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#NHSChangeDay #Quality 2014 #M5 “Seeing” as a health and care radical Ability to make sense of, and reshape.

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Presentation on theme: "#NHSChangeDay #Quality 2014 #M5 “Seeing” as a health and care radical Ability to make sense of, and reshape."— Presentation transcript:

1 #NHSChangeDay #Quality 2014 #M5 “Seeing” as a health and care radical Ability to make sense of, and reshape perceptions of ‘reality’

2 #NHSChangeDay #Quality 2014 #M5 ‘En este muno traidor No hay verdad ni mentira, Que todo esta en el color Del cristal con que se mira’ In this world of many mazes There is nothing false or true: All depends upon the hue Of the glass through which one gazes (Sixteenth-century Spanish quatrain)

3 #NHSChangeDay #Quality 2014 #M5 Seeing “Seeing, looking, monitoring, listening, perceiving and especially the indefinite concept of intuitive feeling ” Aubrey Jango

4 #NHSChangeDay #Quality 2014 #M5 Task Have a table discussion: What are some of the different ways of “seeing” change?

5 #NHSChangeDay #Quality 2014 #M5 What do we mean by resistance to change?

6 #NHSChangeDay #Quality 2014 #M5 Source of image: sport-fitness-advisor.com Any force that stops or slows movement Resistance

7 #NHSChangeDay #Quality 2014 #M5 Employee resistance is the most common reason executives cite for the failure of big organizational-change efforts Scott Keller and Colin Price (2011), Beyond Performance: How Great Organizations Build Ultimate Competitive Advantage Source of image: Businessconjunctions.com

8 #NHSChangeDay #Quality 2014 #M5 Change can either challenge or threaten us……. Your beliefs pave your way to success or block you Marsha Sinetar Source of image: Creatememe.chucklesnetwork.com

9 #NHSChangeDay #Quality 2014 #M5 Diagnostic and dialogic approaches to resistance to change

10 #NHSChangeDay #Quality 2014 #M5 Change is something that happens “out there” in the organisation or system Resistance is a force to overcome Resistance prevents change Change agents must diagnose, manage and/or overcome resistance Resisters may be otherwise known as “laggards”, “blockers”, “in denial” Resistance: a “diagnostic” approach

11 #NHSChangeDay #Quality 2014 #M5 Resistance to change

12 #NHSChangeDay #Quality 2014 #M5 “The role of the change agent is to recognise the causes of resistance and address each one. If this is not done, then the change will be much harder to implement successfully and may not succeed at all” David Stonehouse The change agent: the manager’s role in change British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp Vol. 19, Iss. 9 Diagnostic: the role of the change agent

13 #NHSChangeDay #Quality 2014 #M5 People make their own reality Change results from transformational conversations  involving more and different people in change discussions  altering how and which people engage with each other  by stimulating different perspectives to shape how people think about things Resistance is an inevitable consequence of a complex change process (based on diversity) Resistance should be embraced and worked with Resistance: a “dialogic” approach

14 #NHSChangeDay #Quality 2014 #M5 1.Create the conditions for transformational conversations by asking questions that are focussed on future possibilities, by inviting diversity into the system, and by being welcoming 2.Creat­e opportunities for everyone to express their views, spot opportunities and build on each other’s ideas 3.Create ways for people to reflect together to find meaning, understanding and shared purpose in the change Source: Peggy Holman Dialogic: the role of the change agent

15 #NHSChangeDay #Quality 2014 #M5 “The most basic not-so-secret formula for building an innovation culture is pretty simple - embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities. Do this before you start hiring consultants and rethinking your innovation process, there is no process that works without true diversity.” Idris Moore Source of image: idsgn.org Diversity is critical to innovation and change

16 #NHSChangeDay #Quality 2014 #M5 “Leaders and organisations must let go of the idea that there is “one right way” and instead focus on creating a learning culture where people feel accepted, are comfortable contributing ideas, and actively seek to learn from each other” Diaz_Uda, Medina and Schill (2013) Source of image:fineartamerica.com Health and care radicals should be champions of diversity for change

17 #NHSChangeDay #Quality 2014 #M5 In the context of “rolling with resistance” What are the implications of embracing diversity of thought, experience and background in our change efforts? What skills and perspectives do health and care radicals need to work effectively with diverse teams for change? Source of image:fineartamerica.com Discussion

18 #NHSChangeDay #Quality 2014 #M5 The effectiveness of change agents is not a matter of intention; it’s a matter of impact

19 #NHSChangeDay #Quality 2014 #M5 Helen’s intent was to give people quick solutions, help them do their work faster and get on to the next problem at hand However, her impact was that people did not know how to solve their own problems so that Helen’s style was impeding their development Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee Source of image: thedigitalawards.com

20 #NHSChangeDay #Quality 2014 #M5 Stop talking AT ME Start talking TO ME Source of image: prepbeijing.com

21 #NHSChangeDay #Quality 2014 #M5 Build a trusting and supportive work environment Listen with an open heart and open mind Commit to the change 100% Seek common purpose and common interests Take time to build relationships Be open with my intent Take responsibility for my own actions What should I do to manage intent and impact?

22 #NHSChangeDay #Quality 2014 #M5

23 #NHSChangeDay #Quality 2014 #M5 If your horse dies, get off it Cherokee proverb Source of image: fenwickgallery.co.uk

24 #NHSChangeDay #Quality 2014 #M5 Have a discussion with others at your table: How can I manage my intent and impact? Task

25 #NHSChangeDay #Quality 2014 #M5

26 #NHSChangeDay #Quality 2014 #M5 “Stages of change” Transtheoretical model of behaviour change Prochaska, DiClemente & Norcross (1992)

27 #NHSChangeDay #Quality 2014 #M5 The model is mostly used around health-related behaviours smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake domestic violence HIV prevention use of sunscreens to prevent skin cancer medication compliance mammography screening

28 #NHSChangeDay #Quality 2014 #M5 The model is mostly used around health-related behaviours smoking cessation exercise adoption alcohol and drug use weight control fruit and vegetable intake domestic violence HIV prevention use of sunscreens to prevent skin cancer medication compliance mammography screening It works for organisational and service change too!

29 #NHSChangeDay #Quality 2014 #M5 “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit Prochaska, DiClemente & Norcross (1992)

30 #NHSChangeDay #Quality 2014 #M5 “Stages of change” Smoking I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet Prochaska, DiClemente & Norcross (1992)

31 #NHSChangeDay #Quality 2014 #M5 I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)

32 #NHSChangeDay #Quality 2014 #M5 I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)

33 #NHSChangeDay #Quality 2014 #M5 I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! I am continuing to not smoke. I sometimes miss it – but I am still not smoking “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)

34 #NHSChangeDay #Quality 2014 #M5 I am not aware my smoking is a problem – I have no intention to quit I know my smoking is a problem – I want to stop but no plans yet I am making plans & changing things I do in preparation. I have stopped smoking! I am continuing to not smoke. I sometimes miss it – but I am still not smoking “Stages of change” Smoking Prochaska, DiClemente & Norcross (1992)

35 #NHSChangeDay #Quality 2014 #M5 Prochaska, DiClemente & Norcross (1992) “Stages of change” Transtheoretical model of behaviour change

36 #NHSChangeDay #Quality 2014 #M5 Which stage do most change activities in health and care focus on? Which stage are most people actually at? Some questions

37 #NHSChangeDay #Quality 2014 #M5 The reality of our change situation Our tools are often not effective at the stage of change that most people we work with are at It’s hard to engage people in change It’s hard to get people to make the changes we want them to make People get irritated, defensive, irrational We feel powerless in our ability to lead or facilitate the change 90% of the tools available for health and care change agents are designed for the “action” stage

38 #NHSChangeDay #SHCRchat Designed for Stage 4 – ACTION! Mandated it through targets Despite compelling case for change – people resisted it – no values connection People did the task and missed the point Example - Surgical Checklist

39 #NHSChangeDay #Quality 2014 #M5 Lower our ambitions for improvement Focus our energies on those who are already in the “action” stage Put negative labels on those who are not yet at the action stage such as “blocker” or “resister” or “laggard” Blame “the management” for not enforcing change So what do we TEND to do?

40 #NHSChangeDay #Quality 2014 #M5 The single biggest problem in communication is the illusion that it has taken place George Bernard Shaw

41 #NHSChangeDay #Quality 2014 #M5 Listen and understand  appreciate the starting point  elaborate interests Build meaning and conviction in the change Roll with resistance (Singh)  Don’t argue against it  Encourage elaboration of resistance What makes it so hard? What would help? Build shared purpose So what SHOULD we do?

42 #NHSChangeDay #Quality 2014 #M5 The focus should be on creating awareness for me of the need to change Remember the goal is not to make me (as a precontemplator) change immediately, but to help me move to contemplation Example from the worksheet I am not thinking about changing my behaviours, actions or work processes The problem or issue is outside my frame of awareness or my perceived need

43 #NHSChangeDay #Quality 2014 #M5 Focussing on Prochaska, DiClemente and Norcross’s Stages of Change model: What stage of change are some of the key people that you need to influence for your change initiative at? What actions can you take to help them move to the next stage? Reflection

44 #NHSChangeDay #Quality 2014 #M5 “Seeing” as a health and care radical The big picture Multiple perspectives The positive intentions of others Possibility of bad change processes rather than resistors, blockers and laggards Hopeful futures, creative opportunities and potential Multiple paradigms for change (eg, diagnostic and dialogic) See myself in the context of my higher purpose

45 #NHSChangeDay #Quality 2014 #M5 “Doing” as a health and care radical Skills and methods for creating change

46 @HelenBevan #Quality 2014 #M5 Most large scale change doesn’t fully deliver its objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey Gets anywhere near achieving the change and delivering @JackieLynton #Quality 2014 #M5

47 Most large scale change doesn’t fully deliver its objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey Delivers and sustains the change

48 @HelenBevan #Quality 2014 #M5 Image

49 @HelenBevan #Quality 2014 #M5 Image

50 @HelenBevan #Quality 2014 #M5 It is our contention that most change efforts are built upon the shaky foundation of five flawed assumptions; that change can be managed, that human beings are objective, that there are ‘X’ steps to change, that we have a neutral starting point for change, and that change, itself, is the goal Peter Fuda bootstrap/content/Why-Change-Efforts-Fail.pdf Source of image: Whatsthebigideascwartzy.blogspot.com

51 @HelenBevan #Quality 2014 #M5 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

52 @HelenBevan #Quality 2014 #M5 Leaders as “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, 2009

53 @HelenBevan #Quality 2014 #M5 Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on Increasing number of messages as information cascade through the organisation Source: adapted from don.aspx don.aspx

54 @HelenBevan #Quality 2014 #M5 Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on Increasing number of messages as information cascade through the organisation Source: adapted from don.aspx don.aspx Buy in from front line staff is critical for improvements in quality and safety. Don’t overload them Buy in from front line staff is critical for improvements in quality and safety Don’t overload them dangers-of-quality-improvement-overload-insights- from-the-field/

55 @HelenBevan #Quality 2014 #M5 Typically, around any change effort, there is an initial spike of tangible energy, and change, but when leadership loses interest, the momentum of change slows down drastically.” Tara Paluck

56 @HelenBevan #Quality 2014 #M5 Ten key principles of large scale change 1.Movement towards a new vision that is better and fundamentally different from the status quo 2.Identification and communication of key themes that people can relate to and that will make a big difference 3.Multiples of things (‘lots of lots’) 4.Framing the issues in ways that engage and mobilise the imagination, energy and will of a large number of diverse stakeholders in order to create a shift in the balance of power and distribute the leadership 5.Mutually reinforcing change across multiple processes/subsystems

57 @HelenBevan #Quality 2014 #M5 6.Continually refreshing the story and attracting new, active supporters 7.Emergent planning and design, based on monitoring progress and adapting as you go 8.Many people contribute to the leadership of change, beyond organisational boundaries 9.Transforming mindsets, leading to inherently sustainable change 10.Maintaining and refreshing the leaders’ energy over the long haul Ten key principles of large scale change

58 @HelenBevan #Quality 2014 #M5 Intrinsic motivation People engage in the activity for the pleasure and satisfaction of doing it Invokes many positive behaviours Extrinsic motivation People engage in the activity for the rewards or avoiding punishment Any external influence is referred to as extrinsic motivation Source: and-supporter-of-intrinsic-development

59 @HelenBevan #Quality 2014 #M5 Transformation is not a matter of intent it is a matter of alignment Peter Fuda

60 @HelenBevan #Quality 2014 #M5 You get the best effort from others not by lighting a fire beneath them, but by building a fire within Bob Nelson

61 @HelenBevan #Quality 2014 #M5 “Take your passion and make it happen” Source of image:

62 @HelenBevan #Quality 2014 #M5 Discussion Reflecting on your change process: how have you built both intrinsic and extrinsic motivators of change into your efforts? How have you managed the tension between the two? Any advice for other change agents on how to align intrinsic and extrinsic motivators?

63 @HelenBevan #Quality 2014 #M5 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

64 @HelenBevan #Quality 2014 #M5 Research shows that more than almost any other factor affecting an organisation, organisational energy can lead to either a wellspring of corporate vitality or the destruction of its very core Source: Bruch and Vogel

65 @HelenBevan #Quality 2014 #M5 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%

66 @HelenBevan #Quality 2014 #M5

67 the capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals Psychological Physical Spiritual SocialIntellectual Energy for change is:

68 @HelenBevan #Quality 2014 #M5 Five energies for change

69 @HelenBevan #Quality 2014 #M5 High and low ends of each energy domain LowHigh Socialisolatedsolidarity Spiritualuncommittedhigher purpose Psychologicalriskysafe Physicalfatiguevitality IntellectualIllogicalreason

70 #Quality2013 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? Energy for change profile

71 @HelenBevan #Quality 2014 #M5 Team 1: what’s your assessment of their energy for change?

72 @HelenBevan #Quality 2014 #M5 Team 1: what’s your assessment of their energy for change? 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

73 @HelenBevan #Quality 2014 #M5 Team 2: what’s your assessment of their energy for change?

74 @HelenBevan #Quality 2014 #M5 Team 2: what’s your assessment of their energy for change? 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

75 @HelenBevan #Quality 2014 #M5 There has never been a time in the history of healthcare when this advice has been more pertinent “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

76 @HelenBevan #Quality 2014 #M5 “You can’t impose anything on anyone and expect them to be committed to it” Edgar Schein, Professor Emeritus MIT Sloan School

77 @HelenBevan #Quality 2014 #M5 Source: Helen Bevan Compliance States a minimum performance standard that everyone must achieve Uses hierarchy, systems and standard procedures for co- ordination and control Threat of penalties/ sanctions/ shame creates momentum for delivery What is our approach to change? Commitment States a collective goal that everyone can aspire to Based on shared goals, values and sense of purpose for co- ordination and control Commitment to a common purpose creates energy for delivery

78 @HelenBevan #Quality 2014 #M5 Shared purpose aligns..... Shared purpose allows many communities to engage with us without us having to invest resources in controlling their actions Nilofer Merchant

79 @HelenBevan #Quality 2014 #M5 We know that... Shared purpose is a common thread in successful change programmes* Organisations and change initiatives with strong shared purpose consistently outperform those without it.** *What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute) **Management Agenda 2013 Boury et al (Roffey Park Institute)

80 @HelenBevan #Quality 2014 #M5 A @JackieLynton #Quality 2014 #M5

81 [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. @JackieLynton #Quality 2014 #M5

82 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

83 @HelenBevan #Quality 2014 #M5 Police Inspector and systems thinker

84 @HelenBevan #Quality 2014 #M5 Purpose Obfuscation O-meter Police Inspector and systems thinker

85 @HelenBevan #Quality 2014 #M5 Police Police Inspector and systems thinker

86 @HelenBevan #Quality 2014 #M5 Education Police Inspector and systems thinker

87 @HelenBevan #Quality 2014 #M5 Healthcare Police Inspector and systems thinker

88 @HelenBevan #Quality 2014 #M5....the last era of management was about how much performance we could extract from people.....the next is all about how much humanity we can inspire Dov Seidman

89 #NHSChangeDay #Quality 2014 #M5 “Doing” as a health and care radical Create the conditions where everyone can contribute and do their best Join forces with others to create action Achieve small wins which create a sense of hope, self-efficacy and confidence Appeal to both the head (logic/planning/data) and the heart (shared values/purpose, framing, relationships) Make change (and learning cycles from change) routine rather than an exceptional activity Use models, theories and frameworks effectively

90 #NHSChangeDay #Quality 2014 #M5 ‘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

91 @helenbevan We have a choice “This is the true joy of life, the being used up for a purpose recognised by yourself as a mighty one, being a force of nature instead of a feverish, selfish little clot of ailments and grievances, complaining that the world will not devote itself to making you happy.” George Bernard Shaw

92 #NHSChangeDay #Quality 2014 #M5 Helen Bevan Chief Transformation Officer, NHS Improving #Quality April 2014


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