Presentation on theme: "Leadership and culture for sustaining and spreading improvement Jean Penny."— Presentation transcript:
Leadership and culture for sustaining and spreading improvement Jean Penny
All working life in NHS Diagnostic Radiographer and teacher Improvement roles since 1994 BPR Leicester Royal Infirmary National Patients ‘Access Team NHS Modernisation Agency 2002 – 2005 NHS Institute for Innovation and Improvement Awarded OBE for services to NHS 2003 Visiting professor University of Derby 2008 Improvement: 19 years and still learning
“All models are wrong but some are useful” W Deming “A promise to learn A commitment to act” D Berwick
Recap Culture Sustainability Spread, adoption and social movements
Work with your team /colleagues: value differences Really understand the problem Develop aims and measures: What are you trying to achieve? Measure for improvement: How will you know a change is an improvement? Gather change ideas: What changes can you make that will result in the improvement you want? Test change ideas (PDSA cycles) before implementing and learn from things that do not work Link frontline changes to strategic objectives Share achievements and learning with others
is how things are done in the workplace is heavily influenced by shared unwritten rules Often reflects what has worked well in the past Think about the questions on culture
Unwritten rules are one of the most powerful parts of culture. They are described as 'unwritten' because they are: not often openly discussed rarely questioned or challenged because they are not frequently discussed usually shared by most, if not all, the people who work within the team / organisation provide a common way for people to make sense of what is going on around them often influence people without them necessarily realising it have a powerful influence on how people behave at work The Improvement Leaders' Guide to Building and Nurturing an Improvement Culture (2007) NHS Institute for Innovation and Improvement
Senior clinicians / managers know best Knowledge is power Everyone understands the jargon Only someone in my profession / role understand the problem Meetings constitute activity Filling in a form makes it happen It is wrong to be wrong....and wrong to admit to being wrong The Improvement Leaders' Guide to Building and Nurturing an Improvement Culture (2007) NHS Institute for Innovation and Improvement
Senior clinicians / managers know best Knowledge is power Everyone understands the jargon Only someone in my profession / role understand the problem Meetings constitute activity Filling in a form makes it happen It is wrong to be wrong....and wrong to admit to being wrong Discussion: What are the resulting behaviours as a result of these unwritten rules (behaviours are what you see, hear and feel)
Senior clinicians / managers know best Knowledge is power Everyone understands the jargon Only someone in my profession / role understand the problem Meetings constitute activity Filling in a form makes it happen It is wrong to be wrong....and wrong to admit to being wrong Discussion: What other unwritten rules does your team / organisation have? What are the resulting behaviours?
Find out about the values held Identify as many behaviours as you can. Look and listen dress codes: uniforms, identity symbols level of formality: in relationships and social events working hours: balance between work and family meetings: how often, how they are run, how long they last decision-making: how is this done? communication: jargon, how do you get to know about things? rites rituals and traditions what always happens and what never happens? disagreements and conflicts: how are they handled? Compare the stated values and behaviours Search for the unwritten rules that might account for the apparent discrepancy between the stated values and the behaviours Decide which unwritten rules matter Understand the background to the unwritten rules: how did they come into being and why do they persist The Improvement Leaders' Guide to Building and Nurturing an Improvement Culture (2007) NHS Institute for Innovation and Improvement
Patient centeredness Belief in human potential Improvement and innovation encouraged Recognition in the value of learning Effective team working Communication Honesty and trust The Improvement Leaders' Guide to Building and Nurturing an Improvement Culture (2007) NHS Institute for Innovation and Improvement
The improvement itself and any changes in practice OR Continuous improvement and a commitment to finding a better way of working – a culture change Complexity of sustaining healthcare improvements: what have we learned so far (2004) NHS Modernisation Agency, Research into Practice report 13
Sustainability is the ability to withstand variation and evolve alongside other changes Sustainability is when new ways of working and improved outcomes become the norm not only have the process and outcome changed but the thinking and attitudes behind them are fundamentally altered and the systems surrounding them are transformed in support.
Think about your improvement work and consider the factors of sustainability Where are your strengths? What areas do you need to work on?
Leadership People who influence (at all levels) Support at senior level Ownership of initiative Effective relationships (multi-professional) Staff engagement Incentives Readiness of improvement Local context Nature of initiative Evidence of improvements Process of implementation Integration into practice Dedicates resources Note: No rank order Relative importance of each factor varies from one initiative to another The New Improvement Wheel (2005) NHS Modernisation Agency Research into Practice report 14
Spread means that the learning that takes place in one area is actively shared and acted upon others i.e. that others have adopted Spread indicates ‘push’ Adoption indicates ‘pull’
Solution / change in organisation A Change principle Solution / change in organisation B
The concept of resistance to change is negative and emotionally draining We all change naturally; at our own pace with our own rationale Don’t speak of ‘us’ and ‘them’ ◦ consider the ‘What’s in it for me’ factor Spread can be better understood through ‘attractors’ How can I make my change more naturally attractive to others?
Innovators Early Adopters Early Majority Late Majority Laggards Rogers E (2003) Diffusion of Innovations 5 th ed New York: Free Press 2.5%13.5%34% 16% Roger’s adopter categories are based on studies of when an individual adopted a specific innovation Nearly everyone is a “laggard” at some time; with a very rational reason!
Relative advantage ◦ How clear and how much is this new idea/practice better then current situation? Compatibility ◦ How closely does new idea/practice reflect beliefs and values of potential adopter(s)? Complexity ◦ How easy is it to understand the new practice/idea? Communicability ◦ How easily can it be shared with others? Observability ◦ How visible is the new practice or idea and its results? Trailability ◦ How easy is it to test the new idea? Reversibility ◦ How easily can the potential adopter revert to the old ways? Uncertainty ◦ How certain can an potential adopter be of positive results from the change? Fraser S (2002) Accelerating the spread of good practice, Kingsham Press UK
Core Characteristics Energy Mass Passion Commitment Pace & momentum Spread Longevity NHSI The power of one the power of many m_joomcart&Itemid=194&main_page=document_ product_info&products_id=580 A social movement is a voluntary collective of individuals committed to promoting or resisting change through a co- ordinated activity to produce a lasting and self –generating effect and creating as they do a shared sense of identity
1. Frame to connect with hearts and minds To connect with ideals, needs, values and aspirations 2. Energise and mobilise Engagement to commitment to mobilisation 3. Organise for impact To translate energy and passion into purposeful effective action 4. Change as a personal mission Need every member to believe that their contribution no matter how big or small will make a difference 5. Keep forward momentum Momentum = unstoppable = sustainability Martin Luther King said ‘I have a dream’ He did not say ‘I have a strategic plan’
Traditional programmatic approach A planned programme of change with goals and milestones Centrally led Talks about motivating people Change done to people or with them – leaders and followers Driven by formal systems Movement approach Change is about releasing energy Largely self directing and bottom up Talks about moving people People change themselves and each other – peer to peer Driven by informal social networks systems Need both according to the objective and context
Think quietly by your self for a few minutes Then find two others and share
What are you trying to accomplish? How will you know that a change is an improvement What changes can you make that will result in an improvement? Model for Improvement ActPlan StudyDo Understanding the problem. Knowing what you’re trying to do - clear and desirable aims and objectives Measuring processes and outcomes What have others done? What hunches do we have? What can we learn as we go along? Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009), The improvement guide: a practical approach to enhancing organizational performance 2 nd ed, Jossey Bass Publishers, San Francisco
34 1. Set Direction: Mission, Vision and Strategy Make the status quo uncomfortable Make the future attractive 3. Build Will Plan for improvement Set aims/allocate resources Measure system performance Provide encouragement Make financial linkages Learn subject matter 5. Execute Change Use Model for Improvement for design and redesign Review and guide key initiatives Spread ideas Communicate results Sustain improved levels of performance 4. Generate Ideas Understand organisation as a system Read and scan widely, learning from other industries and disciplines Benchmark to find ideas Listen to patients Invest in research and development Manage knowledge 2. Establish the Foundation Prepare personally Choose and align the senior team Build relationships Develop future leaders Reframe operating values Build improvement capability Source: Robert Lloyd Executive Director Performance Improvement Institute for Healthcare Improvement January 16, 2007