THEME: TRANSFORMING CULTURE

LEADERSHIP IN THE DEFENCELEADERSHIP IN THE DEFENCE MEDICAL SERVICES

FMLM1 NOV 16

Learning through shared experienceLearning through shared experience

MAJOR GENERAL

Martin Bricknell OStJBRIGADIER

Tim Hodgetts CBE OStJMartin Bricknell OStJ

Director Medical Policy & Operational Capability

Tim Hodgetts CBE OStJ

Medical DirectorOperational Capability

SG-DMedPolOpCap@mod.uk SG-DMED-MEDD-D@mod.uk

@DMSMedDir

WorkshopAIMAIM

60

Share tools for complex problem solving and change

Illustrate with examples Application on military operations Application on military operations Application in NHS

Practice to enhance leadership competence

an integration of models

audience roleaudience role Ask questionsq Challenge assumptions Participate in the exercisesp Take away tools and try them out

Context

Recognition of complexRecognition of complex problems with no simple solutionsimple solution

ContextIT DOESN’T GET MESSIER THAN THISIT DOESN T GET MESSIER THAN THIS…

A toolset for innovation & changeIS IT REALLY TRANSFERABLE?IS IT REALLY TRANSFERABLE?

R l C ll f Royal College of Emergency Medicine, 20132013

NHS senior executives NHS senior executives, England & Wales, 2014-152014 15

London Ambulance London Ambulance Service, 2016

!WARNING!

It take’s an academic term to teach this to military officers: we will do it in <1 hour

Selected toolsHIGHLIGHTS TO LEARN & PRACTICE IN 1 HOUR!HIGHLIGHTS TO LEARN & PRACTICE IN 1 HOUR!

How to understand the problem How to understand the problem Cultural analysis External factor analysis External factor analysis Internal factor analysis

Planning for change The campaign planning tools The campaign planning tools

Implementing change Implementing change Kotter’s model

Understanding the problemg p

The problem with understandingp g

“Every age has its follies; perhaps the folly of our age could be defined as an unmatched ambition to change the cou d be de ed as a u atc ed a b t o to c a ge t e

world, without even bothering to study it in detail and understand it first.”

PROF ANTONIO GIUSTOZZIPROF ANTONIO GIUSTOZZIDEPARTMENT OF WAR STUDIES, KCL

Understanding the problemSTEP 1: CULTURAL ANALYSISSTEP 1: CULTURAL ANALYSIS

Understanding the problemSTEP 1: CULTURAL ANALYSIS

5 STEP 1: CULTURAL ANALYSIS

A i t th t h

mins

A picture that shows

Y i f NHS l d hi Your view of NHS leadership now

Your desire for what you wish NHS leadership to Your desire for what you wish NHS leadership to be

HALF AUDIENCE TO DRAW EACH PICTURE

RAPID FEEDBACK

Understanding the problemSTEP 1: CULTURAL ANALYSIS ALTERNATE TOOLSSTEP 1: CULTURAL ANALYSIS—ALTERNATE TOOLS

create

Stories& Symbols

influence

Rituals & Routines

Power Structures

changechange

relaxTHE CULTURAL WEB

ControlSystems

Processes

Structure

Processesreorganise

simplify

Understanding the problemSTEP 2: FACTOR ANALYSISSTEP 2: FACTOR ANALYSIS

External factors STEEPLE

Internal factors TEPID COIL

ILLUSTRATION PREVENTING AVOIDABLEILLUSTRATION: PREVENTING AVOIDABLE HAEMORRHAGE DEATHS (COMBAT TRAUMA)

Understanding the problemSTEP 2a: EXTERNAL FACTOR ANALYSISSTEP 2a: EXTERNAL FACTOR ANALYSIS

Social Technological Technological Economic Environmental Environmental Political

Legal Legal Ethical

External factor analysisSTEEPLE SOCIAL & POLITICALSTEEPLE—SOCIAL & POLITICAL

National social culture and political norms have supported medical advanceshave supported medical advances Casualty aversion in wars of choice

External factor analysisSTEEPLE TECHNOLOGYSTEEPLE—TECHNOLOGY

Emerging technology to stop external bleeding and improve treatment of coagulopathy: required rapidimprove treatment of coagulopathy: required rapid and sustained innovation adoption

External factor analysisSTEEPLE ENVIRONMENTAL

NORTHERN IRELAND KOSOVO

STEEPLE—ENVIRONMENTAL

NORTHERN IRELAND

Each conflict has its own signature injuries

AFGHANISTANIRAQ

External factor analysisWHAT INFLUENCES THE STANDARD OF CARE FOR UK HCWs TO DELIVER TO EBOLA VICTIMS IN WEST AFRICA?WEST AFRICA?

Social Technological

5mins

Technological Economic Environmental

thinking

Environmental Political

Legal Legal Ethical

ONE FACTOR PER GROUP

Understanding the problemSTEP 2b: INTERNAL FACTOR ANALYSISSTEP 2b: INTERNAL FACTOR ANALYSIS

Trainingg Equipment Personnel Infrastructure Doctrine

Clinical Organisation Information systems

L i ti Logistics

Internal factor analysisTEPID COIL CLINICALTEPID COIL—CLINICAL

Preventing avoidable death from haemorrhage

Internal factor analysisTEPID COILTEPID COIL

TrainingBattlefield First AidMilitary Operational Surgical Training

EquipmentTourniquets & topical haemostatics

DoctrineDoctrineABC to CABC

OrganisationN bilitNew capability

Army Team MedicMedical Emergency Response Team

Preventing avoidable death from haemorrhage

Understanding the problemSTEP 2b: INTERNAL FACTOR ANALYSIS

What are the internal factors to translate

STEP 2b: INTERNAL FACTOR ANALYSIS

military learning to civilian MTCs? Training 5 Equipment Personnel Infrastructure

minsthinking Infrastructure

Doctrinethinking

Clinical Organisation Information systems Logistics

Making a ‘campaign’ planA LEXICONA LEXICON

Mission Campaign objectives Campaign objectives End state Centres of gravity Centres of gravity Main effort

Li f ti Lines of operation Time phases

Campaign PlanA ROAD MAP FOR CHANGE

Hodgetts T. J Roy Army Med Corps 2014;160(2):86-91.

A ROAD MAP FOR CHANGE

Vision | End state CoG MainEffort

TiM

TiM

Lines of OperationDecisionPoint2 weeks

JAN 20173 years

T

Campaign planA ‘PLAN ON A PAGE’

Time phases

A PLAN ON A PAGE

Line of OperationStrengt

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DC2DC1 Supporting Effect 1Supporting Effect 2Supporting Effect 3

Enon

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Campaign Objectives

Campaign planningIS IT REALLY TRANSFERABLE?IS IT REALLY TRANSFERABLE?

UNDERSTAND DECISIVE ENDURING

Royal College of Emergency MedicineNATIONAL MANNING & OVERSTRETCH

Moral

CEM VISION The CEM exists to ADVANCE safe, effective, best practice in EM through EDUCATION, TRAINING, RESEARCH and DEVELOPMENT, through INFLUENCE of relevant bodies and authorities and through DISSEMINATION of relevant

and IDENTIFY DECISIVE ENDURING

CEM ENDSTATE

DC 8

Physical

DISSEMINATION of relevant information in order to ensure high quality standards of emergency care.

DC 5

DC 4

DC 6

DC 3

DC 1 1

CEM ENDSTATE

To RESTORE, SUSTAIN and MOTIVATE a credible and satisfied speciality workforce in order to ensure high quality standards of

Conceptual

DC 2

DC 7

Influence

DC 1 Scale and causes of the problem understoodDC 2 Campaign plan endorsed (by key (not all) stakeholders)DC 3 CEM policies, guidance and structures amended

CEM Objectives

OBJ (1): RECRUIT manpower

q yemergency care..

2

DC 4 Balanced messaging achievedDC 5 All available manpower sources exploitedDC 6 Appealing employment models establishedDC 7 Appropriate trained manpower levels achievedDC 8 Harmonious working environment established

D i i C diti (DC) A bi ti f i t ff t ifi

A credible, satisfied emergency care workforce that is restored to the required number of trained personnel

OBJ (2): SUSTAIN manpowerGenerate and maintain an emergency care workforce that is sustainable

UK practicing members

Speciality COG

Decisive Condition (DC). A combination of circumstances, effects, or a specific key event, critical factor, or function that when achieved will contribute materially to delivering an objective. A condition in a system that must be achieved and maintained.

OBJ (3): MOTIVATE manpowerDeliver an emergency care workforce that is motivated

Centre of gravity (COG). The primary element of power that an actor/entity relies on.

London Ambulance ServiceCAMPAIGN PLAN FOR A ‘LEARNING ORGANISATION’CAMPAIGN PLAN FOR A LEARNING ORGANISATION

L d hi t t Leadership support to London Ambulance Service Cross governmental request Cross-governmental request 6 months of close support Executive & senior leadership p

development programme ‘Toolset for innovation & change’ Culture change through enlightened Culture change through enlightened

understanding Campaign plan to generate a

Learning OrganisationLearning Organisation

Time phases: Understand Innovate Develop

‘UNIFY’ Research Programme Campaignon

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Campaign Objectives• Long term non-unions with comorbidities including diabetes, infection and life style issues.• Non-unions in the elderly including those with osteoporosis.• Non-unions in the active young with low-comorbidities but significant contamination.• Elective non-unions including osteotomy.

IMPLEMENTINGIMPLEMENTING

COMPLEX CHANGE

Disruptive changeAN EFFECTIVE MODELAN EFFECTIVE MODEL

What step is missing?

B ild idi li i

Create a sense of urgency

Build a guiding coalition

Generate a vision

Communicate your vision

Remove obstacles

Produce short-term winsProduce short term wins

Build on the change

Anchor the change in corporate culture

Understand & frame the problem

B ild idi li i

Create a sense of urgency

Build a guiding coalition

Generate a vision

Communicate your vision

Remove obstacles

Produce short-term winsProduce short term wins

Build on the change

Anchor the change in corporate culture

Creating a sense of urgencyWHAT FACTORS WILL CREATE URGENCY?WHAT FACTORS WILL CREATE URGENCY?

patient safetypolitical imperative

potential litigationloss of reputation

financial savingg

process efficiency

Disruptive changeDEALING WITH OBSTACLES

5DEALING WITH OBSTACLES mins

thinkingthinking

Wh ’t h th thi kWhy can’t you change the things you know need to change?

change

h

change

change

change

Obstructions to changeg

B B ll ing c lt re a fire blanket to creati itB Bullying culture: a fire blanket to creativity

AE

Apathy: a lack of motivation

EI

Exploitation: a lack of reward

Impotence: a lack of empowerment

OU

p p

Opposition: a resistance to change

U Unappreciation: a lack of recognition

INNOVATION CONSTIPATION:INNOVATION CONSTIPATION: ORGANISATIONAL BLOCKERS TO INNOVATION (B-OWELS)

© TJ HODGETTS 2015

Obstructions to changeTHE CLOSED MINDTHE CLOSED MIND

“The one thing harder than getting aThe one thing harder than getting a new idea into the military mind

is getting an old one out”g g

BASIL LIDDELL HART

Obstructions to changeWE DON’T DO IT LIKE THAT HEREWE DON T DO IT LIKE THAT HERE

Obstructions to changeTHE PROCESS ZOOTHE PROCESS ZOO

© TJ Hodgetts & C Gibson 2016

Obstructions to changeMEET THE PROCESS ANIMALS

DILIGENT LAZY

MEET THE PROCESS ANIMALSVE

LAZY INTEL

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© TJ Hodgetts & C Gibson 2016

BENIGN MALIGNANT

Summaryy

Shared tools for complex problem solving and changeg

Illustrated with examples Application on military operations Application in NHS

Practiced to enhance leadership competence

Support the ReservesVISIT THE STAND IN THE EXHIBITION AREA