C7/D7 Leading Large-Scale Change - H. Bevan
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Transcript of C7/D7 Leading Large-Scale Change - H. Bevan
© NHS Institute for Innovation and Improvement, 2009
Leading large scale change
Helen Bevan
© NHS Institute for Innovation and Improvement, 2009
© NHS Institute for Innovation and Improvement, 2009
Data on transformation efforts
• Only one in three transformation efforts hit the
ball out of the park
• Only one in twenty clear the car park as well
Source: McKinsey Performance Transformation Survey,
3000 respondents to global, multi-industry survey of
company executives
© NHS Institute for Innovation and Improvement, 2009
Risk assessment: why do large scale change efforts
fail?
• They get designed using the same mindset, beliefs and rules as
have been used before
• they get designed as top down, often structural, solutions rather
than transformation of complex adaptive systems
• lack of a holistic model or perspective which links components
together
• A “voltage drop” occurs between radical change aspirations and
the reality of implementation:
• organisations are neither capable of, nor ready for, the breadth
and depth of change
• operational and financial reality gets in the way of re-inventing the
system
© NHS Institute for Innovation and Improvement, 2009
Risk assessment: why do large scale change efforts
fail?• They fail to mobilise clinical and managerial leaders
• Lack of emotional engagement and alignment of
incentives with core values
• Scale and pace:
• it typically takes far longer than the planning horizons
of leaders
• diffusion approach does not go to plan - we are able to
generate change (“pilots”), but unable to generalise it
© NHS Institute for Innovation and Improvement, 2009
Risk assessment: why do large scale change efforts
fail?• They fail to mobilise clinical and managerial leaders
• Lack of emotional engagement and alignment of
incentives with core values
• Scale and pace:
• it typically takes far longer than the planning horizons
of leaders
• diffusion approach does not go to plan - we are able to
generate change (“pilots”), but unable to generalise it
In around 80% of cases, failure can be traced back to the
early stages: change programmes are most likely to go
wrong as a result of the way they are initially
conceptualised and planned
© NHS Institute for Innovation and Improvement, 2009
“Revolution begins with
transformation of
consciousness”Paul Bate
© NHS Institute for Innovation and Improvement, 2009
Different thinking for different results
First order change
More of, or less of… the same thing
© NHS Institute for Innovation and Improvement, 2009
Different thinking for different results
First order change
More of, or less of… the same thing
across the board budget
reductions
cost improvement goals are
separate from quality
improvement goals and are
of primary importance
make the current system
“leaner” and less wasteful
assess and understand
performance
work harder
capture data
© NHS Institute for Innovation and Improvement, 2009
Different thinking for different results
First order change
tighter control and scrutiny; management grip
across the board budget
reductions
cost improvement goals are
separate from quality
improvement goals and are
of primary importance
make the current system
“leaner” and less wasteful
assess and understand
performance
work harder
capture data
© NHS Institute for Innovation and Improvement, 2009
Stand back…........Reframe…...See the big picture…
Different thinking for different results
Second order change
© NHS Institute for Innovation and Improvement, 2009
Stand back…........Reframe…...See the big picture…
Different thinking for different results
Second order change unwarranted variation is driven out
across the system
productivity and cost improvement
goals are a subset of quality and
patient goals
build meaning and understanding of
the need for change, connected to
higher purpose and NHS values
build commitment to take action across
the organisation and the wider system
create the capacity and capability for
change
© NHS Institute for Innovation and Improvement, 2009
Different thinking for different results
Second order change unwarranted variation is driven out
across the system
productivity and cost improvement
goals are a subset of quality and
patient goals
build meaning and understanding of
the need for change, connected to
higher purpose and NHS values
build commitment to take action across
the organisation and the wider system
create the capacity and capability for
change
Call to action to secure the future
© NHS Institute for Innovation and Improvement, 2009
The large scale change model
• “All models are wrong, some
models are useful” George E. P. Box, Statistician, UK, 1919-
• Practically speaking, how it tends to
goBased on case study evidence from a variety of
fields and settings
© NHS Institute for Innovation and Improvement, 2009
How large scale change happens in reality:
• There is a sufficiently well-defined topic area that people can
connect with
… on which there is a sufficient mix of pressure, will, incentive,
attraction, consequences, etc
… that it felt, by a small, but large-enough, group of people …
… who find some means to exert some influences …
… over systems at multiple levels (e.g. service delivery, hand-
over processes, clinical decision-making, finance flow, public
opinion, policy, etc) …
… to initiate some changes in a sufficiently effective and visible
way
• This pattern of framing/re-framing, engaging others, and initiating
changes at multiple levels repeats many times, in hard-to-predict
ways
© NHS Institute for Innovation and Improvement, 2009
How large scale change happens in reality:
• Momentum is created by the appearance of success
… that is communicated widely enough ---
… to attract others who were previously neutral to join in actively in the process of change …
… thereby creating another cycle of framing/re-framing, engaging others, and initiating changes at multiple levels
• This momentum then continues for some time until either :
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
© NHS Institute for Innovation and Improvement, 2009
How large scale change happens in reality:
• The actual, full, measured results and unintended consequences from a true large scale change are often not known until some time into the future,
therefore, throughout most of the process of large scale change a certain amount of faith, intuition, judgement, and proceeding forward on incomplete evidence is inevitable
© NHS Institute for Innovation and Improvement, 2009
Our model of LSC
.
Identifying
need for
change
Framing/
reframing
the
issues
Engaging/
connecting
others
Making
pragmatic
change in
multiple
processesAttracting
further interest
After some
timeSettling in
Possible outcomes
1. sustainable norm
2. plateau
3. run out of energy
Living with
results and
consequences
Maybe later
Repeats
many
times in
hard to
predict
ways
Time delay
© NHS Institute for Innovation and Improvement, 2009
Anatomy of change Physiology of change
Definition The shape and structure 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
© NHS Institute for Innovation and Improvement, 2009
The 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 a
lot of different people
5. Mutually reinforcing change across different parts of the
system
© NHS Institute for Innovation and Improvement, 2009
The ten key principles of large scale change
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. Enabling many people to 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
© NHS Institute for Innovation and Improvement, 2009 Source: Marshall Ganz
Shared understanding
leads to Action
How did the great transformational
leaders change the world?
Strategy
What?
Narrative
Why?
© NHS Institute for Innovation and Improvement, 2009
Leaders ask their staff to be ready for
change, but do not engage enough in
sensemaking........
Sensemaking is not done via marketing...or
slogans but by emotional connection with
employees
Ron Weil
© NHS Institute for Innovation and Improvement, 2009
A challenge
“What the leader cares about (and typically
bases at least 80% of his or her message to
others on) does not tap into roughly 80% of
the workforce’s primary motivators for
putting extra energy into the change
programme”
Scott Keller and Carolyn Aiken (2009)
The Inconvenient Truth about Change Management
© NHS Institute for Innovation and Improvement, 2009
mobilisingversus
organising
© NHS Institute for Innovation and Improvement, 2009
“A cynic, after all,
is a passionate
person who does
not want to be
disappointed again”Zander R and Zander B (2000) The art of
possibility. Harvard Business School
Press. As quoted by Steve Onyett
© NHS Institute for Innovation and Improvement, 2009
Framing
Is the process by which leaders construct,
articulate and put across their message in a
powerful and compelling way in order to win
people to their cause and call them to action
Snow D A and Benford R D (1992)
© NHS Institute for Innovation and Improvement, 2009
If we want people to take action, we have
to connect with their emotions through
values
action
values
emotion
Source: Marshall Ganz
© NHS Institute for Innovation and Improvement, 2009
© NHS Institute for Innovation and Improvement, 2009
But not all emotions are equal.........
inertiaurgency
anger apathy
solidarity isolation
you can make
a difference
Self-
doubt
hope fear
Ov
erc
om
e
Action motivators Action inhibitors
Source: Marshall Ganz
© NHS Institute for Innovation and Improvement, 2009
What the framing literature tells us
People are much more likely to embrace change if it
is framed as something that builds positively on what
they are familiar with than as something that seems
far away and unachievable.
“„a new idea must be at the least couched in the
language of past ideas; often, it must be, at first,
diluted with vestiges of the past”
Saul Alinsky Rules for Radicals
(1971)
© NHS Institute for Innovation and Improvement, 2009
Three components of
transformational change
(Fry 2002)
• Novelty / innovation
• Transition
• Continuity
© NHS Institute for Innovation and Improvement, 2009
“When you have gone as far that you
can‟t manage one more step, then you
have gone just half the distance that
you are capable of”
Proverb of the Inuit people of the Arctic Circle
© NHS Institute for Innovation and Improvement, 2009
What do we need to do?
1. Tell a story
2. Make it personal
3. Be authentic
4. Create a sense of “us” (and be clear who the
“us” is)
5. Build in a call for urgent action
© NHS Institute for Innovation and Improvement, 2009
story of
Selfcall to
leadership
story of
NowStrategy
and action
story of
UsShared values and
shared experience
PURPOSE
Public Narrative
Why
I am
called to
do this
workour shared
EXPERIENCE
reveals
our shared
VALUES
Source: Marshall Ganz
© NHS Institute for Innovation and Improvement, 2009
story of
Selfcall to
leadership
story of
NowStrategy
and action
story of
UsShared values and
shared experience
PURPOSE
Public Narrative
Why
I am
called to
do this
workour shared
EXPERIENCE
reveals
our shared
VALUES
we frame the
urgency and
hopefulness
necessary to secure
commitment and
build momentum
towards our shared
goal
Source: Marshall Ganz
© NHS Institute for Innovation and Improvement, 2009
Telling your narrative
“A good narrative is drawn from the series of
choice points that have structured the “plot” of
your life – the challenges you faced; choices you
made and outcomes you experienced”
• Challenge: why did you feel it was a challenge? Why
was it your challenge?
• Choice: why did you make the choice you did? Where
did you get the courage or hope? How did it feel?
• Outcome: How did the outcome feel? Why did it feel
that way? What do you want us to feel?
Source: Marshall Ganz
© NHS Institute for Innovation and Improvement, 2009
Show – don’t tell!
• Specific moments
• Specific people
• Specific values
• Specific challenges
• Specific choices
• Specific outcomes
…and well chosen vivid details!
Source: Marshall Ganz
© NHS Institute for Innovation and Improvement, 2009
Task
• Find a “partner” to work with
• Spend two minutes quietly developing your story
– The challenge, choice and outcomes should be
explicit
• A timekeeper will make sure that everyone sticks to
timings
• Share your story of self with your partner
• Coach each other on the stories
• Time allowed – two minutes per person to tell story
– two minutes per person to feedback
© NHS Institute for Innovation and Improvement, 2009
Feedback
• Was the
– challenge
– choice
– outcome
explicit?
• Could you identify with the person‟s values?
Where did they come from?
• Were the details vivid in ways that helped you
to identify what the person was feeling?
© NHS Institute for Innovation and Improvement, 2009
© NHS Institute for Innovation and Improvement, 2009
Made in Dagenham
The main character, Sandra, seeks to convince her
audience to take action
• What is the call to action that she is making?
• What fundamental values does she call on?
• What are the shared experiences that revel shared
values?
• How does she create a sense of “us”?
© NHS Institute for Innovation and Improvement, 2009
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
© NHS Institute for Innovation and Improvement, 2009
Fortnightly: 8:30am GMT Friday
(hosted by Director of Learning and
Development, Julia RA Taylor)
To register go to:
www.institute.nhs.uk/LargeScaleChange
For more details contact:
You can also get details of the latest
virtual training programmes from this
website
Six free web seminars for senior leaders (60 minutes each) from January 2012 to March
2012. You can download the recordings
These expert led seminars are designed to give you a rapid overview of the key ideas that
represent the latest thinking on leading large scale change.
1.Delivering large scale change: the reality of how to make it happen
Sarah Fraser (13th January 2012)
2.Creating energy to drive transformation
Helen Bevan (27th January 2012)
3.The leadership of large scale change
Helen Bevan & Karen Lynas (10th February 2012)
4.Large scale change in action
Case study site (24th February 2012)
5.Building widespread commitment
Julia RA Taylor (9th March 2012)
6.Spreading and sustaining large scale change
Sarah Fraser (23rd March 2012)
Leading Large Scale Change: Web seminars for senior leaders