@helenbevan

Burning ambition – meeting the challenges

ADASS/SCIE seminar Leading through turbulence

11 January 2013

Helen Bevan@helenbevan #NHSchange

@helenbevan

How to turbocharge healthcare improvement Energy, more than any other factor, makes the difference between improvement activities that are sustained for the long term and those that fizzle out. Energy fuels high performance. In this workshop, Helen Bevan will show you powerful methods to unleash the latent energy for change from within your organisation to increase the pace and scale of improvement.

Session Objectives• Learn why energy is a critical topic in leading improvement.• Liberate the natural energy and vitality of the workforce and service users

for the cause of high quality care.• Take home a set of useful models and frameworks for understanding,

analysing and building energy for change.

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Most large scale change fails to achieve its objectives

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

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What happens to large scale change efforts in reality?

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

@helenbevan

Anatomy of change Physiology of change

Definition The shape and processes of the system; detailed analysis;

how the components fit together.

The vitality and life-giving forces that enable the system and its people to

develop, grow and change.

FocusProcesses and structures

to deliver health and healthcare

Energy/fuel for change

Leadership activities

measurement and evidence

improving clinical systems reducing waste and

variation in healthcare processes

redesigning pathways

creating a higher purpose and deeper meaning for the change process

building commitment to change connecting with values creating hope and optimism about

the future calling to actionSource: Crump and Bevan

@helenbevan

Anatomy of change Physiology of change

Definition The shape and processes of the system; detailed analysis;

how the components fit together.

The vitality and life-giving forces that enable the system and its people to

develop, grow and change.

FocusProcesses and structures

to deliver health and healthcare

Energy/fuel for change

Leadership activities

measurement and evidence

improving clinical systems reducing waste and

variation in healthcare processes

redesigning pathways

creating a higher purpose and deeper meaning for the change process

building commitment to change connecting with values creating hope and optimism about

the future calling to actionSource: Crump and Bevan

@helenbevan

Anatomy of change Physiology of change

Definition The shape and processes of the system; detailed analysis;

how the components fit together.

The vitality and life-giving forces that enable the system and its people to

develop, grow and change.

FocusProcesses and structures

to deliver health and healthcare

Energy/fuel for change

Leadership activities

measurement and evidence

improving clinical systems reducing waste and

variation in healthcare processes

redesigning pathways

creating a higher purpose and deeper meaning for the change process

building commitment to change connecting with values creating hope and optimism about

the future calling to action

Source: Crump and Bevan

@helenbevan

Intrinsic motivators

build energy and creativity

@helenbevan

Intrinsic motivators •connecting to shared purpose

•engaging, mobilising and calling to action

•motivational leadership

build energy and creativity

@helenbevan

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

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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

@helenbevan

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

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Transformation is not a matter of intent.........

it is a matter of alignmentPeter Fuda

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NHS Change Model

www.changemodel.nhs.uk

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NHS Change Model

www.changemodel.nhs.uk

Why is energy for change important?

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burning platformversus

burning ambition@PeterFuda

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Lessons for transformational change1. In order to sustain

transformational change, we as leaders need to move from a burning platform (fear based urgency) to a burning ambition (shared purpose for a better future)

2. We as leaders need to articulate personal reasons for change as well as organisational reasons

3. If the fire (the energy) goes out, all other factors are redundant

@PeterFuda

@helenbevan

You get the best efforts from others not by lighting a fire

beneath them but by building

Source: Bob Nelson

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@helenbevan

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:

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The five energies

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High and low ends of each energy domain

Low High

Social isolated solidarity

Spiritual uncommitted higher purpose

Psychological risky safe

Physical fatigue vitality

Intellectual Illogical reason

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Key conclusions from our work so far

• Psychological energy is central• Dispersed leadership model• Explanation not judgement• Making explicit the issues that

remain hidden/unarticulated and that really impact on team performance and achievement of improvement goals

Psychological

Physical

Spiritual

Social Intellectual

@helenbevan

Social energy

Deplete d by

Apathy

Isolation

Disconnection

Lack of connection

Emotional awareness

Authenticity

Engagement

Empathy

Autonomy

Enhanced by

Social energy is the energy of personal engagement, relationships and connections between people

Psychological

Physical

Spiritual

social Intellectual

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Spiritual energyDepleted by

Coercion

Ignoring spirit in a crisis

Disbelief in purpose

Conflicts with values

Purpose

Clarity of vision

Co -invention

Integrity

Passion

Commitment

Enhanced by

Spiritual energy is the energy of commitment to a common vision for the future, driven by shared values and a higher

purpose

Psychological

Physical

Spiritual

Emotional Intellectual

@helenbevan

Psychological energy

Depleted by

Fear Setbacks Apathy

Lack of trust Weariness

Awareness Confidence Safe, secure environment

Purpose Role-models Motivation

Enhanced by

Psychological energy is the energy of courage, trust and feeling safe to do things differently

Physical

Psychological

Physical

Spiritual

Emotional Intellectual

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Physical energy

Healthy, supportive work

environment Appropriate

workload Regular renewal

Enhanced by

Stress through overwork Apathy

Disconnection

Depleted by

Physical energy is the energy of action, getting things done and making progress

Psychological

Physical

Spiritual

Emotional Intellectual

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Intellectual energy

Depleted by

Distractions Displacement

activity Lack of discipline

Being overworked

Creativity Focus & alertness

Learning Purpose

Challenge

Enhanced by

Intellectual energy is the energy of curiosity, analysis, thinking and cognition

Psychological

Physical

Spiritual

Emotional Intellectual

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The energy for change index

• The energy of any team or organisation – its capacity and drive to act and make the difference necessary to achieve its goals – determines its agility for change

• We have developed an online tool which is simple and rewarding as it provides an immediate insight into one’s own personal energy for change

• It is the first of a two-stage process for teams to identify areas that need a shift in focus in order to get wider engagement in change and faster action towards achieving it

• It is a powerful tool for organisations and teams undergoing perpetual change

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Facilitated questions - examples

• 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 change goals?

• What would the optimal energy profile look like for our team?

Physical

Psychological

SpiritualSocial

Intellectual

Energy for change profile

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The SSPPI Energy Index1 = Strongly disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree

I am energised by the momentum of change____I have gained insight into the case for change____I feel a sense of solidarity with those around me ____I am weary of change____It feels risky to try out new approaches____Prioritising various activities at work is tricky for me____I believe I make a difference as part of this group____I will be blamed if I try something new and it fails____I feel isolated from others____I trust in our direction of travel____The argument for change enables me to prioritise activities at work____I feel disconnected from others____I am committed to our common vision for the future____I feel safe enough to do things differently____I am driven by shared values____I am experiencing change fatigue____The current state is more attractive to me than the future picture____I feel that my values are compromised at work____I think there is no rational argument for change____I cannot make a difference as part of this group____I believe there is a healthy pace to change____

Those around me are energised by the momentum of change____Those around me have gained insight into the case for change____Those around me feel a sense of solidarity with each other____Those around me are weary of change____Those around me feel its risky to try out new approaches____Prioritising various activities at work is tricky for those around me____Those around me believe they make a difference as part of this group____Those around me will be blamed if they try something new and it fails____Those around me feel isolated from others____Those around me trust in our direction of travel____The argument for change enables those around me to prioritise activities at work____Those around me feel disconnected from others____Those around me are committed to our common vision for the future____Those around me feel safe enough to do things differently____Those around me are driven by shared values____Those around me are experiencing change fatigue____The current state is more attractive to those around me than the future picture____Those around me feel that their values are compromised at work____Those around me think there is no rational argument for change____Those around me cannot make a difference as part of this group____Those around me believe there is a healthy pace to change____

My energy The energy of those around me

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Team 1

Physical

Psychological

SpiritualSocial

Intellectual

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Team 1

Physical

Psychological

SpiritualSocial

Intellectual

Team 1’s energy profile is characterised by an environment that has harnessed their 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

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Team two

Psychological

Social Spiritual

PhysicalIntellectual

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Team twoPsychological

Social Spiritual

PhysicalIntellectual

Team 2 enables 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.

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SSPPI - The five energy domains

Social energy is the energy of personal engagement, relationships and connections between people. It reflects a “sense of us” and is therefore a collective concept that captures a situation where people are drawn into an improvement or change because they feel a connection to it as part of the collective group.

My social energy is ____The social energy of those around me is____The importance of social energy to me is____

Psychological energy is the energy of courage, trust and feeling safe to do things differently. It involves feeling supported to make a change as well as belief in self and the team, organisation or system, and trust in leadership and direction.

My psychological energy is ____The psychological energy of those around me is____The importance of psychological energy to me is____

Physical energy is the energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen, with vitality and kinetic force (motion)

My physical energy is ____The physical energy of those around me is____The importance of physical energy to me is____

Intellectual energy is the energy of curiosity, analysis, thinking and cognition. It involves gaining insight, a thirst for new knowledge as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic and evidence.

My intellectual energy is ____The intellectual energy of those around me is____The importance of intellectual energy to me is____

Complete these statements on a scale of 1 = low - 5 = high

Spiritual energy is the energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It involves giving people the confidence to move towards a different future that is more compelling than the status quo, by finding the deep meaning in what they do.

My spiritual energy is ____The spiritual energy of those around me is____The importance of spiritual energy to me is____

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Profile Preference

Psych

Physical

Social

Spiritual

Intellectual

= individual

Profiles vs. preferences

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Facilitated questions - examples

• Do we need to manage certain energies better (e.g. is social energy really important to the whole team, but poorly managed... is there is an over-emphasis on intellectual energy, which only satisfies two out of fifteen team members?).

• Do we have a bias towards a particular energy preference in our team?

• Should we look to future recruitment to help us create a more balanced team?

Profile (score>3)

Preference (score>3)

Psych

Physical

Social

Spiritual

Intellectual

= individual

Profiles vs. preferences

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An organisation can only realise its

highest potential when each

individual is fully valued and feels fully

vested in a shared purpose

The Energy Project

http://theenergyproject.com/

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Discretionary effort

is contractual

is personal

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[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 Garguilo

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Avoiding “de facto” purpose• 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

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What focus for our improvement projects?

Source: 100 improvement projects on national improvement leadership programme October 2012

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You get the best efforts from others not by lighting a fire

beneath them but by building

Source: Bob Nelson