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Helen Bevan delivered this full-day workshop, where we discussed, with about 80 health care leaders, how to build contagious commitment for change. Much of the redesign effort in health care is focused on the “anatomical” or technical aspects of improvement; how we transform processes, pathways and structures of care. There is growing recognition globally among leaders that we need to give more credence to the “physiological” aspects of redesign; how we capture the imagination and energy of frontline teams, leaders, and patients and families and mobilize them for system-wide transformation. Individuals and teams can weather the inevitable challenges presented by change, and they will sustain energy for change if they have an intrinsic sense of purpose, hope, and possibility about what the change will achieve. At this one-day workshop, Helen Bevan – she is energy personified! - took us through some of the latest thinking and practice on how to build this ‘contagious commitment’ to change. She illustrated why energy is such a critical factor in successful change efforts. We learned about the different kinds of energy required for change, reviewed our Saskatchewan 'energy for change' profile, and built our skills for assessing and building energy levels in ourselves and in our team members. The workshop took place in Regina, Saskatchewan, on Tuesday, April 9th, 2013.
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@helenbevan
Building contagious commitment for improvement
Helen Bevan@helenbevan
@helenbevan
Themes for today
1. Sensemaking about change2. Aligning aspects of change3. Building energy for change4. Shared purpose: change is not the goal,
the goal is the goal
@helenbevan
Most large scale change fails to achieve its objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey
70%
25%5%
@helenbevan
The factors that impact the ability
to deliver Lean transformation are the same as
the factors in other large scale
change strategies
@helenbevan
Gonna change my way of thinkingMake myself a different set of rulesGonna put my good foot forwardAnd stop being influenced by fools
From Gonna change my way of thinking
by Bob Dylan with thanks to Jackie Lynton
Leaders ask their staff to be ready for change, but do not engage enough in sensemaking........
Sensemaking is not done via marketing...or slogans but by emotional connection with employees
Ron Weil
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
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
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
“You can’t impose anything on anyone and expect them
to be committed to it”Edgar Schein, Professor Emeritus
MIT Sloan School
Source: Helen Bevan
FromCompliance
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
What is our approach to change?To
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
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
@helenbevan
Transformation is not a matter of intent.........
it is a matter of alignmentPeter Fuda
@helenbevan
NHS Change Model
www.changemodel.nhs.uk
@helenbevan
TaskWith others at your table:• Identify the component that appeals to you the
most/ that you feel the most connection with• Explain your reasons to your colleagues
@helenbevan
@helenbevan
Five key principles in using the NHS Change Model
1. Start with “shared purpose” but after that there is no prescribed linear or logical order
2. It’s important to use the model to check if all eight components are present but it’s more important to focus on whether they are aligned
3. Use the model to build on what you are doing already
4. Don’t “sell” the change model; “sell” the outcomes you are seeking: change is not the goal; the goal is the goal5. Build commitment to, not compliance with, the NHS Change Model
@helenbevan
In terms of your current initiative
• Where are you on a continuum between one and ten in terms of how aligned the elements are in your initiative?
@helenbevan
In terms of your current initiative
• Where are you on a continuum between one and ten in terms of how aligned the elements are in your initiative?
• Move one step forward
@helenbevan
In terms of your current initiative
• Where are you on a continuum between one and ten in terms of how aligned the elements are in your initiative?
• Move one step forward• Move one point higher on the continuum (i.e.,
if you are a five, move to a six)• What would it take to improve your score by
one?
@helenbevan
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
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
@helenbevan
Bruch and Vogel researchOrganisations with HIGH productive energy scored higher on:• overall performance - 14% higher• productivity – 17%• efficiency – 14%• customer satisfaction – 6%• customer loyalty – 12%
@helenbevan
@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:
@helenbevan
Five energies for change 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
@helenbevan
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
@helenbevan
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
The energy for change index
• The energy of any team, organisation or system – 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
@helenbevan
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 or community?
Physical
Psychological
SpiritualSocial
Intellectual
Energy for change profile
@helenbevan
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 or community?
Physical
Psychological
SpiritualSocial
Intellectual
Energy for change profile
LOW
HIGH
@helenbevan
Team 1
Physical
Psychological
SpiritualSocial
Intellectual
@helenbevan
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
@helenbevan
Team two
Psychological
Social Spiritual
PhysicalIntellectual
@helenbevan
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.
@helenbevan
Saskatchewan Energy for Change
SSPPI Energy Index (V2)
Analysis generated on 8th April 2013by Rosanna Hunt and Paul Woodley
43 respondents
[email protected]+44 777 070 4056
Energy for Change Model and SSPPI Energy Index by NHS Improving Quality is licensed under a Creative Commons Attribution-ShareAlike 2.0 UK: England & Wales License.
@helenbevan
The following two slides show the SSPPI Energy Index, which is presented in two parts.
PART 1 is a psychometric profiling tool – it generates the group “energy for change” profile.
PART 2 asks individuals to self-evaluate their energy for change using the energy definitions – it tells us whether there are any gaps between current energy levels, preferred energy levels and perceived energy levels in the work environment.
The remaining slides show several perspectives on the results, from which some general conclusions are made, on the last slide.
@helenbevan
The SSPPI Energy Index – V2, Part I
This questionnaire enables teams to measure their energy for change. Please agree the nature of the change context with your team before answering the following statements. Then answer all statements with your particular change context in mind.
1 = 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 I work with ____I am weary of change____I am able to keep expressing hope for the change when presented with setbacks_____The reasoning for the change is not compelling___I don’t feel appreciated by others at work_____ I will be blamed if I try something new and it fails____I feel isolated from others____I feel depleted of energy when others express doubt about the change_____The case for change has stimulated my creativity_____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 change does not fit with my sense of purpose_____I am not driven by a shared purpose for change_____I think there is no rational argument for change____The case for change is interesting to me_____I feel that we are getting things done to achieve the change_____I feel the change may conflict with my values___I feel personally engaged in the change___Clear thinking and analysis underpins the change___I feel fearful about the change___I sense openness about the potential to change___
@helenbevan
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 I work with 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 I work with 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 I work with 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 I work with 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 I work with is____The importance of spiritual energy to me is____
The SSPPI Energy Index – V2, Part 2
@helenbevan
min max %
Social 32 100 72Spiritual 47 100 80Psychological 47 97 75Physical 50 95 76Intellectual 48 100 82Total 45 98 77
1. The group’s Energy for Change profileThe group’ energy for change is 77% (43 respondents). NHS groups previously analysed have demonstrated energy levels between 54% and 84%.
The table below shows that spiritual and intellectual energies are particularly high in this group (82% and 80% respectively).
Although social energy appears to be more depleted than the other energy types (72%), this may be skewed by a small number of individuals scoring particularly low (32%) on this energy type.
@helenbevan
Profiling data Self-Evaluation
Social 72 74Spiritual 80 80Psychological 75 72Physical 76 70Intellectual 82 82Total 77 76
Overall, the two perspectives on energy support each otherThis indicates that respondents show good self-awareness of their energy for change. The group may perceive its physical energy to be more depleted than it is in reality (they self-evaluate their levels of physical energy to be at 70% whereas their profile indicates they have higher physical energy in reality (76%).
2. How does your Energy for Change profile compare with your self-evaluated view of your energy?
@helenbevan
3. Gaps between current energy levels and desired energy levels
These results, taken from self-evaluations of energy for change (Part 2 of the questionnaire) indicate that there are large gaps (> 1) between the group’s perceived energy for change (on the green line) and its desired energy level (the red line) on the physical and psychological energies. The group would like to enhance its energy for change in these particular domains. On average, individuals within the group measure the energy of those they work with (the blue line) to be lower than their own energy to be lower than the energy of those around them.
Social
Spiritual
PsychologicalPhysical
Intellectual
1
2
3
4
5
My Energy AverageThe Energy of those I work with AverageThe importance of this energy to me Average
@helenbevan
4. Frequency of high (>3) self-evaluated current and desired energy levels
So far, we have used average (mean) scores to understand the group’s energy levels. However, since the mean can hide patterns in the data, it is important to look at frequency data to gain another perspective and check conclusions.The bar chart above backs up the view that there is a particularly strong need to build an environment for change that enhances physical and psychological energy for individuals.
Social Spiritual Psychological Physical Intellectual0
5
10
15
20
25
30
35
40
45
My Energy
The Importance of this energy to me
@helenbevan
5. Is Energy for Change influenced by “distance from CEO” and “clinical/non-clinical” role?
Our NHS dataset of 200 respondents showed that individuals in clinical roles have higher levels of energy for change than those in non-clinical roles*, which is mostly influenced by their higher levels of spiritual energy** and may also be influenced by higher levels of social energy***.The NHS data also showed that individuals in roles that are closer to the CEO (in hierarchical terms) have higher levels of energy for change**** in four out of the five energy domains (there were no differences in the physical energy levels of individuals at different levels of the hierarchy).
In the Saskatchewan dataset there were no differences between individuals in clinical roles (n=13) compared with those in non-clinical roles (n=30). Interestingly, the only difference to emerge between the various levels of the hierarchy, was on Physical Energy: those closest to the CEO had higher physical energy for change than those two steps away from the CEO++.
However, caution should be exercised in the interpretation of these results. A larger Saskatchewan dataset would be required, as the groups are certainly too small to be representative (clinical = 13, proximity to the CEO = approximately 6 in each group).
*t=2.1,df=190,p=0.03 ++F= 2.7,df=4,p=0.05**t=3.9,df=201,p<0.001***t=1.9, df=198,p=0.056****F=5.3,df=4,p<0.001
@helenbevan
Conclusions
• The group’s energy profile is 77%, but this varies widely across energy domains and individuals
• To build energy for change, the team should focus on the physical and psychological domains
• Physical energy is enhanced by creating opportunities for regular renewal, ensuring workload is appropriate and investing in a healthy work environment
• Psychological energy is enhanced by a safe, secure environment that provides role-models that exhibit courage for, and trust in change
@helenbevan
Resources for building and aligning energyTitle and source S S P P IQuality and Service Improvement Tools – NHS X X X X X
Energy Project tips – The Energy Project X X X X
Emotional Resilience Toolkit – DH/Business in the Community
X X X X
IHI Improvement Map – Institute for Healthcare Improvement
X X X X
P3M Resource Centre – NHS Connecting for Health
X X X X
i-resilience assessment – RobertsonCooper X X X X
Appreciative Inquiry – Appreciative Inquiry Commons
X X X
Good Day at Work network – RobertsonCooper X X X
Juice Intelligent Energy resource centre – Juice Int. Energy
X X X
Leadership tips: change management toolkit – Johns Hopkins
X X X
Action Learning Sets – Action Learning network X X X
Living our Local Values - NHS Institute for Innovation and Improvement
X X X
Thomas-Kilmann Inventory conflict mode instrument
X X
Sustainability Model – NHS Institute for Innovation and Improvement
X X
Benefits Realisation – NHS X X
Myers-Briggs Personality Types – M&B Foundation
X X
Belbin Team Roles – Belbin Associates X X
Productive Series – NHS Institute for Innovation and Improvement
X X X X X
Building Improvement Capability – NHS Institute for Innovation and Improvement
X X
Organising for Quality and Value – NHS Institute for Innovation and Improvement
X X
Call to Action –NHS Institute for Innovation and Improvement
X X
350 Workshops – Marshall Ganz / New Organizing Institute
X X
Staff engagement resource – DH / NHS Employers
X X
Engagement to mobilise – NHS Change Model X X
Strength Development Inventory - SDI X X
Change Management Toolkit – Local Government Programme
X
Managing your energy levels – Bupa X
Our shared purpose – NHS Change Model X
Leadership Framework 360o assessment – NHS Ld Ac
X
McKinsey 7S Framework – McKinsey & Co X
Creating a Culture of Innovation – NHS Institute for Innovation and Improvement
X
Focus On Series – NHS Institute for Innovation and Improvement
X
Physical Activity toolkit – SWYPFT (NHS FT)
@helenbevan
Resources for building and aligning energyTitle and source S S P P IQuality and Service Improvement Tools – NHS X X X X X
Energy Project tips – The Energy Project X X X X
Emotional Resilience Toolkit – DH/Business in the Community
X X X X
IHI Improvement Map – Institute for Healthcare Improvement
X X X X
P3M Resource Centre – NHS Connecting for Health
X X X X
i-resilience assessment – RobertsonCooper X X X X
Appreciative Inquiry – Appreciative Inquiry Commons
X X X
Good Day at Work network – RobertsonCooper X X X
Juice Intelligent Energy resource centre – Juice Int. Energy
X X X
Leadership tips: change management toolkit – Johns Hopkins
X X X
Action Learning Sets – Action Learning network X X X
Living our Local Values - NHS Institute for Innovation and Improvement
X X X
Thomas-Kilmann Inventory conflict mode instrument
X X
Sustainability Model – NHS Institute for Innovation and Improvement
X X
Benefits Realisation – NHS X X
Myers-Briggs Personality Types – M&B Foundation
X X
Belbin Team Roles – Belbin Associates X X
Productive Series – NHS Institute for Innovation and Improvement
X X X X X
Building Improvement Capability – NHS Institute for Innovation and Improvement
X X
Organising for Quality and Value – NHS Institute for Innovation and Improvement
X X
Call to Action –NHS Institute for Innovation and Improvement
X X
350 Workshops – Marshall Ganz / New Organizing Institute
X X
Staff engagement resource – DH / NHS Employers
X X
Engagement to mobilise – NHS Change Model X X
Strength Development Inventory - SDI X X
Change Management Toolkit – Local Government Programme
X
Managing your energy levels – Bupa X
Our shared purpose – NHS Change Model X
Leadership Framework 360o assessment – NHS Ld Ac
X
McKinsey 7S Framework – McKinsey & Co X
Creating a Culture of Innovation – NHS Institute for Innovation and Improvement
X
Focus On Series – NHS Institute for Innovation and Improvement
X
Physical Activity toolkit – SWYPFT (NHS FT)
http://www.institute.nhs.uk/tools/
energy_for_change/energy_for_ch
ange_.html
@helenbevan
burning platformversus
burning ambition@PeterFuda
@helenbevan
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
Task
Talk to the person next to you• What is “my burning ambition” for my service, my
community and /or my patients• Try to make it personal: tell others why this ambition
connects with your personal motivations
@helenbevan
You get the best efforts from others not by lighting a fire
beneath them but by building
Source: Bob Nelson
@helenbevan
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
@helenbevan
Framing Is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action
Snow D A and Benford R D (1992)
@helenbevan
If we want people to take action, we have to connect with their emotions through values
action
values
emotion
Source: Marshall Ganz
@helenbevan
What do we need to do?1. Tell a story
@helenbevan
What do we need to do?1. Tell a story2. Make it personal
@helenbevan
What do we need to do?1. Tell a story2. Make it personal3. Be authentic
@helenbevan
What do we need to do?1. Tell a story2. Make it personal3. Be authentic4. Create a sense of “us” (and be clear who the “us”
is)
@helenbevan
What do we need to do?1. Tell a story2. Make it personal3. Be authentic4. Create a sense of “us” (and be clear who the “us”
is)5. Build in a call for urgent action
@helenbevan
James Croft
@helenbevan
Outwitted
He drew a circle that shut me out -Heretic, rebel, a thing to flout.But Love and I had the wit to win:We drew a circle that took him in.
Edward Markham
@helenbevan
What’s our approach to change?
Deficit based
• what is wrong?• solving problems• identifying what
we need to improve
• gaps and deficiencies to be filled
Asset based
• what is right that we can build on?
• working with existing assets and resources
• “positive deviants”• amplifying what
works
@helenbevan
69
Build on strengths or fix problems?
To what extent did you balance identifying strengths with understanding problems?
Focused exclusively
on problems83
Focused mostly on problems & a little on strengths
77
Focused more on problems than on strengths
61
Equal focus on problems
and strengths49
x 3.0
A study of two bowling teams at University of
Wisconsin showed that the team that was coached using video tape of their
successes improved twice as much as the team that
was shown only their mistakes
51
38
23
17
%, n = 2,043
SOURCE: McKinsey Quarterly Transformational Change survey, January 2010
@helenbevan
“A shared sense of corporate purpose, grounded in universal values, is the highest octane source of fuel for organisational action.” Schwartz and Loehr (2004)
@helenbevan
“Money incentives do not create energy for change; the energy comes from connection to meaningful goals”
Ann-Charlott Norman, Talking about improvements: discursive patterns and their conditions for learning, March 2012
@helenbevan
We know that ...
• 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)
@helenbevan
Shared purpose aligns.....
Shared purpose allows many communities to engage with us without us having to invest resourcesin controlling their actions Nilofer Merchant
@helenbevan
A 3-word concept
@helenbevan
Discretionary effort
is contractual
is personal
@helenbevan
[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
@helenbevan
From compliance to commitment
“We come from a culture of compliance and top down performance management, … It’s task-orientated to get things done. It needs to be much more about cooperation, about leading across boundaries … Being able to focus on shared purpose in those circumstances is absolutely crucial.” NHS interviewee
@helenbevan
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
@helenbevan @SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
Purpose
Obfuscation O-
meter
@SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
Police
@SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
Education
@SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
Healthcare
@SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
How de facto purpose is creeping into NHS improvement projects: how 100 young and emerging clinical leaders framed
their projects
1 2 3 4 5 6 7 8 90
5
10
15
20
25
Project Score
No
of
pro
ject
s
Mainly focussed on quality, safety &/or patient experi-ence
Mainly focussed on cost, pro-
ductivity or effi-ciency
Source: project information from 100 young clinical and managerial leaders taking part in national improvement skills programme October 2012
@helenbevan
How de facto purpose is creeping into NHS improvement projects: how 100 young and emerging clinical leaders framed their projects
1 2 3 4 5 6 7 8 90
5
10
15
20
25
Project Score
No
of
pro
ject
s
Mainly focussed on quality, safety &/or patient experi-ence
Mainly focussed on cost, pro-
ductivity or effi-ciency
Very few framed their projects as quality, safetyor experience
Most framed their projects as cost and efficiency
@helenbevan
How do we create shared purpose?
@helenbevan
Create a safe space
• This can be in small, medium or large groups • Online forums can also be used• Create a level playing field, free from hierarchy• Include patients and service users – they are
expert about their needs
@helenbevan
Creating a safe space
“Just creating the space for people to come together as individuals and feel safe enough to share things … perhaps their vulnerabilities; and how the group built as an entity and a supporting mechanism. I think the thing for me that was really important was that it was across what are conventional boundaries. Focus group participant
@helenbevan
Look for commonalities
• Start with each individual talking about their own values and stories
• Talk about the parts of the stories that unite the group
• Capture some statements that reflect your shared understanding and ambitions
@helenbevan
Finding commonalities
“The perspective of the patient might be quite different than the perspective of the staff nurse on the ward who looks after them ... I think it was really interesting for all the participants to realise that they were talking about the same things essentially.” Focus group participant
@helenbevan
How many of you have worked with driver diagrams?
@helenbevan
Creating a driver diagram
These directly affect the aim These directly affect one or more primary drivers
PRIMARY DRIVERS SECONDARY DRIVERS
?
Write them as “We need to improve . ..”
@helenbevan
Getting Andy Murray to be Wimbledon champion
Increase skill level
Better intelligence on
rivals
Improve backhand accuracy
Decrease double faults
Increase stamina
Increase serve / volley
Reserve challenges
Create top 50 dossiers
Wimbledon
champion
Increase fitness
Improved tactics
Improved hydration
Increase success rate for top 3 tactics per player
Turn round the deficit in General Surgery
Reduce bed requirements (and therefore staffing)
1. Reduce day before admissions
5. Decrease bed capacity buffer
6. Streamline elective demand
7. Increase discharge timeliness (social factors)
8. Increase discharge timeliness (weekend holdups)
3. Improve recording and income capture
10. Improve out-patient profitability
9. Match staffing levels / mix to demand (via flexibility)
11. Increase theatre utilisation
2. Shift elective procedures to high margin day cases
Increase income
Improve resource usage (and
therefore reduce staffing)
Decrease other costs
12. Decrease consumables costs
4. Decrease controllable DNAs
From a hospital system
Quick win Longer term
To deliver harm free care as defined by theabsence of pressureulcers, falls, UTI with Catheter and VTE by
March 2013
Strategic Leadership
Accountability In Care
Focus On Care
Enabler To Care
Leadership Walk Rounds
Commissioner Visits
Risk Assessment
Incidence
95% Harm Free Care
Root Cause Analysis
Collaborative Learning Events
Primary Drivers Secondary DriversLarge Scale
Change Team
Contracting
Aim Care Planning
Adult Safeguarding
Patient Stories
Chief Nurse 6Cs
© NHS Institute for Innovation and Improvement, 2012
Reduce the negative impact of alcohol on
health, well-being, and society in the North
West.
Increase opportunities to directly influence individual decision
making about alcohol Increase use of communication/ messaging/campaigns etc.
Create a grass roots social movement among the public (re: alcohol)
Create leadership and mindset change among professional groups to become advocates for
alcohol awareness
Creating more leaders who can influence others and lead the agenda
Align/create/enhance the performance management system to promote alcohol related
activities
Create an alternatives for economic development (e.g. not nightlife based)
Influence the environment that
determines alcohol consumption and
alcohol related services
Work with alcohol industry to improve labelling and reduce instances of below cost sales
Future activities
Activities currently underway
Increase the number of targeted programmes for specific groups of alcohol users
Educate directly-employed staff in the public sector serve as role models/champions
A large scale example . . .
@helenbevan
Task: stage oneAs a group or table, select one of the driver diagrams to work on:• Familiarise yourself with the diagram• You are going to create a shared purpose to sit at the
beginning of the driver diagramme• Who needs to be involved in creating the shared
purpose?• Can you “stand in the shoes” of these people and reframe
the aims statement as a shared purpose?• How can you utilise spiritual and social energy as well as
intellectual and physical energy?• Can you create a shared purpose rather than a de-facto
purpose?
@helenbevan
Task stage two
Review the entire driver diagram from the point of view of the change model:• Are all eight components represented?• What should be added?• Are the components aligned?
@helenbevan
Level 3: Keeping on track
Have we remained true to our original purpose?
Do we need to re-calibrate to ensure we’re not just doing ‘the wrong things righter?’
@helenbevan
Keeping on track
“It’s challenging sometimes to find time and it’s uncomfortable sometimes to discover how far we have strayed from [our shared purpose].” NHS interviewee.
@helenbevan
Re-energise
Re-visiting the original purpose can help re-energise when a programme has plateaued or run out of steam
@helenbevan
Re-energise
“There is a need for change leaders to be reminded about [shared purpose’s] centrality and therefore for it to be continually revisited, checked, refreshed, that even if the value and the purpose stay the same the messaging might need to be revisited and checked.” NHS Interviewee.
@helenbevan
We need to build capability for knowing, doing, living and being improvement
@helenbevan 105
@helenbevan
‘Hurihia to aroaro ki te ra, tukuna to atarangi
kia taka ki muri i a koe’
“Turn your face to the sun and the shadows
fall behind you”
Māori whakatauki
