This is the basic slide deck that was used during the hack of the NHS Change Model, 14thOctober 2015

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Improving the way we do change!
Hacking the NHS Change Model
14 October 2015
#CMhack
@HelenBevan
@PerryTimms
@ZoeLord1

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Housekeeping and survival!
Breaks…
Fire alarms and exits…
Mobile technology
Toilet location…Security…
Password:
HubWest1 #CMhack
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We are a diverse group
Diversity leads to more disruptive
thinking, faster change and better
outcomes
Aylet Baron

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Joining in today and beyond
• Please tweet using the hashtag #CMhack
• We will produce summaries of the discussions
using Storify and Pinterest
• A report is being produced in real time and
will be emailed to everyone by next Monday,
19th October

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Aims for
today
• Review how change currently
happens in health and care
• Review the NHS Change Model
• Design a proof of concept to support
and enable change across health and
care
• Scope how a change model can be
spread across health and care

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Aims for
today
• Review how change currently
happens in health and care
• Review the NHS Change Model
• Design a proof of concept to support
and enable change across health and
care
• Scope how a change model can be
spread across health and care

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How we will do
this
• Self-directed, not told
• Communal, not siloed
• Blocks, not agendas
• Creative, not forced
• Exploratory , not prescribed

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“Pioneering
is the enemy of
transformative and
systematic change”
David Albury
The Innovation Centre
Why, after
nearly two
decades,
haven’t we
created an
unstoppable,
system-wide
drive for
improvement?

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There have been many attempts to introduce
change models and frameworks

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NHS Change Model
Developed in 2012 with
inputs from hundreds of
people, to distil twenty years
of learning from change in
the NHS into a useable
model to accelerate and get
better outcomes from
improvement

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Drivers
of extrinsic
motivation
create focus &
momentum for
delivery
Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy
and creativity
•System drivers &
incentives
•Payment by results
•Performance
management
•Measurement for
accountability

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Internal
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
build energy and
creativity
Drivers of
extrinsic
motivation
•System drivers &
incentives
•Performance
management
•Measurement for
accountability
create & focus
momentum for
delivery

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The power of extrinsic drivers

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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 standards
Type one:
Type two: Type three:
Source: Health Foundation report Constructive
comfort: accelerating change in the NHS 2015

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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 standards
Type one:
Type two: Type three:
Source: Health Foundation report Constructive
comfort: accelerating change in the NHS 2015
Less than 10%
of the potential
for
improvement
at system level
can be
delivered
through type
one change

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Transformation is not a matter of
intent.........
it is a matter of alignment
Peter Fuda

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The NHS
Change
Model
aligns
intrinsic
and
extrinsic
aspects

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Shared purpose aligns.....
Shared purpose allows
many communities to
engage with us without us
having to invest resources
in controlling their actions
Nilofer Merchant

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0
1
2
3
4
5
6
7
8
9
10
Our shared purpose
Spread of innovation
Improvement
methodology
Rigorous delivery
Transparent
measurement
System drivers
Engagement to
mobilise
Leadership for change
Where are we currently?

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Priority area:
What outcomes do we seek?
Our Shared Purpose
Is there a sense of shared
purpose amongst our key
stakeholders?
Leadership for change
Do all our leaders have the skills
to create transformational
change?
Engagement to mobilise
Are we engaging and mobilising
all the right people?
Spread for innovation
Are we designing for the active
spread of innovation?
Rigorous delivery
Do we have an effective
approach for delivery of change
and monitoring of progress
towards our planned objectives?
System drivers
Are our processes, incentives
and systems aligned to enable
change?
Improvement methodology
Are we using an evidence-based
quality improvement
methodology?
Transparent measurement
Are we measuring the outcome
of the change continuously and
transparently?
People with dementia
Deliver goals of the National Dementia Strategy

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What’s strong? Where are the gaps? How can we align?
Political, clinical,
voluntary and private
sector leadership for
change
Multiple projects and
initiatives at multiple levels
not necessarily aligned
Don’t consider any component of
change in isolation (eg, broad
perspective on CQUIN scheme re
people with dementia in hospital)
Strong sense of
shared purpose and
will for change
Lack of transparent measures
in terms of how well NHS is
playing its part
Support Clinical Commissioning
Groups to act as enablers/aligners
at local level
Key stakeholders
engaged and mobilised
Not exploiting the potential
for spread and adoption of
innovation
Link to local initiatives such as
“Dementia Friendly Communities”
Multiple system
drivers to support
change
Sporadic use of quality
improvement methodologies
Align with other strategies to
support older people across health
and social care and building broad
common commitment to change
Clarity of immediate
programme
Building energy and
engagement for the long haul
Build all the components into
design of future strategies

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Five key principles in using the
NHS Change Model
1. Start with “shared purpose” but after that there is no
prescribed linear or logical order
2. It’s important to use the model to check if all eight
components are present but it’s more important to
focus on whether they are aligned
3. Use the model to build on what you are doing already
4. Don’t “sell” the change model; “sell” the outcomes you
are seeking
5. Build commitment to, not compliance with, the NHS
Change Model

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Peter Fuda
“Change is not the goal,
the goal is the goal”
Peter Fuda

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Insights…

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Insights
• Interviewed and surveyed 200 + people

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What did we find
Similarities and Polarities!!!

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What does the NHS workforce think?
14,000 contributors recently 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
Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change
Challenge” March 2015

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What does the NHS workforce think?
14,000 contributors recently identified 11 building blocks
for change:
Inspiring & supportive
leadership
Collaborative working
Thought diversityAutonomy & trust
Smart use of resources
Flexibility &
adaptability
Long term thinking
Nurturing our people
Fostering an open
culture
A call to action
Source: Health Service Journal, Nursing Times, NHS
Improving Quality, “Change Challenge” March 2015
Challenging the
status quo

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Insights
• Use:
– It is used for many different purposes -Projects, events, meetings
• Knowledge:
– The more people know, the more they find it useful
– Easy accessible information on practical application is required
• Language:
– Some of the language is inhibiting
• Name:
– NHS brand brings prestige
– NHS brand is hindering the uptake from other care providers
– Is it a model or framework?

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Going forward…
• Bring on board the people who don’t like it
and keep hold of the people who do like it
• Enhance the positives – rather than change for
change sake
• Address what ‘it’ should be called
• Think about spread and implementation
• How we frame it so that we focus on the goals
not the model.

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Bingo sheets are on your table.
Keep hold of your bingo card.
Find people who match the words below and ask them
to write their name in one relevant box.
Once you’ve completed the whole grid, shout “bingo!”
There’s a prize for the winner.

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We’re here to
Hack… but what’s
a hack?

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A true hackathon
• Strategic
• Socialised
• Participative
• Fast
• Conclusive

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Plan for the day
• Series of hacks to explore design a proof of
concept to support and enable change across
health and care:
– Problem solving
– Framework hacks
– Mini Hacks
– Spread and
sustainability hacks

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How today will work
This is not your usual conference or workshop,
it is a specially designed process which enables
a depth and quality of output that would
usually be unachievable in such a short
timeframe...
“ “
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We ask you to…
• Go with the flow and have faith in the process
• Unconference - self organise and follow your interests!
• You have permission to create!
• Take collective responsibility for completing the task in the
timescale
• Collaborate, support and constructively challenge others
• Put yourself in other people’s shoes
• Bring and voice your own perspective – that is why you are
here!
• Let reflectors reflect!

38. #CMhack
We ask you to…
• Go with the flow and have faith in the process
• Unconference - self organise and follow your interests!
• You have permission to create!
• Take collective responsibility for completing the task in the
timescale
• Collaborate, support and constructively challenge others
• Put yourself in other people’s shoes
• Bring and voice your own perspective – that is why you are
here!
• Let reflectors reflect!

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TRIZ:
Theory of Inventive
Problem solving
Stopping
counter-productive
activities and
behaviours
“Every act of creation is first an act of destruction”
Pablo Picasso

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There have been many attempts to introduce
change models and frameworks

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There have been many attempts to introduce
change models and frameworks

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TRIZ: our schedule for the next 30
minutes
Step 1:
Make a list of
everything we
could reliably do to
create/promote a
change model or
framework that
never gets used for
any useful purpose
in our world of
health and care
Step 3:
Go through the
items on your
second list and
decide what first
steps will help us
stop what we know
creates undesirable
results?”
Step 2:
Go down this list item
by item & ask ‘Is there
anything that we are
currently doing that in
any way, shape or
form resembles this
item?’ Be brutally
honest to make a
second list of all our
counterproductive
activities & processes
TRIZ

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Our TRIZ topic…
How could we could reliably create/promote
a change model or framework that
NEVER gets used for any useful purpose in
our world of health and care?
TRIZ

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Step 1
As a table group make a list of “to-dos” on the
first paper sheet in answer to the question:
How could we could reliably create/promote
a change model or framework that NEVER
gets used for any useful purpose in our world
of health and care?
• Go wild!
• 10 minutes
TRIZ

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Step 2
As a table group, go down your first list and
ask:
‘Is there anything that we are currently
doing that in any way, shape or form
resembles any of the items on list one?’
• Make a second list on sheet 2
• Be unforgiving about these items and talk
about their impact
• 10 minutes
TRIZ

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Step 3
As a table group, go down your second list
from step 2 and ask:
“what are the first steps that will help us stop
getting undesirable results?”
• Make a list of actions on sheet 3
• Be prepared to share some of your content
from lists 2 and 3 with the wider group
• 10 minutes
TRIZ

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Lets have a warm up hack!
Who is this model for?
Who is our customer?

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Lets get hacking!
Two parallel hacks:
• Framework Hack: Big Picture
• Mini Hack: Elements & bright ideas

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Framework Hack: Big Picture
• Remit:
– Refreshed, revolutionary,
reimagined
– looks like a framework/model.
• Starting point is up to you
- Scrap the current model and start
afresh
- Start with the model and look
what is missing, what could be
improved
• Bring the frameworks together
to make one framework!

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Mini Hacks
• Remit:
– Depth
– Ideas and activities
• Examples of mini hacks:
– What is the detail under the elements? E.g. leadership
– How do you move from idea to reality? Story telling?
– What’s it going to be called?
– What’s it going to look like? Design?
• Pitch your hack A3 paper – and set up your stall!
• Ideas, synthesise and come up with some very useful things!

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Remember:
- Unconference
- Follow your interests
- Self organising
- Go for it!!!!

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Lets get hacking!
Two parallel hacks:
• Framework Hack: Big Picture
• Mini Hack: Elements & bright ideas

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Feedback
• Framework Hack: Big Picture
• Mini Hack: Elements & bright ideas

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Final Sprint: Two Hacks
1) Design team - refining the design of the model
2) Diffusion – spread of our new model

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Feedback
1) Design team - refining the design of the model
2) Diffusion – spread of our new model

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Review of the day….