Leading change from the front line: Understanding and working withemergent change

Steve FairmanNHS England

“In the future, the only organisations to thrive will be those that can change as fast as change itself”

Gary Hamel

Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

…Understand your organisation: It may not be ‘change friendly’…

Research from the sales industry:• 2% of sales are made on the first contact• 3% of sales are made on the second contact• 5% of sales are made on the third contact• 10% of sales are made on the fourth contact• 80% of sales are made on the fifth to twelfth

contact

Source: http://www.slideshare.net/bryandaly/go-for-no

Source: @NHSChangeDay

“Thousands of patients have died needlessly because of a

damaging reluctance amongst doctors and the public to

accept changes in the NHS, according to the country’s top

emergency doctor

“

Is your change process a cathedral or a bazaar?

http://www.unterstein.net/su/docs/CathBaz.pdf

We have a lot of cathedrals

Source: Sewell (2015) : Stop training our project managers to be process junkies

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

• The biggest-ever digital campaign for EMAP (Health Service Journal and Nursing Times)Tapping the collective brilliance of the NHS

• A joint campaign to “challenge top down change”

• Ground-breaking: the first-ever crowd-sourced theory of change in the NHS

@HelenBevan @SteveFairman1 #cmidisrupt

Reach and scale:

• Contributors from 45 different countries

• 13,895 ideas, comments and votes shared - collectively identifying:

Final outputs were • 10 barriers• 11 building blocks• 16 solutions

http://www.hsj.co.uk/5083743.article

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

The 10 barriers to change identified by 14,000 contributions from front line staff

The 11 building blocks for change identified by 14,000 contributions from front line staff

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

A Solution:Use a Change Model

• No one model has all the answers

• A mental framework and a process that can help

• Use evidence of what makes change successful

• Helpful to see the change through different lenses

Use a Change Model (2)

Bigger picture / longer term thinking

Poor workforce planning

Poor project management

A Solution:Empower everyone to be a change agent

• It’s easy to feel isolated if you want to change things

• Build everyone’s QI skills and confidence and willingness to take on a challenge as an antidote

• Resistance to change will fall…

Empower everyone to be a change agent (2)

Flexibility and adaptability Playing it safe

Poor workforce planning

Source: @NHSChangeDay

Source: @NHSChangeDay

What is the issue here?“permission” ?

(externally generated)or

Self efficacy ? (internally generated)

Building self-efficacy: some tactics

1. Create change one small step at a time2. Reframe your thinking: failed attempts are

learning opportunities3. Make change routine rather than an exceptional activity4. Get social support5. Learn from the best

Self-efficacy

“If you think you can or think you

can't, you are right.”

Henry Ford

There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change

and get good outcomesSource of image:www.h3daily.com

5 Questions for to take away for reflection

1. What are the opportunities for me to build my perspectives and skills as an agent of change?

2. How can I build self efficacy as a change agent?3. How do I move beyond skills and knowledge of

change to live and be change?4. Who can help and support me as a change

agent?5. What are the implications for the way I work?

“Even the smallest creature can

change the world”

Galadriel to FrodoLord of the Rings

A final thought…

Thank you