It’s time to rewrite the rules of change in healthcare

Source of image: www.ohiolibertycoalition.org

Based on the talk that Helen Bevan

gave at Yale New Haven Hospital

Grand Rounds10th June 2014

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“New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)

Source of image: installation by the artist Adam Katzwww.thisiscolossal.com

Via @NeilPerkin

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Our new White Paper

• Examines leading trends in change and transformation globally

• How to make change happen at a faster rate and be more disruptive

• Join the new breed of healthcare leaders across the world, rewriting the rules of change and leading change from the future for different results

Release date: 4th July 2014www.nhsiq.nhs.uk/whitepaper

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SEISMIC SHIFTS

Causing us to rethink the very nature of change and how to

enable it in the future

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SEISMIC SHIFTS

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DIGITALCONNECTION

SEISMIC SHIFTS

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Facebook didn’t exist, Twitter was still a sound, the cloud was still in the sky, 4G was a parking place, LinkedIn was a prison, applications were what you sent to college,Skype was a typo

Thomas Friedman, World Economic Forum, Quoted by http://ayeletbaron.com

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….creates additional challenges

Source of quote: Harold JarcheSource of image: http://gotcll.com/about-2/

Gettinginformation off the

internet is like taking a drink from

a fire hydrantMitchell Kapor

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Work complexity

SEISMIC SHIFTS

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DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity

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DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity

Change from the edge

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Whilst back in the world of health and care...Many of the ways we go about improving health and care were designed in a different mindset for a different set of

circumstancesWe are operating with

20th century change practice in a 21st century

worldSource of image:Bain top ten management toolshttp://www.bain.com/management_tools/BainTopTenTools/default.asp

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Some warnings‘‘The organizations that survive the future will be those that are capable of changing as fast as change itself

Gary Hamel’’

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Leading change in a new era

Dominant approach Emerging direction

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‘If people give to a cause, they expect a relationship, not a transaction.’

Nilofer Merchant

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“A cynic, after all, is a passionate person who does not want to be disappointed again.”

Zander R and Zander B (2000) The art of possibility. Harvard Business School Press. As quoted by Steve Onyett

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John Kotter, the most influential thought leader globally, recognises new approaches are needed

FROM

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John Kotter: “Accelerate!”

• We won’t create big change through hierarchy on its own

• We need hierarchy AND network• Many change agents, not just a

few, with many acts of leadership• At least 50% buy-in required• Changing our mindset

• From “have to” to “want to”

TO

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From “have to” to “want to”

Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community

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Unleashing the spirit of the volunteer

You may be able to ‘buy’ a person’s back with a paycheck, position, power or fear but a human being’s genius, loyalty and tenacious creativity are volunteered only.

The world’s greatest problems will be solved by passionate, unleashed ‘volunteers’

Stephen Covey, Turn the ship around, via @MarkGraban

Source of image: www.volunteerweekly.org

‘‘

’’

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The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy

2. If you want to create small scale change, work through a cohesive network

If you want to create big change, create bridge networks between disconnected groups

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5 ways to lead from the edge - and thrive

1. Embrace disruption 2. Curate knowledge3. Build bridges to

connect the disconnected

4. Roll with resistance5. It starts with me

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is the new normal!

“By questioning existing ideas, by opening new fields for action, change agents actually help

organisations survive and adapt to the 21st Century.”

Céline Schillinger

Image by neilperkin.typepad.com

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@corprebelscorporaterebelsunited.com

Across the world, the change agent movement Is exploding!

@rebelsatworkrebelsatwork.com

@chagwwchangeagentsworldwide.com

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What happens to heretics/radicals/rebels/mavericks

in organisations?

Source of image: findingmyself.net

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The 90/30 conundrum

of senior leaders say that to create more

innovation, they need to activate the radicals/

disruptive innovators in their organisations or

systems

of senior leaders are very satisfied that

radicals/innovators can provide this value in their organisations

or systems

Source: rebelsatwork.com

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We need boatrockers!

• Rock the boat but manage to stay in it

• Walk the fine line between difference and fit, inside and outside

• Able to challenge the status quo when we see that there could be a better way

• Conform AND rebel• Capable of working with others

to create success NOT a destructive troublemaker Source: Debra Meyerson

@HelenBevan Source : Lois Kelly www.rebelsatwork.com

There’s a big difference between a rebel and a troublemaker

Rebel

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Reflection• What are your insights around “rebels” and

“troublemakers”?• What moves people from being “rebel” to

“troublemaker”?• How do we protect against this?

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Probably the largest simultaneous improvement initiative in the history of healthcare

A disruptive case study

@HelenBevan #Quality2014 #f1

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NHS Change Day

Aim:to create a mass movement of grass roots NHS staff and people who work with and use the NHS to pledge a simple act that can contribute to better patient care

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NHS Change Day 2014More than 700,000 pledges to take action • 81 separate Campaigns• 86 million twitter

impressions• 35,400 video views • 95,000 daily reach on

Facebook• More than 98% of the

activity through volunteers

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It started with a tweet in June 2012!

Young clinical leaders and improvement

leaders decided to start a social movement to

improve care

Damian RolandStuart Sutton Helen Bevan

@HelenBevan #Quality2014 #f1

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Probably the only winner of a global

challenge to develop leaders in the

corporate world that names Saul Alinsky

and Marshall Ganz as major influencers

@HelenBevan #Quality2014 #f1

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Evaluating NHS Change Day

• We’re evaluating intention (pledging), initiation (doing) and outcomes (delivering)

• We’re having a celebration day on 4th July

• We’re developing and testing new methods to show impact

• We want to build new theory of large scale change

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Change Day is spreading…….

AustraliaSwedenN IrelandDenmarkCanadaNetherlandsSaudi ArabiaUSAFinland…….and many more

@HelenBevan #Quality2014 #f1

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Peter Fuda’s Transformational Change Agent framework

Skills and methods for creating change

Ability to make sense of, and reshape perceptions of ‘reality’

Personal characteristics and qualities

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Peter Fuda’s Transformational Change Agent framework: my perspective

“Doing”•Where most change agents in health and care put most of their effort and emphasis•What others typically judge us on•What we often perceive we need to do to add value•What most change and improvement courses focus on

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Peter Fuda’s Transformational Change Agent framework: my perspective

“Seeing ” and “Being”•We can only do effective “doing” if we build on strong foundations of “seeing and being”•Change begins with me•Hopeful futures, creative opportunities and potential•Multiple lenses for change •See myself in the context of my higher purpose

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Source: @NHSChangeDay

Can I, dare I?

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• A virtual school• Anyone can join• All the resources are

completely open• Five weeks of virtual

lectures, study guides, materials, tweetchats

• Demonstrate learning to earn a virtual badge

The School for Health and Care Radicals

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The School for Health and Care Radicals

More than 1,600 enrollees from 40 countries 90 volunteer mentorsAverage weekly twitter reach 2.6 millionOver 25,000 shares of the slides on SlideShareMore than 10,000 shares of the study guides More than 10,000 tweets using #SCHRchatStorify has been viewed 2,000 times150 people have completed full certification so far

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We learnt...

1. The core audience is different to that which we anticipated

2. The most important need is for connection and community

3. How to build the relationship between tacit and explicit knowledge

4. There is a massive untapped reservoir of energy and talent out there and the potential is outstanding

www.changeday.nhs.uk/healthcareradicals

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Leading change from the edges

Go out to your edges.Explore the possibilities.Because you will find more opportunity in the edges, where you will be able to imagine, invent and thriveAyelet Baron

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• Identify your own opportunities to move to the edge

• Think about the mindset, skills and relationships you need for the future

• Consider how you are going to enable change at a faster rate than the outside world

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ReferencesBaron A (2014) Preparing for a changing world: the power of relationships Bate P, Robert G, Bevan H. The next phase of healthcare improvement: what can we learn from social movements? Quality and Safety in Health Care. 2004 Feb;13(1):62-6. Battilano J, Casciaro T (2013) The network secrets of the great change agents Harvard Business Review, July-August Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Change Agents Worldwide (2013) Moving forward with social collaboration SlideShareDiaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontierFuda P (2012) 15 qualities of a transformational change agentHamel G (2014)Why bureaucracy must dieJarche, H (2013) Rebels on the edgesJarche H (2014) Moving to the edges

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ReferencesKotter J (2014) Accelerate! Harvard Business Review Press

Merchant N (2013) eleven rules for creating value in the social era

Llopis G (2014) Every leader must be a change agent or face extinction

Meyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard

Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BP

Perkins N (2014) Bats and pizzas (agility and organisational change)

Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated Shinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadershipWilliams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activismVerjans S (2013) How social media changes the way we work together