportion of the radiologists who reviewed this scan actually saw the gorilla?
90%
25% 17%
80%
9%
60%
http://www.npr.org/blogs/health/2013/02/11/171409656/why-even-radiologists-can-miss-a-gorilla-hiding-in-plain-sight
#SHCR @School4Radicals Source of image: Whatsthebigideascwartzy.blogspot.com
#SHCR @School4Radicals
Icebreaker: Making change happen
Which of these are you most interested in finding out about today?
#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
#SHCR @School4Radicals
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 @School4RadicalsImage from: @TheWorldStories
#SHCR @School4RadicalsImage from: @TheWorldStories
#SHCR @School4Radicals
‘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
#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 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
Source: Leading Large Scale Change:
a practical guide (2011), NHS Institute
#SHCR @School4Radicals
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
#SHCR @School4Radicals
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
#SHCR @School4Radicals
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/
#SHCR @School4Radicals
“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
#SHCR @School4Radicals
Ten key principles of large scale change
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
http://www.slideshare.net/NHSIQ/leading-large-scale-change-part-1
#SHCR @School4Radicals
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
http://www.slideshare.net/NHSIQ/leading-large-scale-change-part-1
#SHCR @School4Radicals
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
Images: pixgood.com
#SHCR @School4Radicals
Intrinsic motivators
build energy and creativity
#SHCR @School4Radicals
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
#SHCR @School4Radicals
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 & focusmomentum for delivery
#SHCR @School4Radicals
An example
“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).
#SHCR @School4Radicals
Transformation is not a matter of intent.........it is a matter of alignmentPeter Fuda
#SHCR @School4Radicals
Which components appeal to you and why?
#SHCR @School4Radicals
0123456789
10
Our 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?
#SHCR @School4Radicals
You get the best effort from others not by lighting a fire beneath them, but by
building a fire within
Bob Nelson
#SHCR @School4Radicals
“Take your passion and
make it happen.”
Source of image: www.zeelandtheaters.nl
#SHCR @School4Radicals
Discussion
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?
#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 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
Source: Leading Large Scale Change:
a practical guide (2011), NHS Institute
#SHCR @School4Radicals
‘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
#SHCR @School4Radicals
Bruch and Vogel research
Organisations 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
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:
#SHCR @School4Radicals
Five energies for change 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
#SHCR @School4Radicals
High and low ends of each energy domain
Low High
Social isolated solidarity
Spiritual uncommitted higher purpose
Psychological risky safe
Physical fatigue vitality
Intellectual Illogical reason
#SHCR @School4Radicals
Some questions
Which group likely to have higher spiritual energy scores (clinicians/non clinicians?)
Nearer to CEO, higher or lower energy scores?
@helenbevan@helenbevan #Quality2013
• 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
1
2
3
4
5Social
Spiritual
PsychologicalPhysical
Intellectual
#SHCR @School4Radicals
1
2
3
4
5Social
Spiritual
PsychologicalPhysical
Intellectual
Team 1: what’s your assessment of
their energy for change?
#SHCR @School4Radicals
1
2
3
4
5Social
Spiritual
PsychologicalPhysical
Intellectual
Team 1: what’s your assessment of
their energy for change? 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
#SHCR @School4Radicals
1
2
3
4
5Social
Spiritual
PsychologicalPhysical
Intellectual
Team 2: what’s your assessment of
their energy for change?
#SHCR @School4Radicals
1
2
3
4
5Social
Spiritual
PsychologicalPhysical
Intellectual
Team 2: what’s your assessment of
their energy for change?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
#SHCR @School4Radicals
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
#SHCR @School4Radicals
#SHCR @School4Radicals 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
What is our approach to change?
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
#SHCR @School4Radicals
Shared purpose aligns.....
Shared purpose allows
many communities to
engage with us without us
having to invest resources
in controlling their actions
Nilofer Merchant
#SHCR @School4Radicals
We know that ...
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)
#SHCR @School4Radicals
A 3-word concept
#SHCR @School4Radicals
[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 wonderful 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/
#SHCR @School4Radicals
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
#SHCR @School4Radicals
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
#SHCR @School4Radicals @SimonJGuilfoyle Police Inspector and systems thinker
#SHCR @School4Radicals @SimonJGuilfoyle Police Inspector and systems thinker
#SHCR @School4Radicals
Police
@SimonJGuilfoyle Police Inspector and systems thinker
#SHCR @School4Radicals
Education
@SimonJGuilfoyle Police Inspector and systems thinker
#SHCR @School4Radicals
Healthcare
@SimonJGuilfoyle Police Inspector and systems thinker
#SHCR @School4Radicals
“....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
#SHCR @School4Radicals
Case study: Skin to skinJenny Clarke
#SHCR @School4Radicals
Case study: Skin to skinJenny Clarke
#SHCR @School4Radicals
Case study: Skin to skinJenny Clarke
#SHCR @School4Radicals
Discussion
What is your experience as a change agent of:
Building energy for change?
Creating shared purpose?
#SHCR @School4Radicals
Wednesday 25th February
16:00-17:00 Tweet chat #SHCRchat
Next Friday morning 27th February
module 4: Moving beyond the edge
You can start the process of applying to become a “certificated change agent”
Next opportunities for learning
#SHCR @School4Radicals
The certification process
Take some actions to demonstrate your learning from the school and become a “certificated change agent”. If you complete the learning process you will:
• be recognised as a “certificated 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 certificate.
#SHCR @School4Radicals
Call to action
Reflect on how you can use both intrinsic and extrinsic motivators in your practice as a leader or agent of change.
Seek to ignite energy for change in everyone involved in your project.
Build commitment to shared purpose in all your change efforts.
#SHCR @School4Radicals
Questions for reflection
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?