California presentation March 2015 final version used in Disney

@jackielynton

Jackie LyntonCreating a contagious

commitment for change

…..

@HelenBevan #SHCR #QF15

The Horizons Group within NHS Improving Quality

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:

1. how to create radical, system-wide change

2. working with emerging leaders, clinical trainees, students

3. open innovation, open source, digital connection, social media, change platforms, hacking

“You

can’t cross a chasm in small

steps”David

Lloyd George

@helenbevan#SHCR @School4Radicals

http://www.theedge.nhsiq.nhs.uk/school/

1. Change starts with me

2. Forming communities: Rolling with resistance

3. Building alliances for change

4. Making change happen

5. Moving beyond the edge

http://www.theedge.nhsiq.nhs.uk/school/

• Being an effective

change activist

• Transformational leadership

• Thought diversity

and disruptive

innovation

• Scale and spread of

change

• The new methods

for change

@HelenBevan @JackieLynton #mixmashup

Four ways to connect with us!

1. Follow on Twitter @Jackie Lynton

2. Subscribe to

3. The School for Health and Care Radicals: @School4Radical

4. Engage with NHS Change Daywww.ChangeDay.nhs.ukwww.usachangeday.org

TheEdge.nhsiq.nhs.uk

http://www.changeday.nhs.uk/

http://www.usachangeday.org/

@HelenBevan

Five enabling themes in change and transformation www.nhsiq.nhs.uk/whitepaper

http://www.nhsiq.nhs.uk/whitepaper


Agenda

1. What is happening in the world of change?

2. Rocking the boat and staying in it

3. What is your story?

4. A disruptive case study: NHS Change Day

5. Twitter: @jackielynton @transformkp

The NHS is the 5th biggest employer on the globe

Source: BBC

Community

Call to attention Stay with the process

@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5

Activity

Introduce yourself to others at your table. Tell a quick story that demonstrates why you chose to come to this workshop today.

Time allowed: 10 minutes for the whole table


What is happening in the world of change?

Source of image: from guardiansprayerwarrior.com


SEISMIC SHIFTS

Change from the edge


is the new normal!

“By questioning existing ideas, by opening new fields for action, change

agents actually help organisations survive and adapt to the 21st Century.”

Céline SchillingerImage by neilperkin.typepad.com

#NHSChangeDay #SHCRchat

Why is change needed and what needs to change?


Why do we need to change and what needs to change?

Discuss in your community

ACTIVITY

@HelenBevan Source of image: Whatsthebigideascwartzy.blogspot.com

@HelenBevan

Most large scale change doesn’t fullydeliver its objectives

Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey

70%

25%

5%

Gets anywhere near achieving the change and

delivering the benefits


@HelenBevan

Most large scale change doesn’t fullydeliver its objectives

Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey

70%

25%

5% Delivers and sustains the change

@HelenBevan

Many of the ways we go about improving health and

care were designed in a different mindset

for a different set of circumstances

We are operating with 20th century change

practice in a 21st

century world

:

Source of images : http://www.slideshare.net/dachisgroup/dave-gray-the-connected-company

http://www.slideshare.net/dachisgroup/dave-gray-the-connected-company


Leading change in a new era

Dominant approach Emerging direction

@HelenBevan

Most change efforts are built upon the shaky foundation of five flawed assumptions; 1. that change can be managed2. that human beings are objective 3. that there are ‘X’ steps to change4. that we have a neutral starting point for change5. and that change, itself, is the goalPeter Fuda http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf

Source of image: Whatsthebigideascwartzy.blogspot.com

http://www.peterfuda.com/wp-content/themes/peterfuda-bootstrap/content/Why-Change-Efforts-Fail.pdf


Leading change in a new era

Dominant approach Emerging direction

Most policy efforts are driven from this

side


John Kotter: “Accelerate!” most influential thought leader globally, recognises new approaches are needed

• We won’t create big change through hierarchy on its own

• We need hierarchy AND network

• Many change agents, not just a few, with many acts of leadership

• Changing our mindsetTO

FROM


Must do

Want to do

Kotter: From “have to” to “want to”


“Tomorrow’s management systems

will need to value diversity, dissent and

divergence as highly as conformance, consensus

and cohesion.”

Gary Hamel

Source of image: www.fastcompany.com

Embracing difference to change the conversation

Four keys to collaboration

• Lean into your discomfort

• Listen as an ally

• State your intent

• Share your “street corner”Source: Judith Katz and Fred Miller

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5

strong ties (cohesive)v.

weak ties (disconnected)

Source of image:brucemacvaresh.com


When we spread change through strong ties:

• we interact with “people like us”, with the same life experiences, beliefs and values

• Change is “peer to peer”; Physician to Physician, nurse to nurse, gynaecologist to gynaecologist

• Influence is spread through people who are strongly connected to each other, like and trust each other


When we spread change through strong ties:


• Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist


IT WORKS BECAUSE: people are far more likely to be influenced to adopt new behaviours or ways of working from those with whom they are most strongly tied


The pros and cons of strong ties

Pros Cons

ACTIVITY


Strong and weak tiesWhen we seek to spread change

through strong ties:


• Change is “peer to peer”; GP to GP, nurse to nurse, gynaecologist to gynaecologist


When we seek to spread change through weak ties:

• we build bridges between groups and individuals who were previously different and separate

• we create relationships based not on pre-existing similarities but on common purpose and commitments that people make to each other to take action

• our aim is to mobilise all the resources in our organisation, system or community that can help achieve our goals


Why we need to build weak ties AS WELL AS strong ties

• Weak ties are more likely to lead to change at scale because they enable us to access more people with fewer barriers

• In situations of uncertainty, we have a tendency to revert to our strong tie relationships

• yet the evidence tells us that weak ties are much more important than strong ties when it comes to searching out resources in times of scarcity

• The most breakthrough innovations will come when we tap into our weak ties

History suggests that weak ties will probably give us the best chance to deliver large scale improvements in a challenging

timescale


You get the best effort from others not by lighting a fire beneath them, but by

building a fire within

Bob Nelson


What lights the ‘fire in your belly’ and makes you feel passionate and determined to make change happen?

ACTIVITY


Connecting to other people values and emotions


If we want people to take action, we have to connect with their emotions through values

action

values

emotion

Source: Marshall Ganz


What is strategy?

Strategy is the process of turning the you have into the you need to win

the you wantSource: Marshall Ganz


Here have some of mine!

MyPower

Power

Shifting positional power to relational


Unleashing the energy

The more you do what you love the more energy you have. Leadership Freak

Vs


Resources to improve health and care

Economic resourcesdiminish with use• money• materials• technology

Natural resourcesgrow with use• relationships• commitment• community

Based on principles from Albert Hirschman, Against Parsimony

@HelenBevan #SHCR #QF15#NHSChangeDay #SHCRchat

“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

@HelenBevan #SHCR #QF15 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? 3 Mins

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

@HelenBevan

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)

@HelenBevan

Three components of framing

• Diagnostic – what is the problem that we are addressing? What is the extent of the problem? What is the specific source or sources?

• Prognostic – what could the future look like? What is our “plan of attack” and our strategy for carrying out the plan?

• Motivational – why is this urgent? What is our call for action that connects with the motivational and emotional drivers of the audience?

Source: Benford and Snow

@HelenBevan

What’s the financial incentive?

Who is performance managing?

What’s the project plan?

Source: @RobertVarnam

@HelenBevan

“I have some Key

Performance

Indicators

for you”

or

“I have a

dream”

Source: @RobertVarnam

@HelenBevan

Call to Action

• A call to action assumes that we can end an intolerable condition by creating a burning platform from which to organise our resources and seek commitment

• A call to action finds and builds new sources of power and so enables change through

• collaboration and mobilisation• developing leadership

• A call to action unites us around a collective vision and focuses our energy towards a specific and real change and a measureable goal

@HelenBevan

Starts on the fringe

(at the edge)

Starts with the activistsGary Hamel

always


Why am I a radical, rebel, maverick?

@HelenBevan

@HelenBevan

Source : Lois Kelly www.rebelsatwork.com

Sometimes other people see radicals/rebels as troublemakers

Rebel

http://www.rebelsatwork.com/

@HelenBevan

We need to be boatrockers!

• Walk the fine line between difference and fit, inside and outside, rock the boat but manage to stay in it

• Able to challenge the status quo when we see that there could be a better way

• Conform AND rebel

• Capable of working with others to create success NOT a destructive troublemaker Source: Debra Meyerson

@HelenBevan #SHCR #QF15#NHSChangeDay #SHCRchat

If your horse dies, get off itCherokee proverb

Source of image: fenwickgallery.co.uk

@HelenBevan

What are the risks for a boat rocker?

1. Our experiences of “being different” can be fundamentally disempowering. This can lead us to conform because we see no other choice

we surrender a part of ourselves, and silence our commitment, in order to survive

2. leave the organisation

we cannot find a way to be true to our values and commitments and still survive

3. stridently challenge the status quo in a manner which is increasingly radical and self-defeating

this just confirms what we already know – that we don’t belong Source: adapted from Debra E Meyerson


We need rebels!

•They are the principal champion of a change initiative, cause or action

•Rebels don’t wait for permission to lead, innovate, strategise

•They are responsible; they do what is right

•Without rebels, the storyline never changes

Source : @PeterVan http://t.co/6CQtA4wUv1

http://t.co/6CQtA4wUv1

@HelenBevan #SHCR #QF15 Source: Rebelsatwork.com

Rebels learn to tell their story

What’s your story?


"There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley

Source of image: timcoffeyart.wordpress.com


It starts

with me….


Effective framing: 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


Creating our narrative

• Challenge: What was the challenge? Why was it a challenge?

• Choice: What were the choices? 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?



Vivid details



Me at 22 years old

#NHSChangeDay #SHCRchat@HelenBevan @BoelGare @JackieLynton #Quality 2014 #M5Image from: @TheWorldStories

MY GOAL


• Creating a space for getting ready for change

• Invitation to thinking differently about change

• Share the collective wisdom of people in the room – 5 minutes of wisdom

OverviewMY

GOAL


Strong sense public service and community


1986

1. I did not feel heard, supported

2. Let down by my profession

3. I was part of a hierarchical

system that didn’t protect vulnerable people


Always fighting for change an speaking out


Being open to creating

alliances with others,

and not build silos…..


This picture was taken fromthe window of my hotelroom in Scotland when I asked myself one of the mostimportant questions


Connecting to What’s important to me?

Alone/Me

Together/We

Building connections and relationships for change


Knowing your purpose


[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 Carguilo



30 years on

1. Staff didn’t feel heard –

‘checked out’

2. Compliance over

commitment

3. Staff not feeling

‘permission’ to make to

make changes


‘Can I really make the change?’

Will ‘the system’ really ALLOW me?


When you hit up against this wall, how do you feel and how do staff feel?


Change starts with me


When you start with ‘me’ - you can see ‘we and us’

1. Cut on the dotted line2. Rotate 180 degrees


Creating change through connections and building relationships


Reconnecting with my values


Innovation/ideas is not reserved for someone sitting at

the top of a hierarchy, but driven down to unleash new

levels of engagement

Nurse

Doctor ManagerSocial worker

Patient

Carer maker Cleaner

Pharmacist


Now I don’t!Now I bring my authentic self to work

I had to be someone else

to fit in


Talk to the person next to you ACTIVITY

• Tell your story about why the change you are involved in now is so important to you

• Relate it to a personal experience

You have:

• 2 minutes to prepare your story

• 3 minutes each to tell your story


Talk to the person next to you

Have a further discussion

• In terms of the people you want to get on board with your change project, what will create a sense of “us” rather than “us and them”?

• How could telling your story help create the “us”?

You have three minutes for further discussion as a pair

Key messages• Create a “burning ambition” and imperative

for action around quality, improvement and cost

• Make a relevant case that makes both a rational case for change and a connection to emotions, through values

• Frame to connect with hearts and minds and identify levers for commitment rather than compliance

• Build a strategy for both strong and weak ties

• Ask people to commit to specific actions

NHS Change Day

Making a change for

better together.

Disruptive Case Study

Do something better together….

Audacity to imagine we could mobilise

the 1.3m people in the NHS

Must do

Want to do

Shared purposeGoal – 65,000 (500k)

pledgesCore leadership team

Personal pledgeSet a dateWebsite

Social media Took risks

Courage & belief Kept it simple!

Holding each other to account rather than performance management

Change Day pledges and stories

‘…the floodgates of change open’from front line to senior leaders


Change starts with me..

Maker

...Making a

difference

Anyone can pledge – it’s personal to you!

Change Activist


Volunteers – leaders everywhere

98% of activity via volunteers

My pledge/action…..Not let hierarchy get in the way of patient care

What I didWorked with the hierarchy at an early stage. Seeking their support with an explicit understanding that they respected the grassroots nature of Change Day.

Bottom up approach with top down support

I urge as many people as possible to give their support“

"NHS Change Day is a fantastic opportunity to join a movement of young leaders who want to make a

difference in the NHS

Jeremy Hunt Health Secretary

Chief Nursing Officer - England

Professor Sir Bruce Keogh National Medical Director

It's especially an opportunity for the next generation of junior doctors to effect change

in a practical and sustainable way"

Fun day for children Support group with a stomas

NHS CEO personal National pledge campaign

30% shift in staff survey:‘Would you feel confident your hospital

would address your concern?’

Ashley Brooks Patient Champion

‘Change Day gave me the permission to use my energy in the direction I wanted to use it’

Students swap places with patients in mock ward

Change in University nursing curriculum

Louise Trowse – Second year student

Tasting common medicine for children

Discussing pharmacy methods of improving the taste

Dr Damian Roland

“The single most important skill I learned from improvement leaders was narrative. It connects us to the reasons we were called to work forthe NHS. It will stay with me the rest of my career.”

Jeharna sings forchildren’s ward tosay thank you

‘I wanted to say thank you to NHS staff for the way my brother was looked after when he got knocked over,’

Staff feel appreciated

Smile Feedback Wednesday

Ellie Milner


2013 2014 2015

Google Searches Twitter

Google Searches and Twitter posts tell the same story: 50% bigger than last year at peakOnline mentions: 4x bigger than last year (Source — OLR) 9,274 vs1,869 in 2014

Changeathon:

Changeathon peaked on Twitter around 09:00 and 11:00

46 Million Twitter Impressions14 Thousand Tweets9 Thousand online mentions4,859 individuals tweeting200 events flagged on Twitter60 events notified to team

Biggest ever

Events acrossEngland

Twitter:

50% bigger than 2014(tweets & searches — online is 400% bigger)

CHANGEATHON

Chloe at 24

Quote from ChloeI was inspired by the caring,

creative and committed individuals I met in the NHS and realised I need to fulfil a sense of

purpose in using my skills and passion in helping others.

I want ……


A global movement was born

https://www.youtube.com/watch?v=inHc1NgohuA

https://www.youtube.com/watch?v=inHc1NgohuA

OCTOBER 2015 www.usachangeday.org

@helenbevan #IQTGOLD#SHCR @School4Radicals

“You don’t need an engine when you have

wind in your sails”


• We must activate the mavericks, radicals, rebels and heretics

• There is a massive untapped reservoir of energy and talent out there and the

potential is outstanding

SO GO OUT AND CAUSE TROUBLE!

SUMMARY


Four ways to connect with us!

1. Follow on Twitter @Jackie Lynton [email protected]

2. Subscribe to

3. The School for Health and Care Radicals: @School4Radical

4. Engage with NHS Change Daywww.ChangeDay.nhs.ukwww.usachangeday.org

TheEdge.nhsiq.nhs.uk

http://www.changeday.nhs.uk/

http://www.usachangeday.org/

California presentation March 2015 final version used in Disney

Health & Medicine

Transcript of California presentation March 2015 final version used in Disney