transformational leadership in healthcare: icre

@HelenBevan #ICRE2015

Helen Bevan@HelenBevan

#ICRE2015

in healthcare

Source of image: http://cindyscott.org/so-what-is-the-big-deal-with-transformational-leadership-anyway/

http://cindyscott.org/so-what-is-the-big-deal-with-transformational-leadership-anyway/

http://cindyscott.org/so-what-is-the-big-deal-with-transformational-leadership-anyway/

@HelenBevan #ICRE2015 @HelenBevan #ICRE2015

Learning outcomes

• Learn why transformational change is a critical topic in leading improvement.• Identify the future skills that healthcare

leaders need• Understand how future methodologies,

models and frameworks for transformational leadership can create positive conditions for change in healthcare


The NHS Five Year Forward View

• New care models• Reinforcement of list-based

primary care• Potential mismatch between

resources and patient needs of nearly £30 billion a year by 2020/21

• Mentions “radical” 10 times, “transformation” 12 times and “change” 32 times• Radical upgrade on prevention and public health• Patients gain far greater control of their own care


New care models

• Viable smaller hospitals• Maternity services• Health of people in care

homes

• Multispecialty Community Provider

• Primary and Acute Care Systems

• Urgent and emergency care


“Pioneering is the enemy of

transformative and systematic change”

David AlburyThe Innovation Centre

Why, after nearly two decades, haven’t we created an unstoppable, system-wide drive for improvement?


I amar prestar aen, Han mathon ne nen, Han mathon ne chae,

A han noston ned gwilith

The world is changed,I feel it in the water, I feel it in the Earth,I smell it in the air

Galadriel’s prologue: The Lord of the Rings: The Fellowship of the Ring


SEISMIC SHIFTS


Kinthi Sturtevant, IBM 13th

annual Change Management Conference

June 2015

We rarely see two, three or four year change projects anymore. Now it’s 30-60-90 day change

projects

http://www.innovationexcellence.com/blog/2015/07/09/13th-annual-change-management-conference-highlights/?utm_source=hs_email&utm_medium=email&utm_content=20535245&_hsenc=p2ANqtz--W0963q5vEUgL7ecueQKfQ5nK0QPbROyo7BwHs10orC8Mhs-KVEWZbwEyxXf1c8rSQahhkhUXAPaEFtqlTzK5nEygUTw&_hsmi=20535245





Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”

http://www.bromfordlab.com/labblog/2015/7/22/tests-vs-pilots?utm_content=bufferc862c&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer


Source: Bromford P (2015), ”What’s the difference between a test and a pilot?”

https://novoed.com/prototyping-fall-2015/





DIGITALCONNECTION

SEISMIC SHIFTS


How does the NHS improvement community prefer to communicate?


Work complexity

SEISMIC SHIFTS

DIGITALCONNECTION


DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity


“In a connected world, power no longer emanates from the top of the heap, but the centre of the

network.”Greg Satell, 2015

Greg Satell: http://www.digitaltonto.com/2015/how-power-is-shifting-from-corporations-to-platforms/

http://www.digitaltonto.com/2015/how-power-is-shifting-from-corporations-to-platforms/




DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexityChange from the edge


http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final





Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always


Why go to the edge?

“Leading from the edge brings us into contact with a far wider range

of relationships, and in turn, this increases our potential for diversity in terms of thought, experience and

background. Diversity leads to more disruptive thinking, faster

change and better outcomesAylet Baron


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

https://www.youtube.com/watch?v=j-S03JfgHEA


@HelenBevan #ICRE2015 @HelenBevan #ICRE2015For more information/explanation visit: The Collaboration Pyramid revisited

http://www.oscarberg.net/2014/11/the-collaboration-pyramid-revisited.html



Three types of levers for large scale change

‘Prod mechanisms’ targets

performance management

price & payment incentives regulation

competition

‘Proactive support’

relies on building ‘intrinsic motivation’ in

staff to make the right changes to

improve

‘People focused’ education and training

national contractsprofessional regulation

clinical quality standards

Type one:

Type two: Type three:

Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015

http://www.health.org.uk/publications/constructive-comfort-accelerating-change-in-the-nhs/




Three types of levers for large scale change

‘Prod mechanisms’ targets

performance management

price & payment incentives regulation

competition

‘Proactive support’

relies on building ‘intrinsic motivation’ in

staff to make the right changes to

improve

‘People focused’ education and training

national contractsprofessional regulation

clinical quality standards

Type one:

Type two: Type three:

Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015

Less than 10%of the potential

for improvement

at system level can be

delivered through type one change





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


“In a world of mounting performance pressure, [organisations and change processes] need to evolve…the most successful will be those that

evolve into movements.

Success will be determined by their ability to mobilise, inspire and support an

ever-expanding array of participants extending far beyond their own four walls”

John Hagel, SXSW 2015http://www2.deloitte.com/us/en/pages/center-for-the-edge/articles/john-hagel-at-sxsw.html

@HelenBevan @TheEdgenhs #EdgeTalks @HelenBevan @Jodi Olden #EdgeTalks

http://www2.deloitte.com/us/en/pages/center-for-the-edge/articles/john-hagel-at-sxsw.html



The power of the platform“Facebook, YouTube, Twitter and their lesser cousins have proved the power of the platform. They have shown that if

your average 21st century citizen is given the tools to connect and the freedom to create, they will do so with

enthusiasm, and often with an originality that blindsides the so-called creative industries. …..

Good leadership is no longer about ‘taking charge’ or imposing a strategic vision but about creating the

platforms that allow others to flourish and create” Ashoka

http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in-the-21st-century





• systematic “change management”

• too often, leaders prescribe outcome and 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 Programmes

• everyone (including service users and families) can help tackle the most challenging issues

• value diversity of thought• connect people, ideas and

learning• Role of formal leaders is to

create the conditions and get out of the way

Change Platforms

“Tear down the walls”


“A space (physical or virtual) that is created so people get the choice and opportunity to collaborate without boundaries to achieve a common purpose, tackle a challenge or improve a situationChange platforms tackle silo thinking and other barriers to the exchange of knowledge. They enable a diverse group of people to come to the table, share ideas, insight and learned experience, co-create solutions and launch experiments. Platforms thrive on trust, relationships and the collisions of minds. They build energy for change.

What is a change platform?

Definition by @JodiOlden & @HelenBevan 2015


“Change comes naturally when individuals have a platform that allows them to identify shared interests and to brainstorm solutions.”

Gary Hamel & Michele Zanini, 2014Build a change platform not a change program

http://www.mckinsey.com/insights/organization/build_a_change_platform_not_a_change_program



Joy’s Law: No matter who you are, most of the smartest people work for someone else

Bill Joy, Sun Microsystems

“It’s become a kind of ‘Joy’s Law’ for the networked era—the best resources and capabilities always lie somewhere else.”

Greg Satellhttp://www.digitaltonto.com/2015/4-things-you-should-know-about-platforms/?

ct=t%28Why_Some_Movements_Succeed_5_31_2015%29

Platforms give access to resources

http://www.digitaltonto.com/2015/4-things-you-should-know-about-platforms/?ct=t(Why_Some_Movements_Succeed_5_31_2015)



Evolving kinds of change platforms:

They overlap!

1. Connecting platforms

2. Mobilising platforms

3. Learning platforms

4. Knowledge platforms

5. Crowdsourcing platforms


Platform principles have long been part of change practice

• Building on traditions in the field of organisation development of communities of interest and communities of practice

• Technology enables us to connect more widely and at greater speed

Source of image: Socialserviceinstitute.sg


Example platforms

Source of image: @JenniferClemo


Carousal: shows all active challenges open for staff participation

Live activity feed

Click here to submit an idea

Gamification


A platform for system-wide transformationLeeds Teaching Hospitals NHS Trust & Clever Together

WayFinder – a Crowdsourcing methodology and platform • Step 1: 4,500 staff and stakeholders shared 45,000 contributions to

• co-create The Leeds Way – a redefinition of their vision and their values

• co-design a five year strategy – a shared agreement of what needs to happen to achieve their vision

• co-define a new behavioural framework – a new agreement of the acceptable ways in which staff will live their values embedded into recruitment, induction, training and appraisals

• Step 2: WayFinder local – every department trained to use its own crowdsourcing platform • 19 clinical service units trained • A new way of working – online workshops – to ensure staff always

have a say in what’s happening in the Trust, bringing people together to co-create solutions.

Examples of results:• Staff satisfaction is up / buy-in to vision and values at an all time

high / complaints down 17% / 18weeks RTT down by 66% / CQC acknowledgement of staff engagement and impact on quality and safety


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

http://www.breakdengue.org/






www.newhcvoices.co.uk


The Academy of Fabulous NHS Stuff


Effective change platforms:

Gary Hamel & Michele Zanini (2014)http://www.mckinsey.com/insights/organization/build_a_change_platform_not_a_change_program

Encourage people to tackle significant organisational challenges foster honest and forthright discussion of root causes and, in the

process, develop a shared view of the thorniest barriers elicit dozens (if not hundreds) of potential solutions rather than

seeking to coalesce prematurely around a single approach; the goal is first to diverge, then to converge

focus on generating a portfolio of experiments that can be conducted locally to help prove or disprove the components of a more general solution, as opposed to developing a single grand design

encourage people to take personal responsibility for initiating the change they want to see and give them the resources and tools necessary to spur their thinking and imaginations



@HelenBevan #ICRE2015 Source: IDEO: The Field Guide to Human-Centered Design


Knowledge platforms


Because there’s a problem….

Source of quote: Harold JarcheSource of image: http://gotcll.com/about-2/

Gettinginformation off the

internet is like taking a drink from a fire hydrant

Mitchell Kapor


What is the best way to spread new knowledge?

Source of data: Nick Milton http://

www.nickmilton.com/2014/10/why-knowledge-transfer-through.html

Social connection/discussion is 14 times more effective

than written word/best practice

databases/toolkits etc.

Source of image: www.happiness-one-quote-time.blogspot.com

http://www.nickmilton.com/2014/10/why-knowledge-transfer-through.html



http://www.happiness-one-quote-time.blogspot.com/


Platforms as the new documentation

Source of image:Flickr user acaben

http://www.flickr.com/photos/acaben/11518666

@HelenBevan #ICRE2015 Source: Oliver Benson

If you’re a programmer, you don’t even bother reading the manual, you simply

use stackoverflow to answer all your questions”


Horizons Team: All our work is via change platforms

Source of image: @JenniferClemo #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

@HelenBevan #ICRE2015 #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

@HelenBevan #ICRE2015 @HelenBevan #ICRE2015 #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

@HelenBevan #ICRE2015 @HelenBevan #ICRE2015Source: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

http://www.slideshare.net/alwynlau/learning-theories-learner-needs

http://www.slideshare.net/alwynlau/learning-theories-learner-needs


1. Being a health and care radical: change starts with me• The differences between trouble-makers and radicals• How to rock the boat and stay in it• How to be a great change agent

2. Forming communities: building alliances for change• The power of working together by exploring communities and social movements• Techniques for connecting with own/others’ values and emotions to create a call

for action

3. Rolling with resistance• Recognising behaviour, behaviour change and the importance of appreciating

where people are starting from in relation to change

4. Making change happen• A range of tools, tactics and ways to make change happen

5. Moving beyond the edge• Helping radicals to shape how they take their learning from The School forward• What we can do next and where else we might get support and resources


The School is being formally evaluated by the Chartered Institute for Personnel & Development

#EdgeTalks WebEx

http://theedge.nhsiq.nhs.uk/expert/how-has-the-school-for-health-and-care-radicals-made-a-difference/

Or Google: #EdgeTalks School

How has the School for Health and Care Radicals made a difference?







The School is being formally evaluated by the Chartered Institute for Personnel & Development

• Change knowledge• Sense of purpose & motivation to improve practice• Ability to challenge the status quo• Rocking the boat & staying in it• Connecting with others to build support for change

Statistically significant positive effect on EVERY dimension of impact at both individual

and organisational level


Activists from 120 countries

500,000+ Twitter impressions@theedgenhs

21,000 active users


We have supported NHS Change Day for three years

• 800,000 pledges in 2014

• 6X the local activity/connectivity in 2015 compared to 2014

• #nhschangeday: 130m impressions

• Facebook impressions 253,999


The power of th

e platform #MatExp

The power of the platform

#NHSChangeDay + #MatExp


“Top down is a serious disease but it can be treated”

Celine Schillinger


The Change Challenge

Tapping the collective brilliance of the NHS


• The biggest-ever digital campaign for EMAP (Health Service Journal and Nursing Times)

• 14,000 contributors to the joint campaign to “challenge top down change”

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


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


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


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

http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx



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

/



http://healthaffairs.org/blog/2014/03/07/the-dangers-of-quality-improvement-overload-insights-from-the-field/





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

http://www.hsj.co.uk/leadership/change-challenge/


The power of the platform

“...demonstrates, yet again, the collective brilliance of the people who work in the NHS and wider care system”

@HelenBevan


How to create a change platform #1• Be clear about your intention or goal:• Solve a problem?• Learn from others?• Create solutions?• Mobilise for change?• Spread innovation?

• Articulate your mission• Design the stages in your process• Sprints and hacks


How to create a change platform #2• Identify the people you want in your community• Identify how to reach them• Find a platform • Existing or new • Free or paid for• Virtual or face to face

• Measure the outcomes (all the way through)• Engage your community• Set their expectations• Keep the connections flowing• Convert ideas to actions• Always, always follow up


Case study: System redesign principles for care models

Source of image: @JenniferClemo #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden


CAREDESIGN2016System redesign principles for care models

#CareDesign

“Help us to capture redesign principles for care models to get better, quicker outcomes from

change”


What are design principles?

“Design principles are suggestions that are highly likely to be effective, but they are not formulae that guarantee success … The point remains, however, that if one knows the design principles in a field, he or she is much further along in thinking and much more likely to be successful.”

Paul Bates


1. Distil a set of principles for redesign of care models that is globally applicable

2. Organise the principles in a way that makes them accessible and highly useable to people designing new systems for delivering care

3. Identify examples from across the world of the redesign principles in action

4. Signpost tools, methods and resources that can help in the implementation of the redesign principles

5. Demonstrate the power of design thinking for health and care transformation

Our Care Design 2016 aims:


Our ‘starter-for-ten’


● Only 1% participate fully so start with a big crowd● Inject thought diversity to guard against groupthink● Mix high domain knowledge with those with high creativity

Choose the right crowd

Choose the right incentives

● Crowdsourcing cannot happen without a vibrant, committed community ● Rewards must balance intrinsic & extrinsic motivators

Crowds do not replace the team

● You’ll get volume & diversity from the crowd but be prepared to match it with equal time & effort to herd, sift & identify contributions

Crowds needlove too!

● Crowds need direction & guidance to help them feel part of their community & give of their best

Keep itsimple

● Break complex tasks down● Tasks must be small, simple & fun & fit into your crowd’s spare time

Remember Sturgeon’s Law

Communities are always right!

Fulfilling self-actualisation

● “90% of everything is crap / 10% of everything is not crap”● Allow the crowd to surface its best through voting to the top

● Crowdsourcing works because creativity, spontaneity, problem-solving & affiliation achieve self-actualisation (Maslow / Howe)

● Top-down management style does not work in crowds, nor does grass-roots anarchy● Lead with the moral authority the crowd allows

Adapted from: A Guide to Open Innovation and Crowdsourcing, Ed. Paul Sloane

The rules of crowdsourcing

http://www.simplypsychology.org/maslow.html

http://web.mit.edu/evhippel/www/books/DI/DemocInn.pdf

http://www.amazon.co.uk/Guide-Open-Innovation-Crowdsourcing-Leading/dp/0749463074




https://nhsiq.crowdicity.com/




”If people give to a cause, they expect a relationship, not a transaction”

Nilofer Merchant

Once you start down this path, you have to follow up and continue


Platforms are only as good as the people leading them

Source of image: www.activationjourney.com

http://www.activationjourney.com/


Four ways to connect!

1. Follow us on Twitter@HelenBevan @TheEdgeNHS @School4Radicals

2. Subscribe to theedge.nhsiq.nhs.uk

3. Get materials from theedge.nhsiq.nhs.uk/school

…and sign up for our monthly #EdgeTalkstheedge.nhsiq.nhs.uk/edgetalks

4. Save the date for theedge.nhsiq.nhs.uk/transformathon

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

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

http://theedge.nhsiq.nhs.uk/edgetalks/

http://theedge.nhsiq.nhs.uk/transformathon/

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

@HelenBevan #ICRE2015 @HelenBevan #ICRE2015 #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

4pm - 4pm, 27-28th January 2016


“Even the smallest creature can

change the world”Galadriel to FrodoLord of the Rings


Ashoka (2014) What does leadership mean in the 21st century?Berg O (2014) The Collaboration Pyramid revisitedBriggs D (2015) The elements of council as a platformBromford P (2015) What’s the difference between a test and a pilot?Dawson R (2015) The future of work and organisations Deloitte University Press (2015) Business ecosystems come of ageDeloitte University Press (2014) The power of platformsHagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movementsHagel J (2014) Platforms are not created equal: harnessing the full potential of platformsHamel G, Zanini J (2014) Build a change platform not a change programHealth Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’ interactive toolkitHeimans J (2014) What new power looks like [YouTube]Heimens J, Timms J (2014) Understanding “New Power”Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers Ivanov E (2013) The Strength Within

References cited in the slide deck (1/2)







http://davebriggs.io/2015/06/18/the-elements-of-council-as-a-platform/



http://t.co/qPjnafNOs9

http://d2mtr37y39tpbu.cloudfront.net/wp-content/uploads/2015/04/DUP_1048-Business-ecosystems-come-of-age_MASTER_FINAL.pdf

http://dupress.com/articles/platform-strategy-new-level-business-trends/


http://edgeperspectives.typepad.com/edge_perspectives/2014/08/platforms-are-not-created-equal-harnessing-the-full-potential-of-platforms.html


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


https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet

http://www.insme.org/files/open-innovation-handbook

http://connect.forwardmetrics.com/business-management/the-strength-within.html


Jarche H (2014) The Seek > Sense > Share Framework Milton N (2014) Why knowledge transfer through discussion is 14 times more effective than writingO’Reilly T (2010) Government as a platformPearce D (2013) Social business discussions are the new documentationRaymond E S (2001) The Cathedral and the BazaarSatell G (2015) 4 things you should know about platformsSatell G (2012) How power is shifting from corporations to platformsSatell G (2015) Leaders must do more than inspire – we must shape networksSchillinger C (2015) Forget social networks, think social impact [YouTube]Scrivens J (2015) Enabling the experience of wholeness within enterprise social networksSewell S (2015) Stop training our project managers to be process junkiesShaw K (2015) Placing a digital platform at the heart of organisational change with OxfamSimon P (2011) The Age of the Platform

References cited in the slide deck (2/2)

http://jarche.com/2014/02/the-seek-sense-share-framework/


http://chimera.labs.oreilly.com/books/1234000000774/ch02.html#government_as_a_platform

http://www.informationweek.com/software/social/social-business-discussions-are-the-new-documentation/d/d-id/898942





http://www.digitaltonto.com/2015/leaders-must-do-more-than-inspire-we-must-shape-networks/?utm_source=Digital%20Tonto%20Newsletter&utm_campaign=5accd611d0-Leaders_Must_Shape_Networks7_5_2015&utm_medium=email&utm_term=0_3e316dce02-5accd611d0-389205725&ct=t(Leaders_Must_Shape_Networks7_5_2015)


http://www.kinshipenterprise.com/_blog/Blog/post/Experience-Wholeness-Enterprise-Social-Networks-esn/#.VZP7VBtVikr

http://acceleratingchangeprogrammes.com/2015/06/09/stop-training-our-project-managers-to-be-process-junkies/

http://www.codecomputerlove.com/blog/2015/07/placing-a-digital-platform-at-the-heart-of-organisational-change-with-oxfam/

http://www.philsimon.com/books/the-age-of-the-platform/

http://www.philsimon.com/books/the-age-of-the-platform/

transformational leadership in healthcare: icre

Healthcare