What are the latest thinking about change for healthcare? What is the rest of the world talking about?

2. The Million Dollar Question
• Our biggest challenge?
• Why are we failing
• What’s possible?
• Big things to tackle
• Your contribution

4. @HelenBevan #QS2015
Most change programmes fail to
deliver their objectives
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
Gets anywhere near
achieving the
change and
delivering the
benefits

5. @HelenBevan #QS2015
Source: McKinsey Performance Transformation Survey, 3000 respondents to
global, multi-industry survey
Delivers and
sustains the change
Most change programmes fail to
deliver their objectives

6. 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
HSJ journal: Crowdsourced barriers to Change

7. @HelenBevan #QS2015
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 contracts
professional
regulation
Clinical quality
Type one:
Type two: Type three:
Source: Health Foundation report Constructive
comfort: accelerating change in the NHS 2015

8. @HelenBevan #QS2015
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 contracts
professional
regulation
Clinical quality
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

15. Max Valiquette

16. Max Valiquette

18. What cool and innovative health
related practices
have you heard of?

19. Traditional Healthcare Culture
• Need to get things done immediately
• Evidence-based practice (scientific proof)
• Information and data are trusted
• Culture change is complicated
• Leaders need to ‘step-up’
• Top-down leadership
• “Standardize and roll it out”
Zimmerman et. al. Healthcare Papers 2013

20. How we tend to view the healthcare world:
A B
What it tends to be like:
W BBLACK BOXBLACK BOX

21. Simple Complicated Complex
Types of Problems
Adapted from Brenda Zimmerman

22. In a Linear World
• One size can fit all
• Process solutions work (Lean, Model
for improvement…)
• Copying best practices makes sense
• Top down leadership (“develop the
program and roll it out”) works
• Checklists work

24. For every complex problem
there is a solution that is
clear, simple, and wrong
HL Mencken

25. MOMENT

26. Kinds of people at work
The
Contributors
The
Compliant
The
Contras
Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-
winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/

27. Kinds of people at work
The
Contributors
The
Compliant
The
Contras
Gallup global research:
•Only 13% of the workforce are
engaged (Contributors)
•Contributors create six times the
value to an organisation compared
to the Compliant
http://www.gallup.com/poll/165269/wo
rldwide-employees-engaged-work.aspx
Adapted from The Emotional Economy http://emotionaleconomy.com.au/papers-articles/why-the-
winners-in-business-are-taking-the-time-to-build-a-positive-kind-social-culture/

29. The Reality
“What the leader cares about (and typically bases at
least 80% of his or her message to others on) does
not tap into roughly 80% of the workforce’s primary
motivators for putting extra energy into the change
programme”
Scott Keller and Carolyn Aiken (2009)
Source of image: swedenbourg-openlearning.org.uk

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

32. Old Power Managers Words New Power Manager Words
A project charter is a fundamental step to
making sure our project succeeds.
A general direction is a good first step; we
have no idea what is around the first corner
and we want to adjust if we have to.
I think that we need to strike a steering
committee to make sure we are heading in
the right direction.
I want to gather as many ideas and
opportunities from as many people as
possible.
Role clarity is important to avoid confusion. Let’s see who feels they are good and
interested at the task at hand.
A thoughtful project plan will keep us on
track.
Assessing where we need to go as we start
the work will be our guide.
A literature review at the outset of our project
will give us an environmental scan and help
us set the course.
Observing blogs, social media and
conference discussions on an ongoing basis
will inform our work along the way.
A clear vision by our leaders is
fundamentally important.
A shared purpose that invokes passion and
excitement will grow our community.
Consulting experts to establish a direction is
a key objective.
Crowd sourcing ideas from outsiders and
inviting diversity of thought is a key way for
us to know what to do!
@tweetvandijk

33. What are some of your behaviours
that could be seen as old power?

34. New Power
WAYS of Working
• Change Platforms
• Dual Operating Systems
• Innovation Labs
• Hackathons
• Holacracy
• Design Thinking

37. @HelenBevan #QS2015

39. Dual Operating Systems
John Kotter, Accelerate

41. Innovation Labs/Special Teams

43. Design Thinking

44. Augsburg, Germany)

45. Holacracy
Buurtzorg

46. Reference

49. Indicators of Bureaucratic Mass
Overhead Number of management layers
Friction Percentage of time non-managerial
employees spend on internal compliance
Insularity Percentage of total headcount that is not
directly customer-facing
Disempowerment The percentage of employee time that is
not self-directed
Conservatism Extent of perceived disincentives to
personal risk-taking
Mistrust The percentage of employees who don’t
have the opportunity to weigh in on key
policy decisions
Gary Hamel, 2016

52. Some Inconvenient truths
1. What motivates you may not motivate
them
2. Let them write/tell their own story
3. Both positive and negative are important
4. You are part of the problem
5. Influence leaders may not be influential
Keller and Aiken, McKinsey and Company, 2000

53. Some Inconvenient truths
6. Money may not motivate
7. The process is as important as the
outcome
8. Employees are what they think
9. Good intentions are not enough
Keller and Aiken, McKinsey and Company

54. Buy in

55. Ownership

56. How is this different from “sharing”
best practices?
“Point of Care” Ownership
• Winning practices are highly
sensitive to the local
context
• Winning practices come
from those who are
“touching the problem”
• Practices are spread virally
peer to peer
• Sustained
Sharing Best Practices
• What worked there should
work here. Variability is
discouraged
• Winning practices come
from experts
• Practices are spread in top
down fashion
• Often not sustained

57. I’m sorry I broke your company
We have been led to believe…that businesses are
logical and run by the numbers and that their
models and theories will provide step-by-step
instructions on how to succeed.
But
Businesses are people—irrational, emotional,
unpredictable, creative, oddly gifted, and
sometimes ingenious people who don’t operate
according to the theories.
Karen Phelan, 2013

59. Rebels Fighting the Bureaucracy
59
Innovation Leaders

60. School of Healthcare Radicals

62. References
• What is a hackathon
• Design Thinking: IDEO