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Purpose of this slide pack
The purpose of this slide pack is to share a record of the hothouse event.
NHS IQ and NHS Confed are collaborating to create a platform for sharing ideas, thinking and practice on how diversity of thought can make real benefit for people, and service improvement; how this can translate into practical support for leaders, as part of the change process and better decision making for patients.
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Diversity of thought is critical to both service improvement and innovation. The power of diversity guards against group think, promotes innovation and helps organisation understand how people think and be their authentic selves. When valued, thought diversity demonstrates real benefits for people. There is a lot of evidence for it but its not always embraced.
NHS IQ and NHS Confed are working together to support leaders to elevate the principles and practical approaches to diversity of thought to a new level, using the evidence and benefits seen from other industries. We are at the beginning of this journey and this is not a national programme to be rolled out. We all have the potential to promote, manage and recruit for diversity and create new conversations for change locally. Both NHS IQ and NHS Confed see this as part of their commitment to valuing diversity and learning from others about different approaches to inform the way we support the next five years. The platforms for sharing so far have been:
1. THOUGHT DIVERSITY WEBINAR: 3 December 2014, open to anyone in the world. The purpose was to bring people together to begin the conversation about what thought diversity means for all of us. The three big words that kept emerging were – authenticity, power and honesty. The slides from the webinar can be found here: http://www.slideshare.net/NHSIQ/thought-diversity-webinar2. THOUGHT DIVERSITY HOTHOUSE: with the aim of getting a diverse group of people, places were limited to eight people from each group: patient leaders, external to the NHS, frontline staff, OD and leadership community, system leaders, innovation.3. CASE STUDIES: We are currently looking for examples from inside and outside of the NHS who are using these principles4. TALKING HEADS VIDEO: A talking heads video will available from the hothouse event5. PRACTICAL SUPPORT: We will continue to create platforms and collaborate in different ways with a wide range of people who want to work together to improve care, looking out and not up.
If you want to get involved please contact: [email protected]
Background
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THE THOUGHT DIVERSITY HOTHOUSE: 14 January 2015 Coin Street Neighbourhood Centre, London
Purpose of the hothouse event
The purpose of the hothouse event was to stimulate aconversation, which developsour collective thinking andaction on ‘thought diversity’: its potential contribution tohow change happens in healthand care, and the delivery ofnew models of care over thenext five years.
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Agenda
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Scroll down to the brown slides to see the outputs from the day
Scroll down to the pink slides to see the conversation with Simon Stevens
Early tweets
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Tweeters on the day:
Twitter activity
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The numbers:
What does thought diversity mean to us?
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The event opened with a film of quotes taken from the international ‘Thought Diversity Webinar’ which took place on the
3rd December 2014.
http://youtu.be/8taWGfkVvTg
“Thought diversity gives us the opportunity to bring different voices in and really honour and respect people
who think in different ways.”
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WELCOME AND INTRODUCTIONS: Overview of the day
Jackie Lynton opens the day
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“We are asking you to do 3 things:1. There will be some
uncomfortable issues, but we are asking you to lean into your discomfort
2. Realise the benefits and value of TD for patient outcomes, and take responsibility
3. Act on it and do something about it when you leave here”
“This in not a national programme, we will take away what we own and we ask you to do the same.”
“This is my lived experience and I am here because I want to be able to walk into a conference or a place of work and not be looking across the room for difference.”
Sophia Christie - Facilitator
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“Today is about having different conversations and hearing that diversity of voice.”
“We want you to take equal responsibility for making it work, capturing it, producing material that we can go away with.”
“We need to be sensitive about how we capture what is said today, so that we can all feel that can say what needs to be said”
“Today we want to achieve clear common ground on what thought diversity is. We want to go away with some first thoughts on principles for how it might work in the health and care and how we might practice it as of tomorrow.”
Eden Charles - Facilitator
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“Change happens all around us – but often what doesn’t change, is the culture of the organisation.”
“You need to change the conversations people have with each other. This is a day about having different conversations with each other.”
“We want you to step into the ZOUD – the Zone Of Uncomfortable Debate”
“Let’s notice the differences and the similarities today.”
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What does thought diversity mean and in what context?
How do people model “lean into discomfort”, “curiosity about other perspectives”, and “safe challenge”?
On Twitter, this was being dubbed “the yellow chair conversation.”
SIMON STEVENS IN CONVERSATION:
Purpose of the roundtable conversation
Jackie outlined the purpose of the conversation:
• To model the type of conversations and safe challenge individuals and organisations need to make to take diversity of thought to another level
• To lean into our own discomfort about this to help create an environment where others can do the same throughout the day
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Dr Jagtar SinghTrust Chair,
Coventry and Warwickshire Partnership NHS Trust
Simon Stevens CEO, NHS England
Jackie Lynton (Facilitator)Head of Transformation,
NHSIQ
Céline ShillingerHead of Quality Innovation and Engagement, SanofiPasteur, France
Melanie WalkerCEO, Devon Partnership NHS Foundation Trust
Denise MilaniDirector of Business change and Diversity, Metropolitan
Police
Dr Minesh KhashuNeonatologist Consultant, Poole Hospital NHS Foundation Trust
Paula MoultonPatient Leader
Helen BevanChief of Service Transformation, NHSIQ
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Conversation participants
Melanie Walker says…
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“I want to go back to my day job and understand what I
need to do to support people in my organisation to
face its challenges.”
“I question whether the system is ready for
us to do something different.”
Jagtar Singh says…
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“I’ve been on the journey of achieving equality for 45
years.”
“I want to make a difference – I want my organisation to value diversity of thought.”
“There is so much good examples of what is going
on in the NHS but we don’t seem to bring it together for
the NHS.”
Paula Moulton says…
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“I find it really frustrating that change in the NHS is so often
disastrous – that they don’t talk to the people that matter – that
change is made by such a small group.”
“I am lucky – in my area, we make decisions about how
services are run.”
“We need to listen to each other and stop being uncomfortable about throwing discourse into
the middle and challenging things – Why can’t we challenge
this head on?”
“We need to learn to simplify.”
Helen Bevan says…
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“We’ve got to get more voices in – in the change conversation. When you
bring together diverse groups of people, they consistently make better
decisions than a narrow group.”
“We need an NHS that regards diversity and dissent.”
“Far too many decisions in the NHS get made by very few
people in the NHS who work at the top – they gauge what we need to do next. Through that experience, we keep doing the same thing and the storyline
never changes.”
Simon Stevens says…Simon Stevens spoke passionately about the "ease at which we tend to talk past each other" and "zone out" when diversity is discussed;
and called system leaders to consider how to change minds by
moving beyond binary thinking processes, to embrace new
possibilities and ideas on how to do things now that we should do in the future. He said we – the NHS –need ambition, energy and urgency
to bring about the change the service needs.
“A conversation about power is what thought diversity is
about.”
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Minesh Khashu says…
“I am my thoughts and those are shaped by where I come
from.”
“This is not about sprinkling star dust everywhere, we need to take
the fertiliser out there – we have to allow those seeds of thought
diversity out there to take seed and flower.”
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“This is about the moral and motivation of the staff.”
“It’s out there but we are not listening to it”
Céline Shillinger says…
“I am very, very grateful that an organisation like the NHS is
leading on this topic”
“19 people died last week in my country, because some people hate
thought diversity because it’s painful –it’s difficult – it challenges our
education and everything you believe in”
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“How can we help these people – refrain them from being
brainwashed?”
“Keep going, its fantastic”
Feedback from the floor…
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“Fear – the frontline have a lot of fear of being different – being different leads to disaster – leads to punishment and disaster – unless we say its ok to be yourself,
we will never go forwards. For years I have been trying not to be myself – I, at last managed to succeed by being myself.”
“Thought diversity isn’t welcomed in the NHS. You are always seen
as a troublemaker.”
“I believe that all patients should have easy access to their notes –
but it appears that almost nobody around me believes that
it is important.”
What beliefs have changed for you?
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What is something that you fundamentally believe that other people don’t? What did you believe in that
you don’t anymore?”
Simon
“I used to believe in the strategy and the
hierarchy…Now, I believe in grass roots movements.”
Céline
“I used to believe that people more senior to me in the NHS had all the answers and now I
don’t.”
Melanie
“I believe that the magic of change happens when we get
diverse groups together.”
Helen
“I used to believe that it wasn’t ok to challenge
management, doctors, now I challenge them at every turn”
Paula
Our future hinges on…
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Simon Steven’s call to action
“A shared sense of ambition – that better is doable - (we grind it out of people!)
We’ve got to get back a sense of the energy that will allow that to occur.
Urgency – part of what we’ve got to do is see ourselves as other see us and be fiercely critical of what we see in the service. It is morally unacceptable that we provide services that end up with people on the other end getting a raw deal.”
Jackie Lynton highlights words that summarise the discussion
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“Power” “Creativity”
“Dissent”“Authentic self”
“Fear”
“Risk”
Round table summary thoughts
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“Create space in which people are encouraged to be themselves even when it means being different.”
“Capture what already works and use it.”
“We all have other lives but we may not see them.”
“We all have other lives but we may not see them.”
“Needs to include POWER as a theme.”
“Begin to think about being part of a social movement.”
“Biggest deficit is motivation of the staff.”
“Thought diversity is there – How do we mature to action?”
“Thought diversity as a matter of life and death.”
“Charlie Hebdo and Stephen Lawrence experiences – What is the impact in organisations?”
“Be honest about what lies beneath our euphemisms.”
“People to be encouraged to put things out there for challenge or discussion.”
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MAKING CONNECTIONS: Learning from each other and developing an understanding of what is already happening
Connecting with each other
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“We need to connect with people who don’t know
anything about [thought diversity] in the NHS.”
“Subvert this process that separates people from
outcomes.”“Thought diversity for a purpose – get people to
engage with the purpose.”
“There are troublemakers around the table – they were right all along!”
“What is the common purpose – how do we connect it in? How do we use it to address
the next five years of challenge that faces the NHS?”
“Tension and disagreement is at the
heart of this.”
“This is about disagreeing to get to a shared goal.”
Using the NHS Change Model
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Each table was given one component of the NHS Change Model to discuss what they know is happening on thought diversity for that theme.
3 lists were produced: 1. So what should you KEEP doing/ensure is
maintained during further structural orleadership change?
2. So what do you need to jump START, do moreof, accelerate?
3. So what is here which doesn’t seem to beworking / worthwhile, that we should STOP ormove on from?
The group then picked one priority to feedback.
Source: http://www.changemodel.nhs.uk/pg/dashboard
The NHS Change Model was introduced over 3 years ago and is used widely. It is a distillation of over 15 years of evidence that factors the different components needed to take account of in change.
Our shared purpose
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What should we stop or start doing?
“Keep patient stories because they help galvanise energy – people can visualise it and understand it”
“Accelerate co-creation by using crowdsourcing platforms”
“We will stop thinking that clever straplines are the answer (spending money on comms!)”
Transparent measurement
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What should we stop or start doing?
“Use narrative to add more colour to how to show performance.”
“Start using measures that the community will follow (e.g. stop using inner city measures for rural contexts).”
“Stop making meaningless comparisons between metrics that disengage and de-motivate.”
“Focus on how thought diversity improves outcomes.”
“Stop having conversations in hidden rooms and have them more publicly.”
Leadership for change
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What should we stop or start doing?
“Start being authentic.”
“Keep our core values.”
“Start framing the question to its appropriate audience.”
“Stop trying to silence people.”
Spread of innovation
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What should we stop or start doing?
“Start hanging out and getting to know places street by street (good care needs to be discovered)”
“Start more empowerment projects – e.g. the School for Health and Care Radicals”
System drivers
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What should we stop or start doing?
“Stop having indicators for illness.”
“Start having indicators for wellness.”
“Start using the friends and family test but it doesn’t allow the voice to come through – ask the question: what are the diverse voices out there?”
“Start doing diversity impact assessment for everything.”
Improvement methodology
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What should we stop or start doing?
“Start getting more service user involvement”
“It’s got to be more authentic. The unsexy end of healthcare – what matters to people – not what is easy and topical to measure right now”
“Often it is a homogenous group who decide who to bring into the room and then don’t know what to do with the people once they have brought them into the room!”
Engagement to mobilise
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What should we stop or start doing?
“Listen to difficult or challenging patients and service users.”
“Creative ways of thinking; engaging all in different type of conversation. Reporting what matters to everyone.”
“Including more voices, asking more questions, challenging more – encouraging others to be challenging.”
“Stop falling into “usual” ways of working; worrying about outputs.”
“Stop top-down hierarchy.”
“Stop doing what we always did or we will get what we always got.”
Rigorous delivery
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What should we stop or start doing?
“We should start promoting more grass roots movements using compelling narrativesensure positive role models actively engage with communities”
“Keep the focus on tackling health inequalities.”
“Stop working in silos to promote cross sector working.”
“Stop using complex meaningless language to describe things.”
Future visions
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“What would things be like if they were fantastic?Teams were given time to come up with creative way to present their vision
of how organisations would look if thought diversity was present in 2020.
Future visions – Team 1
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(MUSIC IN THE BACKGROUND)
TH
“Time for change”
“Healthcare through my smartphone”
“Organisations without walls”O
U
G
H
T
“Uniformity of care - not a postcode lottery”
“Go from a National Health Service to a personal health service”
“Healthcare records on the cloud”
“Treatment that would make you proud”
Future visions – Team 1
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“Together we can make this change”
DIV
“Delivering care that's personal”
“Yesterday is history”
ER
SI
TY
“I decide what's best for me”
“Valuing everyone as an individual”
“Energised, engaged, enthusiastic”
“Responsibility share between patients and professionals”
“Systems that react and respond rather than restrict and reject”
“Individualised care for all”
Future visions – Team 2
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CLOSE YOUR EYES –
Visualise what will you see in the future…• “True co-production“
• “Different kinds of targets (involving people in decisions about their own healthcare)”
• “Hear the voice about anybody and everybody”
• “Hear the dialogue between carers and patients”
• “Feel included – safe that you can say things and do things differently
• “Liberated, feel you have been heard”
• “It won’t matter what political party is in place
• “People are excited and properly remunerated”
• “Feel comfortable with the discomfort”
Future visions – Team 3
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WHAT WILL IT LOOK LIKE AND FEEL LIKE IN THE FUTURE?
See• Differences/local variability,
e.g. NHS logos• Not looking the same• People have bespoke solutions• True co-production• Different type of target, e.g.,
something about listening
Feel• Inclusive/included• People feel safe to do things
differently• We don’t feel free – liberated• People feel they have been heard• Doesn’t matter which political
party is in place• Excited• Properly re-numerated• Grace• Humility• Comfortable with discomfort –
folks equipped
Hear• Voices of everybody and
anybody and those currently not heard
• Dialogue between carers and patients
• ‘Do you hear the people sing?’
Do• Local offer is evidence based• What patient wants and needs,
done right in the right safe environment
Future visions – Team 3
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A statement about joining up in a world embracing thought diversity
Future visions – Team 4
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Emphasis on different skills for board members
Instead of a CEO we’ll have an Idea Generator
Instead of a HR Director, we’ll have a talent nurturer
We will also have:• Chief bureaucracy buster• People builders• Care improvement agent • Entrepreneur in residence• Chief whistle-blower• Director of marketing sales and
happiness
This is what the new board will look like in the NHS…
Future visions – Team 5
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SAVI group do a rap!I am Significant!I am Appreciated!I am Valued!I am Included
Future visions – Team 6
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A Poem about the future
We want to think but don’t succeedThere is always a patient target to feedSimon says we need to be diverseBut is what Simon says a bit perverse?Simon says but what does he do Where is monitor, CQC or WHORuffling feathers should be the normBut for the naysayers create a stormWe need the space and encouragement to thinkWith time we’ll be less stressed or on the brinkRemove the hierarchies, mobilise the staffGive them autonomy and creativity that they haveUnions Policies all need to changeTo support creativity, give diversity its rangeNow Simon says become diverse in thoughtLet’s all lead by example like it ought
Future visions – Team 7
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THOUGHT DIVERSITY MEANS MOVING FROM ‘I’ TO ‘WE’
WHEN WE ARE WORKING AS WE…. Illness becomes Wellness!
Diversity dogs come to the rescue!
Future visions – Team 8
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What I will see in 2020…
“...There won't be a National Health Service, there will be a National Health System - a mixed economy to support
health...”
“...People in the wider community - not necessarily in the room, contributing to the conversation about what they need to live
healthier lives and how they can be delivered...”
“...I will be working for the National 'Life' Service and I will be depending on the
sharing economy both in my personal life and my work....whatever the diversity of my needs are, I can reach out to society...and I
will be mobile in my job...”
“Local people electing exec and non-exec board members.”
“We won’t work in silos”
“Depoliticised NHS”
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JUST BEFORE LUNCH: How are people in the room feeling?
…. A view from Chris Lawrence - Pietroni
“It’s quite crunchy on my table –but in a good way….
…..This is the most diverse group I think I have ever been
in, in the whole of my professional life”
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DEVELOPING OUR PRINCIPLES AND APPROACH:Identifying actions and next steps
Themes and actions
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This session focussed on defining our principles to underpin approachesParticipants begun to identify activities and initiatives which thought
diversity should include and unleash.
Eight key themes were identified.
Theme 1 - Creativity
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“Creativity is about co-creation.”
“We have noticed a lot of management speak -but for the frontline, the question is, will the 5-year view be meaningful?”
“Make space to reimagine and co-create with diversity of thought.”
Theme 2 – Reverse mentoring
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“Reverse mentoring is where a junior person mentors a senior person in the organisation.”
“This can create a lot of thought diversity.”
“Birmingham Children’s Hospital replicated the idea of matching people in different professions.”
“Reverse mentoring for disruption not replicating the status quo.”
Theme 3 – Inclusivity
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“To be diverse you need more than one person – not different just colours of skin”
“Don’t want to treat people differently….Look at whose being excluded”
“Five things that need to be done (by the way, these are all evidence based!” –(Jim Easton)
• Board-level commitment• Role models• Resources to be allocated• Consistent message• A link to patient outcomes
Theme 4 – Organisations without walls
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• Beyond the NHS
• Creating a new type of environment that is going to thrive
• A strategy that’s broader than the NHS
• We need to create spaces for this really complex debate because its really contentious
• We need time for it
• There are rich conversations to be had about better healthcare if we take it to the front-line
• People can’t get in to help us co-create if we ring-fence funding for the NHS
• What right to we have to be working outside of the business, if we can’t get our core business right?
“I believe this needs to become a
public sector call to this debate -
not just NHS”
Theme 5 – Being subversive/risk taking
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• Being subversive and risk-taking – changing our values
• Started with a thought that we could encourage responsible risk taking
• Changing things and improving things should be part of everybody’s job as standard
• People don’t necessarily have the tools or understanding to do that
• The School for Health and Care Radicals (SHCR) gives people permission
• Where there isn’t that culture – the SHCR creates the network of support that allows people to start doing things
• This will help us to drive out fear
• An idea should be rewarded whether or not that idea works
Theme 6 – What will we do differently tomorrow?
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• Have thought diversity (TD) conversations in team and groups
• Move from pre-contemplative to contemplative (moving to action)
• Inability to work but ability to care (carer perspective)
• We don’t need to have permission to have these conversations
• No agenda, but we were hanging out and let the conversations evolve
• Involving parents
• Listen with intent
• Borderless organisations
• Create space for things to happen
• Curation
Theme 7 – Innovations in the 5 year forward view and how this applies
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One thing to share: Using the compass to drive through the change
Theme 8 – Macro-environments for health and wellbeing
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What is it going to take?• Multi Specialty Community Providers• +/- 5 year settlement• Political air cover from all system leaders• ‘Innovation kitchen’/combinable innovation• All about HOW this happens, this is where TD will add enormous value• TD will help us to think and act differently• Selection of areas and leaders to hothouse, crucial TD to inform selection• Principles of TD key to selection of sites/systems – must reflect key principles• We can identify some systems already working to their principles, in the public domain,
we need to highlight these• ‘Thoughtful’ support to systems to think and act differently – need to have some new
and different design principles• Need to create space in the system/communities to think and act differently – need to
be clear about what we will stop to make space for; i.e. Stop CQC visits for 2 years• Ask the system what would make a difference to them to make space – what do they
think they need to stop doing to make space?
Themes that are important but were left behind for now
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Not included in the discussion:• Talent management• Job mobility• Person centred metrics
Closing the event… one step forward?Participants were asked to stand next to a wall scale from 0-10 to show how they felt about the promise of thought diversity contributing to change in the NHS over the next 5 years (10 being very promising)
Participants were then asked ”What would it take to feel just ‘one step’ better and the to make that step.”
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Were there any elephants in the room?
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Joan and Helen sum up the day
Joan thanked all participants for working hard throughout the day to get to this stage and confirmed the commitment of NHS Confederation to supporting this agenda.
Helen emphasized TD as integral to the Horizons Group’s work and the ability to energise disruption, dissent and diversity. She encouraged participants to use the Change Challenge hashtag and the Edge to stay in touch. Join the HSJ Top-Down Challenge:www.hsj.co.uk/leadership/change-challengeThe Edge: http://theedge.nhsiq.nhs.uk/
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Final tweets of the day
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#thoughtdiversity influencers
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Make space to re-imagine and co-create with different voices
….to build ambition, energy and urgency for the future.
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Delegates feedback on the event“Spread the innovation – champion / spread / disseminate!”
“We had a lot of potential for thought diversity in the room; a lot more needs to come out.”
“Was a good experience – if you have any other events where you need to involve young people I would love to help.”
“Excellent, exciting, edifying, engaging, empowering.”
“Some group think occurred and mixed purpose of the day.”
“Well done on the event. You are creating awareness of the need –it is the first step to change. Don't underestimate the barriers.”
“Continual engagement, relentless commitment, un-silencing the uncomfortable stuff”
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