The document discusses a hothouse event held by NHS IQ and NHS Confederation to stimulate conversation around thought diversity and its potential to improve health care delivery and change processes. It provides an agenda and summaries of discussions from a roundtable with health leaders who shared experiences and beliefs around thought diversity. Participants identified actions like promoting grassroots movements, cross-sector working, and more inclusion of diverse voices to further thought diversity in the NHS.

1. thoughtdiversity@nhsiq.nhs.uk
#thoughtdiversity
THOUGHT DIVERSITY – HOTHOUSE WRITE-UP
14th JANUARY 2015

2. Purpose of this slide pack
The purpose of this slide pack is to share a record of the hothouse
event.
NHS IQ and NHS Confed are collaborating to create a platform for
sharing ideas, thinking and practice on how diversity of thought
can make real benefit for people, and service improvement; how
this can translate into practical support for leaders, as part of the
change process and better decision making for patients.
2

3. 3
Diversity of thought is critical to both service improvement and innovation. The power of diversity guards against group
think, promotes innovation and helps organisation understand how people think and be their authentic selves. When
valued, thought diversity demonstrates real benefits for people. There is a lot of evidence for it but its not always
embraced.
NHS IQ and NHS Confed are working together to support leaders to elevate the principles and practical approaches to
diversity of thought to a new level, using the evidence and benefits seen from other industries. We are at the beginning of
this journey and this is not a national programme to be rolled out. We all have the potential to promote, manage and
recruit for diversity and create new conversations for change locally. Both NHS IQ and NHS Confed see this as part of their
commitment to valuing diversity and learning from others about different approaches to inform the way we support the
next five years. The platforms for sharing so far have been:
1. THOUGHT DIVERSITY WEBINAR: 3 December 2014, open to anyone in the world. The purpose was to bring people
together to begin the conversation about what thought diversity means for all of us. The three big words that kept
emerging were – authenticity, power and honesty. The slides from the webinar can be found here:
http://www.slideshare.net/NHSIQ/thought-diversity-webinar
2. THOUGHT DIVERSITY HOTHOUSE: with the aim of getting a diverse group of people, places were limited to eight people
from each group: patient leaders, external to the NHS, frontline staff, OD and leadership community, system leaders,
innovation.
3. CASE STUDIES: We are currently looking for examples from inside and outside of the NHS who are using these principles
4. TALKING HEADS VIDEO: A talking heads video will available from the hothouse event
5. PRACTICAL SUPPORT: We will continue to create platforms and collaborate in different ways with a wide range of
people who want to work together to improve care, looking out and not up.
If you want to get involved please contact: thoughtdiversity@nhsiq.nhs.uk
Background

4. 4
THE THOUGHT DIVERSITY HOTHOUSE:
14 January 2015
Coin Street Neighbourhood Centre, London

5. Purpose of the hothouse event
The purpose of the hothouse
event was to stimulate a
conversation, which develops
our collective thinking and
action on ‘thought diversity’:
its potential contribution to
how change happens in health
and care, and the delivery of
new models of care over the
next five years.
5

6. Agenda
6
Scroll down to
the brown
slides to see
the outputs
from the day
Scroll down to the
pink slides to see
the conversation
with Simon
Stevens

7. Early tweets
7
Tweeters on the day:

8. Twitter activity
8
The numbers:

9. What does thought diversity mean
to us?
9
The event opened with a film of quotes taken from the
international ‘Thought Diversity Webinar’ which took place on the
3rd December 2014.
http://youtu.be/8taWGfkVvTg
“Thought diversity gives us the opportunity to bring
different voices in and really honour and respect people
who think in different ways.”

10. 10
WELCOME AND INTRODUCTIONS:
Overview of the day

11. Jackie Lynton opens the day
11
“We are asking you to do 3 things:
1. There will be some
uncomfortable issues, but we
are asking you to lean into
your discomfort
2. Realise the benefits and value
of TD for patient outcomes,
and take responsibility
3. Act on it and do something
about it when you leave here”
“This in not a national
programme, we will take away
what we own and we ask you
to do the same.”
“This is my lived experience and I am here because I want to be able to walk into a
conference or a place of work and not be looking across the room for difference.”

12. Sophia Christie - Facilitator
12
“Today is about having different
conversations and hearing that diversity of
voice.”
“We want you to take equal responsibility
for making it work, capturing it, producing
material that we can go away with.”
“We need to be sensitive about how we
capture what is said today, so that we can
all feel that can say what needs to be said”
“Today we want to achieve clear common ground on what thought
diversity is. We want to go away with some first thoughts on principles
for how it might work in the health and care and how we might
practice it as of tomorrow.”

13. Eden Charles - Facilitator
13
“Change happens all around us – but
often what doesn’t change, is the
culture of the organisation.”
“You need to change the conversations
people have with each other. This is a
day about having different
conversations with each other.”
“We want you to step into the
ZOUD – the Zone Of
Uncomfortable Debate”
“Let’s notice the differences and
the similarities today.”

14. 14
What does thought diversity mean and in what context?
How do people model “lean into discomfort”, “curiosity about
other perspectives”, and “safe challenge”?
On Twitter, this was being dubbed “the yellow chair conversation.”
SIMON STEVENS IN CONVERSATION:

15. Purpose of the roundtable
conversation
Jackie outlined the purpose of the conversation:
• To model the type of conversations and safe challenge individuals
and organisations need to make to take diversity of thought to
another level
• To lean into our own discomfort about this to help create an
environment where others can do the same throughout the day
15

16. Dr Jagtar Singh
Trust Chair,
Coventry and Warwickshire
Partnership NHS Trust
Simon Stevens CEO,
NHS England
Jackie Lynton (Facilitator)
Head of Transformation,
NHSIQ
Céline Shillinger
Head of Quality Innovation
and Engagement, Sanofi
Pasteur, France
Melanie Walker
CEO, Devon Partnership NHS
Foundation Trust
Denise Milani
Director of Business change
and Diversity, Metropolitan
Police
Dr Minesh Khashu
Neonatologist Consultant, Poole
Hospital NHS Foundation Trust
Paula Moulton
Patient Leader
Helen Bevan
Chief of Service
Transformation, NHSIQ
16
Conversation
participants

17. Melanie Walker says…
17
“I want to go back to my day
job and understand what I
need to do to support
people in my organisation to
face its challenges.”
“I question whether
the system is ready for
us to do something
different.”

18. Jagtar Singh says…
18
“I’ve been on the journey of
achieving equality for 45
years.”
“I want to make a difference
– I want my organisation to
value diversity of thought.”
“There is so much good
examples of what is going
on in the NHS but we don’t
seem to bring it together for
the NHS.”

19. Paula Moulton says…
19
“I find it really frustrating that
change in the NHS is so often
disastrous – that they don’t talk to
the people that matter – that
change is made by such a small
group.”
“I am lucky – in my area, we
make decisions about how
services are run.”
“We need to listen to each other
and stop being uncomfortable
about throwing discourse into
the middle and challenging
things – Why can’t we challenge
this head on?”
“We need to learn to
simplify.”

20. Helen Bevan says…
20
“We’ve got to get more voices in – in
the change conversation. When you
bring together diverse groups of
people, they consistently make better
decisions than a narrow group.”
“We need an NHS that regards
diversity and dissent.”
“Far too many decisions in the
NHS get made by very few
people in the NHS who work at
the top – they gauge what we
need to do next. Through that
experience, we keep doing the
same thing and the storyline
never changes.”

21. Simon Stevens says…
Simon Stevens spoke passionately
about the "ease at which we tend
to talk past each other" and "zone
out" when diversity is discussed;
and called system leaders to
consider how to change minds by
moving beyond binary thinking
processes, to embrace new
possibilities and ideas on how to
do things now that we should do in
the future. He said we – the NHS –
need ambition, energy and urgency
to bring about the change the
service needs.
“A conversation about power is
what thought diversity is
about.”
21

22. Minesh Khashu says…
“I am my thoughts and those
are shaped by where I come
from.”
“This is not about sprinkling star
dust everywhere, we need to take
the fertiliser out there – we have to
allow those seeds of thought
diversity out there to take seed and
flower.”
22
“This is about the moral and
motivation of the staff.”
“It’s out there but we are not
listening to it”

23. Céline Shillinger says…
“I am very, very grateful that an
organisation like the NHS is
leading on this topic”
“19 people died last week in my
country, because some people hate
thought diversity because it’s painful –
it’s difficult – it challenges our
education and everything you believe
in”
23
“How can we help these people
– refrain them from being
brainwashed?”
“Keep going, its fantastic”

24. Feedback from the floor…
24
“Fear – the frontline have a lot of fear of being different – being different leads to
disaster – leads to punishment and disaster – unless we say its ok to be yourself,
we will never go forwards. For years I have been trying not to be myself – I, at last
managed to succeed by being myself.”
“Thought diversity isn’t welcomed
in the NHS. You are always seen
as a troublemaker.”
“I believe that all patients should
have easy access to their notes –
but it appears that almost
nobody around me believes that
it is important.”

25. What beliefs have changed for you?
25
What is something that you fundamentally believe
that other people don’t? What did you believe in that
you don’t anymore?”
Simon
“I used to believe in the
strategy and the
hierarchy…Now, I believe in
grass roots movements.”
Céline
“I used to believe that people
more senior to me in the NHS
had all the answers and now I
don’t.”
Melanie
“I believe that the magic of
change happens when we get
diverse groups together.”
Helen
“I used to believe that it
wasn’t ok to challenge
management, doctors, now I
challenge them at every turn”
Paula

26. Our future hinges on…
26
Simon Steven’s call to action
“A shared sense of ambition – that
better is doable - (we grind it out
of people!)
We’ve got to get back a sense of
the energy that will allow that to
occur.
Urgency – part of what we’ve got
to do is see ourselves as other see
us and be fiercely critical of what
we see in the service. It is morally
unacceptable that we provide
services that end up with people
on the other end getting a raw
deal.”

27. Jackie Lynton highlights words that
summarise the discussion
27
“Power” “Creativity”
“Dissent”“Authentic self”
“Fear”
“Risk”

28. Round table summary thoughts
28
“Create space in which people are encouraged to be themselves even when it means being
different.”
“Capture what already works and use it.”
“We all have other lives but we may not see them.”
“We all have other lives but we may not see them.”
“Needs to include POWER as a theme.”
“Begin to think about being part of a social movement.”
“Biggest deficit is motivation of the staff.”
“Thought diversity is there – How do we mature to action?”
“Thought diversity as a matter of life and death.”
“Charlie Hebdo and Stephen Lawrence experiences – What is the impact in
organisations?”
“Be honest about what lies beneath our euphemisms.”
“People to be encouraged to put things out there for challenge or discussion.”

29. 29
MAKING CONNECTIONS:
Learning from each other and developing an
understanding of what is already happening

30. Connecting with each other
30
“We need to connect with
people who don’t know
anything about [thought
diversity] in the NHS.”
“Subvert this process that
separates people from
outcomes.”
“Thought diversity for a
purpose – get people to
engage with the purpose.”
“There are troublemakers
around the table – they
were right all along!”
“What is the common purpose – how do we
connect it in? How do we use it to address
the next five years of challenge that faces the
NHS?”
“Tension and
disagreement is at the
heart of this.”
“This is about disagreeing
to get to a shared goal.”

31. Using the NHS Change Model
31
Each table was given one component of the NHS
Change Model to discuss what they know is
happening on thought diversity for that theme.
3 lists were produced:
1. So what should you KEEP doing/ensure is
maintained during further structural or
leadership change?
2. So what do you need to jump START, do more
of, accelerate?
3. So what is here which doesn’t seem to be
working / worthwhile, that we should STOP or
move on from?
The group then picked one priority to feedback.
Source: http://www.changemodel.nhs.uk/pg/dashboard
The NHS Change Model was introduced over 3 years ago and is used widely. It is a distillation of over
15 years of evidence that factors the different components needed to take account of in change.

32. Our shared purpose
32
What should we stop or start doing?
“Keep patient stories because they help galvanise
energy – people can visualise it and understand it”
“Accelerate co-creation by using crowdsourcing
platforms”
“We will stop thinking that clever straplines are the
answer (spending money on comms!)”

33. Transparent measurement
33
What should we stop or start doing?
“Use narrative to add more colour to how to show
performance.”
“Start using measures that the community will
follow (e.g. stop using inner city measures for rural
contexts).”
“Stop making meaningless comparisons between
metrics that disengage and de-motivate.”
“Focus on how thought diversity improves
outcomes.”
“Stop having conversations in hidden rooms and
have them more publicly.”

34. Leadership for change
34
What should we stop or start doing?
“Start being authentic.”
“Keep our core values.”
“Start framing the question to its appropriate
audience.”
“Stop trying to silence people.”

35. Spread of innovation
35
What should we stop or start doing?
“Start hanging out and getting to know places street
by street (good care needs to be discovered)”
“Start more empowerment projects – e.g. the School
for Health and Care Radicals”

36. System drivers
36
What should we stop or start doing?
“Stop having indicators for illness.”
“Start having indicators for wellness.”
“Start using the friends and family test but it doesn’t
allow the voice to come through – ask the question:
what are the diverse voices out there?”
“Start doing diversity impact assessment for
everything.”

37. Improvement methodology
37
What should we stop or start doing?
“Start getting more service user involvement”
“It’s got to be more authentic. The unsexy end of
healthcare – what matters to people – not what is
easy and topical to measure right now”
“Often it is a homogenous group who decide who to
bring into the room and then don’t know what to do
with the people once they have brought them into
the room!”

38. Engagement to mobilise
38
What should we stop or start doing?
“Listen to difficult or challenging patients and service
users.”
“Creative ways of thinking; engaging all in different
type of conversation. Reporting what matters to
everyone.”
“Including more voices, asking more questions,
challenging more – encouraging others to be
challenging.”
“Stop falling into “usual” ways of working; worrying
about outputs.”
“Stop top-down hierarchy.”
“Stop doing what we always did or we will get what
we always got.”

39. Rigorous delivery
39
What should we stop or start doing?
“We should start promoting more grass roots
movements using compelling narratives
ensure positive role models actively engage with
communities”
“Keep the focus on tackling health inequalities.”
“Stop working in silos to promote cross sector
working.”
“Stop using complex meaningless language to
describe things.”

40. Future visions
40
“What would things be like if they were fantastic?
Teams were given time to come up with creative way to present their vision
of how organisations would look if thought diversity was present in 2020.

41. Future visions – Team 1
41
(MUSIC IN THE BACKGROUND)
T
H
“Time for change”
“Healthcare through my smartphone”
“Organisations without walls”
O
U
G
H
T
“Uniformity of care - not a postcode lottery”
“Go from a National Health Service to a personal
health service”
“Healthcare records on the cloud”
“Treatment that would make you proud”

42. Future visions – Team 1
42
“Together we can make this
change”
D
I
V
“Delivering care that's personal”
“Yesterday is history”
E
R
S
I
T
Y
“I decide what's best for me”
“Valuing everyone as an individual”
“Energised, engaged, enthusiastic”
“Responsibility share between
patients and professionals”
“Systems that react and respond
rather than restrict and reject”
“Individualised care for all”

43. Future visions – Team 2
43
CLOSE YOUR EYES –
Visualise what will you see in the
future…
• “True co-production“
• “Different kinds of targets (involving people in
decisions about their own healthcare)”
• “Hear the voice about anybody and
everybody”
• “Hear the dialogue between carers and
patients”
• “Feel included – safe that you can say things
and do things differently
• “Liberated, feel you have been heard”
• “It won’t matter what political party is in place
• “People are excited and properly
remunerated”
• “Feel comfortable with the discomfort”

44. Future visions – Team 3
44
WHAT WILL IT LOOK LIKE AND FEEL LIKE IN THE FUTURE?
See
• Differences/local variability,
e.g. NHS logos
• Not looking the same
• People have bespoke solutions
• True co-production
• Different type of target, e.g.,
something about listening
Feel
• Inclusive/included
• People feel safe to do things
differently
• We don’t feel free – liberated
• People feel they have been heard
• Doesn’t matter which political
party is in place
• Excited
• Properly re-numerated
• Grace
• Humility
• Comfortable with discomfort –
folks equipped
Hear
• Voices of everybody and
anybody and those currently
not heard
• Dialogue between carers and
patients
• ‘Do you hear the people sing?’
Do
• Local offer is evidence based
• What patient wants and needs,
done right in the right safe
environment

45. Future visions – Team 3
45
A statement about joining up in a world embracing thought diversity

46. Future visions – Team 4
46
Emphasis on different skills for board members
Instead of a CEO we’ll have an Idea
Generator
Instead of a HR Director, we’ll have
a talent nurturer
We will also have:
• Chief bureaucracy buster
• People builders
• Care improvement agent
• Entrepreneur in residence
• Chief whistle-blower
• Director of marketing sales and
happiness
This is what the new board
will look like in the NHS…

47. Future visions – Team 5
47
SAVI group do a rap!
I am Significant!
I am Appreciated!
I am Valued!
I am Included

48. Future visions – Team 6
48
A Poem about the future
We want to think but don’t succeed
There is always a patient target to feed
Simon says we need to be diverse
But is what Simon says a bit perverse?
Simon says but what does he do
Where is monitor, CQC or WHO
Ruffling feathers should be the norm
But for the naysayers create a storm
We need the space and encouragement to think
With time we’ll be less stressed or on the brink
Remove the hierarchies, mobilise the staff
Give them autonomy and creativity that they have
Unions Policies all need to change
To support creativity, give diversity its range
Now Simon says become diverse in thought
Let’s all lead by example like it ought

49. Future visions – Team 7
49
THOUGHT DIVERSITY MEANS MOVING FROM ‘I’ TO ‘WE’
WHEN WE ARE WORKING AS WE…. Illness becomes Wellness!
Diversity dogs come to the rescue!

50. Future visions – Team 8
50
What I will see in 2020…
“...There won't be a National Health
Service, there will be a National Health
System - a mixed economy to support
health...”
“...People in the wider community - not
necessarily in the room, contributing to the
conversation about what they need to live
healthier lives and how they can be
delivered...”
“...I will be working for the National 'Life'
Service and I will be depending on the
sharing economy both in my personal life
and my work....whatever the diversity of my
needs are, I can reach out to society...and I
will be mobile in my job...”
“Local people electing exec and non-exec board
members.”
“We won’t work in silos”
“Depoliticised NHS”

51. 51
JUST BEFORE LUNCH:
How are people in the room feeling?
…. A view from Chris Lawrence - Pietroni
“It’s quite crunchy on my table –
but in a good way….
…..This is the most diverse
group I think I have ever been
in, in the whole of my
professional life”

52. 52
DEVELOPING OUR PRINCIPLES AND APPROACH:
Identifying actions and next steps

53. Themes and actions
53
This session focussed on defining our principles to underpin approaches
Participants begun to identify activities and initiatives which thought
diversity should include and unleash.
Eight key themes were identified.

54. Theme 1 - Creativity
54
“Creativity is about co-creation.”
“We have noticed a lot of management speak -
but for the frontline, the question is, will the 5-
year view be meaningful?”
“Make space to reimagine and co-create with
diversity of thought.”

55. Theme 2 – Reverse mentoring
55
“Reverse mentoring is where a junior
person mentors a senior person in
the organisation.”
“This can create a lot of thought
diversity.”
“Birmingham Children’s Hospital
replicated the idea of matching
people in different professions.”
“Reverse mentoring for disruption
not replicating the status quo.”

56. Theme 3 – Inclusivity
56
“To be diverse you need more than one person – not different just colours of
skin”
“Don’t want to treat people differently….Look at whose being excluded”
“Five things that need to be done (by the way, these are all evidence based!” –
(Jim Easton)
• Board-level commitment
• Role models
• Resources to be allocated
• Consistent message
• A link to patient outcomes

57. Theme 4 – Organisations without walls
57
• Beyond the NHS
• Creating a new type of environment that
is going to thrive
• A strategy that’s broader than the NHS
• We need to create spaces for this really
complex debate because its really
contentious
• We need time for it
• There are rich conversations to be had
about better healthcare if we take it to
the front-line
• People can’t get in to help us co-create if
we ring-fence funding for the NHS
• What right to we have to be working
outside of the business, if we can’t get
our core business right?
“I believe this needs to become a
public sector call to this debate -
not just NHS”

58. Theme 5 – Being subversive/risk taking
58
• Being subversive and risk-taking – changing our
values
• Started with a thought that we could encourage
responsible risk taking
• Changing things and improving things should be
part of everybody’s job as standard
• People don’t necessarily have the tools or
understanding to do that
• The School for Health and Care Radicals (SHCR)
gives people permission
• Where there isn’t that culture – the SHCR creates
the network of support that allows people to start
doing things
• This will help us to drive out fear
• An idea should be rewarded whether or not that
idea works

59. Theme 6 – What will we do differently
tomorrow?
59
• Have thought diversity (TD) conversations in team and
groups
• Move from pre-contemplative to contemplative
(moving to action)
• Inability to work but ability to care (carer perspective)
• We don’t need to have permission to have these
conversations
• No agenda, but we were hanging out and let the
conversations evolve
• Involving parents
• Listen with intent
• Borderless organisations
• Create space for things to happen
• Curation

60. Theme 7 – Innovations in the 5 year
forward view and how this applies
60
One thing to share: Using the
compass to drive through the change

61. Theme 8 – Macro-environments for
health and wellbeing
61
What is it going to take?
• Multi Specialty Community Providers
• +/- 5 year settlement
• Political air cover from all system leaders
• ‘Innovation kitchen’/combinable innovation
• All about HOW this happens, this is where TD will add enormous value
• TD will help us to think and act differently
• Selection of areas and leaders to hothouse, crucial TD to inform selection
• Principles of TD key to selection of sites/systems – must reflect key principles
• We can identify some systems already working to their principles, in the public domain,
we need to highlight these
• ‘Thoughtful’ support to systems to think and act differently – need to have some new
and different design principles
• Need to create space in the system/communities to think and act differently – need to
be clear about what we will stop to make space for; i.e. Stop CQC visits for 2 years
• Ask the system what would make a difference to them to make space – what do they
think they need to stop doing to make space?

62. Themes that are important but were
left behind for now
62
Not included in the discussion:
• Talent management
• Job mobility
• Person centred metrics

63. Closing the event… one step forward?
Participants were asked to stand next to a wall scale from 0-10 to show how they felt
about the promise of thought diversity contributing to change in the NHS over the
next 5 years (10 being very promising)
Participants were then asked ”What would it take to feel just ‘one step’ better and the
to make that step.”
63

64. 64
Were there any elephants in the
room?

65. 65
Joan and Helen sum up the day
Joan thanked all participants for working
hard throughout the day to get to this stage
and confirmed the commitment of NHS
Confederation to supporting this agenda.
Helen emphasized TD as integral to the
Horizons Group’s work and the ability to
energise disruption, dissent and
diversity. She encouraged participants to
use the Change Challenge hashtag and the
Edge to stay in touch.
Join the HSJ Top-Down Challenge:
www.hsj.co.uk/leadership/change-
challenge
The Edge: http://theedge.nhsiq.nhs.uk/

66. 66
Final tweets of the day

67. 67
#thoughtdiversity influencers

68. 68
Make space to re-imagine and co-
create with different voices
….to build ambition, energy and
urgency for the future.

69. 69
Delegates feedback on the event
“Spread the innovation – champion / spread / disseminate!”
“We had a lot of potential for thought diversity in the room; a
lot more needs to come out.”
“Was a good experience – if you have any other events where you need to
involve young people I would love to help.”
“Excellent, exciting, edifying, engaging, empowering.”
“Some group think occurred and mixed purpose of the day.”
“Well done on the event. You are creating awareness of the need –
it is the first step to change. Don't underestimate the barriers.”
“Continual engagement, relentless commitment, un-silencing the
uncomfortable stuff”

70. 70

71. 71
thoughtdiversity@nhsiq.nhs.uk