Helen Bevan Chief Transformation Officer February 20 2015 @HelenBevan #qf15

For those of you who attended the Some learning reinforcement after a short space of time helps to retain learning Casebourne I (2015) Spaced Learning: An Approach to Minimize the Forgetting Curve https://www.td.org/Publications/Blogs/Science-of-Learning-Blog/2015/01/Spaced-Learning-an-Approach-to-Minimize-the-Forgetting-Curve

can’t cross a chasm in small steps” David The ideas in this presentation come from a new kind of improvement team: the Horizons Group within NHS IQ Aim of the group: to stimulate new and ‘disruptive’ approaches in support of health and care transformation, operating at the edge of current thinking and practice: skipping a generation of thinking about how to create radical, system-wide change skipping a generation in a wider level of connection: working with emerging leaders, clinical trainees, students skipping a generation of methods for change: open innovation, open source, digital connection, social media, change platforms, hacking “You can’t cross a chasm in small steps” David Lloyd George

“ The greatest danger in times of turbulence is not the turbulence……. The mindset of the past has a tendency to hijack the transformational potential of the future “ The greatest danger in times of turbulence is not the turbulence……. it is to act with yesterday’s logic Peter Drucker

“ History, even if properly construed, can blind us to important possibilities.  After all, it is not the rhythms of the past that define us, but our dreams for the future Greg Satell http://www.digitaltonto.com/2014/are-you-using-data-to-analyze-the-past-or-to-create-a-new-future/

SEISMIC SHIFTS

SEISMIC SHIFTS DIGITAL CONNECTION

SEISMIC SHIFTS DIGITAL CONNECTION Work complexity

SEISMIC SHIFTS DIGITAL CONNECTION Work complexity Hierarchical power

SEISMIC SHIFTS Work complexity DIGITAL CONNECTION Hierarchical power Change from the edge Hierarchical power

Leading change in a new era Dominant approach Emerging direction

Leading change in a new era Dominant approach Emerging direction Most healthcare transformation efforts are driven from this side

‘ Some warnings The organizations that survive the future will be those that are capable of changing as fast as change itself Gary Hamel ’

Curate rather than create knowledge for improvement Source of image: John Curran designedforlearning.co.uk

Because there’s a problem…. Getting information off the internet is like taking a drink from a fire hydrant Mitchell Kapor Source of quote: Harold Jarche Source of image:http://gotcll.com/about-2/ @@HelenBevan #Quality2014 #f1 @@HelenBevan #Quality2014

How do we know what to learn and absorb? Source of image: Frits Ahlefeldt

A big challenge for improvement leaders Tacit knowledge is where the action is…. It’s the people with tacit knowledge who deliver the results Tacit knowledge is critical for large scale change ...but The only way tacit knowledge can be broadly shared… …is to turn it into explicit knowledge VERY difficult Few organisations succeed Gray D (2012) The Connected Company Source: Harold Jarche

What is the best way to spread new knowledge? Social connection/discussion is 14 times more effective than written word/ best practice databases/toolkits etc Source of data: Nick Milton www.nickmilton.com/2/2tOjE Source of image: happiness-one-quote-time.blogspot.com

Curating knowledge Finding things out and keeping up to date “pulling” information, but also having it “pushed” to us by trusted sources Making sense and meaning of information Reflecting and putting into practice what we have learned Plugging information into our own mental models and turning it into knowledge Connecting and collaborating Sharing complex knowledge with our own work teams Testing new ideas with our own networks Increasing connections through social networks Source: Harold Jarche

Moving to the edge In the near future, the edges will be where almost all high-value work will be done in organizations……. Organizational development and change management need to move to the edges, and quickly. Harold Jarche

What are the biggest opportunities for change agents in our system? As bridge builders between disconnected groups As curators and sharers of knowledge

Improvement teams will move from “bench scientists” (programme managers) to knowledge leaders and connectors http://connect.forwardmetrics.com/business-management/the-strength-within.html

Less change programmes More change platforms utilise systematic “change management” approaches Too often, leaders prescribe the outcome and the method of change in a top-down way change is experienced by people at the front line as “have to” (imposed) rather than “want to” (embraced) Change Platforms enable everyone in the organisation/system (including service users) to help tackle the most challenging issues value diversity of thought leadership attention on creating an environment receptive to transformational change http://www.hsj.co.uk/resource-centre/scrap-the-programme-successful-change-starts-with-a-change-platform/5078014.article?blocktitle=Blogs-and-videos&contentID=16031

What are the implications regarding performance goals?

WHY were performance targets introduced? Public institutions were unwieldy, inefficient, with limited accountability Measures that did exist were mostly ad hoc and unsystematic Reformers had virtuous intentions Measurement based on specific quantified targets is easier than the alternatives

Compliance Commitment How are we leading? 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 Source: Helen Bevan

focus on meaning also get compliance, Leaders who focus on meaning also get compliance, without focusing on it @JeremyScrivens

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

Purpose Obfuscation O-meter @SimonJGuilfoyle Police Inspector and systems thinker

Police @SimonJGuilfoyle Police Inspector and systems thinker

Education

Healthcare @SimonJGuilfoyle Police Inspector and systems thinker

The future The numerical goals are meaningful (intrinsic motivation) Linked with shared purpose, not de facto purpose An investment in measurement capability The right performance indicators are selected in the first place Understanding of naturally occurring variation within the performance data produced Measurement for improvement, not just judgement 7. A wider systematic approach to measurement and change where metrics are aligned Source of image: salesshq.monster.com

....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

“Ultimately, the secret of quality is love “Ultimately, the secret of quality is love. …… If you have love, you can then work backward to monitor and improve the system”. Avedis Donabedian

Tactic for success: Source of image: Bradley Burgess

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 Source of image: rachelstivers.com

Identify your own opportunities to move to the edge Think about how to ignite the disruptive innovators in your midst Connect this to your pledge for Change Day BC Consider how you can enable change at a faster rate than the outside world