theedge.nhsiq.nhs.uk/school/

Module 4: Making Change Happen

@Sch4Change #S4CAteam

Brought to you by the

The team today

School Lead:Helen Bevan@HelenBevan

Lead facilitator:Pip Hardy@PilgrimPip

Technical Support

Joanna Hemming@JoannaHemming

Paul Woodley@PaulWoodley4

Olly Benson@OllyBenson

Kate Pound@KateSlater2

Chat Room Monitors

Kathryn Perera@Kathrynperera

Twitter Monitors

Louis Warner@LouisWHorizons

Leigh Kendall@leighakendall

• Please use the chat box to contribute continuously during the talk• Please tweet using hashtag #S4CA and the handle @Sch4Change• Send a request to join our Facebook group School for Change Agents

https://www.facebook.com/sch4change/ • We will produce summaries of each module discussion using Steller and

put on the website

Joining in today…and beyond

16th February: Being a change agent: change begins with me23rd February: From me to we: making connections and building communities2nd March: Rolling with resistance9th March: Making change happen16th March: Moving beyond the edge

Each week we’ll cover different change agent capabilities

Source of image: thenounproject.com

Nurses, Midwives and Allied Health ProfessionalsUse the school experience as part of your CPD reflective account for revalidation

DoctorsWe have applied for CPD credits for the school

Certification and Continuing Professional Development

EveryoneIf you watch all five of the talks and demonstrate you have applied the learning, you can apply to become a certificated change agent (and it’s free).

• Email to join the RCT england.si-horizons@nhs.net

• We will randomly match you with another participant in the School for Change Agents from anywhere in the world

• At some time in the next four weeks, arrange to have a conversation over Skype (or other communication system) with a cup of coffee!

Randomised Coffee Trials

Image source: Pinterest

7

To what extent did the last change initiative you were engaged with deliver all its objectives?1 = delivered very little10 = delivered all its objectives

• understanding why many change efforts fail to deliver their intended benefits

• considering barriers and building blocks to change• recognising the need to align intrinsic and extrinsic

motivators for change• building joy at work• appreciating energy for change• avoiding “de facto” purpose

Change agent capabilities in module 4

Source of image: thenounproject.com

Source of image: Whatsthebigideascwartzy.blogspot.com

Why is

often quoted in the field of change leadership?

From Deloitte “Demystifying change management”

Most change programmes fail to deliver their objectives

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 change programmes fail to deliver their objectives

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

70%

25%5% Delivers and

sustains the change

Source: McKinsey Performance Transformation Survey

Reasons for failure in large scale improvement programmes

Some authors question the 70% figure

Source: 2016 Chartered Institute of Management Quality of Working Life study

Across the UK, poorly led change programmes are damaging morale and the performance of organisations

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

The old power/new power framework has been a thread through every module so far:

Jeremy Heimens, Henry TimmsThis is New Power

Economic resourcesdiminish with use• money• materials• technology

diminish

Natural resourcesgrow with use• relationships• commitment • community

grow

Based on principles from Albert Hirschman and Marshall Ganz

Let’s think about resources for change inold/new power terms

Source: How can asset mapping improve community health?

An asset map from the Institute for Healthcare Improvement

Change is not the goal; the goal is the goal

Peter Fuda

Source of image: timemanagementninja.com

14,000 contributions identified 10 barriers to change:

Confusing strategies

Over controlling leadership

Perverse incentivesStifling innovation

Poor workforce planning

One way communication

Inhibiting environment

Undervaluing staff

Poor project management

Playing it safe

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on

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

Increasing number of messages as information cascade through

the organisation

Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx

Buy in from front line staff is critical for improvements in quality and safety

Don’t overload themhttp

://healthaffairs.org/blog/2014/03/07/the-dangers-of-quality-improvement-overload-insights-from-the-field

/

Poll: Which of these have been blocks for you in the last 12 months?

Confusing strategies

Over controlling leadership

Perverse incentivesStifling innovation

Poor workforce planning

One way communication

Inhibiting environment

Undervaluing staff

Poor project management

Playing it safe

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

Inspiring & supportive leadershipCollaborative working

Thought diversityAutonomy & trust

Smart use of resources

Flexibility & adaptability

Long term thinking

Nurturing our people

Fostering an open culture

A call to action

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

Challenging the status quo

14,000 contributions identified 11 building blocks for change:

Poll: Which of these factors are present in your situation now?

Inspiring & supportive leadershipCollaborative working

Thought diversityAutonomy & trust

Smart use of resources

Flexibility & adaptability

Long term thinking

Nurturing our people

Fostering an open culture

A call to action

Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015

Challenging the status quo

How to make change happen

• Make people feel something

• Emphasise progress• Stop bribing• Start a cult (a group

unified by a provocative idea)

Source: How to motivate people: four steps backed by science

• Teresa Amabile, Harvard Business School: studied the "inner work life" diaries of 238 professionals

• Best days were when they were able to move forward in their work

• 700 managers were asked to rank five employee motivators, including recognition and incentives. They ranked progress last

Emphasise progress

Source: The Progress Principle: Using Small Wins to Ignite Joy, Engagement, and Creativity at Work

Rewards

Mandated quality standards

Incentive systems

Pressure to perform

Compliance

Recognition

Awards

Source: adapted from commons.grd.msu.ed

Competition

Extrinsic versus intrinsic motivation

Tapping into intrinsic motivation is critical to ongoing, large scale change

Emilia Wietrak External incentives and internal motivation – a perfect pairing to boost work performance!

• Works best for straightforward, repetitive tasks

• Build meaning and understanding of performance, tie extrinsic motivators closely to specific performance and reward teams

• Works best for complex tasks that need personal investment, absorption and focus on quality

• Increase intrinsic motivation by making people feel competent/self-efficacious (module1) and giving them more autonomy

Internally motivated people who enjoy what they do RARELY perform poorly

Joy at work /intrinsic motivation RARELY appear in isolation

Intrinsic motivators

build energy and creativity

Intrinsic motivators • connecting to shared purpose

• engaging, mobilising and calling to action

• motivational leadership

build energy and creativity

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

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

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

The Change Model

Source: The Change Model Zoe Lord

Priority area: Reducing inappropriate use of anti-psychotic drugs for people with Learning Disabilities in our inpatient unit

What outcomes do we seek?Our Shared PurposeIs there a sense of shared purpose amongst our key stakeholders?

The shared purpose is to improve the quality of life for people with learning disabilities by reducing the over reliance on antipsychotic drugs.

Leadership by all Do all our leaders have the skills to create transformational change?

Psychiatrists Lead commissioner Clinical LeadManagersClinical staffSupport staff /carersTherapies Patients, families, carers, advocates

Motivate and MobiliseAre we engaging and mobilising all the right people?

Patient , carer and family groups, related charitiesMedication group PsychiatristsLocal improvement groupLocal patient advocate groupTherapies staffCommissioners

Spread and Adoption Are we designing for the active spread of innovation?

Medicines Optimisation ToolkitInduction packNational campaignsHow to Guides – benefits and practical application

Project and performance ManagementDo we have an effective approach for delivery of change and monitoring of progress towards our planned objectives?Inclusion in all team meetings Risk & Issues Log

System DriversAre our processes, incentives and systems aligned to enable change? National Guidance National Publication

Improvement toolsAre we using an evidence-based quality improvement methodology?YES. Using the Trust’s quality improvement tools package

MeasurementAre we measuring the outcome of the change continuously and transparently? Baseline data re number on medication, medication used and why medication is being used. Regular data collection Regional and national data.

“The change model is a structure that helped the team to understand what we are all trying to achieve, where we needed to focus more of our attention and how to achieve it. It helped the team to work together. I encourage more teams to use the change model to achieve successful change.”

Parent of James

Two kinds of people at work

• Feel connected to a higher purpose

• Controlled & coordinated through shared goals & values

• Collaborate• Embrace change• Work to who they are

The contributors The compliant

• Feel disconnected from purpose• Controlled & coordinated through

performance management & standardised procedures

• Hold back• Resist change• Work to a role specification

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

Two kinds of people at workThe compliant

• Feel connected to a higher purpose

• Controlled & coordinated through shared goals & values

• Collaborate• Embrace change• Work to who they are

The contributors

Gallup global research:• Only 13% of the workforce are

engaged (contributors)• Contributors create six times the

value to an organisation compared to the compliant

http://www.gallup.com/poll/165269/worldwide-employees-engaged-work.aspx

The 3rd curve of change

New Public Passion:

a growing global

movement

The capacity and drive of a team, organisation or system to act and make the difference necessary to

achieve its goals

Energy for change

http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html

What happens to large scale change efforts in realityIn 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

Why is energy for change important?

Source: http://www.nhsiq.nhs.uk/8530.aspx

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

Overall performance - 14% higher• productivity – 17%• efficiency – 14%• customer satisfaction – 6%• customer loyalty – 12%

Teams and organisations with high energy score higher on every dimension of performance

Source: Bruch and Vogel

Change is most likely to happen when five energies are high

Psychological

Physical

Spiritual

Social Intellectual

Source: http://www.institute.nhs.uk/tools/energy_for_change/energy_for_change_.html

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”

Social energy

Energy of commitment to a common vision for the future, driven by shared values and

a higher purposeGives people the confidence to move towards a different future that is more compelling than the

status quo

Spiritual energy

Energy of courage, resilience and feeling safe to do things differently

Involves feeling supported to make a change and trust in leadership and direction

Psychological energy

Project Aristotle: http://qz.com/625870/after-years-of-intensive-analysis-google-discovers-the-key-to-good-teamwork-is-being-nice/

After years of intensive analysis, Google discovers that the key to high performing,

teams that deliver change is psychological safety

Energy of action, getting things done and making progress

The flexible, responsive drive to make things happen

Physical energy

Intellectual energy

Energy of analysis, planning and thinking

Involves gaining insight as well as planning and supporting processes, evaluation, and arguing a

case on the basis of logic/ evidence

Social isolated solidarity

Spiritual uncommitted higher purpose

Psychological

risky safe

Physical fatigue vitality

Intellectual Illogical reason

High and low ends of each energy domain

LOW

HIGH

Which one of these energies do you think is disproportionately high (compared to the other energies) in senior leadership teams in health and care?

56

• Social• Spiritual• Psychological• Physical• Intellectual

• Intellectual energy on its own isn’t transformational

• It keeps leaders in their comfort zone (intellect to intellect)

The challenge of disproportionately high intellectual energy

Emotion is the fuel for change; data and information provide

direction Dan Heath

(author of Switch)

• Which group likely to have higher spiritual energy scores:• clinicians• non clinicians

• Nearer to CEO in the structure:

higher or lower overall energy scores?

Some more questions

Source: Respondents to the energy for change questionnaire NHSIQ/Horizons team

Energy analysis of six large scale transformation plans

Energy analysis of six large scale transformation plans

Source: energy for change discourse analysis of six STP plans by the Horizons team

Energy analysis of six large scale transformation plans

Source: energy for change discourse analysis of six STP plans by the Horizons team

What happens when we don’t build a proportionate amount of social and spiritual energy in our change efforts?

“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

As leaders and change agents, we are “signal generators”

Source of image: vintage-radio.com

What leaders pay attention to matters to staff, and consequently staff pay attention to that too

Avoiding “de facto” purpose

• hitting a target• reducing costs• reducing length of stay• eliminating waste• completing activities within a

timescale• complying with regulators

Source: Delivering Public Services That Work: The Vanguard Method in the Public Sector

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

PURPOSEThe difference between

having a purpose and a shared purpose is that shared purpose is owned everyone who has a

stake in the change and improvement we are seeking

to create

SHAREDPURPOSE

[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

We need to go beyond “buy-in”. We don’t need buyers, we need

investors Mark Jaben

We can build shared purpose through social and spiritual energy

....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

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