california presentation march 2015 final 2 - jackie lytnon

@jackielynton

Jackie LyntonCreating a contagious

commitment for change

@HelenBevan #SHCR #QF15

The Horizons Group within NHS Improving Quality

Aim of the group: to stimulate new and ‘disruptive’ approaches in support of health and care transformation, operating at the edge of current thinking and practice:

• skipping a generation of thinking and practice in how to create radical, system-wide change

• skipping a generation in a wider level of connection: working with emerging leaders, clinical trainees, students

• skipping a generation of methods for change and improvement: open innovation, open source, digital connection, social media, change platforms, hacking

“You

can’t cross a chasm in small

steps”David

Lloyd George

@HelenBevan

Five enabling themes in change and transformation www.nhsiq.nhs.uk/whitepaper

@HelenBevan @JackieLynton #mixmashup

Agenda

1. Building a social movement

2. Why programmatic and target-driven approaches to change aren’t enough

3. Leading contagious commitment to change

4. A disruptive case study: NHS Change Day

Community

Call to attention Stay with the process

@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5

Activity

Today you will be working as a community with others on your table so it’s important to find out who is in your community.

Introduce yourself to others at your table. Tell a quick story that demonstrates why you chose to come to this workshop today.

Time allowed: 10 minutes for the whole table

Building a social

movement

The NHS is the 5th biggest employer on the globe

Source: BBC

The National Health Service is the closest thing the English have to a religion, with those who

practice in it regarding themselves as a priesthood. This makes it quite extraordinarily

difficult to reform

Nigel Lawson, politician

Where are we?The dominant NHS approach [to leadership] is

typified by laying down demanding targets, leading from the front, often being reluctant to delegate,

and collaborating little – and is the consequence of the health service focusing on process targets, with

reward dependent on meeting them.

Source: Kings Fund Leadership for engagement and improvement in the NHS http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/leadership-for-engagement-improvement-nhs-final-review2012.pdf

@HelenBevan @JackieLynton #mixmashupBuilding on a legacy of social movement thinking for the NHS

What is happening in the world of change?

Source of image: from guardiansprayerwarrior.com

SEISMIC SHIFTS

Change from the edge

@HelenBevan

Most change efforts are built upon the shaky foundation of five flawed assumptions; 1. that change can be managed2. that human beings are objective 3. that there are ‘X’ steps to change4. that we have a neutral starting point for change5. 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

Leading change in a new era

Dominant approach Emerging direction

Leading change in a new era

Dominant approach Emerging direction

Most policy efforts are driven from this

@HelenBevan

Many of the ways we go about improving health and

care were designed in a different mindset

for a different set of circumstances

We are operating with 20th century change

practice in a 21st

century world

Source of images : http://www.slideshare.net/dachisgroup/dave-gray-the-connected-company

“When we talk of social change, we talk of movements, a word that suggest vast

groups of people walking together, leaving behind one way and travelling towards

another”

Rebecca Solnit

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5

‘If people give to a cause, they expect a relationship, not a transaction.’

Nilofer Merchant

Why am I a radical?

Source : Lois Kelly www.rebelsatwork.com

Sometimes other people see radicals/rebels as troublemakers

Six characteristics of people or groups within effective social movements

1. They share a sense of PURPOSE: There is purposefulness about

collaborations, discussions, actions, decisions and a sense of forward momentum

2. They are UNITED: They have learned to manage their differences well enough

that they can unite to accomplish their purpose. Differences are openly debated, discussed, and resolved.

3. They share UNDERSTANDING: There is a widely shared understanding of what's going on, what the challenges are and why what is being done has to be done

4. People PARTICIPATE: Lots of people and organisations in the system are

active - not just in discussions and meetings, but getting the work done.

5. They take INITIATIVE: Rather than reacting to whatever happens in their

environment, they are proactive, and act upon their environment.

6. They ACT: People do the work they must do to

make the things happen that need to happen

Source: adapted from Wellstone Action

We need rebels!

•The principal champion of a change initiative, cause or action

•Rebels don’t wait for permission to lead, innovate, strategise

•They are responsible; they do what is right

•Without rebels, the storyline never changes

Source : @PeterVan http://t.co/6CQtA4wUv1

Framing… is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action.

Snow D A and Benford R D (1992)

Three components of framing

• Diagnostic – what is the problem that we are addressing? What is the extent of the problem? What is the specific source or sources?

• Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan?

• Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of the audience?

Source: Benford and Snow

What’s the financial incentive?

Who is performance managing?

What’s the project plan?

Source: @RobertVarnam

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5Source: Rebelsatwork.com

“I have some Key

Performance

Indicators

for you”

“I have a

dream”

Source: @RobertVarnam

My first experience of being in large scale change in the NHS 1986

The story of Fredrick……

Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........

Sensemaking is not done via marketing...or slogans but by emotional connection with employees

Ron Weil

Call to Action

• A call to action assumes that we can end an intolerable condition by creating a burning platform from which to organise our resources and seek commitment

• A call to action finds and builds new sources of power and so enables change through

• collaboration and mobilisation• developing leadership

• A call to action unites us around a collective vision and focuses our energy towards a specific and real change and a measureable goal

#NHSChangeDay #SHCRchat

Why do we need to change and what needs to change?

Discuss in your community

ACTIVITY

Why programmatic and target driven

approaches to change aren’t enough in our

system?

Starts on the fringe

(at the edge)

Starts with the activistsGary Hamel

always

Four keys to collaboration

• Lean into your discomfort

• Listen as an ally

• State your intent

• Share your “street corner”Source: Judith Katz and Fred Miller

@HelenBevan

John Kotter: “Accelerate!” most influential thought leader globally, recognises new approaches are needed

• We won’t create big change through hierarchy on its own

• We need hierarchy AND network

• Many change agents, not just a few, with many acts of leadership

• Changing our mindsetTO

Must do

Want to do

Kotter: From “have to” to “want to”

@helenbevan

“Tomorrow’s management systems

will need to value diversity, dissent and

divergence as highly as conformance, consensus

and cohesion.”

Gary Hamel

Source of image: www.fastcompany.com

Embracing difference to change the conversation

Less change programmes More change platforms

Change Programmes:• utilise systematic “change

management” approaches• Too often, leaders prescribe

the outcome and the method of change in a top-down way

• change is experienced by people at the front line as “have to” (imposed) rather than “want to” (embraced)

Change Platforms• enable everyone in the

organisation/system (including service users) to help tackle the most challenging issues

• value diversity of thought• leadership attention on

creating an environment receptive to transformational change

http://www.hsj.co.uk/resource-centre/scrap-the-programme-successful-change-starts-with-a-change-platform/5078014.article?blocktitle=Blogs-and-videos&contentID=16031

@helenbevan

Conclusions• The way that change is changing means that traditional

policy levers (targets, payment incentives, regulation etc) will be increasingly less effective

• They don’t have the track record in delivering the sort of transformational change now required across the NHS New Health Foundation report: 10% impact on overall performance

• Transformation needs frontline staff to learn from the wider world, build shared purpose and have the freedom to take action

• We have to find ways to:

• Build organisations that are activist at their core

• marry innovation with complexity and scale

• balance control and freedom

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 SchillingerImage by neilperkin.typepad.com

Leading contagious commitment to change in the workplace

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

building a fire within

Bob Nelson

What lights the ‘fire in your belly’ and makes you feel passionate and determined to make change happen?

ACTIVITY

Connecting to other people values and emotions

If we want people to take action, we have to connect with their emotions through values

action

values

emotion

Source: Marshall Ganz

Building contagious commitment

Shared understanding leads to

Action

Narrativewhy?

Strategywhat?

What is strategy?

Strategy is the process of turning the you have into the you need to win

the you wantSource: Marshall Ganz

Here have some of mine!

MyPower

Shifting positional power to relational

Unleashing the energy

The more you do what you love the more energy you have. Leadership Freak

Resources to improve health and care

Economic resourcesdiminish with use• money• materials• technology

Natural resourcesgrow with use• relationships• commitment• community

Based on principles from Albert Hirschman, Against Parsimony

#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat

“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5 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? 3 Mins

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

"There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley

Source of image: timcoffeyart.wordpress.com

It starts

with me….

Effective framing: what do we need to do?

1. Tell a story

2. Make it personal

3. Be authentic

4. Create a sense of “us” (and be clear who the “us” is)

5. Build in a call for urgent action

Creating our narrative

• Challenge: What was the challenge? Why was it a challenge?

• Choice: What were the choices? Why did you make the choice you did? Where did you get the courage or hope? How did it feel?

• Outcome: How did the outcome feel? Why did it feel that way? What do you want us to feel?

Vivid details

Me at 22 years old

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5Image 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

OverviewMY

Strong sense public service and community

1. I did not feel heard, supported

2. Let down by my profession

3. I was part of a hierarchical

system that didn’t protect vulnerable people

Always fighting for change an speaking out

Being open to creating

alliances with others,

and not build silos…..

This picture was taken fromthe window of my hotelroom in Scotland when I asked myself one of the mostimportant questions

Connecting to What’s important to me?

Alone/Me

Together/We

Building connections and relationships for change

Knowing your purpose

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

30 years on

1. Staff didn’t feel heard –

‘checked out’

2. Compliance over

commitment

3. Staff not feeling

‘permission’ to make to

make changes

“People who think differently challenge the status quo…. in difference lies value. They are what Cass Sustein (2003) might call “dissenters”……dissenters identify new dimensions, and they force us to abandon our existing predictive models. Dissent is useful. Without it society would falter”Source: Scott E. Page, Making the difference: Applying a Logic of Diversity - Academy of Management Perspectives

Change starts with me

When you start with ‘me’ - you can see ‘we and us’

1. Cut on the dotted line2. Rotate 180 degrees

Creating change through connections and building relationships

Reconnecting with my values

Innovation/ideas is not reserved for someone sitting at

the top of a hierarchy, but driven down to unleash new

levels of engagement

Doctor ManagerSocial worker

Patient

Carer maker Cleaner

Pharmacist

Now I don’t!Now I bring my authentic self to work

I had to be someone else

to fit in

Talk to the person next to you ACTIVITY

• Tell your story about why the change you are involved in now is so important to you

• Relate it to a personal experience

You have:

• 2 minutes to prepare your story

• 2 minutes each to tell your story

Talk to the person next to you

Have a further discussion

• In terms of the people you want to get on board with your change project, what will create a sense of “us” rather than “us and them”?

• How could telling your story help create the “us”?

You have three minutes for further discussion as a pair

Talk to the rest of the table

What insight did you get from that exercise?

You have five minutes for a whole table discussion

How do we create a sense of “us” to build

momentum for change?

Source of image: studentblognmaestics.blogspot.com

strong ties (cohesive)v.

weak ties (disconnected)

Source of image:brucemacvaresh.com

When we spread change through strong ties:

• we interact with “people like us”, with the same life experiences, beliefs and values

• Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist

• Influence is spread through people who are strongly connected to each other, like and trust each other

When we spread change through strong ties:

IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied

The pros and cons of strong ties

Pros Cons

ACTIVITY

Strong and weak tiesWhen we seek to spread change

through strong ties:

When we seek to spread change through weak ties:

• we build bridges between groups and individuals who were previously different and separate

• we create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action

• our aim is to mobilise all the resources in our organisation, system or community that can help achieve our goals

Why we need to build weak ties AS WELL AS strong ties

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

• In situations of uncertainty, we have a tendency to revert to our strong tie relationships

• yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity

• The most breakthrough innovations will come when we tap into our weak ties

History suggests that weak ties will probably give us the best chance to deliver large scale improvements in a challenging

timescale

Key messages• Create a “burning platform” and imperative

for action around quality and cost improvement

• Make a clinically relevant case that makes both a rational case for change and a connection to emotions, through values

• Frame to connect with hearts and minds and identify levers for commitment rather than compliance

• Build a strategy for both strong and weak ties

• Ask people to commit to specific actions

NHS Change Day

Wednesday 11 March

Making a change for

better together.

Disruptive Case Study

Do something better together….

Audacity to imagine we could mobilise

the 1.3m people in the NHS

2013 2014 2015

Must do

Want to do

Shared purposeGoal – 65,000 (500k)

pledgesCore leadership team

Personal pledgeSet a dateWebsite

Social media Took risks

Courage & belief Kept it simple!

Holding each other to account rather than performance management

ENGAGEMENTCOMMITMENT ENERGY

‘Can I really make

the change?’

Will ‘the system’

really ALLOW me?

When you hit up against this wall, how

do you feel and how do staff feel?

Change Day pledges and stories

‘…the floodgates of change open’from front line to senior leaders

Change starts with me..

...Making a

difference

Anyone can pledge – it’s personal to you!

Change Activist

Volunteers – leaders everywhere

98% of activity via volunteers

My pledge/action…..Not let hierarchy get in the way of patient care

What I didWorked with the hierarchy at an early stage. Seeking their support with an explicit understanding that they respected the grassroots nature of Change Day.

Bottom up approach with top down support

I urge as many people as possible to give their support“

"NHS Change Day is a fantastic opportunity to join a movement of young leaders who want to make a

difference in the NHS

Jeremy Hunt Health Secretary

Chief Nursing Officer - England

Professor Sir Bruce Keogh National Medical Director

It's especially an opportunity for the next generation of junior doctors to effect change

in a practical and sustainable way"

Fun day for children Support group with a stomas

NHS CEO personal National pledge campaign

30% shift in staff survey:‘Would you feel confident your hospital

would address your concern?’

Ashley Brooks Patient Champion

‘Change Day gave me the permission to use my energy in the direction I wanted to use it’

Students swap places with patients in mock ward

Change in University nursing curriculum

Louise Trowse – Second year student

Tasting common medicine for children

Discussing pharmacy methods of improving the taste

Dr Damian Roland

“The single most important skill I learned from improvement leaders was narrative. It connects us to the reasons we were called to work forthe NHS. It will stay with me the rest of my career.”

Local anaesthetic for arterial blood gas sampling

Clinician shows painful procedure for patient experience

Jeharna sings forchildren’s ward tosay thank you

‘I wanted to say thank you to NHS staff for the way my brother was looked after when he got knocked over,’

Staff feel appreciated

Smile Feedback Wednesday

Ellie Milner

With the patronage and support of Her Royal Highness Princess Muna Al-Hussein who was the first to pledge

A global movement was born

https://www.youtube.com/watch?v=inHc1NgohuA

OCTOBER 2015

Google Searches Twitter

Google Searches and Twitter posts tell the same story: 50% bigger than last year at peakOnline mentions: 4x bigger than last year (Source — OLR) 9,274 vs1,869 in 2014

Changeathon:

Changeathon peaked on Twitter around 09:00 and 11:00

46 Million Twitter Impressions14 Thousand Tweets9 Thousand online mentions4,859 individuals tweeting200 events flagged on Twitter60 events notified to team

Biggest ever

Events acrossEngland

Twitter:

50% bigger than 2014(tweets & searches — online is 400% bigger)

CHANGEATHON

• We must activate the mavericks, radicals, rebels and heretics

• From the top of the hierarchy:

You CAN support and enable a social movement

You CAN join forces to achieve shared purpose

You CAN utilise movement principles

BUT you CANNOT lead or drive it

• It’s not enough to mobilise, we have to organise

• There is a massive untapped reservoir of energy and talent out there and the potential is outstanding

What have we learnt?

#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat

If your horse dies, get off itCherokee proverb

Source of image: fenwickgallery.co.uk

Chloe at 24

Quote from ChloeI was inspired by the caring,

creative and committed individuals I met in the NHS and realised I need to fulfil a sense of

purpose in using my skills and passion in helping others.

I want ……

More information

For more information visit

changeday.nhs.uk

@jackielynton

Health and care radicals

The school is based on two kinds of learning

Transactional learning Transformational learning

A “toolkit” of ideas & approaches

Learning through motivation, practice &feedback

Seeks to transfer useful knowledge

Seeks to transform beliefs & underlying assumptions

Learning event, presentations & materials

Experiential, interactive & action-based

Generates understanding of “what to do”

Generates increased capacity in “how to do it”

Source: Based on John Wenger https://medium.com/corporate-learning/3deb1bb2e865

@helenbevan#SHCR @School4Radicals

http://www.theedge.nhsiq.nhs.uk/school/

Change starts with me

Forming communities: Rolling with resistance

Building alliances for change

Making change happen

Moving beyond the edge

The extent of our reach

Nearly 5,000 enrolees in 2014 & 2015

2015: #SHCR: 20,786,339 impressions across 14,288 tweets

@School4Radicals: reached 35,044 unique twitter accounts;

1,686 followers; 24,551 views of school materials, including

attendees on live webinars

Nearly 7,000 subscribers, 13,000 unique users

@theedgenhs: 65,438 impressions; reached 50,413 accounts;

1,726 followers / The Edge: 6,652 subscribers;

Since 5 November 2014: 22,328 visits to The Edge website,

with 64,611 page views from 13,011 separate users

Since launch of 2015 campaign on 1 December 2014:

@nhschangeday: 708,100 impressions, 12.2k followers

#nhschangeday: 30,053,800 impressions across 11,396 tweets

#100daysofchange: 1,629,672 impressions across 539 tweets

Facebook reach of 9,995, 10 separate campaigns launched

29,068 visits to website, with 70,593 page views from 19,777 separate users

Since 1 December 2014:

#thoughtdiversity: 10,839,571 impressions across 3,749 tweets

• Being an effective

change activist

• Transformational leadership

• Thought diversity

and disruptive

innovation

• Scale and spread of

change

• The new methods

for change

Four ways to connect with us!

1. Follow on Twitter

1. @Jackie Lynton

2. Subscribe to

3. The School for Health and Care Radicals: @School4Radical

4. Engage with NHS Change Daywww.ChangeDay.nhs.uk @usachangeday

TheEdge.nhsiq.nhs.uk

36.3m twitter impressions (across all main accounts)

Reached 143k individual accounts

36k twitter followers across all main accounts

24.5k views of #SHCR materials, including students on live webinars

64.6k views from 13k unique users of The Edge

480k impressions and 2,451 clicks for Challenge Top-Down Change

Horizons group: numbers for February 2015

@helenbevan #IQTGOLD#SHCR @School4Radicals

“You don’t need an engine when you have

wind in your sails”

Thank you for listening

@jackielyntonJackie.lynton@nhsiq.nhs.uk

california presentation march 2015 final 2 - jackie lytnon

helenbevanleading change

world of change

nhs change day

systemwide change

nhs http

social movementthe nhs

open source

source of image

Healthcare

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