@helenbevan Burning ambition – meeting the challenges ADASS/SCIE seminar Leading through turbulence 11 January 2013 Helen #NHSchange

@helenbevan How to turbocharge healthcare improvement Energy, more than any other factor, makes the difference between improvement activities that are sustained for the long term and those that fizzle out. Energy fuels high performance. In this workshop, Helen Bevan will show you powerful methods to unleash the latent energy for change from within your organisation to increase the pace and scale of improvement. Session Objectives Learn why energy is a critical topic in leading improvement. Liberate the natural energy and vitality of the workforce and service users for the cause of high quality care. Take home a set of useful models and frameworks for understanding, analysing and building energy for change.

@helenbevan Most large scale change fails to achieve its objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey

@helenbevan 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

@helenbevan Anatomy of changePhysiology of change Definition The shape and processes of the system; detailed analysis; how the components fit together. The vitality and life-giving forces that enable the system and its people to develop, grow and change. Focus Processes and structures to deliver health and healthcare Energy/fuel for change Leadership activities  measurement and evidence  improving clinical systems  reducing waste and variation in healthcare processes  redesigning pathways  creating a higher purpose and deeper meaning for the change process  building commitment to change  connecting with values  creating hope and optimism about the future  calling to action Source: Crump and Bevan

@helenbevan Anatomy of changePhysiology of change Definition The shape and processes of the system; detailed analysis; how the components fit together. The vitality and life-giving forces that enable the system and its people to develop, grow and change. Focus Processes and structures to deliver health and healthcare Energy/fuel for change Leadership activities  measurement and evidence  improving clinical systems  reducing waste and variation in healthcare processes  redesigning pathways  creating a higher purpose and deeper meaning for the change process  building commitment to change  connecting with values  creating hope and optimism about the future  calling to action Source: Crump and Bevan

@helenbevan Anatomy of changePhysiology of change Definition The shape and processes of the system; detailed analysis; how the components fit together. The vitality and life-giving forces that enable the system and its people to develop, grow and change. Focus Processes and structures to deliver health and healthcare Energy/fuel for change Leadership activities  measurement and evidence  improving clinical systems  reducing waste and variation in healthcare processes  redesigning pathways  creating a higher purpose and deeper meaning for the change process  building commitment to change  connecting with values  creating hope and optimism about the future  calling to action Source: Crump and Bevan

@helenbevan Intrinsic motivators build energy and creativity

@helenbevan Intrinsic motivators connecting to shared purpose engaging, mobilising and calling to action motivational leadership build energy and creativity

@helenbevan Intrinsic motivators connecting to shared purpose engaging, mobilising and calling to action motivational leadership build energy and creativity create focus & momentum for delivery Drivers of extrinsic motivation

@helenbevan 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

@helenbevan 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

@helenbevan Transformation is not a matter of intent it is a matter of alignment Peter Fuda

@helenbevan NHS Change Model

@helenbevan NHS Change Model Why is energy for change important?

@helenbevan burning platform versus burning

@helenbevan

Lessons for transformational change 1.In order to sustain transformational change, we as leaders need to move from a burning platform (fear based urgency) to a burning ambition (shared purpose for a better future) 2.We as leaders need to articulate personal reasons for change as well as organisational reasons 3.If the fire (the energy) goes out, all other factors are

@helenbevan You get the best efforts from others not by lighting a fire beneath them but by building Source: Bob Nelson

@helenbevan

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:

@helenbevan The five energies

@helenbevan High and low ends of each energy domain LowHigh Socialisolatedsolidarity Spiritualuncommittedhigher purpose Psychologicalriskysafe Physicalfatiguevitality IntellectualIllogicalreason

@helenbevan Key conclusions from our work so far Psychological energy is central Dispersed leadership model Explanation not judgement Making explicit the issues that remain hidden/unarticulated and that really impact on team performance and achievement of improvement goals Psychological Physical Spiritual SocialIntellectual

@helenbevan Social energy Depleted by Apathy Isolation Disconnection Lack of connection Emotional awareness Authenticity Engagement Empathy Autonomy Enhanced by Social energy is the energy of personal engagement, relationships and connections between people Psychological Physical Spiritual social Intellectual

@helenbevan Spiritual energy Depleted by Coercion Ignoring spirit in a crisis Disbelief in purpose Conflicts with values Purpose Clarity of vision Co - invention Integrity Passion Commitment Enhanced by Spiritual energy is the energy of commitment to a common vision for the future, driven by shared values and a higher purpose Psychological Physical Spiritual Emotional Intellectual

@helenbevan Psychological energy Depleted by Fear Setbacks Apathy Lack of trust Weariness Awareness Confidence Safe, secure environment Purpose Role - models Motivation Enhanced by Psychological energy is the energy of courage, trust and feeling safe to do things differently Physical Psychological Physical Spiritual Emotional Intellectual

@helenbevan Physical energy Healthy, supportive work environment Appropriate workload Regular renewal Enhanced by Stress through overwork Apathy Disconnection Depleted by Physical energy is the energy of action, getting things done and making progress Psychological Physical Spiritual Emotional Intellectual

@helenbevan Intellectual energy Depleted by Distractions Displacement activity Lack of discipline Being overworked Creativity Focus & alertness Learning Purpose Challenge Enhanced by Intellectual energy is the energy of curiosity, analysis, thinking and cognition Psychological Physical Spiritual Emotional Intellectual

@helenbevan The energy for change index The energy of any team or organisation – its capacity and drive to act and make the difference necessary to achieve its goals – determines its agility for change We have developed an online tool which is simple and rewarding as it provides an immediate insight into one’s own personal energy for change It is the first of a two-stage process for teams to identify areas that need a shift in focus in order to get wider engagement in change and faster action towards achieving it It is a powerful tool for organisations and teams undergoing perpetual change

@helenbevan Facilitated questions - examples 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 change goals? What would the optimal energy profile look like for our team? Physical Psychological Spiritual Social Intellectual Energy for change profile

@helenbevan The SSPPI Energy Index 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 around me ____ I am weary of change____ It feels risky to try out new approaches____ Prioritising various activities at work is tricky for me____ I believe I make a difference as part of this group____ I will be blamed if I try something new and it fails____ I feel isolated from others____ I trust in our direction of travel____ The argument for change enables me to prioritise activities at work____ 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 current state is more attractive to me than the future picture____ I feel that my values are compromised at work____ I think there is no rational argument for change____ I cannot make a difference as part of this group____ I believe there is a healthy pace to change____ Those around me are energised by the momentum of change____ Those around me have gained insight into the case for change____ Those around me feel a sense of solidarity with each other____ Those around me are weary of change____ Those around me feel its risky to try out new approaches____ Prioritising various activities at work is tricky for those around me____ Those around me believe they make a difference as part of this group____ Those around me will be blamed if they try something new and it fails____ Those around me feel isolated from others____ Those around me trust in our direction of travel____ The argument for change enables those around me to prioritise activities at work____ Those around me feel disconnected from others____ Those around me are committed to our common vision for the future____ Those around me feel safe enough to do things differently____ Those around me are driven by shared values____ Those around me are experiencing change fatigue____ The current state is more attractive to those around me than the future picture____ Those around me feel that their values are compromised at work____ Those around me think there is no rational argument for change____ Those around me cannot make a difference as part of this group____ Those around me believe there is a healthy pace to change____ My energyThe energy of those around me

@helenbevan Team 1 Physical Psychological Spiritual Social Intellectual

@helenbevan Team 1 Physical Psychological Spiritual Social Intellectual Team 1’s energy profile is characterised by an environment that has harnessed their 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

@helenbevan Team two Psychological Social Spiritual Physical Intellectual

@helenbevan Team two Psychological Social Spiritual Physical Intellectual Team 2 enables 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.

@helenbevan SSPPI - The five energy domains 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 around me is____ The importance of social energy to me is____ 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 around me 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 around me 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 around me is____ The importance of intellectual energy to me is____ Complete these statements on a scale of 1 = low - 5 = high 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 around me is____ The importance of spiritual energy to me is____

@helenbevan ProfilePreference Psych Physical Social Spiritual Intellectual = individual Profiles vs. preferences

@helenbevan Facilitated questions - examples Do we need to manage certain energies better (e.g. is social energy really important to the whole team, but poorly managed... is there is an over-emphasis on intellectual energy, which only satisfies two out of fifteen team members?). Do we have a bias towards a particular energy preference in our team? Should we look to future recruitment to help us create a more balanced team? Profile (score>3) Preference (score>3) Psych Physical Social Spiritual Intellectual = individual Profiles vs. preferences

@helenbevan An organisation can only realise its highest potential when each individual is fully valued and feels fully vested in a shared purpose The Energy Project

@helenbevan Discretionary effort is contractual is personal

@helenbevan [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 Garguilo

@helenbevan 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

@helenbevan What focus for our improvement projects? Source: 100 improvement projects on national improvement leadership programme October 2012

@helenbevan You get the best efforts from others not by lighting a fire beneath them but by building Source: Bob Nelson