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Helen Bevan's keynote address at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter. 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. Helen Bevan will show you powerful methods to unleash the latent energy for change from within your organization to increase the pace and scale of improvement. 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, analyzing and building energy for change.
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@helenbevan
#qs13
Building and aligning energy
for change
Helen Bevan @helenbevan
#QS13
@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
#qs13
What happens to large scale
change efforts in reality?
In order of frequency:
1. the effort effectively “runs out of energy” and simply fades away
2. the change hits a plateau at some level and no longer attracts new supporters
3. 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
#qs13
Intrinsic
motivators •connecting to
shared purpose
•engaging, mobilising
and calling to action
•motivational leadership
build energy
and creativity
@helenbevan
#qs13
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
@helenbevan
#qs13
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
#qs13
Internal
motivators
•connecting to
shared purpose
•engaging, mobilising
and calling to action
•motivational
leadership
build energy and
creativity
Drivers of
extrinsic
motivation •System drivers &
incentives
•Performance
management
•Measurement for
accountability create & focus
momentum for
delivery
Transformation is not a matter of
intent.........
it is a matter of alignment
Peter Fuda
@helenbevan
NHS Change Model
www.changemodel.nhs.uk
@helenbevan
@helenbevan
NHS Change Model
www.changemodel.nhs.uk
@helenbevan
#qs13
Does fear motivate people
to change?
@helenbevan
#qs13
burning platform
versus
burning ambition
@PeterFuda
@helenbevan
#qs13
Insert peter Fuda film
@helenbevan
#qs13
Lessons for transformational change
1. 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 compelling reason)
goes out, all other factors are
redundant
@PeterFuda
@helenbevan
#qs13
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
#qs13
@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
The five energies for change Energy Definitions
Social energy of personal engagement, relationships and connections between people. It reflects a “sense of us”, where people are drawn into an innovation or change because they feel a connection to it as part of the collective group
Spiritual 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
Psychological 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
Physical energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen
Intellectual energy of curiosity, analysis 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
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
Spiritual Social
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
Spiritual Social
Intellectual
Energy for change profile
LOW
HIGH
@helenbevan
Team 1
Physical
Psychological
Spiritual Social
Intellectual
@helenbevan
Team 1
Physical
Psychological
Spiritual Social
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
Physical Intellectual
@helenbevan
Team two
Psychological
Social Spiritual
Physical Intellectual
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
Analysis generated on 8th April 2013 by 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 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 72
Spiritual 47 100 80
Psychological 47 97 75
Physical 50 95 76
Intellectual 48 100 82
Total 45 98 77
1. The group’s Energy for Change profile
The group’s energy for change is 77% (43 respondents). NHS
groups previously analysed have demonstrated energy levels
between 54% and 84%.
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%)
@helenbevan
Profiling data Self-evaluation
Social 72 74
Spiritual 80 80
Psychological 75 72
Physical 76 70
Intellectual 82 82
Total 77 76
The two perspectives on energy support each other
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 & desired energy levels
There are large gaps (> 1) between the group’s perceived energy
for change ___and its desired energy level ___on 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 ____to be lower than their own energy
1
2
3
4
5 Social
Spiritual
Psychological Physical
Intellectual
My energy
Energy of those I work with
Importance of this energy
@helenbevan
5. Is Energy for Change influenced by “distance from CEO” and “clinical/non-clinical” role?
NHS dataset shows those 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 those 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.
The groups are too small to be representative (clinical = 13, proximity to the
CEO = approximately 6 in each group).
@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 and trust in change
@helenbevan
#qs13
“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,
Clinical Microsystem Festival, Jönköping March 2012
@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
@helenbevan
#qs13
Air sandwich
http://www.amazon.com/gp/mpd/permalink/m3E4LREIVUTDH3/ref=e
nt_fb_link
History has taught us that the number one reason strategies fail is because of the lack of execution.....
History is now teaching us that unless we learn to engage people, not just people called executives, in a conversation about needs, wants and desires we simply cannot expect to meet those needs. Not meeting those needs means we cannot expect people to even want to be engaged with us for whatever purpose
Jay Deragon
@helenbevan
#qs13
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
#qs13 @SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
#qs13 @SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
#qs13
Police
@SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
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Education
@SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
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Healthcare
@SimonJGuilfoyle Police Inspector and systems thinker
@helenbevan
What focus for our improvement projects?
0
5
10
15
20
25
1 2 3 4 5 6 7 8 9
No
of
pro
jects
Project Score Mainly focussed on
quality, safety &/or
patient experience
Mainly focussed on cost,
productivity or efficiency Source: 100 improvement projects on national improvement
leadership programme October 2012
@helenbevan
#qs13
My three visits to Saskatchewan
2008
2010
2013
@helenbevan
#qs13
....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 inspire
Dov Seidman