Leading change with big ambition

@helenbevan

Leading change with big ambition

Helen BevanDelivery teamNHS Improving Quality@helenbevan@NHSIQ

@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

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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

70%

25%5%

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



































Intrinsic motivators

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





•System drivers & incentives•Payment by results•Performance management•Measurement for accountability

Internal motivators

• connecting to shared purpose

•engaging, mobilising and calling to action



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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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

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TaskWith others at your table:• Identify the component that appeals to you the

least/ that you feel the least connection with• Explain your reasons to your colleagues

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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 already4. 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

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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?

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• Move one step forward

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• 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?

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0123456789

10Our shared purpose

Spread of innovation

Improvementmethodology

Rigorous delivery

Transparentmeasurement

System drivers

Engagement tomobilise

Leadership for change

What's our prognosis for this asthma pathway project?

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NHS Change Model


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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

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Does fear motivate people to change?

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burning platformversus

burning ambition@PeterFuda

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Lessons for transformational change1. In order to sustain

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

2. We 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

TaskTalk 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

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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

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NHS Change Model


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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%

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http://bit.ly/ZUCbfI

http://bit.ly/ZUCbfI

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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

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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

@helenbevan@helenbevan #Quality2013

The SSPPI Energy Index – 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 AgreeI 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___

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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


• 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 improvement goals?

Energy for change profileSocial

Spiritual

PsychologicalPhysical

Intellectual

1

2

3

4

5


• 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 improvement goals?

Energy for change profileSocial

Spiritual


Intellectual

1

2

3

4

5

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Social

Spiritual


Intellectual

1

2

3

4

5

Team 1: what’s your assessment of their energy for change?

@helenbevan

Social

Spiritual


Intellectual

1

2

3

4

5


This energy profile is characterised by an environment that has harnessed people’s 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

Social

Spiritual


Intellectual

1

2

3

4

5


@helenbevan

Social

Spiritual


Intellectual

1

2

3

4

5


This energy profile shows 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. We can build energy by agreeing shared goals for change and using systematic approaches to thinking through and planning the change

UOB01Energy for Change

SSPPI Energy Index (V2)

Analysis generated on 17th May 2013by Rosanna Hunt and Paul Woodley

50 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.

mailto:[email protected]

http://creativecommons.org/choose/www.changemodel.nhs.uk

http://creativecommons.org/licenses/by-sa/2.0/uk/deed.en_GB

Energy for Change Profile

The group’ energy for change is 77% (50 respondents). NHS groups previously analysed have demonstrated energy levels between 54% and 84%.

The table below shows that intellectual energy is particularly high in this group (83%).

Social and Psychological energies are the lowest scoring energies (both 73%).

>20% variation between individuals on all energy domains

min max %

Social 40 92 73Spiritual 47 100 80Psychological 52 90 73Physical 50 100 78Intellectual 63 100 83Overall 50 96 77

Profiling data Self-Evaluation

Social 73 80Spiritual 80 85Psychological 73 77Physical 78 76Intellectual 83 86Total 77 81

The group tends to self-evaluate its energy levels to be slightly higher than they is revealed by the psychometric profiling data, on all but the physical energy domain

How much energy self-awareness does the group have?

Energy gaps

Social

Spiritual


Intellectual

1

2

3

4

5My Energy Average

The Energy of those I work with Average

The importance of this energy to me Average

This bar chart shows another perspective on the data – it uses frequencies of responses >3, rather than the mean (which can be misleading). It compares the data on current and desired energy for change.

The results displayed here confirm that there are very small gaps between current and desired energy levels on all five domains.

Current and desired energy for change

Social Spiritual Psychological Physical Intellectual0

5

10

15

20

25

30

35

40

45

50

My EnergyThe Importance of this energy to me

Conclusions

• The group’s energy profile (77%) is slightly higher than average levels across our NHS sample.

• However, individuals vary significantly in their energy levels, on all five domains

• The group could benefit from building its energy self-awareness - and their awareness of the energies of those they work with, too

Recommendations

• Individuals could use the Energy Index in smaller team settings, to enable those they work closely with, to develop a daily discourse around Energy for Change

• These smaller teams could benefit from facilitated feedback sessions – where they can question and share thoughts about their energy for change with each other

• The impact of these activities could be evaluated by re-administering the Energy Index at another time in the future

Where does team 1 go for help?Roadmap of resources for building energy for change

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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

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“You can’t impose anything on anyone and expect them

to be committed to it”Edgar Schein, Professor Emeritus

MIT Sloan School

@helenbevan Source: Helen Bevan

Compliance

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?

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

@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

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“ The source of energy at work is not in control, it is in connection to purpose”

Don Berwick, 28th February 2012

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Shared purpose aligns.....

Shared purpose allows many communities to engage with us without us having to invest resourcesin controlling their actions Nilofer Merchant

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Leaders as “signal generators”

“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, 2009

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Leading for shared purpose

“Leading effectively is less about mastering situations – or even mastering social skill sets –than about developing a positive interest in and

talent for fostering positive feelings in the people whose cooperation and support you

need”.Daniel Goleman and Richard Boyatzis

The Harvard Business Review

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“A shared sense of corporate purpose, grounded in universal values, is the highest octane source of fuel for organisational action.” Schwartz and Loehr (2004)

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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)

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A 3-word concept

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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 Carguilo

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Feeling “primal”

Watch this film from James Calvert, Respiratory Physician from Bristol

http://t.co/qv59pMrvAZ



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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

@helenbevan @SimonJGuilfoyle Police Inspector and systems thinker

https://twitter.com/SimonJGuilfoyle


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Purpose

Obfuscation O-

meter

@SimonJGuilfoyle Police Inspector and systems thinker



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Police




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Education




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Healthcare




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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

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We have a particular challenge in creating shared purpose in a healthcare setting……

Source: Philip Hadridge Idenk.com

The noble purpose paradox

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=HApTn71ie5yIaM&tbnid=lPXZqw10fM495M:&ved=0CAUQjRw&url=http://www.iep.utm.edu/par-log/&ei=KTiaUZvqJcHJ0AWH34DgCg&bvm=bv.46751780,d.d2k&psig=AFQjCNH_lnFyiBYmfMMpUIfofuDIp77dQQ&ust=1369147696528755

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Definition of a “noble purpose organisation”

An organisation where:• most people would answer the question “why

did you apply to work here?” with an answer that aligns their choice of job with the fundamental purpose of the organisation

• other motives (power, socialisation, rewards, personal achievement, fun, etc) are absent or hard to declare


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The noble purpose paradox

“Why is it that the more compelling the mission, the more tricky it can be to get the best collaborative behaviours and the necessary focused action? And how can some places that are trying to achieve the most crucial and needed changes to the world we live in be riven with petty politics and driven by individuals sometimes ruthlessly pursing their own agendas?”


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The noble purpose paradox: how it manifests itself

• office politics are the norm, often in a way that is perplexing to new recruits

• the motivations and actions of co-workers are regularly questioned and differences in point of view amplified

• personal interpretations of right and wrong, as well as what makes for a ‘noble purpose’, come to the fore

• alternative points of view can be hard to present without leading to arguments

• acknowledging the presence of other personal motivations (such as pay, profile or influence) is hard or impossible

• raising some of the issues at work about power or ambition is almost impossible. Source: Philip Hadridge Idenk.com

@helenbevan

What can we do?

• Listen to other people’s stories and understand their values and motivations

• reflect on the patterns and motivations you see in yourself and others

• Be aware of the gaming that can get in the way if leadership behaviours are not right; do all you can to counter it by identifying and living the values you believe are essential as a leadership group

• invest in and support insightful and strong leadersSource: Philip Hadridge Idenk.com

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How do we create shared purpose?

Create a safe space

Look for commonalities & understand

differences

Create a statement of

purpose

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From defacto purpose……

“Our job is to judge the effectiveness of urban gardens”

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To shared purpose

From“Our job is to judge the effectiveness of urban gardens”To “We’re here to figure out whether or not the free installation of urban gardens helps low-income families eat healthier or not. We’ve got nine months to come up with initial findings. It’s important because if the answer is no, then $500,000 of foundation money can go somewhere that it’s being better spent next year. If the answer is yes, it means we have a national model that other cities can learn from. So this is a huge opportunity to make a worthwhile contribution.”

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We need to build capability for knowing, doing, living and being improvement

@helenbevan 83

“You don’t need an engine when you have wind in your sails”

Paul Bate

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....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 Speidman

Health & Medicine

Leading change with big ambition