Transcript from Helen bevan Edge talk on

NHS IQ Webinar (UKNHSI1506A)

[Mel.Captioner is Live]

HELEN BEVAN: Good morning, let's start. My name is Helen Bevan, I am Chief of Service Transformation at NHS Improvement Quality, the national improvement body for improvement in the NHS in England.

I'm going to be leading the web seminar for the next 90 minutes. And our topic is Scrap the Change Programme, this is an era for change platform.

I don't necessarily think we need to scrap the change programmes, but it is a title that gets attention. In terms of all we're going to see this morning and interact with, I'm going to be leading the session with my colleague Jodi Brown.

Jodi has had a lot of tactical experience setting up change programmes and working with people on change platforms. She is going to be injecting a lot of wisdom into the session. Jodi, do you want to say hello?

JODI BROWN: Can you hear me?

HELEN BEVAN: Yes, that is perfect. We also have two other colleagues we are going to hear from this morning. One is Kate Pound, she is going to be the monitor for our chat room.

We really want to encourage... So many people taking part in this WebEx today have lots of practical experience. It would be really great to share. All of these WebExes are better when we get a lot of chat activity going on.

And our colleague Janet will also be monitoring Twitter. The next slide I'm going to show you is all the details of ways to connect and get in touch. If you're somebody who likes to tweet, we would love you to do so during this session.

Every so often, Jodi and I will stop, and we will get some feedback from Kate on the chat room, and Janet on Twitter. That's continuing talk about joining in today, and beyond.

Please use the chat box. If you're going to tweet please use #edgetalks. If you want to continue the discussion, sign up for our knowledge hub.

There are 21,000 people across the globe that connect with The Edge. What we are going to do, we're going to produce a summary of the discussion today using storage file. What we're also going to do, next Wednesday, 8 July, we're going to run a tweet chat on the issues and content of this Edge Talk today.

So, we hope you can join us for that as well. So, let's get on with the content. We are going to

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start off with some very wise words from a well-known philosopher. That is Galadriel from Lord of the Rings.

I'm not going to pronounce the Elvish version of it, but the English translation is, "The world is changed, I feel it in the water, I feel it in the Earth, I smell it in the air."

Whilst that has been written about fantasy, Lord of the Rings, it perfectly sums up where we are. My job, as transformation officer, I get to meet with change leaders, practitioners, people all over the world, and there is a real sense that the nature of change is changing.

We have to organise ourselves in different ways. So, I think this contribution perfectly sums up where things are.

I also think this quote from John Hagel helps. For those of us that work in health and care, we are in a world of mounting performance pressure, where the demands on our services gets higher and higher, and the resources we have available to meet those demands from our patients, our citizens, get tighter and tighter.

So, in this world of mounting performance pressure, we need to evolve and we need to find ways to change so we can deliver. John Hagel says the most successful are those who evolve into movements. He said, "Success will be determined by their ability to mobilise, inspire and support ever expanding arrays of participants extending far beyond their own four walls."

He is saying many of the answers we need in the future, however clever we are, however hard we work, we cannot find the answers typically within the four walls of our existing organisation.

We need to look way beyond our walls to enable change to happen, and get ideas for change. So, think that is a perfect starting quote when we think about many of the ways that we have typically done change up until now, when we worked with systematic change programmes inside our organisation, to move into change platforms where we can literally engage with the world.

And another thing, going back to (unknown term) and how our world is changing, a helpful way of thinking about this is to contrast old power with new power. What I see happening, certainly in the NHS in England, and the wider health and care, there is a battle going on between old power and new power.

So when we talk about old power, who has the money, who has a resource, who has not? It is held just by a few people, people with a position of power. When they want to make change happen, they push it down in organisations. They use the hierarchy of performance management. Change is commanded.

We have to do this, we have to take this action, we have to be part of this change because it is what the organisation has decided, what the company have decided.

Very often the way we interact is in a very (inaudible) way, it is the actions we can take to improve things. Very often, when reworking old power ways, they are transactional.

They are about the performance objective, or the commission, with a contract, or the national



target. And the way in which these things happen, they are transactions. We're holding people to account for undertaking a transaction.

When we think about that new power, the evolving thinking about power, it is a current. It surges with energy as many people are mobilised around change. Rather than being held by a few people, this power is held by many people coming together.

In a new power era, ideas and power are pulled into the system. In this world, power is shared by many more people. The way we operate is a very open way, bringing lots of people in. Rather than being transactional, essentially it is relational. It is about, how do we engage, how do we mobilise people?

We do that through relationships. When we work relationally, people are engaging in change because they want to. It fits with who they are in the world, their own values and emotions. Rather than having to use a more transactional way.

People taking these ideas forward about old and new power say that the battle and the balancing between the old and new power will be a defining feature of society and business in the coming years.

What I would say is, the battle and balancing between old and new power will also be the defining feature of the health and care system in the coming years. What I see happening is, as performance pressure mounts and money and resources get tighter, when we are thinking in an old power way, what we want to do is get more great. We want to take tighter control and avoid risk.

History tells us that actually, many of the ideas and approaches we need for the future are in that new power world. I think we will increasingly see new power ideas and perspectives.

What we need to do as a community of change agents, where we need to operate is in this difficult zigzag-y place in the middle.

Even though some of us may be around new power, engaging, actually, we're working in a world which is predominantly old power.

I think this is where platforms can come in and thinking about working through change platforms as opposed to change programmes, can be incredibly helpful.

What do we mean by a platform? We keep talking about this word "platform". Jodi put this slide together, it is really clever. She went into the Oxford Dictionary and looked at some of the really basic definitions around what platforms are.

I think it really helps. The first definition is about a raised level surface on which people or things can stand.

On the platform, anybody and everybody can contribute to change. Not just people with a position of power.

So, the next definition, "A raised floor or stage used by public speakers or performers so they



can be seen by their audience."

This idea of being seen by a lot of different people. It is very transparent, it is very open, and can be seen by lots of people.

And we want lots of people because we want new ideas and diversity of thought.

The third definition, "A raised structure standing in the sea from which oil or gas wells can be drilled or regulated."

Again, a very helpful definition of a change platform. When we get lots of people contributing ideas, we can drill in and find the knowledge you need to make a difference.

The fourth definition was, "A raised structure or orbiting satellite from which rockets or missiles may be launched."

The whole point of having a change platform is not just about bringing ideas and wisdom together, it is about using it as a platform to launch change, action, things that make a difference to our patients, colleagues and citizens.

The final definition was, "The declared policy of a political party or group."

A change platform is about having a really clear purpose for doing something that appeals to a lot of different people and enables people to make contributions.

The thing about a platform is, you cannot make people take part in a platform, people have to volunteer. They do it because they want to. It is about bringing lots of people together with a shared purpose in order to enable us to make lots of ideas and discoveries.

So, let's think about the history of platforms. I am going to put a little question into the chat, which is, when we think about platforms, those organisations that were the pioneers of the platform movement.

In the chat box, can you send to all participants what are your ideas about who are some of the organisations, or systems, that started the Genesis, the starting point of platform thinking, or some of the best platforms in the world?

[Sarah.Captioner is Live] Google. I agree with that. Facebook, wait. We have IKEA, Virgin. Apple. Twitter. Very good. Nike. I agree with all of these.

Very often, people talk about the big four. We got most of these, Google, Facebook, Amazon and Apple. These organisations came and started to work in very different ways. Instead of being about pushing products, they created platforms. They did this because they were really good at using technology and were able to create technology that enabled people to share.

Rather than being internally focused organisations, they embraced partnerships and external innovation. So going out and making lots of connections with others. They put a lot of effort and energy into building interactive communities. So constant sharing and learning and growing.



The fourth thing they did was they embraced an entirely new way of doing business. They created the idea of platforms. A lot of our thinking now, thinking that influences us in terms of change platforms is very much part of what came out of this different way of doing things.

If we think about this, the power of the platform, this is a quote from Ashoka. What these four organisations and others have shown is that if your average 21st-century citizen is given the tools to connect and the freedom to create, they will do so with impunity from and often an originality that blindside is the so-called creative industries.

Good leadership is no longer about taking charge or imposing a strategic vision, but creating platforms that allows others to create. There are loads of examples that we have put in the chat box and they demonstrate that really well. This quote says to us, actually, when you look at how incredible NHS workforce, look at the wider health care system, look at the people that use our services, the broader citizens, people in other industries, if we can give them tools to connect and freedom to create, we can move things forward.

We are in an era where we need to think in different ways about change. This was the research I saw quoted by IBM which I thought was interesting. They did a survey completed in how successful they were in managing change. They did the same survey in 2008 and 2014. In 2008, 41% of leaders considered they were successful in managing change. By 2014, only 20% of leaders considered they were successful in managing change.

You could say it was something about the sample and how the study was done, but what they are basically saying is we are working in an environment of change which is so complex, so fast moving that we can't just keep doing change the same way. Yet, if we look at, certainly the NHS and wider health and care system, and you look at the tools we are using to improve performance, to manage change, many of those tools have not changed in 10 or 15 years, but the world around us is changing massively. So maybe it is about time that our change tools and perspectives catch up.

I really like this quote, which have come from Deloitte. New mindset, and I would also say new power, are likely to take hold of the profession and embraces more networked and weblike arrangements. So why can't we as the change community be the people who lead the vanguard in working in these different ways.

They give us access to resources, they take us beyond the four walls of our organisations and give us access to people all over the world.

Joy's Law says, no matter who you are, most of the smartest people work for someone else. However clever you are, the smartest people are somewhere else. What platforms become if they Joy's Law for this era of networking and social engagement. Joy's Law in that era say the best resources and capabilities always lie somewhere else, outside of our organisation. We have choices. We can buy in expensive management consultancy or could connect with platforms and these people.

The final thing I would say in this phase of the talk is that the great thing about platforms is they engage emotions and they have to engage emotions, because people engage because they want to, not because they have to. If you want to engage people and mobilise them in change,



we know, the evidence tells us really clearly, the most effective way to do that is to connect with emotions and values.

When we think about the social technologies we use to underpin our platform, they allow people to not only consume, but also to share and make things together as a social group. If I was going to define the change platforms that we are seeing growing exponentially around the health and care sector, it is about enabling people to share and make things together for the social good. People really get that.

I talked a little bit about the safety of platforms. Let's relate that there is specifically to the way change happens in our sector. When we think about our change processes, are we designing cathedrals or are we designing bazaars?

I would say that most change processes that I see, big, large-scale change processes, certainly in the NHS, our bazaars, rather than cathedrals. A cathedral is very structured, very systematic, there are clearly certain people in charge around that structure. If we think about a bazaar, you create a place where people can trade and share.

We have lots of cathedrals. This is a classic large-scale NHS change programme, where we have a programme management office when we are trying to transform care or integrate care across our local community. We create these very systematic, cathedral like plants and we hold people to account and we say, "These are the timescales, these are the milestones and you are accountable for undertaking certain tasks in a period of time."

There will always be a place for program management offices and cathedrals. But I think we are in an era where working in this way is not fast enough, it is not broad enough, it isn't engaging people emotionally, it isn't connecting with the "want to" rather than the "have to." I think we need a lot more bazaars.

In a sense, I would say, we need to be moving from a situation where most of the change work that I see around the NHS and the wider health and care system are change programs. We talk about systematic change management. We are sticking to manage very large-scale, very complex change. I think even the term "change management" is questionable. The kind of massive, complex change, we are talking about new care models, integrated health and care, people led care, talking about this using terms like change management is really problematic.

I don't think there was anything wrong with change programmes per se, the problem is how people go about them. Too often, the leaders at the top of the system will prescribe not just the outcome, but the method of change. It means that people at the frontline of care, people at the point where the magic of care happens, they will experience that change in a way that is, "you have to do it." It is imposed, rather than wanting to do it.

In this fast moving era, we need to be moving more and more towards change platforms. We actually create a platform, using Jodi's definition, a level place where everyone, including service users and citizens and experts from other industries can help us tackle the most challenging issues.

When we had a change platform, we value different views. In a change programme, we often talk about overcoming resistance to change. We put horrible labels on people who are resistant,



like "in denial." In a change platform, we know we are going to get different views and conflict. We want to connect people with ideas and learning.

Whereas in a change programme, the role of leaders is to oversee things and make sure the change happens, in an era of change platforms, our job as leaders is to actually create the conditions and circumstances where change can happen and then get out of the way.

When I look globally at what is happening in the world of change, I see this very big shift going on from change programs to change platforms. When I look across our health and care sector, what I see is even two or three years ago, there were very few examples of change platforms. Now there are very many. Very shortly, Jodi will take us through some examples.

We could have picked many, but we have just picked a few to show you.

Why? Because we need change that is effective and quick and broad. We know change comes much more naturally when we have a platform that are allowed us to identify our shared interests and brainstorm solutions.

We need approaches to change that our real-time, immediate, socially constructed, so people created together. It is not one person doing it and then getting other people engage. Doing it together. The leader's job is not to create the change programme, but to build the platform that allows everybody to contribute. Allows other people to take part, to suggest solutions and launch experiments.

In a connected world, in a new power world, power no longer emanates from the top of the heap, but from the centre of the network. We are living in a world with both old power and new power and as change agent, we need to deal with both. But we can no longer rely just on positional power and positional leaders to make change happen.

We work with lots and lots of different kinds of change platforms. Just looking around the world, we are seeing lots of different sources and sorts of platforms. We see change platforms that are about connecting people. People that have got a common interest that want to connect with each other. We see mobilising platforms, where we have got a call to action and the platform is used to mobilise people for action. We see learning platforms where people come and learn from each other. We see knowledge platforms, where, and I will talk about this later on, there is so much knowledge and information out there. How can we create a platform where people can share knowledge and understand what might be the best thing to do? And we also see lots of crowd sourcing platforms. A crowd sourcing platform is where you have a really big problem or a really important change process and you use the wisdom of the crowd. You enable lots of people to contribute.


HELEN BEVAN: These platforms can overlap. The final thing I wanted to say, I think, as many of you have already said in the chat box, platform principles are a very long thing, part of change practice.

The change community, organisational development leaders have been using these principles



for way longer than Apple, Google or Facebook.

Actually, what we are seeking to do by using change platforms, is to build on a very fine tradition in the field of organisational development creating community interest and community practice.

When we create network-based communities on a common interest, or common area of practice. I think, the great thing about platforms now is the kind of technology we have that we did not have even five years ago, or 10 years ago, enables us to connect much more widely and at a greater speed.

To build our practice and community of interest at a speed and scale we have never had before. Now, I'm just going to stop there for a moment.

I'm just going to ask our chat monitor, who is Kate, to tell us what is happening in the chat box, and I'm going to put Janet on notice. Kate, what are we seeing in the chat box?

KATE POUND: Hi, so much activity in the chat box it is quite difficult to keep up with it. There was a lot of discussion about the old and the new power. We have had some really great examples given to us as well.

Tracy talks about the maternity examples currently going on. Leslie Callow said it was about everybody having a chance to be part of the platform.

Having an opportunity to become equal partners, and we must remember to support through coaching. There was a great discussion going on, going into a lot of detail over the words that we should use.

It has been an amazing discussion going on there.

HELEN BEVAN: Thanks very much, Kate. If we can mute you, and, Janet, what has been happening on Twitter?

JANET WILDMAN: Some really interesting discussion around some of the key concepts you have been talking about around change management.

Saying it is getting too mechanical, the idea around failure. Kerry says, why can't we learn from it? Some people are saying, "Tear down the walls." There is a lot of momentum around the idea of tearing down the walls. A lot of good suggestions on how we can move forward on this agenda and a lot of activity here.

HELEN BEVAN: Fantastic, thank you, Kate, and thank you, Janet. Let's get practical. I'm going to hand over to my colleague Jodi Brown. She's going to take us through some example platforms.

JODI BROWN: Thank you, Helen.



HELEN BEVAN: I have just handed it to you.

JODI BROWN: Hello, everybody. My name is Jodi Brown, I am in sunny Dorset at the moment. I do hope my sound is OK for you. If you start to experience any problems, please shout in the chat box and let us know, otherwise I will keep talking and assuming everything is going well.

HELEN BEVAN: We can hear you loud and clear.

JODI BROWN: Very good. There is an array of example platforms. The idea of doing this is not to terrify you all into thinking you have now got to go away and create your own high-tech platforms, as many of these are.

I want to really get you thinking about what is it about these platforms that make them so special? (inaudible) think about the traditional change programme to understand what they have done, the benefit of having that platform.

How can you bring elements of these platforms into your change? I am new to this, I am just going to have to flick the slide over. This is the first example, this is giffgaff and the example was given to us by Ollie, one of our team members.

They said, "We are a group of people who one day put down our phones and thought there had to be a better way of doing this stuff."

That got me really excited. That is the beginning of a social movement there. It is a platform. It is inspired by Wikipedia and Facebook. It is based on this concept of mutuality. You give something, and you get something back.

It is all about members creating mobile phone services that they want. It rewards its network of customers for doing much of the work which is actually done by employees. So, the customers themselves are taking the role of the employee and creating value for themselves and other people.

It is very much a non-institutional way getting things done, a real people network. If you think back to what Helen said, how we need to have that emotional connection, the good Samaritan kind of thing in us.

This is something for people who like to get involved, and get excited about doing things differently. Just onto another slide about... I just wanted to talk a little bit about NTS.

I'm not going to get too technical, but because of this community format, there is a fiercely loyal community of customers around this platform now. They have a motor score based on one very simple, and I think you will find quite familiar, question.

How likely is it that you would recommend your company, so giffgaff, to a friend or colleague? Your public thinking, it is a bit like the friends and family test. But most of you probably have not



heard of this company before, but their score is 74, which is on a par with Apple and Amazon.

I am now going to move onto another example. Moving away from the technical side here, perhaps to something a little bit more fun and right up my street. I am a big fan of Lego.

(inaudible) passionate about making their own creations and sets of Lego. These people have come up with ideas of things that can be created with Lego sets.

The Lego Rubiks cube and, my personal favourite, the Lego Beatles. As a creative individual, you can commercialise your own creation on this platform. But you need the support of the people out there, and you need people to vote on it. They have to really like what you are doing. Through the power of the crowd, you have the chance to get your creation into production. This is an open innovation platform which gives people who might not otherwise have that chance, a chance to get their ideas and creativity seen and realised.

I'm now going to move onto something which might be more familiar to you. It is Break Dengue. Some of you might recognise our friend Celine, a health and care graduate and a big supporter of The Edge.

Dengue is a disease and there is no prevention or cure. This platform is all about mobilisation. It is a non-profit mobilisation which engages and educates people around initiatives all over the world in one centralised hub.

This is the first of its kind, nobody has ever brought people together around a single disease or condition like this. In the first week alone, this platform had over 10,000 Facebook followers.

After one year, it had 250,000 followers. This goes to show it is probably one of those conditions which would not have been well supported or known about. But through its community (inaudible).

If you haven't done so, have a click on the slide when it comes out, or I will share the link after I finish talking of Celine talking about it. A really passionate talk about the rationale behind this platform.

So far, we have looked at platforms pretty much based on technology. Online resources. Now, new health and care voices, another great friend of us here at The Edge.

This is a platform which is not purely based on technology. This is about people wanting to make a difference. The idea of New Health and Care Voices was born by our friend Kirstie Stott and Vanessa Garrity. They wanted to create a space, we could call it a platform, for conversations about health care.

They wanted to develop this throughout England. They had to start small and then let the network grow. I am sure many of you will have been to Health and Care Voices events.

This is also about people getting together, through the creation of the facilitated network, amazing things happen.

HELEN BEVAN:



Jodi, some people are struggling hearing you, the audio connection. Can I just check, have you switched off VPN? I will do the next one for you, I will present the next slide, then you can check if you have VPN off.

JODI BROWN: I have switched off VPN. Sorry about that, everybody. Moving onto another example now, I think this is a really exciting, fun platform. This was created by Roy Lilley, and it is the Academy of NHS Fabulous Stuff.

It is a platform for sharing all of the things that are so fabulous about the NHS. It is a collaboration which ensures best practice, great ideas and service solutions are available to all.

What is so wonderful is it is completely powered by you, by the community. You can nominate initiative services, ideas, innovation.

Then the crowd will vote for them to say which ones they think are the best. On a regular basis, awards are given. Not a big ceremony, but through recognition on the platform. This is a really great way of sharing and scaling innovation and best practice.

When you submit an idea, it gets tight. You can go on there, if you're doing a project or a change initiative around, let's said dementia, you can click on the dementia cloud and look at all the ideas which have been submitted. Stuff you would not know about had you been sitting in your office in an unconnected way.

Just a really fantastic example of all that is great in the NHS.

[Sarah.Captioner is Live] We have got another example now. This is something Helen told me about and I have done some reading about this morning. Flip the clinic. It is an open experiment to transform the health care experience. It is a community of people on this platform that share and encourage ideas to reimagine the medical encounter between patients and care providers.

The flips are actionable ideas for change. I really like flip number 35, model your clinic like the Apple Store. I want to have more of a read about it and see what it is about. What we are seeing here is, very similar to Healthcare Voices, we have an online community, but you can spread it to a physical community of people that makes things happen in a lab environment. Let's not get hung up on it being purely about technology.

Another fantastic example, and another really good friend, MatExp and all the wonderful people behind this initiative. It was born out of change day. It is an initiative, a mobilisation, to identify and share best practice across maternity services in the country. It is a really powerful grassroots campaign using Jill Phillips's approach, finding out what is best practice in maternity services.

I don't know if you have seen this on Twitter. Please do look at #MatExp. The conversations that no one, it is just phenomenal. Going back to my original point, how could this have happened if we had sat down with a PMO in a national office in the NHS and said, "how can we make maternity experience everybody's business?" Because it is.



This is an example of a platform that Leeds teaching hospitals are using with a group called Clever Together. We have done some work with Clever Together As Well. It is based on the idea that wherever you are, usually the person that knows the most is in another organisation or somewhere else. Crowd sourcing builds on that philosophy. So within the grass roots of a Trust, everyone contributed to what they called the Leeds way.

The fact of the information on this slide speak for themselves. The platform that has been created is an online workshop eventually. If you needed to go out and find that information face to face, it would be a very slow, tedious and quite forced approach. But this is a fantastic way. To use the phrase you like so much, we are breaking down walls. We are letting people in who traditionally wouldn't have had a chance to have their say.

I'm going to move to something that is close to my heart. It is an initiative that I started in Dorset Healthcare several years ago. We started out with a gorilla marketing campaign. We wanted to make sure that innovation and great ideas were everybody's business in trust. We had a Trust of 5000 people set across 13 different community hospitals, working in the community, working out of the county. How could you connect all those people to harness the power of their passion, their insight, their experience?

We came up with this idea of I Matter. Ideas into action. All these posters appeared one morning on everybody's computers, in everybody's offices. We used a platform called Crowdicity. It felt so social. This is a few years old. I am no longer in Dorset. You can see something that looks very similar to a twitter or Facebook environment.

In the middle, where the speech bubbles are, it says challenges. On a monthly basis, we would set challenges for the Trust. Things that needed solving only did really good engagement. There were different challenges suitable for different groups. They would then be shown on the carousel, which would keep moving. So when anybody went on to the website, something would catch their eye.

We also used the gamification idea, so to contribute, you got points, to submit ideas, you got points. That could lead you up the leaderboard, to show you are making a contribution. I-matter, we were quite early on what we were doing. It was quite groundbreaking. We encountered various technical difficulties, various cultural difficulties. But the important thing was we were trying something different.

Just to give you an example of how important it is that platforms are not just about stagnant ideas. The worst thing that can happen on a platform is people submit ideas and nothing happens.

We had a member of staff who went to the Digital by Default conference. We had had a conversation about how we were overburdened by emails. It was a very email heavy culture. This person, infused by her learning from the Digital by Default Conference, shared an idea that she had got on the train on her way home. From another site in the Trust, somebody read this and thought it was a great idea. She forwarded the idea to one of her colleagues who liked it as well and put it straight into action. Within an hour or two, everybody within that hospital knew about that idea. It was about self detonating emails, which after a certain amount of time delete from the inbox. If they were no longer relevant, they disappeared.



In 22 hours, this idea spread across the whole Trust site. It shows the power of platforms and the power of people who make things happen.

The final thing from me, I just need to click on the last slide. I need to share a bit of learning as to what makes a social innovation platform successful. You can extrapolate this to any platform, but I'm drawing on my experience from i-matter.

We are rebels and radicals and we don't always wait for permission and in this case, we did have some permission and some support, but not Trust wide support. It helps if you can use your influencing skills and get somebody in a senior position to back you up and support you. It can be done without that, of course it can, but it does help your case if you have somebody on your side.

It also helps if you what you are doing is linked to the vision and values and strategy in the Trust at the time. It is going to solve a problem, scratch somebody's itch, and it would therefore be successful.

You need a culture that promotes engagement and values staff. This is hard, because you don't switch this culture on and off. But I creating these platforms, you give people the feeling that things are changing. But they do have a voice. In Dorset, people were so surprised when they were allowed to have these direct conversations with the chief executive of the platform. It was opening up a new line of conversation.

I will skip the meaningful innovation strategy, forgot that was specifically what we were trying to do.

But this is such an important point. No idea is bad. No idea is stupid. We want everybody's ideas and we want people to think outside the box and, with wacky ideas. The principle of crowd sourcing is someone will come in and make sense of what you have said and to make it tangible. So never rule anything out because it seems to offer the wall.

Quick, measurable wins. People need to see that things are happening as a result. It doesn't need to be return on investment in its purist sense. Think of social return on investment, engagement, how people are feeling about being at work. You can measure these things in so many different ways.

Take the good with the bad. Don't succumb to risk aversion. Platforms can be scary places for people who like to control things. Let people have their say and trust people. In the whole time I was running i-matter, we never had anybody that broke any of the policies or use the guidelines.

Keep it alive and fresh. Keep it happening. You have got to keep it active. You are a rule model on that platform.

Make sure there are rewards. What is in it for people? Why should they take part? Sometimes a simple thank you is all that is needed. The gamification idea. People love earning points, people love collecting.

Think about how you can mobilise organisational radicals. You will have your early adopters to



the platform. How can you bring them together and use them as a force for good and set them loose to spread the word across the organisation? This is the networking effect, the trickle down effect. How can you harness that?

I found this resource. It was our friend who tweeted about it. Anybody who might be interested in open innovation and using platforms for open innovation, it is a quick and read resource and it has the most wonderful resources in there and examples of how you can go about bringing about an open innovation culture using crowd sourcing.

I assume you could all hear me. If anybody wants to talk to me about any of the examples off-line or on twitter, please do shout. I'm very happy to share. I will now hand the ball to Helen.

HELEN BEVAN: Thank you, brilliant. Thank you, Jodi. Thank you for some fantastic examples of platforms. There are people that might be upset, because they have a great platform and it wasn't in our presentation, but there were so many to choose from and we tried to pick a variety that demonstrated different aspects.

If you have got an effective change platform and you would like us to be highlighting it, can you write in the chat box or tweet it, so we can understand what you are doing.

I will just stop for a minute now. Having heard what Jodi was saying out of her own experiences, what are some of the characteristics of effective change platforms? Jodi, I might even get you to say this first. In terms of your research and getting ready for this, what do you think are some of the characteristics of effective change platforms?

JODI BROWN: It has got to be in gauging, it has got to look exciting. I have seen so many platforms that look dry and boring and clinical, very industrial. Make it exciting and appealing to people. It is about getting the bus going and finding the right people early on he will create the baths. We have all been to forums where we want to joining conversations and there was nothing really happening. It is so important to get something happening before you start shouting about your platform. The only other thing I would say is don't be afraid to try new things. Just because there are things out there that are marketing themselves as platforms doesn't mean they are the right solution. There is so much free stuff that you can play around with and test out and perhaps be a pioneer as the first person to use that as a platform. Think creatively about what that platform would look like.


HELEN BEVAN: That is really reiterated by what people are putting in the chat box with regards to that. Passion, a sense of togetherness, responsiveness. Finding the right people. A sense of belonging, creating a sense of community, and a sense that everybody is listened to and has a voice.

Bringing people together around shared values. Amanda talks about follow-up, I'm going to talk about that later on. I agree with Amanda, that is absolutely critical. Having new content. Ease of access. The things that colleagues are saying here are great, Jodi has put her email address in



the chat, if anyone wants to follow up, that is great.

Anne has given an example of the Greater Manchester chaplaincy, again, we would be really keen to follow up. If you can keep putting things in the chat box, we will build these in to what we're doing.

Again, just the very fact of working with platforms, and understanding that people are engaging because they want to, not because they have to, it makes us start our change in a different way.

I want to go on now, and I want to talk about knowledge platforms. I want to give notice to Kate and Janet, we will take Twitter and chat comments right at the end. If you get geared up for that, if that is OK?

We talked about knowledge platforms being one of the key platforms that we create around change. I think in this social era of digital connectivity, the need for knowledge platforms becomes greater and greater.

Some of you may have seen the slide before, we have so much access to so much information. Getting information off the internet is like taking a drink from a fire hydrant. You know, there is so much of it, where do we start?

Even as a result of this there is a new disease which has been identified called cyberchondria, and it is the unfounded anxiety concerning the state of one's health brought on by visiting health and medical websites.

If you look up a fractured metafemur, there are several links. How do we know which are the right links? There is another aspect that matters when it comes to platforms which is around if we want to spread new knowledge, and in our current NHS and social care set up, you know, it is critical to get that new knowledge out very widely.

The best way to spread new knowledge is through social connections. Getting people having discussions. Building relationships. And actually spreading knowledge by these kind of connections is 14 times more effective than the way we traditionally do things, like written words, best practice databases, toolkits etc.

I speak as someone who has worked as a leader of national improvement bodies in the NHS in England for 18 years. When we look back at the history of national improvement organisations in the NHS, what do we spend a lot of our time doing? Creating toolkits.

And actually, what the evidence tells us, toolkits are often the least effective mechanism for spreading knowledge.

We have got to create platforms in a social age which enable people to connect, to learn, to discuss in very different ways.

In fact, one of the big things or trends that is happening is around when you think about documentation that you need, whether it is best practice guidance, or manuals on how to utilise machinery or software, what is happening is a lot of the documentation has been done away



with.

Instead people are creating platforms. This is another example of a platform and it comes from our colleague Oliver Benson. This is a platform called Stack Overflow. Basically, it is used by computer programmers. The idea is, if you're a computer programmer, either a professional one, or someone that does it for joy, now don't even bother reading a programme manual.

What we do is we use this platform called Stack Overflow and it answers all your questions. You ask the community, and the community give you advice based on reality rather than something in a book.

In terms of where we are as a health and care community, instead of having best practice toolkit or guidance manuals, how do we set up a fast-moving, credible virtual community platforms where we can actually help each other?

The final thing I wanted to talk about today was about our team. Jodi and I, also Kate and Janet were with us today, we work as part of a team called the Horizons Team.

We don't engage at all in change programmes any more. All our work is done via change platforms. A number of you know our platforms, I wanted to give you some examples. The first is the School for Health and Care Radicals. I know that many of you taking part in the session today are graduates of the School for Health and Care Radicals.

We set the school up, very purposely, to be a learning platform and not a learning program. Also we based the school on a learning theory called connectivism. It has only really grown as a learning approach in the last 10 years. What that means is, the theory of it, if you can actually create a platform where people can come together and learn from each other, that is far more effective than having formal lectures with people.

It is great this morning when we look at the chat and we look at the Twitter coming out of this lecture already, we can see a lot of connectivism. People are learning as much from the conversation and the chat as the lectures.

At the core is a set of specific modules to help people to be effective boat rockers, the kind of change agent that can rock the boat. But it is an open platform, anybody can take part. Whilst 73% of the people that enrolled were from the NHS in England, we have had 6500 people involved from more than 40 countries.

We are a very, very small team. If you look at the impact and reach, it has been really amazing. During our term time, there were 65 million, 65 million reached through Twitter. The slide share for health and care radicals, have been downloaded over 100,000 times. We have had 25,000 tweets.

Very big numbers of people have become certificated change agents. A number of you on this WebEx today had your virtual graduation ceremony yesterday.

If we had done a traditional change programme, it would have taken us years to get the kind of reach, connection and impact we have got. Because we created an open learning platform, the contribution was absolutely massive.



What is happening at the moment, the school is being formally evaluated by the team at the Chartered Institute of Personnel and Development who are the experts in learning programme evaluation.

They have been absolutely blown away by working through a learning platform as a contribution to learning. We all know about The Edge, which is our knowledge platform. The Edge is a knowledge platform where we look around the world and find the most interesting and useful knowledge around being a change activist.

Around transformation (inaudible) and we have 21,000 and have users from 120 countries. If you have not seen the latest addition, go onto the website and sign up. Read what our colleagues are saying. Jodi mentioned earlier, we had a change platform as a collaboration between our team and the health service journal and the Nursing Times. It was called, "challenge top-down change." It was asking our whole community what we need to do for change and to get better results. There were 14,000 contributions to this.

Some amazing stuff. Very much like what people have been saying on the chat. Also Jodi's advice, if you make it attractive and pull people towards that, people want to take part.

As a result of that, the 14,000 contributors collected the first-ever crowd sourced theory or approach to change in the NHS. If you have time to go and look at this, it is phenomenal stuff.

Really, this is only a start. We're going to follow this up and work on it more. Those contributors identified 10 barriers to change.

People took part in a process to identify which ones were the most important and why, and how they should be trained. None of us on the call would be surprised at the things said. What are the biggest barriers to change?

Confusing strategies, over-controlling leadership. Inhibited environments. What our 14,000 contributors also did was identify positively, what are the building blocks for change. Leadership which is inspiring and supportive. Being flexible and adaptive. Having autonomy and trust.

What is interesting, if you look at those 11 building blocks, most of our change thinking at the moment and change practice is often about the leaders and drivers for change and incentives.

What our 14,000 contributors said to us, focusing on shared purpose and building an environment for change and being valued is actually the most important thing. I just think, oh, my goodness, if the leadership community took the lessons from this and built on what was being said, how much (inaudible) we could go.

We are very proud to have supported NHS Change Day for the last three years. It is the one day a year we encourage people to take a change which will make a difference. In 2014 800,000 pledges were made to make a difference on Change Day.

What our evaluation has told us is there is four times the local activity and connectivity in 2015 compared to 2014. And that two thirds of all the Trusts in the country had change activities going on.



When you start to use different techniques, evaluation techniques for social platforms, all sorts of other ideas come through.

So, let's just think about this. Going back to cathedrals and bazaars. We are very good, and we have a long tradition around building cathedrals and structures. How do we create a bazaar? What do we need to be doing to be building change platforms?

[Sarah.Captioner is Live] I just wanted to keep you a little bit of advice. We have to be very clear about our intention or goal. Why do we want this change platform? As we have demonstrated this morning, there are lots of platforms for different things. Is it about problem-solving? Creating learning? Mobilising for change?

The second thing we have to do is articulate our mission. Many of you have said this morning, it has got to be inspiring. It has got to be a mission that lots of people will want to contribute to as a shared purpose.

The next thing is to set out your objectives and the stages in your process. Some platforms are a one stage process where you create a platform for a particular issue and get people in engage in that. Other platforms are multistage. So if you look at the challenge top-down change platform that we created, there were multiple stages to that process.

First, we had a stage where we asked people to contribute around what are the barriers to change. Then we asked people to rank them. Then we asked people to put across what their ideas were around practical ways of enabling change and overcoming the barriers. Then we went through a stage of ranking those again and coming up with 17 at the published in our guidance.

Understand whether it is a one stage of a multistage process.

The next thing is about identifying the people that you want to be in your community and to your change platform is aimed at. If you look at the Leeds teaching hospital example that Jodi told us about, that was a platform for a closed community. 4500 people who work at Leeds teaching hospitals. Other platforms, like the School for health care radicals as a learning platform was an open platform. Anybody could contribute.

People will only contribute to your platform if you can reach them. You have to think about how to connect with these people and engage them.

Then you need to find a platform. As Jodi said, it might not have to be a technical platform. If you do want a technical platform, think about what already exists in your organisation. There may be some already.

Sometimes, we pay for platforms, but there are lots and lots of platforms out there that are free that we can just take. It is really important that we are measuring, and not just at the end, but all the way through. So how many people are contributing, what impact does it having?

We need to massively engage our community and get people on board and contributing. We



need to set their expectations. We need to make it clear, if you contribute to this, what will happen. There needs to be a contract on this. If we want people to give their time and effort and energy and wisdom freely, they need to get something back. We need to be very clear what the give and the get is.

We have to work really hard at keeping the connections going and flowing. The other day, I was speaking to a senior person in the NHS who said they had not seen any crowd sourcing platform that worked very well. The reason that happens is not because it is a bad platform, it is because the people that are leading the work hasn't massively engaged in keeping the connections going. If people contribute, we need to respond, we need to thank them, we need to build on it. People will only contribute if there is a gain from doing it. Something to get out of it.

People put forward lots of ideas, but the ideas have got to result in action. We are not doing platforms because we like doing platforms. We are doing platforms because we want to change the world and make things better for our patients and citizens. We have to openly and transparently show how we are converting ideas into action. Too many platforms end up in a situation where when the couple the happening, it is very active and engaged, then we get to the end and breathe a sigh of relief that it is done and the follow-up doesn't happen.

If we want people to continue doing this, we must always follow-up.

Once you start down this path, you have to do the follow-up and you have to continue. As many of you have said in the chat box, platforms are about people engaging because they want to. There were about relationships, goodwill, the spirit of the volunteer. People won't keep doing this if it feels like you keep abstract ideas and nothing happens. This quote is beautiful. "If people give to a cause,", which is what we want people to do, "they expect a relationship," which is ongoing, "not a transaction."

New power is about relationships and connections. We can't depart out into platforms and new power and then because it is scary, revert back to our old power ways.

Just a final couple of things. I will ask Jodi to say something, then we will hear from Kate and Janet about the Twitter chat and the WebEx chat. One thing that we know about platforms is they are only as good as the people leading them. It is like in the approach to change. We will get platforms that are phenomenally successful and platforms that are less successful. As a change agent, it is really important that we learn these skills and we know how to manage them and maybe partner up with other people who are doing platforms, because this is the way of the future.

I will stop there. Kate, you want to give us an update on the WebEx chat.

KATE POUND: There was initially a lot of concern about people raising concerns about NHS firewalls and how we can actually get a platform that can with that. That is something that most of us do sympathise with.

Also about the culture being one of the most important things we need to build on. That is where platforms can help to support this. Lots of discussion about gamification, love the idea of that.



Going onto Candy Crush and how that has great gamification.

Kerry wrote something in the chat room and it was about how she is a passionate person and this has made her feel that change is possible and she was feeling re-energised, because sometimes you can feel separate and it is difficult to get the energy.

Lots of discussion about boats, and whether we were fast boats or tugs, which was interesting.

Lots of people wanted to build the virtual hospital. Maybe it is called St Twitter.

HELEN BEVAN: Thank you everybody for contributing to a brilliant chat. Janet, what has been happening in the Twittersphere.

JANET WILDMAN: A lot of activity in the Twitter area. A lot of people tweeting out the slides and saying they are learning a lot from this experience. A lot of the slides are being tweeted to buy the communities as a result. One or two really interesting conversation. One saying it is about change and the confidence to do things with originality, ignoring the naysayers and sneaking around barriers.

Another one from Fiona Gibson saying learning is weaving a network like spiders weaving a web.

HELEN BEVAN: Thank you, Janet, and thank you, Kate. Responding to Kate's point about the technology, it is coming. Wi-Fi everywhere, it is coming. We should assume a future where that is going to happen. Even if you work in a place now where it is a real barrier, it is changing and it is coming. We should assume that. If it gets in the way of things you want to do, go and talk to somebody.

One of my colleagues was recently in the hospital and it was a hospital that offered free Wi-Fi to patients. When she was in the hospital, in the medical admissions unit, the Wi-Fi wasn't working very well. I phoned up the chief nurse and he went and got a router put in the area. Sometimes we just don't ask and I think we should.

I have one more thing to say, but I will get Jodi to just do a couple of concluding remarks.

JODI BROWN: Thanks, Helen. I am just really excited to see all the energy that is going on in the chat forum and Twitter about the practicalities of that forms. My concluding remark is let's not leave this here. If we have all these people out their passionate about making this a reality, we need a platform of RM to carry on this conversation. We need to get more examples. I would love to hear all of the examples about change platforms. Together, we can come up with some great, practical tips and advice for people who want to take this further. So don't feel down in the dumps you are not a technical kind of person. It is not about the technology per se. It is about you and your passion. Let's join forces and keep this conversation going.

HELEN BEVAN: Fantastic. We can keep it going next Wednesday. I hope many of you will be able to come to the tweet chat we are having between 4 PM and 5 PM next Wednesday.



I started with Galadriel and I will end with her. She says, "even the smallest creature can change the world." Everyone of us can change the world. In a new power era, working with change platforms, we can connect with others and we can change the world.

Finally, here are some ways to connect. Follow us on Twitter, and it is great that lots of people are adding their Twitter addresses to the chat. Subscribe to The Edge, because everything we do appears in there.

Get materials from the School for Health and Care of Radicals. Finally, there will be an Edge Talk like this every month.

We also have lots of references. When you get the slides, we will put them onto slide share and tweet those out. You can just download all the references we have talked about today.

Thank you for joining us. It is 11 AM and we have been at this intensively for 1.5 hours. Thank you, everybody, for your interaction and your contribution. Let's change the world. Have a lovely weekend. Goodbye.


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