NHS Institute for Innovation and Improvement, 2011 Creating
contagious commitment to change to deliver results in challenging
times Helen Bevan NHS Institute for Innovation and Improvement
Slide 2
NHS Institute for Innovation and Improvement, 2011 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
Slide 3
NHS Institute for Innovation and Improvement, 2011 A question
Where would you start if you wanted to improve quality and reduce
costs at unprecedented scale and pace?
Slide 4
NHS Institute for Innovation and Improvement, 2011 Revolution
begins with transformation of consciousness Paul Bate
Slide 5
NHS Institute for Innovation and Improvement, 2011 Which
tradition of change? Management of change Organising and
mobilising
Slide 6
NHS Institute for Innovation and Improvement, 2011 Which
tradition of change? Organisational behaviour Leadership and
management studies Clinical/medical audit Improvement science
Academic tradition(s) 100 years Management of change
Slide 7
NHS Institute for Innovation and Improvement, 2011 Which
tradition of change? Community organising, campaigns and social
movements Learning from popular, civic and faith-based mobilisation
efforts. Academic tradition 100 years Organising and
mobilising
Slide 8
NHS Institute for Innovation and Improvement, 2011 Which
tradition of change? Organisational behaviour Leadership and
management studies Clinical/medical audit Improvement science
Academic tradition(s) 100 years Community organising, campaigns and
social movements Learning from popular, civic and faith-based
mobilisation efforts Academic tradition 100 years Management of
change Organising and mobilising
Slide 9
NHS Institute for Innovation and Improvement, 2011 Where would
you start? 1.create a burning platform and imperative for action
around quality and cost improvement
Slide 10
NHS Institute for Innovation and Improvement, 2011 Where would
you start? 1.create a burning platform and imperative for action
around quality and cost improvement 2.develop a strong narrative
(story) around how cost improvement can be delivered through
quality
Slide 11
NHS Institute for Innovation and Improvement, 2011 Where would
you start? 1.create a burning platform and imperative for action
around quality and cost improvement 2.develop a strong narrative
(story) around how cost improvement can be delivered through
quality 3.make a clinically relevant case that makes both a
rational case for change and a connection to emotions, through
values
Slide 12
NHS Institute for Innovation and Improvement, 2011 Where would
you start? 1.create a burning platform and imperative for action
around quality and cost improvement 2.develop a strong narrative
(story) around how cost improvement can be delivered through
quality 3.make a clinically relevant case that makes both a
rational case for change and a connection to emotions, through
values 4.make it real for frontline staff (e.g., 200 patients and
5k per person per year)
Slide 13
NHS Institute for Innovation and Improvement, 2011 Where would
you start? 1.create a burning platform and imperative for action
around quality and cost improvement 2.develop a strong narrative
(story) around how cost improvement can be delivered through
quality 3.make a clinically relevant case that makes both a
rational case for change and a connection to emotions, through
values 4.make it real for frontline staff (e.g., 200 patients and
5k per person per year) 5.ask people to commit to specific
actions
Slide 14
NHS Institute for Innovation and Improvement, 2011 Anatomy of
changePhysiology of change Definition The shape and structure of
the system; detailed analysis; how the components fit together. The
vitality and life-giving forces that enable the system and its
people to develop, grow and change. Focus Processes and structures
to deliver health and healthcare. Energy/fuel for change.
Leadership activities measurement and evidence improving clinical
systems reducing waste and variation in healthcare processes
redesigning pathways creating a higher purpose and deeper meaning
for the change process building commitment to change connecting
with values creating hope and optimism about the future calling to
action
Slide 15
NHS Institute for Innovation and Improvement, 2011 The ten key
principles of large scale change 1.Movement towards a new vision
that is better and fundamentally different from the status quo
2.Identification and communication of key themes that people can
relate to and that will make a big difference 3.Multiples of things
(lots of lots) 4.Framing the issues in ways that engage and
mobilise the imagination, energy and will of a large number of
diverse stakeholders in order to create a shift in the balance of
power and distribute the leadership 5.Mutually reinforcing change
across multiple processes/subsystems
Slide 16
NHS Institute for Innovation and Improvement, 2011 The ten key
principles of large scale change 6.Continually refreshing the story
and attracting new, active supporters 7.Emergent planning and
design, based on monitoring progress and adapting as you go 8.Many
people contribute to the leadership of change, beyond
organisational boundaries 9.Transforming mindsets, leading to
inherently sustainable change 10.Maintaining and refreshing the
leaders energy over the long haul
Slide 17
NHS Institute for Innovation and Improvement, 2011
Slide 18
From 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 Based on
organisational accountability (if I don't deliver this, I fail to
meet my performance objectives) To 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 Based on relational
commitment (If I dont deliver this, I let the group or community
and its purpose down) From the old world to the new world Source:
Helen Bevan
Slide 19
NHS Institute for Innovation and Improvement, 2011 Rules cannot
substitute for character Alan Greenspan US Federal Reserve
Slide 20
NHS Institute for Innovation and Improvement, 2011 mobilising
versus organising
Slide 21
NHS Institute for Innovation and Improvement, 2011 A cynic,
after all, is a passionate person who does not want to be
disappointed again Zander R and Zander B (2000) The art of
possibility. Harvard Business School Press. As quoted by Steve
Onyett
Slide 22
NHS Institute for Innovation and Improvement, 2011 How did the
great social movement leaders change the world? Source: Marshall
Ganz Shared understanding leads to Action Narrative why? Strategy
what?
Slide 23
NHS Institute for Innovation and Improvement, 2011 The
challenge 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 workforces primary motivators for putting extra energy
into the change programme Scott Keller and Carolyn Aiken (2009) The
Inconvenient Truth about Change Management
Slide 24
NHS Institute for Innovation and Improvement, 2011 More than
80% of our ability to save costs depends on clinical decision
making Brent James, Institute for Healthcare Delivery Research
Intermountain Healthcare Copyright 2009 NHS Institute for
Innovation and Improvement
Slide 25
NHS Institute for Innovation and Improvement, 2011 If we want
people to take action, we have to connect with their emotions
through values action values emotion Source: Marshall Ganz
Slide 26
NHS Institute for Innovation and Improvement, 2011
Slide 27
But not all emotions are equal......... inertia urgency anger
apathy solidarity isolation you can make a difference Self-doubt
hope fear Overcome Action motivatorsAction inhibitors
Slide 28
NHS Institute for Innovation and Improvement, 2011 What the
framing literature tells us a new idea must be at the least couched
in the language of past ideas; often, it must be, at first, diluted
with vestiges of the past Saul Alinsky Rules for Radicals
(1971)
Slide 29
NHS Institute for Innovation and Improvement, 2011 What the
framing literature tells us In other words.... People are much more
likely to embrace change if it is framed as something that builds
positively on what they are familiar with than as something that
seems far away and unachievable.
Slide 30
NHS Institute for Innovation and Improvement, 2011 Helens
photo
Slide 31
NHS Institute for Innovation and Improvement, 2011
Slide 32
When you have gone as far that you cant manage one more step,
then you have gone just half the distance that you are capable of
Proverb of the Inuit people of the Arctic Circle
Slide 33
NHS Institute for Innovation and Improvement, 2011 What do we
need to do? 1.Tell a story
Slide 34
NHS Institute for Innovation and Improvement, 2011 What do we
need to do? 1.Tell a story 2.Make it personal
Slide 35
NHS Institute for Innovation and Improvement, 2011 What do we
need to do? 1.Tell a story 2.Make it personal 3.Be authentic
Slide 36
NHS Institute for Innovation and Improvement, 2011 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)
Slide 37
NHS Institute for Innovation and Improvement, 2011 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
Slide 38
NHS Institute for Innovation and Improvement, 2011 Three
components of a great narrative (story) 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?
Slide 39
NHS Institute for Innovation and Improvement, 2011 The most
common way people give up their power is by thinking they don't
have any Alice Walker
Slide 40
NHS Institute for Innovation and Improvement, 2011 The leaders
most basic role is to release the human spirit that makes
initiative, creativity, and entrepreneurship possible Bartlett and
Ghoshal
Slide 41
NHS Institute for Innovation and Improvement, 2011 In
everybodys life, at some time, our inner fire goes out. It is then
burst into flame by an encounter with another human being. We
should all be thankful for those people who rekindle the human
spirit Albert Schweitzer