Change in the Age of Disruption: Emergent change

@HelenBevan @SteveFairman1 #cmidisruptSource of image:

Buildingchangetrust.org

Helen Bevan@HelenBevan

Steve Fairman@SteveFairman1

#cmidisrupt

Emergent change

@HelenBevan @SteveFairman1 #cmidisrupt

Our three questions• What is emergent change and why is it so

important to understand?• How can we support a move to change that is

truly demand-led?• Where does leadership and “change

management” fit in?

In the context of the

English National Health

Service!


The English NHS: facts and figures• The world’s largest publically funded health

system• Provides comprehensive healthcare to 54

million people• Sees a million patients every 36 hours• Funded by direct tax• It’s free at the point of use• Provides 95% of the healthcare in England


From a meeting yesterday: NHS Emergency Departments


The NHS is the 5th biggest employer on the globe

Source: BBC


Where are we?• Dramatic improvements in care over 15 years• Only health system globally to manage five years

of little/no real growth without increasing charges, cutting services or cutting staff

• Ranked the highest performing health system of 11 industrialised countries (Commonwealth Fund, USA)

Source: 5 Year Forward Year (2014) NHS England http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf



Where are we?The dominant NHS approach [to leadership] is

typified by laying down demanding targets, leading from the front, often being reluctant to delegate,

and collaborating little – and is the consequence of the health service focusing on process targets, with

reward dependent on meeting them.

Source: Kings Fund Leadership for engagement and improvement in the NHS http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/leadership-for-engagement-improvement-nhs-final-review2012.pdf

“

“

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/leadership-for-engagement-improvement-nhs-final-review2012.pdf




Where are we?

Three giant challenges:• The health and wellbeing gap• The care and quality gap• The funding and efficiency gap

Source: 5 Year Forward Year (2014) NHS England http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf



@HelenBevan @SteveFairman1 #cmidisrupt9

The Dependency Ratio is rising alarmingly


The National Health Service is the closest thing the English have to a religion, with those who

practice in it regarding themselves as a priesthood. This makes it quite extraordinarily

difficult to reformNigel Lawson, politician

“ “


Source: @NHSChangeDay

Can I, dare I?


Between us, we bring more than 40 years experience of leading change in health and care...…..

“It has been positivelyreviewed and reported in the nursing

& healthcare press and its implementation is proven to produce significant savings in

productivity & efficiency”White et al 2013

“Contributed

to a 51% reduction in

antipsychotic prescribing to

people with dementia”

Manchester Business

School

One of the most widely adopted and impactful improvement programmes in the history of the NHS; “releasing

time to care”, typically 10-20% of the time of clinical professionals. The changes were adopted by 78% of NHS hospital wards, 68% of mental health

wards, 54% of NHS operating theatres and 49% of community health teams across England (SHA statistics) as well as 44 territories

across the globe

New Zealand: 19% of time“released to care”

Oregon USA: multi-factorial improvements

Scotland: “20% of time

released to care”

A significant,positive impact on staff

engagement

Irish research: the effects were

sustained over time

Statistically significant positive effect on EVERY dimension of impact at both individual & organisational level

Tangible ROI: both visible

& invisible benefitsExternal

evaluators

@HelenBevan @SteveFairman1 #cmidisruptImage from: @TheWorldStories

@HelenBevan @SteveFairman1 #cmidisruptImage from: @TheWorldStories


Is your change process a cathedral or a bazaar?

http://www.unterstein.net/su/docs/CathBaz.pdf




We have a lot of cathedrals

Source: Sewell (2015) : Stop training our project managers to be process junkies


SEISMIC SHIFTS


Kinthi Sturtevant, IBM 13th

annual Change Management Conference

June 2015

We rarely see two, three or four year change projects anymore. Now it’s 30-60-90 day change

projects

http://www.innovationexcellence.com/blog/2015/07/09/13th-annual-change-management-conference-highlights/?utm_source=hs_email&utm_medium=email&utm_content=20535245&_hsenc=p2ANqtz--W0963q5vEUgL7ecueQKfQ5nK0QPbROyo7BwHs10orC8Mhs-KVEWZbwEyxXf1c8rSQahhkhUXAPaEFtqlTzK5nEygUTw&_hsmi=20535245





DIGITALCONNECTION

SEISMIC SHIFTS


Empower your staff to be the voice of the organisation. They’ve got audience & credibility

Employees have 10x more connections than corporate social accounts


Work complexity

SEISMIC SHIFTS

DIGITALCONNECTION


DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity


“In a connected world, power no longer emanates from the top of the heap, but the centre of the

network.”Greg Satell, 2015

Greg Satell: http://www.digitaltonto.com/2015/how-power-is-shifting-from-corporations-to-platforms/

http://www.digitaltonto.com/2015/how-power-is-shifting-from-corporations-to-platforms/




DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexityChange from the edge


http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final





Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always


Why go to the edge?

“Leading from the edge brings us into contact with a far wider range

of relationships, and in turn, this increases our potential for diversity in terms of thought, experience and

background. Diversity leads to more disruptive thinking, faster

change and better outcomesAylet Baron


Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

https://www.youtube.com/watch?v=j-S03JfgHEA


@HelenBevan @SteveFairman1 #cmidisruptFor more information/explanation visit: The Collaboration Pyramid revisited

http://www.oscarberg.net/2014/11/the-collaboration-pyramid-revisited.html



Three types of levers for large scale change

‘Prod mechanisms’ targets

performance management

price & payment incentives regulation

competition

‘Proactive support’

relies on building ‘intrinsic motivation’ in

staff to make the right changes to

improve

‘People focused’ education and training

national contractsprofessional regulation

clinical quality standards

Type one:

Type two: Type three:

Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015

http://www.health.org.uk/publications/constructive-comfort-accelerating-change-in-the-nhs/




Three types of levers for large scale change

‘Prod mechanisms’ targets

performance management

price & payment incentives regulation

competition

‘Proactive support’

relies on building ‘intrinsic motivation’ in

staff to make the right changes to

improve

‘People focused’ education and training

national contractsprofessional regulation

clinical quality standards

Type one:

Type two: Type three:

Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015

Less than 10%of the potential

for improvement

at system level can be

delivered through type one change





“In a world of mounting performance pressure, [organisations and change processes] need to evolve…the most successful will be those that

evolve into movements.

Success will be determined by their ability to mobilise, inspire and support an

ever-expanding array of participants extending far beyond their own four walls”

John Hagel, SXSW 2015http://www2.deloitte.com/us/en/pages/center-for-the-edge/articles/john-hagel-at-sxsw.html

@HelenBevan @TheEdgenhs #EdgeTalks @HelenBevan @Jodi Olden #EdgeTalks

http://www2.deloitte.com/us/en/pages/center-for-the-edge/articles/john-hagel-at-sxsw.html



The power of the platform“Facebook, YouTube, Twitter and their lesser cousins have proved the power of the platform. They have shown that if

your average 21st century citizen is given the tools to connect and the freedom to create, they will do so with

enthusiasm, and often with an originality that blindsides the so-called creative industries. …..

Good leadership is no longer about ‘taking charge’ or imposing a strategic vision but about creating the

platforms that allow others to flourish and create” Ashoka

http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in-the-21st-century






• systematic “change management”

• too often, leaders prescribe outcome and method of change in a top-down way

• change is experienced by people at the front line as “have to” (imposed) rather than “want to” (embraced)

Change Programmes

• everyone (including service users and families) can help tackle the most challenging issues

• value diversity of thought• connect people, ideas and

learning• Role of formal leaders is to

create the conditions and get out of the way

Change Platforms

“Tear down the walls”


“A space (physical or virtual) that is created so people get the choice and opportunity to collaborate without boundaries to achieve a common purpose, tackle a challenge or improve a situationChange platforms tackle silo thinking and other barriers to the exchange of knowledge. They enable a diverse group of people to come to the table, share ideas, insight and learned experience, co-create solutions and launch experiments. Platforms thrive on trust, relationships and the collisions of minds. They build energy for change.

What is a change platform?

Definition by @JodiOlden & @HelenBevan 2015


“Change comes naturally when individuals have a platform that allows them to identify shared interests and to brainstorm solutions.”

Gary Hamel & Michele Zanini, 2014Build a change platform not a change program

http://www.mckinsey.com/insights/organization/build_a_change_platform_not_a_change_program



Joy’s Law: No matter who you are, most of the smartest people work for someone else

Bill Joy, Sun Microsystems

“It’s become a kind of ‘Joy’s Law’ for the networked era—the best resources and capabilities always lie somewhere else.”

Greg Satellhttp://www.digitaltonto.com/2015/4-things-you-should-know-about-platforms/?

ct=t%28Why_Some_Movements_Succeed_5_31_2015%29

Platforms give access to resources

http://www.digitaltonto.com/2015/4-things-you-should-know-about-platforms/?ct=t(Why_Some_Movements_Succeed_5_31_2015)



Evolving kinds of change platforms:

They overlap!

1. Connecting platforms

2. Mobilising platforms

3. Learning platforms

4. Knowledge platforms

5. Crowdsourcing platforms


Platform principles have long been part of change practice

• Building on traditions in the field of organisation development of communities of interest and communities of practice

• Technology enables us to connect more widely and at greater speed

Source of image: Socialserviceinstitute.sg


Example platforms from our world

Source of image: @JenniferClemo

@HelenBevan @SteveFairman1 #cmidisrupthttp://biggerboat.org/exploring-moodocs/

MOODOCs(Massive, Online, Open, Disease Oriented Communities)

60,000 online diabetes communities and

around 80 million online patient communities

http://biggerboat.org/exploring-moodocs/

http://biggerboat.org/exploring-moodocs/


https://www.youtube.com/watch?v=CMDKkTuLUHw

http://www.breakdengue.org/






The Academy of Fabulous NHS Stuff



Horizons Team: All our work is via change platforms

Source of image: @JenniferClemo #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden

@HelenBevan @SteveFairman1 #cmidisrupt #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden


@HelenBevan @SteveFairman1 #cmidisruptSource: http://www.slideshare.net/alwynlau/learning-theories-learner-needs

http://www.slideshare.net/alwynlau/learning-theories-learner-needs

http://www.slideshare.net/alwynlau/learning-theories-learner-needs


1. Being a health and care radical: change starts with me• The differences between trouble-makers and radicals• How to rock the boat and stay in it• How to be a great change agent

2. Forming communities: building alliances for change• The power of working together by exploring communities and social movements• Techniques for connecting with own/others’ values and emotions to create a call

for action

3. Rolling with resistance• Recognising behaviour, behaviour change and the importance of appreciating

where people are starting from in relation to change

4. Making change happen• A range of tools, tactics and ways to make change happen

5. Moving beyond the edge• Helping radicals to shape how they take their learning from The School forward• What we can do next and where else we might get support and resources


The School is being formally evaluated by the Chartered Institute for Personnel & Development

#EdgeTalks WebEx

http://theedge.nhsiq.nhs.uk/expert/how-has-the-school-for-health-and-care-radicals-made-a-difference/

Or Google: #EdgeTalks School

How has the School for Health and Care Radicals made a difference?







The School is being formally evaluated by the Chartered Institute for Personnel & Development

• Change knowledge• Sense of purpose & motivation to improve practice• Ability to challenge the status quo• Rocking the boat & staying in it• Connecting with others to build support for change

Statistically significant positive effect on EVERY dimension of impact at both individual

and organisational level



Activists from 120 countries

500,000+ Twitter impressions@theedgenhs

21,000 active users


We have supported NHS Change Day for three years

• 800,000 pledges in 2014

• 6X the local activity/connectivity in 2015 compared to 2014

• #nhschangeday: 130m impressions

• Facebook impressions 253,999


The Change Challenge

Tapping the collective brilliance of the NHS


• The biggest-ever digital campaign for EMAP (Health Service Journal and Nursing Times)

• 14,000 contributors to the joint campaign to “challenge top down change”

• Ground-breaking: the first-ever crowd-sourced theory of change in the NHS


Reach and scale:

• Contributors from 45 different countries

• 13,895 ideas, comments and votes shared - collectively identifying:

Final outputs were • 10 barriers• 11 building blocks• 16 solutions


14,000 contributions identified 10 barriers to change:

Confusing strategies

Over controlling leadership

Perverse incentivesStifling innovation

Poor workforce planning

One way communication

Inhibiting environment

Undervaluing staff

Poor project management

Playing it safe


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

Increasing number of messages as information cascade through

the organisation

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

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



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

Increasing number of messages as information cascade through

the organisation

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

Buy in from front line staff is critical for improvements in quality and safety . Don’t overload them

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

Don’t overload themhttp

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

/



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





14,000 contributions identified 11 building blocks for change:

Inspiring & supportive leadershipCollaborative working

Thought diversityAutonomy & trust

Smart use of resources

Flexibility & adaptability

Long term thinking

Nurturing our people

Fostering an open culture

A call to action

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

Challenging the status quo

http://www.hsj.co.uk/leadership/change-challenge/


The power of the platform

“...demonstrates, yet again, the collective brilliance of the people who work in the NHS and wider care system”

@HelenBevan


How to create a change platform #1• Be clear about your intention or goal:• Solve a problem?• Learn from others?• Create solutions?• Mobilise for change?• Spread innovation?

• Articulate your mission• Design the stages in your process• Sprints and hacks


How to create a change platform #2• Identify the people you want in your community• Identify how to reach them• Find a platform • Existing or new • Free or paid for• Virtual or face to face

• Measure the outcomes (all the way through)• Engage your community• Set their expectations• Keep the connections flowing• Convert ideas to actions• Always, always follow up


CAREDESIGN2016System redesign principles for care models

#CareDesign

“Help us to capture redesign principles for care models to get better, quicker outcomes from

change”


New care models

• Viable smaller hospitals• Maternity services• Health of people in care

homes

• Multispecialty Community Provider

• Primary and Acute Care Systems

• Urgent and emergency care


What are design principles?

“Design principles are suggestions that are highly likely to be effective, but they are not formulae that guarantee success … The point remains, however, that if one knows the design principles in a field, he or she is much further along in thinking and much more likely to be successful.”

Paul Bates



Our ‘starter-for-ten’



”If people give to a cause, they expect a relationship, not a transaction”

Nilofer Merchant

Once you start down this path, you have to follow up and continue


Platforms are only as good as the people leading them

Source of image: www.activationjourney.com

http://www.activationjourney.com/


Four ways to connect!

1. Follow us on Twitter@HelenBevan @SteveFairman1 @School4Radicals

2. Subscribe to theedge.nhsiq.nhs.uk

3. Get materials from theedge.nhsiq.nhs.uk/school

…and sign up for our monthly #EdgeTalkstheedge.nhsiq.nhs.uk/edgetalks

4. Save the date for theedge.nhsiq.nhs.uk/transformathon

http://theedge.nhsiq.nhs.uk/

http://www.theedge.nhsiq.nhs.uk/school

http://theedge.nhsiq.nhs.uk/edgetalks/

http://theedge.nhsiq.nhs.uk/transformathon/

http://www.theedge.nhsiq.nhs.uk/school


4pm - 4pm, 27-28th January 2016


“Even the smallest creature can

change the world”Galadriel to FrodoLord of the Rings


Ashoka (2014) What does leadership mean in the 21st century?Berg O (2014) The Collaboration Pyramid revisitedBriggs D (2015) The elements of council as a platformBromford P (2015) What’s the difference between a test and a pilot?Dawson R (2015) The future of work and organisations Deloitte University Press (2015) Business ecosystems come of ageDeloitte University Press (2014) The power of platformsHagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movementsHagel J (2014) Platforms are not created equal: harnessing the full potential of platformsHamel G, Zanini J (2014) Build a change platform not a change programHealth Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’ interactive toolkitHeimans J (2014) What new power looks like [YouTube]Heimens J, Timms J (2014) Understanding “New Power”Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers Ivanov E (2013) The Strength Within

References cited in the slide deck (1/2)







http://davebriggs.io/2015/06/18/the-elements-of-council-as-a-platform/

http://www.bromfordlab.com/labblog/2015/7/22/tests-vs-pilots?utm_content=bufferc862c&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

http://www.bromfordlab.com/labblog/2015/7/22/tests-vs-pilots?utm_content=bufferc862c&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

http://t.co/qPjnafNOs9

http://d2mtr37y39tpbu.cloudfront.net/wp-content/uploads/2015/04/DUP_1048-Business-ecosystems-come-of-age_MASTER_FINAL.pdf

http://dupress.com/articles/platform-strategy-new-level-business-trends/


http://edgeperspectives.typepad.com/edge_perspectives/2014/08/platforms-are-not-created-equal-harnessing-the-full-potential-of-platforms.html


http://m.hsj.co.uk/5083743.article


https://hbr.org/2014/12/understanding-new-power?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet

http://www.insme.org/files/open-innovation-handbook

http://connect.forwardmetrics.com/business-management/the-strength-within.html


Jarche H (2014) The Seek > Sense > Share Framework Milton N (2014) Why knowledge transfer through discussion is 14 times more effective than writingO’Reilly T (2010) Government as a platformPearce D (2013) Social business discussions are the new documentationRaymond E S (2001) The Cathedral and the BazaarSatell G (2015) 4 things you should know about platformsSatell G (2012) How power is shifting from corporations to platformsSatell G (2015) Leaders must do more than inspire – we must shape networksSchillinger C (2015) Forget social networks, think social impact [YouTube]Scrivens J (2015) Enabling the experience of wholeness within enterprise social networksSewell S (2015) Stop training our project managers to be process junkiesShaw K (2015) Placing a digital platform at the heart of organisational change with OxfamSimon P (2011) The Age of the Platform

References cited in the slide deck (2/2)

http://jarche.com/2014/02/the-seek-sense-share-framework/

http://www.nickmilton.com/2014/10/why-knowledge-transfer-through.html

http://chimera.labs.oreilly.com/books/1234000000774/ch02.html#government_as_a_platform

http://www.informationweek.com/software/social/social-business-discussions-are-the-new-documentation/d/d-id/898942





http://www.digitaltonto.com/2015/leaders-must-do-more-than-inspire-we-must-shape-networks/?utm_source=Digital%20Tonto%20Newsletter&utm_campaign=5accd611d0-Leaders_Must_Shape_Networks7_5_2015&utm_medium=email&utm_term=0_3e316dce02-5accd611d0-389205725&ct=t(Leaders_Must_Shape_Networks7_5_2015)


http://www.kinshipenterprise.com/_blog/Blog/post/Experience-Wholeness-Enterprise-Social-Networks-esn/#.VZP7VBtVikr

http://acceleratingchangeprogrammes.com/2015/06/09/stop-training-our-project-managers-to-be-process-junkies/

http://www.codecomputerlove.com/blog/2015/07/placing-a-digital-platform-at-the-heart-of-organisational-change-with-oxfam/

http://www.philsimon.com/books/the-age-of-the-platform/

http://www.philsimon.com/books/the-age-of-the-platform/

Healthcare

Change in the Age of Disruption: Emergent change