Creating contagious commitment to change Willie ......gaps between the vision and current state...

© NHS Institute for Innovation and Improvement, 2011

Creating contagious commitment to change

Willie CruikshankCatherine Holmes

Emmi Honeybourne

@NHSCalltoAction#therightcare #dementiachallenge


Three things that unite us

1. We are leaders who are called to serve those in need

2. We want to help secure the future of the NHS (and the principles it stands for) by helping to deliver high quality care/support that makes best use of precious resources

3. We are prepared to invest in our own learning because we hope there might be some additional perspective, knowledge, skills and relationships that can help us in this quest


So...................

What lights the “fire in your belly” and makes

you determined to improve things?


Creating dementia friendly hospitals

• People with dementia stay longer in hospital

• Average length of stay is 25% longer

• For all elective admissions a readmission is less likely -but it is over twice as likely for people with dementia

• People with dementia are 3x more likely to fall (whilst in hospital)

• A fall more than doubles their length of stay

• Total £265 million


Which tradition of change?

Management

of change

Organising and

mobilising



• Organisational behaviour

• Leadership and management studies

• Clinical/medical audit

• Improvement “science”

• Academic tradition(s) – 100 years

Management

of change



• Community organising,

campaigns and social

movements

• Learning from popular, civic and

faith-based mobilisation efforts.

• Academic tradition– 100 years

Organising and

mobilising








• Community

organising,

campaigns and

social movements

• Learning from

popular, civic and

faith-based

mobilisation efforts

• Academic tradition –100 years

Management

of changeOrganising and

mobilising








• Community organising, campaigns and social movements

• Learning from popular, civic and faith-based mobilisation efforts.

• Academic tradition – 100 years

Management

of change

Organising

and

mobilising


Where would you start?

1. create a “burning platform” and imperative for action around the existing experience of people with dementia in your organisation

2. develop a strong narrative (story) around how dementia care could be improved in your organisation

3. make a clinically relevant case that makes both a rational case for change and a connection to emotions, through values

4. ask people to commit to specific actions


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


From

ComplianceStates 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

Based on organisational

accountability (“if I don't deliver

this, I fail to meet my performance

objectives”)

To

CommitmentStates 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

Based on relational commitment (“If

I don’t deliver this, I let the group or

community and its purpose down”)

From the old world to the new world

Source: Helen Bevan


There is a lot of activity and

energy for change.......

Unless that energy is translated

into appropriate action that

improves outcomes, it counts

for nothing

How do we provide a focus and

an energy that moves everyone

in the same direction?


How did the great social movement leaders change the world?

Source: Marshall Ganz

Shared understanding leads to

Action

Narrativewhy?

Strategywhat?


Drink driving

UK petrol crisis


Activity:

1. Think about a movement or campaign that you have been involved in or know about, outside work.

2. What were its features?

3. How would you describe the leadership?


Calling people to join you in action


Our organising principle

• We work on the principle that we need

commitment to succeed

• And that we must invest significant time and

intention in building relationships that generate

commitment

• Commitment to each other (“us”) and commitment

to our goals


Call to Action• We know that many people want to radically improve

the experience of people with dementia their families

and carers

• A call to action unites them around a collective vision

and focuses their energy towards a specific and real

change

• As call to action finds and builds new sources of power

from those people through

• collaboration and mobilisation

• developing leadership


A Call to Action is about

... putting right a specific intolerable situation

... uniting people with a shared purpose to work together to

this end

... committing to one another to take specific actions

... building energy and capacity through our commitments

and relationships

... achieving change within a specific period of time


Our shared purpose

To enable people with dementia to

experience high quality care in acute

hospitals and support them, their

families, carers and staff to have the

confidence to champion best practice

and create a culture of excellence.


Our goal...

By 31st March 2013 every hospital

in England will be committed to

becoming a dementia friendly

hospital.


What does being committed to becoming dementia

friendly look like?� Environments for care are being developed to support people

with dementia when they are in an acute setting

� The workforce is being developed to raise awareness of and

skills in the support of people with dementia, their families

and carers

� Acute Hospitals are gaining confidence that they are able to

identify and assess cognitive impairment in the people they

care for

� Acute Hospitals can support people with dementia to be able

to go home safely and this being is achieved through

partnership working

� Acute Hospitals are using a care plan which involves the

person with dementia and their carers


The NHS Change Model aligns

intrinsic and

extrinsic aspects

www.changemodel.nhs.uk


Dementia and Acute Care – National Taskforce

What outcomes do we seek: By 31 March 2013 every hospital in England will be committed to becoming a dementia friendly hospital.

Our shared purposeHave the key people committed to the shared

purpose?

•Taskforce in place –bounded and stable.•All key stakeholders have developed and agreed shared purpose and goal

Leadership for changeAre our senior leaders ready for their role? Where are they

located in the organisation? Are there any leadership gaps?

•Built leadership teams to oversee the work•Built strong relationships with strategic partners and other influential organisations.•Learned from and assisted leaders of change to get results in their health care organisations

Engagement to mobiliseHave we engaged our

workforce? Are they mobilised to take action?

•built commitment through our strategic alliances•Articulated a vision for better experiences for people with dementia•Created a compelling story of why people need to take action now• Identified the hope and the contribution of different commitment groups and the unique part that they have to play• Identified the specific actions that we are calling on people to take

Spread for innovationAre we planning to implement and spread the key actions to help us achieve our goal?• Built a community network

to share and disseminate learning and co-develop solutions as needed

•Establish strategic relationships with other influential organisations•Document, publish, and spread learning to enable action to be taken at all levels•Adapt and spread what we know to reduce variation and improve the experiences of all people with dementia/renal disease and their families and carers who access acute care •Establish strategic relationships with other influential organizations


Dementia and Acute Care – National Taskforce

What outcomes do we seek: By 31 March 2013 every hospital in England will be committed to becoming a dementia friendly hospital.

Rigorous deliveryWhat objectives are we delivering? What are the

accountability arrangements?What does delivery mean (i.e. Is it progress against plan)?

• Identified a clear measureable goal that people can sign up to.•Developed the case for change and quantified the gaps between the vision and current state•Organised, lead, and grew the capacity for change through building ownership and shared accountability with our national taskforce members and strategic partners

System driversWhat key enablers are under our control/influence? How should they be deployed? How do we deploy them consistently? How do we line them up?

• Economic analysis and the cost of failure• Clinical evidence base•Dementia CQUIN

Improvement methodologyWhat quality improvement methodology should we be a

applying? In what context?

•Identified existing examples of excellence in dementia and renal care and identified gaps.•Co-designed resources with front line teams to enable people to take action at all levels.

Transparent measurementAre we able to demonstrate progress against each action? Do we have the measurement systems in place across the organisation?

•Develop and use a uniform set of measures for people with dementia in the acute care setting to measure progress.


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)


If we want people to take action, we have to connect

with their emotions through values

action

values

emotion

Source: Marshall Ganz


What the framing literature tells us

“‘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)


What the framing literature tells us

In other words....

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.


My Generation………


Three components of “core framing”

• Diagnostic framing - aims to identify the problem that the

movement will address and attribute the problem to a

specific source or sources-

• Prognostic framing - relates to the creation of a plan of

attack and clear strategies for carrying out the plan

• Motivational framing - typically stresses urgency and an

overall duty of/ call for action that connects with the

motivational and emotional drivers of the audience.


Diagnostic framing

• In the UK 180,000 people a year are treated with

antipsychotic medication

• Of those only 36,000 receive any benefit from this

treatment

• The resulting 144,000 people receive the medication

needlessly as staff and carers are often unaware of

alternative therapies

• As a result over 1600 people experience an adverse cerebral

event and 1800 people die needlessly because of taking

inappropriately prescribed anti-psychotic medication.

• Reducing anti-psychotic medication in two thirds of people

with Dementia would result in a potential saving of £55

Million


Prognostic framing

• To deliver on the national ambition of reducing anti-psychotic prescribing by

two thirds by Nov 2011 we all have a part to play.

• Maximise the opportunities of the Dementia Declaration to bring local

organisations together to discuss improvement across local communities

and ensure that the voice of the person drives service improvement

• We need every PCT and local authority to outline plans to audit anti-

psychotic prescribing practice and adopt best practice

• We need every GP to undertake a prescribing and treatment review of every

patient with Dementia and agree shared decisions regarding treatment

options.

• We need every care home team to review each of their residents and in

partnership with them consider use of alternative therapies.

• We need every acute Trust to provide training in dementia to ensure that

people with dementia spend as less time as possible in acute care and receive

appropriate medication .


Motivational framingI’m not dying with dementia, I’m living with it. I don’t want

to be left on the shelf”.

• I want you to count up to 7…….

• Every 7 seconds someone is diagnosed with dementia and currently

many face a bleak life sentence.

• Every day 5 people die and 4 people experience significant harm as a

result of taking medication they may not need.

• We have the opportunity to give a voice back to 144,000 people with

Dementia-by stopping unnecessary antipsychotic prescribing and

agreeing with them their options for treatment and support

• And in doing so have the power to save 1800 lives and prevent over

1600 adverse cerebral events

• The task ahead is within our grasp-it is the equivalent of every GP

reviewing just 9 people a year -less than 1 per month.


Design a core frame for your dementia

improvement programme

• Diagnostic framing - aims to identify the problem that the movement

will address and attribute the problem to a specific source or sources-

• Motivational framing - typically stresses urgency and an overall duty of/

call for action that connects with the motivational and emotional drivers

of the audience.

• Prognostic framing - relates to the creation of a plan of attack and clear

strategies for carrying out the plan


What you can do

• Share your resources with us.

• Join the call to action community

• Become a testing partner

• Commit your organisation


The leader’s most basic role is to release the human spirit that makes initiative, creativity, and entrepreneurship possible

Bartlett and Ghoshal


• [email protected]

• Willie.


References on Social Movements

Resources on the NHS Institute website www.institute.nhs.uk

• Debra E. Meyerson, Tempered Radicals, 2003• Gerald F. Davis, Doug McAdam, W. Richard Scott, Mayer N. Zald Social

Movements and Organization Theory, 2005• Art Kleiner, The Age of Heretics, 1996• Andrea Shapiro, Creating Contagious Commitment, 2003• Carmel McConnell The Only Way to Do It… Is to Do It, 2003• Jim Collins, Good to Great, 2001• Jim Loehr and Tony Schwartz, The Power of Full Engagement, 2005• Lesley Everett, Walking Tall, 2004• McAdam D, McCarthy JD, Zald MN. (eds.) (1996) Comparative

perspectives on social movements: political opportunities, mobilizing structures, and cultural framings, Cambridge University Press, Cambridge

• Gary Hamel, Competing for the Future, 2006• Martin Seligman, 2006 and Barbara Frederickson, Authentic Happiness,

2005• Leslie, Loch, Schaninger, Managing your organisation by the evidence,

McKinsey Quarterly 2006

Creating contagious commitment to change Willie ......gaps between the vision and current state...

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