Upload
nhs-improving-quality
View
122
Download
2
Tags:
Embed Size (px)
DESCRIPTION
These are the slides for Module 4 of The School for Health and Care Radicals, a five week virtual programme, designed to equip people across the health and care system with the core skills to improve their skills as change agents. It supports NHS Change Day 2014, the grassroots movement in which everyone who values the NHS can make a pledge of action to improve things for patients and the health and care system. Big change only happens in health and care because of heretics and radicals: passionate people who are willing to take responsibility and work with others to make change happen. Being a radical isn't related to hierarchy or position and you don't have to work in the NHS or social care to qualify as one. Registrants to the school so far include patients and carers, students, senior leaders, improvement facilitators and clinical and care staff. There is also a live weekly web seminar which will be available to 'listen again', supported by a raft of other opportunities, including coaching and mentoring, virtual discussions and tweet chats, and an ever- expanding portal of useful resources. Programme The programme focuses on five modules over five weeks, 9:30 to 11:00 am GMT Friday 31 January 2014: Being a health and care radical: change starts with me Friday 7 February 2014: Forming communities: building alliances for change Friday 14 February 2014: Rolling with resistance Friday 21 February 2014: Making change happen Friday 28 February 2014: Moving beyond the edge Tweetchat We will run a tweetchat each Wednesday from 16:00 to 17:00 GMT, based on the content of the module from the previous Friday. A tweetchat is a facilitated conversation using Twitter. The hashtag we will use for the tweetchats is #SHCRchat. The dates for the tweetchats are: 12 February 2014 19 February 2014 26 February 2014 5 March 2014 There is no charge to join the School of Health and Care Radicals and it is open to all, whatever your role or level, and whether or not you work in the NHS Resources from all modules can be found at: http://www.nhsiq.nhs.uk/9059.aspx
Citation preview
#NHSChangeDay #SHCRchat
The School for Health and Care Radicals
www.changeday.nhs.uk/healthcareradicals
Module 4: Making change happen
Supported by
#NHSChangeDay #SHCRchat
Please use the chat box to contribute continuously during the web seminarPlease tweet using hashtags #NHSChangeDay and #SHCRchatWe will produce summaries of the discussions of today’s module using Storify.com and Pinterest and put these on the websiteThe conversation continues on the live chat forum at www.changeday.nhs.uk/healthcareradicalsforum
Joining in today and beyond
#NHSChangeDay #SHCRchat
Modules31st January: Being a health and care radical: change starts with me7th February: Forming communities: building alliances for change14th February: Rolling with resistance21st February: Making change happen28th February: Moving beyond the edge
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Almost…1,300 learners8,000 Slideshare
views1,000 study guide
views
And over…4,500 tweets
#SHCRchat 6,500,000 potential
reach!
#NHSChangeDay #SHCRchat Source of image: www.freshnessmag.com
for today
Why change efforts often fail to achieve their objectivesLeading large scale changeThe NHS Change Model: aligning intrinsic and extrinsic motivators for change Discussion on intrinsic/extrinsic motivatorsBuilding energy for changeCreating shared purposePanel case studies
#NHSChangeDay #SHCRchat
Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey
70%
25%5%
Gets anywhere near achieving the change and
delivering the benefits
Most large scale change doesn’t fullydeliver its objectives
#NHSChangeDay #SHCRchat
Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey
70%
25%5% Delivers and
sustains the change
Most large scale change doesn’t fullydeliver its objectives
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchatImage from: @TheWorldStories
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchatImage from: @TheWorldStories
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
It is our contention that most change efforts are built upon the shaky foundation of five flawed assumptions; that change can be managed, that human beings are objective, that there are ‘X’ steps to change, that we have a neutral starting point for change, and that change, itself, is the goalPeter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf Source of image: Whatsthebigideascwartzy.blogspot.com
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
In order of frequency:1. the effort effectively “runs out of energy” and
simply fades away2. the change hits a plateau at some level and no
longer attracts new supporters3. the change becomes reasonably well established;
several levels across the system have changed to accommodate or support it in a sustainable way
Source: Leading Large Scale Change: a practical guide (2011), NHS Institute
What happens to large scale change efforts in reality?
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
“As a leader, think of yourself as a “signal generator” whose words and actions are constantly being scrutinised and interpreted, especially by those below you [in the hierarchy]”
“Signal generators reduce uncertainty and ambiguity about what is important and how to act”
Charles O’Reilly, Leaders in Difficult Times, 2009
Leaders as “signal generators”
#NHSChangeDay #SHCRchat
Increasing number of messages as information cascade through
the organisation
Source: adapted from 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
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Typically, around any change effort, there is an initial spike of tangible energy, and change, but when leadership loses interest, the momentum
of change slows down drastically.”Tara Paluck
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
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
Ten key principles of large scale change
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
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
Ten key principles of large scale change
#NHSChangeDay #SHCRchat
Intrinsic motivationPeople engage in the activity for the pleasure and satisfaction of doing it
Invokes many positive behaviours
Extrinsic motivationPeople engage in the activity for the rewards or avoiding punishment
Any external influence is referred to as extrinsic motivation
Source: http://www.slideshare.net/JeremyStephens103/coaches-as-extrinsic-motivators-and-supporter-of-intrinsic-development
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Intrinsic motivators
build energy and creativity
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity create focus &
momentum for delivery
Drivers of extrinsic motivation
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Drivers of extrinsic motivation
create focus & momentum for delivery
Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
•System drivers & incentives•Payment by results•Performance management•Measurement for accountability
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Internal motivators
• connecting to shared purpose
•engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
Drivers of extrinsicmotivation
•System drivers & incentives•Performance management•Measurement for accountability
create & focus momentum for delivery
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
“Leaders and managers tasked with applying integrated care ‘at scale and pace’ might … focus on driving forward the organisational solution or introduce various financial inducements in the hope this will be more effective [than starting with values-based shared purpose]. Such an approach would be a mistake…A values-driven approach should be a pre-requisite to the successful adoption of integrated care.”Goodwin, Nick. “Taking Integrated Care Forward: The Need for Shared Values.” International Journal of Integrated Care 13, no. 2 (June 24, 2013).
An example
#NHSChangeDay #SHCRchat
Transformation is not a matter of intent.........
it is a matter of alignmentPeter Fuda
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Which components appeal to you and why?
#NHSChangeDay #SHCRchat
0123456789
10Our shared purpose
Spread of innovation
Improvementmethodology
Rigorous delivery
Transparentmeasurement
System drivers
Engagement tomobilise
Leadership for change
What's our prognosis for this asthma pathway project?
#NHSChangeDay #SHCRchat
NHS Change Model
www.changemodel.nhs.uk
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
You get the best effort from others not by lighting a fire beneath them, but by
building a fire withinBob Nelson
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
“Take your passion and
make it happen”
Source of image: www.zeelandtheaters.nl
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Reflecting on your change process:• how have you built both intrinsic and extrinsic
motivators of change into your efforts?• How have you managed the tension between
the two?• Any advice for other change agents on how to
align intrinsic and extrinsic motivators?
Discussion
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
In order of frequency:1. the effort effectively “runs out of energy” and
simply fades away2. the change hits a plateau at some level and no
longer attracts new supporters3. the change becomes reasonably well established;
several levels across the system have changed to accommodate or support it in a sustainable way
Source: Leading Large Scale Change: a practical guide (2011), NHS Institute
What happens to large scale change efforts in reality?
#NHSChangeDay #SHCRchat
Research shows that more than almost any other factor affecting an
organisation, organisational energy can lead to either a wellspring of corporate
vitality or the destruction of its very core
Source: Bruch and Vogel
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Organisations with HIGH productive energy scored higher on:• overall performance - 14% higher• productivity – 17%• efficiency – 14%• customer satisfaction – 6%• customer loyalty – 12%
Bruch and Vogel research
#NHSChangeDay #SHCRchat
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
the capacity and drive of a team, organisation or system to act and make the
difference necessary to
achieve its goals
Psychological
Physical
Spiritual
Social Intellectual
Energy for change is:
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Energy Definition
Social energy of personal engagement, relationships and connections between people. It’s where people feel a sense of “us and us” rather than “us and them”
Spiritual energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It gives people the confidence to move towards a different future that is more compelling than the status quo
Psychological
energy of courage, resilience and feeling safe to do things differently. It involves feeling supported to make a change and trust in leadership and direction
Physical energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen
Intellectual
energy of analysis, planning and thinking. It involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/ evidence
Five energies for change
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Low High
Social isolated solidarity
Spiritual uncommitted higher purpose
Psychological risky safe
Physical fatigue vitality
Intellectual Illogical reason
High and low ends of each
#NHSChangeDay #SHCRchat
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5 • Are particular energy domains more dominant than others for our team at the moment?
• Is this the optimal energy profile to help us achieve our improvement goals?
Energy for change profile
#NHSChangeDay #SHCRchat
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 1: what’s your assessment of their energy for change?
#NHSChangeDay #SHCRchat
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
This energy profile is characterised by an environment that has harnessed people’s interest and momentum for change, but which has failed to engage people fully. This imbalance results in their feeling some uncertainty regarding how they can contribute fully to the change, and therefore a sense of risk and lack of hope for the future. We can build energy by building team solidarity and developing shared purpose
Team 1: what’s your assessment of their energy for change?
#NHSChangeDay #SHCRchat
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
Team 2: what’s your assessment of their energy for change?
#NHSChangeDay #SHCRchat
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
This energy profile shows strong connections between people, a true sense of solidarity, which gives them enough hope for the future, but this energy is undirected, because the rational argument and shared purpose has not been agreed. We can build energy by agreeing shared goals for change and using systematic approaches to thinking through and planning the change
Team 2: what’s your assessment of their energy for change?
#NHSChangeDay #SHCRchat
There has never been a time in the history of healthcare when this advice
has been more pertinent
“Leadership is not about making clever decisions and doing bigger deals. It is
about helping release the positive energy that exists naturally within people”
Henry Mintzberg
#NHSChangeDay #SHCRchat
“You can’t impose anything on anyone and expect them
to be committed to it”Edgar Schein, Professor Emeritus
MIT Sloan School
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat Source: Helen Bevan
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
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
What is our approach to change?
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Shared purpose allows many communities to engage with us without us having to invest resourcesin controlling their actions Nilofer Merchant
Shared purpose aligns.....
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
• Shared purpose is a common thread in successful change programmes*
• Organisations and change initiatives with strong shared purpose consistently outperform those without it.**
*What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute)
**Management Agenda 2013 Boury et al (Roffey Park Institute)
We know that ...
#NHSChangeDay #SHCRchat
A 3-word concept
#NHSChangeDay #SHCRchat
[Shared] purpose goes way deeper than vision and mission; it goes right into your gut
and taps some part of your primal self. I believe that if you can bring people with similar primal-purposes together and get them all marching in the same direction,
amazing things can be achieved.Seth Carguilo
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
• What leaders pay attention to matters to staff, and consequently staff pay attention to that too
• Shared purpose can easily be displaced by a “de facto” purpose: hitting a target reducing costs reducing length of stay eliminating waste completing activities within a timescale complying with an inspection regime
• If purpose isn’t explicit and shared, then it is very easy for something else to become a de facto purpose in the minds of the workforce
Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector
Avoiding “de facto” purpose
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat@SimonJGuilfoyle Police Inspector and systems thinker
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Purpose
Obfuscation O-
meter
@SimonJGuilfoyle Police Inspector and systems thinker
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat@SimonJGuilfoyle Police Inspector and systems thinker
Police
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat@SimonJGuilfoyle Police Inspector and systems thinker
Education
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat@SimonJGuilfoyle Police Inspector and systems thinker
Healthcare
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
....the last era of management was about how much performance we could extract from people .....the next is all about how much humanity we can inspireDov Seidman
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
What is your experience as a change agent of:• Building energy for change?• Creating shared purpose?
Panel discussion
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Post these or similar actions as a pledge on the NHS Change Day pledge wall http://changeday.nhs.uk/campaign• I will reflect on how I can use both intrinsic and
extrinsic motivators in my practice as a leader or agent of change
• I will seek to ignite energy for change in everyone involved in my project
• I will build commitment to shared purpose in all my change efforts
Calls to action campaigns for this week
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
• Wednesday 26th February 16:00-17:00 Tweet chat #SHCRchat
• Next Friday morning 28st February module 4: Moving beyond the edge• You can start the process of applying to
become a “certificated change agent”
Next opportunities for learning
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
Gain a certificate as a health and care change agent AND claim your continuing professional development points
Get certified!
Take some actions to demonstrate your learning from the school and become a “certified change agent”. If you complete the learning process you will: • Be recognised as a “certified change agent” by the school and
NHS Improving Quality • Be awarded a virtual badge that you can used on your email
signature, personal website, etc• Be invited to take part in one of our virtual graduation
ceremonies• Receive a framed certificate (UK residents only)
More details will be sent out in Naomi’s News today!
#NHSChangeDay #SHCRchat#NHSChangeDay #SHCRchat
1. How can I make the most of both intrinsic and extrinsic aspects of change?
2. How can I build energy for the long haul?3. How can I ensure shared purpose
throughout the change process?4. What can I do tomorrow to accelerate
change?
Questions for reflection