New Lens on Change in Healthcare

The Million Dollar Question

• Our biggest challenge?• Why are we failing• What’s possible?• Big things to tackle• Your contribution

@HelenBevan #QS2015

Most change programmes fail to deliver their objectives

Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey

Gets anywhere near achieving the change and

delivering the benefits

@HelenBevan #QS2015

Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey

Delivers and sustains the change

Most change programmes fail to deliver their objectives

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

HSJ journal: Crowdsourced barriers to Change

@HelenBevan #QS2015

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

Type one:

Type two: Type three:

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

@HelenBevan #QS2015

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

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

Max Valiquette

Max Valiquette

What cool and innovative health related practices

have you heard of?

Traditional Healthcare Culture

• Need to get things done immediately• Evidence-based practice (scientific proof) • Information and data are trusted• Culture change is complicated • Leaders need to ‘step-up’ • Top-down leadership• “Standardize and roll it out”

Zimmerman et. al. Healthcare Papers 2013

How we tend to view the healthcare world:

A B

What it tends to be like:

W BBLACK BOX

Simple Complicated Complex

Types of Problems

Adapted from Brenda Zimmerman

In a Linear World

• One size can fit all• Process solutions work (Lean, Model

for improvement…)• Copying best practices makes sense• Top down leadership (“develop the

program and roll it out”) works• Checklists work

For every complex problem there is a solution that is clear, simple, and wrong

HL Mencken

MOMENT

Kinds of people at workThe

ContributorsThe

CompliantThe

Contras

Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/

Kinds of people at workThe

ContributorsThe

CompliantThe

Contras

Gallup global research:•Only 13% of the workforce are engaged (Contributors)•Contributors create six times the value to an organisation compared to the Complianthttp://www.gallup.com/poll/165269/worldwide-employees-engaged-work.aspx

Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/

The Reality“What the leader cares about (and typically bases at

least 80% of his or her message to others on) does not tap into roughly 80% of the workforce’s primary motivators for putting extra energy into the change

programme”

Scott Keller and Carolyn Aiken (2009)

Source of image: swedenbourg-openlearning.org.uk

Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA

Old Power Managers Words

New Power Manager Words

A project charter is a fundamental step to making sure our project succeeds.

A general direction is a good first step; we have no idea what is around the first corner and we want to adjust if we have to.

I think that we need to strike a steering committee to make sure we are heading in the right direction.

I want to gather as many ideas and opportunities from as many people as possible.

Role clarity is important to avoid confusion. Let’s see who feels they are good and interested at the task at hand.

A thoughtful project plan will keep us on track.

Assessing where we need to go as we start the work will be our guide.

A literature review at the outset of our project will give us an environmental scan and help us set the course.

Observing blogs, social media and conference discussions on an ongoing basis will inform our work along the way.

A clear vision by our leaders is fundamentally important.

A shared purpose that invokes passion and excitement will grow our community.

Consulting experts to establish a direction is a key objective.

Crowd sourcing ideas from outsiders and inviting diversity of thought is a key way for us to know what to do!

@tweetvandijk

What are some of your behavioursthat could be seen as old power?

New Power WAYS of Working

• Change Platforms• Dual Operating Systems• Innovation Labs• Hackathons• Holacracy• Design Thinking

@HelenBevan #QS2015

Dual Operating Systems

John Kotter, Accelerate

Innovation Labs/Special Teams

Design Thinking

Augsburg, Germany)

Holacracy

Buurtzorg

Reference

Indicators of Bureaucratic Mass

Overhead Number of management layersFriction Percentage of time non-managerial

employees spend on internal complianceInsularity Percentage of total headcount that is not

directly customer-facingDisempowerment The percentage of employee time that is

not self-directedConservatism Extent of perceived disincentives to

personal risk-takingMistrust The percentage of employees who don’t

have the opportunity to weigh in on key policy decisions

Gary Hamel, 2016

Some Inconvenient truths

1. What motivates you may not motivate them

2. Let them write/tell their own story3. Both positive and negative are important4. You are part of the problem5. Influence leaders may not be influential

Keller and Aiken, McKinsey and Company, 2000

Some Inconvenient truths

6. Money may not motivate7. The process is as important as the

outcome8. Employees are what they think9. Good intentions are not enough

Keller and Aiken, McKinsey and Company

Buy in

Ownership

How is this different from “sharing” best practices?

“Point of Care” Ownership• Winning practices are highly

sensitive to the local context

• Winning practices come from those who are “touching the problem”

• Practices are spread virally peer to peer

• Sustained

Sharing Best Practices• What worked there should

work here. Variability is discouraged

• Winning practices come from experts

• Practices are spread in top down fashion

• Often not sustained

I’m sorry I broke your companyWe have been led to believe…that businesses are

logical and run by the numbers and that their models and theories will provide step-by-step

instructions on how to succeed.But

Businesses are people—irrational, emotional, unpredictable, creative, oddly gifted, and

sometimes ingenious people who don’t operate according to the theories.

Karen Phelan, 2013

Rebels Fighting the Bureaucracy59

Innovation Leaders

School of Healthcare Radicals

References• What is a hackathon• Design Thinking: IDEO