Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

NHS Improving Quality
NHS Improving QualityDelivery Support Manager at NHS Improving Quality en NHS Improving Quality
Leading 
Radical 
A day of transformation 
Minicourse M5 
Monday 8th December 
Helen Bevan @HelenBevan 
Elaine Bayliss @Elaine_Bayliss 
Jon Hannah @JCHannah77 
#IHI26Forum 
#Radicals 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
We can’t drive into the future using 
only our rear view mirror 
“ 
We will spend an inspiring day with like-minded individuals 
to consider the implications and opportunities for 
transforming health care in a world where the power of 
hierarchy is diminishing in the face of complexity and 
change is happening faster and becoming more disruptive 
Join our new breed of change leaders who are rewriting the 
rules and leading change from the future 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
“ 
Source of image: Abhishekshilpa.blogspot.com
Objectives of our minicourse 
• Identify major themes and trends in the global 
world of change and transformation that are 
likely to shake the world of health care 
improvement 
• Consider the opportunities and implications of 
these for their own practice as a leader of 
change and improvement 
• Model new forms of collective learning, 
collaboration, and community building 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
The Fundamental Law of 
Conventional Conferences 
“ 
The sum of the 
expertise of the 
people in the 
audience is greater 
than the sum of 
expertise of the 
people on stage 
Dave Winer 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
“ 
Source of image: www.citynet.com
Flipped classroom 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Prework for our Minicourse 
• Watch the film 
• Read the White Paper “A new era of thinking 
and practice in change and transformation: a 
call to action for leaders of health and care” 
and watch the embedded films 
• Complete your transformational profile 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Today is based on two kinds of learning 
Transactional learning Transformational learning 
A “toolkit” of ideas & 
approaches 
Learning through 
motivation, practice & 
feedback 
Seeks to transfer useful 
knowledge 
Seeks to transform beliefs 
& underlying assumptions 
Learning events, 
presentations & materials 
Experiential, interactive & 
action-based 
Generates understanding of 
“what to do” 
Generates increased 
capacity in “how to do it” 
Source: John Wenger https://medium.com/corporate-learning/3deb1bb2e865 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Today we are part of a global 
community of change agents! 
• We will monitor and synthesise tweets all day, including 
those from fellow change agents who are connecting 
virtually 
• We will be using polling technology Poll Everywhere 
• We will produce summaries of the minicourse: 
– Storify 
– Pinterest 
• Please use both Twitter hashtags #IHI26Forum and 
#Radicals 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Lunchtime Twitter clinic! 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Design framework for our minicourse 
Designed by M G Taylor 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Design framework for our minicourse 
• Understand 
everything that has 
happened to date 
• Understand the 
opportunity to 
improve things 
• Create a level starting 
point for change 
• Imagine a different 
future 
• Think the unthinkable 
• Identify and test 
ideas 
• Narrow down options 
• Find creative 
solutions 
• Make choices 
• Uncover and remove 
barriers to change 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
• Build shared 
purpose around 
intention to act 
• Make definitive 
decisions 
• Establish action 
plans 
• Agree review 
process
Source of image: www.freshnessmag.com 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
for 
today 
Part 1: 
• Background to Minicourse 
• Our community 
• Learning processes 
• Context: emerging directions 
in transformation and change 
Part 2: 
• Applying the principles to our 
own settings and challenges 
• The 15 actions for leaders 
• Mini talks and discussions 
Part 3: 
• Background to the 
“unconference” 
• First round of “unconference” 
• Postcards from the future 
Part 4: 
• Second round of 
“unconference” 
• Voting 
• Next immediate steps 
R 
C 
T 
R 
C 
T
Four keys to collaboration 
• Lean into discomfort 
• Listen as an ally 
• State your intent 
• Share your “street corner” 
Source: Judith Katz and Fred Miller 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
“I have some Key 
Performance 
Indicators 
for you” 
or 
“I have a 
dream” 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
Source: @RobertVarnam
Task 
We are going to talk to others on our table about our 
goals and ambitions for radical change 
• Pick a picture card from the pack that reflects your 
goals and dreams for 
improvement/change/transformation 
• In turn each person at the table should take turns to: 
• Introduce yourself to others 
• talk about your goals and dreams (and why you 
picked the picture) 
Time allowed (for whole table): 20 minutes 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
What is transformational change? 
Transformational change is a systems approach, 
deriving its power by attending equally to hearts & 
minds (the inner life of human beings), human 
behaviour, and the social systems and structures in 
which they exist. It therefore tends to be multi-disciplinary, 
integrating a range of approaches and 
methodologies. Transformational change aims to be 
irreversible and enduring. 
Robert Gass, Rockwood Leadership Institute 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
“ 
“
Source: Tim Stock http://www.slideshare.net/AnalyzingTrends/5-luxury-codes-stories 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Leading change in a new era 
Dominant approach Emerging direction 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
The battle and balancing between the old 
and new power will be a defining feature of 
society and business in the coming years 
Jeremy Heimans and Henry Timms 
Recommended reading: Understanding new 
power, Harvard Business Review, December 
2014 
https://hbr.org/2014/12/understanding-new-power? 
utm_campaign=Socialflow&utm_sou 
rce=Socialflow&utm_medium=Tweet 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum Source: Gary Hamel
Gary Hamel’s 4 Ms for transformation 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
@HelenBevan @Elaine_Bayli For more information/explsasn @atJiCoHna nvnisaiht:7 7h t#tpRa:/d/ilcianlks i#sI.HcIo2m6F/owruwmw.oscarberg.net/20/QwGqW
Some challenges: 
• Create organisations that are activist at their 
core 
• Find ways to: 
– marry innovation with complexity and scale 
– balance control and freedom 
• out-love everyone 
else 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
Source of image: rachelstivers.com
What is a 
RCT? 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Randomized Coffee 
Trial! 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Outcomes of randomised coffee trials 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
1. Change starts with me 
Source of image: jasonkeath.com
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
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
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
“Being” as a change agent 
Personal characteristics and 
qualities
‘I do not think you can really deal with 
change without a person asking real 
questions about who they are and how they 
belong in the world’ 
David Whyte, The Heart Aroused 1994 
Source of image: fistfuloftalent.com
"There’s only one 
corner of the 
universe you can be 
certain of 
improving, and 
that’s your own 
self." 
Aldous Huxley 
Source of image: timcoffeyart.wordpress.com
Four things we know about successful 
boat rockers 
CHANGE 
BEGINS WITH 
me 
1. able to join forces with others to create action 
2. able to achieve small wins which create a sense 
of hope, self-efficacy and confidence 
3. More likely to view obstacles as challenges to 
overcome 
4. strong sense of “self-efficacy” 
 belief that I am personally able to create the change 
Source: adapted from Debra E Meyerson
Self-efficacy 
There is a positive, significant 
relationship between the 
self-efficacy beliefs of a 
change agent and her/his 
ability to facilitate change 
and get good outcomes 
Source of image:www.h3daily.com
Source: @NHSChangeDay
Source: @NHSChangeDay 
What is the issue here? 
“permission” ? 
(externally generated) 
or 
Self efficacy ? 
(internally generated)
What’s the difference between 
self efficacy 
and 
self esteem, 
self belief, 
self-confidence?
Building self-efficacy: some tactics 
1. Create change one small step at a time 
2. Reframe your thinking: 
• failed attempts are learning opportunities 
• uncertainty becomes curiousity 
3. Make change routine rather than an exceptional 
activity 
4. Get social support 
5. Learn from the best
Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal 
PERFORMANCE target. 
Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Research from the Sales industry: 
How many NOs should we be seeking to get? 
• 2% of sales are made on the first contact 
• 3% of sales are made on the second contact 
• 5% of sales are made on the third contact 
• 10% of sales are made on the fourth contact 
• 80% of sales are made on the fifth to twelfth 
contact 
Source: http://www.slideshare.net/bryandaly/go-for-no
“Papers that are more likely to contend against 
the status quo are more likely to find an opponent 
in the review system—and thus be rejected —but 
those papers are also more likely to have an 
impact on people across the system, earning them 
more citations when finally published” 
— 
V. Calcagno et al., “Flows of research manuscripts among 
scientific journals reveal hidden submission patterns,” 
Science, doi:10.1126/science.1227833, 2012.
2. Frame the issues in ways that 
connect with a wide group of 
stakeholders 
Source of image: www.nytimes.com
The easiest way to thrive as an 
outlier 
...is to avoid being one 
Seth Goodin 
Source of image: outskirtsbattledome.wikispaces.com
“When we talk of social change, we talk of 
movements, a word that suggest vast 
groups of people walking together, leaving 
behind one way and travelling towards 
another” 
Rebecca Solnit
Framing 
… is the process by which leaders construct, 
articulate and put across their message in a powerful 
and compelling way in order to win people to their 
cause and call them to action. 
Snow D A and Benford R D (1992)
http://www.slideshare.net/amitkaps/fifth-elephant-2014-talk-crafting- 
visual-stories-with-data?sf3881865=1
Stories are a key part of the new 
improvement
If we want people to take action, we have to 
connect with their emotions through values 
values 
emotion 
action 
Source: Marshall Ganz
What’s the 
financial incentive? 
Who is 
performance 
managing? 
What’s the 
project plan? 
Source: @RobertVarnam
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) 
The Inconvenient Truth about Change Management 
Source of image: swedenbourg-openlearning.org.uk
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
Effective framing: 
what do we need to do? 
1. Tell a story
Effective framing: 
what do we need to do? 
1. Tell a story 
2. Make it personal
Effective framing: 
what do we need to do? 
1. Tell a story 
2. Make it personal 
3. Be authentic
Effective framing: 
what do we need to do? 
1. Tell a story 
2. Make it personal 
3. Be authentic 
4. Create a sense of “us”
Effective framing: 
what do we need to do? 
1. Tell a story 
2. Make it personal 
3. Be authentic 
4. Create a sense of “us” 
5. Build in a call for urgent action
Talk to the person next to you 
• Tell your story about why the change you are 
involved in now is so important to you 
• Relate it to a personal experience 
You have: 
• 2 minutes to prepare your story 
• 2 minutes each to tell your story
3. Build shared purpose
Leading change in a new era 
Dominant approach Emerging direction
Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
Compliance 
States a minimum standard of 
performance or target that 
everyone must achieve 
Uses hierarchy, performance 
management systems and 
standardised procedures for co-ordination 
and control 
Threat of penalties/ sanctions/ 
shame creates momentum for 
delivery 
Focus on transaction 
Commitment 
States a collective, meaningful 
goal that everyone can aspire to 
Based on shared purpose and 
shared goals (“us and us” rather 
than “us and them”) for co-ordination 
and control 
Commitment to a common 
purpose creates energy for 
delivery 
Focus on relationship 
How are we leading? 
Source: Helen Bevan
Leaders who 
focus on meaning also 
get compliance, 
without focusing on it 
@JeremyScrivens
A 3-word concept
[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 
@HelenBevan
As leaders, we are “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 
Source of image: 
vintage-radio.com
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
@SimonJGuilfoyle Police Inspector and systems thinker
@SimonJGuilfoyle Police Inspector and systems thinker
Police 
@SimonJGuilfoyle Police Inspector and systems thinker
Education 
@SimonJGuilfoyle Police Inspector and systems thinker
Healthcare 
@SimonJGuilfoyle Police Inspector and systems thinker
6. Identify the heretics, disrupters and 
gamechangers in your organisation or 
system and engage them in your most 
significant changes 
“Without rebels, the storyline never 
changes” 
@PeterVan http://t.co/6CQtA4wUv1 Source of image: scotteagan.blogspot.com
There’s a big difference between a 
rebel and a troublemaker 
Rebel 
Source : Lois Kelly www.rebelsatwork.com
Reflection 
• What are your insights around “rebels” and 
“troublemakers”? 
• What moves people from being “rebel” to 
“troublemaker”? 
• How do we protect against this?
There’s a big difference between a 
rebel and a troublemaker 
Rebel 
Source : Lois Kelly www.rebelsatwork.com
A disruptive 
case study: 
Creating a mass movement of people working together in 
and with the NHS demonstrating the difference they can 
make, by one simple act for sustainable improvement 
Probably the biggest day of collective action for 
improvement in the history of the NHS
“The audacity to imagine……..” 
2013 2014 2015
Change 
starts 
with 
me.. 
Maker 
...Making 
a 
difference 
Anyone can pledge – it’s personal to you! 
Change 
Activist
‘Can I really make 
the change?’ 
Will ‘the system’ really 
ALLOW me? 
Owned by the grassroots
Unleashing the energy 
Vs 
The more you do what you love the more energy you have 
Leadership Freak
Volunteers – leaders everywhere 
98% of activity via volunteers
Holding each 
other to 
account 
rather than 
performance 
management
13th March 2013
189,000 
actions 
13th March 2013
Change Day 2014: 
more than 800,000 pledges to take action 
• 81 separate 
Campaigns 
• 86 million twitter 
impressions 
• 35,400 video views 
• 95,000 daily reach on 
Facebook
10. Build your extended network 
of weak ties
The Network Secrets of Great Change Agents 
Julie 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
strong ties (cohesive) 
v. 
weak ties (disconnected) 
Source of image:brucemacvaresh.com
When we spread change through strong ties: 
• we interact with “people like us”, with the same 
life experiences, beliefs and values 
• Change is “peer to peer”; GP to GP, nurse to 
nurse, gynaecologist to gynaecologist 
• Influence is spread through people who are 
strongly connected to each other, like and trust 
each other
When we spread change through strong ties: 
• we interact with “people like us”, with the same 
life experiences, beliefs and values 
• Change is “peer to peer”; GP to GP, nurse to 
nurse, gynaecologist to gynaecologist 
• Influence is spread through people who are 
strongly connected to each other, like and trust 
each other 
IT WORKS BECAUSE: people are far 
more likely to be influenced to 
adopt new behaviours or ways of 
working from those with whom they 
are most strongly tied
The pros and cons of strong ties 
Pros Cons
Strong and weak ties 
When we seek to spread change 
through strong ties: 
• we interact with “people like 
us”, with the same life 
experiences, beliefs and 
values 
• Change is “peer to peer”; GP 
to GP, nurse to nurse, 
gynaecologist to 
gynaecologist 
• Influence is spread through 
people who are strongly 
connected to each other, like 
and trust each other 
When we seek to spread change 
through weak ties: 
• we build bridges between groups 
and individuals who were previously 
different and separate 
• we create relationships based not 
on pre-existing similarities but on 
common purpose and 
commitments that people make to 
each other to take action 
• our aim is to mobilise all the 
resources in our organisation, 
system or community that can help 
achieve our goals
A great film that explains weak ties 
http://www.youtube.com/watc 
h?v=-Bm93gN1zJg
Why we need to build weak ties 
AS WELL AS strong ties 
• Weak ties are more likely to lead to change at scale because they 
enable us to access more people with fewer barriers
Why we need to build weak ties 
AS WELL AS strong ties 
• Weak ties are more likely to lead to change at scale because they 
enable us to access more people with fewer barriers 
• In situations of uncertainty, we have a tendency to revert to our 
strong tie relationships 
– yet the evidence tells us that weak ties are much more 
important than strong ties when it comes to searching out 
resources in times of scarcity
Why we need to build weak ties 
AS WELL AS strong ties 
• Weak ties are more likely to lead to change at scale because they 
enable us to access more people with fewer barriers 
• In situations of uncertainty, we have a tendency to revert to our 
strong tie relationships 
– yet the evidence tells us that weak ties are much more 
important than strong ties when it comes to searching out 
resources in times of scarcity 
• The most breakthrough innovations will come when we tap into 
our weak ties
Why we need to build weak ties 
AS WELL AS strong ties 
• Weak ties are more likely to lead to change at scale because they 
enable us to access more people with fewer barriers 
• In situations of uncertainty, we have a tendency to revert to our 
strong tie relationships 
– yet the evidence tells us that weak ties are much more 
important than strong ties when it comes to searching out 
resources in times of scarcity 
• The most breakthrough innovations will come when we tap into 
our weak ties 
History suggests that weak ties will probably give us the best 
chance to deliver large scale improvements in a challenging 
timescale
109 
http://weneedsocial.com/blog/2013/8/25/disr 
upted-disruptors-unite
Three components of a great 
narrative 
• Diagnostic – what is the problem that we are 
addressing? What is the extent of the problem? 
What is the specific source or sources? 
• Prognostic – what could the future look like? What is 
our “plan of attack” and our strategy for carrying out 
the plan? 
• Motivational – why is this urgent? What is our call 
for action that connects with the motivational and 
emotional drivers of the audience? 
Source: Benford and Snow
Discussion 
• What are our strong ties and weak ties? 
• Is there a balance between diagnostic, 
prognostic and motivational aspects of our 
message for change? 
• What might we do?
14. Take steps to be a more social 
leader
Source: http://www.digitalsherpa.com/blog/how-social-media-has-changed-in-the-last-few-years/
“Social Media is a conversation. 
Between millions of people. 
Word of mouth on steroids. ” 
@ FutureGP Dave Townsend
OBSESSED WITH FACEBOOK 
ENGAGING WITH GENERATION Y 
48% of 18 to 34 year olds check Facebook 
right when they wake up... 
About 28% check their Facebook on their 
smartphones before getting out of bed...
SOCIAL MEDIA IS JUST FOR YOUNG PEOPLE 
The fastest growing age group on 
Facebook is 50+ 
73% of business people visit it every day 
LinkedIn - largest segment – 
45- 54 years (36%) 
Twitter – Largest segment – 45-54 years 
(35%)
“Social media is so powerful 
because it taps into what makes 
us human… and we like it.” 
Maddie Grant and James Notter.
Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
Four aspirational human elements (as seen 
through social media examples) 
Maddie Grant and James Notter 
•Open – decentralised, systems thinking 
•Trustworthy- transparency, truth, authenticity 
•Generative- inclusion, collaboration, 
relationship building 
•Courageous – learning, experimentation , 
personal development.
10 Ways to be a digital influencer or super 
connector @PaulBromford 
1. Have a cause 
2. Talk like a human 
3. Post interesting 
links -inform, 
educate, 
entertain 
4. Don’t wear a 
mask
Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
Curating content
Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
Full slide deck for Minicourse M5 "Leading radical change a day of transformation"
My followers
Source: @NHSChangeDay 
Can I, dare I?
Helen Bevan’s pledge for Change Day 2013 
To support 500 
leaders and activists 
to develop their 
capability as radical 
change agents: to 
rock the boat and 
stay in it 
“ 
“
1,900
28,000 
2,000 
3,000 
150
Health and care radicals
15. Take deliberate action to 
maintain energy for change over 
the long haul
Does fear motivate people to 
change?
burning platform 
versus 
burning ambition 
@PeterFuda
Lessons for transformational change 
1. 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
What happens to large scale 
change efforts in reality? 
In order of frequency: 
1. the effort effectively “runs out of energy” and 
simply fades away 
2. the change hits a plateau at some level and no 
longer attracts new supporters 
3. 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
Bruch and Vogel research 
Organisations with HIGH productive 
energy scored higher on: 
• overall performance - 14% higher 
• productivity – 17% 
• efficiency – 14% 
• customer satisfaction – 6% 
• customer loyalty – 12%
@HelenBevan
Energy for change is: 
the capacity and 
drive of a team, 
organisation or 
system to act 
and make the 
difference 
necessary to 
achieve its goals 
Spiritual 
Psychological 
Social Intellectual 
Physical
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
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
Some questions 
• Which group likely to have 
higher spiritual energy 
scores (clinicians/non 
clinicians?) 
• Nearer to CEO, higher or 
lower energy scores?
@HelenBevan 
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 Agree 
I 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___
The SSPPI Energy Index – V2, Part 2 
Complete these statements on a scale of 1 = low - 5 = high 
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____ 
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____ 
#IQTGOLD 
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____
Energy for change profile 
• 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? 
Social 
5 
4 
3 
2 
1 
Spiritual 
Intellectual 
Physical Psychological
Energy for change profile 
• 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? 
Social 
5 
4 
3 
2 
1 
Spiritual 
Intellectual 
Physical Psychological
Team 1: what’s your assessment of 
their energy for change? 
#IQTGOLD 
Social 
5 
4 
3 
2 
1 
Spiritual 
Intellectual 
Physical Psychological
Team 1: what’s your assessment of 
their energy for change? 
Social 
5 
4 
3 
2 
1 
#IQTGOLD 
Spiritual 
Intellectual 
Physical Psychological 
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
Team 2: what’s your assessment of 
their energy for change? 
#IQTGOLD 
Social 
5 
4 
3 
2 
1 
Spiritual 
Intellectual 
Physical Psychological
Team 2: what’s your assessment of 
their energy for change? 
Social 
5 
4 
3 
2 
1 
#IQTGOLD 
Spiritual 
Intellectual 
Physical Psychological 
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
“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 
There has never been a time in the history 
of healthcare when this advice has been 
@HelenBevan 
more pertinent
Discussion 
Which energies are most prevalent in your 
setting? How might you get more balance (if you 
need it?)
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
The Fundamental Law of 
Conventional Conferences 
“ 
The sum of the 
expertise of the 
people in the 
audience is greater 
than the sum of 
expertise of the 
people on stage 
Dave Winer 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
“ 
Source of image: www.citynet.com
Traditional conference 
The agenda is pre-set 
One way learning style 
with Q&A 
People sit in rows or round 
tables 
Networking between 
sessions 
Hard to leave the session 
once it starts 
Absorbing information 
Unconference 
People set the agenda 
Based on discussion 
People sit in a circle with 
no chairs 
Networking the whole 
time 
Encouraged to find the 
right session 
Connecting to action 
Source: adapted from @BCPSQC 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
The unconference: 
4 principles and a law 
Principles: 
1. Whoever comes are the right people 
2. Whatever happens is the only thing that could 
have happened. 
3. When it starts is the right time 
4. When it's over it's over 
The Law is known as the Law of Two Feet: 
"If you find yourself in a situation where you are not 
contributing or learning, move somewhere where 
you can." 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Our unconference process 
• Think about a topic that you would like to 
explore with other people that will help you 
with your dreams and goals for change and 
improvement 
• It should be a topic that you want to take 
action on over the next twelve months 
• Come to the middle of the circle and write it 
on a sheet 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Four keys to collaboration 
• Lean into discomfort 
• Listen as an ally 
• State your intent 
• Share your “street corner” 
Source: Judith Katz and Fred Miller 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
What’s our approach to change? 
Deficit based 
• what is wrong? 
• solve problems 
• identify what we 
need to improve 
• fill gaps and 
deficiencies 
Strength based 
• what is strong? 
• work with our 
existing assets and 
resources 
• amplify what works 
• “positive deviants” 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Adapted from British Columbia Patient Safety and Quality Council 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
8th 
Dec 
2015 
8th December 
2015 
Topic: 
Where did we start? 
Where are we now? 
How did we get there? 
Who was mobilised? 
*be as specific as possible
“Dotocracy” 
• One person from each group to stand by their 
postcard/idea 
• Each person has four dots 
• We are voting for the idea that offers the best 
potential for radical/transformational change 
• You can give all your dots to one idea or one dot 
each to four ideas 
• Switch the “standing” person half way so they 
can vote 
• Time allowed 10 minutes 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
Source: British Columbia Patient Safety and Quality Council 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
The “two levels down” rule 
What can I achieve in: 
a year? 
a month? 
a week? 
a day? 
an hour? 
If you think your 
improvement initiative 
will take a year to test 
and implement, 
consider what you could 
achieve in a week 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 
If you think it 
will take a 
week, what 
you could 
achieve in an 
hour? 
Source: Paul Plsek
Four ways to connect with us! 
1. Follow us on Twitter 
@HelenBevan 
@Elaine_Bayliss 
@JCHannah77 
@NHSIQ 
2. Subscribe to 
TheEdge.nhsiq.nhs.uk 
3. Enrol for The School for Health and Care Radicals: next 
term starts 30th January 2015 jodi.brown@nhsiq.nhs.uk 
4. Engage with Change Day NHS Change Day 2015: 11th 
March www.ChangeDay.nhs.uk 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
A further 
“unconference” 
session 
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
@HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
1 de 169

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Full slide deck for Minicourse M5 "Leading radical change a day of transformation"

  • 1. Leading Radical A day of transformation Minicourse M5 Monday 8th December Helen Bevan @HelenBevan Elaine Bayliss @Elaine_Bayliss Jon Hannah @JCHannah77 #IHI26Forum #Radicals @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 2. We can’t drive into the future using only our rear view mirror “ We will spend an inspiring day with like-minded individuals to consider the implications and opportunities for transforming health care in a world where the power of hierarchy is diminishing in the face of complexity and change is happening faster and becoming more disruptive Join our new breed of change leaders who are rewriting the rules and leading change from the future @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum “ Source of image: Abhishekshilpa.blogspot.com
  • 3. Objectives of our minicourse • Identify major themes and trends in the global world of change and transformation that are likely to shake the world of health care improvement • Consider the opportunities and implications of these for their own practice as a leader of change and improvement • Model new forms of collective learning, collaboration, and community building @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 4. The Fundamental Law of Conventional Conferences “ The sum of the expertise of the people in the audience is greater than the sum of expertise of the people on stage Dave Winer @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum “ Source of image: www.citynet.com
  • 5. Flipped classroom @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 6. Prework for our Minicourse • Watch the film • Read the White Paper “A new era of thinking and practice in change and transformation: a call to action for leaders of health and care” and watch the embedded films • Complete your transformational profile @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 7. Today is based on two kinds of learning Transactional learning Transformational learning A “toolkit” of ideas & approaches Learning through motivation, practice & feedback Seeks to transfer useful knowledge Seeks to transform beliefs & underlying assumptions Learning events, presentations & materials Experiential, interactive & action-based Generates understanding of “what to do” Generates increased capacity in “how to do it” Source: John Wenger https://medium.com/corporate-learning/3deb1bb2e865 @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 8. Today we are part of a global community of change agents! • We will monitor and synthesise tweets all day, including those from fellow change agents who are connecting virtually • We will be using polling technology Poll Everywhere • We will produce summaries of the minicourse: – Storify – Pinterest • Please use both Twitter hashtags #IHI26Forum and #Radicals @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 9. Lunchtime Twitter clinic! @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 10. Design framework for our minicourse Designed by M G Taylor @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 11. Design framework for our minicourse • Understand everything that has happened to date • Understand the opportunity to improve things • Create a level starting point for change • Imagine a different future • Think the unthinkable • Identify and test ideas • Narrow down options • Find creative solutions • Make choices • Uncover and remove barriers to change @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum • Build shared purpose around intention to act • Make definitive decisions • Establish action plans • Agree review process
  • 12. Source of image: www.freshnessmag.com @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum for today Part 1: • Background to Minicourse • Our community • Learning processes • Context: emerging directions in transformation and change Part 2: • Applying the principles to our own settings and challenges • The 15 actions for leaders • Mini talks and discussions Part 3: • Background to the “unconference” • First round of “unconference” • Postcards from the future Part 4: • Second round of “unconference” • Voting • Next immediate steps R C T R C T
  • 13. Four keys to collaboration • Lean into discomfort • Listen as an ally • State your intent • Share your “street corner” Source: Judith Katz and Fred Miller @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 15. “I have some Key Performance Indicators for you” or “I have a dream” @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum Source: @RobertVarnam
  • 16. Task We are going to talk to others on our table about our goals and ambitions for radical change • Pick a picture card from the pack that reflects your goals and dreams for improvement/change/transformation • In turn each person at the table should take turns to: • Introduce yourself to others • talk about your goals and dreams (and why you picked the picture) Time allowed (for whole table): 20 minutes @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 18. What is transformational change? Transformational change is a systems approach, deriving its power by attending equally to hearts & minds (the inner life of human beings), human behaviour, and the social systems and structures in which they exist. It therefore tends to be multi-disciplinary, integrating a range of approaches and methodologies. Transformational change aims to be irreversible and enduring. Robert Gass, Rockwood Leadership Institute @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum “ “
  • 19. Source: Tim Stock http://www.slideshare.net/AnalyzingTrends/5-luxury-codes-stories @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 20. Leading change in a new era Dominant approach Emerging direction @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 21. The battle and balancing between the old and new power will be a defining feature of society and business in the coming years Jeremy Heimans and Henry Timms Recommended reading: Understanding new power, Harvard Business Review, December 2014 https://hbr.org/2014/12/understanding-new-power? utm_campaign=Socialflow&utm_sou rce=Socialflow&utm_medium=Tweet @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 23. @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum Source: Gary Hamel
  • 24. Gary Hamel’s 4 Ms for transformation @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 25. @HelenBevan @Elaine_Bayli For more information/explsasn @atJiCoHna nvnisaiht:7 7h t#tpRa:/d/ilcianlks i#sI.HcIo2m6F/owruwmw.oscarberg.net/20/QwGqW
  • 26. Some challenges: • Create organisations that are activist at their core • Find ways to: – marry innovation with complexity and scale – balance control and freedom • out-love everyone else @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum Source of image: rachelstivers.com
  • 27. What is a RCT? @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 28. Randomized Coffee Trial! @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 29. Outcomes of randomised coffee trials @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 31. 1. Change starts with me Source of image: jasonkeath.com
  • 32. 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
  • 33. 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
  • 34. 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
  • 35. “Being” as a change agent Personal characteristics and qualities
  • 36. ‘I do not think you can really deal with change without a person asking real questions about who they are and how they belong in the world’ David Whyte, The Heart Aroused 1994 Source of image: fistfuloftalent.com
  • 37. "There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley Source of image: timcoffeyart.wordpress.com
  • 38. Four things we know about successful boat rockers CHANGE BEGINS WITH me 1. able to join forces with others to create action 2. able to achieve small wins which create a sense of hope, self-efficacy and confidence 3. More likely to view obstacles as challenges to overcome 4. strong sense of “self-efficacy”  belief that I am personally able to create the change Source: adapted from Debra E Meyerson
  • 39. Self-efficacy There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change and get good outcomes Source of image:www.h3daily.com
  • 41. Source: @NHSChangeDay What is the issue here? “permission” ? (externally generated) or Self efficacy ? (internally generated)
  • 42. What’s the difference between self efficacy and self esteem, self belief, self-confidence?
  • 43. Building self-efficacy: some tactics 1. Create change one small step at a time 2. Reframe your thinking: • failed attempts are learning opportunities • uncertainty becomes curiousity 3. Make change routine rather than an exceptional activity 4. Get social support 5. Learn from the best
  • 49. Make it a personal PERFORMANCE target. Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
  • 51. Research from the Sales industry: How many NOs should we be seeking to get? • 2% of sales are made on the first contact • 3% of sales are made on the second contact • 5% of sales are made on the third contact • 10% of sales are made on the fourth contact • 80% of sales are made on the fifth to twelfth contact Source: http://www.slideshare.net/bryandaly/go-for-no
  • 52. “Papers that are more likely to contend against the status quo are more likely to find an opponent in the review system—and thus be rejected —but those papers are also more likely to have an impact on people across the system, earning them more citations when finally published” — V. Calcagno et al., “Flows of research manuscripts among scientific journals reveal hidden submission patterns,” Science, doi:10.1126/science.1227833, 2012.
  • 53. 2. Frame the issues in ways that connect with a wide group of stakeholders Source of image: www.nytimes.com
  • 54. The easiest way to thrive as an outlier ...is to avoid being one Seth Goodin Source of image: outskirtsbattledome.wikispaces.com
  • 55. “When we talk of social change, we talk of movements, a word that suggest vast groups of people walking together, leaving behind one way and travelling towards another” Rebecca Solnit
  • 56. Framing … is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action. Snow D A and Benford R D (1992)
  • 58. Stories are a key part of the new improvement
  • 59. If we want people to take action, we have to connect with their emotions through values values emotion action Source: Marshall Ganz
  • 60. What’s the financial incentive? Who is performance managing? What’s the project plan? Source: @RobertVarnam
  • 61. 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) The Inconvenient Truth about Change Management Source of image: swedenbourg-openlearning.org.uk
  • 62. 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
  • 63. Effective framing: what do we need to do? 1. Tell a story
  • 64. Effective framing: what do we need to do? 1. Tell a story 2. Make it personal
  • 65. Effective framing: what do we need to do? 1. Tell a story 2. Make it personal 3. Be authentic
  • 66. Effective framing: what do we need to do? 1. Tell a story 2. Make it personal 3. Be authentic 4. Create a sense of “us”
  • 67. Effective framing: what do we need to do? 1. Tell a story 2. Make it personal 3. Be authentic 4. Create a sense of “us” 5. Build in a call for urgent action
  • 68. Talk to the person next to you • Tell your story about why the change you are involved in now is so important to you • Relate it to a personal experience You have: • 2 minutes to prepare your story • 2 minutes each to tell your story
  • 69. 3. Build shared purpose
  • 70. Leading change in a new era Dominant approach Emerging direction
  • 72. Compliance States a minimum standard of performance or target that everyone must achieve Uses hierarchy, performance management systems and standardised procedures for co-ordination and control Threat of penalties/ sanctions/ shame creates momentum for delivery Focus on transaction Commitment States a collective, meaningful goal that everyone can aspire to Based on shared purpose and shared goals (“us and us” rather than “us and them”) for co-ordination and control Commitment to a common purpose creates energy for delivery Focus on relationship How are we leading? Source: Helen Bevan
  • 73. Leaders who focus on meaning also get compliance, without focusing on it @JeremyScrivens
  • 75. [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 @HelenBevan
  • 76. As leaders, we are “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 Source of image: vintage-radio.com
  • 77. 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
  • 78. @SimonJGuilfoyle Police Inspector and systems thinker
  • 79. @SimonJGuilfoyle Police Inspector and systems thinker
  • 80. Police @SimonJGuilfoyle Police Inspector and systems thinker
  • 81. Education @SimonJGuilfoyle Police Inspector and systems thinker
  • 82. Healthcare @SimonJGuilfoyle Police Inspector and systems thinker
  • 83. 6. Identify the heretics, disrupters and gamechangers in your organisation or system and engage them in your most significant changes “Without rebels, the storyline never changes” @PeterVan http://t.co/6CQtA4wUv1 Source of image: scotteagan.blogspot.com
  • 84. There’s a big difference between a rebel and a troublemaker Rebel Source : Lois Kelly www.rebelsatwork.com
  • 85. Reflection • What are your insights around “rebels” and “troublemakers”? • What moves people from being “rebel” to “troublemaker”? • How do we protect against this?
  • 86. There’s a big difference between a rebel and a troublemaker Rebel Source : Lois Kelly www.rebelsatwork.com
  • 87. A disruptive case study: Creating a mass movement of people working together in and with the NHS demonstrating the difference they can make, by one simple act for sustainable improvement Probably the biggest day of collective action for improvement in the history of the NHS
  • 88. “The audacity to imagine……..” 2013 2014 2015
  • 89. Change starts with me.. Maker ...Making a difference Anyone can pledge – it’s personal to you! Change Activist
  • 90. ‘Can I really make the change?’ Will ‘the system’ really ALLOW me? Owned by the grassroots
  • 91. Unleashing the energy Vs The more you do what you love the more energy you have Leadership Freak
  • 92. Volunteers – leaders everywhere 98% of activity via volunteers
  • 93. Holding each other to account rather than performance management
  • 95. 189,000 actions 13th March 2013
  • 96. Change Day 2014: more than 800,000 pledges to take action • 81 separate Campaigns • 86 million twitter impressions • 35,400 video views • 95,000 daily reach on Facebook
  • 97. 10. Build your extended network of weak ties
  • 98. The Network Secrets of Great Change Agents Julie 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
  • 99. strong ties (cohesive) v. weak ties (disconnected) Source of image:brucemacvaresh.com
  • 100. When we spread change through strong ties: • we interact with “people like us”, with the same life experiences, beliefs and values • Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist • Influence is spread through people who are strongly connected to each other, like and trust each other
  • 101. When we spread change through strong ties: • we interact with “people like us”, with the same life experiences, beliefs and values • Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist • Influence is spread through people who are strongly connected to each other, like and trust each other IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied
  • 102. The pros and cons of strong ties Pros Cons
  • 103. Strong and weak ties When we seek to spread change through strong ties: • we interact with “people like us”, with the same life experiences, beliefs and values • Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist • Influence is spread through people who are strongly connected to each other, like and trust each other When we seek to spread change through weak ties: • we build bridges between groups and individuals who were previously different and separate • we create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action • our aim is to mobilise all the resources in our organisation, system or community that can help achieve our goals
  • 104. A great film that explains weak ties http://www.youtube.com/watc h?v=-Bm93gN1zJg
  • 105. Why we need to build weak ties AS WELL AS strong ties • Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers
  • 106. Why we need to build weak ties AS WELL AS strong ties • Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers • In situations of uncertainty, we have a tendency to revert to our strong tie relationships – yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity
  • 107. Why we need to build weak ties AS WELL AS strong ties • Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers • In situations of uncertainty, we have a tendency to revert to our strong tie relationships – yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity • The most breakthrough innovations will come when we tap into our weak ties
  • 108. Why we need to build weak ties AS WELL AS strong ties • Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers • In situations of uncertainty, we have a tendency to revert to our strong tie relationships – yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity • The most breakthrough innovations will come when we tap into our weak ties History suggests that weak ties will probably give us the best chance to deliver large scale improvements in a challenging timescale
  • 110. Three components of a great narrative • Diagnostic – what is the problem that we are addressing? What is the extent of the problem? What is the specific source or sources? • Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan? • Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of the audience? Source: Benford and Snow
  • 111. Discussion • What are our strong ties and weak ties? • Is there a balance between diagnostic, prognostic and motivational aspects of our message for change? • What might we do?
  • 112. 14. Take steps to be a more social leader
  • 114. “Social Media is a conversation. Between millions of people. Word of mouth on steroids. ” @ FutureGP Dave Townsend
  • 115. OBSESSED WITH FACEBOOK ENGAGING WITH GENERATION Y 48% of 18 to 34 year olds check Facebook right when they wake up... About 28% check their Facebook on their smartphones before getting out of bed...
  • 116. SOCIAL MEDIA IS JUST FOR YOUNG PEOPLE The fastest growing age group on Facebook is 50+ 73% of business people visit it every day LinkedIn - largest segment – 45- 54 years (36%) Twitter – Largest segment – 45-54 years (35%)
  • 117. “Social media is so powerful because it taps into what makes us human… and we like it.” Maddie Grant and James Notter.
  • 119. Four aspirational human elements (as seen through social media examples) Maddie Grant and James Notter •Open – decentralised, systems thinking •Trustworthy- transparency, truth, authenticity •Generative- inclusion, collaboration, relationship building •Courageous – learning, experimentation , personal development.
  • 120. 10 Ways to be a digital influencer or super connector @PaulBromford 1. Have a cause 2. Talk like a human 3. Post interesting links -inform, educate, entertain 4. Don’t wear a mask
  • 130. Helen Bevan’s pledge for Change Day 2013 To support 500 leaders and activists to develop their capability as radical change agents: to rock the boat and stay in it “ “
  • 131. 1,900
  • 133. Health and care radicals
  • 134. 15. Take deliberate action to maintain energy for change over the long haul
  • 135. Does fear motivate people to change?
  • 136. burning platform versus burning ambition @PeterFuda
  • 137. Lessons for transformational change 1. 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
  • 138. What happens to large scale change efforts in reality? In order of frequency: 1. the effort effectively “runs out of energy” and simply fades away 2. the change hits a plateau at some level and no longer attracts new supporters 3. 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
  • 139. Bruch and Vogel research Organisations with HIGH productive energy scored higher on: • overall performance - 14% higher • productivity – 17% • efficiency – 14% • customer satisfaction – 6% • customer loyalty – 12%
  • 141. Energy for change is: the capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals Spiritual Psychological Social Intellectual Physical
  • 142. 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
  • 143. 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
  • 144. Some questions • Which group likely to have higher spiritual energy scores (clinicians/non clinicians?) • Nearer to CEO, higher or lower energy scores?
  • 145. @HelenBevan 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 Agree I 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___
  • 146. The SSPPI Energy Index – V2, Part 2 Complete these statements on a scale of 1 = low - 5 = high 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____ 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____ #IQTGOLD 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____
  • 147. Energy for change profile • 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? Social 5 4 3 2 1 Spiritual Intellectual Physical Psychological
  • 148. Energy for change profile • 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? Social 5 4 3 2 1 Spiritual Intellectual Physical Psychological
  • 149. Team 1: what’s your assessment of their energy for change? #IQTGOLD Social 5 4 3 2 1 Spiritual Intellectual Physical Psychological
  • 150. Team 1: what’s your assessment of their energy for change? Social 5 4 3 2 1 #IQTGOLD Spiritual Intellectual Physical Psychological 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
  • 151. Team 2: what’s your assessment of their energy for change? #IQTGOLD Social 5 4 3 2 1 Spiritual Intellectual Physical Psychological
  • 152. Team 2: what’s your assessment of their energy for change? Social 5 4 3 2 1 #IQTGOLD Spiritual Intellectual Physical Psychological 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
  • 153. “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 There has never been a time in the history of healthcare when this advice has been @HelenBevan more pertinent
  • 154. Discussion Which energies are most prevalent in your setting? How might you get more balance (if you need it?)
  • 155. @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 156. The Fundamental Law of Conventional Conferences “ The sum of the expertise of the people in the audience is greater than the sum of expertise of the people on stage Dave Winer @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum “ Source of image: www.citynet.com
  • 157. Traditional conference The agenda is pre-set One way learning style with Q&A People sit in rows or round tables Networking between sessions Hard to leave the session once it starts Absorbing information Unconference People set the agenda Based on discussion People sit in a circle with no chairs Networking the whole time Encouraged to find the right session Connecting to action Source: adapted from @BCPSQC @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 158. The unconference: 4 principles and a law Principles: 1. Whoever comes are the right people 2. Whatever happens is the only thing that could have happened. 3. When it starts is the right time 4. When it's over it's over The Law is known as the Law of Two Feet: "If you find yourself in a situation where you are not contributing or learning, move somewhere where you can." @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 159. Our unconference process • Think about a topic that you would like to explore with other people that will help you with your dreams and goals for change and improvement • It should be a topic that you want to take action on over the next twelve months • Come to the middle of the circle and write it on a sheet @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 160. Four keys to collaboration • Lean into discomfort • Listen as an ally • State your intent • Share your “street corner” Source: Judith Katz and Fred Miller @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 161. What’s our approach to change? Deficit based • what is wrong? • solve problems • identify what we need to improve • fill gaps and deficiencies Strength based • what is strong? • work with our existing assets and resources • amplify what works • “positive deviants” @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 162. Adapted from British Columbia Patient Safety and Quality Council @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum 8th Dec 2015 8th December 2015 Topic: Where did we start? Where are we now? How did we get there? Who was mobilised? *be as specific as possible
  • 163. “Dotocracy” • One person from each group to stand by their postcard/idea • Each person has four dots • We are voting for the idea that offers the best potential for radical/transformational change • You can give all your dots to one idea or one dot each to four ideas • Switch the “standing” person half way so they can vote • Time allowed 10 minutes @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 164. Source: British Columbia Patient Safety and Quality Council @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 165. @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 166. The “two levels down” rule What can I achieve in: a year? a month? a week? a day? an hour? If you think your improvement initiative will take a year to test and implement, consider what you could achieve in a week @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum If you think it will take a week, what you could achieve in an hour? Source: Paul Plsek
  • 167. Four ways to connect with us! 1. Follow us on Twitter @HelenBevan @Elaine_Bayliss @JCHannah77 @NHSIQ 2. Subscribe to TheEdge.nhsiq.nhs.uk 3. Enrol for The School for Health and Care Radicals: next term starts 30th January 2015 jodi.brown@nhsiq.nhs.uk 4. Engage with Change Day NHS Change Day 2015: 11th March www.ChangeDay.nhs.uk @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 168. A further “unconference” session @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum
  • 169. @HelenBevan @Elaine_Bayliss @JCHannah77 #Radicals #IHI26Forum

Notas del editor

  1. Link below http://www.bbc.co.uk/news/magazine-23790147 http://www.bbc.co.uk/learningzone/clips/martin-luther-king-i-have-a-dream-pt-1-2/1293.html With the brooding statue of Abraham Lincoln peering down at him, King began by telling protesters that their presence in the symbolic shadow of the "great emancipator" offered proof of the marvellous new militancy sweeping the country. For too long, he complained, black Americans had been exiles in their own land, "crippled by the manacles of segregation and the chains of discrimination". The whirlwinds of revolt would continue to shake the very foundations of the country: "And those who hope that the Negro needed to blow off steam and will now be content will have a rude awakening if the nation returns to business as normal," King said. It would be fatal for the nation "to overlook the urgency of the moment and to underestimate the determination of the Negro". “He's good - he's damned good” Kennedy on King Wearied by the suffocating heat, the crowd's initial response was muted. The speech was not going well. "Tell 'em about the dream, Martin," shouted Mahalia Jackson, referring to a rhetorical riff that King had used several times before, but which had not made it into his prepared speech because aides insisted he needed fresh material. But King decided to cast aside his prepared notes, and launched extemporaneously into the refrain for which he will forever be remembered. "I have a dream that one day this nation will rise up and live out the true meaning of its creed," he shouted, his out-stretched right arm reaching towards the sky. Soon he was hitting his rhythm, invigorated by the chants and cries of the crowd. "Dream on!" they shouted. "Dream on!" With his voice thundering down the Mall, King imagined a future in which his children could "live in a nation where they will not be judged by the colour of their skin but by the content of their character". Then he reached his impassioned finale. King asked the crowd to yell so it was heard the world over Watching at the White House, the president was riveted. Like so many Americans, it was the first time he had heard the 34-year-old preacher deliver a speech in its entirety - the first time he had taken its measure, listened to its cadence. "He's good," Kennedy told one of his advisors. "He's damned good." The aide was struck, however, that the president seemed impressed more by the quality of King's performance rather than the power of his message.
  2. So Emotions help us understand what we value in the world. Why did the story of Alice work ? So why was this story powerful? Why do we respond differently when we hear about Alice rather than when we see the policy data and financial balance sheet? So public narrative when used intentionally for a purpose to connect with others to move to action is a powerful skills set and leadership gift. When we hear stories that make us feel a certain way those stories remind us of our core values. We experience our values through emotions. Then we are prepared to take action on those values. Through our emotions we are more likely to take action Research by Martha Nussbaum a Moral philosopher, tells us that people who have a damaged (a-mig-da- la) Amygadla the part of the brain which controls emotions, when faced with decisions can come up with many options from which to choose but cannot make a decision because the decision rests upon judgements of value. If we cannot feel emotion we cannot experience values that orient us to the choices we must make Shortly we will be thinking about the lived experiences that have moved you to action…we’ll be drawing on those a few minutes as you start to craft your own stories.
  3. Large scale action - Not requiring large leadership team or compliance framework Definition used in “The Power of One, the Power of Many” = a voluntary collective of individuals committed to promoting or resisting change through co-ordinated activity.
  4. Our organisations haven’t changed in a hundred years. We’re on a collision course between the new, organic, human powered forces of social media and the machine world of our organisations Social Media implementation hurdles are actually shining a light on much deeper organisational issues.
  5. Digital influencers – people who use social media to break traditional power and knowledge silos